Clinical Medicine & Research最新文献

{"title":"Multidisciplinary Integrated Care in Atrial Fibrillation (MICAF): A Systematic Review and Meta-Analysis.","authors":"Adnan Khan,&nbsp;Alberto Cereda,&nbsp;Claudia Walther,&nbsp;Aqsa Aslam","doi":"10.3121/cmr.2022.1702","DOIUrl":"https://doi.org/10.3121/cmr.2022.1702","url":null,"abstract":"<p><p><b>Objective:</b> To assess the effectiveness of multidisciplinary integrated care in the clinical outcomes of atrial fibrillation patients.<b>Methods:</b> Medline, EMBASE, and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on multidisciplinary integrated care in atrial fibrillation patients. The systematic review and meta-analysis included six and five articles, respectively, that compared the outcomes between the integrated care group and control group.<b>Results:</b> Multidisciplinary integrated care was concomitant with a decrease in all-cause mortality (OR 0.52, 95%CI 0.36-0.74, <i>P</i>=0.0003) and cardiovascular hospitalization (OR 0.66, 95%CI 0.49-0.89, <i>P</i>=0.007). Multidisciplinary integrated care had no significant impact on major adverse cardiovascular event (MACE) (OR 0.76, 95%CI 0.37-1.53, <i>P</i>=0.44), cardiovascular deaths (OR 0.49, 95% CI 0.21-1.17, <i>P</i>=0.11), atrial fibrillation (AF)-related hospitalization (OR 0.76, 95%CI 0.53-1.09, <i>P</i>=0.14), major bleeding (OR 1.02, 95%CI 0.59-1.75, <i>P</i>=0.94), minor bleeding (OR 1.12, 95%CI 0.55-2.26, <i>P</i>=0.76), and cerebrovascular events (OR 0.72, 95%CI 0.45-1.18, <i>P</i>=0.19).<b>Conclusion:</b> In comparison to usual care, a multidisciplinary integrated care approach (i.e., nurse-led care along with usual specialist care) in AF patients is associated with reduced all-cause mortality and cardiovascular hospitalization.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 4","pages":"219-230"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799227/pdf/0200219.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9236319","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":"Acute Mesenteric Ischemia in COVID-19 While Receiving Prophylactic Enoxaparin.","authors":"Nandhini Bindukumari Sureshkumar,&nbsp;Sreerag Alumparambil Surendran","doi":"10.3121/cmr.2022.1751","DOIUrl":"https://doi.org/10.3121/cmr.2022.1751","url":null,"abstract":"<p><p>COVID-19 infection is known to cause thromboembolic complications. This is why patients hospitalized with COVID-19 are put on prophylactic anticoagulation. We present the case of a Caucasian woman, aged 71 years, with risk factors of class 1 obesity, hyperlipidemia, and hypertension, initially admitted for COVID-19 pneumonia, and later developed acute mesenteric ischemia followed by pulmonary embolism. These incidents occurred while the patient was receiving high-dose prophylactic enoxaparin (40 mg twice daily). COVID-19 associated acute mesenteric ischemia is a complication with high mortality. Therefore, high suspicion, early recognition, and surgical management is necessary. Apart from that, this case emphasizes the question of whether there is a need for proactively administering therapeutic anticoagulation for high thrombotic risk COVID-19 patients to prevent deadly complications.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 4","pages":"236-240"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799224/pdf/0200236.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9236316","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":"Awareness of Toxic Stress and Adverse Childhood Experiences among Dutch Pediatric Health Care Providers: A National Survey.","authors":"Lisette K M Walbeehm-Hol,&nbsp;Jamiu O Busari","doi":"10.3121/cmr.2022.1748","DOIUrl":"https://doi.org/10.3121/cmr.2022.1748","url":null,"abstract":"<p><p><b>Introduction:</b> Early recognition of adverse childhood experiences (ACEs) and adequate interventions are required to prevent negative effects on the child's mental and physical health later in life caused by toxic stress. This study aimed to assess how familiar the concepts of ACEs and toxic stress are among Dutch pediatric health care providers (PHCPs) and whether screening for ACEs is standard practice in the Netherlands.<b>Methods:</b> From October 2018 until March 2019, a nation-wide questionnaire survey was held.<b>Results:</b> Of 548 participating PHCPs, 29% were familiar with toxic stress, 67% were familiar with ACEs, and 63% knew of the relationship between multiple ACEs and somatic diseases. Routine inquiries about ACEs were done always by 17% of the participants and sometimes by 65%. The ACEs which PHCPs asked about the most included divorce (n=288; 76.8%), bullying (n=265; 70.7%), physical domestic violence (n=184; 49.1%), parental psychiatric diseases (n=205; 54.7%) and sexual abuse (n=164; 43.7%). The ACEs asked about the least included deportation of a family member (n=22; 5.9%), gender discrimination (n=9; 2.4%) and racism (n=17; 4.5%).