Diagnostic microbiology and infectious disease最新文献

{"title":"A Gated Pathway for Suspected Urinary Tract Infection in Dementia","authors":"Rob E. Carpenter ,&nbsp;Andrew Krouse","doi":"10.1016/j.diagmicrobio.2026.117387","DOIUrl":"10.1016/j.diagmicrobio.2026.117387","url":null,"abstract":"<div><div>Suspected urinary tract infection (UTI) in people living with dementia is a common diagnostic problem: delirium or functional decline often replaces focal urinary symptoms, while asymptomatic bacteriuria and pyuria are common at baseline, making urine positivity easy to misattribute as causal. The result is a predictable dual harm pattern across emergency and long-term care settings, with avoidable antibiotics in low-certainty episodes and dangerous delay when invasive infection is evolving. This instructional review presents a verification-first, certainty-gated approach organized by clinical stability and attribution difficulty. Gate 1 standardizes management of stable, attributable presentations using minimum criteria with urinalysis as screening and culture confirmation before treatment. Gate 2 defines escalation for stable but unresolved or discordant cases via broadened differential diagnosis and selective adjunct diagnostics only when results are decision-grade. Gate 3 prioritizes immediate therapy with parallel source evaluation when instability suggests sepsis or invasive infection. Gate 4 assigns results ownership through 48–72-hour culture follow-up with explicit stop/continue/de-escalate decisions, particularly post-discharge. We provide a high-yield differential, measurable audit metrics, and guardrails for biomarkers and molecular assays to improve specificity without increasing harmful delay. The outcome of this gated pathway is meant to improve specificity without creating delay by aligning testing, treatment, and follow-up to attributable syndromes and actionable microbiology.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"115 3","pages":"Article 117387"},"PeriodicalIF":1.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493673","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":"Comparing the performance of targeted next-generation sequencing and metagenomic next-generation sequencing in diagnosing pneumonia: A systematic review and network meta-analysis","authors":"Yangguang Cao ,&nbsp;Ya Xu ,&nbsp;Chengrui Yan ,&nbsp;Zhangwei Lu ,&nbsp;Qianqian Zhou ,&nbsp;Jing Wang ,&nbsp;Yiyuan Wang ,&nbsp;Lin Cheng ,&nbsp;Lilan Zhang ,&nbsp;Yating He ,&nbsp;Biao Guo ,&nbsp;Baozhu Li","doi":"10.1016/j.diagmicrobio.2025.117234","DOIUrl":"10.1016/j.diagmicrobio.2025.117234","url":null,"abstract":"<div><h3>Background</h3><div>In terms of diagnosing pneumonia, there is currently limited evidence for a direct comparison of the performance of targeted next-generation sequencing (tNGS) and metagenomic next-generation sequencing (mNGS), and is no comprehensive conclusion yet. This systematic review and network meta-analysis (NMA) aimed to comprehensively compare the diagnostic performance of tNGS and mNGS in patients with pneumonia.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science. From the establishment of the database to September 10, 2025. Studies providing diagnostic data (true positive, false positive, false negative, true negative) for tNGS and/or mNGS in patients suspected of pneumonia were included. We conducted a frequency theory random effects network meta-analysis, and calculate pooled odds ratios (ORs) with 95 % confidence interval (CI) for sensitivity and specificity, and to rank diagnostic performance using surface under the cumulative ranking curve (SUCRA) values. Subgroup analyses based on sample type and patient status were conducted.</div></div><div><h3>Results</h3><div>The NMA revealed no statistically significant differences in overall sensitivity (OR = 1.54, 95 % CI [0.47-5.06]) or specificity (OR = 1.29, 95 % CI [0.39-4.28]) between tNGS and mNGS. SUCRA rankings indicated that tNGS had the highest cumulative probability for sensitivity (91.9 %), followed by mNGS (74.6 %), and the cumulative specificity probability of tNGS (37.8 %) is higher than that of mNGS (17.1 %). In subgroup analysis, when multiple sample types were used, tNGS showed significantly higher specificity than mNGS (OR = 4.95, 95 % CI [1.13-21.75]).</div></div><div><h3>Conclusion</h3><div>These findings suggest tNGS may be a more specific and potentially cost-effective option for the etiological diagnosis of pneumonia, particularly when multi-sample testing is employed.