Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献

{"title":"Duodenal transmural perforation caused by a dislodged pigtail plastic stent in a patient with benign biliary stricture.","authors":"Noriyuki Hirakawa, Kenjiro Yamamoto, Takao Itoi","doi":"10.1002/jhbp.12102","DOIUrl":"https://doi.org/10.1002/jhbp.12102","url":null,"abstract":"","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023647","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":"Capnographic monitoring using a novel mainstream system during endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: A prospective randomized controlled trial.","authors":"Yoichi Takimoto, Eisuke Iwasaki, Masayasu Horibe, Seiichiro Fukuhara, Kazuhiro Minami, Shintaro Kawasaki, Tatsuhiro Masaoka, Haruhiko Ogata, Fateh Bazerbachi, Takanori Kanai","doi":"10.1002/jhbp.12110","DOIUrl":"https://doi.org/10.1002/jhbp.12110","url":null,"abstract":"<p><strong>Background/purpose: </strong>Insufficient studies exist on capnography efficacy during endoscopic ultrasound or endoscopic retrograde cholangiopancreatography, and no definitive conclusions have been drawn. To evaluate the feasibility and efficacy of a novel mainstream capnography using an over-the-biteblock end-tidal CO₂ (EtCO₂) detector in decreasing the risk of hypoxemia during endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).</p><p><strong>Methods: </strong>Patients undergoing EUS or ERCP with conscious sedation at a single Japanese center were randomized to a control or a novel capnography monitored (intervention) group in a 1:1 ratio. Hypoxemia correction maneuvers were pursued if the oxygen saturation decreased to <92% in the control or intervention group and if a 15-s suspension of EtCO₂ wave occurred in the intervention group. The primary outcome was the incidence of hypoxemic events, defined as oxygen saturation <90%, during the procedures. Secondary outcomes included technical feasibility of EUS and ERCP with the use of this novel over-the-biteblock monitor.</p><p><strong>Results: </strong>In total, 250 patients were enrolled without dropouts or missing data (control group: 125; capnography group: 125). There was no significant difference in the incidence of hypoxemia between the control and capnography groups (29.6% [37/125] vs. 26.4% [33/125]; p = .573). The estimated odds ratio was 0.925 (95% confidence interval: 0.708-1.208). The EtCO₂ concentration was successfully captured without impeding endoscopic maneuvers from the beginning to the end of the procedure in all patients.</p><p><strong>Conclusions: </strong>Although the novel mainstream capnography with an over-the-biteblock EtCO₂ detector captures the EtCO₂ concentration in EUS or ERCP under conscious sedation, it does not lead to the prevention of hypoxemia.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006510","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":"The efficacy of second-line chemotherapy for advanced biliary tract cancer: A systematic review and network meta-analysis.","authors":"Inhwan Hwang, Sangah Han, Ji Hun Jeong, Chunhwa Ihm, Taeho Greg Rhee, Sung Ryul Shim","doi":"10.1002/jhbp.12113","DOIUrl":"https://doi.org/10.1002/jhbp.12113","url":null,"abstract":"<p><strong>Background: </strong>This network meta-analysis (NMA) aims to provide evidence-based guidance for selecting the second-line chemotherapy for biliary tract cancer (BTC).</p><p><strong>Methods: </strong>A comprehensive literature search was conducted on PubMed, Cochrane, and EMBASE through July 2024. Inclusion criteria involved: (1) patients underwent second-line chemotherapy following platinum-based first-line therapy, (2) intervention/comparator groups consisted of various chemotherapeutic agents, and (3) outcomes measured as hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS) in randomized controlled trials (RCTs) and cohort studies.</p><p><strong>Results: </strong>Outcomes were measured as HR of OS and PFS in RCTs and cohort studies. The eight studies consisting of 1621 patients were selected. In the NMA for OS, 5FU_plus_Plat (fluorouracil plus oxaliplatin or cisplatin; HR 0.52, 95% confidence interval [CI]: 0.30-0.91), nal-IRI_5FU_LV (nano-liposomal irinotecan plus fluorouracil and LV; HR 0.54 [95% CI: 0.32-0.92]), and FOLFOX (fluorouracil plus oxaliplatin; HR 0.69 [95% CI: 0.50-0.96]) demonstrated significant benefits in OS when compared to control. For PFS, nal-IRI_5FU_LV (HR 0.61 [95% CI: 0.44-0.85]) provided a significant advantage over 5FU.