Amir Sadeghi, Hesamoddin Samar, Mohammad Abbasinazari, Parvaneh Mohammadi, Ali Abazarikia, Shadi Ziaie
Background and Aim
Oxidative stress has been considered a factor in the development of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The present clinical trial evaluated whether adding intravenous mesna to rectal indomethacin could prevent or alleviate PEP.
Methods
An open-labeled clinical trial was done on 698 participants undergoing endoscopic retrograde cholangiopancreatography (ERCP). Eligible patients received 100 mg indomethacin suppository 30 min before undergoing ERCP. Randomly, the participants received 400 mg intravenous mesna or nothing 30 min before doing the procedure. The PEP incidence and degree were measured in the patients as the main outcome.
Results
The total rate of PEP was equal to 13.7%. No significant difference was seen in the rate and severity of PEP between the mesna plus indomethacin and indomethacin alone arms (14% vs. 13.4%, respectively, p = 0.671). In high-risk patients, PEP rate and severity were lower in the mesna plus indomethacin group compared with indomethacin alone group and the statistical analysis showed that the difference was significant (41.7% vs. 51.8%, respectively, p = 0.033).
Conclusion
In high-risk patients undergoing ERCP, a combination of intravenous mesna plus rectal indomethacin may decrease the PEP rate and severity.
背景和目的：氧化应激被认为是内镜后逆行胆管胰腺炎（PEP）发展的一个因素。本临床试验评价在直肠吲哚美辛基础上静脉加用肠系膜是否能预防或缓解PEP。方法：对698名接受内窥镜逆行胆管胰胆管造影（ERCP）的参与者进行开放标签临床试验。符合条件的患者在ERCP术前30分钟给予100mg吲哚美辛栓剂。随机地，参与者在手术前30分钟接受400毫克静脉注射或不注射。以患者PEP发生率及程度为主要观察指标。结果：PEP总有效率为13.7%。mesna联合吲哚美辛组与单独使用吲哚美辛组在PEP发生率和严重程度上无显著差异（分别为14%和13.4%,p = 0.671）。高危患者中，mesna联合吲哚美辛组PEP发生率和严重程度均低于单用吲哚美辛组，差异有统计学意义（41.7% vs 51.8%, p = 0.033）。结论：在高危ERCP患者中，静脉肠系膜联合直肠吲哚美辛可降低PEP发生率和严重程度。
{"title":"Efficacy of 2-Mercaptoethane Sulfonate Sodium (MESNA) in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Randomized Open Label Trial","authors":"Amir Sadeghi, Hesamoddin Samar, Mohammad Abbasinazari, Parvaneh Mohammadi, Ali Abazarikia, Shadi Ziaie","doi":"10.1002/jgh3.70083","DOIUrl":"10.1002/jgh3.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Oxidative stress has been considered a factor in the development of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The present clinical trial evaluated whether adding intravenous mesna to rectal indomethacin could prevent or alleviate PEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An open-labeled clinical trial was done on 698 participants undergoing endoscopic retrograde cholangiopancreatography (ERCP). Eligible patients received 100 mg indomethacin suppository 30 min before undergoing ERCP. Randomly, the participants received 400 mg intravenous mesna or nothing 30 min before doing the procedure. The PEP incidence and degree were measured in the patients as the main outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total rate of PEP was equal to 13.7%. No significant difference was seen in the rate and severity of PEP between the mesna plus indomethacin and indomethacin alone arms (14% vs. 13.4%, respectively, <i>p</i> = 0.671). In high-risk patients, PEP rate and severity were lower in the mesna plus indomethacin group compared with indomethacin alone group and the statistical analysis showed that the difference was significant (41.7% vs. 51.8%, respectively, <i>p</i> = 0.033).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In high-risk patients undergoing ERCP, a combination of intravenous mesna plus rectal indomethacin may decrease the PEP rate and severity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We investigated the impact of proteinuria on the therapeutic effect before lenvatinib administration as second-line treatment after atezolizumab-bevacizumab.
Methods
We examined 64 patients who were administered lenvatinib as second-line treatment after discontinuation of atezolizumab and bevacizumab. Proteinuria assessed before lenvatinib administration was considered severe if the qualitative value test (QV) was 3+ or the urine protein/creatinine ratio (UPCR) was ≥ 2.0 (group A, n = 13) and non-severe if the UPCR was < 2.0 or the QV was ≤ 2+ (group B, n = 51).
