Journal of critical care最新文献

{"title":"Letter to the Editor: “ Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: A prospective cohort study”","authors":"Mina Adolf Helmy, Lydia Magdy Milad","doi":"10.1016/j.jcrc.2025.155095","DOIUrl":"10.1016/j.jcrc.2025.155095","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155095"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844846","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":"Lesson learnt from implementing a CRRT reimbursement program in a resource-limited setting","authors":"Prit Kusirisin ,&nbsp;Sadudee Peerapornratana ,&nbsp;Jiratorn Sutawong ,&nbsp;Yot Teerawattananon ,&nbsp;Nattachai Srisawat","doi":"10.1016/j.jcrc.2025.155089","DOIUrl":"10.1016/j.jcrc.2025.155089","url":null,"abstract":"<div><div>Acute kidney injury (AKI) poses significant risks, including high mortality and progression to chronic kidney disease. Effective treatment modalities include peritoneal dialysis (PD), intermittent hemodialysis (IHD), sustained low-efficiency dialysis (SLED), and continuous renal replacement therapy (CRRT). While each modality has specific advantages, CRRT is particularly vital for critically ill patients with severe AKI and contraindications for IHD. Despite its clinical benefits, the high cost of CRRT presents challenges, especially in resource-limited settings like Thailand.</div><div>This manuscript reviews the process of integrating CRRT into Thailand's Universal Coverage Scheme (UCS). Initial proposals in 2017 highlighted CRRT's importance, yet its high costs posed barriers to inclusion. A rigorous policy development process, emphasizing evidence-based and participatory decision-making, led to the proposal's acceptance in 2018. Key recommendations included optimizing reimbursement rates and increasing budget allocations.</div><div>By 2022, CRRT reimbursement was incorporated into the UCS, significantly improving access to treatment for patients with AKI. Specific outcomes from our 2-year policy implementation, including patient outcomes such as mortality, renal recovery, length of hospital stay, and complications, as well as cost-saving outcomes reflecting the need for intensive care resources, are ongoing. These cost-benefit analyses, along with policy adjustments, are necessary to ensure continued equitable and effective treatment. This case underscores the importance of aligning reimbursement strategies with clinical needs and financial realities to enhance both healthcare outcomes and system sustainability.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155089"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833972","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":"Profiles of the patients admitted to intermediate care units in France: Admission criteria appropriateness and potential outcome benefits (UNISURC project part 2)","authors":"Marc Beaussier ,&nbsp;Bertrand Guidet ,&nbsp;Philippe Aegerter ,&nbsp;Christophe Baillard ,&nbsp;Rym Boulkedid ,&nbsp;Mathieu Desmard ,&nbsp;Dominique Pateron ,&nbsp;Lionelle Nkam ,&nbsp;Benoît Misset ,&nbsp;UNISURC Investigators","doi":"10.1016/j.jcrc.2025.155078","DOIUrl":"10.1016/j.jcrc.2025.155078","url":null,"abstract":"<div><h3>Background</h3><div>The added value of Intermediate Care Units (IMCUs) remains controversial. This prospective, multicenter, observational cohort study aimed to: identify the characteristics of patients admitted and evaluate the appropriateness of IMCU stays according to criteria previously established in the UNISURC study; and describe the hospital trajectories and outcomes of patients admitted to IMCUs or not.</div></div><div><h3>Methods</h3><div>Data were collected from 12 IMCUs in seven French hospitals. All patients admitted to the IMCU from the emergency department, after intensive care unit discharge (post-ICU) or post-surgery were followed for 7 days following study inclusion. Primary and secondary outcome measures were: mortality rate over 7 days post-inclusion, demographic characteristics, IMCU-admission criteria, nursing workload assessed with the Nine Equivalents of nursing Manpower Score (NEMS).</div></div><div><h3>Results</h3><div>Among 437 enrolled patients, 398 were analyzed, 260 of whom were admitted to IMCUs. IMCU-admission criteria were in close accordance with previous Delphi-survey selection items (56/63 items used). For emergency department, post-ICU and post-operative trajectories, respectively, median [IQR] SAPS II at IMCU entry were: 17 [12–24], 32 [26–53] and 19 [13–25] (<em>p</em> &lt; 0.05), with respective NEMS of 16 [14–27], 15 [9–21] and 18 [15–21] (<em>p</em> = 0.071). Crude total 7-day mortality of patients with an IMCU stay was 13/260 (5 %), compared to 15/138 (10.8 %) of those without (<em>p</em> = 0.048).