The journal of international advanced otology最新文献

{"title":"Cochlear Implantation in Single-Sided Deafness and Asymmetric Hearing Loss: 12 Months Follow-up Results of a European Multicenter Evaluation.","authors":"Thomas Wesarg, Antje Aschendorff, Regina Baumgaertel, Julia Böttcher, Liesbeth De Coninck, Ingeborg Dhooge, Ann Dierckx, Thomas Klenzner, Philipp Schörg, Georg Sprinzl, Freya Swinnen, Nicolas Verhaert, Annelies Vermeiren, Simone Volpert, Andrzej Zarowsk, Arne Ernst","doi":"10.5152/iao.2024.231457","DOIUrl":"10.5152/iao.2024.231457","url":null,"abstract":"<p><p>People with single-sided deafness (SSD) or asymmetric hearing loss (AHL) have particular difficulty understanding speech in noisy listening situations and in sound localization. The objective of this multicenter study is to evaluate the effect of a cochlear implant (CI) in adults with single-sided deafness (SSD) or asymmetric hearing loss (AHL), particularly regarding sound localization and speech intelligibility with additional interest in electric-acoustic pitch matching. A prospective longitudinal study at 7 European tertiary referral centers was conducted including 19 SSD and 16 AHL subjects undergoing cochlear implantation. Sound localization accuracy was investigated in terms of root mean square error and signed bias before and after implantation. Speech recognition in quiet and speech reception thresholds in noise for several spatial configurations were assessed preoperatively and at several post-activation time points. Pitch perception with CI was tracked using pitch matching. Data up to 12 months post activation were collected. In both SSD and AHL subjects, CI significantly improved sound localization for sound sources on the implant side, and thus overall sound localization. Speech recognition in quiet with the implant ear improved significantly. In noise, a significant head shadow effect was found for SSD subjects only. However, the evaluation of AHL subjects was limited by the small sample size. No uniform development of pitch perception with the implant ear was observed. The benefits shown in this study confirm and expand the existing body of evidence for the effectiveness of CI in SSD and AHL. Particularly, improved localization was shown to result from increased localization accuracy on the implant side.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006238","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 National Ménière's Disease Registry: A Feasibility Study.","authors":"John Phillips, Louisa Murdin, Peter Rea, Jonny Harcourt, Lee Shepstone, Erika Sims, Veronica Bion, Ria Brunton, Abigail Tetteh, Dimitrios Daskalakis, William Rea","doi":"10.5152/iao.2024.22954","DOIUrl":"10.5152/iao.2024.22954","url":null,"abstract":"<p><p>Ménière's disease is a disabling condition causing vertigo and hearing loss yet remains incompletely understood. Registry studies have the potential to answer important questions about phenotypes and natural history of clinical conditions. The aim of this study was to explore the feasibility of a patient-centered national Ménière's disease registry. This was an observational study carried out at 4 state-funded hospitals and 4 independent clinics, within 3 distinct urban and rural regions within the UK. Adults with Ménière's disease were eligible to participate. A range of patient reported data, questionnaire data and clinical data (audiometric, radiological, and specialist balance testing data) was inputted into a bespoke database. The study recruited 411 participants. The majority of participants chose online recruitment (73%) and 27% chose via paper-based methods for participation. A small majority (57%) of participants were female. 96% of participants were of white ethnicity. Data completeness from online or postal data collection was similar. Around 20% of participants had audiological evidence of bilateral Ménière's disease. This feasibility study has successfully piloted methods for recruitment of hundreds of participants diagnosed with Ménière's disease. Participants actively contributed their data to a robust and extensive data collection platform. The positive outcomes from this initial feasibility study are anticipated to serve as a foundation for the future expansion of the registry. This expansion holds the potential to address a broad spectrum of request, encompassing all aspects of the nature of Ménière's disease.