Transplant Infectious Disease最新文献

{"title":"Infection-Associated Immune Reconstitution Inflammatory Syndrome in Hematopoietic Cell Transplantation.","authors":"Mansi Chaturvedi, Brian P Epling, Luxin Pei, Brigit Sullivan, Hye Sun Kuehn, Dima A Hammoud, Sergio Rosenzweig, Sung-Yun Pai, Irini Sereti, Alexandra F Freeman, Jennifer Cuellar-Rodriguez, Corina E Gonzalez, Maura Manion","doi":"10.1111/tid.70000","DOIUrl":"https://doi.org/10.1111/tid.70000","url":null,"abstract":"<p><p>Immune reconstitution inflammatory syndrome (IRIS) is a well-recognized complication in people with HIV (PWH) starting antiretroviral therapy (ART), but data on IRIS in hematopoietic cell transplantation (HCT) recipients are limited. To address this gap, we conducted a narrative review of the literature on IRIS in HCT recipients, including 21 studies encompassing 53 patients. The majority of reported patients had inborn errors of immunity (IEI) and developed IRIS associated with Bacillus Calmette-Guérin (BCG)-infection from prior vaccination (\"BCG-IRIS\"). The remainder had IRIS linked to other infections, most commonly Aspergillus and Non-tuberculous mycobacteria (\"non-BCG-IRIS\"). The median time between transplant and IRIS was 3 months; however, some patients developed IRIS multiple years posttransplant. BCG-IRIS was predominantly unmasking, while non-BCG-IRIS was mostly associated with a new infection acquired after HCT alongside immune recovery and/or changes in immunosuppression (\"post-HCT infection IRIS\"). Inflammatory biomarkers and tissue pathology were helpful in distinguishing IRIS from uncontrolled infection. Initiation or continuation of appropriate antimicrobial therapy in the peri-transplant period was foremost in the prevention and treatment of IRIS. Use of steroidal and nonsteroidal immunosuppression was common, while surgery was used as an adjunctive measure to infection control. Recrudescence of IRIS symptoms was common with discontinuation or decrease in immunosuppression. About one-third of the patients were reported to have graft-versus-host disease, and the rate of graft failure was 8%. The mortality rate was 15%, with most deaths attributed to superimposed infections. Through this review, we aim to highlight that IRIS is an under-recognized entity in HCT recipients and future research is needed to explore its pathogenesis, risk factors, and management in this complex patient population.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70000"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442191","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":"Coccidioidomycosis Prophylaxis in Liver, Kidney, and Heart Transplant Recipients Residing in Endemic Areas Within the United States.","authors":"Faiza Morado, Roland Davoudi, Rachel Cartus, Pnada Kawewat-Ho, Apurva Akkad, Suhail A Shaikh","doi":"10.1111/tid.70004","DOIUrl":"https://doi.org/10.1111/tid.70004","url":null,"abstract":"<p><strong>Background: </strong>Solid organ transplant (SOT) recipients residing in southwestern United States may be at an increased risk of symptomatic coccidioidomycosis (CM). Accordingly, clinical practice guidelines recommend the use of a universal oral azole antifungal prevention strategy for all SOT recipients residing in a CM endemic area. However, this recommendation is based on limited evidence. Our center does not routinely utilize CM azole antifungal prophylaxis for SOT recipients at low risk for de novo CM infection.</p><p><strong>Objective: </strong>To determine the incidence of CM with or without CM prophylaxis in Coccidioides seronegative liver, kidney, and heart transplant recipients residing in endemic areas with no documented history of CM at time of transplant.</p><p><strong>Study design: </strong>A retrospective chart review was performed for SOT recipients who resided in CM endemic areas and received an organ transplant at Keck Hospital of USC between March 2017 and June 2023. Patients receiving CM prophylaxis with fluconazole were compared to patients not receiving CM prophylaxis. The primary end point was incidence of CM infection or asymptomatic seroconversion.</p><p><strong>Results: </strong>In our 85-patient cohort, 18 patients received CM prophylaxis compared to 67 patients who did not. Most patients who received prophylaxis were heart transplant recipients (66.6%). No cases of CM occurred within a median follow-up period of 2.2 years.</p><p><strong>Conclusion: </strong>CM prophylaxis can be considered but may not be warranted for liver and kidney transplant recipients residing in Coccidioides endemic areas who are seronegative for Coccidioides and have no history of CM before transplant.