Pancreas最新文献

{"title":"Adverse Events Associated With Endoscopic Ultrasound Fine-Needle Aspiration and Biopsy of Pancreatic Cysts: Antibiotics Might Cause More Harm Than Help.","authors":"Mark H Hanscom, Ferga C Gleeson, Vanessa M Shami, Nathan W Cummins, Andrew C Storm, Sunanda V Kane, Neil B Marya, Barham K Abu Dayyeh, Aliana M Bofill-Garcia, Vinay Chandrasekhara, Prasad G Iyer, Ryan Law, Shounak Majumder, Randall K Pearson, Bret T Petersen, Elizabeth Rajan, Eric J Vargas, Santhi Swaroop Vege, Michael J Levy","doi":"10.1097/MPA.0000000000002415","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002415","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":"54 4","pages":"e389-e390"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence on Postoperative Results and Cost-effectiveness of Using Cyanoacrylate Glue for Pancreaticojejunal Anastomosis After Duodenopancreatectomy.","authors":"Alberto Facury Gaspar, Rafael Kemp, Ajith Kumar Sankarankutty, Jorge Resende Lopes Júnior, João Almiro Ferreira Filho, Victor Antonio Peres Alves Ferreira Avezum, Gustavo de Assis Mota, José Sebastião Dos Santos, Altacílio Aparecido Nunes","doi":"10.1097/MPA.0000000000002479","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002479","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pancreatic fistula (POPF) remains the most serious complication of pancreatoduodenectomy (PD), which justifies the search for alternatives to reinforce the pancreaticojejunal anastomosis (PJA).</p><p><strong>Objective: </strong>To evaluate the effect on postoperative results and on the cost-effectiveness of using synthetic cyanoacrylate glue in PJA after PD.</p><p><strong>Methods: </strong>Prospective, randomized study, including 63 consecutive patients undergoing PD divided into two groups: GWC-(group with cyanoacrylate) 30 patients using synthetic cyanoacrylate glue in the PJA and 33 patients without application (GWOC, group without cyanoacrylate). The variables studied were organized in epidemiological, clinical, and laboratory terms, with emphasis on the incidence of pancreatic fistula, grouped according to the definition of the International Study Group on Pancreatic Fistula and the postoperative complications were categorized according to the Clavien-Dindo classification. Additionally, the costs of hospital treatment were verified using cost effectiveness ratio (CER) and incremental (ICER) analysis.</p><p><strong>Results: </strong>In the GWC, the incidence of POPF was significantly lower (16.7%) compared to the GWOC (39.7%); P=0.046, as well as the length of hospital stay in days (11.3 GWC, 16.2 GWOC; P=0.04) and the costs of hospital stay (GWOC R$ 12,275.83:; GWC R$ 8,636.07; P=0.0413). In the cost-effectiveness analysis, we found an ICER of -R$ 142.63 and in the total sample an ICER of -R$ 6052.54.</p><p><strong>Conclusion: </strong>The use of synthetic cyanoacrylate glue to reinforce the PJA in patients undergoing PD, under the conditions studied, improved clinical postoperative results and hospitalization costs which justifies expanding studies, especially in circumstances of greater risk for postoperative pancreatic fistula.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Additional Hydration for Hyperamylasemia After Endoscopic Retrograde Cholangiopancreatography: A Propensity-Matched Analysis.","authors":"Rintaro Fukuda, Ryunosuke Hakuta, Yousuke Nakai, Hiroto Nishio, Go Endo, Kohei Kurihara, Shuichi Tange, Shinya Takaoka, Hiroki Oyama, Kensaku Noguchi, Tatsunori Suzuki, Tatsuya Sato, Kazunaga Ishigaki, Tomotaka Saito, Naminatsu Takahara, Tsuyoshi Hamada, Yukiko Ito, Mitsuhiro Fujishiro","doi":"10.1097/MPA.0000000000002493","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002493","url":null,"abstract":"<p><strong>Objectives: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is widely utilized to manage pancreatobiliary diseases, but post-ERCP pancreatitis (PEP) is an unsolved issue. Although post-procedural elevation of serum amylase level is useful for early prediction of PEP, effectiveness of early interventions for hyperamylasemia has not been evaluated. Therefore, we conducted this study to elucidate the role of additional hydration in cases with hyperamylasemia after ERCP.</p><p><strong>Methods: </strong>This retrospective study included patients without a previous history of ERCP who developed hyperamylasemia three hours after the index ERCP in two centers. Patients were divided into a hydration group (with additional hydration of Lactated Ringer's solution at a rate of 40-80 ml per hour) or a control group (without additional hydration). Using propensity score matching, clinical outcomes including an incidence and severity of PEP were compared between the matched hydration and control groups.