Colorectal Disease最新文献

{"title":"Contemporary practices in abdominoperineal resection for early-stage rectal cancer in the United States.","authors":"Totadri Dhimal, Bailey K Hilty Chu, Anthony Loria, Megan Boyer, Xueya Cai, Yue Li, Fernando Colugnati, Paula Cupertino, Erika E Ramsdale, Fergal J Fleming","doi":"10.1111/codi.17281","DOIUrl":"https://doi.org/10.1111/codi.17281","url":null,"abstract":"<p><strong>Aim: </strong>In contrast to significant advances in organ preservation in locally advanced rectal cancer, the contemporary management of early-stage rectal cancer, including the frequency of abdominoperineal resections, remains largely unexplored in the United States. Therefore, we assessed the utilization of neoadjuvant therapy and oncological resections in early-stage rectal cancer patients.</p><p><strong>Study design: </strong>This is a retrospective cohort study of patients with cT1-T3N0 rectal cancer who underwent proctectomies between 2016 and 2022 in the National Surgical Quality Improvement Project proctectomy files. Multivariable logistic regression was used to identify factors associated with abdominoperineal resections and Kendall's tau statistics to evaluate clinical-pathological staging agreement.</p><p><strong>Results: </strong>In all, 3078 patients (29.6% cT1-2N0, 70.4% cT3N0) were included with 55.3% of tumours <5 cm from the anal verge. Overall, 58.2% received neoadjuvant therapy within 3 months of surgery (30.6% for cT1-T2N0 vs. 69.8% for cT3N0, P < 0.001), and 58.6% underwent abdominoperineal resection (55.5% for cT1-T2N0 vs. 59.9% for cT3N0, P = 0.058). The adjusted odds of undergoing abdominoperineal resection were associated with increasing age (OR 1.4 per every 10-year increase; 95% CI 1.2-1.5), cT3N0 tumours (OR 1.7; 95% CI 1.1-2.7) and tumour location <5 cm from the anal verge (OR 10.6; 95% CI 7.7-14.7). There was a weak clinical-pathological T staging correlation (Kendal tau coefficient 0.25; 95% CI 0.20-0.29).</p><p><strong>Conclusion: </strong>In this large cohort of patients with early-stage rectal cancer with high rates of neoadjuvant therapy, over half of patients underwent abdominoperineal resection and one in five had a pathological complete response. These findings underscore opportunities for organ preservation in early-stage rectal cancer, suggesting that treatments typically reserved for locally advanced disease may extend to early stages with the completion of ongoing clinical trials.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 1","pages":"e17281"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection versus endoscopic mucosal resection for laterally spreading rectal tumours.","authors":"Hadrien Alric, Maximilien Barret, Alix Becar, Enrique Perez Cuadrado Robles, Arthur Belle, Guillaume Perrod, Félix Corre, Stanislas Chaussade, Christophe Cellier, Gabriel Rahmi","doi":"10.1111/codi.17268","DOIUrl":"https://doi.org/10.1111/codi.17268","url":null,"abstract":"<p><strong>Aim: </strong>Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the two main techniques used for endoscopic resection of superficial rectal tumours. The aim of this study was to compare the outcomes of ESD and EMR in treating superficial rectal tumours.</p><p><strong>Method: </strong>A retrospective observational study was conducted at two French centres including all patients treated with ESD or EMR for superficial rectal tumours. The primary outcome was the rate of local recurrence at the first follow-up endoscopy after endoscopic resection. Secondary outcomes included the curative resection rate, procedure duration, length of hospital stay, complication rates and the need for additional surgery.</p><p><strong>Results: </strong>A total of 254 patients were included, 159 treated with ESD and 95 treated with EMR. The local recurrence rate at the first follow-up endoscopy was 8.6% and was significantly lower in the ESD group than in the EMR group (4.3% vs. 16.9%; p = 0.005). The rates of en bloc and histologically complete resections were higher in the ESD group (88.1% vs. 42.7% and 85.5% vs. 38.9%, respectively; p < 0.001), while the curative resection rate was 90.6% in the EMR group and 92.5% in the ESD group (p = 0.59). Mostly due to poor histoprognostical criteria, 6.0% of patients underwent additional surgery (6.3% vs. 5.2% in the ESD vs. EMR group, respectively; p = 0.73).</p><p><strong>Conclusion: </strong>ESD demonstrated higher rates of en bloc, R0 resection than EMR, translating into significantly lower rates of local recurrence at the first follow-up endoscopy.