世界危重病急救学杂志(英文版)最新文献

{"title":"Quality indicators in respiratory therapy.","authors":"Manjush Karthika, Sureshkumar Vanajakshy Kumaran, Praveen Beekanahaali Mokshanatha","doi":"10.5492/wjccm.v13.i2.91794","DOIUrl":"10.5492/wjccm.v13.i2.91794","url":null,"abstract":"<p><p>Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance, effectiveness, and safety of healthcare services. These indicators provide a systematic way to evaluate the quality of care offered, and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices. Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives. Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care. By systematically tracking and analyzing indicators related to infection control, treatment effectiveness, and adherence to protocols, respiratory care practitioners can identify areas to improve and implement evidence-based changes. This article reviewed how to identify, implement, and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 2","pages":"91794"},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297409","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":"Sound waves and solutions: Point-of-care ultrasonography for acute kidney injury in cirrhosis.","authors":"David Aguirre-Villarreal, Mario Andrés de Jesús Leal-Villarreal, Ignacio García-Juárez, Eduardo R Argaiz, Abhilash Koratala","doi":"10.5492/wjccm.v13.i2.91212","DOIUrl":"10.5492/wjccm.v13.i2.91212","url":null,"abstract":"<p><p>This article delves into the intricate challenges of acute kidney injury (AKI) in cirrhosis, a condition fraught with high morbidity and mortality. The complexities arise from distinguishing between various causes of AKI, particularly hemodynamic AKI, in cirrhotic patients, who experience hemodynamic changes due to portal hypertension. The term \"hepatocardiorenal syndrome\" is introduced to encapsulate the intricate interplay among the liver, heart, and kidneys. The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis, unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function. The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed, highlighting potential risks and variable patient responses. We advocate for a nuanced algorithm for AKI evaluation in cirrhosis, prominently featuring point-of-care ultrasonography (POCUS). POCUS applications encompass assessing fluid tolerance, detecting venous congestion, and evaluating cardiac function.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 2","pages":"91212"},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297411","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":"Effects of combined aerobic, resistance and inspiratory training in patients with pulmonary hypertension: A systematic review.","authors":"Christos Kourek, Antonia Zachariou, Eleftherios Karatzanos, Michalis Antonopoulos, Theodora Soulele, Andreas Karabinis, Serafim Nanas, Stavros Dimopoulos","doi":"10.5492/wjccm.v13.i2.92585","DOIUrl":"10.5492/wjccm.v13.i2.92585","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) is a serious progressive disorder of the modern world, characterized by endothelial dysfunction and impaired vasoreactivity. Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity. Exercise training has been shown to have beneficial effects in patients with cardiovascular comorbidities. However, data regarding the effects of combined exercise training programs in patients with PH still remains limited.</p><p><strong>Aim: </strong>To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with PH.</p><p><strong>Methods: </strong>Our search included all available randomized controlled trials (RCTs) regarding combined aerobic, resistance and inspiratory training programs in patients with PH in 4 databases (Pubmed, PEDro, Embase, CINAHL) from 2012 to 2022. Five RCTs were included in the final analysis. Functional capacity, assessed by peak VO₂ or 6-min walking test (6MWT), as well as quality of life, assessed by the SF-36 questionnaire, were set as the primary outcomes in our study.</p><p><strong>Results: </strong>Peak VO₂ was measured in 4 out of the 5 RCTs while 6MWT was measured in all RCTs. Both indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs (<i>P</i> < 0.05). Quality of life was measured in 4 out of 5 RCTs. Although patients improved their quality of life in each group, however, only 2 RCTs demonstrated further improvement in patients performing combined training compared to controls.</p><p><strong>Conclusion: </strong>By this systematic review, we have demonstrated that combined aerobic, resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with PH. Such exercise training regimen may be part of the therapeutic strategy of the syndrome.