</p><p><strong>Results: </strong>A total of 399 patients were eligible for the current analysis and 109 patients for each group were selected after propensity score matching. Patient characteristics and endoscopic procedure details were well-balanced between the matched hydration and control groups. The incidences of overall PEP were not different between the two groups (42% vs. 45%, P=0.68), but the incidence of moderate or severe PEP was significantly lower in the matched hydration group (8.3% vs.22%, odds ratio 0.32; P=0.006). Hydration-related complication was not observed in both groups.</p><p><strong>Conclusions: </strong>Additional hydration for patients with hyperamylasemia after ERCP reduced the incidence of moderate or severe PEP without a risk of volume overload.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Driving Pancreatic Cancer Survival Rates.","authors":"Lola Rahib, Tara Coffin, Barbara Kenner","doi":"10.1097/MPA.0000000000002489","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002489","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze trends driving the increase in the 5-year survival rate of pancreatic cancer over the last decade with a focus across disease stages.</p><p><strong>Methods: </strong>Pancreatic cancer survival data was analyzed by disease stage, age, and race/ethnicity using the most recent data from the Surveillance, Epidemiology, and End Results (SEER) program. Stage distribution and survival rates were combined to evaluate the contribution of each stage to the overall survival rate.</p><p><strong>Results: </strong>The most recent SEER 17 data registry reports an overall 5-year survival rate for pancreatic cancer of 12%, with rates varying significantly across stages. The overall 5-year survival, irrespective of stage at time of diagnosis, increased from 6% for patients diagnosed in 2004 to 12% for those diagnosed in 2015. During this same period, the incidence rate of distant disease decreased from 60% to 53%; however, the 5-year survival rate only increased from 2% to 3%, suggesting minimal advancements in treatment outcomes for individuals identified with distant disease at time of diagnosis. In contrast, the 5-year survival rate for localized disease rose from 24% to 46%, while the stage distribution only slightly increased from 11% to 14% during the same period. Survival rates for distant disease at 4-, 3-, 2-year did not increase, however, the 1-year survival increased from 14% to 22% (2004-2019). These trends suggest progress in short term outcomes, aligning with the availability of new FDA approved treatments for advanced or metastatic disease with a median overall survival of <1 year.</p><p><strong>Conclusions: </strong>This research confirms that the overall 5-year survival rate of 12% primarily reflects improved survival among those diagnosed with localized disease. Importantly, since only 14% of patients are diagnosed at this stage, the survival rate for most patients remains unchanged. This work also emphasizes the need for more research around variables that influence the overall 5-year survival rate, along with greater investment in early detection strategies to improve patient survival.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Replacing Liposomal Irinotecan with Standard Irinotecan in Pancreatic Adenocarcinoma: Should We Follow Suit and Substitute Without Dispute?","authors":"Aditya Mahadevan, Armon Azizi, Jennifer Valerin, Farshid Dayyani","doi":"10.1097/MPA.0000000000002490","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002490","url":null,"abstract":"","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of the Comprehensive Acute Pancreatitis Pain Core Outcome Set (CAPPOS): Study Protocol.","authors":"Louise Kuhlmann, Esther M Pogatzki-Zahn, Nejo Joseph, James Lucocq, Jana Aulenkamp, Cecilie Siggaard Knoph, Søren S Olesen, John A Windsor, Asbjørn M Drewes, Sanjay Pandanaboyana","doi":"10.1097/MPA.0000000000002488","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002488","url":null,"abstract":"<p><strong>Introduction: </strong>Acute pancreatitis (AP) is a leading cause of gastrointestinal hospitalizations worldwide, with rising incidence, significant morbidity, and high healthcare costs. Pain, a hallmark symptom of AP, remains inadequately assessed, often relying on unidimensional scales such as visual analogue score, which fail to capture its multidimensional nature. Poorly managed acute pain negatively impacts clinical outcomes, prolongs recovery, and increases the risk of chronic pain syndromes. Comprehensive pain assessment tools specific to AP are lacking, highlighting the need for improved evaluation methods. The proposed study aims to develop and validate the Comprehensive Acute Pancreatitis Pain Outcome Set (CAPPOS) to address this evidence gap.