Journal of Minimal Access Surgery最新文献

{"title":"Safety and efficacy of surgically performed continuous superficial serratus anterior plane block in uniportal video-assisted thoracic surgery.","authors":"Giovanni Punzo, Dania Nachira, Giuseppe Calabrese, Chiara Cambise, Maria Teresa Congedo, Maria Letizia Vita, Elisa Meacci, Stefano Margaritora","doi":"10.4103/jmas.jmas_345_23","DOIUrl":"10.4103/jmas.jmas_345_23","url":null,"abstract":"<p><strong>Introduction: </strong>The 'surgically performed' continuous superficial serratus anterior plane block (continuous s-SAPB) was never described before in uniportal video-assisted thoracic surgery (uniportal VATS) surgery. The aim of the study was to evaluate the safety and efficacy of the technique.</p><p><strong>Patients and methods: </strong>Between March 2022 and April 2023, 50 patients, undergone uniportal VATS surgery at our thoracic surgery department, were scheduled for a surgically performed continuous s-SAPB as post-operative analgesia protocol.</p><p><strong>Results: </strong>The mean execution time for the block was 3.92 ± 2.56 min. Ten patients (20%) required morphine for a visual analogue scale (VAS) score >4 immediately after surgery. The recorded VAS score at chest tube removal was 1.87 ± 1.41, whereas 2 h after the manoeuvre was 0.42 ± 0.72. No complication related to block insertion was recorded. The onset of chronic pain was observed in a total of 2 patients (4%).</p><p><strong>Conclusions: </strong>The surgically performed continuous s-SAPB in uniportal VATS seems to be safe and easy to perform, and it provides a satisfactory analgesic effect.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"162-168"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography roadmap for post-operative fundoplication imaging with a novel structured reporting checklist.","authors":"Ritesh Kamat, Roy Patankar, Avinash Supe, Pallavi Dubey, Ravi Thapar, Vishakha Kalikar","doi":"10.4103/jmas.jmas_325_23","DOIUrl":"10.4103/jmas.jmas_325_23","url":null,"abstract":"<p><strong>Introduction: </strong>With increasing numbers and acceptability of laparoscopic anti-reflux surgery (LARS) procedures over long-term medical treatment in the past decade, it follows that the complications of fundoplication wrap are seen intermittently with recurrent symptoms of heartburn and dysphagia. Endoscopy and barium swallow are the initial investigations performed for suspected fundoplication wrap failures. However, with easy availability of multislice computed tomography (CT) and the multiplanar reconstructions along with reduction in familiarity with barium examinations, it would be prudent for the surgeons to familiarise themselves with various appearances of wrap failure. Currently, there is no accepted standard to report a fundoplication wrap failure. We did a thorough literature review on the use of CT scans for fundoplication wrap failure, created a multidisciplinary hernia team with prominent radiologists and surgeons and discussed the role of CT scans in the management of suspected wrap failure. After completing a pilot study with around 43 patients of wrap failure, we created a standard CT reporting format which helped us in the management of even the most complex cases. This standard reporting format can be used by trainees and surgeons worldwide. This would lead to uniformity in reporting, would help in decision-making and would also help create national and international primary wrap failure and redo fundoplication registry.</p><p><strong>Patients and methods: </strong>A total of 43 patients of wrap failure of multislice CT evaluation were analysed for type of failure along with factors responsible for the maintenance of integrity of the wrap. A novel checklist with structured reporting was used for the description of the post-operative imaging findings.</p><p><strong>Results: </strong>The demographic characteristics, post-operative imaging and intraoperative findings were described. The different types of wrap failure - Hinder types and associated pathologies were analysed for relative frequency in wrap failures. The novel structured reporting included wrap integrity and failure complications in post-operative patients of LARS.</p><p><strong>Conclusion: </strong>Fundoplication wrap failure is not an uncommon complication seen after LARS. A novel structured report with checklist will help the surgeons to evaluate the post-operative patient with recurrent symptoms. Multislice CT is the ideal modality for imaging suspected wrap failures after primary endoscopic evaluation. Multiplanar imaging with coronal and sagittal reconstructions is useful for understanding the integrity of the wrap and its ability to detect failure/migration.