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 2","pages":"92585"},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297339","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":"Extracorporeal organ support for critically ill patients: Overcoming the past, achieving the maximum at present, and redefining the future.","authors":"Panagiotis Papamichalis, Katerina G Oikonomou, Maria Xanthoudaki, Asimina Valsamaki, Apostolia-Lemonia Skoura, Sophia K Papathanasiou, Achilleas Chovas","doi":"10.5492/wjccm.v13.i2.92458","DOIUrl":"10.5492/wjccm.v13.i2.92458","url":null,"abstract":"<p><p>Extracorporeal organ support (ECOS) has made remarkable progress over the last few years. Renal replacement therapy, introduced a few decades ago, was the first available application of ECOS. The subsequent evolution of ECOS enabled the enhanced support to many other organs, including the heart [veno-arterial extracorporeal membrane oxygenation (ECMO), slow continuous ultrafiltration], the lungs (veno-venous ECMO, extracorporeal carbon dioxide removal), and the liver (blood purification techniques for the detoxification of liver toxins). Moreover, additional indications of these methods, including the suppression of excessive inflammatory response occurring in severe disorders such as sepsis, coronavirus disease 2019, pancreatitis, and trauma (blood purification techniques for the removal of exotoxins, endotoxins, or cytokines), have arisen. Multiple organ support therapy is crucial since a vast majority of critically ill patients present not with a single but with multiple organ failure (MOF), whereas, traditional therapeutic approaches (mechanical ventilation for acute respiratory failure, antibiotics for sepsis, and inotropes for cardiac dysfunction) have reached the maximum efficacy and cannot be improved further. However, several issues remain to be clarified, such as the complexity and cost of ECOS systems, standardization of indications, therapeutic protocols and initiation time, choice of the patients who will benefit most from these interventions, while evidence from randomized controlled trials supporting their use is still limited. Nevertheless, these methods are currently a part of routine clinical practice in intensive care units. This editorial presents the past, present, and future considerations, as well as perspectives regarding these therapies. Our better understanding of these methods, the pathophysiology of MOF, the crosstalk between native organs resulting in MOF, and the crosstalk between native organs and artificial organ support systems when applied sequentially or simultaneously, will lead to the multiplication of their effects and the minimization of complications arising from their use.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 2","pages":"92458"},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297404","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":"Steroids in acute respiratory distress syndrome: A panacea or still a puzzle?","authors":"Sharmili Sinha, Rohit Patnaik, Srikant Behera","doi":"10.5492/wjccm.v13.i2.91225","DOIUrl":"10.5492/wjccm.v13.i2.91225","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a unique entity marked by various etiologies and heterogenous pathophysiologies. There remain concerns regarding the efficacy of particular medications for each severity level apart from respiratory support. Among several pharmacotherapies which have been examined in the treatment of ARDS, corticosteroids, in particular, have demonstrated potential for improving the resolution of ARDS. Nevertheless, it is imperative to consider the potential adverse effects of hyperglycemia, susceptibility to hospital-acquired infections, and the development of intensive care unit acquired weakness when administering corticosteroids. Thus far, a multitude of trials spanning several decades have investigated the role of corticosteroids in ARDS. Further stringent trials are necessary to identify particular subgroups before implementing corticosteroids more widely in the treatment of ARDS. This review article provides a concise overview of the most recent evidence regarding the role and impact of corticosteroids in the management of ARDS.