International Journal of Gynecology & Obstetrics最新文献

{"title":"Exploring the causal association between body composition and primary ovarian insufficiency: A retrospective cohort study and Mendelian randomization analyses.","authors":"Junge Zheng, Jiaoxue Zheng, Fang Yao, Jian Gao, Zheng Zheng, Shan Duan, Weiwei Zeng","doi":"10.1002/ijgo.70425","DOIUrl":"https://doi.org/10.1002/ijgo.70425","url":null,"abstract":"<p><strong>Objective: </strong>Primary ovarian insufficiency (POI) is a significant gynecologic condition characterized by menstrual irregularities, sex hormone imbalances, and reduced fertility. Understanding the nature of body composition changes in POI patients is crucial for elucidating its pathologic mechanisms and guiding treatment and management strategies.</p><p><strong>Methods: </strong>This study employed a retrospective research approach to comprehensively analyze body composition measurements of 1157 POI patients. The Mendelian randomization method served as an inferential tool to assess the causal relationship between body composition indices and POI risk. The heterogeneity and pleiotropy of the results were appraised to ensure the robustness of the causal relationship.</p><p><strong>Results: </strong>POI patients exhibited significant deviations in various body composition indices from the normal range. Specifically, 76.9% of POI patients displayed an abnormal \"Fat\" indicator, and 94.6% had a \"waist-to-hip ratio (WHR)\" exceeding the normal range, particularly among those under 30 years of age. Mendelian randomization analysis further corroborated a significant causal association between \"body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters)\" and \"age at menopause (last menstrual period)\" (OR = 1.014, 95% CI: 1.00-1.03, p = 0.021), indicating that abnormal menstrual status resulting from alterations in body composition may contribute to the development of POI.</p><p><strong>Conclusion: </strong>Several lipid metabolism indices in POI patients were outside the normal range observed in the general population. Among these, increased BMI may be an independent factor in the increased risk of POI, suggesting that a genetic predisposition to POI may play a role by influencing body composition. Clinically, monitoring and managing lipid metabolism and BMI levels should be integral components of POI prevention and management strategies.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742100","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":"Morbidity of radical surgery and postoperative radiotherapy in cervical cancer.","authors":"Nathalia Mora-Soto, Carolina Morante-Caicedo, Maria Caicedo-Martínez, David Viveros-Carreño, Emmanuel Sánchez Díaz, Juliana Rodríguez, Santiago Vieira, Jonathan A Peralta, Nadeem R Abu-Rustum, Rene Pareja","doi":"10.1002/ijgo.70281","DOIUrl":"https://doi.org/10.1002/ijgo.70281","url":null,"abstract":"<p><p>Cervical cancer is among the most common cancers affecting women worldwide. The standard treatment for early-stage cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] 2018 stages IA1-IB2, IIA1) typically involves a radical or simple hysterectomy with lymph node assessment. Postoperative management may include observation or tailored adjuvant therapy, such as radiotherapy or chemoradiotherapy, depending on individual pathological risk factors. However, these interventions are associated with significant complications: surgical management can lead to urinary and sexual dysfunction, lymphocysts, and lower limb lymphedema, while radiotherapy may cause genitourinary, gastrointestinal, and sexual toxicities. Less-radical surgery for selected cases could reduce surgical morbidity and advances in radiotherapy techniques, such as intensity-modulated radiotherapy, volumetric modulated arc therapy, and other three-dimensional conformal radiation therapies, have the potential to enhance precision and reduce toxicity. Nonetheless, the morbidity associated with combining radical surgery and adjuvant (chemo)radiotherapy remains an area of uncertainty, particularly in light of these emerging technologies. Most current data on this topic derive from retrospective studies involving heterogeneous populations and inconsistent quality-of-life assessment methods. Prospective studies employing standardized morbidity assessment tools are essential to determine the true impact of combined treatments compared to single-modality approaches. Future research should prioritize understanding the long-term effects of these treatment strategies, aiming to minimize adverse outcomes while maintaining optimal oncological control.