Neurocirugia最新文献

{"title":"Moyamoya disease and moyamoya syndrome: A case series from multicentre private hospitals in Indonesia","authors":"Rusli Muljadi ,&nbsp;Koesbandono ,&nbsp;Teodorus Alfons Pratama ,&nbsp;Gilbert Sterling Octavius","doi":"10.1016/j.neucir.2024.10.012","DOIUrl":"10.1016/j.neucir.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Moyamoya disease (MMD) and moyamoya syndrome (MMS) are considered rare in Indonesia, without any proper epidemiological data backing this claim. Hence, this case series aims to assess all MMD and MMS cases from the perspective of a multicentre private hospital in Indonesia.</div></div><div><h3>Methods</h3><div>This is a descriptive analysis using data from the picture archiving and communication system (PACS) from January 2019 to December 2023. The inclusion criteria included all patients who fulfilled the radiological criteria for MMD and/or MMS, while patients who only underwent brain non-contrast computed tomography (CT) scans were excluded.</div></div><div><h3>Results</h3><div>There are 58,905 unique MRI scans from 2019 to 2023. The cohort comprises 8 females and 2 males, with a median age of 37 (7–65) years old. Three cases are probable MMD. with six MMD cases and one MMS case. Therefore, the prevalence rate for the four years is approximately 11.9 cases per 100,000 scans. Out of the confirmed Moya-Moya cases, the majority (4/7) are ischemic subtypes, followed by epileptic (electroencephalography shows slowing brain waves) and TIA in one case each. The most common presenting symptom is weakness in the extremity (N = 7), followed by headache (N = 5). Four patients underwent operative procedures, with three of them being superior temporal artery to middle cerebral artery (STA-MCA) bypass procedures and one of them being encephalo-duro-myo-arterio-pericraniosynangiosis (EDMAPS).</div></div><div><h3>Conclusion</h3><div>The paucity of confirmed cases either points towards the low prevalence of MMD and MMS in Indonesia or the underdiagnosis of these cases.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 151-160"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895895","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":"Consideraciones diagnósticas de los tumores de la región selar según su geometría de crecimiento vectorial","authors":"Marlon Manuel Ortiz Machín,&nbsp;Omar López Arbolay,&nbsp;Carlos Roberto Vargas Gálvez","doi":"10.1016/j.neucir.2024.11.004","DOIUrl":"10.1016/j.neucir.2024.11.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Sellar and parasellar tumors are frequent lesions in neurosurgical practice, highlighting pituitary adenomas, craniopharyngiomas, and sellar tubercle meningiomas. The clinical manifestations are similar, however; There are imaging aspects that differentiate them.</div></div><div><h3>Objective</h3><div>Show imaging aspects of tumors in the sellar and parasellar region that guide their histopathological diagnosis.</div></div><div><h3>Method</h3><div>A descriptive, longitudinal and prospective study was carried out that included 200 patients from the Hermanos Ameijeiras Hospital, of which 120 had a histopathological diagnosis of pituitary adenoma, 50 of craniopharyngioma and 30 of sellar tubercle meningioma. The variations in the displacement of the point of the anterior communicating arterial complex and in the premammillary angle were analyzed by means of a cerebral nuclear magnetic resonance study. For data analysis, absolute and relative frequencies were used as summary measures.</div></div><div><h3>Results</h3><div>A cephalic displacement of the anterior communicating arterial complex was evident in the craniopharyngiomas, of 10 -11.9<!--> <!-->mm (84.0%); in pituitary macroadenomas, 12-14<!--> <!-->mm (78.3%); and in sellar tubercle meningioma, ≥ 14 (86.6%) mm. When evaluating the premammillary angle, pituitary adenomas were identified between 85°-95° (73.3%); in craniopharyngiomas, &lt;<!--> <!-->85° (90.0%); and in meningiomas of the sellar tubercle, between 85-95° (86.6%).</div></div><div><h3>Conclusions</h3><div>The present study allows us to identify imaging characteristics in sellar and parasellar tumors that guide with high certainty the histopathological diagnosis and thus establish a more effective treatment.