</p><p><strong>Conclusions: </strong>Second-line chemotherapy for BTC after the failure of gemcitabine plus platinum as first-line therapy, nal-IRI_5FU_LV appears to be the most promising second-line therapy in terms of both OS and PFS.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006532","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":"Genetic medicine of familial and hereditary pancreatic cancer: Recent update in the era of precision cancer medicine.","authors":"Hiroyuki Matsubayashi, Yoshimi Kiyozumi, Hiroyuki Ono","doi":"10.1002/jhbp.12112","DOIUrl":"https://doi.org/10.1002/jhbp.12112","url":null,"abstract":"<p><p>In Japan, 5 years have passed since the initiation of precision cancer medicine, and recent data accumulation in familial pancreatic cancer (FPC) and hereditary pancreatic cancer is outstanding. Multigene germline panel tests (MGPTs) have revealed that 7%-18% of patients with pancreatic cancer (PC) harbor pathogenic germline variants (PGVs), almost equal to the levels of breast, ovarian, endometrial, and colorectal cancers, with a higher incidence in FPC (14%-26%). The majority of PGVs seen in PC patients are clinically actionable and associated with homologous recombination (HR) pathways (6%-10%, particularly BRCA1/2 in 5%-6%), and the clinical guidelines recommend or propose genetic testing for all PC patients. Consensus guidelines have been established for most of the hereditary syndromes associated with PC risks, and surveillances of the pancreas and other at-risk organs are recommended for PGV carriers. Hereditary breast and ovarian cancer (HBOC) is the commonest hereditary cancer syndrome that has moderately increasing life-time risks of PC (3%-7% in Western countries); however, recent Japanese research demonstrated a higher risk level (BRCA1: 16%, BRCA2: 14%). Moreover, recent evidence has suggested a risk linkage between PC and ovarian cancer in HBOC pedigrees. High scores of homologous recombination deficiency suggest biallelic dysfunction of BRCA or other HR-related genes, and the likely effectiveness of platinum agents and PARP inhibitors against PCs. Remote counseling and testing are possible option in the future genetic medicine. As PC ranks in the second commonest target of precision cancer medicine in Japan, we must treat the patients and manage their at-risk relatives efficiently.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006526","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 retrospective comparative study of percutaneous transhepatic gallbladder drainage versus endoscopic gallbladder stenting on the clinical course of acute cholecystitis: A propensity score matching analysis using a nationwide inpatient database in Japan.","authors":"Shota Ebinuma, Hiroyuki Nagano, Hisashi Itoshima, Susumu Kunisawa, Kiyohide Fushimi, Ryo Sugiura, Tatsuhiko Kakisaka, Akinobu Taketomi, Yuichi Imanaka","doi":"10.1002/jhbp.12114","DOIUrl":"https://doi.org/10.1002/jhbp.12114","url":null,"abstract":"<p><strong>Background: </strong>We performed a retrospective comparative study to clarify the optimal gallbladder drainage method prior to elective cholecystectomy.</p><p><strong>Methods: </strong>We collected data from the Diagnosis Procedure Combination database about cholecystitis patients who underwent gallbladder drainage prior to cholecystectomy in a subsequent hospitalization between April 2014 and March 2020. We divided the study population into two groups: an endoscopic gallbladder stenting (EGBS) group and a percutaneous transhepatic gallbladder drainage (PTGBD) group. We performed propensity score matching and compared surgical outcomes related to cholecystectomy.</p><p><strong>Results: </strong>We collected 6306 cases (PTGBD: 6112 cases; EGBS: 194 cases). In propensity score matching, we obtained 193 matched pairs from the study population. Long-term postoperative antibiotics therapy (2 vs. 9; risk ratio 4.7 [95% CI: 1.1-30.9]) was more frequent in the EGBS group than the PTGBD group. There were no significant differences between the two groups for laparotomic cholecystectomy and postoperative bile duct drainage. For reoperation, postoperative abdominal drainage and postoperative blood transfusion, there were few outcome occurrences and effect measures were not obtained.</p><p><strong>Conclusion: </strong>Gallbladder drainage by EGBS may have more risk of surgical complications related to elective cholecystectomy than PTGBD. There are a few reports on this topic, so further research should be conducted.