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006241","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":"Investigation of Post-Earthquake Dizziness After 2023 Türkiye Earthquakes: An Observational Case-Control Study.","authors":"Çağlar Eker, Muhammed Dağkıran, Özgür Sürmelioğlu, Ekrem Coşkun, Ahmet Atila, Zeynep Namlı, Sevinç Puren Yücel Karakaya, Elvan Onan","doi":"10.5152/iao.2024.231411","DOIUrl":"10.5152/iao.2024.231411","url":null,"abstract":"<p><p>The primary objective of this study was to investigate the etiological causes and the underlying mechanism of post-earthquake dizziness in affected persons. The present study utilized an observational case-control design to recruit 69 participants (33 with self-reported dizziness complaints and 36 healthy persons) who were exposed to the 2023 earthquakes in Türkiye. The participants underwent assessments including the Dizziness Handicap Inventory for measuring dizziness-related disability, stress, and anxiety assessment using various scales, and equilibrium evaluation through the use of videonystagmography, video head impulse test, and vestibular evoked myogenic potential. The 2 groups were compared based on these assessments. The results indicate that the Dizziness Handicap Inventory score was significantly higher in the patient group compared to the control group (P < .001). The mean score of the Peritraumatic Distress Inventory, as well as the mean scores of the Hospital Anxiety and Depression Scale anxiety score and depression score, were found to be significantly higher in the patient group compared to the control group (P=.012, P < .001, and P < .001, respectively). Furthermore, it was observed that the mean vestibulo-ocular reflex gain of the left posterior semicircular canal exhibited a statistically significant decrease in the patient group (P=.02). The observed equilibrium dysfunction experienced by individuals following a significant earthquake is likely attributable to heightened stress and anxiety stemming from multiple sources, including the impact of recurrent vibrations on the inner ear. Therefore, it is essential to establish a holistic healthcare approach that addresses the psychological needs of individuals affected by earthquakes.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006247","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":"Hearing Aid Silicone Impression Material Discovered During Exploration of the Middle Ear: 2 Case Reports and Literature Review.","authors":"Khalid Al Zaabi, Eiman Al-Ajmi, Mohamed Badr El-Dine","doi":"10.5152/iao.2024.231421","DOIUrl":"10.5152/iao.2024.231421","url":null,"abstract":"<p><p>It is unusual to see complications with the preparation of ear mold in order to get hearing aids for children who are in need. However, we came across 2 cases who had a foreign body retained in the middle ear after a long period of time from taking silicon mold impression for hearing aid fitting. One patient presented after 2 years, and the other patient presented after 10 years of hearing aid fitting. We are reporting 2 cases with silicon impression material left in the middle ear for a long period of time after taking an impression for hearing aid fitting and found unexpectedly during exploratory tympanotomy. These reported cases are among the few cases reported worldwide without clear known incidence. This necessitates proper examination by otolaryngologists and the audiologists who are responsible for taking the impression to prevent such complications.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11363183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006245","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":"Assessing the Vestibulo-ocular Reflex of Contralesional Sides According to Head Impulse Velocity Utilizing the Video Head Impulse Test in Patients with Vestibular Neuritis.","authors":"Wonyong Baek, Young Jae Lee, Jeonghyun Oh, Sung Il Cho, Gi-Sung Nam","doi":"10.5152/iao.2024.231340","DOIUrl":"10.5152/iao.2024.231340","url":null,"abstract":"<p><p>There is a lack of comparative studies examining changes in vestibulo-ocular reflex (VOR) gain with head velocity in the video head impulse test (vHIT) of patients with vestibular neuritis (VN). Thus, the purpose of present study was to identify the effect of head impulse velocity on the gain of the VOR during the vHIT in patients with VN. Head impulse velocities ranging from 100%-200°/s [158.08 ± 23.00°/s in the horizontal canal (HC), 124.88 ± 14.80°/s in the anterior canal (AC), and 122.92 ± 14.26°/s in the posterior canal (PC) were used during vHIT trials of 32 patients with VN. Differences in VOR gain on the ipsilesional and contralesional sides according to head velocity were analyzed. The mean VOR gains in ipsilesional side were decreased to 0.47 in the HC and 0.56 in the AC, leading to marked asymmetry compared to the contralesional side; PC gain was relatively preserved at 0.82 in the ipsilesional side. The mean head impulse velocity applied during vHIT trials in each semicircular canal plane did not differ bilaterally. On the contralesional side, VOR gain was negatively correlated with head impulse velocity (R2=0.25, P=.004 in HC; R2=0.17, P=.021 in AC; R2=0.24, P=.005 in PC), while VOR gain on the ipsilesional sides of the HC and AC was not. Head impulse velocity may have a differential impact on VOR gain, depending on the degree of deficit. Increasing head velocity in vHIT may be considered to identify subtle deficits on the contralesional side of patients with VN.