Pediatric Research最新文献

{"title":"Caffeine and preterm infants: multiorgan effects and therapeutic creep: scope to optimise dose and timing.","authors":"Michael O'Shea, Luke Butler, Sam Holohan, Kate Healy, Rebecca O'Farrell, Amreena Shamit, Ruth Cusack, Mai Elhadi, Sinead Lynch, Megan Gilcrest, Jana Semberova, Aoife Branagan, Mary Isabel O'Dea, Peter Duddy, Namasivayam Ambalavanan, Karel Allegaert, Cynthia F Bearer, Judith Meehan, Eleanor J Molloy","doi":"10.1038/s41390-025-04066-1","DOIUrl":"10.1038/s41390-025-04066-1","url":null,"abstract":"<p><p>Caffeine is a methylxanthine used for nearly 50 years in the treatment of apnoea of prematurity (AOP). Caffeine citrate is effective in the treatment of AOP using standard dosing (loading dose 20 mg/kg, maintenance 5-10 mg/kg/day) and is associated with long-term neurological benefits and other improved organ outcomes as well as immunomodulatory effects. Therapeutic creep has been noted in the use of caffeine in preterm infants differing from the criteria in randomised controlled trials. A Cochrane review showed insufficient evidence to support prophylactic use of caffeine citrate in preterm neonates to prevent AOP, although it is still recommended in many national and local guidelines. Concerns about adverse reactions exist with high-dose caffeine regimens with one high-dose trial reporting statistically significant increases in abnormal neurological outcomes compared with standard doses (80 mg/kg compared to 20 mg/kg). International clinical guidelines vary from clinical trials regarding timing, dose, and duration of caffeine therapy. Further clinical research could help to understand optimal doses for different indications, such as peri-extubation, early postnatal use while ventilated, multiorgan and psychoactive effects, and long-term neurodevelopmental outcomes. This review describes the mechanism and multiorgan effects of caffeine highlighting areas of therapeutic creep and uncertainty requiring further research, such as comparative effectiveness trials. IMPACT: Caffeine citrate is indicated for the management of apnoea of prematurity. Therapeutic creep is evident in international guidelines for the use of caffeine citrate in preterm infants. Caffeine has multiorgan effects involving renal, respiratory, and inflammatory responses, which, by optimising dosing and timing, may improve outcomes. Optimising indications, dose, and timing of caffeine citrate in preterm infants in further large-scale trials is warranted and may have other multiorgan benefits.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The double-edged sword of early antibiotic exposure in extremely preterm infants: implications for necrotizing enterocolitis and growth faltering.","authors":"Jonathan A Berken, Maria C Rico, Joseph H Chou, Juan D Matute","doi":"10.1038/s41390-025-04088-9","DOIUrl":"10.1038/s41390-025-04088-9","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We need to know more, much more about sports participation in adolescents.","authors":"Ricardo Ribeiro Agostinete, Vinícius Almeida-Correa, Antonio Vinícius Ribeiro-de-Oliveira, Pedro Bertacine-Neto, Lucas Rios-Cordeiro, Tiago Galbiatti-Nunes, Antonio Gonçalves-Neto, Romulo Araújo Fernandes","doi":"10.1038/s41390-025-04240-5","DOIUrl":"10.1038/s41390-025-04240-5","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneity in Kawasaki disease patients with coronary artery abnormalities investigated by data-driven cluster analysis.","authors":"Yuto Sunaga, Yohei Hasebe, Natsumi Kikuchi, Masashi Yoshizawa, Yosuke Kono, Nobuyuki Katsumata, Takeshi Inukai","doi":"10.1038/s41390-025-04205-8","DOIUrl":"10.1038/s41390-025-04205-8","url":null,"abstract":"<p><strong>Background: </strong>To clarify the clinical characteristics associated with coronary artery abnormality (CAA) in the acute phase of Kawasaki disease (KD) cases, we performed a cluster analysis.</p><p><strong>Methods: </strong>A retrospective cohort study of 103 KD cases that developed CAA (maximum Z-score for any coronary arteries >2.5) within 30 days after disease onset was conducted among 726 consecutive KD cases. The hierarchical cluster analysis was performed based on 20 continuous variables before treatment.</p><p><strong>Results: </strong>101 out of 103 cases were clustered into 4 subgroups. Cluster 1 was a younger group characterized by leukocytosis and elevated serum triglyceride levels with frequent coronary artery dilation before treatment and good initial treatment responses. Cluster 2 was a younger group characterized by anemia and lower serum albumin and total cholesterol levels. Cluster 3 was an older group with frequent coronary artery dilation before treatment. Cluster 4 was an older group characterized by elevated serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels, with poor treatment response and the lowest incidence of coronary artery dilatation before treatment.