Acta Clinica Belgica最新文献

{"title":"Prognostic value of geriatric and cardiac parameters for one-year mortality in older heart failure patients. A multicentre, observational, prospective study.","authors":"L Kestens, S Billet, L Hens, A Velghe, R Piers","doi":"10.1080/17843286.2024.2352910","DOIUrl":"10.1080/17843286.2024.2352910","url":null,"abstract":"<p><strong>Purpose: </strong>Heart failure is prevalent among older people and has a poor prognosis. The aim of this study is to identify potential prognostic, geriatric, and cardiac parameters which could help clinicians identify older heart failure patients at high risk for one-year mortality.</p><p><strong>Methods: </strong>The multicentre, observational cohort study which included 147 heart failure patients aged ≥75 years, hospitalized in the cardiac or geriatric department in two hospitals. One-year survival was the outcome measure. For univariate analysis Chi-square test and independent sample T-test were used; for multivariate analysis Logistic regression and Cox regression for time-dependent analysis.</p><p><strong>Results: </strong>One-year mortality was 28% (41/147). One-year survivors and non-survivors did not differ in the following characteristics: age, gender, sodium level at hospital discharge, ejection fraction, NYHA Class, basic and instrumental activities of daily living, and the presence of a geriatric risk profile. There was a significant lower systolic blood pressure at discharge in non-survivors compared to one-year-survivors (mean 125.26 mmHg vs. 137.59 mmHg). Non-survivors had more severe underlying comorbidities according to the age adjusted Charlson Comorbidity index (CCI) (mean 8.80 vs. 7.40).Both logistic and Cox regression showed a higher risk and rate of mortality with decreasing systolic blood pressure at discharge (OR 0.963, p=0.001 and HR 0.970, p<0.001) and with increasing CCI (OR 1.344, p=0.002 and HR 1.269, p=0.001); the other variables were not significantly related.</p><p><strong>Conclusion: </strong>Lower blood pressure and more severe comorbidities, but not functionality nor the presence of a geriatric risk profile, are related to one-year mortality in older, in-hospital heart failure patients.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"113-120"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140943660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of the Belgian paediatric clinical trial network.","authors":"E Degraeuwe, L Persijn, L Nuytinck, K Allegaert, L De Taeye, E Gasthuys, D Christiaens, S Karamaria, A Raes, M Turner, J Vande Walle","doi":"10.1080/17843286.2023.2283664","DOIUrl":"10.1080/17843286.2023.2283664","url":null,"abstract":"<p><p>Paediatric clinical trials are critical to ensure that medications prescribed to children are safe and effective. However, evidence-based dosing and labelling of such medications remain limited, and most clinical trials in paediatrics fail. Factors for lack of trial completion include performance at site level (limited patient recruitment, limited site staff experience and lack of infrastructure), the sponsor team (limited paediatric specific expertise in design, uncertainties on robustness of biomarkers or outcome variables) as well as regulatory and administrative burdens. As a result of the growing demand for site support, the Belgian Paediatric Clinical Research Network (BPCRN) established in 2009 has been relaunched in 2018 to improve paediatric clinical trials, with the support of innovative-medicines-initiative 2 (IMI2) pan-European network conect4children (c4c) and the transatlantic network I-ACT for Children (US).This paper highlights the formation of the BPCRN and the practical insights it offers for advancing paediatric clinical trials through national networks. A national network can improve trial quality, safety and efficiency, provide clinical research expertise, identify suitable sites, and help with troubleshooting of common trial issues. The BPCRN's centralized approach has advanced paediatric clinical trials by streamlining communication and standardizing trial conduct. Challenges and opportunities have arisen, including a relaunch in 2018, orphan medicine trials, and network sustainability. Collaboration between network activities, government support, site-level improvements, efficient communication, and interaction with industry are key to achieve lasting transformation in paediatric medicine research.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"34-45"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138486444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Belgian atopic dermatitis guidelines.","authors":"Hilde Lapeere, Reinhart Speeckaert, Marie Baeck, Bita Dezfoulian, Julien Lambert, Pierre-Paul Roquet-Gravy, Annelies Stockman, Jonathan White, Francisca Castelijns, Jan Gutermuth","doi":"10.1080/17843286.2023.2285576","DOIUrl":"10.1080/17843286.2023.2285576","url":null,"abstract":"<p><p>Atopic dermatitis (AD) is one of the most common, bothersome and difficult to treat skin disorders. Recent introduction of new systemic treatments has revolutionized the management of AD. The goal of this guideline is to provide evidence-based recommendations for the management of patients suffering from atopic dermatitis that easily can be implemented in clinical practice. These recommendations were developed by 11 Belgian AD experts. Comments of all experts on the proposed statements were gathered, followed by an online voting session. The most relevant strategies for the management and treatment of AD in the context of the Belgian health care landscape are discussed. General measures, patient education and adequate topical treatment remain the cornerstones of AD management. For moderate to severe AD, the introduction of biologics and JAK inhibitors show unprecedented efficacy, although currently access is limited to a subgroup of patients meeting the reimbursement criteria.