Minerva obstetrics and gynecology最新文献

{"title":"Polycystic ovary syndrome and estroprogestins.","authors":"Stefano Lello, Anna Fagotti, Michele Vignali, Laura Colonna, Anna Capozzi","doi":"10.23736/S2724-606X.25.05815-4","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05815-4","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical characteristics of polycystic ovary syndrome (PCOS) (menstrual irregularities, obesity, anovulation, etc.), occur together with a series of conditions at skin level like seborrhea, acne, hirsutism, and androgenetic alopecia. Estroprogestins (EPs) are recognized as the most powerful therapy to treat hyperandrogenism and/or hyperandrogenemia and regularize menstrual cycle.</p><p><strong>Evidence acquisition: </strong>This review includes the most relevant publications about the effects of EPs in PCOS women published between 1995 and 2025.</p><p><strong>Evidence synthesis: </strong>According to the available data, EPs composed by an anti-androgenic progestin appear the most suitable to reduce the hyperandrogenic manifestations of PCOS. More specifically, cyproterone acetate (CPA), drospirenone (DRSP) and dienogest (DNG) associated with 20-30 μg of ethinylestradiol (EE) seem to be the most effective compounds for the management of androgen excess. As the benefit risk/ratio of the association EE/CPA is less favorable, the use of EPs with other antiandrogenic progestins could be more appropriate to treat PCOS patients, also from a metabolic point of view.</p><p><strong>Conclusions: </strong>In conclusion, an aware choice of the most adequate and tolerable EP formulation according to the pharmacological profile and individual characteristics of PCOS patient is essential to opportunely customize the treatment of androgen excess.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explicit consent for episiotomy: recommendations for improving patient communication in prenatal and labor care.","authors":"Gianluca Montanari Vergallo, Rosagemma Ciliberti, Matteo Gulino","doi":"10.23736/S2724-606X.25.05622-2","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05622-2","url":null,"abstract":"<p><p>Episiotomy is a common surgical procedure during childbirth that involves incising the woman's perineum to facilitate the passage of the fetus. This procedure is used to speed up the delivery, but only in emergencies. It has been reported that explicit consent is unnecessary when the woman in labor is subresponsive or unresponsive. This manuscript analyzes and describes ethical issues regarding the need for explicit consent to use this procedure. The analysis has been made from two perspectives: applying the principlist approach, a system of biomedical ethics that uses the four bioethical principles formulated by Childress and Beauchamp and the principle of vulnerability in its complex relationship with the concepts of dependence and care as articulated in the Barcelona Declaration of 1998. Based on our analysis, we conclude that explicit consent is a fundamental prerequisite in medical practice that should always be sought, even in complex situations such as performing an episiotomy. A table reporting recommendations to enhance communication with the woman throughout the prenatal phase and during labor has also been provided to improve informed consent processes and ensure more effective patient engagement and decision-making.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle and diet in PCOS.","authors":"Anna Capozzi, Giovanni Scambia, Lorenza Driul, Michele Vignali, Stefano Lello","doi":"10.23736/S2724-606X.25.05746-X","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05746-X","url":null,"abstract":"<p><strong>Introduction: </strong>Polycystic ovary syndrome (PCOS) is a multifactorial endocrine-metabolic disease that requires pharmacological and non-pharmacological treatments. The aim of this paper is to review the major evidence about current lifestyle and dietary approaches to manage this syndrome.</p><p><strong>Evidence acquisition: </strong>We include in our research the most relevant publications about lifestyle and diet in PCOS published between 1995 and 2025.</p><p><strong>Evidence synthesis: </strong>According to the most recent recommendations, regular physical activity is crucial to ameliorate hormonal and metabolic parameters as well as to maintain and/or reduce weight in PCOS women. As for the foods, although there is not agreement on a specific diet, low-glycemic index nutrients associated with high fiber intake should be generally preferred in hyperinsulinemic patients.</p><p><strong>Conclusions: </strong>In conclusion, suggestions about lifestyle and diet should represent a cornerstone of the personalized multi-step therapy of PCOS.