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117234"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827289","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":"Rapid detection of Streptococcus pyogenes in skin and soft tissue infections using the Abbott ID NOW™ Strep A 2 isothermal molecular assay","authors":"Jari Karhukorpi,&nbsp;Kati Hallikainen","doi":"10.1016/j.diagmicrobio.2025.117193","DOIUrl":"10.1016/j.diagmicrobio.2025.117193","url":null,"abstract":"<div><div>This study evaluated the performance of the Abbott ID NOW™ STREP A 2, a rapid isothermal nucleic acid amplification test (NAAT), for the detection of <em>Streptococcus pyogenes</em> (<em>S.pyogenes</em>) in non-pharyngeal specimens, primarily from skin and soft tissue infections (SSTIs). A total of 180 non-pharyngeal samples submitted for bacterial culture were analyzed, comprising 120 culture-positive and 60 culture-negative specimens for <em>S. pyogenes</em>. Compared to culture, the ID NOW assay demonstrated a sensitivity of 99.2 % (95 % CI: 95.4–99.98 %) and a specificity of 100.0 % (95 % CI: 94.0–100.0 %). Although the ID NOW STREP A 2 assay is currently approved only for pharyngeal swab specimens, our findings indicate that it may also be a reliable method for detecting <em>S. pyogenes</em> in SSTI samples.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117193"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570967","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":"Revisiting the time to positivity in blood cultures as a prediagnostic tool: an in vitro experiment and retrospective study","authors":"Mélanie Bouillon ,&nbsp;Damasie Malandain ,&nbsp;Sylvie Dargère ,&nbsp;Vincent Cattoir ,&nbsp;Simon Le Hello ,&nbsp;François Gravey","doi":"10.1016/j.diagmicrobio.2025.117224","DOIUrl":"10.1016/j.diagmicrobio.2025.117224","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is an acute response to infection; rapid detection of pathogens is essential. In this work, the time to positivity (TTP) of blood culture (BC), a key factor for species diagnosis, was studied.</div></div><div><h3>Methods</h3><div>In the experimental phase, six bacterial reference strains were tested under varying conditions, and three years of clinical blood culture data were reviewed. A total of 4,924 first positive BC bottles from 3864 patients hospitalized from 2019 to 2021 were analysed.</div></div><div><h3>Results</h3><div>Experimental results revealed that reducing the inoculum by a factor of 10 increased the TTP by an average of 1.5 hours. A blood sample volume between 1 and 3 mL per vial significantly improved bacterial detection. Each hour of delay before incubation reduced the TTP by 21 minutes; however, the overall TTP was still prolonged. Bacterial growth and viability were preserved at room temperature for up to 24 h. TTP could be exploited as a first diagnostic tool, as it significantly varied between species. <em>Staphylococcus aureus</em> can be differentiated from coagulase-negative staphylococci when the TTP is &lt;12 hours (Specificity (Sp) = 0.95, positive predictive value (PPV) = 62 %, negative predictive value (NPV) = 76 %), and Enterobacteriaceae can be differentiated from <em>Pseudomonas aeruginosa</em> under the same threshold (Sensibility (Se) = 0.70, Sp = 0.93, PPV = 99 %). A TTP &gt;15 hours exclude clinically relevant pathogens such as <em>S. pneumoniae, S. agalactiae</em>, and <em>S. pyogenes</em>.</div></div><div><h3>Conclusion</h3><div>This work shows how preanalytical factors play a major role in the time required for diagnosis, and highlights the potential of the TTP as a prediagnostic tool to improve sepsis management.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117224"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786726","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":"Clinical metagenomics for pathogen detection in lower respiratory infections: a diagnostic study","authors":"Jieting Zhou ,&nbsp;Fei Yu ,&nbsp;Wenjuan Wang ,&nbsp;Dan Zhang ,&nbsp;Mengxiao Xie ,&nbsp;Lingjun Yuan ,&nbsp;Jieyuan Zheng ,&nbsp;Jingchao Wang ,&nbsp;Binxiao Li ,&nbsp;Bin Lou ,&nbsp;Dongsheng Han","doi":"10.1016/j.diagmicrobio.2025.117232","DOIUrl":"10.1016/j.diagmicrobio.2025.117232","url":null,"abstract":"<div><h3>Background</h3><div>Metagenomic next-generation sequencing (mNGS) enables comprehensive detection of all potential pathogens in a sample. However, its diagnostic performance in various clinical settings requires further validation through real-world data.</div></div><div><h3>Methods</h3><div>This retrospective study included 186 patients from the First Affiliated Hospital of Zhejiang University School of Medicine who underwent mNGS testing on respiratory samples. We compared mNGS with traditional culture method using the same samples and also assessed its performance against conventional microbiological testing combinations (CMTs) for the same patients. Additionally, we analyzed the diagnostic performance of mNGS in different disease states (immunosuppressive status and mechanical ventilation).