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70004"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442185","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":"Mycobacterium abscessus Complex Infections Among Lung Transplant Recipients: A Multicenter Retrospective Cohort Study in Canada.","authors":"Roni Bitterman, Hafid Soualhine, Pierre-Marie Akochy, Charles Poirier, Pasquale Ferraro, Dima Kabbani, Alim Hirji, Gregory Tyrrell, Celine Bergeron, Robert D Levy, Alissa Wright, Victor Leung, Lianne G Singer, Cecilia Chaparro, Shaf Keshavjee, Melissa Richard-Greenblatt, Shahid Husain, Me-Linh Luong","doi":"10.1111/tid.70003","DOIUrl":"https://doi.org/10.1111/tid.70003","url":null,"abstract":"<p><strong>Background: </strong>Mycobacterium abscessus complex is known to cause life-threatening disease in lung transplantation (LT) recipients (LTRs). Therefore, many centers consider the presence of M. abscessus as a relative contraindication to LT.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study including all 4 LT centers in Canada. All LTRs transplanted in 2006-2016 with at least one respiratory sample positive for M. abscessus prior or posttransplantation were included. Pulmonary disease was defined using the American Thoracic Society criteria. Minimal follow-up duration was 5 years after transplantation.</p><p><strong>Results: </strong>Among 2181 LTRs across Canada, 14 had M. abscessus disease after LT (incidence rate 1.1/1000 transplant-years) and 6 had pulmonary colonization (incidence rate 0.5/1000 transplant-years). Fifteen patients had M. abscessus cultured before LT. Among those with pretransplant M. abscessus, 53% (8/15) developed M. abscessus infection posttransplant (6 disease, 2 colonization). Posttransplant disease was less frequent among those with microbiologic eradication before transplant (0% vs. 85.7%, p = 0.001). LTRs with pretransplant M. abscessus had comparable survival to those without M. abscessus (log rank p = 0.37). Among patients with pretransplant infection, mortality was higher in those who did not achieve microbiological eradication before transplantation (57.1% vs. 0%, p = 0.03) and those who developed disease after transplantation (66.7% vs. 0%, p = 0.01).</p><p><strong>Conclusions: </strong>M. abscessus is an uncommon cause of infection among LTRs. Survival among those with pretransplant M. abscessus infection was similar to that observed in noninfected LTRs. However, lack of eradication before transplantation was associated with higher posttransplant disease and mortality.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70003"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441401","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":"Efficacy and Safety of Letermovir for Cytomegalovirus Prophylaxis in Pediatric Hematopoietic Stem Cell Transplantation Recipients: A Systematic Review, Meta-Analysis, and Meta-Regression.","authors":"Abdullah Yousef Aldalati, Ayham Mohammad Hussein, Elsayed Balbaa, Bara M Hammadeh, Muhammad Idrees, Osama Aloudat, Moath Albliwi, Mohammad Abuassi, Iyad Sultan","doi":"10.1111/tid.70006","DOIUrl":"https://doi.org/10.1111/tid.70006","url":null,"abstract":"<p><strong>Objective: </strong>Letermovir (LTV) is a novel antiviral agent approved by the FDA in 2017 for CMV prophylaxis in adult CMV-seropositive allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients and approved for pediatric use in 2024. This study systematically evaluates the efficacy and safety of LTV prophylaxis for CMV infection in pediatric allo-HSCT recipients.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, Web of Science, Embase, and Cochrane Library up to December 2024 for studies that evaluated the use of LTV prophylaxis in pediatric allo-HSCT recipients. We conducted single-arm meta-analysis using Open Meta Analyst software and double-arm meta-analysis using R Studio. We pooled the dichotomous outcomes as event and total using the fixed-effects model.</p><p><strong>Results: </strong>Twelve articles were included in the analysis. The single-arm meta-analysis indicated that the prophylactic use of LTV against CMV among pediatrics was associated with a 10.9% (95% CI: 0.065, 0.153) infection rate without any disease occurrence. The percentage of patients who discontinued the drug due to adverse reactions was only 2.4% (95% CI: 0.003, 0.045), and all-cause mortality was 7.9% (95% CI: 0.032, 0.126). The double-arm meta-analysis results indicated that the incidence of CMV infection was significantly lower in the LTV group in comparison to the control group (RR: 0.29; 95% CI: 0.16, 0.56; p < 0.001).</p><p><strong>Conclusion: </strong>LTV has demonstrated safety and efficacy in preventing CMV infection and disease among high-risk pediatric patients. Future large scale randomized trials are necessary to validate the findings.