Transfusion Medicine (Oxford, England)最新文献

{"title":"HLA-DRB1 and cytokine polymorphisms in Brazilian patients with myelodysplastic syndromes and its association with red blood cell alloimmunization.","authors":"Marilia Fernandes Mascarenhas Sirianni,&nbsp;Emilia Sippert,&nbsp;Bruna Blos,&nbsp;Flavia Ricioli Vaz Gonçalves,&nbsp;Nelson Hamerschlak,&nbsp;Jose Kutner,&nbsp;Lilian Castilho,&nbsp;Luciana Carvalheiro Marti,&nbsp;Carolina Bonet-Bub","doi":"10.1111/tme.12894","DOIUrl":"https://doi.org/10.1111/tme.12894","url":null,"abstract":"<p><strong>Objective(s): </strong>This study aimed investigate association of HLA-DRB1 and cytokine polymorphisms with red blood cell(RBC) alloimmunization in Brazilian Myelodysplastic syndrome(MDS) patients with prior exposure to RBC transfusion.</p><p><strong>Background: </strong>MDS patients are at risk RBC alloimmunization due to chronic RBC transfusion. However, differences in immune response of MDS transfused patients are not completely known.</p><p><strong>Methods/materials: </strong>A retrospective cohort of 87 polytransfused patients with MDS including 28 alloimmunized (PA) and 59 non-alloimmunized (PNA) was evaluated in three Brazilian reference hospitals. HLA-DRB1genotype was performed by polymerase chain reaction (PCR)-SSOP (Luminex platform) and cytokine polymorphisms analysed by PCR and TaqMan assays.</p><p><strong>Results: </strong>While HLA-DRB1 allele frequencies did not differ between groups, IL17A 197G > A SNP and IL4 polymorphisms showed significant correlation with RBC alloimmunization. IL17A 197A allele A and AA genotype were significantly more frequent in PA than PNA(A, 46.4% versus 27.1%, p = 0.012; OR = 2.3; 95%CI = 1.1-4.9; AA, 25% versus 6.8%, p = 0.041; OR = 6.2; 95%CI 1.3-30.8). Moreover, significant association of alloimmunization to Rh antigens with IL17A 197A allele and AA genotype was also identified in PA group(A, 45% versus 27.1%, p = 0.036; OR = 2.5; 95% CI 1.1-5.7; AA, 30% versus 6.8%, p = 0.042; OR = 7.9; 95%CI 1.5-42.3). Genotype A1A2 of IL4 intron 3 was overrepresented in PA(50% versus 16.9%, p = 0.009; OR = 4.97; 95%CI 1.6-15.5). Similarly, IL4-590 CT genotype was overrepresented in PA(53.6% versus 28.8%, p = 0.049; OR = 3.3; 95%CI 1.2-9.3).</p><p><strong>Conclusions: </strong>This study showed no association regarding HLA-DRB1 alleles for RBC alloimmunization risk or protection, however the IL17A 197G>A, IL4 intron 3 and IL4 590C>T SNP was significantly associated to RBC alloimmunization risk in this cohort of Brazilian MDS patients.</p>","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":" ","pages":"394-401"},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40472208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behaviour based screening questions and potential donation loss using the \"for the assessment of individualised risk\" screening criteria: A Canadian perspective.","authors":"Niamh Caffrey,&nbsp;Mindy Goldman,&nbsp;Antoine Lewin,&nbsp;Lori Osmond,&nbsp;Sheila F O'Brien","doi":"10.1111/tme.12888","DOIUrl":"https://doi.org/10.1111/tme.12888","url":null,"abstract":"<p><strong>Background: </strong>To reduce the risk of HIV transmission through transfusion, gay, bisexual and other men who have sex with men (gbMSM) are deferred from donating blood in many countries for varying lengths of time after having sex with another man. In 2021, screening algorithms to identify high-risk sexual behaviours using gender-neutral criteria (i.e., without any question on MSM or time deferral for MSM) were implemented in the United Kingdom based on recommendations in a report from the FAIR (For the Assessment of Individualised Risk) steering group.</p><p><strong>Objectives: </strong>This study examines the potential donation loss expected with these criteria if implemented in Canada.</p><p><strong>Methods: </strong>Responses from blood donors regarding engagement in behaviours such as chemsex and anal sex with a new or multiple partners within 3 months of donation were collected using an on-site paper questionnaire.</p><p><strong>Results: </strong>Applying the FAIR criteria resulted in donation loss of 1.0% (95% CI: 0.8% - 1.1%). Donation loss would be higher amongst younger donors aged 17-25 (2.0%, 95% CI: 1.6% - 2.3%). Overall, 20% of donors reported feeling uncomfortable answering study questions but only 2.0% said it would stop them from donating.</p><p><strong>Conclusion: </strong>Donation loss could be compensated by newly eligible gbMSM and with increased recruitment and encouraging donation from infrequent donors.