</div></div><div><h3>Results</h3><div>The positivity rate of mNGS was 81.2 % (151/186). In lower respiratory tract infections (LRTIs), mNGS successfully detected 84.6 % (137/162) of bacteria, 89.0 % (65/73) of fungi, 100.0 % (72/72) of viruses, 88.9 % (16/18) of Mycobacterium tuberculosis, and 100.0 % (9/9) of non-tuberculous mycobacteria. Mixed infections were the most common infection type in LRTIs in this study (69/145, 47.6 %). The detection rate of mixed infections by mNGS was significantly higher than that of CMTs (91.3 % vs 43.5 %, P &lt; 0.01). In the comparison based on a composite LRTI diagnostic standard, mNGS showed significantly higher sensitivity than paired culture (89.0 % vs 32.4 %, P &lt; 0.01) and CMTs (89.0 % vs 57.2 %, P &lt; 0.01), but lower specificity (46.3 % vs 87.8 % and 46.3 % vs 82.9 %, P &lt; 0.01). In non-mechanically ventilated patients, mNGS maintained high sensitivity (87.0 % vs 96.7 %, P = 0.19), while culture and CMTs showed significant sensitivity decline (P &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>mNGS demonstrates superior diagnostic performance for LRTIs compared to CMTs.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117232"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786878","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":"Disseminated CMV in immunocompetent patient post-first anal intimacy: A captivating case report","authors":"Mishaal Munir ,&nbsp;Asfand Yar Cheema ,&nbsp;Areesha Nouman ,&nbsp;KV Gopalakrishna","doi":"10.1016/j.diagmicrobio.2025.117195","DOIUrl":"10.1016/j.diagmicrobio.2025.117195","url":null,"abstract":"<div><div>Cytomegalovirus (CMV) infections are uncommon in immunocompetent individuals, often posing diagnostic challenges due to their clinical overlap with other gastrointestinal disorders and sexually transmitted infections (STIs). Here, we report a case of a 37-year-old Immunocompetent Caucasian male who presented with rectal pain, bleeding, and fever following a recent sexual encounter. Initially treated for rectal gonorrhea, his symptoms persisted and worsened, prompting further investigation. Diagnostic evaluation revealed elevated liver enzymes, positive CMV IgM, and characteristic mucosal changes on sigmoidoscopy. Histopathological examination and CMV DNA testing confirmed the diagnosis of CMV proctitis. Treatment with intravenous ganciclovir led to clinical improvement and resolution of symptoms. This case underscores the importance of considering CMV infection in Immunocompetent patients with refractory rectal symptoms post-STI treatment, highlighting the need for thorough diagnostic assessment and timely initiation of antiviral therapy for effective management.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117195"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595990","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":"United we stand, divided we fall: Strengthening clinical alliances between human and veterinary medicine to tackle global priority antimicrobial-resistant bacterial pathogens","authors":"Fábio Parra Sellera ,&nbsp;João Pedro Rueda Furlan ,&nbsp;Luciano Cacciari Baruffaldi Almeida da Silva ,&nbsp;Luciana Sartori ,&nbsp;Nilton Lincopan","doi":"10.1016/j.diagmicrobio.2025.117231","DOIUrl":"10.1016/j.diagmicrobio.2025.117231","url":null,"abstract":"<div><div>Antimicrobial resistance (AMR) is a growing global health threat impacting both human and veterinary healthcare. In veterinary medicine, particularly in small animal practice, multidrug-resistant bacteria mirror trends seen in humans, with the World Health Organization priority pathogens detected in both sectors. Although the One Health approach emphasizes collaboration across sectors, integrating it into routine clinical practice remains difficult. Accordingly, this article examines the barriers to applying One Health approaches in clinical settings and highlights the need for strong interprofessional collaboration between physicians and small animal clinicians to tackle the global AMR crisis.