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742101","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":"New histopathological and molecular findings in gynecological cancers.","authors":"W Glenn McCluggage","doi":"10.1002/ijgo.70283","DOIUrl":"https://doi.org/10.1002/ijgo.70283","url":null,"abstract":"<p><p>This review covers significant developments in the pathological classification of gynecological tumors in recent years. Topics covered include The Cancer Genome Atlas (TCGA) Classification of endometrial carcinomas and how to incorporate this into routine reporting, the fact that most synchronous endometrial and ovarian endometrioid carcinomas represent metastasis from the endometrium to the ovary, and the important subject of lymphovascular space invasion in endometrial carcinomas. The categorization of cervical squamous cell carcinomas (SCCs) and adenocarcinomas and vulval and vaginal SCCs into prognostically meaningful HPV-associated and HPV-independent types is also discussed. Some \"newly\" described tumor types are covered, including endometrial and ovarian mesonephric-like adenocarcinomas, STK11 adnexal tumors, and a number of uterine mesenchymal neoplasms associated with specific molecular abnormalities. Important molecular events in ovarian sex cord-stromal tumors and other rare adnexal neoplasms are also discussed.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753331","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":"Dienogest use and the risk of breast and gynecologic cancers: A nationwide population-based study.","authors":"Hoyol Jhang, Saerom Kim, Hyun-Tae Park, Ju-Young Shin, Seung-Ah Choe","doi":"10.1002/ijgo.70424","DOIUrl":"https://doi.org/10.1002/ijgo.70424","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether dienogest exposure is associated with the risk of breast, endometrial, or tubo-ovarian cancer in women with endometriosis.</p><p><strong>Methods: </strong>In this nationwide retrospective cohort study (January 2012 to December 2023), we used the Korean National Health Insurance Review & Assessment Service database. Women aged 20-49 years with endometriosis who received dienogest for at least 6 months were compared with an active control group treated with gonadotropin-releasing hormone (GnRH) agonists, with cohorts balanced by inverse probability of treatment weighting. Incident breast, endometrial, and tubo-ovarian cancers were ascertained, and adjusted hazard ratios (aHR) were estimated using Cox proportional hazards models.</p><p><strong>Results: </strong>Among 1 887 957 women with endometriosis, 14 647 dienogest users and 181 587 GnRH agonist users met the eligibility criteria for the breast cancer cohort; sample sizes were similar for endometrial and tubo-ovarian analyses. Compared with GnRH agonists, dienogest use was not associated with increased risk of breast cancer (aHR 1.01, 95% confidence interval [CI] 0.75-1.37), endometrial cancer (aHR 0.84, 95% CI 0.40-1.77), or tubo-ovarian cancer (aHR 0.92, 95% CI 0.30-2.80). Use of dienogest for 0.5-1.5 years was associated with a reduced breast cancer risk (aHR 0.72, 95% CI 0.53-0.99), whereas associations for longer durations were inconsistent.</p><p><strong>Conclusion: </strong>Dienogest use in women with endometriosis was not associated with higher or lower risks of breast, endometrial, or tubo-ovarian cancer compared with GnRH agonists, supporting its oncologic safety. Further longer-term studies are warranted to clarify duration-specific effects.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730851","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":"FIGO good practice recommendations for vaginal birth after cesarean section.","authors":"Eytan R Barnea, Diana Ramasauskaite, Akaninyene Eseme Ubom, Nicoletta Di Simone, Martin Mueller, Anderson Borovac-Pinheiro, Alice Guarano, Chiara Benedetto, Jolly Beyeza-Kashesya, Ines Nunes, Bo Jacobsson, Alison Wright","doi":"10.1002/ijgo.70406","DOIUrl":"https://doi.org/10.1002/ijgo.70406","url":null,"abstract":"<p><p>The rising global rate of cesarean section (CS) has prompted renewed focus on vaginal birth after cesarean (VBAC) as a safe and effective alternative to repeat CS in properly selected women. The FIGO good practice recommendations provide evidence-based recommendations to guide VBAC care. Success rates for VBAC range from 60% to 80%, with the highest likelihood in women with prior vaginal birth, non-recurrent CS indications, interbirth intervals ≥18 months, BMI <30 kg/m², and spontaneous labor onset. While uterine rupture is the primary concern, its risk remains low at approximately 0.3%-0.7% for women with one prior low transverse CS. Comparisons show that VBAC generally results in similar or better maternal and neonatal outcomes than planned repeat CS, including lower maternal mortality, fewer infections, and shorter hospital stays. This article emphasizes appropriate patient counseling, facility readiness for emergency CS, and continuous fetal monitoring during labor. With proper implementation, VBAC offers a valuable strategy to reduce unnecessary repeat surgeries, improve outcomes, and support informed maternal choice.