</p>","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":" ","pages":"422-427"},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage of refractory post-transfusion hyperhaemolysis by targeting hyperinflammation and macrophage activation with tocilizumab.","authors":"Frederick Chen,&nbsp;Catherine Booth,&nbsp;Filipa Barroso,&nbsp;Sarah Bennett,&nbsp;Banu Kaya,&nbsp;Nay Win,&nbsp;Paul Telfer","doi":"10.1111/tme.12793","DOIUrl":"https://doi.org/10.1111/tme.12793","url":null,"abstract":"To the Editor Hyperhaemolysis syndrome (HHS) is a severe post-transfusion complication that can develop rapidly and cause life-threatening anaemia and death unless recognised and treated promptly. It is mostly, but not exclusively, seen in sickle cell patients, often after multiple previous transfusions. In patients with previous history of hyperhaemolysis, further transfusions should be avoided, but if essential, transfusion should be administered with prophylactic intravenous immunoglobulins (IVIG) and steroids, antigen-negative red cells if there are known alloantibodies, matching the patient's full extended phenotype if feasible. However, as this case demonstrates, prophylaxis with standard first line therapy and compatible phenotyped blood may not be sufficient to prevent further episodes of HHS. HHS is characterised by the destruction of transfused and autologous red cells resulting in a fall in haemoglobin (Hb) to below pretransfusion levels, and by reticulocytopenia. Typically, in the acute type of HHS, no new alloantibodies are detected, other than preexisting antibodies, and in half the cases the DAT remains negative. The pathogenesis of HHS remains unclear, but is associated with systemic symptoms of inflammation and extreme hyperferritinaemia that are indicative of macrophage activation. Histopathological studies in patients with HHS have demonstrated the presence of widespread macrophage erythrophagocytosis in the liver, spleen and bone marrow, suggesting that macrophage activation and direct erythrophagocytosis is an important mechanism of red blood cell destruction. Recently, two cases of HHS have been successfully treated with immunomodulating drug tocilizumab, a humanised monoclonal antibody against the interleukin-6 receptor that has been successfully used in other hyperinflammatory macrophage activation syndromes (MAS) including COVID19. We describe another case of HHS responding to tocilizumab after failed treatment with IVIG and steroids.","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":" ","pages":"437-440"},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tme.12793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39027457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing antibody positive delayed hemolytic transfusion reactions in sickle cell disease: Lessons learned from a case.","authors":"Alexander Rankin,&nbsp;Jennifer Webb,&nbsp;Robert Sheppard Nickel","doi":"10.1111/tme.12862","DOIUrl":"https://doi.org/10.1111/tme.12862","url":null,"abstract":"<p><strong>Introduction: </strong>Red blood cell (RBC) transfusions are important in the management of patients with sickle cell disease (SCD). However, a potentially catastrophic complication of transfusion in this population is the delayed hemolytic transfusion reaction (DHTR). The pathophysiology of all DHTRs is not understood, but some are known to be caused by an anamnestic resurgence of RBC alloantibodies.</p><p><strong>Case presentation: </strong>A child with SCD transfused for acute chest syndrome re-presented a week after hospital discharge with severe anaemia, hemolysis, and a newly detected anti-E. This patient had been previously transfused years ago at an outside institution and the anti-E had not been previously documented.</p><p><strong>Discussion: </strong>The presented case of an antibody positive DHTR illustrates several concepts critical to the prevention of this complication. RBC alloantibodies must be detected and this information must be shared. Prophylactic C/c, E/e, K antigen matching is helpful for patients with SCD, but systems must be in place to identify these patients. Patients transfused at multiple different hospitals are especially at risk for this complication and efforts are needed to prevent them from suffering a DHTR.</p>","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":" ","pages":"433-436"},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40314542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of blood use in paediatric trauma: A retrospective cohort study.","authors":"Hermela T Gebregiorgis,&nbsp;Rida A Hasan,&nbsp;Zhinan Liu,&nbsp;Jim Phuong,&nbsp;Lynn G Stansbury,&nbsp;Jenna Khan,&nbsp;Hamilton C Tsang,&nbsp;Monica S Vavilala,&nbsp;John R Hess","doi":"10.1111/tme.12901","DOIUrl":"https://doi.org/10.1111/tme.12901","url":null,"abstract":"<p><strong>Objectives: </strong>We asked whether age or injury severity drives blood use patterns in paediatric trauma.</p><p><strong>Background: </strong>Transfusion for paediatric trauma care is complicated by known developmental differences in coagulation and injury patterns.