Arthroplasty Today最新文献

{"title":"Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis","authors":"","doi":"10.1016/j.artd.2024.101548","DOIUrl":"10.1016/j.artd.2024.101548","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events.</div></div><div><h3>Methods</h3><div>The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts.</div></div><div><h3>Results</h3><div>In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, <em>P</em> &lt; .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, <em>P</em> &lt; .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, <em>P</em> &lt; .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, <em>P</em> &lt; .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, <em>P</em> = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, <em>P</em> = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, <em>P</em> = .564).</div></div><div><h3>Conclusions</h3><div>Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planned Realignment Osteotomies Ahead of Knee Arthroplasty for Pronounced Joint Malalignment: A Case Report in Hereditary Multiple Exostoses Disease","authors":"","doi":"10.1016/j.artd.2024.101519","DOIUrl":"10.1016/j.artd.2024.101519","url":null,"abstract":"<div><div>Various approaches have been reported to achieve correctly aligned total knee arthroplasty in cases of knee arthritis with pronounced extra-articular bone malalignment. Revision instrumentation and implants have enabled bone correction coincident with knee arthroplasty in notable tibial and/or femoral deviation, however increasing operative complexity and inherent risks. In the presented patient with hereditary multiple exostoses disease and progressing knee arthritis for extra-articular malalignment, elected treatment strategy was to primarily correct joint plane deformity through femoral and tibial osteotomies, ahead of and preparing for later knee arthroplasty. Staged osteotomies prior to total knee arthroplasty are effective for managing severe extra-articular malalignment, improving surgical outcome and prosthetic longevity.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to Editor: Intraarticular Vancomycin Reduces Prosthetic Infection in Primary Hip and Knee Arthroplasty","authors":"","doi":"10.1016/j.artd.2024.101546","DOIUrl":"10.1016/j.artd.2024.101546","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Benign Prostatic Hyperplasia on Postoperative Complications and Periprosthetic Joint Infections After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.artd.2024.101552","DOIUrl":"10.1016/j.artd.2024.101552","url":null,"abstract":"<div><h3>Background</h3><div>Total joint arthroplasty (TJA) is one of the most frequently performed surgical procedures each year, offering considerable cost-effectiveness and numerous benefits. However, certain postoperative complications can be observed following TJA. While the relationship between various comorbidities and these complications has been well-documented, this study aims to specifically investigate the impact of benign prostatic hyperplasia (BPH) on postoperative outcomes.</div></div><div><h3>Methods</h3><div>For this systematic review, we searched PubMed, Scopus, and Web of Science using terms like \"total hip arthroplasty,\" \"total knee arthroplasty,\" \"BPH,\" and \"benign prostatic hypertrophy.\" Screening of retrieved articles was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing complications in TJA between patients with and without preexisting BPH were eligible for inclusion. Data extraction was performed on the included articles, and their quality was assessed using the Newcastle-Ottawa scale. A meta-analysis was conducted using the Mantel-Haenszel method.</div></div><div><h3>Results</h3><div>This systematic review encompassed 4 articles evaluating TJA outcomes in men with a history of BPH, involving a total of 75,222 male cases. Among these, 17,183 cases (23%) presented with symptomatic BPH. The meta-analysis revealed that the incidence rate of periprosthetic joint infection did not significantly differ between BPH and non-BPH groups across both total hip and knee arthroplasty cases (odds ratio [OR] (95% confidence interval [CI]) = 1.28 [0.92-1.79]). However, postoperative urinary retention was significantly higher among patients with BPH (OR [95% CI] = 3.43 [2.04-5.78]). Additionally, patients with BPH exhibited a notably elevated incidence of postoperative urinary tract infection (OR [95% CI] = 2.55 [2.33-2.79]), as well as sepsis (OR [95% CI] = 1.31 [1.09-1.58]).