</div></div><div><h3>Conclusion</h3><div>These observations provide a rationale supporting the contribution of IMCU implementation in hospitals caring for patients requiring critical-care trajectories.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155078"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833974","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":"Sex specific mortality risk stratification - Evaluation and redevelopment of the simplified acute physiology score II","authors":"Nikolaus Schreiber ,&nbsp;Michael Eichlseder ,&nbsp;Jakob Pannold ,&nbsp;Philipp Zoidl ,&nbsp;Alexander Pichler ,&nbsp;Michael Eichinger ,&nbsp;Gabriel Honnef ,&nbsp;Daniel Freidorfer ,&nbsp;Sascha Hammer ,&nbsp;Michael Schörghuber ,&nbsp;Lioba Heuschneider","doi":"10.1016/j.jcrc.2025.155091","DOIUrl":"10.1016/j.jcrc.2025.155091","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155091"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833975","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":"Comparison of the diagnostic accuracies of various biomarkers and scoring systems for sepsis: A systematic review and Bayesian diagnostic test accuracy network meta-analysis","authors":"Hao-Min Lan ,&nbsp;Chin-Chieh Wu ,&nbsp;Su-Hsun Liu ,&nbsp;Chih-Huang Li ,&nbsp;Yu-Kang Tu ,&nbsp;Kuan-Fu Chen","doi":"10.1016/j.jcrc.2025.155087","DOIUrl":"10.1016/j.jcrc.2025.155087","url":null,"abstract":"<div><h3>Purpose</h3><div>Sepsis affects approximately 50 million people worldwide, resulting in 11 million deaths annually. Conflicting results and insufficient evidence comparing performance biomarkers exist. The study aimed to comprehensively compare available biomarkers and clinical scores for detecting sepsis since its redefinition in 2016 with this systematic review and Bayesian diagnostic test accuracy network meta-analysis.</div></div><div><h3>Materials and methods</h3><div>We conducted searches in the PubMed, EMBASE, and Scopus databases between January 2016 and December 2023. Eligible studies assessed the diagnostic accuracies of biomarkers, the quick Sequential Organ Failure Assessment (qSOFA) score, or Systemic Inflammatory Response Syndrome (SIRS) criteria in detecting sepsis. Bivariate hierarchical random effects arm-based beta-binomial models were used for quantitative synthesis (PROSPERO Registration Number: CRD42018086545).</div></div><div><h3>Results</h3><div>We included 78 studies representing 34,234 patients and compared qSOFA score, SIRS criteria alongside seven of the most studied biomarkers: procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), presepsin (cluster of differentiation 14 subtypes), CD64, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and lipopolysaccharide-binding protein (LBP). CD64 demonstrated the highest superiority index, followed by sTREM-1 and presepsin (diagnostic odds ratio: 20.17 vs 18.73 and 10.04, 95 % credible interval [CrI]: 8.39–38.61 vs 1.31–83.98 and 6.71–14.24; quality of evidence: moderate vs low and low). Multivariable meta-regression analysis identified significant sources of heterogeneity, including study design, proportion of sepsis, sample size, and the risk of bias (patient selection).</div></div><div><h3>Conclusions</h3><div>The best diagnostic accuracy for sepsis was shown by CD64, with a moderate quality of evidence. Compared to CD64, sTREM-1 and presepsin provided suboptimal and low evidence. These biomarkers were more effective at identifying updated sepsis than clinical scores. We recommend re-considering the addition of biomarkers in screening for sepsis or sepsis-related conditions, as this could lead to more accurate and timely decisions for future clinical interventions.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155087"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833969","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":"Nitric oxide biomarkers and circulatory failure in critical illness: A cohort study","authors":"Karoline Myglegård Mortensen ,&nbsp;Morten Heiberg Bestle ,&nbsp;Jakob Stensballe ,&nbsp;Thore Hillig ,&nbsp;Claus Antonio Juel Jensen ,&nbsp;Martin Schønemann-Lund ,&nbsp;Theis Skovsgaard Itenov","doi":"10.1016/j.jcrc.2025.155083","DOIUrl":"10.1016/j.jcrc.2025.155083","url":null,"abstract":"<div><h3>Purpose</h3><div>Arterial hypotension is frequently observed in critically ill patients. Nitric oxide (NO) is pivotal in vasodilation. We investigated the associations between NO-biomarkers (asymmetrical dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), arginine, and homoarginine) and treatment with norepinephrine and plasma lactate on ICU days 1–3.