Journal of Surgical Research最新文献

{"title":"Management of Incidental Thyroid Nodules in the Pretransplant Population","authors":"Patricia G. Lu MD ,&nbsp;Patrick T. Hangge MD ,&nbsp;Amit K. Mathur MD ,&nbsp;Nabil Wasif MD ,&nbsp;Zhi Ven Fong MD, PhD ,&nbsp;Patricia A. Cronin MD ,&nbsp;Cameron Adler MD ,&nbsp;Frederick Chen MD ,&nbsp;Chee-Chee H. Stucky MD","doi":"10.1016/j.jss.2024.09.019","DOIUrl":"10.1016/j.jss.2024.09.019","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of thyroid nodules has increased as diagnostic imaging has become more prevalent, but the management in transplant candidates, a high-risk population because of the need for chronic immunosuppression, has not been described. We sought to review our institution’s approach to thyroid nodules incidentally found during pretransplant workup.</div></div><div><h3>Methods</h3><div>A multisite retrospective review was performed of pretransplant patients with incidental thyroid nodules diagnosed between 2011 and 2021. Demographics, nodule characteristics, treatment timeline, and oncologic outcomes were collected. Patients diagnosed before and after 2017 were compared to evaluate how adoption of Thyroid Imaging Reporting and Data System and expansion of a dedicated transplant center were correlated with changes in patient management.</div></div><div><h3>Results</h3><div>A total of 10,340 patients underwent abdominal transplant, 236 had incidental thyroid nodules. After 2017, radiology recommendations for biopsy decreased from 39% to 29% (<em>P</em> = 0.174) and fewer biopsies were performed, 45%-33% (<em>P</em> = 0.055). Time between imaging and biopsy was significantly shorter after 2017, from 14 mo to 4 (<em>P</em> = 0.038). Overall time from imaging to transplant was also significantly reduced, from 31 mo to 11 (<em>P</em> &lt; 0.001). Thirty-one (13.1%) patients underwent thyroid surgery before transplant and four (1.7%) patients after.</div></div><div><h3>Conclusions</h3><div>In the recent years, thyroid biopsy rates for thyroid incidentalomas found during pretransplant workup have decreased and more closely match imaging-based guideline recommendations. Patients who required biopsy obtained them sooner and underwent transplant surgery sooner. Guideline-driven thyroid incidentaloma workup for the pretransplant population allows for timely and appropriate cancer care while avoiding unnecessary delays in transplant.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of an Education Module to Improve Emergency Medical Service Provider Accuracy and Confidence in Trauma Triage","authors":"Rachel R. Cary BS,&nbsp;Jennifer E. Geller BS,&nbsp;Michael S. Rallo BS,&nbsp;Amanda L. Teichman MD, FACS,&nbsp;Zachary P. Englert DO, FACS,&nbsp;Princeton Pierre MD,&nbsp;Timothy Murphy MSN, RN, ACNP-BC, CEN, TCRN, FAEN,&nbsp;Lisa Falcon MSN, RN, TCRN, NE-BC,&nbsp;Mayur Narayan MD, MPH, MBA, FACS,&nbsp;Rachel L. Choron MD, FACS","doi":"10.1016/j.jss.2024.09.014","DOIUrl":"10.1016/j.jss.2024.09.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Prehospital triage is critical to ensure timely activation of trauma center resources. Undertriage (UT) results in higher morbidity and mortality. To minimize this risk, the American College of Surgeons Committee on Trauma recommends trauma centers aim for a UT rate below 5%. Our center has a 3-tiered triage system aimed at optimizing resource allocation. We hypothesized that a trauma triage criteria educational module (TCEM) would 1) improve emergency medical services (EMSs) provider confidence and accuracy in triage and 2) improve our UT rate.</div></div><div><h3>Methods</h3><div>From July to November 2022, the TCEM was presented to 8 local EMS agencies who transport patients to our Level 1 trauma center. Preclass and postclass surveys assessed EMS provider triage confidence using a Likert scale 1-5. Validated trauma scenario questions were used to measure triage accuracy. The UT rate was compared between January-May 2022 (pre-TCEM) to January-May 2023 (post-TCEM) using trauma registry data. Data were analyzed using paired Wilcoxon signed rank and <em>t</em>-tests.</div></div><div><h3>Results</h3><div>72 prehospital providers participated in TCEM, most were Caucasian (65.3%), non-Hispanic (84.7%), males (77.8%) with emergency medical technician-basic certifications (90.3%). There was a significant increase in triage confidence from pre-TCEM to post-TCEM (2 <em>versus</em> 5; <em>P</em> &lt; 0.001) and accuracy (23.2% <em>versus</em> 88.9%; <em>P</em> &lt; 0.001). Regression analysis did not indicate a significant difference in confidence or accuracy based on years of experience, paid or volunteer provider status, or transport volume per week. The UT rate remained stable after TCEM initiation (2.3% <em>versus</em> 2.0%; <em>P</em> &lt; 0.669).