</p><p><strong>Conclusion: </strong>We identified four subgroups with distinct features, suggesting different backgrounds for CAA development. Consideration of possible heterogeneity might be helpful for a better understanding of the pathophysiology and better treatment strategies.</p><p><strong>Impact: </strong>To investigate possible heterogeneity in Kawasaki disease (KD) cases that developed coronary artery abnormality (CAA) in the acute phase and to evaluate associated clinical characteristics, we performed a cluster analysis in KD cases that developed CAA in the acute phase. Hierarchical cluster analysis in KD cases that developed CAA within 30 days after disease onset, based on clinical data before treatment, identified four subgroups with distinct features, suggesting different backgrounds for CAA development. Cluster analysis might be helpful for a better understanding of the pathophysiology and better treatment strategies in KD cases at high risk for developing CAAs.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events in pediatric orotracheal intubation in the pediatric emergency department: systematic review and meta-analysis.","authors":"Mohammed Alsabri, Ibrahim Kamal, Mohammed Al-Tawil, Eshak I Bahbah, Alaa Ahmed Elshanbary, Mohamed Sayed Zaazouee, Aroosa Zamarud, Abdullah S Binsaeedu, Muhammad Usman Shahbaz, Janu Chhetri","doi":"10.1038/s41390-025-04142-6","DOIUrl":"10.1038/s41390-025-04142-6","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to systematically review all adverse events (AEs) associated with orotracheal intubation in pediatric patients, with the ultimate goal of aiding healthcare center administration in establishing evidence-based guidelines and devising preventive strategies to mitigate AEs in pediatric intubation procedures.</p><p><strong>Methods: </strong>Systematic automated searches across pivotal databases were conducted up to 2023. The screening process was facilitated by EndNote X9 following the importation of citations. Data extraction was guided by predefined eligibility criteria after the elimination of duplicates and ineligible publications. The National Institutes of Health (NIH) quality evaluation instrument was employed to assess biases.</p><p><strong>Results: </strong>A total of twenty-four studies spanning from 2002 to 2023, encompassing 7135 patients were included in the analysis. Among the identified adverse events, moderate desaturation(≤90%) emerged as the most prevalent, affecting 508/2398 (23.9%, 95% CI: 17.6% to 30.3%) of cases across 13 studies. Mainstem intubation was observed in 342 out of 4,481 cases (9.1%, 95% CI: 6.3% to 11.9%) and in 173 out of 3903 cases (3.9%, 95% CI: 2.5% to 5.3%), making these significant AEs. Cardiac complications, including arrhythmias 55/3858 (1.2%, 95% CI: 0.6% to 1.8%), hypotension 121/4536 (2.6%, 95% CI: 1.5% to 3.7%), and cardiac arrest 105/4836 (1.4%, 95% CI: 0.7% to 2.2%), were observed in 10, 11, and 11 trials, respectively. Severe complications, with an incidence rate of 274/3298 (8.8%, 95% CI: 4.2% to 13.3%), were reported in five studies.</p><p><strong>Conclusion: </strong>This comprehensive investigation and subsequent meta-analysis of adverse events associated with pediatric intubation provide valuable insights that can inform the development of enhanced safety protocols and evidence-based guidelines for pediatric emergency care.</p><p><strong>Impact: </strong>High Success Rate with Complications: An 84.7% intubation success rate is reported, with a 30.1% complication rate, including desaturation, mainstem and esophageal intubation, and cardiac issues. Need for Enhanced Safety Measures: Findings stress the importance of better training and standardized protocols to reduce complications in pediatric emergency intubation. Focus on Adverse Events: This study uniquely highlights adverse events, offering crucial data for developing guidelines to improve safety in pediatric intubation.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Danilo Buonsenso: ECI biocommentary.","authors":"Danilo Buonsenso","doi":"10.1038/s41390-025-04236-1","DOIUrl":"10.1038/s41390-025-04236-1","url":null,"abstract":"","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postnatally induced TBX4 insufficiency confers pulmonary hypertension and impairs lung development in infant mice.","authors":"Caroline F Smith, Kathy L Ding, Gregory J Seedorf, Csaba Galambos, Steven H Abman","doi":"10.1038/s41390-025-04127-5","DOIUrl":"10.1038/s41390-025-04127-5","url":null,"abstract":"<p><strong>Background: </strong>Genetic variants in T-box transcription factor 4 (TBX4) cause pulmonary hypertension (PH); however, there are diverse phenotypes with respect to the timing and severity of disease. Previous mouse studies demonstrated that germline TBX4 knockout is embryonic lethal, but knowledge gaps exist in how postnatal disruption of TBX4 signaling affects lung structure and PH.