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"153-161"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of sympathectomy ganglion levels on late complications in the treatment of hyperhidrosis.","authors":"Osman Emre Ersin, Fazli Yanik, Yekta Altemur Karamustafaoglu, Yener Yoruk","doi":"10.4103/jmas.jmas_75_24","DOIUrl":"10.4103/jmas.jmas_75_24","url":null,"abstract":"<p><strong>Introduction: </strong>Pathologically excessive sweating in areas such as the palmar, axillary and/or plantar together with sympathetic hyperactivity that occurs independently of systemic causes is called primary hyperhidrosis. Although primary idiopathic hyperhidrosis can be seen at any age, the disease is most commonly seen in adolescents and young adults. The frequency of male and female genders is usually equal. Some medical and minimally invasive methods can be used in the treatment of primary hyperhidrosis. However, the known curative gold standard treatment method for the disease is thoracoscopic thoracic sympathectomy operation.</p><p><strong>Patients and methods: </strong>In this study, a total of 150 patients who applied to Trakya University Health Practice and Research Center, Department of Thoracic Surgery, between 15 October 2008 and 15 June 2021 and underwent thoracoscopic thoracic sympathectomy due to the diagnosis of hyperhidrosis were evaluated retrospectively. The patients were separated into two groups. Thoracoscopic thoracic sympathectomy was performed on the T2-T4 in the first group (Group I - n : 88) and on the T3-T5 sympathetic ganglions in the second group (Group II - n : 62).</p><p><strong>Results: </strong>The median age of patients included in the study was found to be 24 (20.75-28) years. Group I and Group II were similar in terms of gender characteristics, but Group II was older. Our success rate was found to be 92% ( n = 138). There was no mortality, major complication such as bleeding requiring open thoracotomy, chylothorax or Horner's syndrome in any of the patients. Minor complications were seen in the early and late period of the operation at a low rate. Our overall compensatory hyperhidrosis rate was 52% ( n = 78). Compensatory hyperhidrosis was detected more in Group I, although this was not statistically significant. We determined the overall satisfaction rate of our patients as 87.3% ( n = 133). The satisfaction rates of the patients in Group I and Group II were found to be similar.</p><p><strong>Conclusions: </strong>Thoracoscopic thoracic sympathectomy is a fast, safe and minimally invasive treatment method with a low complication rate. More than 90% success and a significant increase in psychosocial condition and professional quality of life can be achieved with this procedure. Future studies are needed to reveal the relationship between operated ganglion levels and the development of compensatory hyperhidrosis.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"175-182"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of risk factors for major post-operative complications following intraperitoneal hyperthermic perfusion for pseudomyxoma peritonei: A retrospective cohort study.","authors":"Xiang Zhang, Shun-Cai Gao","doi":"10.4103/jmas.jmas_299_23","DOIUrl":"10.4103/jmas.jmas_299_23","url":null,"abstract":"<p><strong>Introduction: </strong>Pseudomyxoma peritonei (PMP) is a condition characterised by the presence of gelatinous tumour-like growth within the peritoneal cavity. Combined cytoreductive surgery and intraperitoneal chemotherapy have shown to improve the survival rate in PMP patients. However, post-operative complications such as cognitive dysfunction, respiratory insufficiency and acute renal failure are still observed. This retrospective study aims to explore the risk factors associated with major post-operative complications and specifically investigate the correlation with intraoperative hypotension.</p><p><strong>Patients and methods: </strong>This retrospective cohort study included PMP patients treated at Beijing Aerospace Center Hospital from 1 June, 2014 to 30 December, 2020. The primary outcome measures were major post-operative complications, including neurological, pulmonary, cardiovascular, surgical complications, acute hepatic injury and acute kidney injuries. The secondary outcome measures included infection, fever and deep venous thrombosis. Statistical analysis was conducted using EmpowerStats and R software.</p><p><strong>Results: </strong>A total of 782 patients were screened, and 668 patients were included in the statistical analysis. Amongst them, 234 (35.03%) individuals experienced major post-operative complications. Factors such as pre-operative American Society of Anaesthesiologists grading, age, haemoglobin and albumin levels, intraoperative mean arterial pressure, blood loss, fluid replacement volume, method of intraperitoneal hyperthermic perfusion and post-operative requirement for intensive care unit mechanical ventilation were found to be correlated with major complications.</p><p><strong>Conclusion: </strong>The identified risk factors provide valuable insights for improving clinical pathways in the management of PMP. Further prospective studies are warranted to establish the association between these factors and patient outcomes.