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance of low-grade appendiceal mucinous neoplasms for progression to pseudomyxoma peritonei: Results from a structured surveillance programme.","authors":"Enda Hannan, Lorena Martin Roman, Lukas O'Brien, Anna Mueller, Oonagh Staunton, Conor Shields, John Aird, Jurgen Mulsow","doi":"10.1111/codi.17266","DOIUrl":"10.1111/codi.17266","url":null,"abstract":"<p><strong>Aim: </strong>Low-grade appendiceal mucinous neoplasm (LAMN) of the appendix is a rare tumour that can progress to pseudomyxoma peritonei (PMP). There is a lack of standardization of surveillance following resection of LAMN as the progression rate to PMP is unclear. The aim of this study was to evaluate the rate of progression following resection of LAMN to PMP in a structured surveillance programme.</p><p><strong>Method: </strong>Data for all patients referred for LAMN surveillance from 2013 to 2021 were retrospectively collected. The surveillance regime consisted of annual CT and tumour markers for a 5-year period. Patients who progressed to PMP were identified.</p><p><strong>Results: </strong>Of the patients enrolled in surveillance following appendicectomy and LAMN diagnosis (65.1% female, median age 56 years), 83 had completed at least 1 year of surveillance (median follow-up 24 months). Of these, 6% (n = 5) showed disease progression during follow-up. The median time to progression was 23 months. Survival analysis revealed no statistically significant difference in progression with regards to T staging (p = 0.39), margin positivity (p = 0.11) or appendiceal perforation (p = 0.26). No patients with Tis disease developed PMP. A statistically significant difference in progression was seen in patients with M1b staging (p = 0.021) and in those with mucin beyond the right iliac fossa at diagnosis (p = 0.04).</p><p><strong>Conclusion: </strong>The observed progression rate justifies the necessity of postappendicectomy surveillance in patients with LAMN, with the risk of progression being highest within the first 3 years of diagnosis. The described surveillance programme allows for early detection of subclinical progression to PMP.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faecal immunochemical tests for patients with symptoms suggestive of colorectal cancer: An updated systematic review and multiple-threshold meta-analysis of diagnostic test accuracy studies.","authors":"Sue Harnan, Jean Hamilton, Emma Simpson, Mark Clowes, Aline Navega Biz, Sophie Whyte, Shijie Ren, Katy Cooper, Muti Abulafi, Alex Ball, Sally Benton, Richard Booth, Rachel Carten, Stephanie Edgar, Willie Hamilton, Matthew Kurien, Louise Merriman, Kevin Monahan, Laura Heathcote, Hayley E Jones, Matt Stevenson","doi":"10.1111/codi.17255","DOIUrl":"10.1111/codi.17255","url":null,"abstract":"<p><strong>Aim: </strong>Extending faecal immunochemical tests for haemoglobin (FIT) to all primary care patients with symptoms suggestive of colorectal cancer (CRC) could identify people who are likely to benefit from colonoscopy and facilitate earlier treatment. The aim of this work was to investigate the diagnostic accuracy of FIT across different analysers at different thresholds, as a single test or in duplicate (dual FIT).</p><p><strong>Method: </strong>This systematic review and meta-analysis searched 10 sources (December 2022). Diagnostic accuracy studies of HM-JACKarc, OC-Sensor, FOB Gold, QuikRead go, NS-Prime and four Immunodiagnostik (IDK) tests in primary care patients were included. Risk of bias was assessed (QUADAS-2). Statistical syntheses produced summary estimates of sensitivity and specificity at any chosen threshold for CRC, inflammatory bowel disease and advanced adenomas separately. Sensitivity analyses investigated reference standard and population type (high, low or all-risk). Subgroup analyses investigated patient characteristics (e.g. anaemia, age, sex, ethnicity).</p><p><strong>Results: </strong>Thirty-seven studies were included. At a threshold of 10 μg/g, pooled results for sensitivity and specificity (95% credible intervals) for CRC, respectively, were: HM-JACKarc (n = 16 studies) 89.5% (84.6%-93.4%) and 82.8% (75.2%-89.6%); OC-Sensor (n = 11 studies) 89.8% (85.9%-93.3%) and 77.6% (64.3%-88.6%); FOB Gold (n = 3 studies), 87.0% (67.3%-98.3%) and 88.4% (81.7%-94.2%). There were limited or no data on the other tests, dual FIT and relating to patient characteristics.</p><p><strong>Conclusion: </strong>Test sensitivity at a threshold of 10 μg/g highlights a requirement for adequate safeguards in test-negative patients with ongoing symptoms. Further research is needed into the impact of patient characteristics and dual FIT.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Choice December 2024","authors":"Sue Clark","doi":"10.1111/codi.17262","DOIUrl":"10.1111/codi.17262","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"26 12","pages":"2030-2031"},"PeriodicalIF":2.