Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Choosing between lobectomy or segmentectomy: moving beyond the two-centimetre debate.","authors":"Herbert Decaluwé","doi":"10.1093/icvts/ivaf113","DOIUrl":"https://doi.org/10.1093/icvts/ivaf113","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112373","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":"Characteristics of calcium deposition on expanded polytetrafluoroethylene membrane as a valve substitute in the pulmonary position.","authors":"Hayato Konishi, Akiyo Suzuki, Takahiro Katsumata, Yu Fujisawa, Tetsuya Motoyoshi, Shintaro Nemoto","doi":"10.1093/icvts/ivaf115","DOIUrl":"https://doi.org/10.1093/icvts/ivaf115","url":null,"abstract":"<p><p>An expanded polytetrafluoroethylene membrane has been widely used off-label as a substitute for a pulmonary valve leaflet. However, details regarding the calcification of the membrane in human samples have not been fully described. This report observed the precise extent and distribution of calcification in the membrane. Two samples of calcified expanded polytetrafluoroethylene membranes used as pulmonary valve substitutes were taken at replacement surgery 10 and 15 years after implantation into a valved conduit or transannular patch, respectively. In addition to general histological examination, 3D micro-computed tomography imaging and scanning electron microscopy-backscattered electron imaging were performed to reveal the precise location and extent of calcium deposition in the excised valve leaflets. Along with mineralization across the immobile membrane embedded in calcified pseudointimal tissue, calcium deposits were also detected in micro-interstices of the membrane in areas not covered by calcified fibrous tissue in both specimens. Fluorine properties and specific membrane interstices structure may cause unique calcium deposition independent of the foreign body reactions, leading to transmural calcification with thick pseudointimal embedding.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112209","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":"Thoracoscopic resection of residual aneurysm following hybrid aortic arch repair to prevent secondary aortoesophageal fistula in cases of severe oesophageal compression.","authors":"Fumio Yamana, Kazuo Shimamura, Soichiro Funaki, Shigeru Miyagawa","doi":"10.1093/icvts/ivaf112","DOIUrl":"https://doi.org/10.1093/icvts/ivaf112","url":null,"abstract":"<p><p>Secondary aorto-oesophageal fistulas after thoracic endovascular aortic repair are a severe complication associated with high mortality rates. We present a case of staged oesophageal decompression performed via thoracoscopic resection of a residual aneurysm following thoracic endovascular aortic repair to prevent secondary aorto-oesophageal fistulas in a patient with a distal arch aneurysm causing significant oesophageal compression. A 70-year-old woman with a 3-month history of hoarseness was referred to our hospital. Computed tomography revealed a penetrating ulcer in the aortic arch, complicated by a 60 mm pseudoaneurysm causing significant oesophageal compression. Owing to multiple comorbidities, the patient had high perioperative risk, rendering total arch replacement unfeasible; therefore, endovascular repair was selected. After Zone 1 hybrid thoracic endovascular aortic repair, complete thrombosis of the aneurysm was confirmed. Staged residual aneurysm resection was performed via thoracoscopy through a small left thoracotomy relieve oesophageal compression. Two years postoperatively, computed tomography revealed aneurysmal reduction, complete resolution of the oesophageal pressure drainage, and no evidence of secondary aorto-oesophageal fistula or stent graft infection.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065172","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":"Association between aortic low-attenuation plaques and the risk of cerebral infarction in hybrid aortic arch repair.","authors":"Fumio Yamana, Kazuo Shimamura, Ryoto Sakaniwa, Kizuku Yamashita, Yoshiki Watanabe, Koichi Maeda, Shigeru Miyagawa","doi":"10.1093/icvts/ivaf108","DOIUrl":"10.1093/icvts/ivaf108","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the association between aortic low-attenuation plaque (LAP) and the risk of cerebral infarctions, including microemboli, during hybrid aortic arch repair.</p><p><strong>Methods: </strong>Between January 2016 and February 2023, 149 patients underwent hybrid aortic arch repair. Patients were excluded if they lacked preoperative or postoperative magnetic resonance imaging (MRI), had insufficient computed tomography (CT) data, a history of arch replacement or Kommerell's diverticulum. The LAP area (CT values: 0-60 Hounsfield unit) was measured in the total and the greater curvature area of aorta. The LAP area was categorized as large or small based on the median value. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for new cerebral infarction lesions (NCILs).</p><p><strong>Results: </strong>Eighty-four patients were evaluated for NCILs using both pre- and postoperative MRI (NCIL positive: 41 patients, NCIL negative: 43 patients). The NCIL-positive group had a higher proportion of zone 0 landing (46% versus 21%; P = 0.020), greater use of the chimney graft technique (20% versus 5%; P = 0.046) and a larger LAP area in the greater curvature of the aortic arch (27 mm2 versus 13 mm2; P < 0.001). Multivariable-adjusted logistic regression model showed a large LAP area in the greater curvature of the aortic arch significantly increased the risk of NCILs (OR 5.23, 95% CI 1.29-18.34).</p><p><strong>Conclusions: </strong>A large LAP area in the greater curvature of the aortic arch is independently associated with an increased risk of NCILs during hybrid aortic arch repair.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043276","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":"Coronary artery bypass grafting using both internal mammary arteries-a safe concept for surgical training.","authors":"Tim Knochenhauer, Yvonne Schneeberger, Martin Beyer, Friedrich Sobik, Xiaoqin Hua, Beate Reiter, Jens Brickwedel, Svante Zipfel, Hermann Reichenspurner, Lenard Conradi, Bjoern Sill, Andreas Schaefer","doi":"10.1093/icvts/ivaf100","DOIUrl":"https://doi.org/10.1093/icvts/ivaf100","url":null,"abstract":"<p><strong>Objectives: </strong>In our centre, a bilateral internal mammary artery first approach is established from day 1 of surgical training. We herein aimed to investigate safety and clinical efficacy of this training concept.</p><p><strong>Methods: </strong>All patients undergoing isolated bypass grafting between 2009 and 2021 at our institution were included in this study. Patients provided with single mammary artery, radial artery or vein grafts were excluded. According to a preoperative evaluation conducted by experienced coronary bypass surgeons, coronary artery disease severity was classified, and patients were allocated to group 1 (surgery performed by staff surgeons) and group 2 (surgery performed by residents under supervision of staff surgeons). Thirty-day outcome parameters were compared between groups.</p><p><strong>Results: </strong>A total of 2125 patients were allocated to group 1, and 431 patients were assigned to group 2. Patients in group 1 presented a higher risk profile. Coronary artery bypass grafting in group 2 was more often performed as on-pump procedure with a longer procedure duration. Number of performed bypasses was lower in group 2 with fewer composite grafting and fewer anastomoses to the RCA territory. No significant differences in 30-day all-cause mortality, myocardial infarction, stroke or acute kidney injury were seen.</p><p><strong>Conclusions: </strong>Thirty-day outcomes after coronary artery bypass grafting using bilateral internal mammary artery grafts performed by residents were without significant differences to outcomes of staff surgeons, suggesting that application of both internal mammary arteries by residents is safe and effective when performed under supervision and after preoperative patient screening.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"40 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044122","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":"Effect of patent complete revascularization on myocardium with persistent perfusion defects in preoperative single-photon emission computed tomography.","authors":"Min-Seok Kim, Joon Yeun Park, Seong Wook Hwang, Ki-Bong Kim","doi":"10.1093/icvts/ivaf092","DOIUrl":"10.1093/icvts/ivaf092","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the changes in perfusion assessed by myocardial single-photon emission computed tomography after coronary artery bypass grafting (CABG) and to examine the myocardial segments with persistent perfusion defect preoperatively in patients who underwent CABG and who had all patent grafts 1 year postoperatively.</p><p><strong>Methods: </strong>Patients who underwent complete revascularization, who were assessed by preoperative and postoperative 3- and 12-month myocardial single photon emission computed tomography, and who showed all patent grafts on angiograms taken 1 year postoperatively were included. Myocardial single-photon emission computed tomography imaging was performed during stress and rest, and a 17-segment model was adopted for regional analysis of the perfusion defect. Myocardial segments were analysed based on a 5-point scale (0-4). After excluding the segments with normal stress scores, the difference scores (DSs) of the segments with impaired stress perfusion were calculated. The segments were divided into group P (DS ≤1) and group R (DS ≥2).