</div></div><div><h3>Materials and methods</h3><div>A prospective cohort study of 527 adult ICU patients with NO-biomarkers at admission. Associations with norepinephrine treatment were analyzed in logistic regressions on the first three days of ICU admission. Associations with the highest daily plasma lactate were analyzed with linear mixed models.</div></div><div><h3>Results</h3><div>Increasing ADMA and arginine were associated with decreased norepinephrine treatment (ICU day 1: OR 0.36 pr 1 μmol/L ADMA, 95 % CI 0.17–0.78; <em>p</em> = 0.009, and OR 0.85 pr 10 μmol/L arginine; 95 % CI 0.79–0.92; <em>p</em> &lt; 0.001). An increase in homoarginine of 1 μmol/L was associated with an increase in plasma lactate of 6 % (95 % CI -2 % to 15 %) from ICU days 1–2 and 4 % (95 % CI -4 % to 13 %) from ICU days 2–3. SDMA was not associated with either outcome.</div></div><div><h3>Conclusions</h3><div>Increased ADMA and arginine at admission are associated with decreased norepinephrine treatment on the first three days of ICU admission. Increased homoarginine concentrations are associated with increasing plasma lactate.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155083"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833970","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":"Performance of the Nociception Level Index and the PainSensor to predict and detect responsiveness to nociceptive procedures in critical care patients","authors":"Viktor Bublitz ,&nbsp;Teresa Ringat ,&nbsp;Carlo Jurth ,&nbsp;Gregor Lichtner ,&nbsp;Falk von Dincklage","doi":"10.1016/j.jcrc.2025.155090","DOIUrl":"10.1016/j.jcrc.2025.155090","url":null,"abstract":"<div><h3>Background</h3><div>Monitoring of pain and nociception in critical care patients unable to self-report pain remains challenging. Technical nociception monitors could provide valuable support. Here, we investigated the Nociception Level Index (NOL) and the PainSensor for their ability to predict and detect behavioral responsiveness to two potentially painful clinical interventions.</div></div><div><h3>Methods</h3><div>We included 196 critical care patients undergoing endotracheal suctioning (<em>n</em> = 149) and positioning (<em>n</em> = 47). Clinical responsiveness was graded using the Behavioral Pain Scale (BPS). As potential predictors of responsiveness, we recorded data from the NOL and PainSensor along with a variety of nociception-unspecific confounders, including the Richmond Agitation-Sedation Scale (RASS). We assessed their ability to predict behavioral responsiveness using prediction probability.</div></div><div><h3>Results</h3><div>Both nociception monitors predicted behavioral responsiveness to endotracheal suctioning (NOL 0.67 [0.61–0.74, 95 % confidence interval], PainSensor 0.57 [0.51–0.63]), but neither outperformed the RASS (0.73 [0.68–0.77]). Behavioral responsiveness to positioning was predicted by the NOL (0.80 [0.66–0.94]) but not the PainSensor (0.54 [0.40–0.67]). Again, neither outperformed the RASS (0.68 [0.56–0.80]).</div></div><div><h3>Conclusion</h3><div>Both nociception monitors can predict behavioral responsiveness to nociceptive clinical stimulation. However, the added value of nociception monitors for detecting pain and nociception in critical care patients remains questionable, as readily available non-technical observational scales show a comparable performance.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155090"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833973","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":"A pilot feasibility study of continuous cardiac output and blood pressure monitoring during intermittent hemodialysis in patients recovering from severe acute kidney injury","authors":"Sofia Spano ,&nbsp;Akinori Maeda ,&nbsp;Joey Lam ,&nbsp;Anis Chaba ,&nbsp;Atthaphong Phongphithakchai ,&nbsp;Yukiko Hikasa ,&nbsp;Nuttapol Pattamin ,&nbsp;Nuanprae Kitisin ,&nbsp;Emily See ,&nbsp;Peter Mount ,&nbsp;Rinaldo Bellomo","doi":"10.1016/j.jcrc.2025.155086","DOIUrl":"10.1016/j.jcrc.2025.155086","url":null,"abstract":"<div><h3>Purpose</h3><div>To detect changes in cardiac output and blood pressure during intermittent hemodialysis (IHD) in patients recovering from severe acute kidney injury (AKI) after transition from continuous renal replacement therapy (CRRT).</div></div><div><h3>Material and methods</h3><div>In this single-center pilot feasibility study, we applied continuous hemodynamic monitoring (ClearSight System™) before and during IHD sessions in patients recovering from severe AKI. We also measured relative blood volume (BV; CRIT-LINE®IV) and Net Ultrafiltration Rate (NUF). CI changes were categorized as follows: Increase (&gt;5 %), Stable (−5 % to 5 %), Mild Decrease (−5 % to −15 %), Moderate Decrease (−15 % to −25 %), and Severe Decrease (&lt;−25 %).