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 2","pages":"91225"},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297412","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":"Inhaled volatile anesthetics in the intensive care unit.","authors":"Erin D Wieruszewski, Mariam ElSaban, Patrick M Wieruszewski, Nathan J Smischney","doi":"10.5492/wjccm.v13.i1.90746","DOIUrl":"10.5492/wjccm.v13.i1.90746","url":null,"abstract":"<p><p>The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres, finding diverse applications in intensive care settings. In the dynamic landscape of intensive care, volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements, managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus, conditions of high sedative requirements including burns, high opioid or alcohol use and neurological conditions such as status epilepticus. Volatile anesthetics can be administered through either inhaled route <i>via</i> anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry, providing intensivists with multiple options to tailor therapy. Furthermore, their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy, mitigating risks associated with conventional sedation modalities. Despite the amounting enthusiasm for the use of these therapies, barriers to widespread utilization include expanding equipment availability, staff familiarity and training of safe use. This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology, administration considerations in intensive care settings, complication considerations, and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"13 1","pages":"90746"},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11019627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860628","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":"Should we initiate vasopressors earlier in patients with septic shock: A mini systemic review.","authors":"Hang-Xiang Zhou,&nbsp;Chun-Fu Yang,&nbsp;He-Yan Wang,&nbsp;Yin Teng,&nbsp;Hang-Yong He","doi":"10.5492/wjccm.v12.i4.204","DOIUrl":"https://doi.org/10.5492/wjccm.v12.i4.204","url":null,"abstract":"<p><p>Septic shock treatment remains a major challenge for intensive care units, despite the recent prominent advances in both management and outcomes. Vasopressors serve as a cornerstone of septic shock therapy, but there is still controversy over the timing of administration. Specifically, it remains unclear whether vasopressors should be used early in the course of treatment. Here, we provide a systematic review of the literature on the timing of vasopressor administration. Research was systematically identified through PubMed, Embase and Cochrane searching according to PRISMA guidelines. Fourteen studies met the eligibility criteria and were included in the review. The pathophysiological basis for early vasopressor use was classified, with the exploration on indications for the early administration of mono-vasopressors or their combination with vasopressin or angiotensinII. We found that mortality was 28.1%-47.7% in the early vasopressors group, and 33.6%-54.5% in the control group. We also investigated the issue of vasopressor responsiveness. Furthermore, we acknowledged the subsequent challenge of administration of high-dose norepinephrine <i>via</i> peripheral veins with early vasopressor use. Based on the literature review, we propose a possible protocol for the early initiation of vasopressors in septic shock resuscitation.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"12 4","pages":"204-216"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8a/d4/WJCCM-12-204.PMC10515096.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122980","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":"Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?","authors":"Prithviraj Bose,&nbsp;Binila Chacko,&nbsp;Ashwin Oliver Arul,&nbsp;Leena Robinson Vimala,&nbsp;Balamugesh Thangakunam,&nbsp;George M Varghese,&nbsp;Mohan Jambugulam,&nbsp;Audrin Lenin,&nbsp;John Victor Peter","doi":"10.5492/wjccm.v12.i4.226","DOIUrl":"https://doi.org/10.5492/wjccm.v12.i4.226","url":null,"abstract":"<p><strong>Background: </strong>During the second wave of the coronavirus disease 2019 (COVID-19) pandemic, a subset of critically ill patients developed delayed respiratory deterioration in the absence of new infection, fluid overload or extra-pulmonary organ dysfunction.</p><p><strong>Aim: </strong>To describe the clinical and laboratory characteristics, outcomes, and management of these patients, and to contrast this entity with other post COVID-19 immune dysregulation related inflammatory disorders.</p><p><strong>Methods: </strong>This was a retrospective observational study of adult patients admitted to the medical intensive care unit of a 2200-bed university affiliated teaching hospital, between May and August 2021, who fulfilled clearly defined inclusion and exclusion criteria. Outcome was assessed by a change in PaO₂/FiO₂ ratio and levels of inflammatory markers before and after immunomodulation, duration of mechanical ventilation after starting treatment, and survival to discharge.</p><p><strong>Results: </strong>Five patients developed delayed respiratory deterioration in the absence of new infection, fluid overload or extra-pulmonary organ dysfunction at a median interquartile range (IQR) duration of 32 (23-35) d after the onset of symptoms. These patients had elevated inflammatory markers, required mechanical ventilation for 13 (IQR 10-23) d, and responded to glucocorticoids and/or intravenous immunoglobulin. One patient died (20%).