Annals of Medicine & Surgery最新文献

{"title":"Disease X and COVID-19: Turning lessons from India and the world into policy recommendations","authors":"Mainak Bardhan, Ishita Ray, Shubhajeet Roy, Priyanka Roy, Priya Thanneeru, A. Twayana, Sakshi Prasad, Mayukh Bardhan, Ayush Anand","doi":"10.1097/ms9.0000000000002391","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002391","url":null,"abstract":"Disease X is caused by pathogen X, an unknown infectious agent that can potentially trigger an epidemic or pandemic. Pathogen X might be any pathogen, including bacteria, viruses, parasites, fungi, and prions. World Health Organization (WHO) uses the term ‘Disease X’ for any new emerging disease caused by an unknown pathogen X. Disease X stands for any possible future pandemic in WHO’s shortlist of high-priority diseases. This review looks at the manifestations of the recent COVID-19 epidemic as the first Disease X to evaluate what has happened and to learn from what went wrong in India and worldwide. To this end, a summary is presented of response measures by governments, often lacking flows of information, discrepancies in the views of experts and decisions of policymakers, and undesirable variations in individual and collective behavior and their consequences. The elements of combating Disease X in a world with considerable inequalities in relevant knowledge, expertise, information, quality of governance, and financial possibilities are discussed. Based on this, recommendations are given for an innovative global pandemic preparedness system.","PeriodicalId":503882,"journal":{"name":"Annals of Medicine & Surgery","volume":"122 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141821933","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":"The evaluation of risk factors in fascia dehiscence after abdominal surgeries","authors":"Hossein Parsa, Leila Haji Maghsoudi, Alireza Mohammadzadeh, Maryam Hosseini","doi":"10.1097/ms9.0000000000002335","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002335","url":null,"abstract":"\u0000 \u0000 Despite the advances in surgical techniques and risk control practices in recent years, open wounds following abdominal laparotomy still have a high prevalence. The purpose of this study is to investigate the risk factors of fascia dehiscence (FD) in abdominal surgery patients.\u0000 \u0000 \u0000 \u0000 In this observational study, a total of 60 emergency and elective laparotomy patients were enrolled. For all patients, with (treatment) or without (control) wound dehiscence, a checklist was used to extract data from medical records regarding underlying diseases, suturing method, emergency or elective surgical procedure, duration of surgery less than 180 minutes, intraoperative bleeding, wound closure method, hernia repair, age, gender, smoking history, comorbidities, type of surgery, colostomy placement, wound complications, reoperation, mortality, wound complications including wound infection, wound dehiscence, incisional hernia, and anastomotic leak, and preoperative readiness assessments such as laboratory tests including CRP (c-reactive protein), Alb (Albumin), etc., were completed, and then comparisons were made.\u0000 \u0000 \u0000 \u0000 Patients were examined in two groups: 14 patients (70%) in wound dehiscence with age 40-60 and 6 patients (30%) in non-wound dehiscence with age 60-75. 8 patients (40%) underwent elective surgery, and 12 patients (60%) underwent emergency surgery (P=0.2). 14 patients (70%) experienced mortality (P<0.001) and 13 patients (65%) had alb<3 (P<0.001).14 patients (70%) had drain installation (P=0.02). it was determined that the increase in CRP levels (compared to pre-dehiscence levels) was observed in 17 out of 20 cases, with the highest difference being CRP=91 and an average increase of 30. None of the patients suspected of anastomotic leakage were confirmed to have it. Dehiscence was typically diagnosed between the 4th and 7th days post-surgery. The colon and rectum were significantly more associated with dehiscence, while the stomach had the lowest association among surgical sites.\u0000 \u0000 \u0000 \u0000 Based on this study, FD is more common in patients treated in the emergency room than in elective procedures. Mortality occurred more in patients with FD and there is a significant relationship between FD with albumin less than 3 and drain placement.\u0000","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141821610","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 case report of hemorrhagic shock from rare ruptured intertitial pregnancy","authors":"Roughaya Teyib, Oumaima kassou, N. Zeraidi, A. Lakhdar, A. Baidada","doi":"10.1097/ms9.0000000000002194","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002194","url":null,"abstract":"\u0000 \u0000 Interstitial pregnancy is rare and exhibit a mortality rate notably higher than that observed in other types of ectopic pregnancies.