</p><p><strong>Results: </strong>Of 2057 myocardial segments from 120 patients, a total of 761 segments [segment group P (n = 572) vs segment group R (n = 189)] with impaired stress perfusion were included in the final analyses. The stress scores tended to decrease in both groups after the operation, although the changes in the stress perfusion scores over time were more significant in group R than in group P. The differences in the rest scores between groups P and R tended to decrease during postoperative year 1. Although the preoperative DSs were significantly lower in group P than in group R, the differences between the groups became insignificant during postoperative year 1.</p><p><strong>Conclusions: </strong>Complete revascularization including myocardium with persistent perfusion defect should be considered when performing CABG.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"40 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059391","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":"Moving from minimally invasive to totally endoscopic mitral valve surgery: a retrospective review of outcomes.","authors":"Mark Boyle, Ahmed Elfadil, Saeed Mirsadraee, Toufan Bahrami","doi":"10.1093/icvts/ivaf106","DOIUrl":"10.1093/icvts/ivaf106","url":null,"abstract":"<p><strong>Objectives: </strong>Mitral valve surgery has undergone significant advancements with the emergence of minimally invasive mitral surgery harnessing endoscopic technology to facilitate repair through a right anterior thoracotomy. Further refinement within the field has borne the novel totally endoscopic approach, reducing incision size, and surgical trauma, to 3 cm. While there is evidence to support non-inferiority of minimally invasive techniques compared to a traditional sternotomy, a knowledge gap exists regarding the comparative safety and efficacy between minimally invasive modalities, necessitating.</p><p><strong>Methods: </strong>A retrospective review of outcomes following totally endoscopic and minimally invasive mitral valve surgery by right anterior thoracotomy was completed. One hundred eighty-six patients were included, all operations having been performed by a single surgeon, between January 2019 and June 2023. The hypothesis posits that the former offers an equivalence in repair while reducing postoperative pain, bleeding from the wound and enhancing cosmesis.</p><p><strong>Results: </strong>While low 30-day mortality rates were seen in both cohorts, the totally endoscopic group exhibited lower rates of patients discharged with opiates (16% vs 23%), reduced blood product transfusion requirements (33% vs 43%) and shorter postoperative stays (mean of 9.2 days vs 11.4 days).</p><p><strong>Conclusions: </strong>Moving from minimally invasive to totally endoscopic mitral valve surgery has been a positive experience with key patient advantages characterized by smaller incisions and avoidance of rib spreading. In this dataset, improved patient outcomes such as postoperative bleeding, pain, length of hospital stay and cosmesis were observed with all limitations given its fully uncontrolled nature. Validation of these findings warrants a larger study.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032072","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":"Transcatheter aortic valve implantation versus surgery in low-risk patients: in-hospital and mid-term outcomes.","authors":"Vittoria Lodo, Enrico Giuseppe Italiano, Luca Weltert, Edoardo Zingarelli, Claudio Pietropaolo, Gabriella Buono, Paolo Centofanti","doi":"10.1093/icvts/ivaf103","DOIUrl":"10.1093/icvts/ivaf103","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of our study is to compare post-procedural outcomes and mid-term mortality of low-risk patients treated by transfemoral TAVI or surgical aortic valve replacement (AVR) for severe aortic stenosis.</p><p><strong>Methods: </strong>Data of consecutive patients undergoing AVR or TAVI from September 2017 to December 2021 were prospectively collected and retrospectively reviewed. Eligible patients were aged between 75 and 85 years with low-surgical risk and isolated severe aortic stenosis. Exclusion criteria were prior heart surgery, valve-in-valve procedure and the need for concomitant procedures. The primary end-point was mid-term all-cause mortality.