Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

{"title":"Artificial intelligence in metabolic and bariatric surgery: current applications and future direction from the ASMBS Emerging Technology and Procedures Committee.","authors":"Yung Lee, Jerry Dang, Benjamin Clapp, Timothy Snow, Nirav Desai, Christopher Daigle, Thomas Shin","doi":"10.1016/j.soard.2026.08.032","DOIUrl":"https://doi.org/10.1016/j.soard.2026.08.032","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is increasingly integrated across the perioperative continuum of metabolic and bariatric surgery (MBS), yet adoption is outpacing specialty-specific guidance on safe, effective, and equitable implementation.</p><p><strong>Objectives: </strong>To synthesize current evidence on AI applications in MBS, identify key implementation challenges, and provide recommendations for responsible clinical adoption.</p><p><strong>Setting: </strong>American Society for Metabolic and Bariatric Surgery (ASMBS) Emerging Technology and Procedures (ET&P) Committee.</p><p><strong>Methods: </strong>Surgeon-led narrative review of published literature on AI in MBS and relevant adjacent surgical and chronic disease fields, organized by preoperative, intraoperative, postoperative, and administrative domains, with recommendations developed by committee consensus.</p><p><strong>Results: </strong>Preoperatively, machine learning models outperform conventional risk indices for predicting complications and readmission and can forecast long-term weight trajectories. Intraoperatively, computer vision systems recognize procedural steps in sleeve gastrectomy and Roux-en-Y gastric bypass with accuracy comparable to expert annotators, and AI-enabled video and virtual reality platforms support objective skills assessment. Postoperatively, wearable-based remote monitoring and predictive models may identify early deterioration, weight regain, and comorbidity recurrence. Administratively, ambient AI scribes, prior authorization automation, and operating room scheduling may reduce clerical burden. Most evidence remains retrospective and single-center. Key challenges include large language model hallucination, automation bias and deskilling, algorithmic bias, and data privacy. Eight operational recommendations address clinical role, MBS-specific validation, equity auditing, documentation, governance, technical safety, workflow integration, and learning health systems.</p><p><strong>Conclusions: </strong>AI can enhance the safety, efficiency, and scalability of MBS when clinician-led, rigorously validated, equitable, and transparent. Prospective, multicenter evaluation is needed before broad adoption.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187130","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":"Obesity treatment access in the United States: a state-level scorecard.","authors":"John David Scott, Allyson Lynn Hale, Tracy Zvenyach, Joseph Nadglowski, Lisa Renee Hilton","doi":"10.1016/j.soard.2026.09.020","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.020","url":null,"abstract":"<p><strong>Background: </strong>Obesity affects more than 40% of U.S. adults and carries substantial morbidity and mortality, yet access to evidence-based treatment varies widely across jurisdictions.</p><p><strong>Objectives: </strong>To evaluate and compare state-level access to evidence-based obesity treatment across the United States using a standardized composite framework.</p><p><strong>Setting: </strong>50 U.S. states and the District of Columbia (51 jurisdictions).</p><p><strong>Methods: </strong>Ecological cross-sectional study using publicly available policy and administrative data aggregated in 2026; the unit of analysis was the jurisdiction and no individual patient-level data were used. The Obesity Treatment Access Scorecard was derived from 44 metrics across 6 weighted tiers, coverage, access barriers, workforce capacity, regulatory factors, patient context, and treatment utilization, yielding scores of 0-100 mapped to letter grades (A-F). Data were verified by expert review with multisource validation, and sensitivity analyses tested alternative tier-weighting schemes.</p><p><strong>Results: </strong>Scores ranged from 25.5 to 77.7 (mean, 48.5; standard deviation [SD], 12.8). No state achieved an A grade (≥80). Fifteen jurisdictions (29.4%) scored below 40 and 10 (19.6%) scored 60 or higher. Massachusetts (77.7) and Minnesota (76.4) ranked the highest; Arkansas (25.5), Oklahoma (28.5), and West Virginia (28.9) ranked the lowest. Mean scores were highest in the Northeast (62.7 [SD, 10.2]) and lowest in the South (39.9 [SD, 10.5]). Variability was greatest in the patient context and workforce capacity tiers. Jurisdiction rankings were robust to alternative tier-weighting schemes (Spearman ρ ≥ .99).