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic risk in women with polycystic ovary syndrome: a comprehensive review.","authors":"Angelo Cagnacci, Gino A Antonelli, Giulia Vatteroni, Anjeza Xholli","doi":"10.23736/S2724-606X.25.05732-X","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05732-X","url":null,"abstract":"<p><strong>Introduction: </strong>Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, which is associated with a significantly higher risk of developing cardiometabolic abnormalities. The present review is aimed to understand the different mechanism related to the cardiometabolic alteration of women with PCOS.</p><p><strong>Evidence acquisition: </strong>A literature search was made on terms encompassing PCOS, hyperandrogenism, obesity, lipid metabolism, insulin resistance, inflammation, oxidative stress, gut microbiota, cardiovascular event, and mortality.</p><p><strong>Evidence synthesis: </strong>Hyperandrogenism is the key signature of women with PCOS. Androgens by reducing the intracellular signal of insulin, induce an insulin resistance that is compensated by hyperinsulinemia. Hyperinsulinemia and insulin resistance are the key determinants of the metabolic syndrome and therefore of the cardiovascular risk. Obesity, oxidative stress and chronic inflammation further increase insulin resistance and represent adjunctive pejorative risk factors. Modification of gut microbiota is common in women with PCOS, and it is consequent to hyperandrogenism and obesity. Gut dysbiosis contributes to induce metabolic alterations. In women with PCOS the cardiovascular risk depends upon syndrome manifestation. The risk is maximal in hyperandrogenic obese anovulatory women, milder in hyperandrogenic non obese women, and is not increased in non-hyperandrogenic PCOS women.</p><p><strong>Conclusions: </strong>Among PCOS women, phenotypes characterized by hyperandrogenism, anovulation and obesity are at high risk of cardiometabolic alterations. In general, a careful investigation on the presence of cardiovascular risk factors, and the use of appropriate remedies to reduce them, is useful in all PCOS women with hyperandrogenism, and in particular in those with associated anovulation and obesity.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postnatal outcomes and surgical management of prenatally detected unilateral congenital anomalies of the kidney and urinary tract.","authors":"Marta Fiorentini, Bianca Nedu, Sara Doroldi, Clotilde Mattarelli, Francesca Petrillo, Gianluigi Pilu, Elisa Montaguti","doi":"10.23736/S2724-606X.25.05702-1","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05702-1","url":null,"abstract":"<p><strong>Background: </strong>Congenital anomalies of the kidney and urinary tract (CAKUT) represent 15-20% of prenatally diagnosed congenital anomalies, often presenting unilaterally. This study aimed to describe sonographic features of fetuses with unilateral renal anomalies and evaluate their postnatal outcomes. Additionally, we assessed whether specific prenatal ultrasound findings predicted postnatal complications.</p><p><strong>Methods: </strong>This was a retrospective, observational study including singleton pregnancies referred to our center from 2008 to 2023 for unilateral renal anomalies identified in second or third trimester ultrasounds. Sequential prenatal ultrasound evaluations were conducted to monitor disease progression and associated anomalies. Postnatal outcomes were retrieved from delivery records and pediatric follow-ups. Statistical analyses included Chi-square tests, t-tests, and ROC curve analysis to assess the predictive value of the antero-posterior diameter (DAP) of the renal pelvis for postnatal complications.</p><p><strong>Results: </strong>A total of 226 cases were included: 116 (51.3%) pyelectases, 51 (22.6%) hydroureteronephroses, 48 (21.2%) multicystic kidneys, and 11 (4.9%) renal dysplasias. Diagnosis occurred at an average gestational age of 25 weeks, with 19.3% showing progression during pregnancy and 23% having associated anomalies detected during ultrasound examinations. Of 135 children with follow-up data, 47.4% required surgery, 1.5% developed hypertension, and 1.5% developed chronic kidney disease (CKD). Associated anomalies significantly correlated with unfavorable outcomes, such as need for intervention (P=0.001), risk of developing postnatal recurrent urinary infections (P=0.025), vesicoureteral reflux (P=0.001) and CKD (P=0.010). Progression during pregnancy correlated with vesicoureteral reflux (P=0.002) and development of anomalies in the contralateral kidney (P=0.012). DAP measurement did not reliably predict postnatal complications (AUC=0.590, P=0.191).</p><p><strong>Conclusions: </strong>Unilateral renal anomalies are often associated with other congenital anomalies, influencing postnatal outcomes. DAP measurement was not a significant predictor of postnatal complications. Comprehensive prenatal ultrasound assessments are critical for guiding parental counseling, pregnancy management, and postnatal care.