</p><p><strong>Methods/materials: </strong>We linked 10 years of Trauma Registry and blood bank data, 2011-2020, for all acute trauma patients aged <18 treated at a large US Level 1 adult and paediatric trauma centre. We assessed age, injury severity and mechanism for association with any blood use, use within the first 4 h of care, and resuscitation balance, using grouped-age Chi-square and multivariable regression models.</p><p><strong>Results: </strong>Of 60 066 acute trauma arrivals at our centre in the study period, 7979 (13.3%) met inclusion criteria. Median age (IQR) was (7.6[2.4-14.5]); 6230(78.1%) were < 15 years old; 590(7.4%) received any blood products; and 128(1.6%) died. Among the 5842(73.2%) patients with impact-related injury, 2023(34.6%) met standards for severe injury (New Injury Severity Score [NISS] ≥ 16); 541(9.3%) were transfused, 171(31.6%) in the first 4 h and 72(13.3%) using ≥3 units of products in the first hour. Firearms injuries were the most severe, most likely to be transfused urgently, using balanced resuscitation, and to die (p < 0.001 for all). Multivariable logistic regression showed any blood use as strongly associated with NISS (Odds Ratio 1.124832; p < 0.0001; 95% CI 1.11-1.13) but not with age (OR 0.98; p = 0.07; 95% CI 0.96-1.00).</p><p><strong>Conclusion: </strong>Transfusion in the care of acute paediatric trauma is uncommon (<10% of injured minors in our cohorts received any blood products), and injury severity, particularly firearms injury-not age-drove transfusion.</p>","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":" ","pages":"383-393"},"PeriodicalIF":1.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33493843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood transfusion needs in COVID‐19 patients: An observational prospective unicentric study","authors":"U. La Rocca, G. Giovannetti, F. Maldarelli, Mirella Farinelli, M. Piazzolla, A. Angeloni, F. Pugliese, S. Coluzzi","doi":"10.1111/tme.12886","DOIUrl":"https://doi.org/10.1111/tme.12886","url":null,"abstract":"Dear Editor, In 2019 a severe acute respiratory syndrome (SARS-CoV-2), caused by a novel coronavirus (2019-nCoV), was described in Wuhan City, Hubei Province, China, which then rapidly spread and evolved into a pandemic. As of 5 July 2021, 183,298,109 confirmed cases of coronavirus disease (COVID-19) and 3,971,687 deaths all over the world have been reported. Italy is one of the most involved countries, reaching 4,259,909 confirmed cases (as of 2 July 2021) and 127,566 deaths. Clinical presentations of SARS-CoV-2 are various. Most infected patients are asymptomatic, others develop mild symptoms like dry cough, sore throat, and fever, with a spontaneous resolution. Some cases evolve into pulmonary oedema, severe pneumonia, acute respiratory distress syndrome (ARDS), and septic shock resulting in organ failure. Most-used treatments are chloroquine and hydroxychloroquine, claimed to block viral entry into cells and have immunomodulatory effects, lopinavir/ritonavir and other antivirals, corticosteroids, anti-cytokines or immunomodulatory agents (tocilizumab, a monoclonal antibody IL-6 receptor antagonist), low-molecular-weight heparin (LMWH) to limit the risk of an associated coagulopathy and disseminated intravascular coagulation (DIC). The WHO has published guidelines to manage the blood supply in response to the COVID-19 pandemic. The guidance underlines the role of blood services in assessing, planning, and responding to the outbreak. In fact, lockdown and social distancing may lead to limited blood resources. Moreover, while blood transfusion requirement may decrease as the health care system is focused on treating COVID-19 patients, thus deferring other clinical interventions, transfusions will still be necessary for emergency situations and to support COVID-19 patients with severe sepsis. Critical patients may develop anaemia as a consequence of multifactorial and complex pathogenesis. Phlebotomies and other surgical procedures, coagulopathies, pathogen-associated haemolysis, hypoadrenalism, and nutritional deficiencies, as well as the concomitant administration of different drugs, may cause Haemoglobin (Hb) to drop. Decreased erythropoietin production and/or activity could be the consequence of inflammatory cytokines such as IL-1 and TNF-α. The risk in COVID-19 patients is even higher due to the well-known pro-haemolytic effect of hydroxychloroquine, especially in G6PDHdeficient individuals, even if there are few findings supporting the necessity for G6PDH deficiency screening before starting this drug. Here we report the results of a retrospective evaluation of blood transfusion supply in patients (pts) affected by COVID-19, admitted to Policlinico Umberto I, Sapienza University of Rome, during the epidemic outbreak, taking into account treatments, comorbidities, clinical and laboratory parameters, especially those related to RBC transfusion. From the 1 March 2020 to 27 April 2020, 71 patients with COVID-19 infection were admitted to Policl","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":"193 