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

{"title":"The impact of bariatric surgery on maternal and neonatal health: a systematic review and meta-analysis.","authors":"Alexander Arbis, Abdul Rafay, Christopher Namgoong, Jeong Hyun Yoon, Hutan Ashrafian, Matyas Fehervari, Samer Humadi","doi":"10.1016/j.soard.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.soard.2025.03.005","url":null,"abstract":"<p><strong>Background: </strong>Maternal obesity increases the risk of neonatal and maternal complications. Although the weight-loss benefits of bariatric surgery are well established, the effects on subsequent pregnancies, particularly regarding timing of pregnancy after surgery, are not yet fully understood OBJECTIVES: To evaluate the impact of bariatric surgery on weight-related, maternal, and neonatal outcomes in subsequent pregnancies, focusing on the timing of pregnancy after surgery.</p><p><strong>Setting: </strong>A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO ID: CRD42024570170).</p><p><strong>Methods: </strong>The systematic review process identified 129 studies eligible for inclusion involving 227,792 women who became pregnant after bariatric surgery. Data were analyzed for body mass index (BMI) changes, gestational age, and neonatal birth weight.</p><p><strong>Results: </strong>Prepregnancy BMI reduced by 13.93 kg/m² (P < .001) compared with presurgery BMI. There was no significant change in BMI throughout the antenatal period against non-bariatric surgery controls. Neonatal birth weight was 257.8 g lower (P < .001) in patients who had previously undergone bariatric surgery. There was no significant difference in neonatal birth weight (-69.41 g, P = .152) or gestational age (-.749 d, P = .826) in patients who became pregnant fewer than 18 months after surgery and those who became pregnant greater than 18 months after surgery.</p><p><strong>Conclusions: </strong>Bariatric surgery successfully reduced maternal BMI before pregnancy but lowered neonatal birth weight, indicating the need for careful fetal monitoring. The timing of pregnancy after surgery appears flexible, with no significant impact on gestational age or birth weight, suggesting that clinical management should focus on individualized nutritional and health monitoring rather than fixed guidelines.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063788","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 of insurance status with postoperative resource utilization after metabolic/bariatric surgery-A multi-institutional study.","authors":"Florina Corpodean, Michael Kachmar, Jake Doiron, Denise Danos, Michael W Cook, Philip R Schauer, Vance L Albaugh","doi":"10.1016/j.soard.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.soard.2025.03.003","url":null,"abstract":"<p><strong>Background: </strong>Postoperative emergency department (ED) use and readmissions are key quality outcome measures for Metabolic & Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers. Given increasing costs, limiting postoperative resource use is of paramount importance.</p><p><strong>Objectives: </strong>This study aimed to investigate disparities in postoperative resource use after metabolic and bariatric surgery (MBS) across primary payor status.</p><p><strong>Settings: </strong>Two MBSAQIP-accredited centers.</p><p><strong>Methods: </strong>Using data from our institutional MBSAQIP dataset (2020-2023), MBS cases were identified and categorized on the basis of primary payor type. Analysis of 30-day readmissions, reinterventions, and reoperations was performed on the basis of case characteristics and stratified by payor status to examine intergroup differences.</p><p><strong>Results: </strong>Medicaid beneficiaries were overall younger (40.4 years versus 46.5 years; P < .05) than patients with private insurance (PI) and more likely to be female. Body mass index was significantly greater for Medicaid compared with PI or Medicare (49.8 versus 47.8 versus 48.2; P < .05). Medicaid recipients had significantly greater rates of ED use (P < .0001) compared with PI and self-pay and longer operative times compared with PI and Self-Pay (144.8 min versus 126.7 versus 108.1 min; P < .05). Patients with Medicaid status also had a longer length of stay than patients with PI (1.68 days versus 1.48 days, P < .05). Despite these differences, Medicaid status was not associated with increased composite complications, composite infection, length of stay >5 days, or readmission.