Scandinavian Journal of Surgery最新文献

{"title":"16-year outcomes of blunt thoracic aortic injury treated with thoracic endovascular aortic repair: A single-institution experience.","authors":"Tasnia Rahman, Lauri M Halonen, Lauri Handolin, Tatu Juvonen, Mikko Jormalainen, Sebastian Dahlbacka","doi":"10.1177/14574969241255242","DOIUrl":"10.1177/14574969241255242","url":null,"abstract":"<p><strong>Background: </strong>Blunt thoracic aortic injury (BTAI) is associated with considerable mortality and morbidity. Thoracic endovascular aortic repair (TEVAR) has essentially replaced open aortic repair (OAR) with superior outcome. The objective of this study was to evaluate the early and intermediate-term outcomes in patients sustaining BTAI treated with TEVAR, and to evaluate the prevalence and impact of left subclavian artery (LSA) coverage.</p><p><strong>Methods: </strong>This retrospective analysis includes patients undergoing TEVAR for BTAI between February 2006 and December 2022 at the Helsinki University Hospital, Finland. The primary endpoints were 30-day and 2-year mortality, technical success of stent-graft system deployment, and procedural and device-related complications. The secondary endpoints pertained to reintervention events: conversion to OAR, re-TEVAR, any endovascular/surgical reinterventions for optimal stent-graft function, or any reinterventions during follow-up.</p><p><strong>Results: </strong>A total of 38 consecutive BTAI patients treated with TEVAR were included in the analyses. Median patient age was 45.5 years (range, 15-79) and 66% were male. The median follow-up period was 39 months. Technical success was 100%, 30-day mortality was 0%, and 2-year mortality was 11% in the study cohort. Coverage of LSA without revascularization (13/18) resulted in one postoperative nondisabling stroke (1/13), no paraplegia, and one had ischemic left arm findings (1/13). Only one patient required reintervention (LSA embolization; 1/38).</p><p><strong>Conclusion: </strong>In this institutional series, we provide further evidence in favor of TEVAR for BTAI treatment. We demonstrated that TEVAR is linked to highly favorable outcomes in the short and intermediate term, and coverage of LSA without revascularization was quite well tolerated.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"282-292"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141097185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperatively suspected gallbladder cancer improves survival compared with incidental gallbladder cancer in pT3 patients.","authors":"Carolina Muszynska, Linda Lundgren, Helene Jacobsson, Per Sandström, Bodil Andersson","doi":"10.1177/14574969241263539","DOIUrl":"10.1177/14574969241263539","url":null,"abstract":"<p><strong>Background: </strong>The aim was to compare survival for incidental gallbladder cancer (IGBC), respectively, preoperatively suspected gallbladder cancer (GBC), subjected to surgery for different pathological tumour (pT) stages and in different treatment groups in a national cohort.</p><p><strong>Methods: </strong>Data were collected and crosslinked from two national quality registers, SweLiv (2009-2019) and GallRiks (2009-2016). Survival was estimated using Kaplan-Meier analysis. The log-rank test and Cox regression analyses were used to compare groups.</p><p><strong>Results: </strong>In total, 466 IGBC patients, including 225 who only underwent simple cholecystectomy (SC), and 477 GBC patients were included. Most patients were female, with small differences in mean age between groups. In all IGBC patients compared with GBC patients, an improved 5-year overall survival in pT3 GBC undergoing surgery (GBC 13% vs all IGBC 8%, <i>p</i> < 0.001), was seen. GBC was shown to be an independent predictor for improved survival in pT3 patients (hazard ratio (HR): 0.6; 95% confidence interval (CI): 0.4-0.8, <i>p</i> <i><</i> 0.001). In addition, in GBC with curative reresection compared with IGBC SC and IGBC with curative resection, an improved 5-year overall survival in pT3 GBC was shown (GBC 20% vs all IGBC 10%, <i>p</i> < 0.001). GBC was an independent predictor for improved survival in pT3 patients with curative resection (HR: 0.4; 95% CI: 0.3-0.7, <i>p</i> <i><</i> 0.001).</p><p><strong>Conclusions: </strong>GBC was shown to be an independent predictor for improved survival in pT3 patients, and patients with GBC may benefit from one-stage resection. It is, therefore, reasonable to recommend that radiological suspicion of malignancy should be evaluated at a liver tumour centre to optimize patient outcomes.