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrauterine adhesions following fibroid surgery: incidence and prevention strategies. A systematic review.","authors":"Alexandros Lazaridis, Alexandros L Grammatis, Martin Hirsch, Olga Triantafyllidou, Funlayo Odejinmi, Nikos F Vlahos","doi":"10.23736/S2724-606X.25.05733-1","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05733-1","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this review was to provide current evidence of the relationship between fibroid surgery (hysteroscopic, laparoscopic/robotic, open) and the formation of intrauterine adhesions (IUA).</p><p><strong>Evidence acquisition: </strong>A systematic electronic literature search was conducted to provide a survey of the various surgical modalities and their relevant incidence of intrauterine adhesions. Utilizing PRISMA methodology the search identified 23 full text original studies that were included in the analysis.</p><p><strong>Evidence synthesis: </strong>Our analysis identified 2437 cases reported in the international literature whereby the de novo formation of IUAs were systematically assessed with second look hysteroscopy at least 4 weeks and usually up to 3 months after the surgery. In our analysis, out of 1678 hysteroscopic cases the mean incidence was 9.4% for all different techniques, including monopolar or bipolar diathermy, cold loop and radio frequency ablation. The reported numbers for laparoscopic/robotic and open surgery were 399 and 360 cases respectively. The incidence of IUA following endoscopic abdominal surgery was 12.8% and for the traditional open approach (laparotomy) was 18.3%. There is substantial heterogeneity on the reported data regarding risks factors contributing to IUAs; such as fibroid size, location, number as well as uterine cavity breach during abdominal surgery (either open, laparoscopic or robotic).</p><p><strong>Conclusions: </strong>Iatrogenic IUAs following myomectomies are not uncommon and may be implicated in patient morbidity and sub fertility. Further studies are necessary to evaluate the prevention of such sequelae and improve therapeutic outcomes following fibroid surgery.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant radiotherapy for early-stage endometrial cancer based on randomized controlled trials: a narrative review.","authors":"Gabriel Levin, Susie Lau, Shannon Salvador, Melica Brodeur, Raanan Meyer, Walter Gotlieb","doi":"10.23736/S2724-606X.25.05723-9","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05723-9","url":null,"abstract":"<p><p>Endometrial carcinoma (EC) is the most common gynecologic malignancy in the USA, with surgical staging as the cornerstone of treatment. Although most patients are diagnosed at an early stage, adjuvant therapies, including external beam radiation therapy (EBRT), vaginal brachytherapy (VBT), and systemic treatments, are employed in select cases to reduce recurrence risk. This review highlights data from randomized controlled trials assessing the efficacy of adjuvant radiotherapy in early-stage EC. For low-risk EC, studies suggest that postoperative brachytherapy has minimal impact on locoregional recurrence and is not recommended without significant uterine risk factors. In intermediate-risk EC, trials such as GOG 99 and PORTEC-1 demonstrated reduced recurrence with pelvic RT, particularly in high-intermediate risk subsets, though overall survival benefits were not observed. For high-intermediate risk EC, PORTEC-2 showed that VBT effectively controls vaginal recurrence with less morbidity compared to EBRT, recommending VBT as the preferred modality. Medium-risk cases benefit similarly from VBT alone, as shown in Swedish trials. In high-risk EC, RCTs such as GOG 249 and PORTEC-3 examined the addition of chemotherapy to radiotherapy, finding comparable recurrence and survival outcomes between VBT with chemotherapy and EBRT, though acute toxicity was higher with combined therapy. Across these trials, the degree of lymphovascular space invasion (LVSI), patient age, tumor grade, and histology were key prognostic factors influencing treatment recommendations. Despite advancements in molecular classification and modern radiotherapy techniques, most data derive from earlier studies, emphasizing the need for updated research to refine treatment paradigms.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual tumor using CT scan based on modified radiologic Lakhman Index after optimal cytoreduction in advanced ovarian cancer: advantages of a simplified method.","authors":"Alexandra Trelis Blanes, Víctor Lago, Vicente Belloch Ripollés, Rosario Pérez Martínez, Guillermina Montoliu, Pablo Padilla Iserte, Marta Gurrea, Jose M Cardenas Rebollo, Santiago Domingo","doi":"10.23736/S2724-606X.25.05771-9","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05771-9","url":null,"abstract":"<p><strong>Background: </strong>Advanced ovarian cancer is the deadliest gynecological malignancy, with treatment combining cytoreductive surgery and platinum/taxane chemotherapy. Surgical success is defined by residual tumor size, but visual assessment may underestimate residual disease. Postoperative computed tomography (CT) scans can detect residual tumors in up to 49% of cases initially deemed tumor-free. Structured radiologic reporting, such as the Peritoneal Carcinomatosis Index (PCI), improves accuracy and prognosis correlation. This study aims to validate a simplified structured reporting method based on the Lakhman index.