</p><p><strong>Conclusions: </strong>Postoperative ED use and readmission/reoperation rates were notably higher in publicly insured (Medicare or Medicaid) patients compared with those with PI or self-pay. This highlights the importance of implementing targeted quality improvement measures to improve access to care in this population.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797559","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":"Evaluating the impact of the COVID-19 pandemic on outcomes of conversion and revisional bariatric surgery: a Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) study.","authors":"Mélissa V Wills, Komol Chaivanijchaya, Juan S Barajas-Gamboa, Gabriela Restrepo-Rodas, Valentin Mocanu, Ayan Farah, Sol Lee, Salvador Navarrete, John Rodriguez, Matthew Allemang, Ricard Corcelles, Matthew Kroh, Andrew T Strong, Jerry Dang","doi":"10.1016/j.soard.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.soard.2025.03.004","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic significantly impacted healthcare delivery worldwide, including bariatric surgery. While revisional procedures remained essential for weight recurrence and complications, practice patterns evolved during different phases of the pandemic.</p><p><strong>Objectives: </strong>To evaluate the effect of COVID-19 on revisional bariatric procedures by comparing trends across pandemic (2020), vaccination rollout (2021), and postpandemic (2022) periods.</p><p><strong>Setting: </strong>Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, United States.</p><p><strong>Methods: </strong>Retrospective analysis of 72,189 bariatric surgeries (of which 55,854 conversions and 16,335 revisions) from 2020 to 2022. Outcomes included surgical volume, indications, complications, and mortality.</p><p><strong>Results: </strong>Of 609,240 bariatric procedures, 72,189 (11.8%) were revisional or conversion procedures, with conversions representing 9.2% (55,854) and revisions 2.7% (16,335). The combined proportion remained stable (12.1%, 12.1%, 11.5%, P < .001), but urgent revision rates were higher during the pandemic (3.1% versus 2.2% versus 1.8%, P < .001). Pandemic-era cases focused on severe complications (fistula, perforation, stricture), shifting postpandemic toward weight recurrence and reflux. Sleeve-to-bypass conversions increased from 41.2% to 53.6%. Serious complications were highest in 2020-2021 (6.6%, 6.4%) compared to 2022 (5.8%, P < .001), while mortality remained unchanged (.15%).</p><p><strong>Conclusions: </strong>The study demonstrates distinct trends throughout pandemic periods, reflecting Centers for Disease Control and Prevention guidance on surgical urgency . While complication rates were slightly higher during the pandemic, procedures remained safe with stable mortality. Postpandemic shifts toward elective indications and increasing conversion procedures suggest adaptation to accumulated surgical needs.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057008","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":"Distressed community index as a predictor of metabolic and bariatric surgery outcomes.","authors":"Micah P Wildes, Rana M Higgins, Jon C Gould, Farheen Chunara, Aniko Szabo, Tammy L Kindel","doi":"10.1016/j.soard.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.soard.2025.02.009","url":null,"abstract":"<p><strong>Background: </strong>Obesity is associated with serious health and social consequences. Socioeconomically disadvantaged people are less likely to undergo metabolic and bariatric surgery (MBS) than their socioeconomically advantaged counterparts and experience increased complications or health care resource utilization, such as longer length of stay. The Economic Innovation Group's Distressed Communities Index (DCI) offers a metric to broadly assess socioeconomic distress.</p><p><strong>Objectives: </strong>This study investigated the relationship between community distress, as determined by DCI, and complications following MBS, including length of hospital stay, likelihood of an emergency department (ED) visit, 30-day readmissions, and perioperative/postoperative occurrences.</p><p><strong>Setting: </strong>Academic Medical Center, United States.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on a cohort of patients undergoing primary sleeve gastrectomy or Roux-en-Y bypass at a large academic hospital from 2016 to 2020 (n = 758). Patients were categorized based on the DCI of their community. We used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database to record each patient's postoperative complications. Descriptive statistics were used to evaluate the association between community distress and complications.