Bulletin of emergency and trauma最新文献

{"title":"Clinical Evaluation and Surgical Management of Diaphragmatic Eventration Mimicking Traumatic Hernia: A Case Report.","authors":"Anurag Kumar, Majid Anwer, Anil Kumar, Deepak Kumar, Ankit, Abdul Vakil Khan","doi":"10.30476/beat.2025.108284.1630","DOIUrl":"10.30476/beat.2025.108284.1630","url":null,"abstract":"<p><strong>Objective: </strong>Diaphragmatic eventration (DE) is a rare condition that can mimic a traumatic diaphragmatic hernia, particularly in trauma cases. We present a case of DE initially misdiagnosed as a diaphragmatic hernia following a road traffic accident, highlighting diagnostic challenges and surgical management.</p><p><strong>Case presentation: </strong>A 50-year-old man presented to the hospital after a road traffic accident with chest discomfort and decreased air entry on the left side. Chest X-ray revealed a left paracardiac opacity. Contrast-enhanced CT (CECT) of the thorax suggested a central diaphragmatic defect with herniation of the transverse colon and mesocolon. An exploratory laparotomy, however, revealed no diaphragmatic rupture but instead a central eventration measuring 10×5×7 cm containing bowel loops. The contents were reduced, and diaphragmatic plication was performed using non-absorbable polypropylene sutures. The patient's postoperative recovery was uneventful, and he was discharged on the eighth day. At follow-up, he remained asymptomatic.</p><p><strong>Conclusion: </strong>This case underscored the importance of considering DE as a differential diagnosis in trauma patients. Surgical exploration is crucial for definitive diagnosis, and plication could provide an effective and durable management strategy.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 1","pages":"40-43"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Hemorrhage Control Strategies and Outcomes in Hemodynamically Unstable Pelvic Fracture Trauma: A Systematic Review.","authors":"Elnaz Olama, Omid Nikoo, Salma Dehbozorgi, Elham Hassannia, Zahra Jafarzadeh Jahromi, Amin Azad Nowzari, Majid Salamati","doi":"10.30476/beat.2025.107327.1614","DOIUrl":"10.30476/beat.2025.107327.1614","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review aimed to evaluate and compare emergency hemorrhage control interventions for hemodynamically unstable pelvic fracture trauma, assessing clinical outcomes, including mortality, transfusion requirements, and complication rates.</p><p><strong>Methods: </strong>A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar was conducted in December 2024. Studies were selected based on predefined inclusion criteria, which considered adult patients (≥18 years) with hemodynamically unstable pelvic fractures. Data extraction and quality assessment were performed using standardized tools. Interventions of interest included preperitoneal pelvic packing (PPP), angioembolization (AE), resuscitative endovascular balloon occlusion of the aorta (REBOA), and mechanical stabilization.</p><p><strong>Results: </strong>Ten studies were included. PPP and AE demonstrated comparable in-hospital mortality rates. However, PPP was associated with shorter intervention times and reduced early transfusion requirements. Mechanical stabilization was universally recommended as an initial step, while REBOA served as a temporizing measure. The overall strength of evidence was moderate, derived primarily from retrospective studies and meta-analyses, with no randomized controlled trials identified.</p><p><strong>Conclusion: </strong>Both PP and AE were effective for hemorrhage control in hemodynamically unstable pelvic fractures, with the choice of first-line intervention often dependent on logistical factors. The development of standardized protocols and prospective studies should be prioritized in future work to optimize management strategies.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Diagnostic Value of the Neutrophil-to-Lymphocyte Ratio Versus the Pediatric Appendicitis Scoring System in Children with Suspected Acute Appendicitis.","authors":"Mohammadjavad Moshtaghi, Tooraj Zandbaf, Jamshid Yousefi, Ali Khakshour, Fateme Omid, Seyed Mohammad Ali Raisolsadat","doi":"10.30476/beat.2026.110093.1657","DOIUrl":"10.30476/beat.2026.110093.1657","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate and compare the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) and the pediatric appendicitis score (PAS) in pediatric patients with suspected acute appendicitis (AA).