\u0000 \u0000 \u0000 \u0000 We report a 38-year-old female admitted for a hemorrhagic shock. She was ten weeks pregnant. The suspicion of a ruptured ectopic pregnancy arose based on amenorrhea accompanied by abdominal pain and a pelvic ultrasound showing an empty uterus and abundant free fluid in the abdomen. Emergent exploratory laparotomy was indicated by hemodynamic instability, revealing a ruptured left interstitial ectopic pregnancy.\u0000 \u0000 \u0000 \u0000 The use of three dimensional ultrasonographic imaging specially in the first trimester improves the rate for early detection. The medical or surgical management of an interstitial pregnancy depends on the patient’s hemodynamic stability considering the rupture of the pregnancy.\u0000 \u0000 \u0000 \u0000 interstitial pregnancy is linked to elevated morbidity. Early diagnosis and adequate management both can avoid its catastrophic outcomes.\u0000","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141826612","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":"Femoral blood gas analysis, a new promising tool to assess hemorrhagic shock status","authors":"Preet Imran, Malaika Habib, Tagwa Kalool Fadlalla Ahmed, Muhammad Ashir Shafique","doi":"10.1097/ms9.0000000000002380","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002380","url":null,"abstract":"","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141826902","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":"Insights into the clinical impact of complete blood cell inflammatory markers on body composition variations and fatty liver grading in Iranian adults undergoing bariatric surgery: A retrospective longitudinal study","authors":"Hanieh Radkhah, Ali Alirezaei, Peyvand Parhizkar, Razieh Khalooeifard, Batoul Khoundabi, K. Najjari, M. Talebpour, Reza Hajabi","doi":"10.1097/ms9.0000000000002257","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002257","url":null,"abstract":"\u0000 \u0000 In bariatric surgery, inflammatory biomarkers predict outcomes. Limited research on complete blood cell (CBC) markers stresses the need for correlation study. This research explores links between CBC inflammatory markers, body changes, and fatty liver grades in Iranian bariatric patients.\u0000 \u0000 \u0000 \u0000 This retrospective longitudinal study examined 237 bariatric surgery patients who satisfied the inclusion criteria and were deemed eligible for participation. These criteria encompassed patients who had undergone sleeve or mini-bypass surgery and were aged between 18 and 65 years.The study gathered demographic data, pre and post-surgery changes in CBC inflammatory biomarkers (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), mean platelet volume (MPV), MPV-to-platelet count ratio (MPV/PC), and red cell distribution width (RDW)) and fatty liver grades. Additionally, it recorded pre and post-surgery changes in body composition, such as weight, muscle mass (MM), fat mass (FM), and fat-free mass (FFM).\u0000 \u0000 \u0000 \u0000 The pre-surgery RDW marker significantly associated with FM changes, highlighting its predictive nature. While no significant association was found between changes in patients’ fatty liver grade and baseline marker values, it’s worth noting that individuals with higher MM at 3 months achieved a fatty liver grade of zero. Also, at 6 months, higher FFM and MM were also associated with reaching a fatty liver grade of zero.\u0000 \u0000 \u0000 \u0000 While the retrospective design of this study limits its findings to existing clinical data, future prospective research should collect additional samples, extend the observation time, and examine the long-term predictive value of these markers.\u0000","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141823915","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":"Clinical profile and complications seen in the patients in the later stages of chronic kidney disease presenting to the Emergency department in a tertiary care center in Nepal: A cross-sectional study","authors":"Aditi Sharma, L. Bhusal, Ajaya Rajbhandari, S. Maharjan, Abhishek Adhikari, Egesh Aryal","doi":"10.1097/ms9.0000000000002377","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002377","url":null,"abstract":"\u0000 \u0000 Chronic Kidney Disease has an estimated prevalence of 6% in Nepal, which has resulted in a huge public health and socioeconomic burden for the country. People with different stages of CKD come to the Emergency Department with various clinical features and complications, which if detected and managed early can result in a decreased need for Renal replacement therapy and thus decreased medical cost.\u0000 \u0000 \u0000 \u0000 We conducted a cross-sectional analysis taking nonprobability convenience sampling in the Emergency Department of a tertiary-level hospital of Nepal, after getting approval from the Institutional Review Committee and obtaining informed consent from the patient. Kruskal-Wallis test and Chi-square test of homogeneity were conducted to determine if there were differences in the continuous variables and categorical variables of three stages of CKD. Pairwise comparisons with a Bonferroni correction was done for both variables.