World neurosurgery最新文献

{"title":"Letter to the Editor Regarding “Intersection of Care: Navigating Patient-Hospital Relationships in Neurosurgery”","authors":"Saarang Patel , Nathan A. Shlobin","doi":"10.1016/j.wneu.2025.123656","DOIUrl":"10.1016/j.wneu.2025.123656","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123656"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infrastructural Barriers to Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Systematic Review","authors":"Muhammad Shakir ,&nbsp;Aly Hamza Khowaja ,&nbsp;Hammad Atif Irshad ,&nbsp;Izza Tahir ,&nbsp;Syeda Fatima Shariq ,&nbsp;Ali I. Rae ,&nbsp;Radzi Hamzah ,&nbsp;Saksham Gupta ,&nbsp;Kee B. Park ,&nbsp;Syed Ather Enam","doi":"10.1016/j.wneu.2024.10.104","DOIUrl":"10.1016/j.wneu.2024.10.104","url":null,"abstract":"<div><h3>Background</h3><div>Appropriate surgical infrastructure is important for improving patient outcomes. However, low- and middle-income countries (LMICs) often struggle to provide adequate brain tumor surgery due to fractured infrastructure. This study aims to identify and evaluate barriers to surgical care infrastructure for brain tumors in LMICs.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted from inception to October 20, 2022, using PubMed, Scopus, CINAHL, and Google Scholar. Inclusion criteria were studies that focused on surgical care of brain tumors in terms of infrastructure in low-resource settings. Studies were excluded if they did not focus on surgical care or were not conducted in LMIC. Data was extracted and analyzed qualitatively.</div></div><div><h3>Results</h3><div>A final analysis of 39 studies showed significant barriers: 66% had poor operating room infrastructure, 32% lacked specialized care centers and imaging facilities, 26% faced long-distance travel issues, 13% had poor public health infrastructure, and 11% had poor referral pathways and lacked advanced diagnostic facilities. Additionally, 3% had an uneven distribution of quality centers and inadequate ward capacity. Proposed strategies include cross-border collaboration (29%), optimizing existing resources (29%), improving referral pathways (7%), resource sharing within hospitals, and acquiring surgical devices through donations (7%).</div></div><div><h3>Conclusions</h3><div>The review highlights key barriers in infrastructure while providing effective neurosurgical care to brain tumors in LMICs. To overcome these challenges, targeted strategies need to be implemented by stakeholders, policymakers, and health ministries.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123375"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Antidepressant Use on Intraoperative Blood Loss and Transfusion Rates in Lumbar Fusion Surgery","authors":"Michael McCurdy,&nbsp;Rajkishen Narayanan,&nbsp;Jonathan Dalton,&nbsp;Chloe K. Herczeg,&nbsp;Jeremy Heard,&nbsp;Yunsoo Lee,&nbsp;Alec Giakas,&nbsp;Emma Boyajieff,&nbsp;Abbey Glover,&nbsp;Saurav Sumughan,&nbsp;Grace Bowen,&nbsp;Yoni Dulitzki,&nbsp;Emmanuel Dean,&nbsp;Mark Kurd,&nbsp;Jose A. Canseco,&nbsp;Alan S. Hilibrand,&nbsp;Alexander R. Vaccaro,&nbsp;Christopher K. Kepler,&nbsp;Gregory D. Schroeder","doi":"10.1016/j.wneu.2024.10.142","DOIUrl":"10.1016/j.wneu.2024.10.142","url":null,"abstract":"<div><h3>Objective</h3><div>A quarter of spine surgery patients take antidepressants. Basic science research has suggested serotonergic antidepressants impair platelet function. This has been supported by only a small number of works in the setting of spine surgery. The purpose of this study is to investigate the impact of antidepressants on intraoperative bleeding risk during lumbar fusion.</div></div><div><h3>Methods</h3><div>Patients who underwent elective 1–3 level lumbar fusion at a single, academic, tertiary center (2017–2021) were identified. Antidepressant use and class, demographic, and surgical data were evaluated. Bleeding risk was assessed by total intraoperative blood loss (mL), calculated using the formula by Gross et al., and by postoperative transfusion. Patients prescribed versus not prescribed an antidepressant were matched 1:1 by age, sex, body mass index, Elixhauser, smoking status, and levels fused. Appropriate statistical analysis was performed (alpha was set at 0.05).</div></div><div><h3>Results</h3><div>A total of 420 patients with and 420 patients without an antidepressant prescription at the time of lumbar fusion were identified. Patients without an antidepressant prescription had a higher Charlson Comorbidity Index (0.91 ± 1.09 vs. 0.76 ± 1.1; <em>P</em> = 0.048), but otherwise the groups were demographically similar, and underwent similar surgeries. Antidepressant use was not associated with increased intraoperative bleeding or postoperative transfusion rate, regardless of subanalysis by procedure type or antidepressant class.