</p><p><strong>Conclusions: </strong>Access to evidence-based obesity treatment is highly variable across the United States, with no state achieving top performance. These findings highlight significant geographic disparities and support the need for policy and system-level reforms. The Obesity Treatment Access Scorecard is presented as an exploratory benchmarking framework requiring further validation before use in policy evaluation.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198214","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":"Percentile-based weight loss benchmarks: toward more informed bariatric counseling.","authors":"David Alejandro Romero Funes","doi":"10.1016/j.soard.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.003","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208421","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":"Diabetic nephropathy and postoperative complications in metabolic and bariatric surgery: a propensity score-matched nationwide cohort study.","authors":"Yongzhe Cui, Mi Yan, Jiawen Liao, Ying Xu, Xiaojun Xiang, Xiaoyu Lin","doi":"10.1016/j.soard.2026.09.011","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.011","url":null,"abstract":"<p><strong>Background: </strong>Diabetic nephropathy (DN) is increasingly prevalent among people with obesity undergoing metabolic bariatric surgery (MBS) in the United States, yet its impact on perioperative complications remains poorly understood.</p><p><strong>Objectives: </strong>This study utilizes a large nationwide database to investigate the association between DN and in-hospital postoperative complications after MBS.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from the National Inpatient Sample (2016-2019). Adults with obesity undergoing MBS were identified using International Classification Of Diseases, tenth revision (ICD-10) codes. DN patients were matched 1:1 to non-DN controls using propensity score matching, balancing demographics, hospital characteristics, and 24 Elixhauser co-morbidities. Multivariate logistic regression assessed the association between DN and perioperative complications.</p><p><strong>Results: </strong>DN patients had significantly higher odds of blood transfusion (odds ratio (OR): 1.178, 95% confidence interval (CI): 1.026-1.353), anastomotic complications (OR: 1.669, 95% CI: 1.158-2.492), acute myocardial infarction (OR: 1.553, 95% CI: 1.276-1.891), acute kidney injury (AKI) (OR: 3.024, 95% CI: 2.786-3.281), urinary tract infection (UTI) (OR: 1.175, 95% CI: 1.054-1.309), and extended length of stay (LOS) (OR: 1.205, 95% CI: 1.118-1.300).</p><p><strong>Conclusions: </strong>This study demonstrates that DN is a significant independent risk factor for blood transfusion, anastomotic complications, acute myocardial infarction, AKI, UTI, and prolonged hospitalization after MBS. These findings highlight the need for enhanced preoperative counseling and targeted perioperative management in this high-risk population.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198100","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":"Total healthcare costs and cost savings after bariatric surgery and glucagon-like peptide-1 receptor agonist treatment for obesity and diabetes vary with insurance coverage.","authors":"Mohammad E Alomari, Elizabeth Wall-Wieler, Yuki Liu, Feibi Zheng, Michael A Edwards","doi":"10.1016/j.soard.2026.09.012","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.012","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonist (GLP-1-RA) options continue to evolve. Given different levels of reimbursement across insurance payors, we compared healthcare costs across payors for patients treated with metabolic and bariatric surgery (MBS) or GLP-1-RAs.</p><p><strong>Setting: </strong>Academic Health Center.</p><p><strong>Methods: </strong>Using the STATinMED RWD Insights all-payor claims database, we performed a retrospective 1:1 propensity-matched cohort analysis of patients with class II or III obesity and type 2 diabetes (T2D) treated with sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or GLP-1-RAs from 2017 to 2023. Current Procedural Terminology 4 and International Classification of Diseases, Tenth Revision, codes identified MBS, and national drug codes identified GLP-1-RA prescriptions. The primary outcome was 2-year overall healthcare cost for MBS and GLP-1-RA treatments stratified by insurance type.