Results
In the entire cohort, the modified albumin–bilirubin grades were grades 1, 2a, 2b, and 3 in 12, 21, 26, and 5 patients, respectively. Regarding the Barcelona Clinic of Liver Cancer stage, 2, 22, and 40 patients had stages A, B, and C, respectively. The objective response rate (ORR) was 14.0% and the disease control rate (DCR) was 59.3%. The median survival time and progression free survival after administration of lenvatinib was 14.8 (95% confidence interval [CI], 11.3–18.4) and 5.5 (95% CI, 3.6–7.5) months, respectively. The ORR and DCR were 0% and 38.4% for group A (n = 13) and 17.6% and 64.7% for group B (n = 51), respectively. The median time to treatment failure was 2.2 months in group A and 4.2 months in group B (p = 0.120).
Conclusions
Severe proteinuria before lenvatinib as a second-line therapy after atezolizumab-bevacizumab treatment may affect the duration of lenvatinib administration and treatment efficacy.
{"title":"Effect of Proteinuria Before Lenvatinib Administration on Treatment Response After Atezolizumab Bevacizumab Combination Therapy","authors":"Hironori Ochi, Masayuki Kurosaki, Takaaki Tanaka, Nobuharu Tamaki, Kaoru Tsuchiya, Yutaka Yasui, Hiroyuki Marusawa, Toshifumi Tada, Shinichiro Nakamura, Takehiro Akahane, Eisuke Okamoto, Haruhiko Kobashi, Hirotaka Arai, Michiko Nonogi, Namiki Izumi","doi":"10.1002/jgh3.70098","DOIUrl":"10.1002/jgh3.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We investigated the impact of proteinuria on the therapeutic effect before lenvatinib administration as second-line treatment after atezolizumab-bevacizumab.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined 64 patients who were administered lenvatinib as second-line treatment after discontinuation of atezolizumab and bevacizumab. Proteinuria assessed before lenvatinib administration was considered severe if the qualitative value test (QV) was 3+ or the urine protein/creatinine ratio (UPCR) was ≥ 2.0 (group A, <i>n</i> = 13) and non-severe if the UPCR was < 2.0 or the QV was ≤ 2+ (group B, <i>n</i> = 51).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the entire cohort, the modified albumin–bilirubin grades were grades 1, 2a, 2b, and 3 in 12, 21, 26, and 5 patients, respectively. Regarding the Barcelona Clinic of Liver Cancer stage, 2, 22, and 40 patients had stages A, B, and C, respectively. The objective response rate (ORR) was 14.0% and the disease control rate (DCR) was 59.3%. The median survival time and progression free survival after administration of lenvatinib was 14.8 (95% confidence interval [CI], 11.3–18.4) and 5.5 (95% CI, 3.6–7.5) months, respectively. The ORR and DCR were 0% and 38.4% for group A (<i>n</i> = 13) and 17.6% and 64.7% for group B (<i>n</i> = 51), respectively. The median time to treatment failure was 2.2 months in group A and 4.2 months in group B (<i>p</i> = 0.120).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Severe proteinuria before lenvatinib as a second-line therapy after atezolizumab-bevacizumab treatment may affect the duration of lenvatinib administration and treatment efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helicobacter pylori (H. pylori) infection can cause a wide range of gastrointestinal disorders, including chronic nonatrophic gastritis, multifocal atrophic gastritis, peptic ulcer disease, gastric adenocarcinoma, and extra-nodal B-cell lymphoma. Although the prevalence of H. pylori infection has decreased among adults, it is still very common. Approximately 90% of gastric adenocarcinomas are associated with H. pylori infection. Despite the established link between H. pylori infection and noncardiac gastric cancer, and the increasing incidence of gastric cancer in Kazakhstan, there are limited data on the prevalence of H. pylori in the country. This may be due to the difficulty of detecting H. pylori and the unavailability of diagnostic methods. This review presents the current data of diagnostic tests for the detection of H. pylori in Kazakhstan with a focus on limitations and practical significance.