</div></div><div><h3>Conclusions</h3><div>Antidepressant use was not associated with increased intraoperative blood loss or increased postoperative transfusion requirement, regardless of subanalysis by fusion type or antidepressant class. The current findings do not support discontinuing antidepressants prior to lumbar fusion.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123413"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electromagnetic Navigation Improves Accuracy and Reduces Complications of Ventriculoperitoneal Shunts in Patients with Idiopathic Normal Pressure Hydrocephalus: A Single-Center Clinical Experience","authors":"Xudong Ma ,&nbsp;Xuehai Fan ,&nbsp;Wenqinyi Yang ,&nbsp;Jiahe Guo ,&nbsp;Ziwei Zhou ,&nbsp;Dong Wang ,&nbsp;Yimeng Wu ,&nbsp;Ningnannan Zhang ,&nbsp;Guozhi Song ,&nbsp;Yan Xing ,&nbsp;Xiuyun Liu ,&nbsp;Kai Yu ,&nbsp;Huijie Yu","doi":"10.1016/j.wneu.2024.11.011","DOIUrl":"10.1016/j.wneu.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Ventriculoperitoneal (VP) shunt surgery is the primary treatment for patients with idiopathic normal pressure hydrocephalus (iNPH). This study compared the outcomes of VP shunt placement using electromagnetic (EM) navigation versus standard methods in patients with iNPH, focusing on catheter accuracy and postoperative complication rates.</div></div><div><h3>Methods</h3><div>This retrospective study included 31 patients with iNPH who underwent standard shunt placement using anatomical landmarks and 50 patients who underwent EM-guided shunt placement. Parameters assessed included shunt placement grade, catheter tip position, catheter angle, puncture attempts, operative duration, postoperative infection rates, intraparenchymal hemorrhage rates, and shunt malfunction rates. Patients had follow-ups at 3, 6, 12, and 24 months after surgery or until shunt failure.</div></div><div><h3>Results</h3><div>In the EM-guided group, a higher percentage of grade 1 shunt placements (92% vs. 71%, <em>P</em> = 0.03) and fewer grade 3 placements (2% vs. 13%, <em>P</em> = 0.068) were observed. The catheter tip position at the foramen of Monro was significantly more accurate (<em>P</em> &lt; 0.001), with smaller lateral catheter deviation angles in both coronal (19.69° vs. 24.2°, <em>P</em> &lt; 0.0001) and sagittal (21.75° vs. 39.3°, <em>P</em> &lt; 0.01) sections. The EM-guided group had fewer puncture attempts, shorter operative durations, lower incidence of intraparenchymal hemorrhage (<em>P</em> &lt; 0.01), and fewer shunt malfunctions over the 2-year follow-up period (2% vs. 26%, <em>P</em> = 0.0003).</div></div><div><h3>Conclusions</h3><div>The use of EM navigation in VP shunt placement for patients with iNPH improves catheter placement accuracy, reduces postoperative complications and shunt malfunction rates, and provides precise and individualized surgical treatment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123428"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Occipital Transtentorial Approach for Dorsal Midbrain Cavernous Malformation: Technical Notes With Illustrative Case","authors":"Shuang Liu,&nbsp;Chongjing Sun,&nbsp;Pin Chen,&nbsp;Hantao Yang,&nbsp;Tao Xie,&nbsp;Jinlong Huang,&nbsp;Qiang Xie,&nbsp;Fan Hu,&nbsp;Xiaobiao Zhang","doi":"10.1016/j.wneu.2024.11.043","DOIUrl":"10.1016/j.wneu.2024.11.043","url":null,"abstract":"<div><h3>Background</h3><div>The dorsal midbrain, an anatomically intricate region, presents significant challenges for traditional surgical interventions due to the heightened risk of vascular and neurological injury, and the necessity of brain tissue retraction.</div></div><div><h3>Methods</h3><div>This study retrospectively reviewed the case of a 29-year-old male diagnosed with a cavernous malformation located in the dorsal aspect of the left midbrain. The patient underwent resection via the endoscopic occipital transtentorial approach (EOTA) in July 2024. Comprehensive records were analyzed, including preoperative magnetic resonance imaging and computed tomography imaging, detailed surgical notes, and postoperative outcomes.