</div></div><div><h3>Conclusions</h3><div>This novel community based educational program demonstrated improvements in EMS provider confidence and accuracy regarding prehospital trauma triage. Outreach programs like these are often well received by EMS, and implementation is highly reproducible at other centers.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391412","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":"Plasma Inclusive Resuscitation Is Not Associated With Coagulation Profile Changes in Burn Patients","authors":"Shane K. Mathew MD ,&nbsp;Tuan D. Le MD, DrPH ,&nbsp;Anthony E. Pusateri PhD ,&nbsp;Desiree N. Pinto MD ,&nbsp;Bonnie C. Carney PhD ,&nbsp;Melissa M. McLawhorn RN, BSN ,&nbsp;Shawn Tejiram MD ,&nbsp;Taryn E. Travis MD ,&nbsp;Lauren T. Moffatt PhD ,&nbsp;Jeffrey W. Shupp MD","doi":"10.1016/j.jss.2024.09.013","DOIUrl":"10.1016/j.jss.2024.09.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Dynamically titrated crystalloids are the standard of care for burn shock resuscitation. There are theoretical concerns that the adjunctive use of allogeneic plasma may perturb the patient's coagulation and inflammation status deleteriously. It was hypothesized that plasma-inclusive resuscitation (PIR) would not be associated with prothrombotic changes relative to baseline after thermal injury.</div></div><div><h3>Methods</h3><div>Patients admitted to a regional burn center who were treated with PIR as part of their burn resuscitation were enrolled. Whole blood samples were analyzed prospectively via rapid thromboelastography and rotational thromboelastometry to assess for coagulopathy at four time points throughout their acute burn resuscitation. The mixed-effect model for repeated measures followed by Tukey's post hoc test for comparisons was used to examine group differences.</div></div><div><h3>Results</h3><div>There were 35 patients in the analysis. Most were male (74.3%) with a median age of 43 y (32-55), concomitant inhalation injury of 28.6%, total body surface area burn size of 34% (27%-48.5%), and the overall mortality of the cohort was 28.6%. There were no transfusion reactions or thrombotic events. There were no differences in thromboelastography or rotational thromboelastometry parameters overall or when stratified by mortality, total body surface area burn, and inhalation injury. There were no significant differences between the fibrinolytic phenotypes over time.</div></div><div><h3>Conclusions</h3><div>Data suggest that PIR was not associated with prothrombotic or lytic changes in burn patients relative to baseline. Further research is needed to confirm these findings and evaluate efficacy of PIR in acute burn resuscitation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Clots Used as Natural Biomaterials for Antibiotic Delivery in Vitro","authors":"Jennifer C. Ku BA ,&nbsp;Haiying Pan MS ,&nbsp;Genevieve M. Abd PhD ,&nbsp;David M. Richter BS ,&nbsp;Ashley Minor BS ,&nbsp;Robert G. Sawyer MD ,&nbsp;Yong Li MD, PhD","doi":"10.1016/j.jss.2024.09.018","DOIUrl":"10.1016/j.jss.2024.09.018","url":null,"abstract":"<div><h3>Introduction</h3><div>The search for an optimal drug delivery system capable of addressing a wide range of wounds and defects in regenerative medicine remains a challenge. Blood clots (BCs) have been implicated as a promising candidate due to their natural occurrence, autologous nature, and potential for tissue repair. The aim of this study is to investigate BC as a vehicle for antibiotic delivery and its effectiveness in infection control.</div></div><div><h3>Methods</h3><div>BCs derived from murine and porcine models were used to study the <em>in vitro</em> release of gentamicin and vancomycin over a 7-d period. Moreover, BCs conjugated with mesenchymal stem cells and these antibiotics were assessed for antimicrobial activity via microdilution and agar well diffusion, and quantification of vascular endothelial growth factor release through enzyme-linked immunosorbent assay.</div></div><div><h3>Results</h3><div>Conjugated BCs maintained a sustained release of gentamicin and vancomycin throughout the 7-d period. Functional tests confirmed antimicrobial activity with zones of inhibition comparable to antibiotic controls. Vascular endothelial growth factor quantification revealed a pronounced and sustained release, especially from BCs conjugated with male mesenchymal stem cells, suggesting a gender influence on therapeutic outcomes. This sex-specific variance underscores the need for tailored therapeutic approaches in regenerative medicine applications.