\u0000 \u0000 \u0000 \u0000 Among 291 patients of CKD, 25 were in stage 3, 15 in stage 4, and 251 in stage 5. Significant differences between groups were found in continuous variables of SBP, pulse, temp, TLC, platelet, sodium, potassium, urea, and creatinine. Similarly, a significant difference was found for the categorical variables of Hyperkalemia, hyponatremia, thrombocytopenia, leukocytosis, and high creatinine levels.\u0000 \u0000 \u0000 \u0000 Patients with CKD commonly present to the Emergency Department due to electrolyte imbalances, uremia, shortness of breath, and high SBP. Hyperkalemia, thrombocytopenia are more frequently observed in stage 5 CKD, whereas the incidence of hypertension significantly increase from stage 4 onwards. Hyponatremia, on the other hand, is more prevalent in stage 3 than in the later stages.\u0000","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":" 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141824022","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":"Clinical management controversy caused by a rare case of silver clip detachment and displacement after tubal sliver clip sterilization","authors":"Chunyan Zheng, Guangxing Wu, Linli Wu, Yaqin Zheng, Zijun Li","doi":"10.1097/ms9.0000000000002367","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002367","url":null,"abstract":"\u0000 \u0000 The treatment of rare long-term complications such as ectopic silver clips after tubal silver clip sterilization, still follows the principle of removing metal foreign body(MFB) in the abdominal cavity: first choice removal, which seems to be a habitual treatment method by clinical gynecologists. However, this measure has recently been greatly questioned.\u0000 \u0000 \u0000 \u0000 A 54-year-old postmenopausal woman who had undergone tubal sterilization with a sliver clip 32 years ago, presented to emergency department(ED) with severe left upper abdominal colic, paroxysmal, accompanied by vomiting and radiating pain. Her vital signs were stable and emergency routine urine test showed microscopic hematuria. Preliminary consideration was given to ureteral stones and abdominal pain was relieved after treatment. Abdominal CT confirmed the previous consideration, but unexpectedly found that the left tubal sterilization metal clip disappeared and was ectopic in the perihepatic space.\u0000 \u0000 \u0000 \u0000 This traditional conception of removing metal foreign body(MFB) in the abdominal cavity is often accepted by many surgeons. Based on the management measures of this case and the systematic review of literature, we found that the detached ectopic silver clip did not cause serious long-term complications, possibly due to its good tissue receptivity and other characteristics.\u0000 \u0000 \u0000 \u0000 Although an ectopic silver clip is a MFB in the abdominal cavity, it has been increasingly shown that removing the silver clip is not necessary because of the good receptivity of silver to human tissue and uncertainty of long-term side effects on human body.\u0000","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":"24 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141640156","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":"Reverse takotsubo cardiomyopathy in the setting of small bowel obstruction: a case report","authors":"Daniel Bishev, Hussein A. Noureldine, Fernando Ortiz","doi":"10.1097/ms9.0000000000002368","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002368","url":null,"abstract":"\u0000 \u0000 Stress cardiomyopathy refers to a syndrome of acute but reversible left ventricular dysfunction, often triggered by emotional or physical stress. Reverse takotsubo cardiomyopathy is an uncommon variant that occurs in about 5% of cases. Classically, it has been known to be following a catecholamine surge due to physical or emotional stress. This case highlights the importance for physicians to be aware of the possibility of developing a stress cardiomyopathy in patients with acute intrabdominal processes.\u0000 \u0000 \u0000 \u0000 41-year-old Caucasian female with was admitted with an acute small bowel obstruction. After failing conservative management, it was decided to proceed with surgery. After induction with anesthesia but prior to the surgeons first incision, the patient developed a tachyarrhythmia with hemodynamic compromise requiring the surgery to be aborted. That evening, she developed chest pain with concerns for an acute coronary syndrome. She was taken urgently to the for invasive angiography which demonstrated reverse takotsubo.\u0000 \u0000 \u0000 \u0000 Intra-abdominal processes and intubation have previously been reported be catalyst for this disease process. This patient had multiple stressors including mechanical bowel obstruction and anesthesia after failing conservative management. The diagnosis was confirmed by coronary angiography and left ventriculogram, and followed up with repeat outpatient echocardiography.\u0000 \u0000 \u0000 \u0000 A case of small bowel obstruction that developed reverse takotsubo preceded by sustained ventricular tachycardia after intubation. The patient did well and had complete recovery cardiac function. Risk factors and underlining mechanism for the different variants of stress cardiomyopathy are not well understood, further investigation is warranted.