<b>Conclusion:</b> Even in 2019, there is limited awareness among Dutch PHCPs of ACEs and toxic stress. While most acknowledged to be aware of the role that toxic stress plays in the physical and mental health consequences of ACEs later in life, only 17% of the respondents performed standard ACE screening. Our findings underscore the need for standard ACE screening guidelines to support early recognition and adequate treatment of children suffering with toxic stress.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 4","pages":"211-218"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799223/pdf/0200211.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9236315","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":"Three Cases of Atypical Breast Metastasis from Lung Adenocarcinoma.","authors":"Roshini Ramwani, Jessica Wernberg","doi":"10.3121/cmr.2022.1735","DOIUrl":"10.3121/cmr.2022.1735","url":null,"abstract":"<p><p>Metastatic disease to the breast is rare. Melanoma and lymphoma are the most common primary tumors metastasizing to the breast, and breast metastasis from a primary lung neoplasm is uncommon. It can be difficult to distinguish metastatic disease from primary breast cancer clinically. Immunohistochemistry, combined with further diagnostic imaging, play important roles in identifying the primary origin of the malignancy. An accurate diagnosis is imperative for therapeutic planning, and further workup should be considered for unusual cytological patterns. In this report, three cases of pulmonary metastasis to the breast with atypical clinical presentations are presented and discussed.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 4","pages":"231-235"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799225/pdf/0200231.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9236320","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":"Changes in <i>Streptococcus pneumoniae</i> Susceptibility in Wisconsin: Implications for Clinical Treatment Decisions for Respiratory Infections.","authors":"Erik Munson,&nbsp;Stephen C Lavey,&nbsp;Megan R Lasure,&nbsp;Barry C Fox","doi":"10.3121/cmr.2022.1767","DOIUrl":"https://doi.org/10.3121/cmr.2022.1767","url":null,"abstract":"<p><p><b>Objective:</b> In 2019, the American Thoracic Society and Infectious Diseases Society of America updated clinical practice guidelines for community-acquired pneumonia (CAP). In contrast to guidelines published in 2007, macrolide monotherapy for outpatients was made a conditional recommendation based on resistance levels. Local knowledge of current antimicrobial susceptibility is needed to guide management of CAP and other bacterial respiratory pathogens. The purpose of this study was to investigate antimicrobial susceptibility profiles and trending for Wisconsin <i>Streptococcus pneumoniae</i> isolates.<b>Design:</b> Multi-center laboratory surveillance, with testing at a central location utilizing standardized susceptibility testing protocols.<b>Methods:</b> Data published by the Wisconsin Department of Health Services (DHS) were augmented with data from the Surveillance of Wisconsin Organisms for Trends in Antimicrobial Resistance and Epidemiology (SWOTARE) program. Data were stratified by invasive or non-invasive sources, as well as DHS region and compared to data compiled from 2006-2010.<b>Results:</b> Susceptibility rates for ≥ 916 invasive <i>S. pneumoniae</i> assessed from 2016-2020 were greater than 91% for ceftriaxone, tetracycline, and fluoroquinolone agents and were generally higher than those from 354 non-invasive isolates. Low susceptibility rates were observed for invasive isolates of penicillin (78.7%) and erythromycin (64.8%) and were even lower for non-invasive isolates (73.8% and 59.9%, respectively). This erythromycin susceptibility rate was a significant reduction from that observed in 2006-2010 (80.4; <i>P</i> < 0.0002). 24.8% of isolates generated an erythromycin MIC ≥ 8 μg/mL. Statewide geographic variability was noted.<b>Conclusions:</b> Rates of <i>S. pneumoniae</i> susceptibility to parenteral penicillins and cephems, and oral tetracycline and fluoroquinolone agents, remain high throughout Wisconsin. However, low oral penicillin susceptibility rates, taken together with declining macrolide susceptibility rates, should cause clinicians to consider alternative treatment options for respiratory tract infections, especially with macrolides.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 4","pages":"185-194"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799222/pdf/0200185.