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730853","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":"Optimizing endometriosis diagnosis and mapping: The important role of advanced transvaginal ultrasound.","authors":"Álvaro Ramos-Reyes, Carlos Hernandez-Nieto, Homero Flores-Tamez, Homero Flores-Mendoza","doi":"10.1002/ijgo.70410","DOIUrl":"https://doi.org/10.1002/ijgo.70410","url":null,"abstract":"<p><p>Endometriosis is estimated to affect 5%-10% of women of reproductive age, making timely diagnosis essential for initiating treatment, alleviating symptoms, and reducing the risk of disease progression. Unfortunately, the diagnostic delay in this disease is estimated to be approximately 10 years. The aim of this study is to present a case series of three patients assessed with both imaging modalities for endometriosis diagnosis and mapping, advanced transvaginal ultrasound (ATVUS) and magnetic resonance imaging (MRI). The findings obtained by performing the ATVUS imaging study protocol with different pelvic compartments according to the International Deep Endometriosis Analysis (IDEA) consensus are described and contrasted with those for MRI, along with their correlation to surgical and histological findings. A single gynecologist with specialized training in ATVUS performed a systematic pelvic evaluation in patients with clinical suspicion of endometriosis. The physician performed the anatomo-sonographic assessments described by the IDEA consensus. A retrospective analysis of the three cases was performed comparing both imaging modalities and surgical and histological findings. It was demonstrated in this case series that endometriosis is detectable in distinct pelvic compartments by ATVUS, with results comparable to MRI, while offering the benefits of lower cost and widespread accessibility. In contrast, individuals, insurance companies, and healthcare systems in some countries might be unable or unwilling to cover MRI costs for endometriosis diagnosis or presurgical mapping. In conclusion, given the high prevalence of endometriosis, mastering ATVUS is essential. Future studies should aim to robustly evaluate the role of ATVUS alongside other imaging modalities, including MRI, to maximize diagnostic accuracy.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730845","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":"Advances in non-invasive diagnostic tools for endometriosis: A narrative review of the past ten years.","authors":"Lauren Cosgriff, Avni Mukker, Courtney Ford, Jovana Tavcar","doi":"10.1002/ijgo.70412","DOIUrl":"https://doi.org/10.1002/ijgo.70412","url":null,"abstract":"<p><p>Endometriosis is a chronic condition defined by endometrium-like tissue outside the uterus, with symptoms including pain, infertility, and fatigue. Despite the high prevalence of disease, diagnosis is frequently delayed, in part due to reliance on invasive procedures such as laparoscopy. Over the past decade, scientific research and international collaborations have focused on the development of non-invasive diagnostic tools to allow earlier detection and reduce the burden of surgical diagnosis. This narrative review summarizes key developments in non-invasive tools over the past decade. These advances include those in the biomarker space, imaging techniques and protocols, and artificial intelligence applications. While no single test has yet replaced laparoscopy, significant strides have been made toward safer, earlier diagnosis. Continued interdisciplinary collaboration, standardization of imaging and research protocols, and large-scale validation studies are essential for translating these findings into clinical practice.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730849","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":"Leveraging artificial intelligence for evidence-based recommendations in uterine fibroid therapy: Addressing the unmet need in German healthcare-A clinical trial.","authors":"Iason Psilopatis, Laura Lotz, Nadezda Sipulina, Felix Heindl, Georgia Levidou, Julius Emons","doi":"10.1002/ijgo.70407","DOIUrl":"https://doi.org/10.1002/ijgo.70407","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the potential of an artificial intelligence (AI)-driven large language model, ChatGPT 4.0, to provide personalized, evidence-based treatment recommendations for uterine fibroids.</p><p><strong>Methods: </strong>ChatGPT 4.0 was trained using evidence-based data from Uptodate and German medical literature. The algorithm generated individualized recommendations based on clinical characteristics and patient preferences. Usability and quality were assessed through questionnaires completed by 40 gynecologists and 45 women with fibroids.</p><p><strong>Results: </strong>Most gynecologists found the algorithm user-friendly and comprehensive, with 15 expressing a willingness to integrate it into practice and 24 acknowledging its potential to enhance healthcare efficiency. Although only half believed it would improve patient outcomes, the tool was generally well received. Patients found the algorithm easy to understand and helpful for exploring treatment options, with the majority feeling it empowered informed discussions with their healthcare providers. A minority expressed dissatisfaction with usability or helpfulness.</p><p><strong>Conclusion: </strong>ChatGPT 4.0 offers a promising AI-driven tool for personalized fibroid management in the absence of formal guidelines. Although not a substitute for official recommendations, it could support clinical decision making and enhance patient education. Further integration with standardized guidelines and prospective trials is needed to optimize its clinical utility.