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134541737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher levels of von Willebrand factor in hospitalised patient plasma provides an explanation for the association of ABO blood group and secretor status with COVID19 severity.","authors":"Tosti J Mankelow,&nbsp;Allison Blair,&nbsp;David T Arnold,&nbsp;Fergus W Hamilton,&nbsp;Kathleen M Gillespie,&nbsp;David J Anstee,&nbsp;Ashley M Toye","doi":"10.1111/tme.12860","DOIUrl":"https://doi.org/10.1111/tme.12860","url":null,"abstract":"Early studies of COVID19 in Wuhan suggested a relationship between SARS-CoV-2 infection and an individual's ABO blood group with a higher frequency of infected blood group A patients than would be expected if ABO group had no influence on infection status. 1 Since then numerous additional studies have corroborated this observation, whilst some have found no link at all. 2 – 4 Possible explanations for this discrepancy may be differences in the frequency of different blood groups within different populations and the presence of underlying disease in infected hospitalised patients when compared with healthy individuals. In a study of COVID19 patients in Bristol, UK, we observed a significant association between COVID19 hospitalisation, blood group A patients, who are secretors, and cardiovascular compli-cations. 5 Other studies have also reported an association between blood groups, cardiovascular events and COVID19. 6 There is a well described link between blood group “ non-O \" (A, B, AB) and throm-botic events centred on higher circulating levels of von Willebrand factor (VWF) in non-O individuals when compared with those of group O. 7 This may be because additional glycosylation of an H anti-gen, spatially close to amino-acid 1574 within VWF, to form either the A or B antigen, provides protection against proteolytic degrada-tion by the VWF regulator protease ADAMTS13. 7 Fucosylation of a terminal galactose to form the H-antigen on secreted proteins is per-formed by Fucosyltransferase 2 (FUT2) and individuals with a functional FUT2 gene express ABO on non-haematological cells and on secreted proteins (such as VWF) and are termed secretors. However, (cid:1) 20% of the population have an inactivating mutation in FUT2 , con-sequently they only express ABO on haematological cells, and are","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":" ","pages":"261-262"},"PeriodicalIF":1.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40326335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A critical contribution in a time of crisis: Examining motivations and deterrents to COVID‐19 convalescent plasma donation and future donation intentions among prospective Canadian donors","authors":"K. Holloway, Chantal Campbell, Ridwaanah Ali, Larkin Davenport Huyer, D. Hart, J. Haw, S. Brennenstuhl, Q. Grundy","doi":"10.1111/tme.12875","DOIUrl":"https://doi.org/10.1111/tme.12875","url":null,"abstract":"To understand motivations and deterrents to donate COVID‐19 convalescent plasma for a clinical trial and determine whether they predict intention to donate source plasma.","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126044329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of pre‐operative haemoglobin concentration to guide peri‐operative blood tests for hip and knee arthroplasty: A decision curve analysis","authors":"P. Dhiman, V. Gibbs, G. Collins, B. Van calster, Gardash Bakhishli, G. Grammatopoulos, A. Price, Adrian Taylor, Melissa S. Murphy, B. Kendrick, A. Palmer","doi":"10.1111/tme.12873","DOIUrl":"https://doi.org/10.1111/tme.12873","url":null,"abstract":"Assess the prognostic value of pre‐operative haemoglobin concentration (Hb) for identifying patients who develop severe post‐operative anaemia or require blood transfusion following primary total hip or knee, or unicompartmental knee arthroplasty (THA, TKA, UKA).","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121687259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trust and distrust: Identifying recruitment targets for ethnic minority blood donors","authors":"E. Ferguson, E. Dawe-Lane, Zaynah Khan, C. Reynolds, K. Davison, D. Edge, S. Brailsford","doi":"10.1111/tme.12867","DOIUrl":"https://doi.org/10.1111/tme.12867","url":null,"abstract":"We explore the role of trust, distrust, and the prevailing socio‐political context to better understand why people from ethnic minority communities are less likely to be blood donors compared to people from White communities. Recruiting more ethnic minority donors will enhance representativeness, reduce inequality, and help meet the clinical need to increase the proportion of blood with Ro Kell antigen to treat Sickle Cell Disease (SCD).","PeriodicalId":442504,"journal":{"name":"Transfusion Medicine (Oxford, England)","volume":"183 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127033314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}