{"title":"Review of Methods for Detection Helicobacter pylori in Kazakhstan","authors":"Lavrinenko Alyona, Seisenbekova Aizhan, Turemuratova Aidana, Shkreba Alexey, Yukhnevich Yekaterina","doi":"10.1002/jgh3.70101","DOIUrl":"10.1002/jgh3.70101","url":null,"abstract":"<p><i>Helicobacter pylori</i> (<i>H. pylori</i>) infection can cause a wide range of gastrointestinal disorders, including chronic nonatrophic gastritis, multifocal atrophic gastritis, peptic ulcer disease, gastric adenocarcinoma, and extra-nodal B-cell lymphoma. Although the prevalence of <i>H. pylori</i> infection has decreased among adults, it is still very common. Approximately 90% of gastric adenocarcinomas are associated with <i>H. pylori</i> infection. Despite the established link between <i>H. pylori</i> infection and noncardiac gastric cancer, and the increasing incidence of gastric cancer in Kazakhstan, there are limited data on the prevalence of <i>H. pylori</i> in the country. This may be due to the difficulty of detecting <i>H. pylori</i> and the unavailability of diagnostic methods. This review presents the current data of diagnostic tests for the detection of <i>H. pylori</i> in Kazakhstan with a focus on limitations and practical significance.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Umar Akram, Obaid Ur Rehman, Eeshal Fatima, Zain Ali Nadeem, Omer Usman, Waqas Rasheed, Ramsha Ali, Khawaja Abdul Rehman, Abdulqadir J. Nashwan
Background and Aim
Lubiprostone increases chloride and water secretion in the intestines, and several studies have demonstrated the efficacy of lubiprostone in treating functional constipation. Several new clinical trials have emerged since the previous meta-analysis conducted in 2020. We conducted this updated meta-analysis to assess clinical efficacy of lubiprostone in these patients.
Methods
A systematic search was conducted on MEDLINE, Cochrane, and Scopus. Randomized controlled trials published between July 2019 and June 2024 were selected. Cochrane's RoB 2 tool was used to assess the risk of bias. A meta-analysis was performed and findings were presented using forest plots.
Results
A total of 14 studies, comprising 4550 patients, were included in the review. Only 12 studies were pooled in the meta-analysis. Lubiprostone was associated with greater spontaneous bowel movements (SBM) per week (RR 1.454, 95% CI 1.193–1.771) and SBM within 24 h (RR 1.790, 95% CI 1.491–2.150) in patients with chronic idiopathic constipation (CIC). However, it was not associated with abdominal pain in either arm (RR 1.415, 95% CI 0.873–2.294). In opioid-induced constipation (OIC), lubiprostone increased SBM within 24 h (RR 1.277, 95% CI 1.105–1.475) but did not significantly affect abdominal pain (RR 4.321, 95% CI 0.624–29.941). Lubiprostone improved all selected SBM-related and abdominal pain outcomes in patients with irritable bowel syndrome with constipation (IBS-C).
Conclusion
Lubiprostone significantly improves all SBM-related outcomes. Owing to its good safety and efficacy profile, lubiprostone can be used in the combination regimens for management of CIC, IBS-C, and OIC.
背景与目的：Lubiprostone可增加肠内氯离子和水分的分泌，多项研究证实Lubiprostone治疗功能性便秘的疗效。自2020年进行的上一次荟萃分析以来，出现了几项新的临床试验。我们进行了这项最新的荟萃分析，以评估鲁比前列酮在这些患者中的临床疗效。方法：在MEDLINE、Cochrane和Scopus上进行系统检索。选择2019年7月至2024年6月发表的随机对照试验。采用Cochrane的RoB 2工具评估偏倚风险。进行了荟萃分析，并使用森林样地呈现了研究结果。结果：共纳入14项研究，包括4550例患者。荟萃分析中只有12项研究。Lubiprostone与慢性特发性便秘（CIC）患者每周更多的自发排便（SBM） （RR 1.454, 95% CI 1.193-1.771）和24小时内更多的自发排便（RR 1.790, 95% CI 1.491-2.150）相关。然而，它与两臂的腹痛无关（RR 1.415, 95% CI 0.873-2.294）。在阿片类药物引起的便秘（OIC）中，脂比prostone在24 h内增加了SBM (RR 1.277, 95% CI 1.105-1.475)，但对腹痛没有显著影响（RR 4.321, 95% CI 0.624-29.941）。Lubiprostone改善了肠易激综合征合并便秘（IBS-C）患者所有选择的sbm相关和腹痛结局。结论：Lubiprostone可显著改善sbm相关的所有预后。由于其良好的安全性和有效性，lubiprostone可用于治疗CIC， IBS-C和OIC的联合方案。
{"title":"The Efficacy of Lubiprostone in Patients of Constipation: An Updated Systematic Review and Meta-Analysis","authors":"Umar Akram, Obaid Ur Rehman, Eeshal Fatima, Zain Ali Nadeem, Omer Usman, Waqas Rasheed, Ramsha Ali, Khawaja Abdul Rehman, Abdulqadir J. Nashwan","doi":"10.1002/jgh3.70070","DOIUrl":"10.1002/jgh3.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Lubiprostone increases chloride and water secretion in the intestines, and several studies have demonstrated the efficacy of lubiprostone in treating functional constipation. Several new clinical trials have emerged since the previous meta-analysis conducted in 2020. We conducted this updated meta-analysis to assess clinical efficacy of lubiprostone in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted on MEDLINE, Cochrane, and Scopus. Randomized controlled trials published between July 2019 and June 2024 were selected. Cochrane's RoB 2 tool was used to assess the risk of bias. A meta-analysis was performed and findings were presented using forest plots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 14 studies, comprising 4550 