JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

{"title":"Application of Enhanced Recovery after Surgery in the Perioperative Period for Elderly Patients with Lung Cancer.","authors":"Zhihai Wang, Miaomiao Lin, Geng Geng, Weiwei Wu, Yong Tao","doi":"10.4293/JSLS.2024.00037","DOIUrl":"10.4293/JSLS.2024.00037","url":null,"abstract":"<p><strong>Objective: </strong>To explore a model suitable for enhanced recovery after surgery (ERAS) for elderly patients with lung cancer in this region.</p><p><strong>Methods: </strong>A total of 200 elderly patients with lung cancer who were admitted to our department and received thoracoscopic surgery from January 1, 2020, to December 31, 2021, were enrolled as observation subjects and were randomly assigned to an ERAS group (100 cases) and a control group (100 cases). All patients were aware of and agreed to enter the study, and the protocols were approved by the hospital ethics committee (2021 Medical Ethics Review 26). The incidence of postoperative pulmonary complications, duration of postoperative chest tube, postoperative pain, and pulmonary function (including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1)) on postoperative day 7 were compared between the 2 groups.</p><p><strong>Results: </strong>The incidence of postoperative pulmonary complications was significantly lower in the ERAS group (8.00%) than in the control group (18.00%). The incidence of postoperative atelectasis in the ERAS group (2%) was significantly lower than that in the control group (10%). The duration of postoperative chest tube in the ERAS group (2.57 ± 0.72 days) was significantly shorter than that in the control group (3.92 ± 1.54 days). The postoperative pain score of the ERAS group (2.14 ± 0.86) was significantly lower than that of the control group (3.78 ± 1.15). On postoperative day 7, both FVC and FEV1 in the ERAS group were significantly better than those in the control group. SPSS 20 was used for statistical analysis, and the <i>P</i> < .05 was considered clinically significant.</p><p><strong>Conclusion: </strong>The ERAS model established in our department can reduce the incidence of postoperative complications, relieve postoperative pain, and better protect the lung function of elderly patients with lung cancer. The model is worth promoting because it enhances recovery after surgery and reduces the family burden of patients.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Surgery Deserts: Is There a Role for Robotic Assisted Surgery?","authors":"Brian Mitzman, Shaneeta Johnson, Maureen Lichtveld, Richard Culbertson, Zhi Ven Fong","doi":"10.4293/JSLS.2024.00039","DOIUrl":"10.4293/JSLS.2024.00039","url":null,"abstract":"<p><p>Despite evidence indicating patient and hospital benefits of minimally invasive surgery (MIS) over open surgery, there is still access barriers to MIS. Availability of training and associated learning curve, health literacy, and hospital characteristics (location, size) have been identified as the primary barriers to the adoption of MIS. Robotic assisted surgery could help to overcome some of these barriers and increase access to MIS through easier tele-mentoring and potential for remote access.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pain Desensitization Algorithm for Phenotyping and Treating Chronic Pelvic Pain.","authors":"Liane Silva Rafael Rogério, Maurice K Chung, Charles W Butrick, Stanley J Antolak, Danniel Rocha Bevilaqua, Sunna Kureishy, Mariana Eiras Cardoso Conforto","doi":"10.4293/JSLS.2024.00009","DOIUrl":"10.4293/JSLS.2024.00009","url":null,"abstract":"<p><strong>Background: </strong>Chronic pelvic pain remains challenging for physicians to manage due to central and peripheral sensitization and multiple pain generators including the bladder, pelvic floor, and pudendal nerve. Pain management providers have used nerve blocks for years for diagnosis and treatment. We developed a desensitization algorithm that provides a stepwise approach to improve patients pain scores.</p><p><strong>Methods: </strong>This is a prospective observational cohort study of 182 women aged 15-90 years old with chronic pelvic pain using an algorithm from 2016 to 2018. Treatment started with an Anesthetic Challenge Test of the bladder to guide us through a protocol of intravesical therapy and/or pudendal nerve blocks as a second step.</p><p><strong>Results: </strong>ACT POSITIVE patients, who received intravesical therapy: 84% had a Visual Analog Score pain improvement of at least 50%, 64% improved at least 80% (41% pain-free). Those desiring additional relief that received further Pudendal Blocks: 83% had final improvement of at least 50% (67% pain-free). ACT NEGATIVE patients received Pudendal Blocks with 80% of subjects achieving at least 50% relief, 65% improved at least 80% (35% pain-free). All final groups showed a statistically significance of <i>P</i> < .05% when compared to their initial pain scores.