World Journal of Pediatric Surgery最新文献

{"title":"Level of awareness regarding MIS-C among medical students and surgeons in Switzerland.","authors":"Sebastiano Brazzola, Laura Guglielmetti, Stephanie Gros, Stefan Holland-Cunz, Raphael Vuille-Dit-Bille, Julian Louis Muff","doi":"10.1136/wjps-2024-000986","DOIUrl":"10.1136/wjps-2024-000986","url":null,"abstract":"<p><strong>Background: </strong>Multisystem inflammatory syndrome in children (MIS-C) is a disease that emerged during the COVID-19 pandemic. Patients exhibit symptoms mimicking the clinical presentation of an acute abdomen, representing a novel differential diagnosis, particularly in the young generation. This study aims to investigate the current level of awareness of MIS-C among surgeons and medical students.</p><p><strong>Methods: </strong>We conducted an anonymous online questionnaire among members of the Swiss Surgical Society and Swiss medical students. The questionnaires collected participants' baseline demographics and their awareness regarding MIS-C.</p><p><strong>Results: </strong>Both students and surgeons obtained very low scores in the self-assessment and had a low score in the section with awareness questions (true score). In medical students, we observed a positive correlation between self-assessment and true scores (<i>ρ</i>=0.422, <i>p</i>=0.001), while surgeons had a negative correlation (<i>ρ</i>=-0.243, <i>p</i><0.001). Furthermore, there was a positive correlation between gender and self-assessment (<i>ρ</i>=0.245, <i>p</i><0.001), depicting a higher self-assessed score in female surgeons (median female self-assesment=5, IQR: 2-7). Likewise, board-certified pediatric surgeons and surgeons treating both children and adults had a higher self-assessment compared with non-pediatric surgeons. In both populations (surgeons and students), the true scores were similar in all the variables analyzed. Two-thirds of surgeons stated that MIS-C should be considered a differential diagnosis, and about half of surgeons indicated MIS-C being part of their differential diagnosis already.</p><p><strong>Conclusion: </strong>The results show an insufficient level of awareness concerning MIS-C among students and surgeons, warranting implementation in students' curriculum and surgeons' continuous training.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 2","pages":"e000986"},"PeriodicalIF":0.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095265","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}

{"title":"Operative management of congenital early-onset scoliosis using the vertical expandable prosthetic titanium rib (VEPTR): a case series.","authors":"Riaz Mohammed, Pranav Shah, Alwyn Jones, Sashin Ahuja, John Howes","doi":"10.1136/wjps-2024-000972","DOIUrl":"10.1136/wjps-2024-000972","url":null,"abstract":"<p><p>To analyze surgical challenges and outcomes in patients who completed the whole journey of vertical expandable prosthetic titanium rib (VEPTR) treatment for congenital early-onset scoliosis (C-EOS), given the limited evidence available on VEPTR graduates. A retrospective review was conducted on nine consecutive patients with C-EOS and thoracic hypoplasia treated at a single tertiary care center, with assessment of clinical and radiological outcomes. At mean duration of 7.4 (range 4.3-10.5) years of VEPTR treatment, the mean coronal deformity angle measured 65° preoperatively, 50° postoperatively, and 58° at final follow-up. Mean T1-S1 length (pre-op 252 mm, final follow-up 333 mm) and T1-T12 length (preop 128 mm, final follow-up 196 mm) improved by 32% at final follow-up. Mean space available for lung was 86% (range 79%-93%) preoperatively, increasing to 90% (range 85%-95%) postoperatively and 97% (range 87%-107%) at final follow-up. Nine children had a cumulative 17 (188%) complications comprising wound problems, infection, and device migration or prominence. In five patients who underwent definitive fusion, mean coronal deformity angle and T1-S1 length improved by 17% and 11%, respectively. VEPTR is valuable in managing EOS, particularly in patients with thoracic insufficiency syndrome. However, the need for multiple surgeries, limited correction potential, and risk of partial loss of correction make it less suitable for other cases.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 2","pages":"e000972"},"PeriodicalIF":0.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095267","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}

{"title":"Abandoning scientific colonization in pediatric global surgery: breaking barriers in knowledge dissemination to close gaps in surgical care.","authors":"Luiza Telles, Ayla Gerk, Madeleine Carroll, Ana Maria Bicudo Diniz, Brenda Feres, Roseanne Ferreira, Lauren Kratky, Joaquim Bustorff-Silva, David P Mooney","doi":"10.1136/wjps-2025-001033","DOIUrl":"10.1136/wjps-2025-001033","url":null,"abstract":"","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 2","pages":"e001033"},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095347","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}