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9236318","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":"Plasma Brain-Derived Neurotrophic Factor and Opioid Therapy: Results of Pilot Cross-Sectional Study.","authors":"Ursula Kosciuczuk,&nbsp;Piotr Jakubow,&nbsp;Jolanta Czyzewska,&nbsp;Pawel Knapp,&nbsp;Ewa Rynkiewicz-Szczepanska","doi":"10.3121/cmr.2022.1731","DOIUrl":"https://doi.org/10.3121/cmr.2022.1731","url":null,"abstract":"<p><p><b>Objective:</b> The neurotoxic effect of opioid has not been thoroughly described. No studies have been conducted to explain the effect of opioids in chronic non-cancer pain therapy on the neurotrophic factors level. Due to the ability to cross the blood-brain barrier, it seems the determination of serum Brain-derived neurotrophic factor (BDNF) concentration is a reliable presentation of the concentration in the central nervous system. The aim of the study was to explore the changes of plasma BDNF concentration during long-term opioid therapy.<b>Methods:</b> The study group included 28 patients with chronic low back pain treated with opioid therapy buprenorphine (n=10), tramadol (n=8), oxycodone (n=6), morphine (n=3), fentanyl (n=1). The control group included 11 patients. Measurements of plasma BDNF concentrations were performed, and information about opioid therapy were recorded (age, sex, opioid substance type, daily dose and the duration of opioid therapy). Data were analyzed using nonparametric tests.<b>Results:</b> The median BDNF level in the study group was significantly lower (2.73 ng/mL) than that in the control group (5.04 ng/mL, <i>P</i><0.05). BDNF levels did not differ among groups based on the type of opioid substance used, but the lowest median value was observed for tramadol (2.62 ng/mL), and the highest median value was observed for buprenorphine (2.73 ng/mL). The widest minimum-maximum ranges of BDNF for oxycodone were noted, minimum 1.23 ng/mL and maximum 4.57 ng/mL, respectively. BDNF concentrations were correlated with age in the tramadol group and with the duration of opioid therapy in the buprenorphine group.<b>Conclusion:</b> Chronic opioid therapy for noncancer pain induces specific changes in the BDNF concentration. Tramadol and buprenorphine exerted an important effect on BDNF levels in the examined patients. The BDNF level depends on duration of opioid therapy with buprenorphine, and age in tramadol therapy.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 4","pages":"195-203"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799226/pdf/0200195.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9236321","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":"Disease Staging: Prevalence of Cardiorespiratory Complications in Type 2 Diabetes Mellitus.","authors":"Maria Cristina Carrondo","doi":"10.3121/cmr.2022.1699","DOIUrl":"https://doi.org/10.3121/cmr.2022.1699","url":null,"abstract":"<p><p><b>Introduction:</b> The incidence of cardiorespiratory complications in diabetic patients is a major concern for healthcare organizations and providers in Portugal. The objectives of this study were (1) to study the prevalence of cardiorespiratory complications during hospitalization in the diabetic population and (2) to identify their associated factors.<b>Methods:</b> This is a cross-sectional study and included 7,347 diabetic patients admitted to all specialty services enrolled between January 1, 2018 and December 31, 2018 in 32 public hospitals in Portugal. Hospital discharge summary data and both Disease-Related Diagnosis Groups and Disease Staging were used. Descriptive statistical analysis was used where the distribution and rates of cardiorespiratory complications were calculated. Logistic regression using the risk adjustment model was used to calculate the associated risk factors for cardiorespiratory complications.<b>Results:</b> The total rate of cardiorespiratory complications was 18.2% cardiorespiratory complications; in women it was 21.5% and in men 15.6%. The comorbidity of congestive heart failure (98.0%) was significantly higher (<i>P</i><0.001) among patients undergoing medical treatment, and the comorbidities bacterial pneumonia and coronary artery disease without prior coronary revascularization were significantly higher (63.9%, 45.1%, and 33.4%, <i>P</i><0.001).<b>Discussion:</b> The use of different therapies to control glucose levels and the absence of antibiotic prophylaxis during medical treatment may account for these data.<b>Conclusions:</b> Cardiorespiratory complications were higher in women than in men and in those who received medical treatment. Comorbidities such as congestive heart failure, such as bacterial pneumonia and coronary artery disease without prior coronary revascularization were identified as risk factors.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"20 4","pages":"204-210"},"PeriodicalIF":1.