Canadian liver journal最新文献

{"title":"Appropriate Timing and Interval for Surveillance Colonoscopy after Liver Transplantation Based on a Single-Centre Experience.","authors":"Dae Gon Ryu, Hongqun Liu, Samuel S Lee, Ki Tae Yoon, Mayur Brahmania","doi":"10.3138/canlivj-2024-0041","DOIUrl":"10.3138/canlivj-2024-0041","url":null,"abstract":"<p><strong>Background: </strong>Colon cancer surveillance post liver transplantation (LT) is generally recommended. This study aimed to determine the appropriate timing for the first colonoscopy after LT and the interval for subsequent surveillance colonoscopies based on our single-centre real-world experience.</p><p><strong>Methods: </strong>The medical records of patients who underwent LT at Pusan National University Yangsan Hospital between December 2008 and March 2024 were reviewed. Patients who underwent colonoscopy at least once after LT were analyzed. After the first post-transplant colonoscopy, subsequent colonoscopies were divided into an intensive and a nonintensive surveillance group based on a 3-year interval.</p><p><strong>Results: </strong>A total of 404 LT recipients with 1,076 colonoscopies were analyzed. The analysis included pre-transplant (n = 219), first post-transplant (n = 404), and subsequent colonoscopies (n = 453). Cecal intubation failure and poor bowel preparation were higher in the pre-transplant colonoscopy than the post-transplant colonoscopy (3.2% versus 0.8%, <i>p</i> = 0.010; 13.2% versus 4.4%, <i>p</i> < 0.001). Although high-risk polyps were resected in 17 recipients (7.8%) through pre-transplant colonoscopy, they were also discovered in 17 recipients (4.2%) at the first post-transplant colonoscopy. There were no differences in malignancy or high-risk polyp detection between recipients who underwent intensive surveillance (median interval, 22 months) after the first post-transplant colonoscopy and those who did not (median interval, 52 months; 0.6% versus 2.1%, <i>p</i> = 0.381 and 3.7% versus 2.1%, <i>p</i> = 0.598).</p><p><strong>Conclusions: </strong>Colonoscopy prior to LT may be insufficient; therefore, the first colonoscopy after LT should be performed within 1 year. Subsequent colonoscopies should follow the general surveillance interval.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"39-48"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661617","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":"Investing in the Future: Training for Clinical Care and Research in Liver Disease.","authors":"Carla S Coffin","doi":"10.3138/canlivj-2025-0006","DOIUrl":"10.3138/canlivj-2025-0006","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"1-4"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661622","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":"Cross-sectional Study of Resident Physician Knowledge and Perceptions Regarding MASLD in Canada.","authors":"Kai Zhu, Manisha Jogendran, Yanru Zhang, Trana Hussaini, Daljeet Chahal, Eric M Yoshida","doi":"10.3138/canlivj-2024-0009","DOIUrl":"10.3138/canlivj-2024-0009","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 25% of Canadians. As its prevalence grows, it is crucial for future primary care physicians to have a thorough understanding of MASLD to improve patient care.</p><p><strong>Methods: </strong>We conducted a nationwide cross-sectional survey among resident physicians in primary care specialties to assess their knowledge and perceptions of MASLD. \"Reasonable knowledge\" was defined as correctly answering over 50% of the questions. Associations were analyzed using χ² testing and multiple logistic regression analysis.</p><p><strong>Results: </strong>We received 413 responses, with 252 (61%) from Family Medicine residents and 161 (39%) from Internal Medicine residents. Among the respondents, 91% considered MASLD an important public health issue; however, only 11% felt they had adequate exposure to the condition and 94% endorsed a need for more teaching. Overall, 35% of the respondents displayed a reasonable knowledge of MASLD. In univariate analysis, factors associated with greater MASLD knowledge included Internal Medicine residency (<i>p</i> = 0.001), higher post-graduate year (<i>p</i> = 0.003), prior GI or hepatology rotations (<i>p</i> = 0.003), previous MASLD lectures (<i>p</i> = 0.021), and higher subjective familiarity with MASLD (<i>p</i> <0.001). However, only moderate (odds ratio (OR) 5.7, 95% CI 1.1-26.3, <i>p</i> = 0.026) and high (OR 10.1, CI 1.6-65.3, <i>p</i> = 0.015) subjective familiarity with MASLD, and three or more prior MASLD lectures (OR 3.4, CI:1.1-10.4, <i>p</i> = 0.031) remained statistically significant in multivariate analysis.