</div></div><div><h3>Results</h3><div>The patient initially presented with headaches and diplopia. Imaging revealed a 17 × 13 mm tumor in the dorsal aspect of the left midbrain, associated with obstructive hydrocephalus. The 2.5-hour EOTA surgery resulted in complete resection of the tumor, with the resolution of headache symptoms and improvement of diplopia. No new complications were reported postoperatively. The patient was discharged 7 days postsurgery without the need for intensive care unit admission. Pathological examination confirmed the diagnosis of a cavernous malformation. Additionally, the EOTA facilitated a concurrent endoscopic third ventriculostomy, and no evidence of hydrocephalus was observed during the 3-month follow-up period.</div></div><div><h3>Conclusions</h3><div>The EOTA constitutes a significant advancement in neurosurgical techniques for the resection of dorsal midbrain tumors, enhancing surgical precision and safety. This approach contributes to improved patient outcomes and a reduction in complication rates. Further studies are warranted to validate these findings and to establish standardized protocols for the application of EOTA in midbrain tumor resection.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123460"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal Fluid Prognostic Index in Ventriculoperitoneal Shunt Infection","authors":"Abdurrahman Arpa,&nbsp;Pinar Aydin Ozturk","doi":"10.1016/j.wneu.2024.11.088","DOIUrl":"10.1016/j.wneu.2024.11.088","url":null,"abstract":"<div><h3>Background</h3><div>Considering the consequences of shunt infection, the importance of early diagnosis and effective treatment becomes clear. However, there is no clear parameter to predict the management of shunt infection. Since we thought that an index including cerebrospinal fluid (CSF) leukocyte, glucose, and protein levels may affect treatment guidance, we aimed to investigate its effect on prognosis using the index we defined as CSF prognostic index.</div></div><div><h3>Methods</h3><div>Ventriculoperitoneal shunt infection patients' age, gender, etiology of hydrocephalus, serum glucose, leukocytes, white blood cell, C-reactive protein, CSF leukocyte, glucose, and leukoglycemic index (LGI) at admission were included. A new index was defined to include leukocyte, glucose, and protein values in CSF and investigate their effect on prognosis. CSF prognostic index = CSF leukocyte × CSF protein/CSF glucose.</div></div><div><h3>Results</h3><div>The study included 46 patients aged less than 18 years with shunt infection. There was no correlation among serum glucose, C-reactive protein, leukocytes, monocytes, lymphocytes, platelets, serum LGI, CSF LGI, and treatment duration. A positive correlation was found between CSF prognostic index and treatment duration, which was statistically significant (<em>P</em> = 0.011).</div></div><div><h3>Conclusions</h3><div>The CSF prognostic index is an index that can be easily evaluated with CSF findings at the time of presentation and can predict both the duration of treatment and the need for intrathecal treatment. Considering the use of broader spectrum antibiotherapies initially in patients with a high CSF prognostic index will avoid possible complications, provide less psychosocial impact on the patient and his/her relatives, and reduce the cost of treatment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123505"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigated Osteosynthesis for Unstable Atlas Fractures: Technical Note and Case Series","authors":"John D. Arena ,&nbsp;Yohannes Ghenbot ,&nbsp;Samuel B. Tomlinson ,&nbsp;Connor A. Wathen ,&nbsp;Andrea L.C. Schneider ,&nbsp;H. Isaac Chen ,&nbsp;Zarina S. Ali ,&nbsp;James M. Schuster ,&nbsp;Dmitriy Petrov","doi":"10.1016/j.wneu.2024.11.107","DOIUrl":"10.1016/j.wneu.2024.11.107","url":null,"abstract":"<div><h3>Objective</h3><div>Fractures of the atlas are typically considered stable or unstable based on the integrity of the transverse ligament. Whereas stable Jefferson burst fractures can be treated nonoperatively, unstable fractures with disruption of the transverse ligament often require surgical intervention. Atlas osteosynthesis has been proposed as a motion-preserving alternative to atlantoaxial fusion. Intraoperative navigation may facilitate safe placement of C1 instrumentation.</div></div><div><h3>Methods</h3><div>Cases of patients with unstable atlas fractures treated with navigated osteosynthesis at a single level I trauma center were identified and retrospectively reviewed. Clinical presentation, surgical management, and postoperative outcomes were assessed.