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"112-118"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First ever reported case of right-sided rupture of eventration of the diaphragm: Thoraco-laparoscopic approach.","authors":"Priya Gupta, Sachin Wani, Vishakha Kalikar, Roy Patankar","doi":"10.4103/jmas.jmas_333_23","DOIUrl":"10.4103/jmas.jmas_333_23","url":null,"abstract":"<p><strong>Abstract: </strong>Diaphragmatic eventration (DE) is an abnormal condition where a portion or the entire hemidiaphragm elevates due to insufficient muscle or nerve function while maintaining its anatomical attachments. On the other hand, congenital diaphragmatic hernias occur due to the abnormal development of muscular entities of the diaphragm, resulting in the displacement of abdominal contents into the thorax. The difference between diaphragmatic hernia and eventration is important as there is no true defect in DE. Ruptured eventration of the diaphragm is a rare entity, with only three cases reported in adults in literature till date, all on the left side. We report the first case of ruptured eventration of the diaphragm on the right side, which was repaired by a combination of laparoscopy and thoracoscopy and with double-mesh placement.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"205-208"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139492618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel technique to identify midline during endoscopic thyroidectomy.","authors":"Kamal Kataria, Richa Garg, Vikram Saini, Pritam Yadav, Sehaj Preet, Yashwant Virwadia, T Nelson","doi":"10.4103/jmas.jmas_341_23","DOIUrl":"10.4103/jmas.jmas_341_23","url":null,"abstract":"<p><strong>Abstract: </strong>Endoscopic thyroidectomy is a minimally invasive surgical approach that has become popular due to its cosmetic advantages and reduced post-operative discomfort. Central to the success of this procedure is the accurate identification of the midline, which becomes a challenge in endoscopic surgeries. We propose a novel method of using methylene blue, a Food and Drug Administration-approved dye, which offers the ability to clearly mark the midline, enhancing orientation and reducing the potential for injury to critical anatomical structures. Although using methylene blue has many benefits, there are drawbacks, including the requirement for intraoperative ultrasonography. Continued research and clinical experience will be critical in improving and extending its use in the field of thyroid surgery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"214-216"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidetector computed tomography evaluation of normal thymus and variations with age.","authors":"Suprava Naik, Aishvarya Shri, Simran Sidhu, Yuvraj Lahre, Nerbadyswari Deep Bag, Sanjeev Kumar Bhoi, Sudipta Mohakud","doi":"10.4103/jmas.jmas_25_23","DOIUrl":"10.4103/jmas.jmas_25_23","url":null,"abstract":"<p><strong>Background: </strong>Thymus is a T-cell-producing lymphoid organ that appears prominent in the paediatric population and involutes in size with ageing. The gland shows a wide variety of appearances across different age groups. The purpose of the study is to evaluate the computed tomography (CT) appearance of thymus gland in the normal population with a focus on size, CT attenuation and fatty infiltration in different age groups.</p><p><strong>Patients and methods: </strong>This is a retrospective study done after taking approval from the Institutional Ethics Committee. Patients undergone CT scans of the thorax were identified from our database. All evaluations were done in non-contrast CT scans. Patients having underlying diseases that may have associated thymic abnormality were excluded. The appearance of thymus and the presence of fatty replacement were assessed. The size of thymus (length and thickness of right limb and left limb) and non-contrast CT Hounsfield unit (HU) value of thymic tissue were measured and compared in various age groups.</p><p><strong>Results: </strong>Four hundred and fifty patients were included, 262 (58.2%) were male. Mean age was 33.6 ± 17.1 years, range (3 months-80 years). The size of thymus was observed to decrease with increasing age. The mean age of complete fatty replacement in our study was 45 years. Complete fatty replacement was noted in all cases with an age of more than 60 years. The most common shape was arrowhead, and the most common location was pre-aortic and para-aortic location. Non-contrast CT HU value was maximum in infants and gradually decreased with advancing age.</p><p><strong>Conclusion: </strong>Even normal thymus can show varied appearance on CT which changes with the age of the patient being imaged. A comparison with normative data could help differentiate normal from abnormal glands to avoid unnecessary intervention.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"101-106"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of laparoscopic single-incision caecal pole resection for low-grade appendiceal mucinous neoplasm.","authors":"Han Deok Kwak","doi":"10.4103/jmas.jmas_113_23","DOIUrl":"10.4103/jmas.jmas_113_23","url":null,"abstract":"<p><strong>Introduction: </strong>Low-grade appendiceal mucinous neoplasm (LAMN) is a rare disease, and its clinical course varies from an incidental finding without symptoms to pseudomyxoma peritonei. Furthermore, there are few established treatment guidelines. This study was designed to confirm the outcomes in patients diagnosed with LAMN who underwent single-incision laparoscopic caecal pole resection.