</p><p><strong>Methods: </strong>Patients with advanced ovarian cancer (FIGO stages II and IV) diagnosed between 2007 and 2019 at Hospital La Fe Valencia were included in the study. All underwent cytoreductive surgery with R0 or R1 outcomes, followed by a postoperative CT scan performed between the third and eighth weeks after surgery and before the initiation of chemotherapy. Two gynecologic oncology-specialized radiologists independently analyzed the CT scans in a double-blind manner. They assessed the images using the Lakhman Index, which divides the abdominopelvic cavity into eight regions. Additionally, they applied the Qualitative Assessment (QA) scale to determine the presence of tumor disease in each region, classifying them as QA 1-2 (definitely/probably normal), QA 3 (indeterminate) and QA 4-5 (probably/definitely metastatic).</p><p><strong>Results: </strong>The study analyzed a cohort of 117 patients. Radiological evaluation detected macroscopic measurable tumor disease in 44%-49% of patients following optimal primary cytoreduction (R0 or R1). Kappa analysis showed a moderate level of concordance between the two radiologists (0.589). Findings from both radiologists (A and B) were significantly associated with reduced disease-free survival (DFS) and overall survival (OS) in patients with macroscopic disease compared to those without (P<0.05).</p><p><strong>Conclusions: </strong>The identification of radiological tumor presence on standardized, systematic postoperative CT scans prior to adjuvant chemotherapy is linked to the prognosis of patients with advanced ovarian cancer.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the silence on urinary incontinence: the hidden epidemic and its socioeconomic effects.","authors":"Sara Trapani, Giulia Villa, Ilaria Marcomini, Elisabetta Bagnato, Stefania Rinaldi, Martina Caglioni, Andrea Poliani, Debora Rosa, Stefano Salvatore, Massimo Candiani, Duilio F Manara","doi":"10.23736/S2724-606X.25.05777-X","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05777-X","url":null,"abstract":"","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes from assisted reproductive technology in predicted hyper-responders: a narrative review.","authors":"Isabel Saavedra-Rocha, Michel DE Vos","doi":"10.23736/S2724-606X.25.05726-4","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05726-4","url":null,"abstract":"<p><p>The management of assisted reproductive technology (ART) in predicted hyper-responders to ovarian stimulation represents a complex and challenging clinical scenario, whereby the benefits of higher oocyte yield must be balanced against the drawbacks and risks of ovarian hyperstimulation syndrome. This review explores advances in ART for hyper-responders, focusing on adapted stimulation protocols, ovulation triggering, cryopreservation, and personalized strategies to optimize outcomes. In-vitro maturation of oocytes, an emerging alternative, is gaining traction for increasing live birth rates in selected cases and expert centers. A comprehensive review of the literature was conducted. Articles were selected based on relevance, rigor, and contributions to advancing the management of hyper-responders in assisted reproductive technology. Key findings were synthesized to provide an overview of evidence and emerging trends. Findings suggest a paradigm shift from indiscriminate oocyte retrieval towards achieving a target range, with 15-19 oocytes per cycle correlating with an optimal balance between live birth rates and complication risks. However, challenges remain in predicting ovarian response accurately, particularly in patients with elevated Anti-Müllerian Hormone levels or specific clinical profiles. The variability of ovarian response in these categories underscores the need for individualized protocols, incorporating patient-specific factors of age, Body Mass Index, and ovarian reserve markers. Strategies like tailored gonadotropin dosing and advances in cryopreservation techniques, such as embryo and oocyte vitrification, have shown promise but still require refinement. Future research should aim to refine dosing algorithms, explore genetic contributions, and enhance personalized, patient-centered approaches that prioritize safety, comfort, and improved outcomes in managing hyper-responders.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}