BJS Open最新文献

{"title":"DiffErential attainment and Factors AssoCiated with Training applications and Outcomes (DE FACTO) for general surgery applications in the UK: retrospective study.","authors":"Sarika Grover, Siddarth Raj, Martina Spazzapan, Beth Russell, Harroop Bola, Noel Biju, Sachin Malde, Simon Fleming, Stella Vig","doi":"10.1093/bjsopen/zrae166","DOIUrl":"10.1093/bjsopen/zrae166","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive versus open lateral pancreaticojejunostomy in patients with painful chronic pancreatitis: systematic review.","authors":"Roberto M Montorsi, Michiel F G Francken, Marja A Boermeester, Olivier R Busch, Freek Daams, Thilo Hackert, Roel Haen, Markus W Hollmann, Hjalmar C van Santvoort, Marc G Besselink","doi":"10.1093/bjsopen/zrae135","DOIUrl":"10.1093/bjsopen/zrae135","url":null,"abstract":"<p><strong>Background: </strong>Patients with painful chronic pancreatitis combined with a dilated main pancreatic duct and a normal size pancreatic head are treated according to guidelines by lateral pancreaticojejunostomy (LPJ). This systematic review compared outcomes of minimally invasive LPJ and open LPJ.</p><p><strong>Methods: </strong>From 1 January 2000 until 13 November 2023, series reporting on minimally invasive LPJ and open LPJ in patients with symptomatic chronic pancreatitis were included. This study was structured in accordance with the PRISMA guidelines. The primary outcome was intraoperative and postoperative complications. Secondary outcomes included long-term clinical outcomes.</p><p><strong>Results: </strong>Overall, 19 retrospective studies were included. Morbidity rate ranged from 0% to 57% after minimally invasive LPJ versus 4% to 68% after open LPJ (median: 25, i.q.r.: 23). Length of hospital stay ranged from 5 to 7 days after minimally invasive LPJ and from 6 to 16 days after open LPJ. The rate of pain relief ranged from 62% to 91% after open LPJ (median: 78.5, i.q.r.: 23) and from 71% to 100% (median: 82.5, i.q.r.: 12.5) after minimally invasive LPJ respectively. New-onset endocrine insufficiency ranged from 21% to 22% in minimally invasive LPJ and 19% to 26% after open LPJ. New-onset exocrine insufficiency was shown in 11% to 27% in minimally invasive LPJ versus 8% to 26% after open LPJ. Weight gain ranged from 60% to 100% (median: 97, i.q.r.: 23) after minimally invasive LPJ.</p><p><strong>Discussion: </strong>This systematic review suggested that minimally invasive LPJ can be performed safely in selected patients with symptomatic chronic pancreatitis. Phase 2 randomized trials should assess potential short-term benefits such as postoperative pain and length of hospital stay after minimally invasive LPJ.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of the postoperative fatality window in colorectal cancer surgery.","authors":"Martin Rutegård, Peter Matthiessen, Jörgen Rutegård, Markku M Haapamäki, Johan Svensson","doi":"10.1093/bjsopen/zrae153","DOIUrl":"10.1093/bjsopen/zrae153","url":null,"abstract":"<p><strong>Background: </strong>Postoperative death measured 30 days after surgery is a conventional quality metric, whereas intervals up to 90 days are increasingly used, although data-driven time windows have scarcely been investigated.</p><p><strong>Methods: </strong>The Swedish Colorectal Cancer Registry was used to identify all patients subjected resection for colorectal cancer between 2007 and 2020. All patients were followed up until 180 days after surgery. A join-point statistical hazard model was used to model a declining hazard to a transition point, followed by a stable death rate. This method was subsequently applied to describe postoperative deaths for the entire cohort and subgroups according to tumour location (colon and rectum).</p><p><strong>Results: </strong>Some 56 096 patients electively operated on for colorectal cancer during the study interval were included, with a 30-day and 90-day fatality of 805 (1.43%) and 1458 (2.60%) patients respectively. The derived postoperative fatality window, after which the death rate transitioned to a stable rate, was 23.8 (95% c.i. 21.5 to 28.2) days after surgery. There was no significant difference in the time window between rectal cancer (22.9 days; 95% c.i. 15.1 to 28.4) and colon cancer (27.3 days; 95% c.i. 21.4 to 31.8) patients (P = 0.455). However, postoperative fatality time windows were extended in patients aged at least 80 years and with American Society of Anesthesiologists' grade III or IV.