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 179-184"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895898","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":"Cord compression due to atypical T-cell lymphoma from paraspinal soft tissue: Report of a case","authors":"Alejandro Augusto Ortega Rodriguez,&nbsp;Santiago Nicolás Valbuena Dussan,&nbsp;José Luís Caro Cardera,&nbsp;Jordi de Manuel-Rimbau Muñoz","doi":"10.1016/j.neucir.2024.10.006","DOIUrl":"10.1016/j.neucir.2024.10.006","url":null,"abstract":"<div><div>During lymphoma’s natural history of disease, 5–10% of cases may develop Central Nervous affectation. We present the case of a 57-years-old man with less than 24 h of onset symptoms of paraparesis, lower limb hypoesthesia and sphincter dysfunction who was operated due to dorsal tumor with epidural component which caused severe cord compression. Pathological analysis concluded atypical T-cell lymphoblastic lymphoma, a rare subtype of lymphoma which accounts 1%−2% of all Non-Hodgkin Lymphomas. Our case was particularly aggressive and atypical due to its origin in paraspinal soft tissue. Despite specific treatment, the patient presented an early epidural relapse, frequent in this lymphoma subtype.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 199-203"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895900","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":"Trigeminal neuralgia secondary to minor size lesion, anatomical considerations and pathophysiology","authors":"Adrián Fernández García,&nbsp;Carlos Alberto Rodríguez Arias,&nbsp;Estefanía Utiel Monsálvez,&nbsp;Herbert Daniel Jiménez Zapata","doi":"10.1016/j.neucir.2024.11.002","DOIUrl":"10.1016/j.neucir.2024.11.002","url":null,"abstract":"<div><div>Trigeminal neuralgia is a well-characterized disorder of high prevalence among the current population. It may be caused, among many other causes, by a tumor which contacts with the trigeminal nerve, often of large volume. We present the case of a middle-aged woman without any remarkable medical background who suffered a trigeminal neuralgia caused by a subcentimeter tumor which appeared to be a meningioma. Some small tumors like this one may be symptomatic whereas larger ones will not. We discuss the pathogenesis and characterization of the trigeminal neuralgia in such cases proposing some mechanisms that could be involved in the development of a secondary neuralgia.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 204-207"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895901","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":"Mortality risk factors for adult trauma patients treated with halo brace for cervical spine fracture","authors":"Kim Hoang ,&nbsp;Jeffrey Santos ,&nbsp;Areg Grigorian ,&nbsp;Lourdes Swentek ,&nbsp;Hansen Bow ,&nbsp;Jeffry Nahmias","doi":"10.1016/j.neucir.2024.09.001","DOIUrl":"10.1016/j.neucir.2024.09.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Halo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures.</div></div><div><h3>Materials and methods</h3><div>The 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale &gt;3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed.</div></div><div><h3>Results</h3><div>From 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p &lt; 0.001) and chronic kidney disease (14.3% vs. 1.2%, p &lt; 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p &lt; 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p &lt; 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality.</div></div><div><h3>Conclusions</h3><div>Only 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 145-150"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896041","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":"Utility of very high-pressure valves in persistent symptomatic shunt overdrainage","authors":"Iván Federico Narváez Moscoso,&nbsp;Bienvenido Ros López,&nbsp;Sara Iglesias Moroño,&nbsp;Julia Casado Ruiz,&nbsp;Raquel Simón Wolter,&nbsp;Miguel Ángel Arráez Sánchez","doi":"10.1016/j.neucir.2024.11.003","DOIUrl":"10.1016/j.neucir.2024.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Shunt overdrainage is one of the long-term complications associated with ventriculoperitoneal shunts. Treatment of refractory cases may require further upgrading of both the valve opening pressure and antisiphon device. The aim of this paper is to describe the results of this combination in a selected group of patients.</div></div><div><h3>Methods</h3><div>Retrospective cohort study that included 18 pediatric patients between 2003–2022. Previous shunts were exchanged for the combination of a SOPHYSA Polaris® SPVA-300 valve and upgraded fixed or adjustable antigravitatory devices. The following variables were collected: etiology of the hydrocephalus, age at first shunt and type of valve, number of shunt revisions, other surgical procedures, age at inclusion, clinical and radiological outcomes, and follow-up time. A descriptive analysis was done with means, medians and ranges for quantitative variables; percentages and frequencies for the analysis of qualitative data.