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006485","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":"Influence of endoscopic sphincterotomy on hepatolithiasis with Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma: A three-decade, real word cohort study.","authors":"Xue Yu, Jie Zhang, Yunyi Zhang, Xiaoyu Zhao, Zhi Xu, Lixin Wang, Chunsheng Hou, Lingfu Zhang, Xiaofeng Ling","doi":"10.1002/jhbp.12107","DOIUrl":"https://doi.org/10.1002/jhbp.12107","url":null,"abstract":"<p><strong>Background: </strong>Hepatolithiasis frequently presents with recurring cholangitis and complications. Oddi sphincter-preserved cholangioplasty with hepatico-subcutaneous stoma (OSPCHS), introduced in 1993, has shown favorable long-term results. Endoscopic sphincterotomy (EST) is commonly used, but its impact on OSPCHS outcomes remains unclear.</p><p><strong>Methods: </strong>From January 1993 to June 2021, 254 patients with hepatolithiasis underwent OSPCHS. A total of 31 patients had prior EST (group with EST, n = 31), while 223 did not (group without EST, n = 223). Perioperative and long-term outcomes were compared, and risk factors for stone and cholangitis recurrence were analyzed using a Cox regression model.</p><p><strong>Results: </strong>The immediate and final stone clearance rates were 67.3% and 81.9%, respectively. Patients with prior EST had higher rates of stone recurrence (57.7% vs. 35.7%, p = .031), shorter stone-free duration (median: 51.5 vs. 112.0 months, p = .001), higher cholangitis recurrence (45.2% vs. 25.6%, p = .023), and shorter cholangitis-free duration (median: 71.0 vs. 134.0 months, p = .006). Multivariable analysis identified bilateral intrahepatic stones (HR: 1.815, p = .010) and prior EST (HR: 3.157, p = .000) as independent risk factors for stone recurrence, whereas combined hepatectomy was a protective factor (HR: 0.448, p = .001). For cholangitis recurrence, male gender (HR: 2.308, p = .001) and EST (HR: 2.241, p = .009) were independent risk factors, while complete stone clearance reduced recurrence risk (HR: 0.423, p = .002).</p><p><strong>Conclusion: </strong>Prior EST adversely affects the long-term outcomes of OSPCHS. Therefore, in the management of hepatolithiasis, emphasis should be placed on preserving the Oddi sphincter.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971169","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":"Questionnaire on the surgical indications for intrahepatic cholangiocarcinoma administered to Japanese board-certified expert hepatobiliary and pancreatic surgeons and instructors.","authors":"Shintaro Kuroda, Tsuyoshi Kobayashi, Etsuro Hatano, Shoji Kubo, Itaru Endo, Hideki Ohdan","doi":"10.1002/jhbp.12108","DOIUrl":"https://doi.org/10.1002/jhbp.12108","url":null,"abstract":"<p><strong>Background: </strong>Treatment of intrahepatic cholangiocarcinoma (ICC) remains challenging owing to the lack of clear guidelines on surgical resection. The 2021 ICC guidelines have not fully resolved the ongoing debate between surgical and nonsurgical treatment options. This study aimed to identify trends and issues in ICC treatment strategies in the clinical field by surveying the attitudes of hepatobiliary and pancreatic (HBP) surgeons.</p><p><strong>Methods: </strong>A survey was conducted among 235 board-certified HBP surgeons affiliated with the Japanese Society of Hepato-Biliary-Pancreatic Surgery. This survey explored the perspectives on tumor conditions that define resectable, borderline resectable, and unresectable diseases, focusing on tumor size, number, and vascular invasion.</p><p><strong>Results: </strong>Notable variability was observed in the criteria for oncological resectability. While 42.1% of the respondents considered a maximum tumor diameter of 5 cm as resectable, 37.5% indicated no size limit for resectability. Opinions regarding the resectability of tumors with lymph node involvement and vascular invasion vary widely, highlighting the need for standardized criteria.</p><p><strong>Conclusion: </strong>This survey revealed diverse approaches for defining resectability in ICC, emphasizing the necessity for more precise guidelines. Further research and expert consensus are required to establish standardized criteria that can guide clinical decision-making and improve patient outcomes.