Cleft Palate-Craniofacial Journal最新文献

{"title":"A Unique Presentation of Velopharyngeal Dysfunction Secondary to Chiari I Malformation.","authors":"Julia Fedorova, Hannah Brown, Pedro Fuenmayor, Yeraldi Geronimo, Angelo Leto Barone, Andrea Scherer, Brian Kellogg","doi":"10.1177/10556656251342403","DOIUrl":"https://doi.org/10.1177/10556656251342403","url":null,"abstract":"<p><p>An 8-year-old female presented with severe hypernasality and suspected velopharyngeal dysfunction (VPD). Physical examination demonstrated a hypoplastic hemi-velum, tongue atrophy, and deviated uvula. Nasopharyngoscopy demonstrated a significant, asymmetric velopharyngeal gap with adynamic hemi-velum and no lateral pharyngeal wall movement. Given the patient's focal neurologic findings, a magnetic resonance imaging was obtained for further evaluation. Magnetic resonance imaging findings were consistent with Chiari malformation type 1. This case illustrates an unusual presentation of VPD likely secondary to cranial nerve compression and resulting atrophy. Chiari malformation should be considered in the differential diagnosis of noncleft VPD, especially in the setting of palatal asymmetries or other focal neurologic deficits.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251342403"},"PeriodicalIF":1.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Language-Common and Language-Specific Speech Characteristics of Vietnamese Children With Repaired Cleft Palate: A Single-Site Observational Study.","authors":"Thanh Thi Nguyen, Tam Minh Nguyen-Phuoc, Sue Ann S Lee","doi":"10.1177/10556656251340251","DOIUrl":"https://doi.org/10.1177/10556656251340251","url":null,"abstract":"<p><p>ObjectivesSpeech characteristics of children with cleft palate (CP) have primarily been studied in Indo-European languages. Vietnamese has a unique phonological system that differs from English and other Indo-European languages. The speech characteristics of Vietnamese children with CP, however, have not been thoroughly explored. This study aimed to investigate the speech and resonance characteristics of Vietnamese children with repaired CP who attended a speech evaluation clinic in Hanoi, Vietnam.MethodSeventy-two monolingual Vietnamese children with repaired CP, aged 3 to 12 years, participated in the study. Resonance, cleft-related errors, phonological errors, and speech production accuracy were examined. In particular, cleft-related errors and phonological errors were analyzed separately for word-initial and word-final positions. A database of 63 typically developing Vietnamese children was used to compare speech production accuracy.ResultsBoth language-common and language-specific characteristics were identified. Most Vietnamese children with repaired CP in this study demonstrated persistent abnormal resonance and lower articulation skills than their typically developing peers. Nasal air emission and cleft-related speech errors primarily occurred in the word-initial position, whereas the most frequent type of errors in the word-final position were developmental errors. This language-specific characteristic was likely due to the Vietnamese phonotactic constraints.ConclusionsLanguage-common and language-specific speech characteristics in Vietnamese children with CP may improve our understanding of CP speech. These error patterns are especially beneficial for Vietnamese speech therapists worldwide when assessing and treating children with CP who speak Vietnamese.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251340251"},"PeriodicalIF":1.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Hamulotomy on Middle Ear Pressure and Eustachian Tube Dysfunction in Children With Cleft Palate: A Randomized Controlled Trial.","authors":"Suleka Ranganath, Shibani Das, Subrat Kumar Jena, Ruchi Gupta, Sibasish Khuntia","doi":"10.1177/10556656251342393","DOIUrl":"https://doi.org/10.1177/10556656251342393","url":null,"abstract":"<p><p>BackgroundHamulotomy is a surgical procedure primarily performed during palatoplasty procedure in cleft children. This study aims to explore the effects of hamulotomy on middle ear pressure and eustachian tube dysfunction, a critical factor in maintaining proper ear function and hearing.Material and MethodologyA total of 24 patients under the age of 3 were recruited for the study and underwent primary palatoplasty. Patients were assigned randomly to either have hamulotomy or not have hamulus fracture preoperatively. Middle ear pressure, ear canal volume, compliance, reflex, and eustachian tube function was assessed pre- and post-operatively in patients undergoing primary palatoplasty using impedance audiometry. Data were analyzed using the Wilcoxon signed rank test, McNemar's change test, and Mann-Whitney <i>U</i> test, with a significance level set at <i>P</i> ≤ 0.05.ResultsOtoscopy revealed that there was no significant difference in the improvement of middle ear status between the groups. Additionally, there was no significant difference in impedance audiometry results in either group. However, the test revealed that middle ear peak pressure in cleft children ranged from -324 to 375 dapa, and 58% of cleft children exhibited a type B tympanogram.ConclusionsHamulotomy does not appear to have a significant effect on middle ear pressure changes suggesting its safe use in palatoplasty without increasing the risk of middle ear dysfunction. Given the potential benefits of Hamulotomy in improving surgical access, tension free closure during palatoplasty, its use can be considered a viable option, with minimal concern for adverse effects on middle ear function.