</p><p><strong>Conclusions: </strong>Resident physicians recognize MASLD as an important health issue but lack adequate exposure and knowledge about the condition. Further emphasis and education are required to bridge these knowledge gaps and improve patient outcomes.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"8-17"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661619","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":"Discrete Choice Experiments and Conjoint Analyses in Health Screening Programs for Type 2 Diabetes and Liver Disease: A Scoping Review.","authors":"Felice Cinque, Clara Long, Duy A Dinh, Genevieve Gore, Mark Swain, Alnoor Ramji, Keyur Patel, Michael Betel, Harpreet S Bajaj, Kaberi Dasgupta, Thomas G Poder, Sahar Saeed, Giada Sebastiani","doi":"10.3138/canlivj-2024-0050","DOIUrl":"10.3138/canlivj-2024-0050","url":null,"abstract":"<p><strong>Background: </strong>We aimed to summarize the evidence on the use of discrete choice experiments (DCEs) and conjoint analyses to quantify stakeholders' preferences for screening programs for type 2 diabetes (T2D) and liver diseases, with a specific focus on metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Methods: </strong>For this scoping review, five databases (MEDLINE [PubMed], PubMed Central, EMBASE [Ovid], Europe PMC, Google Scholar) were searched with the assistance of a librarian, and deduplicated records were screened by two independent reviewers. Inclusion criteria: using DCE/CA, addressing screening programs for T2D and liver disease, published in English, French, or Spanish after January 1990.</p><p><strong>Results: </strong>Among 2,282 studies, 9 (7 from high- and 2 from low-income countries) elicited preferences for screening for liver disease (n = 1), hepatitis C (n = 1), hepatitis B (n = 1), hepatocellular carcinoma (n = 2), noncommunicable diseases (n = 2), diabetic retinopathy (n = 1), and cardiovascular diseases (n = 1). No studies addressed MASLD screening in T2D. Stakeholders included patients (n = 3), health care providers (n = 1), patients plus health care providers (n = 1), and the general population (n = 3). Studies used 18 structure, 6 process, and 4 outcome attributes. Screening sensitivity, setting, duration, provider, and cost were the most important structure attributes in participant choices. Physician support for treatment was the preferred process attribute. Outcome attributes were the least used, but of major importance (screening adherence followed by treatment) when considered.</p><p><strong>Conclusions: </strong>With no study focusing on MASLD screening in T2D, our scoping review highlights the need to develop a DCE addressing this topic to better design a patient-centred continuum of care.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 1","pages":"63-78"},"PeriodicalIF":0.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661620","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":"Higher Pre-Operative Non-Invasive Fibrosis Scores are not Associated with Surgical Outcomes in Patients with MASLD Undergoing Metabolic and Bariatric Surgery.","authors":"Louis Huynh, Ekaterina Kouzmina, Boris Zevin, Jennifer A Flemming","doi":"10.3138/canlivj-2024-0015","DOIUrl":"10.3138/canlivj-2024-0015","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of cirrhosis in Canada. Metabolic and bariatric surgery (MBS) leads to histologic improvement in patients with MASLD and obesity; however, patients with advanced fibrosis may be at risk for decompensation in liver function following MBS. There are currently no Canadian data evaluating the association between pre-operative advanced fibrosis and post-operative complications among patients with obesity undergoing MBS.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study of individuals undergoing primary MBS (Roux-en-Y gastric bypass and sleeve gastrectomy) between September 2016 and August 2021. The primary exposure was pre-operative NAFLD (non-alcoholic fatty liver disease) fibrosis score (NFS). Outcomes of interest included post-operative complications and health care utilization at 30 and 90 days, and weight loss at 30 days post-operatively.</p><p><strong>Results: </strong>After exclusions, 204 patients who received MBS and had the data required to calculate NFS were included. The median age was 46 years (interquartile range 38-55 years) and 181 (89%) were female. A total of 55 (27%) patients had NFS, suggesting advanced fibrosis. There was no significant difference in 30- or 90-day complications and health care utilization rates in patients with higher NFS.</p><p><strong>Conclusions: </strong>Patients undergoing MBS have a high prevalence of steatosis and advanced fibrosis based on the NFS. Our data suggest that higher NFS is not associated with higher short-term post-operative complications in patients undergoing MBS. Further work needs to be done to determine the optimal method of screening for advanced liver disease in patients living with severe obesity.