</div></div><div><h3>Results</h3><div>The median age at first shunt was two months (0–67). The mean number of shunt revisions before inclusion was three. Shunt removal was attempted in seven patients without success; temporary success was observed in two patients who underwent ETV. Two patients had previous cranial expansions. The mean age at inclusion was 9.1 years (2.7–15.2). After the shunt system was exchanged and upgraded, clinical improvement was observed in 94.4% (17/18) of patients, and radiological improvement was observed in 83.3% (15/18) of patients. The median follow-up was 21 months.</div></div><div><h3>Conclusions</h3><div>Before considering more invasive therapeutic measures, shunt system optimization by the combination of very high-pressure valves and upgraded in-line antisiphon devices is a valid and safe strategy for refractory symptomatic shunt overdrainage.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 161-168"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895896","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":"Neuroblastoma olfatorio: revisión de literatura y presentación de dos casos clínicos con diferentes infiltraciones tumorales y diferentes abordajes","authors":"Carlos A. Ferreira ,&nbsp;Carlos E. Quevedo ,&nbsp;Gina V. Vilardy ,&nbsp;Mario Andrés Arias Depablos","doi":"10.1016/j.neucir.2024.10.002","DOIUrl":"10.1016/j.neucir.2024.10.002","url":null,"abstract":"<div><div>The olfactory neuroblastoma is a rare malignant neoplasm derived from the olfactory neuroepithelium. It can metastasize to cervical lymph node chains and distant organs through hematogenous or lymphatic routes. Two clinical cases are presented: the first, a 56-year-old man with no pathological history, exhibited symptoms evolving over 2 months, characterized by persistent rhinorrhea with frequent epistaxis, ipsilateral proptosis, left hemicranial pain, anosmia, and dysgeusia. Radiological images showed involvement of paranasal sinuses, left orbital cavity, and intracranial region. The second case involved a 46-year-old male with progressive symptoms over more than 1 year, including nasal obstruction, rhinorrhea, self-limited epistaxis, anosmia, weight loss in the last 3 months, and subjective decrease in visual acuity. A protruding mass in the left nasal fossa was observed without intracranial involvement. Both cases were pathologically and immunohistochemically consistent with olfactory neuroblastoma, Hyams grade 2.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 194-198"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896029","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":"Cirugía robótica de columna vertebral: nota técnica y análisis descriptivo de los primeros 40 casos","authors":"Víctor Rodríguez-Domínguez,&nbsp;Jorge Bedia Cadelo,&nbsp;Javier Giner García,&nbsp;María Luisa Gandía González,&nbsp;Catalina Vivancos Sánchez,&nbsp;Alberto Isla Guerrero","doi":"10.1016/j.neucir.2024.10.013","DOIUrl":"10.1016/j.neucir.2024.10.013","url":null,"abstract":"<div><h3>Introduction</h3><div>The global incidence of spinal pathology is increasing due to the progressive aging of the population and increased life expectancy. Vertebral fixation with transpedicular screws is the most commonly used technique in unstable or potentially unstable pathologies. There are different implantation methods, the most recently developed being implantation guided by robotic navigation.</div></div><div><h3>Materials and methods</h3><div>We describe the technical aspects and the different workflows available with the ExcelsiusGPS® robotic navigation system (GlobusMedical, Inc, Audubon, PA, USA), as well as the results of the first 40 patients operated on at the Hospital Universitario La Paz between July 2023 and February 2024.</div></div><div><h3>Results</h3><div>A total of 250 screws were implanted at the thoracic and lumbar levels. Twelve patients underwent minimally invasive surgery (MIS) (30%) and 28 patients underwent open surgery (70%). The median number of screws implanted per patient was 6.00 (4.00-6.00). The intraoperative malpositioning rate was 2.5% (1<!--> <!-->case). The median duration of surgery was 143.00<!--> <!-->minutes (113.00-165.50). The median hospital stay was 4.00<!--> <!-->days (3.00-5.50). The median intraoperative radiation delivered was 899<!--> <!-->mGy/cm² (523.25-1595.00). The median blood loss was 150.00<!--> <!-->ml (100.00-300.00) and the blood transfusion rate was 0%.