</p><p><strong>Methods: </strong>This cross-sectional study included 300 children presenting with suspected AA who underwent appendectomy at Akbar Children's Hospital in Mashhad, Iran, between March 2022 and February 2024. Preoperative white blood cell count, neutrophil count, NLR, and PAS were assessed. Following appendectomy and histopathological confirmation, patients were stratified into three groups: negative appendicitis (normal appendix), uncomplicated appendicitis, and complicated appendicitis. Diagnostic parameters were then compared among these groups.</p><p><strong>Results: </strong>A total of 300 children aged 6 to 18 years suspected of having AA were studied, including 175 boys (58.3%), with a mean age of 9.7±3.18 years. For the diagnosis of AA, an NLR cutoff of >2.82 yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 97.15%, 92.59%, 98.35%, and 87.72%, respectively. Conversely, a PAS cutoff of >6.5 yielded a sensitivity, specificity, PPV, and NPV of 89.43%, 94.44%, 98.65%, and 66.23%, respectively.</p><p><strong>Conclusion: </strong>Both NLR and the PAS were significantly elevated in children with AA. The NLR had higher sensitivity, whereas the PAS had greater specificity. Given its sensitivity, simplicity, and availability, the NLR could be effectively integrated into other clinical evaluations to enhance the diagnostic accuracy for AA in pediatric patients.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 2","pages":"68-73"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Minimum Dataset for a Prehospital Stroke Emergency Dashboard.","authors":"Zahra Shahabinia, Azam Sadat Hosseini, Seyed Mohammad Reza Hosseini, Hamid Moghaddasi","doi":"10.30476/beat.2026.110560.1663","DOIUrl":"10.30476/beat.2026.110560.1663","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a Minimum Dataset (MDS) for a prehospital stroke emergency information dashboard in Iran.</p><p><strong>Methods: </strong>This applied study was conducted in four phases. Phase 1 involved a scoping review (Arksey and O'Malley framework, PRISMA-ScR) of PubMed, Scopus, and Web of Science databases in August 2024. In phase 2, data items were extracted and refined from the included studies and aligned with key domestic and international clinical guidelines. Phase 3 consisted of element classification with expert input. In phase 4, content validity was assessed using the content validity ratio (CVR) and content validity index (CVI) among 10 experts, and elements were finalized based on necessity, clarity, and simplicity.</p><p><strong>Results: </strong>Data elements were organized into two main categories: management data and clinical data. The validated MDS comprised 91 essential elements. Management data (41 elements) included identity and mission information (17 elements: mission identifier, patient information, incident location, dispatch team), key time indicators (11 elements: golden times, standard time intervals), and structural/logistical indicators (13 elements: equipment, human resources). Clinical data (50 elements) comprised initial assessment and stroke screening (5 elements: level of consciousness, Face-Arm-Speech-Time [FAST] test, symptom onset time), vital signs and clinical findings (18 elements: continuous monitoring, associated symptoms, medical history), prehospital interventions (10 elements: airway/ABC, specialized measures, pharmacotherapy), in-hospital interventions (2 elements: diagnostic and therapeutic measures), and outcome/final diagnosis (15 elements: dispatch, technician, in-hospital diagnoses; patient outcome; prehospital quality of care).</p><p><strong>Conclusion: </strong>This standardized MDS integrated prehospital data, reduced documentation burden, and supported dashboards for performance monitoring, outcome feedback, benchmarking, delay reduction, and improved stroke outcomes.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 2","pages":"79-91"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palm Vein Biometrics A Rapid Patient Identification Tool for Emergency and Trauma Care.","authors":"Mehrdad Karajizadeh, Mohammadreza Khosravi, Shahram Paydar, Mahnaz Yadollahi, Sajed Arabian","doi":"10.30476/beat.2026.109718.1651","DOIUrl":"10.30476/beat.2026.109718.1651","url":null,"abstract":"","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 2","pages":"92-94"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Utility of Clinical Scoring System and D-Dimer Assay in Suspected Cerebral Venous Thrombosis: A Prospective Observational Study.","authors":"Aravind Ca Ranjan, Ashima Sharma, Mohammed Ismail Nizami, Shaik Afshan Jabeen","doi":"10.30476/beat.2026.109075.1642","DOIUrl":"10.30476/beat.2026.109075.1642","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the diagnostic accuracy of a clinical scoring system, both alone and in combination with D-dimer assay, for suspected cerebral venous thrombosis (CVT) in the emergency department.