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251342393"},"PeriodicalIF":1.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CLAPP Classification Scheme and Treatment Algorithm for Submucous Cleft Palate.","authors":"Muhammad Daiem, Farrukh Aslam Khalid, Marvee Turk, Muhammad Mustehsan Bashir, Muhammad Azam, Corstiaan Breugem, David Low, Renato da Silva Freitas, Nauman Ahmad Gill, Ghulam Qadir Fayyaz","doi":"10.1177/10556656251341093","DOIUrl":"https://doi.org/10.1177/10556656251341093","url":null,"abstract":"<p><p>ObjectiveThis study aimed to introduce a classification scheme and treatment algorithm for Submucous Cleft Palate (SMCP) to improve surgical outcomes and standardize patient management.DesignA retrospective review of patients presenting with SMCP was conducted, categorizing them according to the proposed classification scheme based on the extent of the zona pellucida and palatal length. Tailored surgical interventions were implemented for each category.SettingCLAPP Hospital, Lahore, Pakistan, from 2015 to 2023.Patients/Participants252 patients with SMCP were identified (<i>M</i>_age = 8.29 years; 52.8% male, 47.2% female). Patients with other cleft variants were excluded.InterventionsThe classification scheme categorized patients into three types based on the extent of the zona pellucida and further stratified them by palatal length. Surgical interventions included midline incisions, modified and standard Von Langenbeck techniques, and adjunctive palatal lengthening or pharyngeal flaps for patients with inadequate palatal length.Main Outcome MeasuresSpeech was assessed pre- and post-operatively using a modified Ann Kummer Speech Evaluation Protocol. Post-operative complications, including fistula formation, were recorded.ResultsSignificant speech improvement was observed, with 89.9% of patients improving from moderate/severe hypernasality to mild hypernasality. Patients receiving a pharyngeal flap exhibited a significant improvement in speech (<i>p</i> < .001) compared to those who did not. Fistulas were observed in 8.7% of cases, consistent with rates reported in the literature.ConclusionThe proposed classification scheme and treatment algorithm show promise in providing a practical framework for SMCP management. This framework will help standardize the management of patients with SMCP and improve postoperative outcomes in these patients.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251341093"},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dutch Workflow for Diagnosis and Treatment of Velopharyngeal Insufficiency in Patients with Cleft Palate-A Survey Study.","authors":"J J Peters, S A van der Kooij, Cdl van Gogh, M J Coerts, Jpw Don Griot, C M Moues-Vink, T Wagner, R M Schols, B van Nimmen, M M Pleumeekers, M Ruettermann, E C Paes, T R De Jong, C C Breugem","doi":"10.1177/10556656251341757","DOIUrl":"https://doi.org/10.1177/10556656251341757","url":null,"abstract":"<p><p>ObjectiveThe aim of this study was to investigate the workflow of cleft teams in the Netherlands with regard to the diagnosis and treatment of velopharyngeal insufficiency (VPI) in patients with cleft palate (CP).DesignThis is a cross-sectional survey study.SettingMulticenter study, tertiary hospital setting.ParticipantsEar-nose-throat surgeons, plastic surgeons and speech language pathologists of the eight cleft teams in the Netherlands.InterventionsA cross-sectional online survey was sent to the participants.Main Outcome Measure(s)The survey questions covered the following topics: diagnostic tests used to assess VPI, use of classification systems and cut-off values to determine the most optimal treatment, treatment of VPI, and postoperative follow-up.ResultsThe response rate was 88% (n = 7 cleft teams). Frequently described diagnostic tests to assess VPI include perceptual speech assessment, mirror test, nasendoscopy, oral inspection, patient-reported outcome measures, nasometry, and videofluoroscopy. Most centers reported that they did not use a classification system to determine the severity of VPI. None of the centers reported to use cut-off values based on the diagnostic tests to determine optimal treatment. The reported minimum duration of speech therapy prior to surgery varied. Many different surgical techniques were reported for the treatment of VPI. Regarding postoperative follow-up, survey responses indicate agreement on the multidisciplinary approach and diagnostic tests used. The timing of the visits varied.ConclusionFurther standardization of the diagnostic process and treatment workflow of VPI in patients with CP between Dutch cleft centers is needed in order to compare outcomes of different surgical techniques and to establish a national protocol for optimal treatment.