Advances in Digestive Medicine最新文献

{"title":"Glasgow coma scale score and albumin level are associated with patient survival after emergent colonoscopy in the intensive care unit","authors":"Tung-Lung Wu,&nbsp;Hsu-Heng Yen,&nbsp;Siou-Ping Huang,&nbsp;Yang-Yuan Chen","doi":"10.1002/aid2.13326","DOIUrl":"10.1002/aid2.13326","url":null,"abstract":"<p>Due to poor patient condition and the high risk associated with the procedure, colonoscopy is rarely performed in the intensive care unit (ICU). It is indicated for ICU patients with suspected ischemic colitis, decompression of colonic distension, or lower gastrointestinal hemorrhage. ICU patients usually have more co-morbidities and higher mortality rates than other inpatient patients. Data in the literature regarding the outcomes of ICU patients after colonoscopy are limited. The aim of this study was to identify factors that are predictive of outcomes following colonoscopy in ICU patients. We retrospectively analyzed the medical records and imaging findings of patients who underwent colonoscopy in an ICU setting between January 2018 and June 2020. A total of 79 patients were identified and enrolled for analysis. The median age of the patients was 78 years. The colonoscopy findings included angiodysplasia (n = 3, 3.8%), colitis (n = 17, 21.5%), colonic ulcer (n = 2, 2.5%), diverticulosis (n = 3, 3.8%), hemorrhoid (n = 10, 12.7%), rectal ulcer (n = 16, 20.3%), tumor (n = 10, 12.7%), volvulus (n = 1, 1.3%), bleeding of unknown origin (n = 4, 5.1%), and no diagnosis (n = 13, 16.5%). A total of 46 patients (58%) survived to discharge. Patients who survived had statistically significantly higher Glasgow coma scale (GCS) scores (<i>P</i> = .009) and albumin levels (<i>P</i> = .002) than patients who did not survive. Patient survival is associated with GCS score and albumin level, but not with colonoscopy findings.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 3","pages":"143-149"},"PeriodicalIF":0.3,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45771020","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":"Splenic artery pseudoaneurysm as a fatal complication of acute pancreatitis","authors":"Yu-Hsuan Tseng,&nbsp;Chuen-Huei Liu,&nbsp;Chun-Yang Lee,&nbsp;Nai-Chi Chiu,&nbsp;Chien-Wei Su","doi":"10.1002/aid2.13328","DOIUrl":"10.1002/aid2.13328","url":null,"abstract":"<p>Splenic artery pseudoaneurysm (SAP) is a rare but potentially fatal complication of acute pancreatitis. We present a 67-year-old female with ruptured SAP as a complication of acute pancreatitis. The patient had mild clinical symptoms on admission, thus was difficult to identify for severe complications. However, she had experienced two episodes of hypovolemic shock on the 10th day after admission. Abdominal computer tomography scan and angiography revealed evidence of splenic artery injury possibly due to acute pancreatitis. The patient underwent transcatheter embolization of splenic artery and total spleen. However, she was still hemodynamically unstable and eventually expired due to severe sepsis. This case raised our clinical awareness of SAP as a rare but life-threatening complication of acute pancreatitis even in patients with short clinical courses and initially mild symptoms. SAP should be kept in mind during image study or in hemodynamically unstable cases of acute pancreatitis.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 2","pages":"110-113"},"PeriodicalIF":0.3,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48199716","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":"Severe low gastrointestinal bleeding due to Dieulafoy's lesion: A report of two cases and review of literature","authors":"Cheng-Chi Lee,&nbsp;Jen-Chieh Huang,&nbsp;Jeng-Shiann Shin","doi":"10.1002/aid2.13324","DOIUrl":"https://doi.org/10.1002/aid2.13324","url":null,"abstract":"<p>Massive low gastrointestinal bleeding is an uncommon but severe event. Dieulafoy's lesion is a rare cause of gastrointestinal bleeding but associated with a high mortality rate. In this report, we describe two cases of massive low gastrointestinal bleeding due to Dieulafoy's lesion of the colon who were successfully treated with endoscopic therapy, despite severe bleeding with inadequate bowel preparation. These two cases emphasize the importance of careful endoscopic evaluation to investigate gastrointestinal bleeding and that rare entities should be considered in the differential diagnosis of common clinical presentations.