{"title":"European strategies in the screening of biliary atresia: a scoping review.","authors":"Barbara E Wildhaber, Ana Maria Calinescu","doi":"10.1136/wjps-2025-001026","DOIUrl":"10.1136/wjps-2025-001026","url":null,"abstract":"<p><strong>Background: </strong>Biliary atresia (BA) is a rare condition that meets the criteria for neonatal screening. Taiwan province of China led the way in BA screening during the 1990s by introducing a neonatal stool color card (SCC), which proved effective in facilitating early BA diagnosis and improving outcomes. Another commonly studied BA screening approach is serum bilirubin measurement. Several European countries have also begun implementing BA screening initiatives, although slowly. In this study, we evaluate BA screening strategies across Europe.</p><p><strong>Methods: </strong>Published data, after having performed a scoping review, as well as internet searches were analyzed. Screening approaches proposed in Europe are described, including SCC, serum bilirubin measurements, and other biochemical markers such as bile acids or amino acid profiles.</p><p><strong>Results: </strong>In Europe, national BA screening programs have been established solely in Switzerland, France, and Germany, all using the SCC. Other European countries, such as the Netherlands, Portugal, and Italy, have made efforts, but have yet to achieve broad implementation beyond localized initiatives. Skepticism among healthcare professionals and logistical challenges seem to hinder broader adoption. Emerging technologies, such as artificial intelligence-enhanced SCC applications, may show promise in overcoming these barriers. Serum bilirubin measurement is another widely deliberated method, particularly in the UK, where it has been shown to be sensitive and specific for BA detection. However, logistical and financial limitations remain key obstacles to its widespread use. Other biochemical methods, such as bile acid and amino acid profiling, have shown potential in research settings, but lack clinical translation in Europe.</p><p><strong>Conclusions: </strong>This review highlights Europe's limited role in global BA screening efforts and emphasizes the need for advocacy, collaboration, and integration of screening strategies tailored to regional healthcare systems. Combining the SCC with bilirubin measurements could optimize cost-effectiveness and efficiency. Expanding BA screening programs requires strengthening advocacy efforts to improve outcomes for affected infants.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 2","pages":"e001026"},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095263","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}

{"title":"Increased morbidity associated with secondary abdominal closure in pediatric liver transplantation.","authors":"Carolina Magalhães Costa, Eduardo A Fonseca, Renata Pugliese, Marcel R Benavides, Rodrigo Vincenzi, Nathália P T Rangel, Caio M Oliveira, Karina Roda, Debora P Fernandes, João Seda Neto","doi":"10.1136/wjps-2024-000975","DOIUrl":"https://doi.org/10.1136/wjps-2024-000975","url":null,"abstract":"<p><strong>Background: </strong>The discrepancy in size between donor and recipient presents a complex challenge in pediatric liver transplantation (PLT), often necessitating secondary abdominal closure to prevent abdominal compartment syndrome. The aim of this study is to determine the variables associated with an increased risk of requiring secondary closure in PLT.</p><p><strong>Methods: </strong>The retrospective study analyzed all primary liver transplantations performed in patients under 18 years of age from January 2014 to July 2022. The primary endpoint was the risk of secondary abdominal closure. Variables analyzed included pretransplant status, perioperative and postoperative data.</p><p><strong>Results: </strong>A total of 664 PLT recipients were identified, of which 58 required secondary abdominal closure (8.7%). Most patients had biliary atresia (<i>n</i>=412, 62.0%), followed by metabolic diseases (<i>n</i>=78, 11.7%). Statistical difference were found in donor gender (<i>p</i>=0.020) and the recipient-to-donor body weight ratio (RDBW), which was lower in the secondary closure group (0.1±0.1 <i>vs.</i> 0.2±0.27; <i>p</i>=0.001), lower in secondary closure. The mean hospital and intensive care unit (ICU) stay after PLT was significantly longer in the intervention group compared to those with primary abdominal closure (24.4±20.4 days <i>vs.</i> 12.5±13.1 days, <i>p</i><0.001). Multivariable Cox regression analysis identified male donor as an independent risk factor for secondary abdominal closure (hazard ratio 1.9, <i>p</i>=0.030).</p><p><strong>Conclusions: </strong>Patients requiring secondary closure were smaller, had a lower RDBW, and received grafts with a higher graft-to-recipient weight ratio (GRWR), Graft size modulation and secondary abdominal closure are currently the techniques used to prevent compartment syndrome in PLT, particularly for children with low body weight.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 2","pages":"e000975"},"PeriodicalIF":0.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018784","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}