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 2","pages":"284-289"},"PeriodicalIF":0.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661638","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":"Validation of FIB-4 for the Diagnosis of Liver Cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Chinmay Bera, Nashla Hamdan-Perez, Heather Mary-Kathleen Kosick, Mohamed Shengir, Giada Sebastiani, Keyur Patel","doi":"10.3138/canlivj-2024-0063","DOIUrl":"10.3138/canlivj-2024-0063","url":null,"abstract":"<p><p>American Association for the Study of Liver Diseases practice guidance on metabolic dysfunction-associated steatotic liver disease (MASLD) has recommended using specific cut-off values for the Fibrosis-4 index (FIB-4) to detect cirrhosis. A cut-off of 3.48 is recommended for identifying stage 4 fibrosis (F4) with high specificity, while a cut-off of 1.67 is suggested for ruling out advanced fibrosis. Our study aimed to validate the diagnostic performance of these new FIB-4 cut-offs in our cohort of biopsy-proven MASLD from two Canadian tertiary care centres. Our study included 390 patients with biopsy-proven MASLD with F4 prevalence of 22%. Among the 87 patients with cirrhosis, 37 (42.5%) were correctly identified with a FIB-4 ≥3.48. FIB-4 had an area under the receiver operating characteristic curve of 0.79 at the proposed cut-off points, with 32% of patients being indeterminate or misclassified. Sensitivity and positive-predictive value for the FIB-4 cut-off were 65% and 68.5%, respectively, while the specificity and negative-predictive value were 93% and 92%, respectively. In conclusion, in our biopsy-proven MASLD cohort, recommended FIB-4 cut-offs ≥3.48 and <1.67 had low sensitivity but high specificity. An upper FIB-4 cut-off of 3.48 would have missed nearly one in four cirrhosis cases. The proposed FIB-4 thresholds for identifying F4 in MASLD patients have limited diagnostic utility in higher prevalence tertiary hepatology cohorts.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 2","pages":"280-283"},"PeriodicalIF":0.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661650","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":"The Development of an Online Palliative Care Toolkit for Cirrhosis.","authors":"Kinjal Patel, Amanda Brisebois, Sara N Davison, Jordan Tate, Noush Mirhosseini, Ingrid DeKock, Sarah Burton-MacLeod, Martin Labrie, Mino Mitri, Aynharan Sinnarajah, Denise Campbell-Scherer, Puneeta Tandon","doi":"10.3138/canlivj-2024-0022","DOIUrl":"10.3138/canlivj-2024-0022","url":null,"abstract":"<p><strong>Background: </strong>Liver cirrhosis carries high symptom burden and health care utilization. Palliative care (PC) has demonstrated improvements in symptom burden and overall quality of life. Despite this, PC remains underutilized in patients with chronic liver disease. As a step to bridge this gap, we developed cirrhosiscare.ca as an easy-to-access, evidence-, and expert consensus-based online PC resource for health care providers.</p><p><strong>Methods: </strong>This short report describes the development of the health care practitioner 'Symptom Management' section of www.cirrhosiscare.ca, covering common symptoms (e.g., pain, pruritus, anxiety, depression, nausea/vomiting) experienced by patients with cirrhosis. A multidisciplinary team included representatives from hepatology, palliative care, pain management, psychiatry, pharmacy, and primary care. The project was carried out over four phases: Symptom selection, Material development, Website creation, and Feedback, revisions, and maintenance.</p><p><strong>Results: </strong>The cirrhosiscare.ca website was launched to the public on March 15, 2021. Twelve detailed content pages were developed alongside four end-of-life algorithms. The developed pages have been well received, and there are between 10,000 and 12,000 new users on the site each month.</p><p><strong>Conclusions: </strong>The development of the cirrhosiscare.ca website is a digital strategy to increase awareness and access to evidence-based and expert consensus-based materials for PC. Ongoing dissemination and sustainability will include regular maintenance and updates to online content, links to inpatient care pathways, and incorporation within the Alberta one:carepath primary care initiative.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"8 2","pages":"276-279"},"PeriodicalIF":0.