</p><p><strong>Conclusion: </strong>The traditional postoperative time window of 30 days was confirmed to be an appropriate metric in elective colorectal cancer surgery when evaluated with a hazards-based statistical framework. Importantly, this time window is influenced by older age and advanced co-morbidity, which could prompt increased vigilance for these patient groups.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformational journey in ileo-pouch anal anastomosis surgery for ulcerative colitis.","authors":"Franco Scaldaferri, Franco Sacchetti","doi":"10.1093/bjsopen/zrae157","DOIUrl":"10.1093/bjsopen/zrae157","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Operative versus conservative management for inguinal hernia: a methodology scoping review of randomized controlled trials.","authors":"","doi":"10.1093/bjsopen/zrae164","DOIUrl":"10.1093/bjsopen/zrae164","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes from the 'Watch and Wait' (WoW) study: prospective cohort study.","authors":"Daniel Rydbeck, Najia Azhar, Lennart Blomqvist, Abbas Chabok, Joakim Folkesson, Anders Gerdin, Linda Hermus, Peter Matthiessen, Anna Martling, Per J Nilsson, Eva Angenete","doi":"10.1093/bjsopen/zrae151","DOIUrl":"10.1093/bjsopen/zrae151","url":null,"abstract":"<p><strong>Background: </strong>Despite absence of level 1 evidence on the long-term oncological safety of non-operative management for rectal cancer (watch and wait), increased implementation has occurred globally over the past decades. In Sweden, a pan-national prospective non-randomized study was initiated in 2017 to assess its implementation.</p><p><strong>Method: </strong>Patients with biopsy-proven rectal cancer receiving neoadjuvant therapy according to national guidelines in whom a clinical complete response was detected at reassessment were eligible for inclusion following informed consent. Only patients with an opportunistic watch-and-wait approach were included. Inclusion and follow-up, according to the study protocol, was managed at the participating study centres. The primary outcome measure of the study is 3-year disease-free survival. Here, the secondary short-term outcomes local regrowth rate, distant metastasis rate and outcomes after surgery for regrowth, at 6 months follow-up, are reported.</p><p><strong>Results: </strong>Between January 2017 and February 2023, 211 patients with a clinical complete response were included in the study. Thirty-three (16%) patients developed suspicious regrowth within 6 months of inclusion. Thirty-two of 33 patients had abdominal resectional surgery for regrowth. The curative intention rate was 94% for patients with regrowth. Three patients (1.4%) developed distant metastases within 6 months of inclusion.</p><p><strong>Conclusion: </strong>This Swedish national study on watch and wait reports regrowth rates after 6 months are in line with previous reports in the literature. Nearly all patients with early regrowth could be treated with salvage surgery and curative intent.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric partitioning versus gastrojejunostomy for gastric outlet obstruction due to unresectable gastric cancer: randomized clinical trial.","authors":"Marcus Fernando Kodama Pertille Ramos, Marina Alessandra Pereira, André Roncon Dias, Osmar Kenji Yagi, Bruno Zilberstein, Ulysses Ribeiro-Junior","doi":"10.1093/bjsopen/zrae152","DOIUrl":"10.1093/bjsopen/zrae152","url":null,"abstract":"<p><strong>Background: </strong>Gastric outlet obstruction due to unresectable tumours is usually managed with a gastrojejunostomy. Unfortunately, the unsatisfactory outcomes of this procedure have led to the search for alternatives, including gastric partitioning.</p><p><strong>Methods: </strong>Monocentric, randomized, parallel, open-label trial that included patients with obstructive, unresectable distal gastric tumours. The objective was to compare gastric partitioning to gastrojejunostomy, considering the gastric outlet obstruction scoring system scale as the main outcome. Randomization was performed using computer-generated software available online and after the application of the informed consent term, the allocation group was revealed to the surgeon before the surgical procedure.