</div></div><div><h3>Results</h3><div>Eight patients underwent navigated posterior atlas osteosynthesis for unstable C1 fractures between December 2015 and January 2024. All patients demonstrated injury to the transverse ligament (Dickman type I [<em>n</em> = 1] and type II [<em>n</em> = 7]). Patients were followed with serial radiographs showing preserved alignment, with no significant change in postoperative atlantodental interval at the most recent follow-up (+0.2 ± 0.87 mm [mean change ± standard deviation]; <em>P</em> = 0.53). Six patients obtained follow-up computed tomography, all of which demonstrated evidence of osseous union across fractures without hardware complication. No patients developed postoperative instability requiring fusion.</div></div><div><h3>Conclusions</h3><div>Atlas osteosynthesis is an attractive motion-preserving approach to the treatment of unstable atlas fractures, avoiding the morbidity of atlantoaxial fusion. Classically reserved for Jefferson fractures with Dickman type II transverse ligament injury, atlas osteosynthesis may also be a viable option for type I transverse ligament injuries. Intraoperative navigation can be particularly useful for screw placement in the setting of traumatically distorted anatomy with lateral mass displacement.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123524"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the Technical Pearls for L5–S1 Anterior Lumbar Interbody Fusion in Patients with Body Mass Index More Than 30: Clinical and Radiographic Outcomes at 1-Year Follow-Up","authors":"Juan P. Giraldo,&nbsp;Gabriella P. Williams,&nbsp;Martin P. Zomaya,&nbsp;Winward Choy,&nbsp;Jay D. Turner,&nbsp;Laura A. Snyder,&nbsp;Juan S. Uribe","doi":"10.1016/j.wneu.2024.11.119","DOIUrl":"10.1016/j.wneu.2024.11.119","url":null,"abstract":"<div><h3>Background</h3><div>Performing anterior lumbar interbody fusion (ALIF) in patients with a body mass index (BMI) &gt;30 presents surgical challenges. To overcome those challenges, a modified procedure is described.</div></div><div><h3>Methods</h3><div>This study retrospectively reviewed patients with a BMI &gt;30 who underwent the modified L5–S1 ALIF procedure from August 2017 to September 2023. Patient demographic and operative characteristics were collected. Clinical and radiographic outcomes were analyzed before surgery and at 1-year follow-up. An analysis was performed comparing patients with a BMI &gt;30 who underwent the modified ALIF procedure versus the standard ALIF procedure.</div></div><div><h3>Results</h3><div>A total of 26 patients with BMI &gt;30 were evaluated. Thirteen received treatment with the modified ALIF technique, and 13 received treatment with the standard ALIF technique. Operative time was significantly shorter in the modified ALIF technique cohort (<em>P</em> = 0.006). Preoperative and postoperative radiographic findings indicated significant differences in anterior disc height (<em>P</em> &lt; 0.001), posterior disc height (<em>P</em> = 0.02), and L5–S1 segmental lordosis (<em>P</em> &lt; 0.001) in patients undergoing the modified ALIF technique. There were no intraoperative complications. Postoperative visual analog scale for back pain, visual analog scale for leg pain, and Oswestry Disability Index scores significantly improved after surgery (<em>P</em> &lt; 0.05) in both cohorts after 1 year. Complete interbody fusion was achieved according to computed tomography evaluation 1 year after surgery in more than 80% of cases.</div></div><div><h3>Conclusions</h3><div>ALIF surgery is a safe technique to address lumbar pathologies. This operative technique provides complimentary abdominal exposure data for access surgeons while performing ALIFs in patients with BMI &gt;30. This technique could reduce operative time in such patients.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123536"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding “Global Trends of Mechanical Thrombectomy in Acute Ischemic Stroke over the Past Decade: A Scientometric Analysis Based on WOSCC and GBD Database”","authors":"Saarang Patel,&nbsp;Kyle W. Scott,&nbsp;Visish M. Srinivasan","doi":"10.1016/j.wneu.2024.123622","DOIUrl":"10.1016/j.wneu.2024.123622","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123622"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a Personalized Paradigm for Extracranial Pseudoaneurysm Treatment","authors":"Emmanuel O. Mensah,&nbsp;Jean Filo,&nbsp;Christopher S. Ogilvy","doi":"10.1016/j.wneu.2024.11.071","DOIUrl":"10.1016/j.wneu.2024.11.071","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123488"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}