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 4","pages":"254-256"},"PeriodicalIF":0.3,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138713815","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":"Langerhans cell histiocytosis presenting as a submucosal solitary colonic lesion: A case report and review of the literature","authors":"Shu-Han Huang,&nbsp;Meng-Yu Chen,&nbsp;Yuh-Yu Chou","doi":"10.1002/aid2.13321","DOIUrl":"10.1002/aid2.13321","url":null,"abstract":"<p>Langerhans cell histiocytosis (LCH) is a rare histiocytic neoplasm. The clinical presentation and the disease extension are variable. LCH may involve a single site, multiple sites within a single system, or multiple systems. Gastrointestinal tract involvement is rare and most often observed in children with multisystem disease. Adult patients with gastrointestinal tract involvement are extremely rare, and only a few cases have been reported. We present a 45-year-old man with LCH presenting as a submucosal solitary colonic lesion.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 2","pages":"119-122"},"PeriodicalIF":0.3,"publicationDate":"2022-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45908499","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":"Mixed neuroendocrine-non-neuroendocrine neoplasms of the ampulla of Vater: A case report and literature review","authors":"Chien-Hung Chen,&nbsp;Hsing-Tao Kuo,&nbsp;Ming-Jen Sheu,&nbsp;Chi-Shu Sun,&nbsp;Yu-Min Lin,&nbsp;Khin Than Win,&nbsp;I-Che Feng","doi":"10.1002/aid2.13322","DOIUrl":"https://doi.org/10.1002/aid2.13322","url":null,"abstract":"<p>Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) of the ampulla of Vater are extremely rare. We present a case of a MiNEN of the ampulla of Vater and review the literature related to management and treatment recommendations. A 72-year-old woman presented with Charcot's triad for a week. Computed tomography revealed a periampullary tumor. Endoscopic retrograde cholangiopancreatography with internal drainage and sphincterotomy with biopsy revealed mixed adenocarcinoma-neuroendocrine carcinoma. Ampullary MiNEN with an American Joint Committee on Cancer (8th edition) TNM classification of Stage IIIA T3bN1M0 was diagnosed, and the Whipple procedure was performed. Both components of the tumor were of high grade, each component accounting for approximately 50% of the tumor. FOLFOX (oxaliplatin + de Gramont) was prescribed as adjuvant chemotherapy. No recurrence was noted at the 3-month follow-up. Diagnosis of MiNENs through biopsies is challenging, and core biopsies should be suggested when a surgical sample is unavailable. Although heterogeneous, MiNENs are usually highly aggressive neoplasms, contributing to the dissemination of metastases and poor prognosis. In conclusion, radical resection is the optimal treatment choice for almost all potentially curable cases. In addition, treatment strategies for patients with a new diagnosis of MiNENs of the ampulla of Vater should be formulated after discussions in multidisciplinary meetings and should be based on the most aggressive and predominant component in the diagnostic sample.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 3","pages":"179-183"},"PeriodicalIF":0.3,"publicationDate":"2022-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13322","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50144887","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":"Mixed neuroendocrine‐non‐neuroendocrine neoplasms of the ampulla of Vater: A case report and literature review","authors":"Chien‐Hung Chen, H. Kuo, M. Sheu, Chi‐Shu Sun, Yu‐Min Lin, K. Win, I. Feng","doi":"10.1002/aid2.13322","DOIUrl":"https://doi.org/10.1002/aid2.13322","url":null,"abstract":"Mixed neuroendocrine‐non‐neuroendocrine neoplasms (MiNENs) of the ampulla of Vater are extremely rare. We present a case of a MiNEN of the ampulla of Vater and review the literature related to management and treatment recommendations. A 72‐year‐old woman presented with Charcot's triad for a week. Computed tomography revealed a periampullary tumor. Endoscopic retrograde cholangiopancreatography with internal drainage and sphincterotomy with biopsy revealed mixed adenocarcinoma‐neuroendocrine carcinoma. Ampullary MiNEN with an American Joint Committee on Cancer (8th edition) TNM classification of Stage IIIA T3bN1M0 was diagnosed, and the Whipple procedure was performed. Both components of the tumor were of high grade, each component accounting for approximately 50% of the tumor. FOLFOX (oxaliplatin + de Gramont) was prescribed as adjuvant chemotherapy. No recurrence was noted at the 3‐month follow‐up. Diagnosis of MiNENs through biopsies is challenging, and core biopsies should be suggested when a surgical sample is unavailable. Although heterogeneous, MiNENs are usually highly aggressive neoplasms, contributing to the dissemination of metastases and poor prognosis. In conclusion, radical resection is the optimal treatment choice for almost all potentially curable cases. In addition, treatment strategies for patients with a new diagnosis of MiNENs of the ampulla of Vater should be formulated after discussions in multidisciplinary meetings and should be based on the most aggressive and predominant component in the diagnostic sample.