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251341757"},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthodontic-Surgical Approach for Treating Skeletal Class II Malocclusion with Severe Mandibular Hypoplasia in Williams Syndrome.","authors":"Tomoya Murotani, Hiroshi Kurosaka, Sayuri Yamamoto, Aikawa Tomonao, Susumu Tanaka, Takashi Yamashiro","doi":"10.1177/10556656251339315","DOIUrl":"https://doi.org/10.1177/10556656251339315","url":null,"abstract":"<p><p>This case report details the successful treatment of a severe malocclusion of a patient with Williams syndrome, characterized by a retrognathic profile, severe constriction of the lower arch and mandibular hypoplasia. The procedure involved symphyseal distraction and anterior mandibular alveolar osteotomy for mandibular expansion. Subsequent treatment involved LeFort I osteotomy, mandibular advancement with bilateral sagittal split osteotomy, and genioplasty, resulting in significant improvement in occlusion and facial profile. The purpose of this case report is to present the treatment outcomes of a Williams syndrome patient with severe lower arch constriction and mandibular hypoplasia, treated using an orthodontic-surgical approach.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251339315"},"PeriodicalIF":1.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet Rich Products in Cleft Palate Repair.","authors":"Samer T Elsamna, Fayssal Alqudrah, Mahnoor Khan, Teagen Smith, Jon Robitschek, Julia Toman","doi":"10.1177/10556656251342003","DOIUrl":"https://doi.org/10.1177/10556656251342003","url":null,"abstract":"<p><p>ObjectiveCleft palate (CP) is a common congenital malformation with numerous popular and effective techniques described for operative repair. Despite this, the fistula rate following primary as well as secondary palate repairs remains high with reports ranging between 15% and 55% fistula rate. We conducted a systematic meta-analysis review to evaluate the effect of platelet rich products (PRPs) on rate of fistula formation given its well documented association with accelerated wound healing.DesignMeta-analysis systematic review.SettingArticles identified through MEDLINE, Embase, Pubmed, Google Scholar, Web of Science, Scopus, Cochrane, References, related articles.Patients, ParticipantsPatients in randomized controlled trials undergoing primary or secondary CP repair.InterventionsPRP vs no PRP.Main Outcome MeasureRate of fistula formation.ResultsFive articles with a total of 164 patients were identified and included in our final meta-analysis. There were 82 patients in each experimental and control groups. A total 22 patients experienced a fistula. Fistula rates in PRP and non-PRP groups were 4.9% (n = 4) and 22.0% (n = 18). The difference of fistula rates between PRP and non-PRP groups was statistically significant (pooled risk ratio: 0.32 (0.12-0.82, <i>p</i> = .02) on our overall pooled meta-analysis.ConclusionIn our meta-analysis review, PRP was found to significantly reduce fistula rates after primary or secondary palatoplasty in CP repair. PRP may represent an effective intra-operative adjunct to conventional surgical management and repair of CP to reduce the risk of fistula formation. Further investigation is required to explore the impact of the use of PRP on other post-operative parameters for CP.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251342003"},"PeriodicalIF":1.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Craniofacial Fellowship Training: How Are We Doing?","authors":"Demetrius M Coombs, Niyant Patel, Kanlaya Ditthakasem, Jeffrey A Fearon","doi":"10.1177/10556656251340787","DOIUrl":"https://doi.org/10.1177/10556656251340787","url":null,"abstract":"<p><p>ObjectiveAs a follow-up study, we solicited opinions a decade later from fellowship-trained craniofacial surgeons to explore shifting perspectives on their training and assess the impacts on careers and practice patterns.DesignAn anonymous 26-question survey was sent to all surgeons completing craniofacial fellowships in 2013. Additionally, current craniofacial fellowship descriptions were tabulated to assess variations in program experiences.ResultsWith a 47% response rate out of 30 original respondents, 14% reported no longer practicing craniofacial surgery. Among those still engaged, 42% described no longer performing intracranial/midfacial osteotomies, with 21% desiring more intracranial/midfacial volumes, 29% more cleft/orthognathic, and 30% less pediatric plastic surgery. Surprisingly, 31% reported in retrospect they would have chosen a different training program. Fifty percent had changed jobs since fellowship, with 50% practicing at centers with an average of 4.5 craniofacial surgeons. A review of current craniofacial fellowship descriptions revealed aside from intracranial/midface and cleft training, an additional 29 different surgical procedure types were advertised.ConclusionsThis follow-up assessment suggests most trainees remain active in craniofacial surgery, but many expressed dissatisfaction with their training. Almost one-third indicated they would have selected a different program, raising questions about the perceived quality of training. Considering the diversity of procedures currently falling under the craniofacial marque, a clearer description of expected case volumes might improve reported levels of fulfillment. An additional consideration is restricting the term craniofacial to programs focused on intracranial/midfacial surgery, while developing more descriptive alternative labels that better reflect the unique surgical experiences provided at each center.