</p><p><strong>Patients and methods: </strong>This study was conducted on pathologically confirmed LAMNs from patients who underwent surgery at a single centre, a tertiary institution, from July 2016 to August 2022. Patients diagnosed with LAMN as a result of biopsy were included. All surgeries were performed with single-incision laparoscopic caecal pole resection by a single surgeon.</p><p><strong>Results: </strong>A total of 70 patients were included. The median age was 65.5 years and 36 (51.4%) patients were female. The baseline carcinoembryonic antigen (CEA) was 8.08 ng/mL (0.76-148.11). The mean maximum diameter was 29.4 mm (7-70) and calcification was seen in 22 cases on pre-operative computed tomography (CT). As a result of histological examination, all patients were marginally negative. The larger the tumour size, the higher the CEA was ( P = 0.011), and it was often accompanied by calcification ( P = 0.021). In addition, tumour size and CEA showed a positive partial correlation with each other ( r = 0.318, P = 0.018). The overall median follow-up period was 22.7 months (2-60). One case had suspected of recurrence on CT scan performed at 33 months following the surgery, but there were no related symptoms.</p><p><strong>Conclusion: </strong>Single-port laparoscopic caecal pole resection without margin involvement in LAMN was safe and feasible, and showed a favourable long-term outcome.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"107-111"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experience of SSI Mantra robot-assisted transabdominal pre-peritoneal repair of primary ventral hernias.","authors":"Magan Mehrotra, Chukka Gautam Kumar","doi":"10.4103/jmas.jmas_344_23","DOIUrl":"10.4103/jmas.jmas_344_23","url":null,"abstract":"<p><strong>Introduction: </strong>Small and medium sized primary midline ventral hernias are best treated by pre-peritoneal mesh placement. This helps in prevention of complications related to intra-peritoneal mesh placement. The challenges we face while performing laparoscopic transabdominal pre-peritoneal (TAPP) procedure can be overcome by robot-assisted TAPP (rTAPP), and we present our initial experience with the same. We describe the surgical technique used in rTAPP using the relatively new SSI Mantra platform for primary midline ventral hernia repair and evaluate its feasibility and present the outcomes.</p><p><strong>Patients and methods: </strong>we performed rTAPP for primary midline ventral hernia repair in 10 patients from July 2023 to September 2023. Demographic patient data, hernia characteristics and peri-operative outcomes were measured.</p><p><strong>Results: </strong>A total of 10 patients underwent elective rTAPP for primary midline ventral hernia, of which 7 were male and 3 were female. The average defect size was 3.2 cm. The average operative time was 113 min. All the patients were discharged within 24-36 h after the procedure. There were no deaths. No post-operative complications such as haematoma, clinically significant seroma, deep or superficial wound infection or recurrence were noted within 30 days.</p><p><strong>Conclusion: </strong>rTAPP is a technically feasible procedure for the repair of small- and medium-sized midline ventral hernias with defect sizes up to 5 cm. SSI Mantra robotic platform provides the same benefit that other conventional robotic platforms provide at a much lesser cost. Further studies looking at the cost-benefit ratio are required to substantiate the above.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":"141-146"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary comparative outcomes of Versius Robotic System-assisted cholecystectomy and laparoscopic cholecystectomy for benign gall bladder disease: Retrospective single-centre, single-surgeon analysis.","authors":"Muharrem Oner","doi":"10.4103/jmas.jmas_13_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_13_24","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the outcomes of Versius Robotic System-assisted cholecystectomy with conventional laparoscopic cholecystectomy for benign gall bladder pathologies, focusing on the perioperative and post-operative parameters.</p><p><strong>Patients and methods: </strong>A retrospective study was conducted on patients with Versius Robotic System-assisted (Group VRS) or conventional laparoscopic cholecystectomy (Group LAP) between September 2021 and June 2023. Patient demographics, perioperative (operative time, conversion and intraoperative complications) details, post-operative pain management and complications were analysed.</p><p><strong>Results: </strong>The study included 44 and 58 patients in Groups VRS and LAP. In Group VRS, we detected significantly reduced post-operative pain (P = 0.009), lower opioid use (P = 0.009) and shorter hospital stays (P = 0.029) than in Group LAP. Total operative time was longer in Group VRS (P < 0.001). No intraoperative complications or conversions occurred in either group.</p><p><strong>Conclusion: </strong>Versius Robotic System-assisted cholecystectomy is a safe and feasible approach for benign gall bladder pathologies, offering benefits such as reduced post-operative pain and shorter hospital stays.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}