</div></div><div><h3>Conclusions</h3><div>We demonstrated the remarkable potential of BC as a drug delivery system through sustained antibiotic and growth factor release, both of which are key in preventing infection and promoting tissue regeneration. The ease and cost effectiveness of BC preparation as well as its favorable federal regulatory profile support the potential translational application of BCs as a natural biomaterial in regenerative medicine.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Communication Among Men and Women Surgeons With Nursing and Anesthesia Providers.","authors":"Deanna Plewa, Caroline Ricard, Diana Hockett, Dena Shehata, Abigail Corrington, Tasneem Zaihra Rizvi, Zhibang Lin, Manuel Castillo-Angeles, Elizabeth Preston, Luke Dong, Dmitry Nepomnayshy, Ammara Watkins","doi":"10.1016/j.jss.2024.07.129","DOIUrl":"https://doi.org/10.1016/j.jss.2024.07.129","url":null,"abstract":"<p><strong>Introduction: </strong>Gender bias has been reported by women surgeons, but its impact on communication in the operating room (OR) is unclear. OR communication is critical to understand, as it directly impacts patient outcomes. The current study evaluates potential gender bias in the type and quality of communication between surgeons and OR nursing and anesthesia providers.</p><p><strong>Methods: </strong>We developed a novel intraoperative communication assessment tool, Operating Room Communication Quality assessment tool (OComm), which was adapted from previously validated teamwork assessment tools. Independent coders recorded the instances of conversation and categorized them into clinical or casual communication. After the operation, the participants were assigned a score from the OComm tool. Participants were then given the same OComm measure to assess their self-perceived communication quality and collect demographic information.</p><p><strong>Results: </strong>For both genders, surgeons' median self-perceived OComm scores was 3.47/4, but surgeons observed OComm score was 2.91/4. Anesthesia providers noted the highest median self-perceived OComm score of 3.65/4 but the lowest observed OComm median score of 2.29/4. From both surgeon to nurse and surgeon to anesthesia provider, there was no association between the gender and frequency of casual conversation (P = 1 > 0.025).</p><p><strong>Conclusions: </strong>There was no gender difference in the degree to which women and men surgeons engaged in casual conversation with nursing and anesthesia providers. Surgeons, both men and women, were also more likely to rate their quality of communication lower than the nurses and anesthesia providers, while independent coders were more likely to rate surgeons' quality of communication higher than that of nurses and anesthesia providers.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor: Physicians are Unable to Consistently Predict Patient Health Literacy in a Breast Clinic.","authors":"Lena M Turkheimer, Shayna L Showalter","doi":"10.1016/j.jss.2024.08.024","DOIUrl":"https://doi.org/10.1016/j.jss.2024.08.024","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter Regarding: \"Digital Ink and Surgical Dreams: Perceptions of Artificial Intelligence-Generated Essays in Residency Applications\".","authors":"Shigeki Matsubara, Daisuke Matsubara","doi":"10.1016/j.jss.2024.08.025","DOIUrl":"https://doi.org/10.1016/j.jss.2024.08.025","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter Regarding: Tactical Indications of Cricothyroidotomy in Combat-Setting.","authors":"Audrey Jarrassier, Arwad Alkahwaji, Jean-Baptiste Morvan, Pierre Pasquier","doi":"10.1016/j.jss.2024.07.128","DOIUrl":"https://doi.org/10.1016/j.jss.2024.07.128","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Pediatric Surgical Infrastructure With Clinical and Economic Outcomes: A Cohort Study","authors":"Samuel Negash MD ,&nbsp;Ava Yap MD, MHS ,&nbsp;Caroline Q. Stephens MD, MPH ,&nbsp;Beimnet Girma Nigussie MD ,&nbsp;Ruth Fekadu Tefera MD ,&nbsp;Emma Bryce MPH ,&nbsp;Maija Cheung MD ,&nbsp;Maira Fedatto PhD ,&nbsp;Ruth Laverde BS ,&nbsp;Doruk Ozgediz MD, MSc ,&nbsp;Amezene Tadesse MD ,&nbsp;Miliard Derbew MD","doi":"10.1016/j.jss.2024.09.006","DOIUrl":"10.1016/j.jss.2024.09.006","url":null,"abstract":"<div><h3>Introduction</h3><div>A significant burden of unmet pediatric surgical disease exists in low- and middle-income countries. We sought to assess the associations between the installation of a pediatric operating room (OR) and clinical and economic outcomes for families with children in Ethiopia.