</div></div><div><h3>Conclusions</h3><div>It is noteworthy that while patients with BPH are prone to certain complications, meta-analysis indicate that BPH cannot be considered a comorbidity that increases the risk of periprosthetic joint infection.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mathematical Evaluation of the Effects of the Head and Neck Diameter on the Arc of Motion and the Implications in Total Hip Arthroplasty","authors":"","doi":"10.1016/j.artd.2024.101556","DOIUrl":"10.1016/j.artd.2024.101556","url":null,"abstract":"<div><h3>Background</h3><div>Instability following total hip arthroplasty (THA) is a leading cause of revisions. Our objective was to evaluate the options that the surgeon has, to gain inherent stability with the use of conventional large femoral and dual mobility systems, and how the arc of motion (AOM) and jump distances (JDs) vary between them.</div></div><div><h3>Methods</h3><div>The head sizes examined spanned from 22 mm-54 mm, and neck sizes spanned from 10 mm-14 mm. Autodesk Fusion 360 is full-scale computer-aided designsoftware that can run simulations to validate a design. It was employed to calculate the AOM for each model. The JD was calculated with varying head sizes and 10- and 20-degree highwall liners.</div></div><div><h3>Results</h3><div>Increasing head sizes from 22, 28, 32-36 mm showed a considerable increase in the AOM for every neck size; however, there was substantially less of an increase with head sizes larger than 36 mm. As neck sizes increased from 10-14 mm, the AOM decreased. The JD increased substantially with the addition of 10- and 20-degree highwall liners.</div></div><div><h3>Conclusions</h3><div>Both classical THA and the dual mobility systems achieve greater AOM than an anatomical normal hip. As the head diameter increases, the AOM and the JD increases. Increases in head size improve range of motion; however, head sizes over 36-40 mm gain little regarding component stability. The more durable and thinner modern polyethylene liners allow for larger conventional femoral heads. When considering between a classical THA or a dual mobility system, the minimal gains with increasing the head size in using a dual mobility system may be far outweighed by the increase in directional stability offered by the large head THA with highwall liners.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Are the Research Highlights of Periprosthetic Joint Infections From the 100 Most Cited Studies?","authors":"","doi":"10.1016/j.artd.2024.101564","DOIUrl":"10.1016/j.artd.2024.101564","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infections (PJIs) are a serious complication after total joint arthroplasty. Our study aimed to analyze the characteristics and research highlights of the top 100 most cited studies on PJI from an orthopaedic standpoint. Moreover, we sought to assess whether there has been a change in the level of evidence (LOE) throughout time.</div></div><div><h3>Methods</h3><div>We conducted a search of the PubMed, Embase, and Web of Science databases to identify the top 100 studies primarily focusing on PJI. Study characteristics assessed included publication year, LOE, journal of publication, and type of study. Research highlights of the included studies were classified into 6 sections. Linear regression was employed to assess correlation between LOE and publication year.</div></div><div><h3>Results</h3><div>The aggregated citation count of all studies was 19,558 and the median citation number was 129.5. While cohort studies were the most prevalent, articles focusing on analysis of costs associated with PJI care or PJI definition garnered the highest yearly citation counts. The bulk of included studies were concentrated in 3 orthopaedic journals and published in the 2010s. The majority of studies had a LOE II (30%) or III (34%). On regression analysis, LOE was not correlated with publication year (Pearson’s <em>r</em> = 0.013, <em>P</em> = .61).</div></div><div><h3>Conclusions</h3><div>The most cited PJI articles assessed the definition of PJI and PJI cost. Despite growing interest in PJI, the majority of studies had LOE II or III, highlighting the difficulty of conducting prospective randomized controlled trials in PJI patients.