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 1","pages":"179 - 183"},"PeriodicalIF":0.3,"publicationDate":"2022-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51374356","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":"Identification of Barrett's neoplasia: Beyond Seattle protocol","authors":"Yen-Po Wang,&nbsp;Ching-Liang Lu","doi":"10.1002/aid2.13320","DOIUrl":"10.1002/aid2.13320","url":null,"abstract":"<p>Barrett's esophagus (BE), a complication of gastroesophageal reflux disease (GERD), is derived from prolonged gastric acid or bile exposure to the esophagus.<span>^{1, 2}</span> This refluxate may lead to erosions and chronic inflammatory cells infiltration in the esophageal mucosa. Prolonged damage in healthy squamous epithelium in esophagus would promote its replacement with intestinal metaplasia containing goblet cells, that is, BE. BE is considered as a premalignant lesion for esophageal adenocarcinoma (EAC).<span>²</span> EAC is the predominant form of esophageal cancer in Western countries with progressively increased incidence.<span>³</span> BE can have neoplastic transformation from low-grade dysplasia (LGD), high-grade dysplasia (HGD), to EAC.<span>²</span> The prognosis of advanced esophageal cancer is poor, while the survival is excellent if detected at early stages for early intervention.<span>^{3, 4}</span> Therefore, it is extremely important to detect dysplasia or early EAC during surveillance endoscopy in BE patients.</p><p>Seattle protocol is recommended for endoscopic surveillance in BE patients. It is suggested to perform random biopsies at four quadrants every 1 to 2 cm of the Barrett's segment for detecting subtle dysplasia.<span>⁵</span> Modern enhanced imaging technologies have been developed to improve dysplasia detection beyond the traditional high definition—white light endoscopy (HD-WLE). Update guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) suggest using dye-based or virtual chromoendoscopy to detect target lesion for biopsies identified in Barrett's segment.<span>⁵</span> In a systemic review involving 14 studies with over 800 patients, chromoendoscopy would show a 34% increase in yield in detecting dysplasia or cancer compared with WLE, irrespective of dye-based or virtual.<span>⁶</span> Nevertheless, ASGE did not recommend chromoendoscopy as a replacement for the Seattle protocol but rather as an adjunct technique.<span>⁵</span></p><p>Several dyes, including acetic acid, methylene blue, and indigo carmine, are the dyes commonly used to detect Barrett's dysplasia in surveillance. Acetic acid is the only dye-based chromoendoscopy that fulfill the ASGE preservation and incorporation of valuable innovations (PIVI) thresholds (sensitivity 96.6%, negative predictive value 98.3%, specificity 84.6%).<span>^{5, 7}</span> However, the dye application in BE surveillance is hampered by increased cost for special dye spraying equipment, dye preparation, increased procedure time, potential risk of including DNA damage, and difficulty in adequate dye application evenly.<span>⁵</span> Because of these limitations, virtual chromoendoscopy may be the preferred, advanced imaging technique for BE surveillance.</p><p>Virtual chromoendoscopy applied light filters, emitting light with a short wavel","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"9 1","pages":"5-7"},"PeriodicalIF":0.3,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47574557","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":"Invisible or negligent—EUS detection for the negative CT or/and MRCP CBD stone","authors":"Jiann-Hwa Chen","doi":"10.1002/aid2.13319","DOIUrl":"10.1002/aid2.13319","url":null,"abstract":"<p>Since the advent of endoscopic sphincterotomy, developed in Japan and Germany in 1974, it has become a very common technique used for the treatment of a wide variety of conditions of the biliary system. However, because of the risk of adverse events associated with endoscopic retrograde cholangiopancreatography (ERCP)-guided treatment of bile duct stones, it is important to identify appropriate candidates for this procedure and reserve biliary endoscopy for patients with the highest probability of intraductal stones.</p><p>The prevalence of common bile duct (CBD) stones is reported to be 5% to 15% in patients undergoing elective cholecystectomy for symptomatic, uncomplicated cholelithiasis.<span>^1-3</span> Liver biochemical tests may be most useful in excluding the presence of CBD stones. The negative predictive value of a normal liver function test in a series of more than 1000 patients undergoing laparoscopic cholecystectomy was over 97%, whereas the positive predictive value of any abnormal liver biochemical test was only 15%.<span>⁴</span> The role of endoscopy in the evaluation of suspected choledocholithiasis, a guideline statement developed by the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) in 2010, proposed a strategy to assign the risk of choledocholithiasis in patients with symptomatic cholelithiasis based on clinical predictors.