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661646","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":"Long-term use of subcutaneous octreotide reduces variceal bleeding in non-cirrhotic portal hypertension.","authors":"Aashish Chalasani, Alice Unah Lee","doi":"10.3138/canlivj-2024-0025","DOIUrl":"10.3138/canlivj-2024-0025","url":null,"abstract":"<p><strong>Background: </strong>Non-cirrhotic portal hypertension from a portal vein thrombus can cause variceal bleeding. The use of vasoactive agents such as octreotide is currently limited to acute bleeding episodes. Current strategies to reduce recurrent bleeding events include non-selective beta blockers, treatment of underlying disease including management of risk factors, and periodic endoscopic therapy. There is limited literature on the use of subcutaneous octreotide in the long-term management of recurrent variceal bleeding.</p><p><strong>Case: </strong>We present a 55-year-old male with progressive non-cirrhotic portal hypertension on the basis of a portal vein thrombus with extensive thrombosis leading to significant portal hypertension and episodic acute variceal bleeding over the course of 15 years. Progression of varices throughout the gastrointestinal tract led to more severe bleeding with requirement for massive transfusion protocols. He was deemed not suitable for shunting procedures or transplantation due to increased bleeding episodes and development of ascites.</p><p><strong>Results: </strong>Following commencement of twice-daily subcutaneous octreotide, no further clinically significant bleeding events occurred. He remains stable more than 3 years on from therapy.</p><p><strong>Conclusions: </strong>This case demonstrates an observed reduction in clinically significant bleeding and red cell transfusion requirements in a non-cirrhotic portal hypertension patient on daily octreotide. Further larger-scale, randomized controlled studies are required to investigate this observation.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"505-510"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661599","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":"The effect of spatial variation on linkage to care and treatment rates among patients with hepatitis C: A Canadian population-based study.","authors":"Shubhreet Gill, Rizwan Shahid, Ranjani Somayaji, Mayur Brahmania, Jason Jiang, Jawad Chishtie, Stefania Bertazzon, Abdel-Aziz Shaheen","doi":"10.3138/canlivj-2024-0031","DOIUrl":"10.3138/canlivj-2024-0031","url":null,"abstract":"<p><strong>Introduction: </strong>Despite significant global efforts towards eliminating hepatitis C virus (HCV) infection, multiple challenges remain in achieving this goal. In this study, we assessed the impact of geographical variation on HCV diagnosis and treatment rates in Alberta, Canada.</p><p><strong>Methods: </strong>Adults aged ≥20 years with a positive HCV antibody were identified from the provincial administrative sources from the fiscal years 2012 through 2017. To assess the differences across Alberta's rural-urban continuum, high-resolution spatial analyses using global and local spatial autocorrelation were applied to the HCV age- and sex-standardized prevalence rate at the sub-local geographic area level. We compared and tested differences in HCV RNA tests, HCV RNA positivity rates, and HCV treatment status across the different areas.</p><p><strong>Results: </strong>Between 2012 and 2017, we identified 18,768 patients who had tested positive for HCV Ab. Within this cohort, only 63.1% had HCV RNA repetitive. The HCV RNA positivity rate was 42.1%, and 65.3% had received HCV treatment after testing as HCV RNA positive. HCV Ab positive case counts exhibited a spatial distribution consistent with that of the population at risk: 67.5% in metro, 11.1% in urban, 19.7% in rural, and 1.8% in remote areas. The metropolitan area of Edmonton's age-and sex-standardized prevalence of 8.2 (95% CI 8.0-8.4) per 1,000 persons was higher than Calgary's standardized prevalence of 5.0 (95% CI 5.1-5.4) per 1,000 persons (<i>p</i> < 0.001). HCV RNA and HCV treatment rates demonstrated significant spatial variation.</p><p><strong>Conclusions: </strong>HCV prevalence, diagnosis, and treatment exhibit significant spatial variation across rural-urban Alberta. Implementation of geographically oriented screening and treatment interventions would result in a time- and cost-efficient HCV elimination strategy.</p>","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"447-457"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661560","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":"Coffee: nature's remedy for liver disease.","authors":"Natasha Chandok, Eric M Yoshida","doi":"10.3138/canlivj-2024-0055","DOIUrl":"10.3138/canlivj-2024-0055","url":null,"abstract":"","PeriodicalId":510884,"journal":{"name":"Canadian liver journal","volume":"7 4","pages":"413-414"},"PeriodicalIF":0.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661593","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}