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Metal Ion Levels After Hip Resurfacing: A Comparison of 2 Different Implants","authors":"","doi":"10.1016/j.artd.2024.101555","DOIUrl":"10.1016/j.artd.2024.101555","url":null,"abstract":"<div><h3>Background</h3><div>While hip resurfacing arthroplasty has been shown to be an effective prosthetic solution for end-stage osteoarthritis, prior studies have also reported an increasing concern regarding blood metal ion levels following the use of metal-on-metal articulations. The purpose of this study was to compare early and midterm blood metal ion levels to functional outcomes and implant survivorship for patients treated with the Birmingham Hip Resurfacing (BHR) implant system and the ReCap Magnum.</div></div><div><h3>Methods</h3><div>A retrospective review identified 104 patients who underwent 134 hip resurfacing arthroplasties using BHR (n = 67) and ReCap (n = 67) at a single institution between 2006 and 2018. ReCap and BHR patients were matched 1:1 by sex, femoral head and acetabular cup sizes, age, and year of surgery. The primary outcome of interest was cobalt (Co) and chromium (Cr) ion levels.</div></div><div><h3>Results</h3><div>The ReCap cohort had lower median metal ion levels compared to the BHR cohort at 1-2 y (Co: 1.5 vs 1.9 parts per billion [ppb], <em>P</em> = .018; Cr: 1.3 vs 2.8 ppb, <em>P</em> = .008) and 3-5 y (Co: 1.1 vs 1.9 ppb, <em>P</em> = .001; Cr: 1.2 vs 2.2 ppb, <em>P</em> = .003) after surgery. Correlation analysis showed no significant associations between Co and Cr ion levels and pre- and postoperative patient-reported outcomes. Indications for revision differed between groups. Three BHR hips were revised due to adverse reactions to metal debris, whereas 2 ReCap hips required revisions: one for instability and another for periprosthetic fracture.</div></div><div><h3>Conclusions</h3><div>BHR patients had higher metal ion levels than ReCap patients at 1-2 and 3-5 y after surgery, though these metal levels are still low and in line with prior studies. Indications for revision differed between patients treated with BHR and ReCap. Surgeons should be aware of these outcomes when counseling patients regarding these metal-on-metal articulations.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Wear Still a Concern in Total Knee Arthroplasty With Contemporary Conventional and Highly Crosslinked Polyethylene Tibial Inserts in the mid- to Long-Term?","authors":"","doi":"10.1016/j.artd.2024.101550","DOIUrl":"10.1016/j.artd.2024.101550","url":null,"abstract":"<div><h3>Background</h3><div>Modern literature has brought into question if wear of tibial inserts made from conventional or highly crosslinked polyethylene (HXL PE) is still a factor limiting longevity of total knee arthroplasty (TKA) in the mid- to long-term. It is the objective of this study to determine: 1) most common causes of mid- to long-term TKA failure, 2) the prevalence of delamination, and 3) the medial/lateral linear wear rates of conventional and HXL PE tibial inserts retrieved in the mid- to long-term.</div></div><div><h3>Methods</h3><div>A tibial insert retrieval cohort of 107 inserts (79 conventional, 28 HXL PE) with a minimum time in situ of 6.5 years (mean 11.7 ± 4) was studied. Failure causes were determined from chart-review, delamination presence was assessed microscopically, and medial/lateral linear wear was determined by minimal thickness changes measured with a dial-indicator.</div></div><div><h3>Results</h3><div>The most common mid-to long-term etiologies for failure were instability (44.9%), PE wear 15%), aseptic loosening (14%), and infection (13.1%). Delamination occurred in 70% of inserts (72.1% conventional, 64.3% HXLPE). Gross material loss due to delamination appeared to be the underlying reason for at least 33.3% of cases exhibiting instability. Of the cases removed for infection, 75% exhibited no histopathological hallmarks of acute infection. The medial/lateral wear rates were 0.054/0.051 (conventional) and 0.014/0.011 (HXL) mm/y, respectively.</div></div><div><h3>Conclusions</h3><div>Polyethylene wear still appears to be a major primary and secondary cause for TKA revision in the mid- to long-term. Wear may manifest as destabilizing delamination or as continuous release of fine wear particles potentially resulting in inflammatory responses and subsequent failure.