</p><p><strong>Results: </strong>Over 7 years, 90 patients were initially randomized. After applying the inclusion and exclusion criteria, 25 patients were included in the gastrojejunostomy group and 27 in the partitioning group. Both groups were similar regarding initial clinical characteristics including sex, age, weight, clinical performance, and the acceptance of oral diet. Surgery duration, length of hospital stay, postoperative complications, and 30- and 90-day mortality rates were similar between groups. Acceptance of normal diet was more frequently reached by patients in the partitioning group (96% versus 72%; P = 0.022). During outpatient follow-up, maintenance of oral intake and weight was similar between groups. Patients in the partitioning group received more frequent red blood cell transfusions (81% versus 52%; P = 0.024). There was no difference regarding the administration of palliative chemotherapy lines and survival. In the multivariable analysis, the inability to eat a full diet (P = 0.035) and the absence of palliative chemotherapy after the procedure (P = 0.001) were associated with worse survival.</p><p><strong>Conclusions: </strong>Gastric partitioning provided a better return of the ability to accept food orally. There was no difference regarding postoperative complications and long-term survival.</p><p><strong>Trial registration: </strong>NCT02065803, clinicaltrials.gov.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of quality of life, anxiety, and depression over time in patients with an abdominal aortic aneurysm approaching the surgical threshold.","authors":"Alexander Vanmaele, Petros Branidis, Maria Karamanidou, Elke Bouwens, Sanne E Hoeks, Jorg L de Bruin, Sander Ten Raa, K Martijn Akkerhuis, Felix van Lier, Ricardo P J Budde, Bram Fioole, Hence J M Verhagen, Eric Boersma, Isabella Kardys","doi":"10.1093/bjsopen/zrae150","DOIUrl":"10.1093/bjsopen/zrae150","url":null,"abstract":"<p><strong>Background: </strong>Contrary to the impact of screening, the effect of long-term surveillance on the quality of life of patients with an abdominal aortic aneurysm is not well known. Therefore, the aim of this study was to describe patient-reported outcomes of patients with an abdominal aortic aneurysm approaching the surgical threshold.</p><p><strong>Methods: </strong>This multicentre, observational cohort study included patients with an abdominal aortic aneurysm with a maximum aneurysm diameter of greater than or equal to 40 mm. The EuroQol five-dimension five-level questionnaire (range -0.446 to 1, minimal clinically important difference 0.071), the Hospital Anxiety and Depression Scale questionnaire (0-21 points/subscale, minimal clinically important difference 1.7 points), and the short version of the Patient Health Questionnaire (0-6 points) were mailed to patients with an abdominal aortic aneurysm at baseline and after 1 and 2 years or until abdominal aortic aneurysm surgery/death. Linear mixed-effects models were used to describe the evolution of patient-reported outcomes over time and investigate changes attributable to clinical characteristics.</p><p><strong>Results: </strong>In total, 291 to 294 responses to each questionnaire were available from 124 patients with an abdominal aortic aneurysm, of whom 34 underwent surgery during follow-up. The mean health-related quality of life and anxiety and depression scores over time were 0.781 (95% c.i. 0.749 to 0.814), 4.4 points (95% c.i. 3.9 to 4.9), and 4.6 points (95% c.i. 4.0 to 5.2) respectively. Anxiety and depression scores decreased in patients who underwent surgery with a mean of 2.8 (95% c.i. 1.1 to 4.6) and 2.0 (95% c.i. 0.4 to 3.6) points/year respectively, compared with patients who had not had surgery. Considering the minimal clinically important difference, patients with a primary education alone, compared with a secondary education, had higher or increasing anxiety and depression scores. Patients with a first-degree relative with an abdominal aortic aneurysm had a higher risk of clinical anxiety.</p><p><strong>Conclusion: </strong>Although health-related quality of life, anxiety, and depression remain stable over time on average, anxiety and depression decrease in patients approaching surgery. Patients with a family history of abdominal aortic aneurysm or a primary education alone experience more anxiety and/or depression and thus might benefit from a tailored approach during surveillance.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-impact complications after breast cancer surgery in the Dutch national quality registry: evaluating case-mix adjustment for hospital comparisons.","authors":"Elfi M Verheul, David van Klaveren, Hester F Lingsma, Elvira Vos, Marije J Hoornweg, Sabine Siesling, Linetta B Koppert","doi":"10.1093/bjsopen/zrae147","DOIUrl":"10.1093/bjsopen/zrae147","url":null,"abstract":"<p><strong>Background: </strong>Comparison of quality indicators can improve quality of care. However, case-mix adjustment is deemed essential. The aim of this study was to develop and validate case-mix adjustment models and to evaluate the effect of case-mix adjustment for the quality indicators related to complications after breast cancer surgery.