\u0000","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":"26 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639894","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":"Efficacy and outcomes of BCG Re-vaccination in COVID-19: a systematic review, meta-analysis, and meta-regression of randomized controlled trials","authors":"Hritvik Jain, Ramez M. Odat, Ayham Mohammad Hussein, Debankur Dey, Mushood Ahmed, Jyoti Jain, Aman Goyal, Tanya Ratnani, Muhammad Idrees, Priyadarshi Prajjwal, Siddhant Passey, Rukesh Yadav","doi":"10.1097/ms9.0000000000002370","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002370","url":null,"abstract":"\u0000 \u0000 The Bacillus Calmette-Guerin (BCG) vaccine has a beneficial “off-target” effect that offers heterologous protection against respiratory tract infections by inducing trained immunity. The need for producing antigen-specific COVID-19 vaccines leads to delays in vaccine administration. Current randomized controlled trials (RCTs) report conflicting data on BCG’s efficacy in COVID-19 infection.\u0000 \u0000 \u0000 \u0000 A comprehensive literature search was conducted using major bibliographic databases to identify RCTs evaluating the outcomes of BCG re-vaccination in COVID-19. For dichotomous outcomes, odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the DerSimonian-Laird random-effects model. Statistical significance was set at P<0.05.\u0000 \u0000 \u0000 \u0000 13 RCTs with 13939 participants (7004 in the BCG re-vaccination group and 6935 in the placebo group) were included. BCG re-vaccination did not lead to a statistically significant difference in the incidence of COVID-19 infection [OR: 1.04; 95% CI: 0.91, 1.19; P=0.56], COVID-19-related hospitalizations [OR: 0.81; 95% CI: 0.38, 1.72; P=0.58), ICU admissions [OR: 0.43; 95% CI: 0.13, 1.46; P=0.18], or mortality [OR: 0.67; 95% CI 0.15, 3.04; P=0.60]. For safety outcomes, BCG re-vaccination led to a significant increase in the local injection site complications [OR: 99.79; 95% CI: 31.04, 320.80; P<0.00001], however, the risk of serious adverse events was similar [OR: 1.19; 95% CI: 0.84, 1.67; P=0.33].\u0000 \u0000 \u0000 \u0000 BCG re-vaccination does not decrease the incidence of COVID-19 infection, COVID-19-related hospitalizations, ICU admissions, COVID-19-related mortality, and serious adverse events, however, it leads to a rise in local injection site complications. Caution should be exercised when overstating BCG’s efficacy in COVID-19 prevention.\u0000","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":"19 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639904","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":"Revolution in malaria detection: unveiling current breakthroughs and tomorrow’s possibilities in biomarker innovation","authors":"E. Obeagu, G. Okoroiwu, N. I. Ubosi, G. U. Obeagu, H. Onohuean, Tukur Muhammad, T. C. Adias","doi":"10.1097/ms9.0000000000002383","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002383","url":null,"abstract":"The ongoing battle against malaria has seen significant advancements in diagnostic methodologies, particularly through the discovery and application of novel biomarkers. Traditional diagnostic techniques, such as microscopy and rapid diagnostic tests (RDTs), have their limitations in terms of sensitivity, specificity, and the ability to detect low-level infections. Recent breakthroughs in biomarker research promise to overcome these challenges, providing more accurate, rapid, and non-invasive detection methods. These advancements are critical in enhancing early detection, guiding effective treatment, and ultimately reducing the global malaria burden. Innovative approaches in biomarker detection are leveraging cutting-edge technologies like next-generation sequencing (NGS), proteomics, and metabolomics. These techniques have led to the identification of new biomarkers that can be detected in blood, saliva, or urine, offering less invasive and more scalable options for widespread screening. For instance, the discovery of specific volatile organic compounds (VOCs) in the breath of infected individuals presents a revolutionary non-invasive diagnostic tool. Additionally, the integration of machine learning algorithms with biomarker data is enhancing the precision and predictive power of malaria diagnostics, making it possible to distinguish between different stages of infection and identify drug-resistant strains. Looking ahead, the future of malaria detection lies in the continued exploration of multi-biomarker panels and the development of portable, point-of-care diagnostic devices. The incorporation of smartphone-based technologies and wearable biosensors promises to bring real-time monitoring and remote diagnostics to even the most resource-limited settings.","PeriodicalId":503882,"journal":{"name":"Annals of Medicine &amp; Surgery","volume":"17 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639798","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}