</p><p><strong>Conclusion: </strong>Management of women with chronic pelvic pain would ideally start with treating a specific diagnosis which, in most cases, is difficult to establish since the majority have more than one pain generator. Our algorithm simplified the approach and reduced the severity of pain scores prior to any further necessary surgical interventions.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Status and Role of Artificial Intelligence in Anorectal Diseases and Pelvic Floor Disorders.","authors":"Maryam Aleissa, Tijani Osumah, Ernesto Drelichman, Vijay Mittal, Jasneet Bhullar","doi":"10.4293/JSLS.2024.00007","DOIUrl":"10.4293/JSLS.2024.00007","url":null,"abstract":"<p><strong>Background: </strong>Anorectal diseases and pelvic floor disorders are prevalent among the general population. Patients may present with overlapping symptoms, delaying diagnosis, and lowering quality of life. Treating physicians encounter numerous challenges attributed to the complex nature of pelvic anatomy, limitations of diagnostic techniques, and lack of available resources. This article is an overview of the current state of artificial intelligence (AI) in tackling the difficulties of managing benign anorectal disorders and pelvic floor disorders.</p><p><strong>Methods: </strong>A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed database to identify all potentially relevant studies published from January 2000 to August 2023. Search queries were built using the following terms: AI, machine learning, deep learning, benign anorectal disease, pelvic floor disorder, fecal incontinence, obstructive defecation, anal fistula, rectal prolapse, and anorectal manometry. Malignant anorectal articles and abstracts were excluded. Data from selected articles were analyzed.</p><p><strong>Results: </strong>139 articles were found, 15 of which met our inclusion and exclusion criteria. The most common AI module was convolutional neural network. researchers were able to develop AI modules to optimize imaging studies for pelvis, fistula, and abscess anatomy, facilitated anorectal manometry interpretation, and improved high-definition anoscope use. None of the modules were validated in an external cohort.</p><p><strong>Conclusion: </strong>There is potential for AI to enhance the management of pelvic floor and benign anorectal diseases. Ongoing research necessitates the use of multidisciplinary approaches and collaboration between physicians and AI programmers to tackle pressing challenges.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11189024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing CRP levels in Laparoscopic and Robotic Total Hysterectomy.","authors":"Shohei Tanabe, Shi Yutoku, Kotaro Ichida","doi":"10.4293/JSLS.2024.00005","DOIUrl":"https://doi.org/10.4293/JSLS.2024.00005","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with high postoperative C-reactive protein levels are known to have a high risk of complications such as intestinal injuries than those with low levels. However, the factors that influence postoperative C-reactive protein levels in patients without complications are unknown. In this study, we aimed to determine the factors affecting postoperative C-reactive protein levels in patients undergoing laparoscopic and robotic total hysterectomy.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients who had undergone laparoscopic or robotic total hysterectomy for uterine fibroids, adenomyosis, or cervical neoplasia.</p><p><strong>Results: </strong>The study was conducted between July 2016 and December 2022 at our hospital. In total, 185 patients underwent laparoscopic or robotic total hysterectomy during the relevant period. Of these, 180 patients were included, excluding 3 who underwent laparotomy, 1 who developed an abscess, and 1 who did not have a postoperative blood draw. The measured outcome was the C-reactive protein level on the first postoperative day. Patient age, body mass index, operative time, blood loss, and uterine weight were deemed the possible influencing factors. Multiple regression analysis was performed to evaluate the influence of these factors on the postoperative C-reactive protein values. Statistical significance was defined as a <i>P</i> value less than .05. The median value was 1.72 (interquartile range, 1.11-2.52). Body mass index and operative time were determined to be the most significant factors.