Pediatric Cardiology最新文献

{"title":"Maternal Hyperoxygenation for Prenatal Risk Stratification of Pulmonary Venous Obstruction in Total Anomalous Pulmonary Venous Return.","authors":"Michelle Mathevosian, Shuo Wang, Arpine Davtyan, Jon Detterich, Jodie Votava-Smith, Jay Pruetz","doi":"10.1007/s00246-026-04452-4","DOIUrl":"https://doi.org/10.1007/s00246-026-04452-4","url":null,"abstract":"<p><p>Pulmonary venous obstruction (PVO) is a major determinant of early morbidity and mortality in neonates with total anomalous pulmonary venous return (TAPVR). Accurate prenatal identification of obstructed TAPVR remains challenging due to low pulmonary blood flow in fetal circulation. Maternal hyperoxygenation (MHO) increases fetal pulmonary blood flow and may unmask clinically significant obstruction. We retrospectively reviewed three fetuses with prenatally diagnosed TAPVR who underwent late‑gestation fetal echocardiography with MHO testing. Doppler indices of pulmonary vasoreactivity and vertical vein (VV) flow were assessed at baseline and during MHO and correlated with postnatal clinical outcomes. All fetuses demonstrated preserved pulmonary vasoreactivity during MHO. One fetus had no Doppler evidence of PVO at rest or during MHO and had a stable postnatal course without emergent intervention. One fetus demonstrated elevated VV velocities at baseline that worsened during MHO and required emergent surgical repair shortly after birth. In the third fetus, VV Doppler findings were normal at baseline but became abnormal during MHO, accurately predicting postnatal clinical deterioration and the need for early catheter‑based intervention. These findings suggest that MHO testing can unmask occult pulmonary venous obstruction in fetal TAPVR and may improve prenatal risk stratification and perinatal planning.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897819","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":"Pre-operative Pediatric Ross Evaluation: Does Echocardiogram or Cardiac CT More Closely Approximate Direct Surgical Measurement?","authors":"Rachel E Henning, Nicholas B Aizcorbe, Matthew D Beaver, B Kelly Han, Aaron W Eckhauser, S Adil Husain, Eric R Griffiths, Reilly D Hobbs, Zhining Ou, Laura N Milles, Richard V Williams, Spencer B Barfuss","doi":"10.1007/s00246-026-04456-0","DOIUrl":"https://doi.org/10.1007/s00246-026-04456-0","url":null,"abstract":"<p><p>Pre-operative valve assessment is critical for surgical planning prior to the Ross procedure. No pediatric studies have assessed preoperative sizing comparing different imaging modalities. Single center study including all patients undergoing the Ross procedure from January 2018 - December 2023. Demographics and measurements of the aortic and pulmonary valve dimensions using transthoracic echocardiography (TTE), cardiac CT (CCT), and direct surgical measurement were included. Bland Altman Plots and intraclass correlation coefficient (ICC) assessed agreement between direct surgical measurement, TTE, and CCT, and between investigators. Of the 71 Ross patients during the study period, 62 patients met surgical inclusion criteria and of those, 58 met TTE inclusion criteria, 39 met CCT inclusion criteria, and 35 met both TTE and CCT criteria. CCT overestimated aortic and pulmonic valve annular dimensions while TTE more closely approximated direct surgical measurement. ICC demonstrated poor agreement between direct surgical measurement and pulmonary valve CCT. Agreement for CCT evaluation of the aortic valve was fair (0.74) and for TTE was fair to good for both valve measurements (range 0.71 to 0.88). TTE evaluation of the aortic and pulmonary valve annular measurements had better agreement with surgical measurements when compared to CCT. While CCT may not be required for pre-operative valve sizing in these patients, CCT plays an important role in delineating coronary, sternal, and other anatomic variables. Both modalities provide valuable complementary pre-operative information.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892083","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":"Thrombocytopenia Following Transcatheter Self-Expanding Pulmonary Valve Replacement.","authors":"Yuval Barak-Corren, Eli Fried, Maali Abu Omer, Tamir Dagan, Gabriel Amir, Einat Birk, Elchanan Bruckheimer","doi":"10.1007/s00246-026-04437-3","DOIUrl":"https://doi.org/10.1007/s00246-026-04437-3","url":null,"abstract":"<p><p>Thrombocytopenia following transcatheter aortic valve implantation has been described, but platelet count decline after self-expanding transcatheter pulmonary valve replacement (TPVR) has not been previously highlighted. This study aimed to describe the frequency, magnitude, and short-term clinical associations of platelet count decline after self-expanding TPVR. We retrospectively reviewed all consecutive self-expanding TPVRs performed at our institution between May 2022 and August 2025. Demographic, procedural, echocardiographic, and laboratory data were collected, including platelet and hemoglobin levels before and after TPVR. Descriptive