</p><p><strong>Methods: </strong>A mouse model was used in which TBX4 was inactivated on day of life (DOL) 1. On DOL21, lung function was evaluated, and tissue was collected. Radial alveolar counts (RAC), vessel density, and right ventricular hypertrophy (RVH) were assessed. Downstream lung angiogenic (VEGF, KDR, and eNOS) and inflammatory mediators (TNF-a and IL-1) were measured.</p><p><strong>Results: </strong>TBX4-deficient mice exhibited decreased RAC compared to controls (p < 0.05). Total lung resistance was increased, and total lung compliance was reduced in the TBX4-deficient group (p < 0.05, p < 0.01). Postnatal TBX4 deletion reduced lung vessel density (p < 0.001) and caused RVH (p < 0.01). Lung pro-angiogenic and inflammatory cytokine expression was reduced in TBX4-deficient mice.</p><p><strong>Conclusion: </strong>Postnatal disruption of TBX4 signaling is sufficient to impair lung function, reduce alveolar and vascular growth, and cause RVH, which are associated with decreased lung expression of pro-angiogenic mediators but not enhanced inflammation.</p><p><strong>Impact: </strong>TBX4 insufficiency is a rare genetic cause of pulmonary hypertension (PH) with poorly understood, variable phenotypes. Postnatal disruption of TBX4 is sufficient to cause pulmonary vascular disease and impair lung development in infant mice. Although narrower in scope, we hypothesize that the late timing of TBX4 disruption plays a role in the severity of the lung phenotype. Pro-angiogenic mediators (VEGF, KDR, and eNOS) and inflammatory cytokines (TNF-a and IL-1) are downregulated in the lungs of TBX4-deficient mice. We speculate that greater insight into the mechanisms underlying TBX4-related PH may provide novel therapeutic targets for the management of TBX4 disease.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum uric acid/creatinine ratio and metabolic-associated fatty liver disease risks in children.","authors":"Bi Chen, Xiaoning Qu, Ting Li, Minghua Jiang","doi":"10.1038/s41390-025-04219-2","DOIUrl":"10.1038/s41390-025-04219-2","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the correlation between serum uric acid/creatinine ratio (SUA/Cr) and Metabolic-associated fatty liver disease (MAFLD) in children.</p><p><strong>Methods: </strong>1387 participants aged 4-15 who underwent health examinations from 1/2020-12/2023 were included. Clinical indicators were compared and analyzed.</p><p><strong>Results: </strong>Overweight/obese group had elevated levels compared to non-overweight/obese group in male proportion, uric acid (UA), serum uric acid/creatinine ratio (SUA/Cr), systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), gamma-glutamyltransferase(GGT), total protein(TP), albumin(ALB), globulin(GLO), and serum creatinine(SCr) (p < 0.001, Kruskal-Wallis test). As SUA/Cr increased, UA, ALT, ALP, TP, GGT levels and the prevalence rates of overweight/obesity rose, while SCr levels fell (p < 0.05, Jonckheere-Terpstra test), and positively related to body mass index (BMI) (p < 0.05). The OR for overweight/obesity increased in higher SUA/Cr quartile groups, as Q3 (OR = 2.399, 95% confidence interval CI = 1.554-3.703) and Q4 (OR = 5.044, 95% CI = 3.281-7.754). The SUA/Cr exhibited an AUC of 0.828 (95% CI = 0.764-0.892, p < 0.001) in predicting overweight/obesity and elevated ALT levels, with a specificity of 0.764 and sensitivity of 0. 805.</p><p><strong>Conclusions: </strong>Children with overweight/obesity have higher liver enzymes, and elevated SUA/Cr levels may predict an increased incidence of overweight/obesity and hepatic injury.</p><p><strong>Impact: </strong>This study found a close association between serum uric acid/creatinine ratio (SUA/Cr) and risk factors for Metabolic-associated fatty liver disease (MAFLD) in children. SUA/Cr may be an indicator of risk factors for MAFLD in children. Elevated SUA/Cr levels may predict an increased incidence of overweight/obesity and hepatic injury. Providing an easily accessible non-invasive biomarker for predicting and preventing MAFLD in children.