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70006"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442187","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":"Crusted Scabies with Facial Involvement in a Patient Following Haploidentical Hematopoietic Stem Cell Transplantation: A Case Report.","authors":"Yingying Qian, Siyuan Song, Yan Li","doi":"10.1111/tid.70002","DOIUrl":"https://doi.org/10.1111/tid.70002","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e70002"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442186","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":"Universal Multiplex Panel Testing of Donor Lungs as a Strategy to Optimize Antibiotic Prophylaxis Against Multidrug-Resistant Bacteria.","authors":"Rayid Abdulqawi, Rana A Saleh, Reem M Alameer, Roaa Alabiri, Ruba Alabiri, Khaled Alkattan, Reem S Almaghrabi, Zainab Al Duhailib, Sahar Althawadi, Najib M Rahman, Waleed Saleh, Amani H Yamani, Eid A Al-Mutairy","doi":"10.1111/tid.14446","DOIUrl":"https://doi.org/10.1111/tid.14446","url":null,"abstract":"<p><strong>Background: </strong>Twenty percent of lung donors in our transplant program carry respiratory carbapenem-resistant (CR) gram-negative bacteria (GNB), most commonly CR Acinetobacter baumannii. Universal multiplex panel testing of lung transplant donors was introduced in June 2022 as a strategy to expedite CR-GNB detection and optimize perioperative antibiotic prophylaxis. We herein describe our experiences with this approach.</p><p><strong>Methods: </strong>Retrospective single-center cohort study including 53 adult patients who underwent lung-only transplantation between June 2022 and December 2023.</p><p><strong>Results: </strong>The most common bacteria identified by the multiplex panel were Staphylococcus aureus (n = 20), A. baumannii (n = 13), Klebsiella pneumoniae (n = 13), and Pseudomonas aeruginosa (n = 10). The panel detected 6/9 A. baumannii, 2/2 CR K. pneumoniae, 1/1 CR P. aeruginosa, and 7/8 methicillin-resistant S. aureus that were grown on conventional cultures, corresponding to negative predictive values of 94%, 100%, 100%, and 98%. Based on panel or culture results, IV tigecycline was administered as prophylaxis in 19% of patients, colistin in 17%, and novel beta-lactams in 15%.</p><p><strong>Conclusion: </strong>The multiplex panel rapidly detected donor CR-GNB with a high negative predictive value and resulted in clinical effects of reducing broad-spectrum antibiotic prescriptions and maintaining adequate posttransplant outcomes. Prospective studies with predefined outcomes are needed to compare panel-directed therapy against current standards of care.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14446"},"PeriodicalIF":2.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441411","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":"Application of Syndromic Panels for respiratory Tract Infections in Lung Transplantation: A Critical Review on Current Evidence and Future Perspectives.","authors":"Andrea Lombardi, Giulia Renisi, Arianna Liparoti, Chiara Bobbio, Alessandra Bandera","doi":"10.1111/tid.14448","DOIUrl":"https://doi.org/10.1111/tid.14448","url":null,"abstract":"<p><strong>Background: </strong>Infections are a common complication among lung transplant recipients (LuTR), particularly in the first year post-transplant, with respiratory tract infections (RTI) being predominant. Syndromic molecular panels have been suggested to reduce morbidity and mortality by providing a diagnosis quickly. However, integrating these panels into clinical practice remains debated.</p><p><strong>Methods: </strong>An electronic search was conducted in PubMed, Scopus, and Embase to identify studies on applying syndromic panels for RTI diagnosis in LuTR. Three reviewers independently screened-extracted data from relevant studies, focusing on concordance between syndromic panels and standard microbiologic tests and reporting isolates not detected by syndromic panels.</p><p><strong>Results: </strong>Four studies met the inclusion criteria, including 308 patients. The BioFire FilmArray Pneumonia Panel was the syndromic panel most frequently employed. In three studies, the syndromic panel was employed in LuTR with suspected RTI or during routine surveillance bronchoalveolar lavage; only in one case was the syndromic panel employed during the transplant procedure on samples from the donor. Agreement between syndromic panels and standard tests ranged from 0.56 to 0.98, with result turnaround times between 2.3 and 21.2 h. Sensitivity ranged from 58% to 94%, and specificity from 78% to 100%. Pathogens outside syndromic panels targets but identified by standard tests included Candida spp., unspecified gram-negative rods, and Aspergillus spp.</p><p><strong>Conclusion: </strong>Syndromic panels offer a faster alternative to standard microbiologic tests. However, they miss numerous possible pathogens, highlighting the necessity for concurrent standard testing. Further research is needed to establish the most efficient integration of syndromic panels in LuTx infection diagnostic.