patients, were included in the review. Only 12 studies were pooled in the meta-analysis. Lubiprostone was associated with greater spontaneous bowel movements (SBM) per week (RR 1.454, 95% CI 1.193–1.771) and SBM within 24 h (RR 1.790, 95% CI 1.491–2.150) in patients with chronic idiopathic constipation (CIC). However, it was not associated with abdominal pain in either arm (RR 1.415, 95% CI 0.873–2.294). In opioid-induced constipation (OIC), lubiprostone increased SBM within 24 h (RR 1.277, 95% CI 1.105–1.475) but did not significantly affect abdominal pain (RR 4.321, 95% CI 0.624–29.941). Lubiprostone improved all selected SBM-related and abdominal pain outcomes in patients with irritable bowel syndrome with constipation (IBS-C).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lubiprostone significantly improves all SBM-related outcomes. Owing to its good safety and efficacy profile, lubiprostone can be used in the combination regimens for management of CIC, IBS-C, and OIC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reports of pseudoaneurysms associated with biliary self-expandable metallic stent (SEMS) placement have been increasing. Recently, cases of hepatic pseudoaneurysm rupture caused by double pigtail plastic stents (DPS) have also been reported. The symptoms of pseudoaneurysms are often non-specific, and many cases are diagnosed only after rupture. Therefore, early detection and appropriate treatment are required.
Case Presentation
A 45-year-old woman presented with obstructive jaundice caused by pancreatic head cancer, with imaging revealing common bile duct stenosis and intrahepatic bile duct dilation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to place a DPS in the left hepatic duct, relieving jaundice. However, follow-up contrast-enhanced computed tomography (CE-CT) revealed differences in arterial-phase blood flow between the liver lobes without reduction in portal vein blood flow. Therefore, the compression and stenosis of the left branch of the portal vein caused by the DPS were clearly identified using three-dimensional computed tomography (3D-CT). The DPS was replaced with a straight-type stent, preventing further complications. The patient subsequently underwent successful pancreaticoduodenectomy without any surgical complications.
Conclusion
This is a case of portal vein compression caused by double-pigtail plastic biliary stent. By promptly recognizing the differences in arterial-phase blood flow between the liver lobes and replacing the DPS with a straight-type plastic stent, complications, such as portal vein pseudoaneurysm formation, rupture, embolism, or thrombosis, were successfully avoided.
{"title":"Portal-Vein Compression Caused by Double-Pigtail Plastic Biliary Stent","authors":"Shinsuke Akiyama, Masaya Wada, Tetsuro Inokuma","doi":"10.1002/jgh3.70094","DOIUrl":"10.1002/jgh3.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Reports of pseudoaneurysms associated with biliary self-expandable metallic stent (SEMS) placement have been increasing. Recently, cases of hepatic pseudoaneurysm rupture caused by double pigtail plastic stents (DPS) have also been reported. The symptoms of pseudoaneurysms are often non-specific, and many cases are diagnosed only after rupture. Therefore, early detection and appropriate treatment are required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 45-year-old woman presented with obstructive jaundice caused by pancreatic head cancer, with imaging revealing common bile duct stenosis and intrahepatic bile duct dilation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to place a DPS in the left hepatic duct, relieving jaundice. However, follow-up contrast-enhanced computed tomography (CE-CT) revealed differences in arterial-phase blood flow between the liver lobes without reduction in portal vein blood flow. Therefore, the compression and stenosis of the left branch of the portal vein caused by the DPS were clearly identified using three-dimensional computed tomography (3D-CT). The DPS was replaced with a straight-type stent, preventing further complications. The patient subsequently underwent successful pancreaticoduodenectomy without any surgical complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is a case of portal vein compression caused by double-pigtail plastic biliary stent. By promptly recognizing the differences in arterial-phase blood flow between the liver lobes and replacing the DPS with a straight-type plastic stent, complications, such as portal vein pseudoaneurysm formation, rupture, embolism, or thrombosis, were successfully avoided.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is important for endoscopist to diagnose the lesion redness. In this study, we focused on the redness of duodenal bulb. We objectively analyzed the changes in redness of the duodenal bulb using linked color imaging (LCI) with chromatic indicators.