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251340787"},"PeriodicalIF":1.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert Recommendations for Neurodevelopmental Screening in Children with Craniosynostosis: A Consensus Report from the Craniosynostosis Research Neurodevelopmental Working Group (SynRG).","authors":"Naman Baraya, Lia Thibodaux, Arianna Martin, Caitlin Stone, Jennifer Strahle, Kamlesh Patel, Leah Chapman","doi":"10.1177/10556656251339879","DOIUrl":"https://doi.org/10.1177/10556656251339879","url":null,"abstract":"<p><p>ObjectiveThis study aims to address the gap in standardized neurodevelopmental screening for children with craniosynostosis following surgical intervention. It proposes a structured timeline for assessments to identify developmental delays and cognitive deficits, facilitating early intervention and improved outcomes.DesignTwo neurodevelopmental expert consensus meetings were held virtually with pediatric neuropsychologists and psychologists to review existing literature and identify screening tools, timelines, and implementation strategies. The proposed protocol was then presented to multidisciplinary members of the SynRG research group, including surgeons and craniofacial specialists, to refine recommendations.SettingThe protocol is intended for implementation in multidisciplinary craniosynostosis clinics at tertiary care institutions across the United States.Patients, ParticipantsThe study involved pediatric neuropsychologists and psychologists with expertise in neurodevelopment, as well as neurosurgeons and craniofacial specialists of the SynRG research group.InterventionsThe proposed screening schedule spans infancy through adolescence, incorporating tools such as the Ages and Stages Questionnaire, NIH Toolbox, and PROMIS measures. Screening intervals align with developmental milestones and academic transitions.Main Outcome MeasuresThe study focused on feasibility, clinical utility, and the ability of the proposal to detect developmental concerns among craniosynostosis patients early.ResultsThe panel recommended a screening protocol tailored to key developmental stages, integrating caregiver input and direct assessments. Feedback from the SynRG group supported the protocol's feasibility but highlighted barriers such as neuropsychologist availability and insurance challenges.ConclusionsThe proposal offers a scalable protocol to neurodevelopmental screening in craniosynostosis care. Implementation in clinical practice could enhance early identification and intervention, improving long-term outcomes.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251339879"},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unprecedented Complication in Pharyngeal Flap Surgery: Cerebrospinal Fluid Leakage.","authors":"Gökberk Çavuşoğlu, Murat Kara, Rahşan Göçmen","doi":"10.1177/10556656251340979","DOIUrl":"https://doi.org/10.1177/10556656251340979","url":null,"abstract":"<p><p>Velopharyngeal insufficiency (VPI) arises from inadequate closure of the velopharyngeal unit, resulting in hypernasality. The primary approach for treating severe VPI is surgical intervention, most commonly through pharyngeal flap procedures. Although the pharyngeal flap has been considered the gold standard for the correction of VPI, recent studies have raised concerns about its safety, particularly due to significant complication rates. The pharyngeal flap is elevated above prevertebral fascia, which is anatomically proximate to both the clivus and the internal carotid artery. Various midline anomalies may coexist in patients presenting with isolated cleft palate and syndromic features, such as the case described here. We present the case of an 18-year-old female with atypical craniofacial features who underwent a pharyngeal flap procedure for VPI. Intraoperatively, cerebrospinal fluid (CSF) leakage was encountered but successfully managed with purse-string sutures. Postoperative imaging revealed pneumocephalus without active CSF leakage. Clinically, no postoperative CSF leakage was detected. The patient was discharged after antibiotics and showed significant speech improvement, with no neurological complications. This case highlights challenges and critical management strategies for complex craniofacial anatomy in pharyngeal flap surgery. In selected patient populations, preoperative computed tomography or magnetic resonance cisternography can help mitigate the risk of complications such as CSF leakage or injury to the internal carotid artery during the elevation of pharyngeal flap. A review of the existing literature did not reveal any previously published reports documenting this rare complication of CSF leakage. Level of Evidence: Level 5 case report.</p>","PeriodicalId":49220,"journal":{"name":"Cleft Palate-Craniofacial Journal","volume":" ","pages":"10556656251340979"},"PeriodicalIF":1.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}