</div></div><div><h3>Discussion</h3><div>Compared to conventional techniques, robotic spine surgery increases accuracy to 96-100% and reduces the radiation dose received by the patient and surgical team. In addition, it allows the implantation of larger screws, which has been associated with increased biomechanical strength and reduced risk of loosening. Initially, it may involve an increase in total surgical time, but this is reduced once the learning curve is reached, around 40 cases.</div></div><div><h3>Conclusions</h3><div>ExcelsiusGPS® is the most recent robot model on the market and different studies have demonstrated its effectiveness in different techniques and indications. Unlike other robotic systems used exclusively in dorsolumbar spine pathology, it can be used in the pathology of the entire spinal axis (from C1 to the sacrum) and brain pathology (deep electrode implantation, brain biopsy, SEEG, among others).</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 169-178"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895897","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":"Association of the C-reactive protein/albumin ratio with the prognosis of Aneurysmal Subarachnoid Hemorrhage: A systematic review","authors":"Gerardo Luna-Peralta ,&nbsp;Alvaro Lopez-Luza ,&nbsp;Claudia Cruzalegui-Bazán ,&nbsp;Miguel Cabanillas-Lazo","doi":"10.1016/j.neucir.2024.11.001","DOIUrl":"10.1016/j.neucir.2024.11.001","url":null,"abstract":"<div><div>The C-Reactive Protein/Albumin Ratio (CAR) is being studied as a potential predictor of severe outcomes in various diseases. Our study aimed to review current evidence on the prognostic value of CAR in patients with aneurysmal subarachnoid hemorrhage (aSAH). We conducted a systematic search in PubMed, Embase, Scopus, Web of Science, and Google Scholar up to April 2023 and assessed the risk of bias using the NewCastle-Ottawa tool. A narrative synthesis was performed, and the GRADE system was used to evaluate the certainty of the evidence. Out of 534 articles, 4 were selected. We found that a higher CAR level is moderately associated with a lower score on the Glasgow Outcome Scale at 3 months and a higher incidence of in-hospital mortality. However, no significant association was found with the modified Rankin scale or delayed cerebral ischemia. Although the evidence is limited, CAR could be a useful tool for predicting poor prognosis in aSAH patients, but more prospective studies are needed to determine optimal cut-off points and include CAR in long-term prognostic models.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 185-193"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895899","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":"Lateralization in visualization among neurosurgeons","authors":"Hrvoje Barić ,&nbsp;Sara Komljenović ,&nbsp;Helena Ljulj","doi":"10.1016/j.neucir.2024.10.005","DOIUrl":"10.1016/j.neucir.2024.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Handedness is an epiphenomenon of brain lateralization which has been researched in the context of surgical performance, yet the same does not hold true for lateralization at a more fundamental level. We aimed to investigate whether neurosurgeons are biased in visualizing and depicting anatomy and pathology.</div></div><div><h3>Methods</h3><div>This was a two part study consisting of an online survey and image analysis. An online questionnaire was used to collect basic sociodemographic data and prompt subjects to visualize surgical approaches and pathological entities and report on the side of the visualized topics. Prominent neurosurgical literature was screened for depictions of the same entities and approaches and the depicted side was noted.</div></div><div><h3>Results</h3><div>There were 49 responses, most from Croatia (n = 26), men (n = 38), right-handed (n = 42), of average age 37 years, and with 9 years of neurosurgical experience. Ambidexterity was more prevalent than in the general population. The respondents imagined the right side more commonly in all cranial-related questions, and the left side in spine-related questions. Images in neurosurgical literature showed correspondingly biased laterality.</div></div><div><h3>Conclusion</h3><div>There is a significant bias among neurosurgeons in laterality in processing topographical information on anatomy and pathology. Research is warranted to investigate the causes and real life implications of this phenomenon.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 2","pages":"Pages 93-97"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526667","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}