Methods
Seven endoscopists observed the duodenal bulb with white light imaging (WLI) and LCI, and evaluated them by visual analogue scale (VAS) for the degree of redness. The difference in VAS between WLI and LCI was defined as ΔVAS. All images were quantified by the Comission Internationale de l'Eclariage-L*a*b* color space. Values related to color differences (ΔE*, ΔL*, Δa*, and Δb*) were calculated from the two images of WLI and LCI. Multiple regression analysis was performed for the factors with the health checkup correlated with ΔVAS and the correlation between ΔVAS and ΔE*, ΔL*, Δa*, and Δb* was also examined.
Results
The analysis prospectively included 1144 examinees. In multiple regression analysis, it revealed that sex (β = 0.5847, p < 0.0001) and metabolic syndrome (β = 0.4138, p = 0.0012) were the factors independently influenced ΔVAS. And only Δa*, a chromatic index for changes in the degree of redness, showed a statistically and considerably positive correlation with ΔVAS (r = 0.4529, p < 0.0001).
Conclusion
To evaluate the difference in the degree of redness between WLI and LCI of duodenal bulb in esophagogastroduodenoscopy may help in early detection of metabolic syndrome, which rarely has symptoms.
背景与目的：内窥镜医师对病变发红的诊断具有重要意义。在本研究中，我们着重于十二指肠球部的发红。我们采用彩色联联成像（LCI）客观分析了十二指肠球部红度的变化。方法：7名内镜医师采用白光成像（WLI）和LCI对十二指肠球部进行观察，并采用视觉模拟评分（VAS）对其发红程度进行评价。定义WLI与LCI的VAS差异为ΔVAS。所有图像都通过国际宣言委员会- l *a*b*色彩空间进行量化。根据WLI和LCI两幅图像计算色差相关值（ΔE*， ΔL*， Δa*， Δb*）。对健康体检与ΔVAS相关的因素进行多元回归分析，并检验ΔVAS与ΔE*、ΔL*、Δa*、Δb*之间的相关性。结果：前瞻性分析纳入1144名考生。多元回归分析显示，性别（β = 0.5847, p β = 0.4138, p = 0.0012）是独立影响ΔVAS的因素。只有表示发红程度变化的色度指标Δa*与ΔVAS有统计学显著正相关（r = 0.4529, p）。结论：评价食管胃十二指肠镜下十二指肠球部WLI与LCI的发红程度差异，有助于代谢综合征的早期发现，代谢综合征很少有症状。
{"title":"Significance of Endoscopic Redness of Duodenum in Health Checkup","authors":"Atsushi Nakayama, Motohiko Kato, Yoshiki Sakaguchi, Yu Takahashi, Shinya Kodashima, Ai Fujimoto, Nobutake Yamamichi, Kazumasa Miki, Naohisa Yahagi","doi":"10.1002/jgh3.70096","DOIUrl":"10.1002/jgh3.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>It is important for endoscopist to diagnose the lesion redness. In this study, we focused on the redness of duodenal bulb. We objectively analyzed the changes in redness of the duodenal bulb using linked color imaging (LCI) with chromatic indicators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven endoscopists observed the duodenal bulb with white light imaging (WLI) and LCI, and evaluated them by visual analogue scale (VAS) for the degree of redness. The difference in VAS between WLI and LCI was defined as ΔVAS. All images were quantified by the Comission Internationale de l'Eclariage-<i>L</i>*<i>a</i>*<i>b</i>* color space. Values related to color differences (Δ<i>E</i>*, Δ<i>L</i>*, Δ<i>a</i>*, and Δ<i>b</i>*) were calculated from the two images of WLI and LCI. Multiple regression analysis was performed for the factors with the health checkup correlated with ΔVAS and the correlation between ΔVAS and Δ<i>E</i>*, Δ<i>L</i>*, Δ<i>a</i>*, and Δ<i>b</i>* was also examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis prospectively included 1144 examinees. In multiple regression analysis, it revealed that sex (<i>β</i> = 0.5847, <i>p</i> < 0.0001) and metabolic syndrome (<i>β</i> = 0.4138, <i>p</i> = 0.0012) were the factors independently influenced ΔVAS. And only Δ<i>a</i>*, a chromatic index for changes in the degree of redness, showed a statistically and considerably positive correlation with ΔVAS (<i>r</i> = 0.4529, <i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To evaluate the difference in the degree of redness between WLI and LCI of duodenal bulb in esophagogastroduodenoscopy may help in early detection of metabolic syndrome, which rarely has symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Philippe Onana Ndong, Karine Baumstarck, Véronique Vitton
Background and Aims
Diagnosing dyssynergic disorders (DD) often requires 3D high-definition anorectal manometry (3D-HRAM), raising concerns about cost, availability, and delayed referral. Digital rectal examination (DRE) offers a reliable, cost-effective alternative for DD diagnosis. This study aimed to assess DRE's capability to classify DD patients into the four subtypes outlined in Rao's classification.