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial December 2024","authors":"Sue Clark","doi":"10.1111/codi.17257","DOIUrl":"10.1111/codi.17257","url":null,"abstract":"","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"26 12","pages":"2032"},"PeriodicalIF":2.9,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers faced by surgeons in identifying and managing malnutrition in emergency general surgery: A qualitative study.","authors":"Daniel L Ashmore, Daniel M Baker, Timothy R Wilson, Vanessa Halliday, Matthew J Lee","doi":"10.1111/codi.17261","DOIUrl":"10.1111/codi.17261","url":null,"abstract":"<p><strong>Aim: </strong>Many patients undergoing emergency surgery are malnourished. Identifying malnutrition is a prerequisite to offering targeted nutritional support. Guidelines exist but little is known regarding exactly how surgeons identify malnutrition, or the barriers that influence surgeons' clinical decision-making. The aim of this work was to explore how consultant surgeons identify malnutrition in emergency general surgery (EGS) patients and the barriers to nutritional assessment and intervention.</p><p><strong>Method: </strong>Consultant surgeons with emergency surgery duties were invited to participate. Semi-structured interviews were conducted online, audiovisually recorded and transcribed. An inductive approach was used for data analysis using the framework method. Coding and analysis were performed by two independent researchers using NVivo software. Themes were developed and reviewed with the supervising team. Interviews continued until data saturation was reached. Ethical approval was gained prior to interviews.</p><p><strong>Results: </strong>Eighteen interviews were conducted across three hospital settings. Identification of malnutrition consisted of three themes: 'The surgeon' (knowledge, experience, planning ahead); 'The patient' (selection, composition, clinical progress, operative considerations); and 'The institution' (collaboration, extended surgical team). Three themes encompassed barriers experienced: 'The surgeon' (understanding, culture, ownership, time constraints); 'The institution' (provision, staffing, conflict, hospital setting); and 'The wider context' (research, external factors). These influenced clinical decision-making, which had two themes: 'To join or not to join' (risk taking, site of anastomosis) and 'Nutritional support' (timing, referral pathways).</p><p><strong>Conclusions: </strong>The identification and management of malnutrition in EGS is fraught with barriers, impacting operative and clinical decision-making. Improvements in surgeon education, culture, collaborative working and resources are needed.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of anal duct ligation and muscle closure: A novel sphincter-preserving surgical technique for fistula-in-ano.","authors":"Yoon Hyung Kang, Keehoon Hyun, Dong Ho Cho, Jong-Kyun Lee, Do-Yeon Hwang","doi":"10.1111/codi.17260","DOIUrl":"10.1111/codi.17260","url":null,"abstract":"<p><strong>Aim: </strong>Although various sphincter-preserving techniques exist for treating anal fistulas, none have demonstrated clear superiority. Therefore, the aim of this study was to introduce a novel sphincter-preserving technique for anal duct ligation and muscle closure (ALMC) and analyse its perioperative outcomes.</p><p><strong>Method: </strong>The data for patients who underwent ALMC for fistula-in-ano at Seoul Song Do Hospital between 2009 and 2023 were retrospectively reviewed. Patient demographics, intraoperative information and postoperative outcomes were assessed. The main outcomes were recurrence and wound healing. Recurrence was defined as the presence of a fistula tract or discharge more than 12 weeks after the primary surgery after achieving complete healing. Faecal incontinence was also investigated clinically.</p><p><strong>Results: </strong>Overall, 556 patients (84.0% male; mean age 41.7 ± 12.3 years) underwent ALMC. Among these, 152 (27.3%) had a history of fistula surgery and 261 (46.9%) had suprasphincteric fistulas. Fistula-in-ano recurred in 33 patients (5.9%), wound healing was delayed in 97 (17.4%) and faecal incontinence was observed in 12 (2.2%). The mean follow-up duration was 10.0 ± 16.0 months, and the average duration until recurrence was 13.8 ± 10.7 months. The proportion of suprasphincteric fistulas was similar in those who experienced recurrence and those who did not (57.6% vs. 46.3%, respectively; p = 0.239). The proportion of suprasphincteric fistulas in the delayed wound healing group was slightly higher, although the differences were not statistically significant (56.7% vs. 44.9%, respectively; p = 0.054).