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730854","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":"Rhesus testing and anti-D prophylaxis in RhD-negative women undergoing first-trimester abortion-Systematic Review and Opinion.","authors":"Kristina Gemzell-Danielsson, Sharon Cameron, Teresa Bombas, Mirella Parachini, Marek Lubusky, Aubert Agostini, Sandra Kroeze, Mary Favier, Myriam Chebbah, Varlet Alice-Anaïs, Linda Verhagen, Fiala Christian","doi":"10.1002/ijgo.70404","DOIUrl":"https://doi.org/10.1002/ijgo.70404","url":null,"abstract":"<p><strong>Background: </strong>The introduction of immunoglobulin G (IgG) anti-D prophylaxis for Rhesus D (RhD)-negative women has substantially reduced the incidence of RhD alloimmunization and hemolytic disease of the fetus and newborn in Europe by 85%, transforming fetal health outcomes. However, there is little evidence for the need of giving IgG anti-D prophylaxis to RhD-negative women in first-trimester abortions.</p><p><strong>Objectives: </strong>To analyze the international and national evidence-based guidelines on Rh testing and anti-D prophylaxis in first-trimester abortion, along with current literature both supporting and opposing this practice, to facilitate informed decision making in clinical practice.</p><p><strong>Search strategy: </strong>A systematic search was conducted in Pubmed/MEDLINE, EMBASE, Cochrane Library, Google Scholar, and Gry literature for publications from January 1, 2003 to January 17, 2024.</p><p><strong>Selection criteria: </strong>Guidelines, reviews, meta-analyses, observational and qualitative studies, randomized trials, real-world data, and cohort studies that addressed the use of IgG anti-D prophylaxis in first-trimester abortions were included.</p><p><strong>Data collection and analysis: </strong>Identified studies were screened and assessed independently by two authors. A standardized extraction grid was used to extract information from the selected articles.</p><p><strong>Main results: </strong>Guidelines published from 2022 onwards, such as those from the World Health Organization, recommend against anti-D for women undergoing first-trimester abortion. In contrast, most older guidelines recommend RhD testing and the administration of IgG anti-D prophylaxis in abortions even before 12 weeks of amenorrhea, although exact gestational age thresholds vary widely. These discrepancies in the management of RhD-negative women undergoing first-trimester abortion are caused by different interpretations of the available evidence, IgG anti-D availability, cultural and social influences, as well as legal and regulatory considerations.</p><p><strong>Conclusions: </strong>This review highlights the need for evidence-based, harmonized guidelines on IgG anti-D prophylaxis in first-trimester abortions. It is crucial for healthcare providers to stay informed on the latest recommendations and engage in shared decision-making with women undergoing first-trimester abortion.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730856","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":"Navigating risk: Effect of counseling on contraception practice in urban Hispanic women with systemic lupus erythematosus.","authors":"Oleg Stens, Katherine Ruddy, Jack Rodman, Leanna Wise","doi":"10.1002/ijgo.70414","DOIUrl":"https://doi.org/10.1002/ijgo.70414","url":null,"abstract":"<p><strong>Objective: </strong>To examine the frequency of and associations among contraception counseling, contraception use, and the use of teratogenic medications in women of child-bearing age from the Hispanic Los Angeles systemic lupus erythematosus (SLE) population.</p><p><strong>Methods: </strong>A 28-Question Anonymous Survey, Based on the 2020 American College of Rheumatology Reproductive Health Guideline, Was Distributed to 151 Female SLE Patients of Child-Bearing Age in the Outpatient Setting. Pearson χ² Test, Fisher Exact Test, and Wilcoxon Rank Sum Test Were Used, with Multivariable Analysis Conducted Via Logistic Regression.</p><p><strong>Results: </strong>Contraception counseling significantly increased the likelihood of contraception use among sexually active patients on teratogenic medications (P = 0.009). However, no significant difference was found in the use of effective/highly effective contraception methods between patients on teratogenic medications and those not on them (P = 0.07). Spanish-speaking patients reported significantly less counseling in the past year compared with English-speaking patients (34.9% vs. 77.2%, P < 0.01), even after adjusting for age.</p><p><strong>Conclusions: </strong>Many patients with SLE on teratogenic medications do not use appropriate contraception. Among this high-risk Hispanic SLE population, contraception counseling was associated with increased contraception use. However, Spanish-speaking patients reported lower rates of counseling compared with their English-speaking counterparts, highlighting a disparity that warrants further investigation.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730844","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}