Methods
This retrospective monocentric study involved patients diagnosed with DD through 3D-HRAM. After initial 3D-HRAM performed by one physician, patients underwent a clinical examination, including DRE by a second senior clinician blinded to DD subtypes. Statistical tests measured the correlation between DRE and HRAM in classifying the four DD subtypes.
Results
The study included 200 patients, revealing commendable overall agreement between DRE and 3D-HRAM (Kappa = 0.658). For subtype diagnosis, correlation was substantial for Subtypes I, II, and IV (0.679, 0.741, 0.649, respectively) and moderate for Subtype III (Kappa = 0.325).
Conclusion
DRE demonstrates satisfactory performance in diagnosing the four subtypes of DD. Enhanced training in DRE, emphasizing functional information, has the potential to reduce reliance on additional tests, thereby mitigating economic and organizational impacts.
{"title":"Can Digital Rectal Examination Identify the Subtype of Dyssynergic Disorders as Well as High Resolution Anorectal Manometry?","authors":"Philippe Onana Ndong, Karine Baumstarck, Véronique Vitton","doi":"10.1002/jgh3.70097","DOIUrl":"10.1002/jgh3.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Diagnosing dyssynergic disorders (DD) often requires 3D high-definition anorectal manometry (3D-HRAM), raising concerns about cost, availability, and delayed referral. Digital rectal examination (DRE) offers a reliable, cost-effective alternative for DD diagnosis. This study aimed to assess DRE's capability to classify DD patients into the four subtypes outlined in Rao's classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective monocentric study involved patients diagnosed with DD through 3D-HRAM. After initial 3D-HRAM performed by one physician, patients underwent a clinical examination, including DRE by a second senior clinician blinded to DD subtypes. Statistical tests measured the correlation between DRE and HRAM in classifying the four DD subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 200 patients, revealing commendable overall agreement between DRE and 3D-HRAM (Kappa = 0.658). For subtype diagnosis, correlation was substantial for Subtypes I, II, and IV (0.679, 0.741, 0.649, respectively) and moderate for Subtype III (Kappa = 0.325).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DRE demonstrates satisfactory performance in diagnosing the four subtypes of DD. Enhanced training in DRE, emphasizing functional information, has the potential to reduce reliance on additional tests, thereby mitigating economic and organizational impacts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that negatively impacts individuals' quality of life.
Methods
This study investigates the effect of circadian preferences on the quality of life in patients with GERD. A total of 152 participants (80 patients diagnosed with GERD and 72 healthy controls) were included in the study. Participants' circadian preferences were assessed using the morningness-eveningness questionnaire (MEQ), quality of life was evaluated with the SF-36 scale, and the severity of GERD symptoms was measured using the gastroesophageal reflux disease quality of life scale (GERD-QOL).
Results
The study's findings indicate that the quality of life and circadian preferences of GERD patients differ significantly from those of the control group. Correlation analyses revealed a positive relationship between SF-36 and MEQ, but no direct relationship was found between GERD-QOL and SF-36 or MEQ. Mediation analyses demonstrated that the effect of GERD-QOL on SF-36 is entirely mediated by circadian preferences.
Conclusions
These results highlight the significant impact of circadian preferences on the quality of life in GERD patients, suggesting that individuals with an evening chronotype may have lower quality of life. Our study contributes to the literature as one of the first to suggest that circadian preferences should be considered in the management of GERD.
{"title":"The Impact of Circadian Preferences on Quality of Life in Patients With Gastroesophageal Reflux Disease: An Evaluation Using the SF-36","authors":"Uğur Ergün, Ahmet Güleç, Taner Buğra Tan","doi":"10.1002/jgh3.70086","DOIUrl":"10.1002/jgh3.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aims</h3>\u0000 \u0000 <p>Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that negatively impacts individuals' quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study investigates the effect of circadian preferences on the quality of life in patients with GERD. A total of 152 participants (80 patients diagnosed with GERD and 72 healthy controls) were included in the study. Participants' circadian preferences were assessed using the morningness-eveningness questionnaire (MEQ), quality of life was evaluated with the SF-36 scale, and the severity of GERD symptoms was measured using the gastroesophageal reflux disease quality of life scale (GERD-QOL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study's findings indicate that the quality of life and circadian preferences of GERD patients differ significantly from those of the control group. Correlation analyses revealed a positive relationship between SF-36 and MEQ, but no direct relationship was found between GERD-QOL and SF-36 or MEQ. Mediation analyses demonstrated that the effect of GERD-QOL on SF-36 is entirely mediated by circadian preferences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results highlight the significant impact of circadian preferences on the quality of life in GERD patients, suggesting that individuals with an evening chronotype may have lower quality of life. Our study contributes to the literature as one of the first to suggest that circadian preferences should be considered in the management of GERD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Shehab, Abdulwahab Alsayegh, Munirah Alabdulhadi, Shahed Snober, Nouf Aleissa, Ahmad Alfadhli
Introduction
Biologic therapies treat patients with moderate to severe inflammatory bowel disease (IBD). This study aims to investigate the demographics of biologic therapy use and its association with patient characteristics, a topic that has not yet been thoroughly assessed in our region.