</p><p><strong>Results: </strong>Patients from distressed communities were more likely to have Medicaid and less likely to have private insurance (P < .001). Community distress was significantly correlated with longer hospital stay (P < .001) and a higher likelihood of an ED visit (P < .007). No significant correlation was observed between community distress and 30-day readmissions or perioperative/postoperative occurrences.</p><p><strong>Conclusions: </strong>DCI is not an independent risk factor for complications after adjusting for other variables but increase resource utilization.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695044","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: Addressing recurrent weight gain after Roux-en-Y gastric bypass: efficacy of a dual surgical approach-short-term results of a single center cohort study.","authors":"Dimitrios Kehagias, Charalampos Lampropoulos, Ioannis Kehagias","doi":"10.1016/j.soard.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.soard.2025.02.007","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":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618093","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":"Addressing recurrent weight gain after Roux-en-Y gastric bypass: efficacy of a dual surgical approach-short-term results of a single-center cohort study.","authors":"Arturo Estrada, Jorge Humberto Rodriguez Quintero, Xavier Pereira, Ya Zhou, Erin Moran-Atkin, Jenny Choi, Diego Camacho","doi":"10.1016/j.soard.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.soard.2025.02.004","url":null,"abstract":"<p><strong>Background: </strong>There is no gold standard for recurrent weight gain following Roux-en-Y gastric bypass (RYGB). Combining jejuno-jejunostomy distalization type 1 (JJD1) and sleeve resection of the gastrojejunostomy and gastric pouch (GJ-P) may be a potential approach for these patients.</p><p><strong>Objectives: </strong>To describe 1-year perioperative and nutritional outcomes of patients who underwent JJD1 with sleeve resection of the GJ-P.</p><p><strong>Setting: </strong>High-volume academic bariatric center of excellence.</p><p><strong>Methods: </strong>Patients with recurrent weight gain after RYGB who underwent JJD1 with sleeve resection of the GJ-P from 2020 to 2022 were included and studied for 1 year postoperatively. During the procedure, we aimed for a total alimentary limb length (TALL) of 350-500 cm, a new common channel (CC) of 200-350 cm, and a gastrojejunostomy <2 cm in diameter.</p><p><strong>Results: </strong>A total of 61 patients underwent this combined revisional procedure. The median preoperative body mass index (BMI) was 42.59 kg/m². The median lengths of the biliopancreatic limb (BPL) before and after distalizatiovn were 50 cm (interquartile range [IQR]: 42.5-75) and 175 cm (IQR: 150-200), respectively. After revision, the median new CC was 270 cm (IQR: 250-300) and the median TALL was 400 cm (interquartile range [IQR]: 362.5-450). The median total small bowel length (TSBL) was 580 cm (IQR 550-640 cm), and the median BPL/TSBL ratio was .32 (IQR .29-.34). At 1, 6, and 12 months, the median BMI of the cohort was reduced to 39.14, 35.55, and 32.9 kg/m², respectively. At 1 year, the total weight loss (%TWL) was 22.18%. Only 3 (n = 3) patients developed major complications at 1 year. After distalization, the resolution of all obesity-related co-morbidities improved, including type 2 diabetes (3.2%), sleep apnea (13.1%), hypertension (HTN) (11.4%), and hyperlipidemia (HLD) (1.6%).</p><p><strong>Conclusions: </strong>The combination of JJD1 and sleeve resection of the GJ-P for RYGB revision was safe and effective, with substantial improvement in weight loss at 1 year.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631144","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":"Evaluation of patients on immunosuppressants undergoing sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch: analysis of 19,414 patients.","authors":"Emily A Grimsley, Melissa A Kendall, Tyler Zander, Paul C Kuo, Salvatore Docimo","doi":"10.1016/j.soard.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.soard.2025.02.001","url":null,"abstract":"<p><strong>Background: </strong>Bariatric surgery is being offered to more medically complex patients, including patients on immunosuppressants, although outcomes after different bariatrics surgeries have not been studied in this population.</p><p><strong>Objectives: </strong>We compared perioperative safety of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) in patients on immunosuppression.</p><p><strong>Setting: </strong>National sample from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.