</p><p><strong>Conclusion: </strong>ALMC appeared to be a safe and feasible option for treating anal fistulas, providing good perioperative outcomes, particularly when sphincter preservation was crucial.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative outcomes in colorectal surgery by day of surgery: A national cohort study.","authors":"Nejo Joseph, William Xu, Matthew J McGuinness, Chris Varghese, Wal Baraza, Greg O'Grady, Ian Bissett, Christopher Harmston, Cameron I Wells","doi":"10.1111/codi.17251","DOIUrl":"https://doi.org/10.1111/codi.17251","url":null,"abstract":"<p><strong>Aim: </strong>Poorer postoperative outcomes have been observed for patients admitted and operated on later in the week and over the weekend. This is thought to be related to temporal fluctuations in the quality of perioperative care. The aim of this work was to identify if the day of surgery influenced outcomes in a national cohort of colorectal cancer (CRC) resections.</p><p><strong>Method: </strong>A retrospective population-based study of patients undergoing CRC resection during the period 2010-2020 in Aotearoa New Zealand (AoNZ) was conducted. Ninety-day postoperative mortality, morbidity, postoperative length of stay (PLOS), reoperation and failure to rescue (FTR) were calculated for elective and acute cohorts, stratified by the day of surgery. FTR-Surgical (mortality following reoperation within 90 days of the index operation) was also analysed by day of reoperation. Univariable and mixed-effects, multivariate, logistic regression models were analysed.</p><p><strong>Results: </strong>The overall cohort included 17 174 patients who underwent surgery for CRC. The 90-day mortality in the elective and acute cohorts was 2.4% (336/13 744) and 11% (371/3430), respectively. Ninety-day mortality, inpatient complications, FTR and PLOS did not differ by day of surgery in acute and elective cohorts. Notably, patients having elective surgery on a Wednesday had a significantly higher rate of reoperation (OR 1.29, 95% CI 1.06-1.56, p = 0.012). Furthermore, reoperation following complication of the index surgery was associated with a significantly higher 90-day mortality (FTR-Surgical) for patients having reoperation on a Friday (OR 2.10, 95% CI 1.01-4.33, p = 0.045).</p><p><strong>Conclusion: </strong>There is no variation in postoperative outcomes across the week for both elective and emergency cases. This study does, however, highlight a higher FTR-S later on Friday, suggesting that these high-risk patients may require closer postoperative monitoring over the weekend.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appraisal of current surgical guidelines for inflammatory bowel disease using the AGREE-S instrument: A scoping review.","authors":"Zarnigar Mussarat Khan, Camille Ball, Dalha Saeed, Grace Tai, Shaneil Chandran, Abhishek Vashista, Simon Davey, Matthew James Lee, Steven R Brown, Daniel Hind, Adele Elizabeth Sayers","doi":"10.1111/codi.17258","DOIUrl":"10.1111/codi.17258","url":null,"abstract":"<p><strong>Aim: </strong>Guidelines play a crucial role in improving patient care by providing clinicians with up to date evidence-based recommendations. A vast number of guidelines exist on the surgical management of inflammatory bowel disease (IBD). The aim of this scoping review was to identify current surgical IBD guidelines, assess their quality and identify areas of variation between the existing guidelines.</p><p><strong>Method: </strong>A systematic search of the literature from January 2008 to September 2023 was conducted. After identifying eligible guidelines, they were assessed for quality using the Appraisal of Guidelines for Research and Evaluation for Surgical Interventions (AGREE-S) instrument. Data were extracted on descriptive guideline characteristics and recommendations.</p><p><strong>Results: </strong>Fifteen guidelines were identified globally. Most guidelines were published between 2011 and 2023, with six focusing solely on Crohn's disease, five on ulcerative colitis and four on both. Six guidelines focused exclusively on surgical management, while nine contained both medical and surgical recommendations. The overall mean AGREE-S score was 59%, with more recent guidelines scoring higher.</p><p><strong>Conclusions: </strong>The quality of IBD surgical guidelines varies considerably. High-quality, collaborative, international guidelines are needed to reduce duplication and ensure consistent, evidence-based surgical care for IBD patients worldwide. Future guideline development should adhere to the AGREE-S criteria to enhance methodological rigour and transparency.</p>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}