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117231"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145818583","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":"Evaluation of aztreonam/avibactam gradient test strip and aztreonam-ceftazidime/avibactam broth disk elution method for susceptibility testing of metallo-β-lactamase positive carbapenemase-producing bacteria","authors":"Hasan Hamze ,&nbsp;Aleksandra Stefanovic ,&nbsp;Leah Gowland ,&nbsp;Patrick Tang ,&nbsp;Nancy Matic ,&nbsp;Victor Leung ,&nbsp;Gordon Ritchie ,&nbsp;Christopher F Lowe ,&nbsp;Marc G Romney ,&nbsp;Michael Payne","doi":"10.1016/j.diagmicrobio.2025.117216","DOIUrl":"10.1016/j.diagmicrobio.2025.117216","url":null,"abstract":"<div><div>Metallo-β-lactamase (MBL)-producing carbapenemase-producing Enterobacterales (CPE) present significant therapeutic challenges due to resistance to most β-lactam agents, including carbapenems. Aztreonam combined with avibactam (ATM/AVI) provides a promising treatment strategy, but standardized antimicrobial susceptibility testing (AST) methods remain limited. This study evaluated the performance of the MTS™ ATM/AVI gradient strip (Liofilchem) with the CLSI-recommended ceftazidime-avibactam plus aztreonam (CZA/ATM) broth disk elution (BDE) method in 36 CPE and 9 <em>Stenotrophomonas maltophilia</em> clinical isolates. Categorical agreement between these methods was 97.2 % for CPE and 88.9 % for <em>S. maltophilia</em>. Whole-genome sequencing was used for discrepancy analysis. Based on accuracy, reproducibility, and ease of use, the ATM/AVI gradient strip was selected as the preferred method for clinical laboratory testing.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117216"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721664","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":"A clinical pitfall in caseating necrotizing granulomatous lymphadenitis: Tularemia","authors":"Sevgi Özan Köse ,&nbsp;Hazal Erdem ,&nbsp;Özgün Cevdet Köse ,&nbsp;Fatma Yılmaz Ertürk","doi":"10.1016/j.diagmicrobio.2025.117228","DOIUrl":"10.1016/j.diagmicrobio.2025.117228","url":null,"abstract":"<div><div>Tularemia, caused by <em>Francisella tularensis</em>, is a zoonotic infection that typically presents with lymphadenopathy, acute tonsillitis, or ulcerative skin lesions. Various infectious agents and malignancies may underlie lymphadenopathy. Although necrotizing granulomatous reactions are common in suppurative lymphadenitis, caseating granulomas are rare and often raise suspicion for tuberculosis. We report two tularemia cases presenting with lymph node enlargement and caseating granulomas on histopathology.</div><div>Case 1 involved a 27-year-old woman with axillary lymphadenopathy and no systemic symptoms. Tularemia was confirmed by serology and PCR, and treatment with gentamicin and ciprofloxacin led to regression within three months.</div><div>Case 2 involved a 34-year-old woman with inguinal lymphadenopathy initially misdiagnosed as tuberculosis; during a local outbreak, tularemia was identified, and treatment with gentamicin and ciprofloxacin resulted in clinical improvement. These cases illustrate that tularemia can mimic tuberculosis or malignancy and highlight the importance of clinical awareness and targeted diagnostic testing in endemic regions.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117228"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780584","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":"Mycoplasma pneumoniae macrolide resistance acquisition in a CCR2-deficient child","authors":"Nora Poey ,&nbsp;Jennifer Guiraud ,&nbsp;Carla Balcon ,&nbsp;N. Aladjidi ,&nbsp;Marie Gardette ,&nbsp;Sabine Pereyre ,&nbsp;Francois Galode ,&nbsp;Mickael Fayon ,&nbsp;Cécile Bébéar","doi":"10.1016/j.diagmicrobio.2025.117219","DOIUrl":"10.1016/j.diagmicrobio.2025.117219","url":null,"abstract":"<div><div>Since November 2023, an increase in <em>M. pneumoniae</em> respiratory infections has been observed in France. Macrolides are the reference treatment and are indicated as first-line therapy. Macrolide-resistant strains have been described in clinical isolates, especially in Asian countries. In the present manuscript, we report the persistence of an <em>M. pneumoniae</em> strain from an immunocompromised child with CCR2 deficiency on prophylactic azithromycin treatment. Antimicrobial susceptibility testing showed acquisition of macrolide resistance after treatment with azithromycin. Molecular typing using two typing methods revealed the persistence of the same strain over time. This case highlights the need for access to rapid detection tools to determine the causative pathogen and potential antimicrobial resistance mechanisms. This is particularly important for patients with comorbidities receiving prophylactic antibiotics and require additional caution. Acquisition of resistance can lead to complications and extended hospitalisation. Higher molecular resolution would be useful for the detection of putative heteroresistance in <em>M. pneumoniae</em>.</div></div>","PeriodicalId":11329,"journal":{"name":"Diagnostic microbiology and infectious disease","volume":"114 3","pages":"Article 117219"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780603","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}