Pub Date : 2025-11-24DOI: 10.1016/j.cpcardiol.2025.103214
Christian Stadlbauer , Andrea Stadlbauer , Sigrid Wiesner , Ekrem Ücer , Carsten Jungbauer , Christof Schmid , Simon Schopka , Andreas Keyser
The circumstances leading to the origins of "Twiddler", "Reel", and "Ratchet" in patients with cardiac implantable electronic devices (CIED) have not yet been fully determined. This retrospective study was performed to address different mechanisms that lead to impairment of implanted leads within the context of "Twiddler", "Reel", and "Ratchet".
From 2004 and 2023, 5966 patients underwent CIED procedures at our institution. 31 patients with lead impairment by rotation were identified with evidence of pulse generator mobility, lead dislodgement with retraction and / or associated coiling of the lead(s) radiographically or intraoperatively. A review of the literature from 1963 to 2024 identified 216 cases from 165 publications.
In less than half of our patients lead retraction could be attested, and a minority of patients had clinical symptoms attributable to lead impairment by rotation. Psychiatric comorbidities and patients´ manipulation could not be ascertained.
Thorough follow-up of all patients with CIEDs appears mandatory. Precise implantation techniques from the outset may limit lead impairment by rotation.
{"title":"Twiddler-, Reel-, and Ratchet-syndrome: an alternative approach to address the underlying mechanism of complication in cardiac implantable electronic devices","authors":"Christian Stadlbauer , Andrea Stadlbauer , Sigrid Wiesner , Ekrem Ücer , Carsten Jungbauer , Christof Schmid , Simon Schopka , Andreas Keyser","doi":"10.1016/j.cpcardiol.2025.103214","DOIUrl":"10.1016/j.cpcardiol.2025.103214","url":null,"abstract":"<div><div>The circumstances leading to the origins of \"Twiddler\", \"Reel\", and \"Ratchet\" in patients with cardiac implantable electronic devices (CIED) have not yet been fully determined. This retrospective study was performed to address different mechanisms that lead to impairment of implanted leads within the context of \"Twiddler\", \"Reel\", and \"Ratchet\".</div><div>From 2004 and 2023, 5966 patients underwent CIED procedures at our institution. 31 patients with lead impairment by rotation were identified with evidence of pulse generator mobility, lead dislodgement with retraction and / or associated coiling of the lead(s) radiographically or intraoperatively. A review of the literature from 1963 to 2024 identified 216 cases from 165 publications.</div><div>In less than half of our patients lead retraction could be attested, and a minority of patients had clinical symptoms attributable to lead impairment by rotation. Psychiatric comorbidities and patients´ manipulation could not be ascertained.</div><div>Thorough follow-up of all patients with CIEDs appears mandatory. Precise implantation techniques from the outset may limit lead impairment by rotation.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 2","pages":"Article 103214"},"PeriodicalIF":3.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145584290","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}
Pub Date : 2025-11-24DOI: 10.1016/j.cpcardiol.2025.103212
Yuxiang Chen MM , Jiaxin Zhong MM , Beilei Li MM , Ruijin Hong MM , Hui Chen MM , Lianglong Chen MD , Yuanming Yan MD , Yukun Luo MD , Qin Chen MD
Background
Residual ischemia and metabolic dysregulation remain determinants of long-term prognosis after percutaneous coronary intervention (PCI). We investigated the prognostic impact of the three-vessel quantitative flow ratio (3V-QFR) and the triglyceride–glucose (TyG) index in this population.
Methods
A total of 546 patients who underwent repeat angiography one year after PCI were followed for four years. Restricted cubic spline analysis was used to determine risk thresholds for both 3V-QFR and TyG. The primary endpoint was major adverse cardiac events (MACEs).
Results
The optimal cutoffs for predicting MACEs were 2.44 for 3V-QFR and 8.75 for TyG. Patients with 3V-QFR < 2.44 experienced significantly higher adverse event rates. Among patients with 3V-QFR ≥ 2.44, TyG ≥ 8.75 was independently associated with increased MACEs (adjusted HR 1.51, 95 % CI 1.04–2.05), mainly driven by ischemia-driven revascularization. No such association was observed in patients with 3V-QFR < 2.44.
Conclusions
3V-QFR < 2.44 reflects residual functional ischemia and portends poor prognosis after PCI. In patients with complete functional revascularization, a high TyG index indicates elevated metabolic risk. A combined physiological–metabolic assessment provides improved risk stratification for long-term secondary prevention.