{"title":"Congenital focal nodular hyperplasia-like lesion mimicking hepatoblastoma: anecdotal but plausible.","authors":"Alessandra Gatto, Chiara Natale, Alessandra Preziosi, Michela Casanova, Rita Alaggio, Maurizio Cheli, Francesco Macchini, Andrea Zanini","doi":"10.1136/wjps-2024-000980","DOIUrl":"https://doi.org/10.1136/wjps-2024-000980","url":null,"abstract":"<p><p>Focal nodular hyperplasia (FNH)-like lesions of the liver are rare in the pediatric population and are seldom reported as congenital lesions. The differential diagnosis between these lesions and pure-fetal hepatoblastoma (HBL) is challenging. We present a case of a congenital FNH-like hepatic lesion, managed with a right hepatectomy due to suspected fetal HBL. Additionally, a review of all published cases of congenital FNH-like lesions of the liver was carried out.MRI.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 2","pages":"e000980"},"PeriodicalIF":0.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021529","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}

{"title":"Systematic review of ultrasound and MRI prediction of spinal cord anomalies in children with anorectal malformations: what a pediatric urologist writing a protocol needs to know.","authors":"Georgia Kirby, Iyad Zarifa, Abdelhameed Elkassaby, Patricia Delacy, Ashok Raghavan, Caroline MacDonald","doi":"10.1136/wjps-2024-000978","DOIUrl":"10.1136/wjps-2024-000978","url":null,"abstract":"<p><strong>Background: </strong>Anorectal malformation (ARM) have a high association with spinal cord anomaly (SCA) impacting bladder and bowel function. This study aims to report the diagnostic accuracy of ultrasound (US) and MRI to detect SCA in children with ARM.</p><p><strong>Method: </strong>A systematic review was performed as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Search terms used were broadened in three consecutive searches to find papers investigating outcomes from spinal imaging in ARM, with four author search validation. Study quality was assessed as per Quadas 2 score. Meta-analysis comparing US diagnosis to MRI findings was performed using random effects model, including only clinically relevant SCA and considering children who did not develop negative outcomes as a true negative.</p><p><strong>Results: </strong>Eight studies were included, six reporting US outcomes, and two MRI. All studies but one were retrospective studies. Overall, the included studies were applicable, but all suffered risk of bias with incomplete and non-protocolized follow-up. Pooled analysis for MRI compared with surgery found a sensitivity of 97% and a specificity of 94%, with one false positive and one false negative in an 8-month-old baby. When clinically relevant diagnoses were extracted and meta-analysis performed, a sensitivity of 33% and a specificity of 87% were found for infant US diagnosis of SCA.</p><p><strong>Conclusion: </strong>The normal US spine in early infancy does not have diagnostic weight. A positive early scan will allow you to stream into active surveillance. Mandated MRI of infants will depend on the local approach to prophylactic de-tethering surgery.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 1","pages":"e000978"},"PeriodicalIF":0.8,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804050","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}

{"title":"Current and future state of the management of Hirschsprung disease.","authors":"Jessica L Mueller, Ryo Hotta","doi":"10.1136/wjps-2024-000860","DOIUrl":"10.1136/wjps-2024-000860","url":null,"abstract":"<p><p>The enteric nervous system (ENS) consists of a network of neurons and glia that control numerous complex functions of the gastrointestinal tract. Hirschsprung disease (HSCR) is a congenital disorder characterized by the absence of ENS along variable lengths of distal intestine due to failure of neural crest-derived cells to colonize the distal intestine during embryonic development. A patient with HSCR usually presents with severe constipation in the neonatal period and is diagnosed by rectal suction biopsy, followed by pull-through procedure to surgically remove the affected segment and reconnect the proximal ganglionated intestine to the anus. Outcomes after pull-through surgery are suboptimal and many patients suffer from ongoing issues of dysmotility and bowel dysfunction, suggesting there is room for optimizing the management of this disease. This review focuses on discussing the recent advances to better understand HSCR and leverage them for more accurate and potentially less invasive diagnosis. We also discuss the potential future management of HSCR, particularly cell-based approaches for the treatment of HSCR.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 1","pages":"e000860"},"PeriodicalIF":0.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773585","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}