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001656","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":"Efficacy of Otoendoscopy for Residual Cholesteatoma Detection During Microscopic Chronic Ear Surgery.","authors":"Floor Couvreur, Elke Loos, Christian Desloovere, Nicolas Verhaert","doi":"10.5152/iao.2024.231122","DOIUrl":"10.5152/iao.2024.231122","url":null,"abstract":"<p><p>The aim of this article is to determine the efficacy of otoendoscopy during microscopic cholesteatoma surgery on residual cholesteatoma rates postoperatively. The medical records of patients (aged 4-90) with primary acquired cholesteatoma who underwent microscopic cholesteatoma surgery (exclusively transcanal approach or canal wall-up tympano-mastoidectomy) with subsequent otoendoscopic examination (80 ears) for intraoperative cholesteatoma residues were retrospectively reviewed. All cases with mixed microscopic/endoscopic, fully endoscopic, or fully microscopic dissection were excluded, as well as cases where a canal wall-down technique was used. After microscopic cholesteatoma removal, the otoendoscope was used to inspect the middle ear recesses for intraoperative cholesteatoma residues. The intra- and postoperative cholesteatoma residue rate were evaluated. On endoscopic examination, intraoperative cholesteatoma residues were encountered in 24 patients (30%). A total of 30 foci were detected. Most of them were found in the superior retrotympanum (15 foci). In 9 cases an antral remnant guided the surgeon to convert to a canal wall up tympanomastoidectomy. During the postoperative follow-up period, residual cholesteatoma was detected on postoperative magnetic resonance imaging in 6 patients (7.5%). Adding an otoendoscopic examination to microscopic cholesteatoma surgery reduced the postoperative cholesteatoma residues rate (odds ratio=0.16). A negative otoendoscopic examination led to a cholesteatoma residue-free follow-up period in 95% of cases(NPV=0.95). Otoendoscopy is effective in identifying intraoperative cholesteatoma residues after microscopic cholesteatoma surgery. It reduces the postoperative cholesteatoma residue rate, and a negative otoendoscopic examination increases the likelihood of a cholesteatoma residue-free follow-up.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001659","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":"The Impact of Oleuropein on Cisplatin-Induced Toxicity in Cochlear Cells in Relation to the Expression of Deoxyribonucleic Acid Damage-Associated Genes.","authors":"Yüksel Olgun, Zekiye Altun, Merve Tütüncü, Selen Kum Özşengezer, Safiye Aktaş, Enis Alpin Güneri","doi":"10.5152/iao.2024.231288","DOIUrl":"10.5152/iao.2024.231288","url":null,"abstract":"<p><p>Different organs respond differently to cisplatin (CDDP)-induced toxicity. Oleuropein (OLE) is a natural phenolic antioxidant. The purpose of this study was to determine the potential protective effect of OLE against CDDP-induced ototoxicity by evaluating expression of genes associated with deoxyribonucleic acid (DNA) damage and repair in cochlear cells. House Ear Institute-Organ of Corti 1 (HEI-OC1) cells were treated using CDDP, OLE, and OLE-CDDP. The water-soluble tetrazolium salt assay was used for monitoring cell viability. Deoxyribonucleic acid damage in cells due to the CDDP, OLE, and combination treatments was determined using a flow-cytometric kit. The change in the expression of 84 genes associated with CCDP, OLE, and OLE-CDDP treatments that induced DNA damage was tested using the reverse transcription polymerase chain reaction array. Changes ≥3-fold were considered significant. House Ear Institute-Organ of Corti 1 cell viability was significantly reduced by CDDP. The OLE-CDDP combination restored the cell viability. Cisplatin increased the H2AX ratio, while OLE-CDDP combination decreased it. Some of the DNA damage-associated genes whose expression was upregulated with CDDP were downregulated with OLE-CDDP, while the expression of genes such as Gadd45g and Rev1 was further downregulated. The expression of DNA repair-related Abl1, Dbd2, Rad52, and Trp53 genes was downregulated with CDDP, whereas their expression was upregulated with OLE-CDDP treatment. In cochlear cells, the OLE-CDDP combination downregulated DNA damage-associated gene expression relative to that upregulated mainly by CDDP. The results revealed that OLE has a potential protective effect on CDDP-induced ototoxicity in cochlear cells by altering the expression of DNA damage-related genes.