<span>⁵</span> The very strong predictors (major criteria) include CBD stones found on transabdominal ultrasound (US) study, clinical cholangitis, and total bilirubin level &gt;4 mg/dL. The strong predictors (minor criteria) are dilated CBD on US (&gt;6 mm with gallbladder in situ) or total bilirubin level 1.8 to 4 mg/dL. Patients with one major or two minor predictors are considered high risk and should receive preoperative ERCP. However, if patients have intermediate risk, they should undergo endoscopic ultrasonography (EUS) or magnetic resonance cholangiopancreatography (MRCP) examination before surgery to detect the presence of CBD stones. Two years earlier, ASGE released new guidelines for choledocholithiasis management.<span>⁶</span> Emphasis was increased on using laboratory results and bile duct diameter in deciding when to perform ERCP. We noticed that there was no additional new definition of risk predictors in comparison to 2010. However, in the 2019 guidelines, new criterion requiring both bilirubin &gt;4 mg/dL and biliary dilatation was added, which has a specificity approaching 90%. This is similar to the other two high-risk predictors, cholangitis and bile duct stones on imaging, both of which have a specificity exceeding 90%.<span>⁷</span> Likewise, computed tomography (CT) is not included in the diagnostic algorithm if CBD stones are diagnosed based on US, liver function test, and clinical information. Most of the invisible CBD stones are small (&lt;5 mm) or less calcified; therefore, they","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"9 1","pages":"8-9"},"PeriodicalIF":0.3,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45485226","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":"Acute cholangitis due to food reflux after self-expanding metal stent implantation without duodenal obstruction: A case report","authors":"Min-Jie Yang,&nbsp;Ming-Lun Han,&nbsp;Kao-Lang Liu,&nbsp;Yu-Heng Chien","doi":"10.1002/aid2.13312","DOIUrl":"10.1002/aid2.13312","url":null,"abstract":"<p>Acute cholangitis has been reported as an uncommon adverse event after self-expandable metallic stent (SEMS) implantation. Herein, we report a case of an acute cholangitis caused by duodenal refluxate without duodenal obstruction. A 62-year-old woman received SEMS for an obstructive jaundice caused by a pancreatic head adenocarcinoma. She had been in stable condition until her percutaneous transhepatic cholangial drainage (PTCD) was clamped on the second postoperative day, and when a high fever and severe right epigastric pain developed. Fecal-impacted bowel loops were found through abdominal X-rays, and food contents were drained from PTCD afterward. Acute cholangitis caused by SEMS migration was initially suspected, and SEMS revision was performed two times, which did not improve the chymus reflux from PTCD. Metoclopramide was given after the second SEMS revision, and post-procedural upper gastrointestinal series with urografin shows no duodenal obstruction. No febrile event has been noted since the administration of metoclopramide. Acute cholangitis after SEMS implantation without duodenal obstruction could develop in patient with moderate to severe constipation. Prompt post-procedural prophylactic prokinetics for few days may prevent such episodes.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 2","pages":"114-118"},"PeriodicalIF":0.3,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48304216","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":"Time trend and age-specific gender difference in the incidence of liver cancer from 2009 to 2018 in Taiwan","authors":"Chuen-Fei Chen,&nbsp;Hung-Chuen Chang","doi":"10.1002/aid2.13313","DOIUrl":"10.1002/aid2.13313","url":null,"abstract":"<p>Liver cancer has a significant impact on global health. Taiwan is a country with a high incidence rate of liver cancer. Efforts in primary prevention and treatment of chronic hepatitis B and C are projected to decrease the liver cancer incidence in Taiwan. We used the Taiwan Cancer Registry data to explore the time trend of liver cancer incidence over the last decade, which showed a decreasing trend of 21% in males and 26.1% in females from 2009 to 2018. Both genders aged 30-39 years had the greatest decrease in liver cancer incidence, while those &gt;70 years old had the least decrease. Our study also showed gender disparity in liver cancer with a persistent male predominance over time. In the past decade, the liver cancer incidence had a 2.5 to 2.7 sex ratio (male to female) and varied gender differences at different ages. Sex ratios peaked at age 40-49 years and gradually decreased as age increases. The pattern of age-specific gender differences was similar between 2009 and 2018. This finding implies that female sex hormones may play a protective role in the development of liver cancer.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"10 3","pages":"135-142"},"PeriodicalIF":0.3,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43613198","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}