</p><p><strong>Methods: </strong>The MBSAQIP database was queried from the years 2015 to 2021 for adult patients on chronic immunosuppression who underwent SG, RYGB, or DS. Revisional, open, endoscopic, or emergency surgeries were excluded, as were patients with an American Society of Anesthesiologists class of 5 and patients without full 30-day follow-up. Propensity-score matching was performed with a 3:3:1 ratio (SG:RYGB:DS) controlling for surgical approach, sex, age, functional status, American Society of Anesthesiologists, body mass index, and comorbidities.</p><p><strong>Results: </strong>There were 19,414 patients on immunosuppression who underwent SG (n = 14,358), RYGB (n = 4864), or DS (n = 192). After propensity-score matching , RYGB and DS had longer LOS (P < .01), greater global 30-day complication (P < .01), and 30-day reoperation rates (P = .048). Compared with SG and RYGB, DS had greater rates of patients requiring mechanical ventilation >48-hour postoperatively (P < .05). Compared with SG, DS had greater rates of renal insufficiency (P = .01), organ space infection (P = .01), unplanned intubation (P < .01), and unplanned intensive care unit admission (P < .01).</p><p><strong>Conclusions: </strong>For patients on immunosuppression, SG carried the lowest complication and reoperation rates, whereas DS had overall complication rates in line with RYGB.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538289","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":"Impact of high-protein bariatric diet on the prevention of postoperative nausea and vomiting.","authors":"Brigitte Anderson, Amrita Iyer, Martina Rama, Abigail M O'Connell, Anna P Torres, Scott H Koeneman, Renee Tholey, Alec Beekley, Francesco Palazzo, Talar Tatarian","doi":"10.1016/j.soard.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.soard.2025.02.002","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) commonly occurs following metabolic/bariatric surgery, contributing to increased health care utilization and length of stay (LOS). Studies have suggested the benefit of protein-predominant meals in suppressing gastric tachyarrhythmia and PONV.</p><p><strong>Objective: </strong>To investigate the impact of a high-protein postoperative liquid diet on PONV and LOS after primary sleeve gastrectomy (SG).</p><p><strong>Setting: </strong>University Hospital, United States.</p><p><strong>Methods: </strong>This prospective randomized trial included adult patients undergoing primary SG. Exclusion criteria were history of bariatric/foregut surgery, chronic nausea/vomiting, HbA1C ≥9, or therapeutic anticoagulation. Patients were randomized 1:1 to receive a clear liquid (control) or high-protein full-liquid diet (intervention) starting 4 hours postoperatively. The primary endpoint was incidence of PONV. Secondary endpoint was increased LOS due to PONV. Pearson's chi squared test for independence compared outcomes between groups on an intention to treat basis.</p><p><strong>Results: </strong>One-hundred and twelve patients were randomized (56 control, 56 intervention). Most patients were female (80.4%). All underwent laparoscopic (72.3%) or robotic (27.7%) SG and 90.2% received inhalational anesthesia. In the intervention arm, 15 patients had zero protein intake due to PONV, 6 had missing data, and 35 had a mean intake of 24.2 grams. There was no observed treatment effect on PONV (78.6% control versus 89.3% intervention; P = .20). Almost 70% of patients were discharged home on postoperative day (POD) 1. Delay in discharge due to PONV was not significant between groups (32.1% control versus 28.6% intervention; P = .84).</p><p><strong>Conclusions: </strong>Early introduction of liquid protein after SG does not improve PONV or LOS.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639953","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":"Reply to \"One-anastomosis/mini gastric bypass: have we forgotten the lessons of the past?\"","authors":"S. Chiappetta, M. Kermansaravi","doi":"10.1016/j.soard.2022.05.006","DOIUrl":"https://doi.org/10.1016/j.soard.2022.05.006","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76041280","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":"American Society for Metabolic and Bariatric Surgery review on fasting for religious purposes after surgery.","authors":"Lillian Craggs-Dino, M. El Chaar, F. Husain, A. Rogers, A. Lima, M. Sadegh, Jumana Bashiti, Katie Chapmon","doi":"10.1016/j.soard.2022.04.020","DOIUrl":"https://doi.org/10.1016/j.soard.2022.04.020","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84896768","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}