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"314-323"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency surgery influences oncological outcome in small intestinal neuroendocrine tumors.","authors":"Frederike Butz, Leonie Supper, Lisa Reinhard, Agata Dukaczewska, Henning Jann, Uli Fehrenbach, Charlotte Friederike Müller-Debus, Tatiana Skachko, Johann Pratschke, Peter E Goretzki, Martina T Mogl, Eva M Dobrindt","doi":"10.1177/14574969241271841","DOIUrl":"10.1177/14574969241271841","url":null,"abstract":"<p><strong>Background and aims: </strong>Patients with small intestinal neuroendocrine tumors (siNETs) frequently present emergently due to bowel ischemia or bowel obstruction. The influence of emergency surgery on the prognosis of siNET remains controversial. The aim of this study was to investigate the association between type of presentation (emergency/elective) and oncological outcome.</p><p><strong>Methods: </strong>Clinicopathological data of patients who underwent bowel resection and were treated due to siNET at the Charité - Universitätsmedizin Berlin, Germany were analyzed retrospectively.</p><p><strong>Results: </strong>A total of 165 patients underwent bowel resection for siNET. Of these, 22.4% (n = 37) were emergency and 77.6% (n = 128) were elective procedures. A preoperative known diagnosis was less common in patients with emergency surgery (48.6% vs 85.2%; <i>p</i> < 0.001) and complete resections of all tumor manifestations were performed less often (32.4% vs 50.8%; <i>p</i> = 0.049), while more completion operations had to be performed (24.3% vs 11.1%; <i>p</i> = 0.049). Overall survival (OS) and progression-free survival (PFS) of emergently operated patients were reduced (5-year OS: 85.2% vs 89.5% (<i>p</i> = 0.023); 5-year PFS: 26.7% versus 52.5% (<i>p</i> = 0.018)). In addition, emergency surgery was negatively associated with OS after multivariable regression analysis.</p><p><strong>Conclusion: </strong>Emergency surgery in siNET patients is associated with adverse oncological outcomes including shorter OS and PFS. Prevention of emergency conditions should be emphasized in advanced disease.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"303-313"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spine injuries among severely injured trauma patients: A retrospective single-center cohort study.","authors":"Henri Lassila, Mikko Heinänen, Joni Serlo, Tuomas Brinck","doi":"10.1177/14574969241271781","DOIUrl":"10.1177/14574969241271781","url":null,"abstract":"<p><strong>Backgrounds and aims: </strong>We aimed to determine the incidence and severity of spine injuries among severely injured trauma patients (Injury Severity Score (ISS)/New Injury Severity Score (NISS) > 15) treated in a single tertiary trauma center over 15 years. We also wanted to compare the demographics between patients with and without spine injuries and to determine the mortality of spine-injury patients.</p><p><strong>Methods: </strong>Data from the years 2006-2020 from the Helsinki Trauma Registry (HTR), a local trauma registry of the trauma unit of the Helsinki University Hospital (HUH), were reviewed. We divided patients into two groups, namely those with traumatic spine injury (TSI) and those without traumatic spine injury (N-TSI). TSI patients were further subdivided into groups according to the level of injury (cervical, thoracolumbar, or multilevel) and the presence of neurological symptoms.</p><p><strong>Results: </strong>We included 2529 patients: 1336 (53%) had a TSI and 1193 (47%) had N-TSI. TSI patients were injured more frequently by a high-fall mechanism (37% vs 21%, p < 0.001). Among TSI patients, 38% of high-fall injuries were self-inflicted. High falls, young age, and female gender were overrepresented in spine-injury patients with a self-inflicted injury mechanism. Cervical spine-injury patients were mostly elderly persons injured by a low-energy mechanism.</p><p><strong>Conclusions: </strong>Unlike other severely injured trauma patients, severely injured trauma patients with spine injuries are more frequently injured by a high-fall mechanism and self-injury.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"293-302"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic surgery: Challenges and opportunities.","authors":"John-Peder Escobar Kvitting","doi":"10.1177/14574969241263529","DOIUrl":"10.1177/14574969241263529","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"334-335"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operative versus non-operative treatment for non-displaced Lisfranc injuries: A two-center randomized clinical trial.","authors":"Ville Ponkilainen, Heikki Mäenpää, Heikki-Jussi Laine, Nikke Partio, Olli Väistö, Janne Jousmäki, Ville M Mattila, Heidi Haapasalo","doi":"10.1177/14574969241295585","DOIUrl":"https://doi.org/10.1177/14574969241295585","url":null,"abstract":"<p><strong>Background and aims: </strong>There is no consensus on which Lisfranc injuries can be treated non-operatively. The aim of the study was to compare non-operative treatment and open reduction and internal fixation (ORIF) in the treatment of non-displaced Lisfranc injuries.</p><p><strong>Materials and methods: </strong>This study was a multicenter randomized controlled trial (RCT) conducted at two hospitals in Finland between 19 March 2012, and 20 December 2022, with a target sample size of 60 patients. The primary outcome was Visual Analogue Scale Foot and Ankle (VAS-FA) at 2 years. The secondary outcomes included VAS-FA pain, function, and other complaints subscales and the American Orthopedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6 months, 1 and 2 years.