</p><p><strong>Results: </strong>Ninety thousand seven hundred sixty nine individuals met inclusion criteria; 5%, 64.1%, and 30.4% were treated with GLP-1-RAs, SG, and RYGB, respectively. A propensity-matched analysis compared 4931 GLP-1-RA and SG patients. Healthcare costs for GLP-1-RAs and SG were higher among noncommercial payors than those among commercial payors, more so for GLP-1-RAs. Two-year total costs were significantly lower for SG than those for GLP-1-RAs across all insurance payors (P < .01; delta: $11,310-$18,918). Medicaid insurance had the greatest cost savings ($18,927, P < .01). The propensity-matched analysis also compared 4271 GLP-1-RA and RYGB patients. Two-year total costs varied by insurance type and were similar for RYGB and GLP-1-RA (P > .05), except for the commercial insurance cohort having a significant lower cost for RYGB than for GLP-1-RAs (delta: $4973, P < .01).</p><p><strong>Conclusion: </strong>Costs associated with both MBS and GLP-1-RAs were higher with Medicaid and Medicare than with commercial insurance. SG and RYGB were associated with cost savings compared with GLP-1-RA treatment across most payor types.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217801","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":"Comment on: Anastomotic marginal ulceration after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass.","authors":"Alec C Beekley","doi":"10.1016/j.soard.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.004","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187151","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":"Surgery still leads: body contouring's last baseline before the glucagon-like peptide-1 receptor agonist era.","authors":"Mohamed A Abdelsalam","doi":"10.1016/j.soard.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.009","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169999","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":"Clinical outcomes in solid organ transplant recipients undergoing Roux-en-Y gastric bypass surgery: a propensity score-matched study.","authors":"Tamar Tsenteradze, Steven P Bowers, Enrique F Elli","doi":"10.1016/j.soard.2026.09.015","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.015","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy of bariatric surgery in solid organ transplant recipients remain incompletely understood because of chronic immunosuppression and increased medical complexity.</p><p><strong>Objectives: </strong>This study evaluated perioperative outcomes, long-term morbidity, and weight loss following Roux-en-Y gastric bypass (RYGB) in transplant recipients compared with matched nontransplant patients.</p><p><strong>Setting: </strong>Tertiary academic medical center, United States.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained database identified 566 patients who underwent primary robotic RYGB between January 2014 and December 2024. Seventeen solid organ transplant recipients receiving chronic immunosuppressive therapy were identified and matched 3:1 to nontransplant patients using propensity scores based on age, body mass index, and obesity-related co-morbidities. Perioperative outcomes, postoperative complications, readmissions, reinterventions, survival, and weight loss outcomes were compared.</p><p><strong>Results: </strong>After propensity score matching, 68 patients were included (17 transplant recipients and 51 nontransplant patients). Baseline demographic and clinical characteristics were comparable between groups. Early postoperative outcomes did not differ significantly, including complications (41.2% versus 27.5%, P = .29), readmissions (35.3% versus 25.5%, P = .44), and reinterventions (.0% versus 7.8%, P = .23). Observed late complication, readmission, and reoperation proportions were higher among transplant recipients. Kaplan-Meier analysis demonstrated lower freedom from late complications (log rank P = .006), lower freedom from late reoperation (log rank P = .010), and lower overall survival (log rank P = .029). Weight loss outcomes were comparable between groups, with no significant differences in body mass index reduction or total body weight loss at 6 or 12 months.</p><p><strong>Conclusions: </strong>RYGB demonstrated comparable early perioperative safety and short-term weight loss outcomes in solid organ transplant recipients and matched nontransplant patients. However, transplant recipients experienced higher rates of late complications, readmissions, and reinterventions, emphasizing the importance of close multidisciplinary follow-up and long-term surveillance in this high-risk population.