{"title":"Physiological and metabolic predictors of adverse outcomes one year after coronary intervention: A two-tiered approach","authors":"Yuxiang Chen MM , Jiaxin Zhong MM , Beilei Li MM , Ruijin Hong MM , Hui Chen MM , Lianglong Chen MD , Yuanming Yan MD , Yukun Luo MD , Qin Chen MD","doi":"10.1016/j.cpcardiol.2025.103212","DOIUrl":"10.1016/j.cpcardiol.2025.103212","url":null,"abstract":"<div><h3>Background</h3><div>Residual ischemia and metabolic dysregulation remain determinants of long-term prognosis after percutaneous coronary intervention (PCI). We investigated the prognostic impact of the three-vessel quantitative flow ratio (3V-QFR) and the triglyceride–glucose (TyG) index in this population.</div></div><div><h3>Methods</h3><div>A total of 546 patients who underwent repeat angiography one year after PCI were followed for four years. Restricted cubic spline analysis was used to determine risk thresholds for both 3V-QFR and TyG. The primary endpoint was major adverse cardiac events (MACEs).</div></div><div><h3>Results</h3><div>The optimal cutoffs for predicting MACEs were 2.44 for 3V-QFR and 8.75 for TyG. Patients with 3V-QFR < 2.44 experienced significantly higher adverse event rates. Among patients with 3V-QFR ≥ 2.44, TyG ≥ 8.75 was independently associated with increased MACEs (adjusted HR 1.51, 95 % CI 1.04–2.05), mainly driven by ischemia-driven revascularization. No such association was observed in patients with 3V-QFR < 2.44.</div></div><div><h3>Conclusions</h3><div>3V-QFR < 2.44 reflects residual functional ischemia and portends poor prognosis after PCI. In patients with complete functional revascularization, a high TyG index indicates elevated metabolic risk. A combined physiological–metabolic assessment provides improved risk stratification for long-term secondary prevention.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 3","pages":"Article 103212"},"PeriodicalIF":3.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642447","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}
Pub Date : 2025-11-24DOI: 10.1016/j.cpcardiol.2025.103215
Ibrahim Mohammed Fawzi Al-Shahwani , Dr Al-Attar Nawwar
Background
Healthcare contributes approximately 4–5 % of the United Kingdom’s total greenhouse gas emissions, with patient and visitor travel responsible for up to 14 % of this footprint. Implementing telehealth in outpatient care offers potential to reduce travel-related emissions while maintaining high-quality care.
Objective
To evaluate the environmental impact and feasibility of replacing routine in-person cardiothoracic outpatient consultations with video appointments at a tertiary cardiothoracic center in Scotland.
Methods
This prospective quality improvement initiative converted 50 routine cardiothoracic outpatient appointments to virtual consultations using the NHS-endorsed Near Me video platform between January and April 2025. Round-trip distances from patient postcodes to hospital were estimated using standard geocoding tools. Carbon dioxide (CO₂) emissions avoided were calculated using the UK Government’s BEIS conversion factor of 211.2 g/mile for average petrol vehicles. Patient satisfaction and technical feasibility were evaluated through post-consultation surveys.
Results
Substituting 50 face-to-face appointments with Near Me video consultations avoided a total of 3,014.4 miles of patient travel, corresponding to approximately 636.7 kg of CO₂ emissions. No consultations required rescheduling due to technical difficulties. Patient satisfaction ratings were high, particularly for convenience and quality of interaction. Extrapolated to 1,000 patients annually, this model could prevent approximately 12.7 tones of CO₂ emissions.
Conclusions
Replacing in-person cardiothoracic consultations with telehealth is feasible, well accepted by patients, and environmentally beneficial. Scaling this approach across high-volume outpatient services supports the NHS’s commitment to net-zero emissions while preserving care quality and efficiency.