Methods
Electronic health record data from June 1, 2021, to May 31, 2023, were collected at a tertiary care IBD center in Kuwait. The primary outcome of this single-center cross-sectional study was to assess the demographics of use of various biologic therapies among patients with IBD. The secondary outcome was to assess whether the type of biologic therapy differed based on gender, age, and IBD type.
Results
Among the 513 patients using biologic therapy in this study, there were 210 (40.9%) on adalimumab (ADL), 154 (30.0%) on infliximab (IFX), 112 (21.9%) on ustekinumab (UST), and 33 (6.4%) on vedolizumab (VDZ). Patients taking VDZ were more likely to have ulcerative colitis (UC) (p < 0.001) and were more likely to be over 30 years old (p < 0.001). In contrast, patients on UST were less likely to be over 30 (p = 0.011) and more likely to have Crohn's disease (CD) (p < 0.001). In addition, patients on ADL were more likely to have Crohn's disease (p = 0.003), as were patients on IFX (p < 0.001).
Conclusion
Patients taking VDZ were more likely to have UC and be over 30 years of age, while those on UST were more likely to be under 30 years of age and to have CD. Additionally, patients on ADL and IFX were more likely to have CD. This study highlighted the need for further research evaluating physicians' preferences and the effectiveness of different biological therapies in patients with IBD.
生物疗法治疗中度至重度炎症性肠病（IBD）患者。本研究旨在调查生物治疗使用的人口统计学及其与患者特征的关系，这是一个尚未在我们地区进行彻底评估的主题。方法：从2021年6月1日至2023年5月31日的电子健康记录数据收集于科威特一家三级保健IBD中心。这项单中心横断面研究的主要结果是评估IBD患者使用各种生物疗法的人口统计学特征。次要结局是评估生物治疗的类型是否因性别、年龄和IBD类型而不同。结果：本研究513例使用生物治疗的患者中，阿达木单抗（ADL） 210例（40.9%），英夫利昔单抗（IFX） 154例（30.0%），乌斯特金单抗（UST） 112例（21.9%），维多珠单抗（VDZ） 33例（6.4%）。服用VDZ的患者更容易发生溃疡性结肠炎（UC） （p p p = 0.011），更容易发生克罗恩病（CD） （p p = 0.003），服用IFX的患者也是如此(p服用VDZ的患者更有可能患有UC，年龄超过30岁，而服用UST的患者更有可能在30岁以下，患有CD。此外，服用ADL和IFX的患者更有可能患有CD。该研究强调需要进一步研究评估医生的偏好和不同生物疗法对IBD患者的有效性。
{"title":"Relationship Between Patient Demographics and Biologic Therapy Use in Inflammatory Bowel Disease. A Single Center Cross-Sectional Study","authors":"Mohammad Shehab, Abdulwahab Alsayegh, Munirah Alabdulhadi, Shahed Snober, Nouf Aleissa, Ahmad Alfadhli","doi":"10.1002/jgh3.70092","DOIUrl":"10.1002/jgh3.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Biologic therapies treat patients with moderate to severe inflammatory bowel disease (IBD). This study aims to investigate the demographics of biologic therapy use and its association with patient characteristics, a topic that has not yet been thoroughly assessed in our region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Electronic health record data from June 1, 2021, to May 31, 2023, were collected at a tertiary care IBD center in Kuwait. The primary outcome of this single-center cross-sectional study was to assess the demographics of use of various biologic therapies among patients with IBD. The secondary outcome was to assess whether the type of biologic therapy differed based on gender, age, and IBD type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 513 patients using biologic therapy in this study, there were 210 (40.9%) on adalimumab (ADL), 154 (30.0%) on infliximab (IFX), 112 (21.9%) on ustekinumab (UST), and 33 (6.4%) on vedolizumab (VDZ). Patients taking VDZ were more likely to have ulcerative colitis (UC) (<i>p</i> < 0.001) and were more likely to be over 30 years old (<i>p</i> < 0.001). In contrast, patients on UST were less likely to be over 30 (<i>p</i> = 0.011) and more likely to have Crohn's disease (CD) (<i>p</i> < 0.001). In addition, patients on ADL were more likely to have Crohn's disease (<i>p</i> = 0.003), as were patients on IFX (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients taking VDZ were more likely to have UC and be over 30 years of age, while those on UST were more likely to be under 30 years of age and to have CD. Additionally, patients on ADL and IFX were more likely to have CD. This study highlighted the need for further research evaluating physicians' preferences and the effectiveness of different biological therapies in patients with IBD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jalpa Devi, Tanyaporn Chantarojanasiri, Dao Viet Hang, Rashid Lui, Raja Affendi Raja Ali, Amna Subhan Butt, Rohan Raja, Trinh To Tram, Ting Ting Chan, Women in GI Focus Group, Emerging Leaders Committee, Asian Pacific Association of Gastroenterology
Objectives
Despite progress in promoting gender equality, gender bias remains a significant obstacle for women and hinders their academic advancement. We aim to survey and critically analyze women's representation in conferences and changes over time in various regions of Asian countries.