statistics were used, and correlation analysis assessed the relationship between platelet and hemoglobin decreases. Forty-one patients were included, with a median age of 18.7 years [IQR 16.1-23.9]; 80% had undergone tetralogy of Fallot repair. Twenty-one patients received a Harmony valve and 20 received an Alterra-Sapien valve. Pre- and post-procedural platelet counts were available in 30 patients. A platelet count decrease occurred in 27/30 patients (90%), including 23/30 (77%) with a decrease of > 25% or ≥ 50 × 10⁹/L. Platelet count fell below 150 × 10⁹/L in 14 patients (47%) and below 100 × 10⁹/L in five (17%). No bleeding or thrombotic complications were observed, and no patient required platelet transfusion or thrombocytopenia-directed intervention. Hemoglobin decrease was less common and did not correlate with platelet count decrease. No difference was observed between valve types. Early platelet count decline was frequent after self-expanding TPVR, with nearly half developing thrombocytopenia. Routine post-procedural platelet monitoring may be warranted.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892064","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":"Incomplete Kawasaki Disease Versus Non-severe Multisystem Inflammatory Syndrome in Children: Distinguishing Features from Contemporaneous Patients.","authors":"Ashraf S Harahsheh, Megan Gunsaulus, Seda Tierney, Todd T Nowlen, Joseph J Pagano, Frederic Dallaire, Simon Lee, Kambiz Norozi, William B Orr, Audrey Dionne, Matthew D Elias, Mark D Hicar, Marianna Fabi, Adriana H Tremoulet, Geetha Raghuveer, Supriya S Jain, Nilanjana Misra, Desiree T Nwanze, Cedric Manlhiot, Brian W McCrindle","doi":"10.1007/s00246-026-04444-4","DOIUrl":"https://doi.org/10.1007/s00246-026-04444-4","url":null,"abstract":"<p><p>Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) share overlapping clinical features, making diagnosis challenging. We compared patients with incomplete KD to those with non-severe MIS-C to identify distinguishing characteristics. Patients were enrolled in the International KD Registry (01/2020-10/2023) from 40 centers across eight countries. Among 2146 MIS-C patients, 769 met criteria for non-severe confirmed MIS-C (no shock or ICU admission). Among 1358 KD patients, 146 met American Heart Association (AHA) criteria for confirmed incomplete KD and 372 were classified as unconfirmed incomplete KD. Demographics, clinical and laboratory features, treatment, and cardiac outcomes were compared. Non-severe MIS-C patients were significantly older (median 7.4 years) than both confirmed (2.3 years) and unconfirmed (2.5 years; p < 0.001) incomplete KD patients, and had different ethnic distributions with more Black and fewer East or South Asian patients. MIS-C patients had shorter fever duration, fewer classic KD features, and more gastrointestinal and respiratory symptoms. They demonstrated lower white blood cell counts but higher inflammatory markers and markers of organ dysfunction. Cardiac involvement differed: MIS-C patients had more myocardial dysfunction, including lower ejection fraction and higher cardiac biomarkers. Coronary artery involvement in MIS-C (median maximum z-score 1.3) was similar to unconfirmed incomplete KD (median z-score 1.3) but less than confirmed incomplete KD (median z-score 2.0; p < 0.01). Older age, distinct ethnicity, prominent gastrointestinal and respiratory symptoms, and multisystem inflammation with ventricular dysfunction but relatively less coronary artery involvement help distinguish non-severe MIS-C from incomplete KD.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892068","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":"Selected Abstracts from the PICS Society Symposium 2026.","authors":"","doi":"10.1007/s00246-026-04387-w","DOIUrl":"https://doi.org/10.1007/s00246-026-04387-w","url":null,"abstract":"","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887691","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":"Pediatric Cardiology as the Science of Adaptation Under Cardiovascular Constraint: Rethinking the Fundamental Unit of Analysis.","authors":"Colin J McMahon, Michael Kim","doi":"10.1007/s00246-026-04458-y","DOIUrl":"https://doi.org/10.1007/s00246-026-04458-y","url":null,"abstract":"<p><p>Pediatric cardiology has traditionally been organized around cardiac anatomy and physiology. Congenital and acquired cardiovascular disorders are classified according to structural and functional abnormalities, and clinical management is directed toward their identification and treatment. This approach has transformed survival and remains foundational to the discipline. As outcomes improve, however, an increasingly important question is why individuals exposed to similar cardiovascular constraints follow markedly different long-term trajectories. We propose adaptation under cardiovascular constraint as an integrative framework for studying this variation. Cardiovascular disorders establish physiological constraints within developing individuals, while trajectories of