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187178","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":"The hidden burden: how binge-eating symptoms impact postmetabolic and bariatric surgery success.","authors":"Victoria Ferrari Canedo de Sant'Anna, Rafaela Dutra, Alessandra Pinheiro Mulder","doi":"10.1016/j.soard.2026.09.016","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.016","url":null,"abstract":"<p><strong>Background: </strong>Binge-eating symptoms after metabolic and bariatric surgery (MBS) may impair dietary intake, postoperative outcomes, and health-related quality of life, yet their manifestations remain insufficiently characterized OBJECTIVES: To evaluate whether binge-eating symptoms are associated with dietary intake, postoperative outcomes, and health-related quality of life in women after MBS, and to characterize reported binge-eating episodes quantitatively and qualitatively SETTING: Obesity Outpatient Unit of Policlinic Piquet Carneiro, State University of Rio de Janeiro.</p><p><strong>Methods: </strong>This cross-sectional study included 66 women at least 12 months after MBS without nutritional follow-up in the previous 6 months, classified as controls (Binge Eating Scale (BES) <17; n = 37) or with binge-eating symptoms (BES ≥17; n = 29). Anthropometric, body composition, dietary, and quality-of-life data were obtained; dietary intake and episodes were assessed using 24-hour recalls and classified by NOVA (the NOVA food classification system, based on the extent and purpose of industrial processing).</p><p><strong>Results: </strong>Women with binge-eating symptoms showed lower excess weight loss, higher body fat percentage, higher energy and carbohydrate intake, and lower relative protein intake than controls. High quality of life was less frequent, and BES score was inversely associated with Bariatric Analysis and Reporting Outcome System (BAROS) score (rho = -.418, P = .0005). Episodes were energy-dense, carbohydrate-predominant, emotionally triggered, and often occurred without hunger, mainly at home and later in the day. Overall NOVA distribution did not differ between groups; however, episodes themselves were markedly dominated by ultra-processed foods (81.3% of caloric content), versus unprocessed/minimally processed foods (12.5%) and processed foods (6.3%).</p><p><strong>Conclusions: </strong>Binge-eating symptoms after MBS were associated with poorer dietary intake, less favorable postoperative outcomes, and poorer health-related quality of life.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187234","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":"Gastroesophageal reflux disease as a risk factor for postoperative complications in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program registry (2015-2022): implications for preoperative evaluation.","authors":"Héctor J García-Navas, Emily Jordan, Florina Corpodean, Carlos Galvani, Elizabeth M Hechenbleikner, Maria V Hayes, Philip R Schauer, Vance L Albaugh, Michael W Cook, Michael Kachmar, Thomas H Shin","doi":"10.1016/j.soard.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.soard.2026.09.010","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) is frequently reported in metabolic surgery patients and has been associated with increased postoperative complications. However, variability in GERD diagnosis, reliance on self-reported symptoms, and medication use may be confounding factors.</p><p><strong>Objectives: </strong>Evaluate GERD as an independent risk factor for postoperative outcomes.</p><p><strong>Setting: </strong>Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), 2015-2022.</p><p><strong>Methods: </strong>A total of 1,577,175 cases (sleeve gastrectomy [SG], Roux-en-Y gastric bypass [RYGB], or biliopancreatic diversion/duodenal switch) were available for inclusion. Exclusions included age <18, body mass index <30, missing sex or operative length, and revisions/conversions. Adjusted logistic regression models evaluated GERD as a predictor of 30-day and procedure-specific outcomes (SG, RYGB). All statistical analyses were performed using R, version 4.4.1.</p><p><strong>Results: </strong>Overall, a total of 1,282,883 patients met inclusion criteria, and patients were more likely to undergo SG than RYGB regardless of the GERD status. GERD diagnosis was present in 30.5% of patients. Preoperatively, GERD was associated with clinically relevant differences in cardiac history and was also associated with increased odds of postoperative complications, including infections (odds ratio [OR], 1.27), serious complications (OR, 1.20), and 30-day readmission (OR, 1.26).</p><p><strong>Conclusion: </strong>After adjustment for co-morbidities, GERD was associated with modestly increased odds of adverse events after metabolic and bariatric surgery. In addition, SG was the most performed procedure among patients with GERD despite clinical recommendations favoring RYGB. Surgeons should consider a preoperative GERD diagnosis-as defined in the MBSAQIP-as a potential marker for identifying patients who may warrant enhanced perioperative risk assessment and optimization of coexisting co-morbidities.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198130","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}