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14448"},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068308","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":"Drug-Induced Hypersensitivity Syndrome/Drug Reaction With Eosinophilia and Systemic Symptoms With Reactivation of Human Herpesvirus-6 in a Liver Transplant Recipient.","authors":"Rebecca Unterborn, Kaitlin Blotske, Maheen Z Abidi","doi":"10.1111/tid.14447","DOIUrl":"10.1111/tid.14447","url":null,"abstract":"","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14447"},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066670","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":"Invasive Fungal Diseases in Patients with Multiple Myeloma: Experience at a Large, Urban Referral Center.","authors":"Emily Baneman, Alan Weinberg, Timothy Sullivan, Risa Fuller, Dallas Dunn, Sarah Taimur, Meenakshi Rana, Samantha E Jacobs","doi":"10.1111/tid.14439","DOIUrl":"https://doi.org/10.1111/tid.14439","url":null,"abstract":"<p><strong>Background: </strong>Although infections are a leading cause of morbidity and mortality among patients with multiple myeloma (MM), the epidemiology of invasive fungal disease (IFD) is less well characterized in this population than in other hematologic malignancies.</p><p><strong>Methods: </strong>We conducted a nested 3:1 case-control study of IFD at a large MM referral center to identify risk factors for IFD in this population.</p><p><strong>Results: </strong>In a cohort of 2960 patients, we identified 32 episodes of IFD among 31 patients between 01/2011 and 06/2019. There was a median of 3.6 years from MM diagnosis to IFD, and patients had a median of four lines of chemotherapy (range 1-12) before IFD. Seventeen (53%) had previous autologous hematopoietic cell transplants. At the time of IFD, 23 (72%) had progressive disease status. Fifteen (47%) and 13 (41%) had severe neutropenia and lymphopenia, respectively, and 18 (56%) had hypogammaglobulinemia. Microbiologic etiologies included Aspergillus (n = 18), Candida (n = 6), Cryptococcus (n = 3), Mucorales (n = 3), Histoplasma (n = 1), and undetermined organism (n = 1). In the case-control analysis, progressive disease status (OR 1.35, p = 0.02) and neutropenia (OR 17.5, p = 0.02) were significant risk factors for IFD. In addition, ≥3 prior lines of chemotherapy trended toward statistical significance (OR 5.6, p = 0.07).</p><p><strong>Conclusion: </strong>This is the largest detailed description of IFD epidemiology in MM patients and the largest controlled analysis of risk factors in this population. Overall, the risk of IFD was low.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14439"},"PeriodicalIF":2.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012479","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":"Carbapenemase-Producing Enterobacterales: An Increasing Threat to Australian Liver Transplant Recipients.","authors":"Dinuli Kamaladasa, Ken Liu, Leanne Dolan, Sebastiaan J van Hal, Andie Lee, Tina Marinelli","doi":"10.1111/tid.14432","DOIUrl":"https://doi.org/10.1111/tid.14432","url":null,"abstract":"<p><strong>Introduction: </strong>Carbapenemase-producing Enterobacterales (CPE) are associated with increased morbidity and mortality in liver transplant recipients (LTRs). There is a paucity of data regarding CPE colonization and infection in Australian LTRs.</p><p><strong>Methods: </strong>A single-center retrospective cohort study of CPE was performed in LTRs from 2015 to 2024. LTRs underwent targeted screening and a period of enhanced screening to evaluate the incidence of CPE colonization. CPE infections were identified via clinical samples. All CPE isolates underwent whole genome sequencing. CPE isolation rates in LTRs were compared to the general hospital population and trends over time were analyzed.</p><p><strong>Results: </strong>There were 31 episodes of CPE isolation (5 community acquired, 26 healthcare associated) from 28 LTRs. Nine episodes of CPE infection were found: urinary tract (n = 3), bloodstream (n = 3), wound/abscess (n = 2), and Salmonella gastroenteritis (n = 1). The remaining 22 episodes represented new CPE colonization. CPE Klebsiella pneumoniae was the most common bacterial species (n = 12) with the New Delhi metallo-β-lactamase (n = 13), the most common CPE gene detected. CPE isolation rates in LTRs increased over the study period (p = 0.06). The overall rate of CPE infection was significantly higher in LTRs than the general hospital population (1.92 vs. 0.30 per 10 000 occupied bed days, p = 0.04). Enhanced CPE screening identified an additional eight episodes of CPE colonization in 415 patients screened (1.9%).</p><p><strong>Conclusion: </strong>CPE is an emerging threat for Australian LTRs and there is an urgent need to optimize strategies to prevent CPE colonization and infection in LTRs.</p>","PeriodicalId":23318,"journal":{"name":"Transplant Infectious Disease","volume":" ","pages":"e14432"},"PeriodicalIF":2.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012478","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}