</p><p><strong>Results: </strong>Altogether 27 patients with computed tomography (CT)-confirmed non-displaced Lisfranc injuries were enrolled in this trial resulting in an underpowered trial. In patients with non-displaced Lisfranc injuries, the mean VAS-FA overall score in the non-operative group was 96.1 [confidence interval (CI): 91.5-100] and 91.8 [86.9-96.7] in the ORIF group at 2 years with no statistically significant difference between the groups (mean between-group difference (MD) 4.3 [CI, -2.4 to 11], Cohen's d = 0.706) in this underpowered RCT.</p><p><strong>Conclusion: </strong>There was no difference in VAS-FA between non-operative and ORIF in patients with non-displaced Lisfranc injuries, but the trial is underpowered to draw robust conclusions.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241295585"},"PeriodicalIF":2.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the accuracy gap in early postoperative complication surveillance: ICD-10 codes versus manual curation-clinical and economic implications.","authors":"Emilie Even Dencker, Alexander Bonde, Stephan Sloth Lorenzen, Anders Troelsen, Martin Sillesen","doi":"10.1177/14574969241294263","DOIUrl":"https://doi.org/10.1177/14574969241294263","url":null,"abstract":"<p><strong>Background and objective: </strong>Assessing surgical outcomes, notably postoperative complications (PCs), is crucial for healthcare systems. However, reliance on International Classification of Diseases, 10th revision (ICD-10) codes, may be suboptimal. This study aims to compare the accuracy of ICD-10 codes against manual curation of electronic healthcare records (EHRs) for identifying 13 individual PCs and evaluate associated resource utilization.</p><p><strong>Methods: </strong>EHR data from 11,827 surgical cases across 18 Danish hospitals in November 2021 were analyzed. PCs were identified and extracted through both manual curation and ICD-10 codes. Outcomes such as readmission, admission days, intensive care unit (ICU) stays, reoperations, and radiology procedures were assessed as proxies for resource consumption. Statistical and economic analyses quantified resource utilization and associated costs.</p><p><strong>Results: </strong>In total, 1047 PCs were found through manual curation and 439 PCs were found through ICD-10 codings. Only 218 of the PCs found through ICD-10 codes were retrieved during manual curation-corresponding to a correct ICD-10 coding of 20.8% of PCs. Patients with PCs experienced significantly higher resource utilization, including a 6.6 times higher readmission rate, 6 additional admission days, 2 extra ICU days, 7.7 times more reoperations. PCs incurred substantial economic costs, with additional admission days alone accounting for €25.5 million annually, over four times higher than estimates from ICD-10 codes.</p><p><strong>Conclusions: </strong>ICD-10 codes inadequately capture early PCs highlighting the need for improved detection strategies. The actual costs associated with PCs far exceed current estimates, emphasizing the necessity for enhanced monitoring for informed decision-making. In the Danish healthcare system, ICD-10 codes only capture approximately 21% of PCs, making it inadequate for surgical quality monitoring. The actual costs related to PCs, based on study assumptions, are more than four times higher than estimated from current standard. This calls for novel strategies for PC detection to improve healthcare as well as political and financial decision-making.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241294263"},"PeriodicalIF":2.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of the ascending aortic length with acute type A aortic dissection: A retrospective cohort study.","authors":"Tarmo Korpela, Elina Salomaa, Petteri Kauhanen, Tuomas Selander, Marja Hedman, Annastiina Husso","doi":"10.1177/14574969241294261","DOIUrl":"https://doi.org/10.1177/14574969241294261","url":null,"abstract":"<p><strong>Background and aims: </strong>To investigate whether, alongside aortic dilatation, ascending aortic (AA) elongation is associated with the increased risk for aortic dissection.</p><p><strong>Methods: </strong>This retrospective study included patients treated for Stanford type A aortic dissection (n = 102) in Kuopio University Hospital between 2009 and 2022, patients with AA dilatation (maximal diameter > 40 mm) (n = 134), and healthy controls (n = 191). AA length and dimensions were measured from aortic computed tomography angiography (CTA) images. AA length was defined as the distance between the aortic annulus and the origin of the brachiocephalic trunk.