Methods
An international survey was conducted with representatives from East Asia (Hong Kong, China, and Japan), South Asia (India and Pakistan), and Southeast Asia (Vietnam and Thailand). The survey collected data on faculty members serving as chairpersons, moderators, speakers, and organizing committee members of annual scientific meetings held between 2018 and 2022.
Results
A total of 33 conferences were held between 2018 and 2022: 24 in gastroenterology, 5 in hepatology, and 4 in endoscopy across East, South, and Southeast Asia, respectively. The total number of invited faculty members was 4106. Out of 4106, the number of women involved as chairperson, moderator, speakers, and organizing committee was 105, 78, 290, and 146, respectively. The representation of women faculty ranged from 3.8% to 25% in East Asia, 9.2% to 13.5% in South Asia, and 11.8% to 34.3% in Southeast Asia. Overall, the increase in women's participation was minor and statistically non-significant. However, there was an increase of women's participation as chairpersons, moderators, speakers, and organizing committee members from 14.1% in 2018 to 15.2% in 2022.
Conclusion
Participation of women in Asian annual conferences in the capacity of chairperson, moderator, speaker, and/or organizing committee member was significantly under-represented. This under-representation necessitates targeted measures to enhance women's roles in these meetings, thereby supporting their career advancement.
{"title":"Trend of Representation of Women in Gastroenterology, Hepatology, and Endoscopy Conferences in Asia","authors":"Jalpa Devi, Tanyaporn Chantarojanasiri, Dao Viet Hang, Rashid Lui, Raja Affendi Raja Ali, Amna Subhan Butt, Rohan Raja, Trinh To Tram, Ting Ting Chan, Women in GI Focus Group, Emerging Leaders Committee, Asian Pacific Association of Gastroenterology","doi":"10.1002/jgh3.70080","DOIUrl":"10.1002/jgh3.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Despite progress in promoting gender equality, gender bias remains a significant obstacle for women and hinders their academic advancement. We aim to survey and critically analyze women's representation in conferences and changes over time in various regions of Asian countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An international survey was conducted with representatives from East Asia (Hong Kong, China, and Japan), South Asia (India and Pakistan), and Southeast Asia (Vietnam and Thailand). The survey collected data on faculty members serving as chairpersons, moderators, speakers, and organizing committee members of annual scientific meetings held between 2018 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 33 conferences were held between 2018 and 2022: 24 in gastroenterology, 5 in hepatology, and 4 in endoscopy across East, South, and Southeast Asia, respectively. The total number of invited faculty members was 4106. Out of 4106, the number of women involved as chairperson, moderator, speakers, and organizing committee was 105, 78, 290, and 146, respectively. The representation of women faculty ranged from 3.8% to 25% in East Asia, 9.2% to 13.5% in South Asia, and 11.8% to 34.3% in Southeast Asia. Overall, the increase in women's participation was minor and statistically non-significant. However, there was an increase of women's participation as chairpersons, moderators, speakers, and organizing committee members from 14.1% in 2018 to 15.2% in 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Participation of women in Asian annual conferences in the capacity of chairperson, moderator, speaker, and/or organizing committee member was significantly under-represented. This under-representation necessitates targeted measures to enhance women's roles in these meetings, thereby supporting their career advancement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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