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950004","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":"Correction to \"Outcomes of patients with initially unresectable pancreatic cancer who underwent conversion surgery after FOLFIRINOX or gemcitabine plus nab-paclitaxel chemotherapy: A multicenter retrospective cohort study (PC-CURE-1)\".","authors":"","doi":"10.1002/jhbp.12096","DOIUrl":"https://doi.org/10.1002/jhbp.12096","url":null,"abstract":"","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950002","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":"Efficacy of mapping biopsy using a novel sheath system for the histological diagnosis of superficial ductal spread in distal cholangiocarcinoma: A retrospective multicenter study.","authors":"Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Takuji Iwashita, Takuji Tanaka, Akinori Maruta, Keisuke Kawashima, Ichiro Yasuda, Hisataka Moriwaki, Masahito Shimizu","doi":"10.1002/jhbp.12103","DOIUrl":"https://doi.org/10.1002/jhbp.12103","url":null,"abstract":"<p><strong>Background: </strong>Mapping biopsy (MB) can evaluate superficial ductal spread (SDS) through the histopathological diagnosis of cholangiocarcinoma, enabling the selection of an appropriate surgical procedure. This retrospective study evaluated the efficacy of MB using a novel sheath system in distal cholangiocarcinoma (dCCA) cases.</p><p><strong>Methods: </strong>A total of 199 cholangiocarcinoma cases underwent preoperative diagnosis. Among them, 40, 21, and 26 cases underwent direct, sheath, and peroral cholangioscopy (POCS) MB, respectively, for dCCA. Each group was compared regarding their technical success rate and the diagnostic accuracy for SDS.</p><p><strong>Results: </strong>Although all cases achieved technical success, the median procedure time of POCS (48-min) tended to be longer than direct (33-min) and sheath MB (30-min) (p overall = .092). Diagnostic specificity and accuracy were significantly higher in the sheath group (95.2%, 95.2%) compared to the direct (71.0%, 70.0%) and POCS (60.9%, 57.7%) MB groups (p overall = .019 and .0094). Multivariate analysis revealed that the sheath MB group was an independent significant factor for the accurate margin diagnosis (OR 0.11; 95% CI: 0.01-0.86, p = .0358).</p><p><strong>Conclusions: </strong>The sheath MB method provided the most accurate histopathological diagnosis of SDS in dCCA. To obtain a larger tissue sample and avoid tumor cell contamination, sheath MB is worth performing to assess the accuracy of the preoperative SDS diagnosis.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950003","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":"Subcutaneous adipose tissue radiodensity as a predictor of poor prognosis in advanced biliary tract cancer.","authors":"Ryo Sugiura, Yasuyuki Kawamoto, Masaki Kuwatani, Kazumichi Kawakubo, Kazuaki Harada, Masatsugu Ohara, Hiroki Yonemura, Shunichiro Nozawa, Naoya Sakamoto","doi":"10.1002/jhbp.12105","DOIUrl":"https://doi.org/10.1002/jhbp.12105","url":null,"abstract":"<p><strong>Background: </strong>High subcutaneous adipose tissue radiodensity (SATr), an indirect surrogate marker of adipose tissue quality, was associated with poor prognosis in various cancers. The present study aimed to assess the association of SATr with survival outcomes in patients with advanced biliary tract cancer (BTC).</p><p><strong>Methods: </strong>This retrospective, single-center study included patients with unresectable or recurrent BTC who underwent chemotherapy/chemoradiotherapy. Overall survival (OS) and progression-free survival (PFS) were assessed using the log-rank test and the Cox proportional hazards model according to the SATr status.</p><p><strong>Results: </strong>The study cohort included 234 patients, including 38 and 196 patients with high and non-high SATr, respectively. The median OS durations were 10.5 and 17.4 months (HR = 1.72, 95% CI: 1.19-2.49, p < .01) and the median PFS durations were 4.9 and 8.0 months (HR = 1.52, 95% CI: 1.05-2.20, p = .03) in patients with high and non-high SATr, respectively. By multivariate analysis, high SATr, neutrophil/lymphocyte ratio >5, modified Glasgow prognostic score 1-2, and serum carcinoembryonic antigen >5.0 ng/mL were predictors for OS (HR, 1.66, 2.42, 2.00, and 1.56, respectively; p < .05). By multivariate analysis, metastatic disease status, high SATr, neutrophil/lymphocyte ratio >5, and modified Glasgow prognostic score 1-2 were independent risk factors for worse PFS (HR, 1.56, 1.56, 1.81, and 1.57, respectively; p < .05).</p><p><strong>Conclusions: </strong>High SATr was associated with risk of tumor progression and poor prognosis in patients with advanced BTC treated by palliative chemotherapy/chemoradiotherapy.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950127","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}