</p><p><strong>Conclusion: </strong>This delayed respiratory worsening with elevated inflammatory markers and clinical response to immunomodulation appears to contrast the well described Multisystem Inflammatory Syndrome - Adults by the paucity of extrapulmonary organ involvement. The diagnosis can be considered in patients presenting with delayed respiratory worsening, that is not attributable to cardiac dysfunction, fluid overload or ongoing infections, and associated with an increase in systemic inflammatory markers like C-reactive protein, inteleukin-6 and ferritin. A good response to immunomodulation can be expected. This delayed inflammatory pulmonary syndrome may represent a distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"12 4","pages":"226-235"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/aa/WJCCM-12-226.PMC10515099.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160649","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":"Biomarkers in sepsis-looking for the Holy Grail or chasing a mirage!","authors":"Neelmani Ahuja,&nbsp;Anjali Mishra,&nbsp;Ruchi Gupta,&nbsp;Sumit Ray","doi":"10.5492/wjccm.v12.i4.188","DOIUrl":"https://doi.org/10.5492/wjccm.v12.i4.188","url":null,"abstract":"<p><p>Sepsis is defined as a life-threatening organ dysfunction caused by the dysregulated host response to infection. It is a complex syndrome and is characterized by physiologic, pathologic and biochemical abnormalities in response to an infection. Diagnosis of sepsis is based on history, physical examination and other investigations (including biomarkers) which may help to increase the certainty of diagnosis. Biomarkers have been evaluated in the past for many diseases and have been evaluated for sepsis as well. Biomarkers may find a possible role in diagnosis, prognostication, therapeutic monitoring and anti-microbial stewardship in sepsis. Since the pathophysiology of sepsis is quite complex and is incompletely understood, a single biomarker that may be robust enough to provide all information has not been found as of yet. However, many biomarkers have been studied and some of them have applications at the bedside and guide clinical decision-making. We evaluated the PubMed database to search for sepsis biomarkers for diagnosis, prognosis and possible role in antibiotic escalation and de-escalation. Clinical trials, meta-analyses, systematic reviews and randomized controlled trials were included. Commonly studied biomarkers such as procalcitonin, Soluble urokinase-type plasminogen activator (Supar), presepsin, soluble triggering receptor expressed on myeloid cells 1, interleukin 6, C-reactive protein, <i>etc</i>., have been described for their possible applications as biomarkers in septic patients. The sepsis biomarkers are still an area of active research with newer evidence adding to the knowledge base continuously. For patients presenting with sepsis, early diagnosis and prompt resuscitation and early administration of anti-microbials (preferably within 1 h) and source control are desired goals. Biomarkers may help us in the diagnosis, prognosis and therapeutic monitoring of septic patients. The marker redefining our view on sepsis is yet a mirage that clinicians and researchers continue to chase.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"12 4","pages":"188-203"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/8d/WJCCM-12-188.PMC10515097.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164578","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":"Improving environmental sustainability of intensive care units: A mini-review.","authors":"Kay Choong See","doi":"10.5492/wjccm.v12.i4.217","DOIUrl":"10.5492/wjccm.v12.i4.217","url":null,"abstract":"<p><p>The carbon footprint of healthcare is significantly impacted by intensive care units, which has implications for climate change and planetary health. Considering this, it is crucial to implement widespread efforts to promote environmental sustainability in these units. A literature search for publications relevant to environmental sustainability of intensive care units was done using PubMed. This mini-review seeks to equip intensive care unit practitioners and managers with the knowledge necessary to measure and mitigate the carbon cost of healthcare for critically ill patients. It will also provide an overview of the current progress in this field and its future direction.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"12 4","pages":"217-225"},"PeriodicalIF":0.0,"publicationDate":"2023-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/52/WJCCM-12-217.PMC10515098.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164579","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}