</p><p><strong>Results: </strong>After adjusting the AA length to the patients' age, height, body surface area (BSA), sex, and maximal diameter, the dissected aortas were 14 mm longer than in the healthy controls and 5 mm longer than in the dilated non-dissected aortas (p < 0.001). The dilated non-dissected aortas were 8 mm longer than in the healthy controls (p < 0.001). In the dissection cohort, 25/102 (25%) patients had maximal AA diameter < 55 mm and 16/102 (16%) patients had maximal AA diameter ⩾ 55 mm together with AA length > 110 mm. By combining 110 mm AA length and < 55 mm diameter, 58% of the dissection patients would have been identified instead of using solely AA diameter ⩾ 55 mm as a cut-off criterion, based on which only 33% patients met the indication for elective surgery.</p><p><strong>Conclusion: </strong>AA length seemed to have an association with acute type A dissection, and therefore, it could be an additional tool in identifying patients who may benefit from preventive aortic surgery.[Formula: see text].</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241294261"},"PeriodicalIF":2.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic accuracy of intraoperative near-infrared spectroscopy in carotid artery endarterectomy under general anesthesia: A systematic review with meta-analysis.","authors":"Luís Duarte-Gamas, Mariana Fragão-Marques, Petar Zlatanovic, José P Andrade, João Rocha-Neves","doi":"10.1177/14574969241282611","DOIUrl":"https://doi.org/10.1177/14574969241282611","url":null,"abstract":"<p><strong>Background: </strong>Carotid endarterectomy (CEA) carries a risk of perioperative stroke, particularly during carotid cross-clamping. While neurological monitoring is reliable for patients under regional anesthesia, alternative options are needed for those unsuitable for regional anesthesia. Near-infrared spectroscopy (NIRS) is commonly used during CEA, but its diagnostic accuracy varies, particularly under general anesthesia.</p><p><strong>Methods: </strong>A systematic review with meta-analysis was performed to assess the diagnostic accuracy of intraoperative NIRS in detecting clamp-associated hemodynamic cerebral ischemia in patients under general anesthesia. MEDLINE, Google Scholar, and Web of Science were searched for studies that compared NIRS with the occurrence of immediate or early postoperative neurological deficits in patients undergoing CEA under GA. Meta-regression was performed to explore causes of heterogeneity.</p><p><strong>Results: </strong>A total of 28 studies involving 5729 patients were included. The results show that NIRS has a summary sensitivity of 47.5% and a summary specificity of 90.3% in diagnosing clamp-associated cerebral ischemia under general anesthesia, with an area under the ROC curve (AUC-ROC) of 0.85. The presence of a contralateral carotid occlusion (CCO) increased summary sensitivity while smoking history the presence of CCO and smoking history decreased summary specificity. For postoperative stroke prediction, NIRS has a summary sensitivity of 49.5% and summary specificity of 88.5%, with an AUC-ROC of 0.85.</p><p><strong>Conclusions: </strong>NIRS is a specific but not highly sensitive tool for detecting cerebral ischemia during CEA, and its use in combination with more sensitive neuromonitoring methods is recommended, in order to guide intraoperative neuroprotective strategies.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241282611"},"PeriodicalIF":2.5,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of frailty in geriatric surgical oncology.","authors":"Joanna Abi Chebl, Ponnandai Somasundar, Lidia Vognar, Steve Kwon","doi":"10.1177/14574969241298872","DOIUrl":"https://doi.org/10.1177/14574969241298872","url":null,"abstract":"<p><p>Frailty is a common phenomenon in older adult population and associated with an elevated risk of adverse health outcomes. Recent studies have demonstrated that patients with frailty undergoing surgery had a significantly higher morbidity and mortality compared to those without frailty. This is particularly important in patients with cancer because the prevalence of frailty is persistently high across a spectrum of primary cancers. Identifying frailty in oncological patients undergoing surgery may provide an important preoperative intervention opportunity to mitigate operative risks. In this review, we provide an overview of frailty and its association with other geriatric syndromes. We will also review the impact of frailty on postoperative outcomes focusing on the field of surgical oncology. We then describe currently available tools to objectively measure frailty to provide clinicians with various practical tools that may be adopted in their clinical practice. Finally, we will describe potential interventional programs, including the recently introduced Geriatric Surgery Verification program by the American College of Surgeons, that may be institutionally adopted to mitigate postoperative complications and improve meeting patient-centered goals in the frail patient population.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241298872"},"PeriodicalIF":2.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}