</p><p><strong>Results: </strong>Three hundred fifty-one patients were enrolled. Of these, 243 underwent TAVI and 108 underwent AVR. Compared to AVR, TAVI patients were older (82 [78-83 ] vs 78 [77-80], P < 0.001), with higher incidence of advanced chronic kidney disease (33.3% vs 15.7%, P < 0.001) and poor mobility (15.6% vs 5.6%, P = 0.008) and a higher Euroscore II (2.2 [1.72-2.98] vs 1.9 [1.31-2.46 ], P = 0.002). AVR patients had a higher incidence of post-procedural AKI (29.6% vs 4.5%, P < 0.001), while TAVI patients had a higher incidence of LBBB (23.9% vs 1.8%, P < 0.001) and at least mild to moderate PVL (4.5% vs 0%, P = 0.021). Mid-term mortality was higher among TAVI patients (HR 0.38 [95% CI 0.23-0.88], P = 0.020). In the matched cohort, TAVI had a higher incidence of LBBB (11.5% vs 1.3%, P = 0.018) and permanent PM implantation (12.8% vs 5.1%, P = 0.041), while AVR patients had a higher incidence of post-procedural AKI (33.3% vs 5.1%, P < 0.001). Mid-term mortality was higher in TAVI patients (HR 0.36 [95% CI 0.21-0.87], P = 0.019).</p><p><strong>Conclusions: </strong>TAVI patients demonstrated a higher mid-term mortality and a higher incidence of post-procedural conduction abnormalities and PVL which remain a concern in low-risk patients.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058662","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":"Video-assisted thoracoscopic surgery for adult benign idiopathic bronchoesophageal fistula: a report of two cases.","authors":"Qihang Zhu, Jing Zhan, Xiaojing Yao, Haiping Xiao","doi":"10.1093/icvts/ivaf114","DOIUrl":"10.1093/icvts/ivaf114","url":null,"abstract":"<p><p>We described two cases with idiopathic bronchoesophageal fistula presented recurrent postprandial coughing. Abnormal tracts connecting the oesophagus and bronchus were identified by videofluoroscopy. Thoracoscopic surgery was successfully performed, which involved the resection of the fistula and the interposition of a pedicle of viable parietal pleura between oesophageal and bronchial closures. Neither patient experienced symptoms of any subsequent complications.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082610","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":"Sex-related differences in patient characteristics, practice patterns and outcomes after bioprosthetic and mechanical aortic valve replacement.","authors":"Milos Matkovic, Igor Zivkovic, Slobodan Micovic, Ilija Bilbija, Petar Milacic, Nemanja Aleksic, Nemanja Milosevic, Milan Milojevic, Svetozar Putnik","doi":"10.1093/icvts/ivaf110","DOIUrl":"10.1093/icvts/ivaf110","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines sex-based differences in baseline characteristics, practice patterns and mid-term survival following aortic valve replacement (AVR).</p><p><strong>Methods: </strong>The study design included all consecutive patients from the AVR Registry with a 3-year follow-up. Patients were initially categorized by sex and prosthesis type. The primary end-point was 3-year all-cause mortality. Subgroup observations included the age-recommended threshold for mechanical prosthesis (<65 years) and the patient-prosthesis mismatch (PPM).</p><p><strong>Results: </strong>The present study revealed that females (n = 517) compared to males (n = 732) were significantly older (67.2 ± 9.3 years vs 64.4 ± 12.2 years, P < 0.001), had higher body mass index (2.23 ± 7.2 cm2 vs 2.01 ± 0.2 cm2, P < 0.005) and lower left ventricular ejection fractions (51.8 ± 13.5% vs 57.7 ± 10.8%, P < 0.001) at the time of the index procedure. Additionally, females received significantly more bioprosthetic AVR than males (38.1% vs 32.6%, P = 0.040). There were no significant differences in 3-year mortality risk between males and females (14.6% vs 14.1%, P = 0.87). In subgroup analyses of patients with mechanical prostheses, females experienced a higher incidence of PPM than males (9.6% vs 2.2%, P < 0.001), whereas no significant difference was observed among those who received bioprosthetic valves. The male cohort observed reduced mortality associated with mechanical versus bioprostheses (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.36-0.81, P = 0.003). This effect was particularly significant in males under 65 (HR 0.27, 95% CI 0.11-0.68, P = 0.005). However, there was no difference in mortality related to prosthesis type in females, regardless of age group.</p><p><strong>Conclusions: </strong>At the time of referral for AVR, female patients were significantly older and had worse clinical profiles than male patients. Despite the higher rates of bioprosthetic valve implantation and PPM in females, mid-term survival rates were not significantly different. In contrast, males, especially those under 65, showed higher mortality following bioprosthetic AVR. These findings underscore the need for further research focusing on the sex-based treatment determinates in AVR.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059388","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}