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001663","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":"Intralabyrinthine Schwannoma Mimicking Posterior Canalithiasis.","authors":"Jonathan Olsgård Hansen, Niels Cramer West, Per Cayé-Thomasen","doi":"10.5152/iao.2024.231410","DOIUrl":"10.5152/iao.2024.231410","url":null,"abstract":"<p><p>Intralabyrinthine schwannomas are a rare subgroup of vestibular schwannomas located within the membranous labyrinth of the inner ear and are known for their variable clinical presentations and symptoms. In the present study, we report on a patient with a persistent history of dizziness and positional vertigo, who was misdiagnosed with posterior canalithiasis. As hearing loss was not developed until late in the disease course, the patient was not properly diagnosed until magnetic resonance imaging revealed an intralabyrinthine schwannoma, which was not discovered on earlier imaging. In addition to the unusual clinical presentation, we describe the audio-vestibular profile of our patient. We suggest that a thorough vestibular evaluation, including caloric testing and a careful examination of the inner ear on imaging, is warranted in cases of treatment of refractory vertigo, even in patients where a diagnosis seems certain.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001660","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":"Long-Term Results of Sodium 2-Mercaptoethane Sulfonate Usage on Cholesteatoma Surgery.","authors":"Serdal Çelik, M Zeki Yalçın, Osman Kılıç, Mehmet Tan, Mahmet Tayyar Kalcioğlu","doi":"10.5152/iao.2024.231208","DOIUrl":"10.5152/iao.2024.231208","url":null,"abstract":"<p><p>Although advanced technologies and surgical procedures are used, cholesteatoma is a disease with the possibility of recurrence. The aim of this study was to determine the long-term effect of sodium 2-mercaptoethane sulfonate (MESNA) on cholesteatoma surgery. Patients who underwent cholesteatoma surgery between January 2009 and July 2014 by the same surgeon were divided into 2 groups: those where MESNA was used and those where it was not. Otomicroscopic examinations were performed to see the presence of cholesteatoma recurrence in the patients who had surgery at least 8 years ago. Pure-tone audiometry was performed to evaluate the hearing results. Sodium 2-mercaptoethane sulfonate was used in 23 patients and was not used in 39 patients who came to the control. In the MESNAused group, cholesteatoma was seen in only 1 of the patients who underwent a canal wall-down (CWD) mastoidectomy. In the MESNA non-used group, cholesteatoma was seen in 3 patients who underwent CWD. The difference was not statistically significant. Although there was no statistically significant difference, recurrence of cholesteatoma was seen less frequently in patients who received MESNA during surgery. Studies to be conducted in larger patient series may clarify this issue.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001662","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":"Association of Metabolic Syndrome or Weather Conditions with the Severity and Prognosis of Sudden Sensorineural Hearing Loss.","authors":"Yixi Xu, Yao Zhang, Qi Yan, Chen Chen, Bin Zhu, Ying Wang","doi":"10.5152/iao.2024.231059","DOIUrl":"10.5152/iao.2024.231059","url":null,"abstract":"<p><p>It is reported that sudden sensorineural hearing loss (SSNHL) is closely related to diabetes, hypertension, and hyperlipidemia. While the metabolic syndrome (MetS) is a multifactorial disease that includes diabetes, hypertension, dyslipidemia, and obesity, which are known to be associated with SSNHL. Weather conditions have long been known to affect the SSNHL. This study aimed to make a clear connection between MetS, or weather conditions, and the severity and prognosis of SSNHL. 127 SSNHL patients have been divided into the MetS group and the non-MetS group, and the demographic and clinical characteristics of the 2 groups have been analyzed retrospectively. There were 52 (40.9%) patients in the MetS group, while there were 75 (59.1%) patients in the non-MetS group. The rate of vertigo, hypertension, diabetes, lower high-density lipoprotein cholesterol (HDL-C) levels, high triglyceride (TG), and body mass index (BMI) ≥25 (kg/m2 ) were significantly higher in the MetS group than those in non-MetS group. Vertigo, hypertension, and Mets were linked to the severity of hearing loss. The rate of complete recovery and partial recovery in the MetS group was clearly lower than that in non-MetS group. According to the multivariate analysis, MetS was significantly associated with a poorer prognosis of SSNHL; a high ambient temperature difference at onset and hypertension were correlated with a poor prognosis. These results demonstrate that the severity and prognosis of SSNHL can be influenced by the MetS. High ambient temperature differences at onset and hypertension were indicators of a poor prognosis for SSNHL.</p>","PeriodicalId":94238,"journal":{"name":"The journal of international advanced otology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11232085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001657","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}