neurodevelopment, exercise capacity, growth, physiological reserve, and multisystem health emerge through interactions among those constraints, development, and adaptive responses. We propose the developmental trajectory as a fundamental unit through which adaptation can be observed and studied alongside anatomical diagnosis and conventional physiology. This perspective builds on developments already occurring within pediatric cardiology, including longitudinal and precision-health approaches, and integrates concepts from resilience theory, developmental biology, complexity science, network physiology, and physiological reserve. Pediatric cardiovascular disorders provide particularly informative models of developmental adaptation because physiological constraints may begin early, persist across development, and be characterized longitudinally. The framework reframes a central scientific question in pediatric cardiology: how do developing individuals maintain, modify, or lose function under sustained cardiovascular constraint? Its empirical value will depend on whether longitudinal measures of adaptation improve prediction, identify emerging vulnerability, or reveal potentially modifiable processes beyond established risk models.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881365","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":"Hybrid Transaortic Emergency Stenting of an Obstructed Left Main Coronary Artery in an Infant on ECMO and Ongoing Myocardial Infarction.","authors":"Katia Librandi, Sara Cooke, Carles Bautista-Rodriguez, Oluwatoyin Ocholi, Maraisa Fachini-Spada, Simon Davies, Andreas Hoschtitzky, Alain Fraisse","doi":"10.1007/s00246-026-04448-0","DOIUrl":"https://doi.org/10.1007/s00246-026-04448-0","url":null,"abstract":"<p><p>We report hybrid transaortic coronary intervention for severe stenosis of a left main coronary artery in a 3-month-old 2.9-kg female, following surgical repair of an anomalous left coronary artery from the pulmonary artery. The patient experienced myocardial ischaemia with severe left ventricular dysfunction, necessitating extracorporeal membrane oxygenation. Surgical reoperation was deemed of high-risk. After 2 failed attempts of percutaneous coronary interventions, hybrid transaortic access of the left main coronary artery was successfully performed. Because of immediate recoil after balloon angioplasty, a drug-eluting stent was implanted. The patient dramatically improved, with ECMO discontinuation, extubation, and recovery of an almost normal left-ventricular function. She was discharged home but experienced in-stent restenosis with suboptimal compliance to antiplatelet treatment. She remained clinically stable and awaiting bypass coronary graft. Such procedure with LMCA stenting in small infants is feasible and successful. It should be limited to life-saving situations, when no other treatment option is available.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881341","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":"Role of Health-Related Discrimination on Academic Performance Among Children with Congenital Heart Disease.","authors":"Aliba Syed, Timothy Dixon, Dmitry Tumin, Meredith Sooy-Mossey","doi":"10.1007/s00246-026-04459-x","DOIUrl":"https://doi.org/10.1007/s00246-026-04459-x","url":null,"abstract":"<p><p>Congenital heart disease (CHD) can lead to neurodevelopmental impairments and increased need for routine healthcare visits, potentially leading to deficits in academic performance. Children with CHD may also experience health-related discrimination in school and clinical settings. To determine the association of health-related discrimination (independent of bullying) with academic performance and school absenteeism among children with CHD. We analyzed data on schoolchildren with CHD from the 2022-2023 National Survey of Children's Health (NSCH). Our primary exposure was health-related discrimination towards the child, based on caregiver report, with bullying included as one of the covariates. Our outcomes were children's academic performance categorized as excellent, good and poor and school absenteeism dichotomized into 0-10 and 11 or more missed school days. Based on a sample of 1,058 children, approximately 10% experienced caregiver-reported health-related discrimination. On bivariate analysis, caregiver-reported health-related discrimination was associated with lower academic performance and higher school absenteeism. On multivariable analysis, bullying was significantly associated with both lower academic performance (OR: 0.57; 95% CI: 0.36, 0.89; p = 0.013) and higher odds of school absenteeism (OR: 2.30; 95% CI: 1.11, 4.74; p = 0.025), but there were no significant associations between caregiver-reported health-related discrimination and children's academic performance (OR: 0.76; 95% CI: 0.37, 1.56, p = 0.452) or school absenteeism (OR: 0.67; 95% CI: 0.26, 1.71, p = 0.404). As health-related discrimination is a broad term encompassing discrimination from peers, teachers and healthcare providers, bullying may be a more relevant determinant of school performance among children with CHD.