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Anesthesia in Total Hip Arthroplasty is Associated With Improved Outcomes in the American Joint Replacement Registry Population","authors":"","doi":"10.1016/j.artd.2024.101566","DOIUrl":"10.1016/j.artd.2024.101566","url":null,"abstract":"<div><h3>Background</h3><div>Despite previous studies showing benefits of spinal anesthesia (SA) for patients undergoing elective total hip arthroplasty (THA), most THA procedures throughout the United States still utilize general anesthesia (GA). Using the American Joint Replacement Registry data, our study explored outcome difference for patients undergoing THA administered SA vs GA.</div></div><div><h3>Methods</h3><div>All available THAs were identified using American Joint Replacement Registry data from 2017 to 2020. THA patients were categorized into 2 cohorts by anesthesia type. Demographics, hospital characteristics, and comorbidities were documented for each patient. Outcomes included operative time, length of stay, 30- and 90-day readmission, and 90-day all-cause revision. <em>Chi</em>-square analysis was used to assess categorical variables while multivariable regression analyzed the association between anesthesia type and outcomes of interest.</div></div><div><h3>Results</h3><div>A total of 217,124 THAs were identified, including 119,425 (55.0%) patients who received GA and 97,699 (45.0%) patients who received SA. Multivariable regression showed that SA was associated with a decreased risk of hospital length of stay &gt;3 days (adjusted odds ratio [aOR] 0.4, 95% confidence interval [CI]: 0.34-0.36, <em>P</em> &lt; .0001) and a lower likelihood of prolonged operative time (aOR 0.8, 95% CI: 0.79-0.82, <em>P</em> &lt; .0001). Additionally, patients who received SA had lower rates of 90-day readmission (aOR 0.7, 95% CI: 0.67-0.78, <em>P</em> &lt; .0001) and a decreased risk of 90-day all-cause revision (aOR 0.5, 95% CI: 0.47-0.54, <em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Patients receiving SA during THA had shorter operative time, reduced length of stay, and decreased rates of readmission and revision compared to patients who received GA. These findings add to the growing body of literature supporting the benefits of SA over GA for THA patients.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Bilateral Total hip Arthroplasty in Patients With Juvenile Idiopathic Arthritis via Direct Anterior Approach: Long-Term Outcomes","authors":"","doi":"10.1016/j.artd.2024.101557","DOIUrl":"10.1016/j.artd.2024.101557","url":null,"abstract":"<div><h3>Background</h3><div>Juvenile idiopathic arthritis (JIA) often results in significant bilateral hip damage, necessitating total hip arthroplasty (THA). Simultaneous bilateral THA offers potential advantages, particularly when executed via the Direct Anterior Approach (DAA). This study aims to assess the functional, radiological, and patient-reported outcomes, along with the complications of bilateral uncemented THA performed via DAA in patients with JIA.</div></div><div><h3>Methods</h3><div>A retrospective review of 39 patients with JIA who underwent bilateral THA via DAA from January 2006-January 2015 was conducted. Inclusion and exclusion criteria were defined, focusing on a minimum of 7 years of post-THA follow-up. Functional outcomes were assessed using the Harris Hip Score.</div></div><div><h3>Results</h3><div>Data were available for 33 patients (66 hips). The mean age at surgery was 21.3 years, and the average follow-up was 11.3 years. All patients reported severe bilateral hip pain presurgery, which was alleviated post-THA. The mean preoperative Harris Hip Score improved from 49.6-79.7 postoperatively. Complications included 3 calcar cracks, 2 greater trochanter fractures, and 1 superficial wound dehiscence. No instances of dislocation, postoperative periprosthetic fracture, or any revision surgery were recorded.</div></div><div><h3>Conclusions</h3><div>Simultaneous bilateral THA using DAA is an effective and safe surgical approach for patients with JIA with bilateral end-stage hip involvement, providing notable improvements in functional and radiological outcomes while maintaining a favorable complication profile.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}