</p><p><strong>Methods: </strong>This prospective observational study was conducted in the Emergency Department of a tertiary care teaching hospital in India. Patients who met the inclusion criteria were assessed using a CVT scoring system. They underwent non-contrast computed tomogography of the brain to rule out other types of strokes and to detect signs of CVT. D-dimer testing was also performed. The diagnosis of CVT was subsequently confirmed by magnetic resonance venography (MRV).</p><p><strong>Results: </strong>Among the75 study subjects, the frequency of CVT, as confirmed by MRV, was 53.33%. Elevated D-dimer levels were observed in 32 out of 75 patients, of whom 26 (65%) patients had CVT. A low-probability clinical score demonstrated a sensitivity of 73.33% and a pecificity of 71.1% for ruling out CVT. When a low-probability score was combined with D-dimer values below 500 <i>μ</i>g/L, the sensitivity for ruling out CVT improved to 92.5%.</p><p><strong>Conclusion: </strong>The present study indicated that moderate- and high-probability clinical scores were associated with a higher likelihood of CVT. In this cohort, a low-probability clinical score combined with a negative D-dimer assay had a high negative predictive value for CVT. While a moderate or high-probability score warranted urgent imaging, it could not confirm the diagnosis on its own. This approach is particularly useful in resource-limited settings for triaging and referring patients for the early initiation of treatment.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 1","pages":"20-27"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture Patterns in Pediatric Maxillofacial Trauma: Retrospective Study at a Tertiary Care Center in Iran.","authors":"Mojtaba Fazel, Mina Kakhki, Elham Afshari","doi":"10.30476/beat.2026.110324.1660","DOIUrl":"10.30476/beat.2026.110324.1660","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the demographic characteristics, etiology, and fracture patterns of maxillofacial traumas in patients aged 18 years or less in Gorgan, northern Iran.</p><p><strong>Methods: </strong>In this cross-sectional study, 132 patients (≤18 years old) were enrolled. These patients were referred to the emergency department (ED) of 5 Azar Hospital, a major tertiary referral center in Gorgan, Iran, between October 2020 and September 2021. Medical records and computed tomography (CT) scans were reviewed. Data regarding age, sex, mechanism of injury, and fracture type were extracted and analyzed using STATA software (version 12).</p><p><strong>Results: </strong>Most of the patients were male (male: female ratio, approximately 4:1), with a mean age of 12.6±0.5 years. Road traffic accidents (RTAs) were the most prevalent cause of injury (63.1%), followed by falls (32.3%). Motorcycles were involved in 79% of RTA cases. Fractures were identified in 30.3% (n=40) of patients. Among these, midface/maxillary fractures were the most common (72.5%), followed by mandibular (15%) and combined fractures (12.5%). No statistically significant associations were found between fracture type and age, sex, or trauma mechanism.</p><p><strong>Conclusion: </strong>In northern Iran, pediatric maxillofacial trauma predominantly affects teenage male adolescents and is primarily caused by RTAs, particularly those involving motorcycles. These findings underscored the critical need for enhanced traffic safety regulations and targeted public health interventions to protect children and adolescents.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 2","pages":"74-78"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Clinical Outcomes of Vertebral Fractures in Older Adults: A Three-Year Study from Northwestern Iran.","authors":"Somayae Abdollahi Sabet, Roya Khodaei","doi":"10.30476/beat.2026.110152.1658","DOIUrl":"10.30476/beat.2026.110152.1658","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the epidemiological characteristics of elderly patients hospitalized for spinal fractures at Mousavi Referral Hospital in Zanjan, Iran, from 2021 to 2023.</p><p><strong>Methods: </strong>In this cross-sectional study, medical records of 261 elderly patients hospitalized with vertebral fractures were reviewed. Data on demographic characteristics, injury mechanisms, vertebral involvement, associated injuries, spinal cord damage, and patient outcomes were extracted and analyzed.