{"title":"Reducing carbon emissions through remote patient interview: A quality improvement initiative","authors":"Ibrahim Mohammed Fawzi Al-Shahwani , Dr Al-Attar Nawwar","doi":"10.1016/j.cpcardiol.2025.103215","DOIUrl":"10.1016/j.cpcardiol.2025.103215","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare contributes approximately 4–5 % of the United Kingdom’s total greenhouse gas emissions, with patient and visitor travel responsible for up to 14 % of this footprint. Implementing telehealth in outpatient care offers potential to reduce travel-related emissions while maintaining high-quality care.</div></div><div><h3>Objective</h3><div>To evaluate the environmental impact and feasibility of replacing routine in-person cardiothoracic outpatient consultations with video appointments at a tertiary cardiothoracic center in Scotland.</div></div><div><h3>Methods</h3><div>This prospective quality improvement initiative converted 50 routine cardiothoracic outpatient appointments to virtual consultations using the NHS-endorsed <em>Near Me</em> video platform between January and April 2025. Round-trip distances from patient postcodes to hospital were estimated using standard geocoding tools. Carbon dioxide (CO₂) emissions avoided were calculated using the UK Government’s BEIS conversion factor of 211.2 g/mile for average petrol vehicles. Patient satisfaction and technical feasibility were evaluated through post-consultation surveys.</div></div><div><h3>Results</h3><div>Substituting 50 face-to-face appointments with <em>Near Me</em> video consultations avoided a total of 3,014.4 miles of patient travel, corresponding to approximately 636.7 kg of CO₂ emissions. No consultations required rescheduling due to technical difficulties. Patient satisfaction ratings were high, particularly for convenience and quality of interaction. Extrapolated to 1,000 patients annually, this model could prevent approximately 12.7 tones of CO₂ emissions.</div></div><div><h3>Conclusions</h3><div>Replacing in-person cardiothoracic consultations with telehealth is feasible, well accepted by patients, and environmentally beneficial. Scaling this approach across high-volume outpatient services supports the NHS’s commitment to net-zero emissions while preserving care quality and efficiency.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 2","pages":"Article 103215"},"PeriodicalIF":3.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618360","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}
Pub Date : 2025-11-24DOI: 10.1016/j.cpcardiol.2025.103213
Elia Nunzio Maria Salerno , Isabella Fumarulo , Barbara Garramone , Marcello Vaccarella , Carolina Ierardi , Francesco Burzotta , Nadia Aspromonte
Obesity is a highly prevalent chronic disease strongly associated with cardiometabolic complications, including type 2 diabetes, hypertension, heart failure and other cardiovascular diseases. The growing understanding of these interrelationships has fundamentally changed clinical approaches to their management. In this context, a new class of agents, the glucagon-like peptide-1 receptor agonists (GLP-1 RAs), has gained increasing importance in patient care, supported by relevant scientific evidence that made them a first-line therapeutic option in various clinical settings. Nevertheless, in clinical practice, there is still concern about their long-term use and the potential risk of adverse effects. As a consequence, GLP1-RAs are often prescribed only for limited periods and discontinued once weight reduction has been achieved. The aim of this review is to examine the clinical effects and main indications of GLP-1 RAs and to compare the risk of long-term adverse outcomes associated with their use versus the risks related to their discontinuation.
{"title":"GLP1-RAs: long-term use versus discontinuation events of an emerging therapy for obesity and cardiovascular diseases","authors":"Elia Nunzio Maria Salerno , Isabella Fumarulo , Barbara Garramone , Marcello Vaccarella , Carolina Ierardi , Francesco Burzotta , Nadia Aspromonte","doi":"10.1016/j.cpcardiol.2025.103213","DOIUrl":"10.1016/j.cpcardiol.2025.103213","url":null,"abstract":"<div><div>Obesity is a highly prevalent chronic disease strongly associated with cardiometabolic complications, including type 2 diabetes, hypertension, heart failure and other cardiovascular diseases. The growing understanding of these interrelationships has fundamentally changed clinical approaches to their management. In this context, a new class of agents, the glucagon-like peptide-1 receptor agonists (GLP-1 RAs), has gained increasing importance in patient care, supported by relevant scientific evidence that made them a first-line therapeutic option in various clinical settings. Nevertheless, in clinical practice, there is still concern about their long-term use and the potential risk of adverse effects. As a consequence, GLP1-RAs are often prescribed only for limited periods and discontinued once weight reduction has been achieved. The aim of this review is to examine the clinical effects and main indications of GLP-1 RAs and to compare the risk of long-term adverse outcomes associated with their use versus the risks related to their discontinuation.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 2","pages":"Article 103213"},"PeriodicalIF":3.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618350","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}
Pub Date : 2025-11-14DOI: 10.1016/j.cpcardiol.2025.103210
Nicolaas P. Pronk PhD , Ross Arena PhD , Colin Woodard MA, FRGS
{"title":"The GLP-1 RA Era - A positive disruptor to the ecological framework of population health","authors":"Nicolaas P. Pronk PhD , Ross Arena PhD , Colin Woodard MA, FRGS","doi":"10.1016/j.cpcardiol.2025.103210","DOIUrl":"10.1016/j.cpcardiol.2025.103210","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 1","pages":"Article 103210"},"PeriodicalIF":3.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535046","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}
Pulmonary arterial hypertension (PAH) creates a prothrombotic environment that may result in in situ pulmonary arterial thrombosis (PAT), a subtype that can resemble pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) but requires different management.
Methods
We conducted a narrative review of epidemiology, mechanisms, diagnostic differentiation, imaging (CT pulmonary angiography [CTPA], ventilation–perfusion [V/Q] scanning, echocardiography), and treatment of in situ PAT, and incorporated an institutional retrospective series (screened 2020–2025).