</p><p><strong>Methods: </strong>The CAPPOS initiative follows COMET and COSMIN guidelines. Three systematic reviews will identify pain domains and assessment methods in AP, acute abdominal pain, and post-pancrectomy pain. A consensus process, using a modified Delphi approach, will involve multidisciplinary experts and patients to confirm and define key domains. Measurement tools will be selected for each domain and refined through iterative feedback. Pilot testing with 50 patients will evaluate the feasibility, clarity, and responsiveness to change of the preliminary tool. Validation studies with 200 AP patients will assess structural, content, and criterion validity, reliability, and sensitivity to change, ensuring content validity and clinical utility.</p><p><strong>Conclusion: </strong>CAPPOS will provide a validated, multidimensional core outcome set to optimize pain assessment in AP. It will also facilitate standardized reporting in clinical trials, advancing research and care for AP-related pain.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Abdominal Aortic Calcification on Pancreas Graft Survival in Patients Undergoing Simultaneous pancreas-kidney Transplantation.","authors":"Shohei Takaichi, Yoshito Tomimaru, Shogo Kobayashi, Toshinori Ito, Kazuki Sasaki, Yoshifumi Iwagami, Daisaku Yamada, Takehiro Noda, Hidenori Takahashi, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1097/MPA.0000000000002487","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002487","url":null,"abstract":"<p><strong>Background: </strong>Pancreas transplantation (PTx) is definitive therapy for patients with type 1 diabetes and advanced chronic kidney disease. Abdominal aortic calcification (AAC) is often observed in patients waiting for PTx and progresses according to the waiting period, but the impact of AAC on long-term outcomes remains unclear. In this study, we aimed to elucidate the impact of AAC on long-term outcomes.</p><p><strong>Methods: </strong>We reviewed 65 consecutive PTx cases at our institution between April 2000 and November 2022 and enrolled 50 patients with simultaneous pancreas-kidney transplantation (SPK). AAC was assessed as AAC score by the Agatston method using multi-detector computed tomography.</p><p><strong>Results: </strong>Receiver operating characteristic curves were used to determine the cut-off value of the AAC score for death-uncensored pancreas graft survival; the area under the curve was 0.711 (P=0.029). After dividing the patients into two groups according to the AAC cut-off, the dialysis period was significantly longer in the high AAC score group than in the low AAC score group (P=0.001). Death-uncensored pancreas graft survival and patient survival after SPK were significantly lower in the high AAC score group than in the low AAC score group (P=0.001, 0.001, respectively). In a Cox proportional hazards regression model, high AAC score was independently associated with death-uncensored pancreas graft loss (P=0.002).</p><p><strong>Conclusions: </strong>AAC is associated with death-uncensored pancreas graft survival in patients undergoing SPK. Evaluation of AAC could be useful for predicting post-PTx prognosis.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coupled Plasma Filtration and Adsorption in Eliminating Inflammatory Mediators and Enhancing Sublingual Microcirculation in Severe Acute Pancreatitis.","authors":"Hongli Zhou, Chunjian Ma, ShengNian Zhong","doi":"10.1097/MPA.0000000000002486","DOIUrl":"10.1097/MPA.0000000000002486","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the effectiveness of coupled plasma filtration and adsorption (CPFA) in patients with SAP through its effect on inflammatory mediators and sublingual circulating blood volume. The hypothesis put to test is that CPFA can achieve a satisfactory reduction in inflammatory mediators and enhance sublingual microcirculation in SAP with a very good clinical outcome.</p><p><strong>Methods: </strong>A cohort of 112 SAP patients admitted to the ICU of our institution between January 2018 and December 2022 was consecutively recruited. Participants were randomized to the CPFA or the control group (standard treatment) using a random number table for assignment. Post-treatment alterations in inflammatory mediators and sublingual microcirculation were analyzed and compared.