</p><p><strong>Conclusion: </strong>Patients' body mass index and operative time were found to be associated with first postoperative day C-reactive protein levels in uncomplicated cases.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Sling Technique for Laparoscopic Liver Mobilization.","authors":"Andrew N de la Torre, Justin Adibi, Zaineb Zubair","doi":"10.4293/JSLS.2024.00011","DOIUrl":"https://doi.org/10.4293/JSLS.2024.00011","url":null,"abstract":"<p><strong>Background: </strong>As liver surgery continues to evolve, be it open, laparoscopic or robotic, it remains a procedure that can deteriorate in the blink of an eye. Liver surgery in patients with hepatoma is further complicated, as the vast majority have significant fibrosis, if not cirrhosis. Thus, parenchymal sparing resection is increasingly necessary. Effective and safe intracorporeal mobilization of the liver is essential for minimal access parenchymal-sparing and conventional resection.</p><p><strong>Methods: </strong>This retrospective review of over 150 cases performed provides a hands-on approach to laparoscopic hepatic mobilization with the use of an inexpensive technique using a 1\" packing tape to \"Sling\" the liver in-order to divide the ligaments holding the liver in place and optimally position the liver for parenchymal transection.</p><p><strong>Results: </strong>Use of a 1\" packing tape to \"Sling\" the liver intracorporeally is demonstrated to enable mobilization of the liver for tissue sparing non-anatomic, anatomic and major resections.</p><p><strong>Conclusion: </strong>Use of a 1\" packing tape to \"Sling\" the liver intracorporeally can facilitate mobilization for resection. Surgeons hoping to master minimal access resection should also be well versed in the use of laparoscopic ultrasound and liver transplant \"Piggyback\" technique.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11406476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Hemostasis and Staple-Line Integrity between Medtronic Tri-Staple^TM with Preloaded Buttress Material and the AEON^TM Stapler in Bariatric Surgery.","authors":"Gabrielle Hogan, Ravi Rao, Aditya Rao, Faran Talebi","doi":"10.4293/JSLS.2023.00058","DOIUrl":"10.4293/JSLS.2023.00058","url":null,"abstract":"<p><strong>Background and objectives: </strong>Haemostasis-related complications associated with Medtronic Tri-staple^TM with preloaded buttress material and the novel, naked AEON^TM gastrointestinal staplers have not been extensively studied in bariatric surgery. The study aimed to assess and compare the 30-day haemostasis-related complications between Medtronic Tri-staple^TM and AEON^TM GIA staplers.</p><p><strong>Methods: </strong>A retrospective analysis was performed on data from patients who underwent primary or revision sleeve gastrectomy (SG) or the sleeve component of single anastomosis duodeno-ileal bypass with SG (SADI-S) in a private hospital in Australia between November 2021 and December 2022. The surgeries were performed by a single surgeon, using either Medtronic Tri-staple^TM or AEON^TM staplers.</p><p><strong>Results: </strong>The analysis included 250 patients, with the first 125 consecutive patients receiving staple line using the Medtronic Tri-staple^TM GIA stapler and the subsequent 125 patients receiving staple line using the AEON^TM GIA stapler. Statistical analysis revealed no significant differences in the distribution of surgical procedures between the Medtronic and AEON groups. In the AEON group, there were statistically higher numbers of diabetics and former tobacco users, while other preoperative characteristics did not significantly differ between the two groups. The AEON group had a significantly longer mean operative time, while the length of hospital stay was significantly shorter. No intraoperative or 30-day complications, deaths, emergency room visits, readmissions, or reoperations were observed in either group.</p><p><strong>Conclusion: </strong>The novel, naked AEON^TM stapler demonstrated non-inferiority to the established Medtronic Tri-Staple^TM with preloaded buttress material in achieving hemostasis and maintaining staple-line integrity in bariatric surgery.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11189025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations in Medical Research: Recognition, Influence, and Warning.","authors":"Douglas E Ott","doi":"10.4293/JSLS.2023.00049","DOIUrl":"https://doi.org/10.4293/JSLS.2023.00049","url":null,"abstract":"<p><strong>Background: </strong>As the number of limitations increases in a medical research article, their consequences multiply and the validity of findings decreases. How often do limitations occur in a medical article? What are the implications of limitation interaction? How often are the conclusions hedged in their explanation?