{"title":"Value of preoperative APRI and FIB-4 in assessing short-term prognosis after Kasai portoenterostomy.","authors":"Bingliang Li, Yingyu Jia, Hongxia Ren","doi":"10.1136/wjps-2025-001002","DOIUrl":"10.1136/wjps-2025-001002","url":null,"abstract":"<p><strong>Objective: </strong>To explore the value of preoperative Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) and Fibrosis-4 score (FIB-4) in predicting short-term prognosis of children with biliary atresia (BA) undergoing Kasai portoenterostomy (KPE).</p><p><strong>Methods: </strong>Clinical data from children who underwent KPE were analyzed. Patients were divided into two groups based on their 2-year native liver survival after KPE. General information and laboratory findings were collected before KPE. The difference in liver fibrosis between the two groups was analyzed. The predictive efficacy of each index for short-term prognosis of children with BA was evaluated using the receiver operating characteristic curve.</p><p><strong>Results: </strong>The APRI and FIB-4 in the good prognosis group were lower than those in the poor prognosis group (<i>p</i>=0.008 and 0.023, respectively), and postoperative jaundice clearance rate was higher (<i>p</i>=0.002). In the poor prognosis group, gamma-glutamyl transpeptidase levels in the F3+F4 fibrosis subgroup were significantly higher than those in the F1 subgroup (<i>p</i>=0.038). The area under the curve (AUC) for preoperative APRI in predicting short-term prognosis was the highest at 0.667, with a cut-off value of 1.190. The AUC for preoperative FIB-4 was predicted to be 0.642. The combination of preoperative APRI and alanine aminotransferase showed a higher AUC for prognosis prediction compared with either marker alone.</p><p><strong>Conclusions: </strong>Preoperative APRI and FIB-4 may havepredictive values for short-term prognosis. The predictive value of APRI and FIB-4 combined with liver function indicators for the short-term prognosis of children is superior to that of a single indicator, but the results are not satisfactory.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 1","pages":"e001002"},"PeriodicalIF":0.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754730","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}

{"title":"Management of urachal anomalies in children: insights from a retrospective cohort study.","authors":"Suhaib Abdulfattah, Iqra Nadeem, Yashaswi Parikh, Sami Shaikh, Sonam Saxena, Aznive Aghababian, Katherine Fischer, Sameer Mittal, Arun K Srinivasan, Aseem R Shukla","doi":"10.1136/wjps-2024-000977","DOIUrl":"10.1136/wjps-2024-000977","url":null,"abstract":"<p><strong>Introduction: </strong>While large and symptomatic urachal anomalies (UAs) often lead to surgical excision, urachal malignancy is rare, rendering prophylactic excision unwarranted. We hypothesize that in the pediatric population, the presentation of an infected UA is the predominant etiology leading to surgical intervention.</p><p><strong>Methods: </strong>We retrospectively identified patients with UA from July 2012 to December 2021 evaluated in our urology outpatient. Inclusion criteria included patients ≤18 years old and confirmation of UA on ultrasound (US). Exclusion criteria were patients diagnosed with clinical mimickers on US, excision by general pediatric surgery service, or excision done concomitantly as part of another urological procedure.</p><p><strong>Results: </strong>We identified a total of 78 patients with UA. Of those, 35 (44.9%) underwent excision. The observation cohort was younger (5 months <i>vs.</i> 73 months, <i>p</i>=0.002), more likely to be asymptomatic (65.1% <i>vs.</i> 85.7%, <i>p</i>=0.038), and more likely to have UA characterized as a 'remnant' on US (72.1% <i>vs.</i> 48.6%, <i>p</i>=0.034). Univariate analysis showed that infected or symptomatic UA, or those characterized as hyperemic, cystic, or as a diverticulum on US were more likely to be excised. Multivariable analysis shows that patients with a 'urachal cyst' classification (<i>p</i>=0.008) and infectious presentation (<i>p</i>=0.046) were more likely to undergo surgical intervention. Excision was accomplished laparoscopically (80.0%) or robotically (11.4%). No excised UA was suspicious for malignancy.</p><p><strong>Conclusion: </strong>We present a large pediatric cohort with UA and found that infectious symptoms at presentation and those classified as 'urachal cyst' based on US were more likely to prompt surgical excision as compared with other factors.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":"8 1","pages":"e000977"},"PeriodicalIF":0.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701718","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}