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"62-74"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138298072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Belgian physiotherapy reimbursement criteria for fall prevention fails in screening appropriately fall-prone community-dwelling older adults.","authors":"Ellis Rommers, Mirko Petrovic, Robby de Pauw, Anke Van Bladel, Dirk Cambier","doi":"10.1080/17843286.2023.2268916","DOIUrl":"10.1080/17843286.2023.2268916","url":null,"abstract":"<p><strong>Objectives: </strong>The incidence of falling in older adults has remained unchanged over the past decades, despite evidence-based prevention initiatives. Therefore, it is appropriate to reflect on the current screening approach for preventive initiatives. The objective of this study was to determine whether the multifactorial algorithm proposed by Lusardi et al. (2017) exhibits superior predictive validity compared to the currently employed algorithm by the Belgian National Institute for Health and Disability Insurance (NIHDI).</p><p><strong>Methods: </strong>The current study includes a secondary analysis of data collected from a falls-related study in the Department of Rehabilitation Sciences at Ghent University to compare the predictive validity of the two algorithms. Sensitivity, specificity, positive and negative predictive value and area under the curve (AUC) were calculated to ascertain which algorithm is more accurate.</p><p><strong>Results: </strong>The database included a total of 94 community-dwelling older adults (mean age 76 years ±7.4, 35% male). Thirty-nine participants experienced at least one fall in the 8 month follow up. Lusardi's approach has a higher sensitivity score (89.7% compared to 10.3%) and negative predictive value (89.9% compared to 61.1%), but a lower specificity score (61.8% compared to 100%) and positive predictive value (62.2% compared to 100%) than the NIHDI approach. The AUC is 0.76 for Lusardi's approach and 0.55 for the NIHDI approach.</p><p><strong>Conclusion: </strong>The use of the multifactorial algorithm proposed by Lusardi et al. may be significant and more accurate in identifying adults at risk to falls. Further research is needed particularly with a larger, more heterogenous group of older adults.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"5-11"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41181764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence, risk factors and clinical implications of dehydration in older patients: a cross-sectional study.","authors":"Kubra Atciyurt, Cihan Heybeli, Lee Smith, Nicola Veronese, Pinar Soysal","doi":"10.1080/17843286.2023.2275922","DOIUrl":"10.1080/17843286.2023.2275922","url":null,"abstract":"<p><strong>Objectives: </strong>Adequate hydration is essential for the maintenance of physiological functions. Older adults may not be able to maintain adequate hydration, which is often not recognized. Our aim was to investigate the prevalence, risk factors and clinical implications of dehydration in older adults.</p><p><strong>Methods: </strong>This cross-sectional study included 964 older adults in one geriatric outpatient clinic in Turkey. Dehydration was defined as a calculated [1,86 × (Na+K)+1,15×glucose+urea +14] plasma osmolarity of ≥ 295 mOsm/L. Clinical characteristics and measures of comprehensive geriatric assessments of patients with dehydration and normohydration were compared. Predictors of dehydration were assessed using logistic regression analysis.</p><p><strong>Results: </strong>Mean age was 79.9 ± 7.7 years, (71.7% female). The prevalence of dehydration was 31%. Female patients, diabetes mellitus (DM), chronic renal failure (CKD), a higher risk of falling (based on Timed Up and Go test), probable sarcopenia, dependence based on basic and instrumental daily living activities (BADL and IADL) were more common in the dehydrated group (<i>p</i> < 0.05). After adjusting for age and gender, dependency on BADL and IADL, the risk of falling were still higher in the dehydrated group (<i>p</i> < 0.05). There were significant relationships between dehydration and risk of falling (OR 1.38, 95% CI 1.00-1.90; <i>p</i> < 0.05), after adjustment for age, gender, DM, CKD.</p><p><strong>Conclusion: </strong>Dehydration is common among older adults and is associated with a dependency, probable sarcopenia, and an increased risk of falling. Screening for dehydration and taking preventive measures may be beneficial in avoiding the negative consequences associated with dehydration.