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881286","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 Use of Inhaled Nitric Oxide After Pediatric Cardiac Surgery.","authors":"J Wesley Diddle, Jason Patregnani, Claudia A Algaze, Mousumi Banerjee, John Berger, Garrett Reichle, James St Louis, Jun Sasaki, Kurt R Schumacher, Jamie Sinton, William Stigall, Joshua Wolovits, Wenying Zhang, Sarah Tabbutt","doi":"10.1007/s00246-026-04457-z","DOIUrl":"https://doi.org/10.1007/s00246-026-04457-z","url":null,"abstract":"<p><p>Inhaled nitric oxide (iNO) lowers pulmonary vascular resistance and improves pulmonary gas exchange. It has become a common therapy following pediatric cardiac surgery, but there are limited data on its current use or clinical impact in this population. This retrospective analysis reviewed all patients within the Pediatric Cardiac Critical Care Consortium (PC⁴) clinical registry, representing 63 North American cardiac intensive care units (CICU), who underwent cardiac surgery from August 2014 to August 2023, to describe contemporary iNO use and its relationship to patient characteristics and outcomes. We also investigated the relationship between timing of iNO therapy for postoperative pulmonary hypertension (PH) and mortality. Of 63,582 non-neonatal patients admitted to the CICU following cardiac surgery, 12.2% received iNO, with 34.8% of those receiving it for PH. Of 17,792 neonates who underwent cardiac surgery, 26.6% received iNO, with 29.3% of those receiving it for PH. Single ventricle surgeries and heart transplant were the most common operations associated with iNO use. iNO use has increased over time, and utilization varies widely across centers, ranging from 0% to 65% of neonates, and 4% to 47% of infants. In a multivariable logistic regression model of patients who received iNO postoperatively for PH, initiation of therapy during the CICU stay, as compared to at CICU admission, was associated with increased mortality (odds ratio 1.54). Using contemporary multicenter registry data, we identify patient and operative characteristics associated with iNO use. Variations by center and by timing suggest opportunities to optimize use of the therapy.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881315","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":"Association of Prior Balloon Atrial Septostomy with Mortality and Perioperative Outcomes in Neonates with D-Transposition of the Great Arteries Undergoing Arterial Switch Operation: A Systematic Review and Meta-analysis.","authors":"Mohammed A M Ahmed, Bwambale Jonani, Felix Bongomin, Abdifatah Ahmed Mohamed, Abdinafic Mohamud Hussein, Mohamed Mukhtar Kassim","doi":"10.1007/s00246-026-04446-2","DOIUrl":"https://doi.org/10.1007/s00246-026-04446-2","url":null,"abstract":"<p><p>The role of balloon atrial septostomy (BAS) in the contemporary management of neonates with dextra-transposition of the great arteries (d-TGA) undergoing arterial switch operation (ASO) remains controversial, with marked inter-institutional practice variation and conflicting outcome data. We evaluated the association between prior BAS and mortality, length of stay, pre-operative intubation rate, and neurological outcomes in neonates with d-TGA undergoing ASO, with pre-specified subgroup analyses stratified by TGA anatomical subtype. We conducted a systematic review and meta-analysis of studies reporting outcomes in neonates with d-TGA undergoing ASO with and without prior BAS. Databases were searched from inception to 2024. Risk of bias was assessed using ROBIN-I. Random-effects meta-analyses were performed for mortality, length of stay, and pre-operative intubation rate. Studies reporting only adjusted effect estimates without counts data were described narratively. The protocol was registered in PROSPERO (CRD420251041501). Twenty-eight studies (1983-2024) were included. Six contributed to mortality analysis (n=1151; 43 deaths). The pooled odds ratio (OR) for mortality was 0.73 (95% CI 0.40-1.34, I2 = 0%). In TGA-IVS (4 studies, n = 443), OR was 0.89 (95% CI 0.30-2.65; I2 = 0%). in mixed TGA (2 studies, n=708), OR was 0.66 (95% CI 0.27-1.62, I2 = 34%), with no significant subgroup difference. Sensitivity analysis showed similar results. Overall length of stay did not differ significantly, though TGA-IVS neonates showed moderately longer pre-operative stay. Pre-operative intubation was more frequent with BAS (OR 8.96, 95% CI 3.69-21.71). Prospective MRI studies showed no clear association with pre-operative brain injury. Prior BAS was not associated with reduced mortality in neonates with d-TGA undergoing ASO. Higher intubation rates likely reflect illness severity rather than harm. This evidence does not exclude benefit in selected high-risk neonates but remains insufficient to confirm it.</p>","PeriodicalId":19814,"journal":{"name":"Pediatric Cardiology","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881277","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}