</p><p><strong>Methods: </strong>Multivariable logistic regression with backward selection (P < 0.1) was used to develop case-mix models in patients undergoing breast cancer surgery (all types, breast-conserving surgery, mastectomy with or without immediate reconstruction) in the Netherlands (NABON Breast Cancer Audit). High-impact complications were defined as Clavien Dindo grade ≥3. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), corrected for optimism with bootstrap validation. Observed-to-expected plots were used to visualize the difference between unadjusted and case-mix adjusted hospital performance (hospital shifts).</p><p><strong>Results: </strong>In total 32 084 patients from 72 hospitals treated in 2021-2022 were included. A between-hospital variation in complication rates was observed for all surgeries (interquartile range 2.4-6.0%), breast-conserving surgery (interquartile range 1.4-3.4%), and mastectomy with (interquartile range 9.4-9.1%) and without reconstruction (interquartile range 3.3-9.7%). Of the considered variables, body mass index, smoking, multifocality and neoadjuvant therapy were weakly associated with complications. However, surgery type was strongly related to complications (AUC 0.70), resulting in noticeable hospital shifts in the quality indicator scores comprising all surgeries. After stratification for surgery type, no evident hospital shifts were observed after case-mix correction.</p><p><strong>Conclusion: </strong>For valid comparison of complication rates after breast cancer surgery between hospitals, stratification by surgery type is crucial. Subsequently, the evaluated patient and tumour characteristics have a negligible effect on the hospital variation.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ileal pouch-anal anastomosis for ulcerative colitis: 30-year analysis on surgical evolution and patient outcome.","authors":"Gabriele Bislenghi, Antonio Luberto, Wout De Coster, Leen van Langenhoven, Albert Wolthuis, Marc Ferrante, Severine Vermeire, André D'Hoore","doi":"10.1093/bjsopen/zrae111","DOIUrl":"10.1093/bjsopen/zrae111","url":null,"abstract":"<p><strong>Background: </strong>Proctocolectomy with ileal pouch-anal anastomosis is the treatment of choice for patients with ulcerative colitis with medical refractory disease or dysplasia. The aim of this research was to describe the evolution of ileal pouch-anal anastomosis surgery and surgical outcomes over a three-decade interval in a high-volume referral centre.</p><p><strong>Methods: </strong>All consecutive patients undergoing ileal pouch-anal anastomosis for ulcerative colitis between 1990 and 2022 at the University Hospitals of Leuven were retrospectively included. Patients were divided into three interval arms (interval A 1990-2000, interval B 2001-2010 and interval C 2011-2022). The primary outcomes of interest were anastomotic leakage at 30 days and pouch failure.</p><p><strong>Results: </strong>Overall, 492 patients were included. The use of preoperative advanced therapies increased over time (P < 0.001). An increase in laparoscopic procedures (23.2% in interval A, 66.4% in interval B, 86.0% in interval C; P < 0.001) and a shift towards delayed ileal pouch-anal anastomosis (colectomy-first approach with delayed ileal pouch-anal anastomosis construction: 23.0% in interval A, 40.9% in interval B, 85.8% in interval C; P < 0.001) were observed. Anastomotic leakage rate decreased from 16.7% (interval A) to 8.4% (interval C) (P = 0.04). Delayed ileal pouch-anal anastomosis was the most relevant factor in limiting leakage (OR 0.49 (95% c.i. 0.27 to 0.87); P = 0.016). Median follow-up was 7.5 years (interquartile range 2.5-16). Cumulative pouch failure incidence was 8.2%, not significantly different between the three intervals (P = 0.580). Anastomotic leakage was the only significant risk factor for pouch failure (HR 2.82 (95% c.i. 1.29 to 6.20); P = 0.010).</p><p><strong>Conclusion: </strong>Significant changes in the management of ulcerative colitis patients occurred. Despite the widespread use of advanced therapies and the expanded surgical indications, anastomotic leakage rate decreased over time. In the context of a delayed ileal pouch-anal anastomosis, diverting ileostomy could be avoided in selected cases. Anastomotic leakage remains the most relevant risk factor for pouch failure. Pouch failure incidence remained stable over the years.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}