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological differences in cardiopulmonary exercise testing between children and adults.","authors":"Valentina Papic, Romina Ledergerber, Ralf Roth, Raphael Knaier","doi":"10.1038/s41390-025-04212-9","DOIUrl":"10.1038/s41390-025-04212-9","url":null,"abstract":"<p><strong>Background: </strong>Physiological responses to exercise differ between children and adults, but achieving maximal exertion in children complicates the interpretation of VO₂_max. This study, therefore, examines age- and sex-related physiological differences in submaximal parameters during incremental exercise.</p><p><strong>Methods: </strong>In this cross-sectional study, 24 children (7-11 years), 20 moderately trained adults (MTA), and 20 well-trained adults (WTA; 20-30 years) completed a maximal incremental exercise test on a cycle ergometer with continuous respiratory measurement. Linear regression models analysed age and sex differences in ventilatory thresholds (VT1, VT2) and oxygen uptake efficiency slope and plateau (OUES), with Cohen's d effect sizes reported.</p><p><strong>Results: </strong>Children showed higher body mass-adjusted VO₂ at VT1 and VT2 (d = 0.58-0.66) compared to MTA, and slightly lower VT2 values than WTA (d = 0.35). Adults had higher absolute OUES (d = 0.37-1.45) and OUEP (d = 0.60-0.81), while children exhibited higher body mass-adjusted OUES (d = 0.87 - 1.80). Males had higher VO₂ at VT2, OUES, and OUEP (d = 0.41-0.81), while females showed higher relative VO₂ at VT1 and VT2 (d = 0.44-0.59) compared to males.</p><p><strong>Conclusions: </strong>Children rely more on oxidative metabolism than adults. Maturation influences exercise efficiency more than body mass, underscoring physiological differences. These age- and sex-specific patterns call for longitudinal studies to further explore the roles of growth and training.</p><p><strong>Impact: </strong>This study identifies clear physiological differences in submaximal CPET parameters between children and adults. It adds novel insight by including both ventilatory thresholds and oxygen uptake efficiency, adjusted for body mass and training status. The findings suggest children rely more on oxidative metabolism, emphasizing the importance of maturation on exercise efficiency and informing age- and sex-specific assessment protocols in pediatric exercise physiology.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil heterogeneity in Kawasaki disease and multisystem inflammatory syndrome in children.","authors":"Nana Wang, Ling Sun, Guanghui Qian, Haitao Lv, Zhiheng Liu","doi":"10.1038/s41390-025-04200-z","DOIUrl":"10.1038/s41390-025-04200-z","url":null,"abstract":"<p><p>Neutrophils, specialized cells of the early innate immune response, are important for maintaining the body's internal homeostasis. Upon invasion by foreign microbes, neutrophils are swiftly activated and recruited to the infection site, where they perform bactericidal functions through phagocytic clearance, degranulation-mediated toxin release, and NADPH oxidase-dependent killing. While their presence is crucial in the early stages of inflammation to combat infection, the prolonged engagement of neutrophils at the infection site can cause tissue damage due to apoptosis and the release of cytotoxic mediators. Neutrophils exhibit significant heterogeneity in response to allostatic conditions, with their phenotypic and functional properties undergoing distinct changes. Therefore, understanding the heterogeneity and diversity of neutrophils under physiological and pathological conditions is important. Multisystem inflammatory syndrome in children (MIS-C) is a pediatric inflammatory syndrome that emerges following exposure to SARS-CoV-2, while Kawasaki disease (KD) is a childhood systemic vasculitis with unknown etiology. Both conditions share clinical features, including neutrophilia and cardiovascular complications. This suggests the likelihood of overlapping underlying immunopathogenic mechanisms, and neutrophils may play a crucial role in these processes. This review focuses on the heterogeneity and function of neutrophils in KD and MIS-C, providing a comprehensive overview of the current research in this field. IMPACT: Neutrophils exhibit significant heterogeneity under physiological and pathological states. Different neutrophil subsets perform diverse functional characteristics. KD and MIS-C have apparent phenotypic similarities of systemic inflammation and cardiovascular complications. Neutrophil heterogeneity correlates with disease severity, and studies of neutrophil subsets reveal potential shared immunological drivers. Multi-omics analysis of neutrophil heterogeneity helps to better understand neutrophil subsets and discover new functions. Research into MIS-C and KD enhances our understanding of pediatric inflammatory diseases with cardiovascular involvement.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}