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed of children who underwent elective surgery in a tertiary-level Ethiopian public hospital, comparing patient outcomes before and after OR installation in August 2019. Clinical data were collected via chart review, and an inpatient economic survey was administered to patient caregivers. Interrupted time series analysis investigated trends in surgical volume over time. The relative economic benefit was determined by comparing the patients’ household income to the monetary health benefit gained using the value of statistical life method.</div></div><div><h3>Results</h3><div>One thousand one hundred and ninety-six patients were included from August 2018 to July 2022. Surgery averted 20,541 disability-adjusted life years (DALYs) cumulatively or 17 DALYs per patient. Monthly case volume and DALYs averted significantly increased postinstallation. The median annual household income of the economic survey responders (<em>n</em> = 339) was $1337 (IQR 669-2592). 27.7% (<em>n</em> = 94/339) lived in extreme poverty, and 41.3% (<em>n</em> = 140/339) experienced catastrophic healthcare expenditure. Net monetary health benefit was $29.3 million or $26,646 per patient. The ratio of net monetary health benefit to household annual income was 60:1.</div></div><div><h3>Conclusions</h3><div>Installing a pediatric OR in a public Ethiopian hospital ensures increased access to surgery for those most impoverished in Ethiopia and improves equitable access to surgical care. Greater investment in expanding pediatric surgical infrastructure can help address global inequities in child health.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Alert Cards for Pediatric Patients With Antegrade Continence Enemas to Enhance Awareness","authors":"Elizaveta Bokova MD ,&nbsp;Ninad Prasade BS ,&nbsp;Ismael Elhalaby MD ,&nbsp;Margaret Martin-McLain MSN, RN, CPN ,&nbsp;Wendy E. Lewis RN, NP ,&nbsp;Christine N. Feira NP ,&nbsp;Irene Isabel P. Lim MD, MPH ,&nbsp;Rebecca M. Rentea MD, MS, MBA","doi":"10.1016/j.jss.2024.09.020","DOIUrl":"10.1016/j.jss.2024.09.020","url":null,"abstract":"<div><h3>Introduction</h3><div>The antegrade continence enema (ACE) is a surgical technique that establishes a route for colonic irrigation, necessitating a detailed comprehension of the procedural methodology, including the conduit construction, the catheters selection, and the administration of irrigation solutions. It is critical to disseminate comprehensive information regarding ACE procedures to health-care professionals and caregivers to enhance their understanding and support management of patients undergoing this intervention. This study aims to evaluate the efficacy of a novel educational tool designed to augment the knowledge base of physicians and caregivers regarding ACE procedures.</div></div><div><h3>Methods</h3><div>Medical alert cards were conceptualized for patients managed with ACEs via an appendicostomy, neoappendicostomy, or cecostomy. These cards included essential information such as (1) contact details of the health-care team, (2) specifics of the surgical procedure, (3) criteria for emergency department referral, and (4) bespoke patient-specific information. A single-institution survey was conducted to assess the cards’ role in improving awareness of ACE procedures among health-care providers and caregivers and guiding management of patients with ACEs. The study adhered to Consensus-Based Checklist for Reporting of Survey Studies guidelines.</div></div><div><h3>Results</h3><div>Twenty-seven responses were collected from 18 health-care providers and nine caregivers. A significant majority (<em>n</em> = 24, 88%) affirmed the cards’ effectiveness in providing detailed information about individual patients. The design and layout of the card were well-received by 93% (<em>n</em> = 25) of respondents, with a median readability score of 8 (interquartile range 7-10). Additionally, some providers (<em>n</em> = 3, 17%) highlighted the card’s utility in facilitating patient referrals to specialized care centers. Suggestions for improvement included adding information about different types of tubes, enhancing readability, and optimizing the visual representation of the conduit.</div></div><div><h3>Conclusions</h3><div>Medical alert cards demonstrated a significant potential to improve understanding of ACEs among health-care providers and caregivers. The cards aid in informing stakeholders about the ACE procedure, guiding the child’s management, and referring the patients to specialized care facilities when necessary.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}