</p><p><strong>Results: </strong>Following treatment, the study group showed significantly reduced levels of IL-1β, TNF-α, and IL-6 versus the control group. Additionally, the study group witnessed lower serum and urinary amylase levels and APACHE II and SOFA scores. Parameters related to sublingual microcirculation, including Total Vessel Density (TVDs), Small Vessel Perfusion Ratio (PPVs), Perfusion Small Vessel Density (PVDs), and Microvascular Flow Index (MFIs), were significantly improved in the study group. Moreover, the study group observed lower rates of Systemic Inflammatory Response Syndrome (SIRS) and 30-day mortality versus the control group.</p><p><strong>Conclusion: </strong>The application of CPFA in SAP patients effectively eliminates inflammatory mediators and enhances microcirculation, leading to improved clinical outcomes and reduced mortality rates.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Continuous Glucose Monitoring After Total Pancreatectomy With or Without Islet Autotransplantation: A Scoping Systematic Review.","authors":"Ayat Bashir, Nejo Joseph, John S Hammond, Steve White, Maisam Abu-El-Haija, Asbjørn Mohr Drewes, James A M Shaw, Sanjay Pandanaboyana","doi":"10.1097/MPA.0000000000002424","DOIUrl":"10.1097/MPA.0000000000002424","url":null,"abstract":"<p><strong>Objectives: </strong>This scoping review aims to provide evidence synthesis of continuous glucose monitoring (CGM) and insulin pump use after undergone total pancreatectomy (TP) with or without islet autotransplantation (TPIAT).</p><p><strong>Methods: </strong>The review was conducted adhering to PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist.</p><p><strong>Results: </strong>Fifteen studies including 147 patients (adult n = 71/pediatric n = 76) reported on CGM use post-TP (n = 42) and TPIAT (n = 105). Four were randomized controlled trials and 10 observational studies. Six studies evaluated CGM use in the perioperative and 6 in the immediate postoperative period (n = 8) with variable follow-up (14 hours to 20 months). CGM was used as a stand-alone device (8 studies), which allowed assessment of glycemic variability (n=5) and detection of hypoglycemia (n = 1), resulting in lower glucose levels (n = 1). Six studies evaluated insulin pump with CGM with reduction in postoperative mean glucose (n = 4) and hypoglycemic episodes (n = 2). No patient-reported outcome measures (PROMs) or quality of life (QoL) measures were reported.</p><p><strong>Conclusions: </strong>CGM can be used following TP for glucose monitoring and/or linked with insulin pump device in the perioperative period with improved glycemic control. However, the data are limited by short follow-up and lack of PROMs and QoL measures.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":" ","pages":"e268-e277"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Nomogram for Predicting the Transition From Recurrent Acute Pancreatitis to Chronic Pancreatitis.","authors":"Wanzhen Wei, Yifei Ma, Jiahui Zeng, Yiqun Song, Yimin Han, Weikun Qian, Xue Yang, Zheng Wu, Zhenhua Ma, Zheng Wang, Wanxing Duan","doi":"10.1097/MPA.0000000000002420","DOIUrl":"10.1097/MPA.0000000000002420","url":null,"abstract":"<p><strong>Objectives: </strong>Acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis are recognized as a continuum of pancreatic diseases. Recurrence increases the risk of progression to chronic pancreatitis. The aim of this study was to search for clinical features that may promote the progression of chronic pancreatitis in patients with recurrent acute pancreatitis.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed patients with recurrent acute pancreatitis from Medical Information Mart for Intensive Care-IV database. They were divided into a training cohort and a validation cohort. A nomogram was constructed based on clinical features during the second hospitalization. The discrimination and calibration of the nomogram were evaluated using the concordance index, area under the time-dependent receiver operating characteristic curve, and calibration plots.</p><p><strong>Results: </strong>A total of 432 recurrent acute pancreatitis patients were evaluated, of which 93 (21.53%) were diagnosed with chronic pancreatitis later. Age, biliary pancreatitis, admission interval, alcohol dependence, lipase, and platelet were selected. The concordance index was 0.717 (95% confidence interval: 0.691-0.743) for the training cohort and 0.718 (95% confidence interval: 0.662-0.774) for the validation cohort. The area under the time-dependent receiver operating characteristic curve was >0.7 over 1000 days.</p><p><strong>Conclusions: </strong>A nomogram was developed and validated to evaluate the transition from recurrent acute pancreatitis to chronic pancreatitis.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":"54 3","pages":"e201-e209"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503083","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}