</p><p><strong>Results: </strong>Of the 261 patients, 138 (52.9%) were men and 123 (47.1%) were women. The mean age was 70.4±8.37 (range: 60-95). Women were significantly older than men (70±11 vs. 67±11, <i>p</i>=0.03). Male patients sustained a significantly higher number of fractured vertebrae than females (<i>p</i>=0.02). The incidence of fractures varied significantly across seasons (<i>p</i>=0.001). The most common fracture site was the thoracolumbar junction (56.2%), and the main cause was falling (58.6%). Spinal cord injuries occurred in 7.3% of patients. The most frequent associated fractures were pelvic (25.9%). The length of hospital stay increased significantly with the presence of associated fractures (<i>p</i>=0.001), spinal cord injuries (<i>p</i>=0.02), and a greater number of fractured vertebrae (<i>p</i>=0.04).</p><p><strong>Conclusion: </strong>Elderly spinal fracture patients, particularly men and those with multiple vertebral fractures, are at an increased risk of spinal cord injury, associated fractures, prolonged hospitalization, and mortality. Falls remain the most frequent cause, and the thoracolumbar junction the most common site. These findings highlighted the need for targeted prevention strategies, cautious clinical management, and early identification of high-risk patients to improve outcomes.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 1","pages":"11-19"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Abscess and Jugular Vein Thrombosis Caused by a Migratory Fish Bone: A Case Report and Literature Review.","authors":"Faramarz Farahmand, Kimia Falamarzi, Mehrdad Karajizadeh, Hooman Rezaei, Hamid Reza Abbasi","doi":"10.30476/beat.2026.108807.1635","DOIUrl":"10.30476/beat.2026.108807.1635","url":null,"abstract":"<p><p>We present a rare case of a migratory fish bone into the thyroid gland with abscess formation and internal jugular vein (IJV) thrombosis. A 73-year-old woman was referred to our emergency department due to several syncopal attacks, a ground-level fall, drowsiness, and left-sided neck swelling, with a history of consuming fish three months ago. CT scan and ultrasound revealed abscess formation at the left side of the neck, a foreign body within the left lobe of the thyroid, and left IJV thrombosis. The fish bone was removed successfully, and a left thyroid lobectomy was performed. The postoperative course was uneventful, and the IJV reopened without further intervention. Fish bone migration into the thyroid gland is an unusual event, and its possibility should be considered, especially when the patient has persistent symptoms with negative findings on examination. In such cases, appropriate imaging and advanced interventions are essential for timely diagnosis and management.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 1","pages":"36-39"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Sublingual Hematoma Caused by Warfarin Toxicity: A Case Report.","authors":"Payam Emami, Moiheddin Barzegar, Mohammad Azad Majedi, Darab Zohri","doi":"10.30476/beat.2026.106003.1580","DOIUrl":"10.30476/beat.2026.106003.1580","url":null,"abstract":"<p><strong>Objective: </strong>Anticoagulation therapy is an exceptionally effective approach for preventing thromboembolic events, including both primary and secondary occurrences that can significantly affect patient health. Among the range of anticoagulants available for clinical use, warfarin is particularly prominent, having gained extensive recognition and acceptance within the medical field for its demonstrated efficacy in treating coagulation disorders. One of the main adverse effects linked to warfarin administration is the heightened risk of bleeding, which can present in various forms. However, it is important to note that sublingual hematoma remains a relatively rare complication, though it has the potential to cause serious airway obstruction if it occurs. In situations where a patient shows symptoms of an unstable airway due to such complications, performing an urgent surgical procedure, which may involve interventions such as tracheostomy-to restore airway patency and ensure sufficient ventilation is typically recommended.</p><p><strong>Case presentation: </strong>This report outlines a clinical case involving a 69-year-old male patient who developed a sublingual hematoma as a direct result of warfarin therapy, which subsequently led to airway obstruction.</p><p><strong>Conclusion: </strong>Sublingual hematoma is a rare but potentially life-threatening complication of anticoagulation therapy. Early recognition, prompt airway management, and rapid reversal of coagulopathy using available resources are critical to preventing fatal airway obstruction in the emergency setting.</p>","PeriodicalId":9333,"journal":{"name":"Bulletin of emergency and trauma","volume":"14 1","pages":"44-47"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}