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"12-18"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71410106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A first case of <i>Chimaeribacter</i> species catheter-related bloodstream infection.","authors":"Stijn Van Hees,&nbsp;Stefanie Desmet,&nbsp;Lode VanOverbeke,&nbsp;Geertrui Mertens,&nbsp;Len Verbeke,&nbsp;Truus Goegebuer,&nbsp;Ann Lemmens","doi":"10.1080/17843286.2023.2246227","DOIUrl":"10.1080/17843286.2023.2246227","url":null,"abstract":"<p><p>We present a case of a 80-year-old patient with a catheter-related bloodstream infection caused by Chimaeribacter species. The Chimaeribacter genus represents a novel genus within the Yersiniaceae family. To the best of our knowledge, as of today, nothing is known about the pathogenicity of Chimaeribacter species, nor about the appropriate antimicrobial management. In the present case, we demonstrate, for the first time, a potential clinical relevance of the Chimaeribacter species. Antimicrobial susceptibility data are presented.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"521-523"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10070842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical approach to the older person with anorexia.","authors":"Annelies Somers,&nbsp;Stany Perkisas,&nbsp;Sophie Bastijns,&nbsp;Femke Ariën,&nbsp;Anne-Marie De Cock","doi":"10.1080/17843286.2023.2228037","DOIUrl":"10.1080/17843286.2023.2228037","url":null,"abstract":"<p><strong>Objective: </strong>Anorexia is a challenging problem among older people. Apart from being the consequence of normal ageing, it can also be a symptom of underlying disease. Despite the high prevalence of anorexia, only few recommendations exist on the evaluation in older people. The objective of this study is to summarize evidence and provide guidance through creating a flowchart.</p><p><strong>Methods: </strong>A systematic literature search was performed through combining following keywords: older people (aged, geriatrics, older adult), anorexia (also loss of appetite, unintentional weight loss) and diagnosis. After removal of duplicates and case-reports, articles were selected based on title and abstract by two reviewers. Guidelines, reviews, studies and relevant publications discussing anorexia or unintentional weight loss were included. Relevant data were extracted and processed into a flowchart.</p><p><strong>Results: </strong>Out of 619 hits, 25 articles were included discussing either the evaluation of anorexia or unintentional weight loss. Consensus in the work-up of unintentional weight loss is to start with a detailed history and physical examination followed by full bloodwork, urinalysis, chest x-ray and a faecal occult blood test. In certain cases, ultrasound and upper endoscopy are further recommended. In the work-up of anorexia, medication, social, psychological, logopaedic and neurocognitive aspects need to be taken into consideration.</p><p><strong>Conclusions: </strong>One of the main challenges of the evaluation of anorexia in older people is the lack of guidance in existing literature. Therefore, we investigated what is currently known about the management of anorexia and unintentional weight loss as well and combined best practices to form a flowchart.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"486-496"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9673273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regression of a melanoma brain metastasis that had appeared after immune checkpoint inhibitor discontinuation: a hypothesis-generating case.","authors":"Julien Pierrard,&nbsp;Emmanuel Seront,&nbsp;Rachel Galot,&nbsp;Idil Gunes Tatar,&nbsp;Jean-François Baurain,&nbsp;Dario Di Perri","doi":"10.1080/17843286.2023.2238374","DOIUrl":"10.1080/17843286.2023.2238374","url":null,"abstract":"<p><p>We present the case of a 50-year-old woman previously treated with nivolumab-ipilimumab combination therapy for a metastatic melanoma. Despite premature discontinuation of these immune checkpoint inhibitors (ICIs) after 2 cycles due to severe immune-related hepatitis, the patient achieved a complete response. Nine months later, brain magnetic resonance imaging (MRI) showed progression of a single cerebral lesion, and the patient was referred for stereotactic radiosurgery. Unexpectedly, the brain MRI acquired one month later as part of radiosurgery planning showed a spontaneous regression of this lesion, allowing for radiosurgery cancellation. Follow-up imaging showed a sustained response, although the patient did not receive any other oncological treatment. We discuss here the potential immune mechanisms involved in this unusual course and the importance of better understanding the behaviour of tumours in the era of ICIs.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"516-520"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9831920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on <i>Clostridioides difficile</i> infection in a tertiary healthcare institution in Belgium.","authors":"Bastien Tossens,&nbsp;Philippe Barthelme,&nbsp;Caroline Briquet,&nbsp;Leila Belkhir,&nbsp;Eléonore Ngyuvula,&nbsp;Kate Soumillion,&nbsp;Alexia Verroken,&nbsp;Hector Rodriguez-Villalobos,&nbsp;Michel Delmée,&nbsp;Ahalieyah Anantharajah","doi":"10.1080/17843286.2023.2250624","DOIUrl":"10.1080/17843286.2023.2250624","url":null,"abstract":"<p><strong>Objectives: </strong>Clostridioides difficile infection (CDI) causes the greatest number of healthcare-associated infectious diarrhoea. CDIs are transmitted by direct and indirect patient-to-patient contact and risk increases with the use of antibiotics. Since early 2020, the COVID-19 pandemic has affected healthcare systems in many ways including substantial changes in hygiene behaviour. The aim of this study was to assess whether CDI incidence differed during the COVID-19 pandemic compared to a year before.