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9799228/pdf/0200204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9236314","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":"Cardiac Involvement and Absence of Asthma – What is Phenotype Specificity of EGPA: A Case Report","authors":"J. Fijołek, E. Wiatr, K. Błasińska, D. Piotrowska-Kownacka, K. Roszkowski-Śliż","doi":"10.3121/cmr.2022.1683","DOIUrl":"https://doi.org/10.3121/cmr.2022.1683","url":null,"abstract":"Eosinophilic granulomatosis with polyangiitis (EGPA) typically is characterized by asthma, blood eosinophilia, and extrapulmonary manifestations. Asthma is a major EGPA symptom affecting almost all patients, but cardiac involvement is one of the most serious manifestations, responsible for 31% of deaths. Two recently defined phenotypes of EGPA, according to the patient’s antineutrophil cytoplasmic antibody (ANCA) status, differ significantly in clinical features and prognosis. We share a case of EGPA characterized by atypical manifestation without any evidence of asthma, in whom extensive cardiac involvement was the dominant manifestation of vasculitis. This case demonstrates the difficulties associated with phenotyping EGPA and highlights the importance of cardiac magnetic resonance imaging (CMRI) in definitive diagnosis.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"2 1","pages":"170 - 176"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86992190","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 Review of the Efficacy of Therapeutic Maneuvers in Posterior Canal Benign Paroxysmal Positional Vertigo","authors":"S. Yetişer, Z. Salturk","doi":"10.3121/cmr.2022.1686","DOIUrl":"https://doi.org/10.3121/cmr.2022.1686","url":null,"abstract":"Benign paroxysmal positional vertigo (BPPV) is associated with significant functional impairment with the change of head position with respect to gravity. Therapeutic maneuvers provide relief of symptoms; however, some patients may have persistent symptoms and can be significantly disabled. The aim of this study is to review the critical factors that may have an impact on outcome. Six main categories that may possibly affect the outcome of therapeutic maneuvers in patients with posterior canal (PC) BPPV were selected. A review of the 1095 articles on therapeutic maneuvers in patients with PC BPPV was conducted by means of a search in PubMed, Embase, and Scopus databases between 1989 and 2020. We documented 14 articles about the comparative analysis of success rate of Semont and Epley maneuvers, 7 articles about the comparative analysis of success rate of therapeutic maneuvers and no treatment or sham maneuver, 7 articles about the comparison of success rate in treatment of traumatic and idiopathic cases, 12 articles about the comparison of outcome of repositioning maneuvers with or without postural restrictions, 12 articles about the comparison of success rate of medication and therapeutic maneuvers, and 9 articles about the comparison of vestibular exercises and therapeutic maneuvers. In conclusion, therapeutic maneuvers provide better outcome as compared to no treatment or sham maneuver. Epley maneuver has greater success rate than Semont maneuver. Traumatic cases are prone to develop more recurrences than idiopathic cases and have lower rate of symptom resolution. Body restrictions following successful repositioning maneuver has no impact on recurrence. Medical therapy or vestibular exercise alone is not an alternative to therapeutic maneuvers. However, the rate of residual dizziness is low when the vestibular exercises are combined.","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":"44 1","pages":"153 - 163"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73937191","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":"Extended Tourniquet Times and the Impact on Wound Healing in Foot Surgery.","authors":"Callum Robertson, Victoria Wilson, R M Dominic Meek, Robert Carter","doi":"10.3121/cmr.2022.1668","DOIUrl":"10.3121/cmr.2022.1668","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the effect of tourniquet time less than or in excess of 120 minutes on foot surgery wound healing.</p><p><strong>Null hypothesis: </strong>A tourniquet time of over 120 minutes will not affect wound healing in foot surgery.</p><p><strong>Design, setting, participants and method: </strong>A retrospective comparative cohort analysis was performed on 96 patients undergoing complex hindfoot surgery in a large central teaching hospital. Fifty-five patients receiving tourniquet pressure for >120 minutes and 41 receiving <120 minutes of tourniquet pressure were identified from electronic case records. The primary outcome was surgical wound healing. Secondary outcomes were discharge date and complication rate.</p><p><strong>Results: </strong>There was no significant difference in reported time for wounds to heal in the <120-minute or >120-minute cohort. There were no other significant differences in secondary clinical outcomes and no significant variations in patient demographics.</p><p><strong>Conclusion: </strong>This study suggests that tourniquet times from 2 to 3 hours in foot and ankle surgery with pressures up to 300 mmHg are not associated with a significant effect on wound healing.</p>","PeriodicalId":47429,"journal":{"name":"Clinical Medicine & Research","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9544197/pdf/0200141.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460081","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}