</p><p><strong>Objective: </strong>To identify the number, type, and frequency of limitations and words used to describe conclusion(s) in medical research articles.</p><p><strong>Methods: </strong>Search, analysis, and evaluation of open access research articles from 2021 and 2022 from the <i>Journal of the Society of Laparoscopic and Robotic Surgery</i> and 2022 <i>Surgical Endoscopy</i> for type(s) of limitation(s) admitted to by author(s) and the number of times they occurred. Limitations not admitted to were found, obvious, and not claimed. An automated text analysis was performed for hedging words in conclusion statements. A limitation index score is proposed to gauge the validity of statements and conclusions as the number of limitations increases.</p><p><strong>Results: </strong>A total of 298 articles were reviewed and analyzed, finding 1,764 limitations. Four articles had no limitations. The average was between 3.7% and 6.9% per article. Hedging, weasel words and words of estimative probability description was found in 95.6% of the conclusions.</p><p><strong>Conclusions: </strong>Limitations and their number matter. The greater the number of limitations and ramifications of their effects, the more outcomes and conclusions are affected. Wording ambiguity using hedging or weasel words shows that limitations affect the uncertainty of claims. The limitation index scoring method shows the diminished validity of finding(s) and conclusion(s).</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139972463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic-Assisted Transvaginal Cholecystectomy - the US Military Experience With Long-Term Follow Up.","authors":"Carolyn Judge, Jesse Bandle, Andrew Wang, Kyle Gadbois, Amanda Simsiman, Robin Wood, Gordon Wisbach","doi":"10.4293/JSLS.2023.00059","DOIUrl":"10.4293/JSLS.2023.00059","url":null,"abstract":"<p><strong>Objectives: </strong>We present our initial clinical experience applying Natural Orifice Transluminal Endoscopic Surgical (NOTES) technique to perform cholecystectomy in ten patients at a military institution.</p><p><strong>Methods: </strong>A posterior colpotomy was created to accommodate a single site working port used to facilitate dissection and gallbladder mobilization under direct visualization via an infraumbilical port. The specimen was retrieved through the vagina and the colpotomy was closed with absorbable suture under direct visualization. Long-term follow up was performed over the phone to assess quality of life with 2 widely used health-related quality of life (HRQoL) surveys including RAND-36 Health Item Survey (Version 1.0),¹ and the Female Sexual Function Index (FSFI).².</p><p><strong>Results: </strong>Ten women underwent a laparoscopic-assisted transvaginal cholecystectomy (TVC) with 7 available for long-term follow-up. The average age was 28.9 years (20-37) and the indications for surgery included symptomatic cholelithiasis (9) and biliary dyskinesia (1). The mean operative time was 129 mins (95-180), and median blood loss was 34 ml (5-400). There were no conversions and the average length of stay was 9.98 hours (2.4-28.8). Pain (analogue scale 1-10) on postoperative day three was minimal (mean 2.3) and was limited to the infraumbilical incision. On average patients returned to work by postoperative day six and resumed normal daily activities at seven days. Immediate postoperative complications included one incident of postoperative urinary retention requiring bladder catheterization. One intra-operative cholangiogram was successfully performed due to elevated preoperative liver enzymes without significant findings. Long-term complications included one asymptomatic incisional hernia repair at the infraumbilical port site. The RAND-36 survey demonstrated an average physical and mental health summary score of 82.2 and 63.7 with an average general health score of 63.6. The average FSFI total score was 21.8.</p><p><strong>Conclusion: </strong>TVC is safe and effective. Implementation may improve operational readiness by returning service members to normal activities more expeditiously than conventional laparoscopy.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence and Scientific Publication.","authors":"Michael S Kavic, Raymond J Lanzafame","doi":"10.4293/JSLS.2024.00006","DOIUrl":"10.4293/JSLS.2024.00006","url":null,"abstract":"","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"28 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}