</p><p><strong>Methods: </strong>All tests for suspected CDI cases were recorded for a hospital in Brussels, Belgium. The percentage of CDI-positive results and incidences (total and healthcare-associated (HA)-CDI)) for years 2019, 2020, 2021, and 2022 were calculated. Antibiotic consumption was analysed for years 2019 and 2020.</p><p><strong>Results: </strong>Since the COVID-19 pandemic struck, a significant reduction of up to 39% was observed in the number of <i>Clostridioides difficile</i> stool tests in our hospital. A significant decrease in the percentage of positive tests and a 50% decrease in the incidence of CDI (total and HA-CDI) was found for 2020 compared with 2019 and confirmed for years 2021 and 2022. The decrease in CDI incidence was mostly marked in haematology, nephrology, and gastroenterology units. No significant change in the use of antibiotics was found.</p><p><strong>Conclusion: </strong>The global decrease in CDI incidence observed in our hospital was not associated with a change in the use of antibiotics. The control measures implemented to prevent COVID-19 transmission may explain a reduction in CDI incidence. An underdiagnosis of CDI cannot be excluded.</p>","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"459-466"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10051381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visceral leishmaniasis and potential role of vitamin D.","authors":"Vitorino Modesto Dos Santos,&nbsp;Taciana Arruda Modesto Sugai","doi":"10.1080/17843286.2023.2233235","DOIUrl":"10.1080/17843286.2023.2233235","url":null,"abstract":"We read with special interest the recent article published in this Journal by Zaghi I et al. describing their case study of visceral leishmaniasis confirmed by liver biopsy [1]. The 59-year-old female had the initial hypothesis of hepatic and splenic metastases, based on her symptoms besides the nodular images revealed by the abdominal ultrasonography. Worthy of note was the hypercalcemia due to an excess of vitamin D, which was properly managed and led to successful control of her longstanding asthenia and loss of appetite. After the correct diagnosis was established by histopathologic studies, she underwent the specific anti-parasitic treatment resulting in complete regression of the nodular lesions. The authors emphasized that this was the first case report of several unsuspected foci of visceral leishmaniasis related to the antiinflammatory effect of hypervitaminosis D [1]. In this setting, with base on the literature data, the important role of proteases and micronutrient levels on the evolution of clinical manifestations, treatment responses, and outcomes of patients with Leishmania infections have merited a crescent interest [1–6]. Feleke BE et al. checked serum levels of micronutrients, just before and in the four initial weeks of treatment of leishmaniasis, to compare the patient profile with success rate [2]. The study included dosages of iodine, iron, selenium, zinc, and the vitamins A and D. They found lower levels of vitamin D in those patients with visceral leishmaniasis, a condition that persisted in spite of the adequate specific anti-leishmaniasis management. Gogulamudi VR et al. studied the effects of vitamins A and D3 to treat mice experimentally infected by L. donovani, and there was control of the parasite growth and infectivity [3]. The authors concluded that the utilization of the vitamins can reduce the parasitism and modulate the pro-inflammatory immune response to the anti-inflammatory activation, and the immune stimulation can have usefulness to control the visceral leishmaniasis [3]. Kumar VU et al. stressed the role of serum levels of the vitamins A, B, C, D, besides calcium, iron, and zinc on the responses to treatment and outcomes of leishmaniasis [4]. Defense mechanisms related to vitamin D can include the induction of antimicrobial peptides such as cathelicidin and the binding and killing of promastigotes in macrophages. The macrophage capacity of killing promastigotes (IFNactivated) may be reduced by vitamin D3, being associated with the cellular reduction of nitrous oxide production [4]. The authors concluded that the potential role of the cited micronutrients should be better evaluated for the public health management of leishmaniasis in the endemic regions [4]. Ribeiro-Dias F et al. reviewed the literature about the IL-32 in Leishmania infections, besides the role of vitamin D-dependent microbicidal pathway for parasite control [5]. They focused on the production of vitamin D-dependent peptides by human monocy","PeriodicalId":7086,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"529-530"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9754647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}