</div></div><div><h3>Results</h3><div>We enrolled 10 AKI patients. Overall, there were 119 episodes of severe and 286 episodes of moderate reductions in cardiac index (CI). The median time spent with severe and moderate intradialytic reductions in CI was 8.2 min [2.1–115.8] and 49.5 min [21.6–57.5], respectively. Severe CI reductions happened in nine patients out of 10, and in three patients, they lasted more than 2 h. During IHD, mean arterial pressure increased or remained stable in &gt;78 % of measurements, regardless of changes in CI. Overall, CI decreased by −1.14 L/min/m² during a moderate BV decrease (<em>p</em> &lt; 0.001) and by −0.57 L/min/m² when NUF rate was high (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>CI often, repeatedly, and markedly decreased during IHD. Such decreases were not detected by MAP monitoring and were extreme in some patients.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155086"},"PeriodicalIF":3.2,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823442","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":"Analgosedation practice during noninvasive respiratory supports: Results from an Italian survey","authors":"G. Spinazzola ,&nbsp;G. Ferrone ,&nbsp;G. Cammarota ,&nbsp;A. Cortegiani ,&nbsp;S.M. Maggiore ,&nbsp;N. Patroniti ,&nbsp;G. Cinnella ,&nbsp;L. Cabrini ,&nbsp;S. Grasso ,&nbsp;G. Conti ,&nbsp;M. Antonelli ,&nbsp;D.L. Grieco ,&nbsp;L. Ball ,&nbsp;G. Misseri ,&nbsp;C. Gregoretti ,&nbsp;A. Giarratano ,&nbsp;S. Spadaro","doi":"10.1016/j.jcrc.2025.155080","DOIUrl":"10.1016/j.jcrc.2025.155080","url":null,"abstract":"<div><h3>Purpose</h3><div>There are currently no established guidelines pertaining the application of analgosedation strategies for patients undergoing Noninvasive Respiratory Supports (NRSs) for acute respiratory failure treatment. The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) conducted a nation-wide survey to describe the current clinical practice in the management of analgosedation during NRSs.</div></div><div><h3>Methods</h3><div>This is a nationwide online survey, involving Italian anesthesiologist-intensivists, developed by experts affiliated with SIAARTI. Invitations to participate were distributed via emails and social networks. Data were collected over a period of three months (March 16 to May 10, 2024).</div></div><div><h3>Results</h3><div>Two hundred and seventy-seven full responses were collected. Most respondents were attending physician (83 %), with &lt;10 years of ICU experience (56 %) and work in ICU medical department (75 %). In terms of optimizing the NRS success, 80 % of respondents used a pharmacological strategy and 50 % of respondents did not use a non-pharmacological strategy. Dexmedetomidine was the most commonly administered drug (82 %), followed by morphine and remifentanil. Additionally, 33 % of respondents reported using a combination of dexmedetomidine and remifentanil as part of their pharmacological strategy during NRSs. Concerning the motivations for analgosedation use during NRSs, over 80 % of respondents aimed to improve patient-ventilator interaction, more than 60 % focused on reducing patient anxiety and dyspnea, 59 % sought for having a lower respiratory rate, and only 40 % prioritized pain reduction.</div></div><div><h3>Conclusion</h3><div>Sedation is frequently used in patients with acute respiratory failure undergoing NRSs. Current analgesic practices are becoming more standardized, with analgosedation strategies increasingly tailored to individual patient characteristics.</div></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155080"},"PeriodicalIF":3.2,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820650","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":"Enibarcimab for the treatment of septic shock in patients selected by a combination of the biomarkers bio-ADM and DPP3: A prespecified subgroup analysis of the AdrenOSS-2 trial","authors":"Claudia Knothe ,&nbsp;Stephan Witte ,&nbsp;Andreas Bergmann ,&nbsp;Alexandre Mebazaa ,&nbsp;Pierre-Francois Laterre ,&nbsp;Peter Pickkers ,&nbsp;on behalf of the ADRENOSS-2 Investigators","doi":"10.1016/j.jcrc.2025.155077","DOIUrl":"10.1016/j.jcrc.2025.155077","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"88 ","pages":"Article 155077"},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816711","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}