Results
In situ PAT typically appears on CTPA as central or wall-adherent thrombi within markedly dilated proximal pulmonary arteries, often without stenosis. Early V/Q scanning is useful to rule out CTEPH; non-segmental or mottled perfusion favors Group 1 PAH. Caliber metrics (PA diameter, PA/Ao) and RV strain indices (RV/LV, TAPSE) support but do not by themselves establish the diagnosis. Of 364 PAH patients screened, 7 (1.9 %) met imaging criteria for in situ PAT; mean age 42 years, 71 % female, 43 % congenital heart disease. All had PA ≥30 mm and RV/LV ≥1; 71 % had aneurysmal PA ≥40 mm; 71 % had negative DVT Doppler. Functional and hemodynamic impairment was substantial.
Conclusions
A stepwise workflow—DVT assessment, V/Q to exclude CTEPH, and targeted CTPA morphology interpreted with hemodynamics—facilitates accurate classification of in situ PAT and avoids misdirected CTEPH interventions. Therapy should begin with PAH-targeted treatment; anticoagulation should be individualized according to phenotype, bleeding risk, and clinical course.
背景：肺动脉高压（PAH）产生血栓前环境，可能导致原位肺动脉血栓形成（PAT），这是一种类似于肺栓塞和慢性血栓栓塞性肺动脉高压（CTEPH）的亚型，但需要不同的治疗。方法：我们对原位PAT的流行病学、机制、诊断鉴别、影像学（CT肺血管造影[CTPA]、通气灌注[V/Q]扫描、超声心动图）和治疗进行了叙述性回顾，并纳入了一个机构回顾性系列（筛选2020-2025年）。结果：原位PAT通常在CTPA上表现为明显扩张的肺动脉近端中心或壁贴血栓，通常无狭窄。早期V/Q扫描有助于排除CTEPH；非节段性或斑驳灌注有利于1组PAH。口径指标（PA直径，PA/Ao）和RV应变指标（RV/LV， TAPSE）支持但不能单独确定诊断。在筛选的364例PAH患者中，7例（1.9%）符合原位PAT的影像学标准；平均年龄42岁，71%为女性，43%为先天性心脏病。PA≥30 mm, RV/LV≥1；动脉瘤样PA≥40 mm占71%；71% DVT多普勒阴性。功能和血流动力学损伤是实质性的。结论：分步工作流程——dvt评估、排除CTEPH的V/Q和用血流动力学解释的靶向CTPA形态学——有助于准确分类原位PAT，避免错误的CTEPH干预。治疗应从针对多环芳烃的治疗开始；抗凝治疗应根据表型、出血风险和临床病程进行个体化治疗。
{"title":"In situ pulmonary arterial thrombosis in pulmonary arterial hypertension: Diagnostic differentiation, imaging criteria, and management—A narrative review with an institutional case-series snapshot","authors":"María-José Bravo-Vásquez M.D. , Guillermo Cueto-Robledo M.D. , Ernesto Roldan-Valadez M.D., M.Sc., D.Sc. , Dulce-Iliana Navarro-Vergara M.D., M.Sc. , Luis-Eugenio Graniel-Palafox M.D. , Jonathan Ruiz-Ruiz M.D. , Nicolai Gonzalez-Stoylov M.D. , Erick-Mauricio Garcia-Luna M.D.","doi":"10.1016/j.cpcardiol.2025.103209","DOIUrl":"10.1016/j.cpcardiol.2025.103209","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary arterial hypertension (PAH) creates a prothrombotic environment that may result in in situ pulmonary arterial thrombosis (PAT), a subtype that can resemble pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH) but requires different management.</div></div><div><h3>Methods</h3><div>We conducted a narrative review of epidemiology, mechanisms, diagnostic differentiation, imaging (CT pulmonary angiography [CTPA], ventilation–perfusion [V/Q] scanning, echocardiography), and treatment of in situ PAT, and incorporated an institutional retrospective series (screened 2020–2025).</div></div><div><h3>Results</h3><div>In situ PAT typically appears on CTPA as central or wall-adherent thrombi within markedly dilated proximal pulmonary arteries, often without stenosis. Early V/Q scanning is useful to rule out CTEPH; non-segmental or mottled perfusion favors Group 1 PAH. Caliber metrics (PA diameter, PA/Ao) and RV strain indices (RV/LV, TAPSE) support but do not by themselves establish the diagnosis. Of 364 PAH patients screened, 7 (1.9 %) met imaging criteria for in situ PAT; mean age 42 years, 71 % female, 43 % congenital heart disease. All had PA ≥30 mm and RV/LV ≥1; 71 % had aneurysmal PA ≥40 mm; 71 % had negative DVT Doppler. Functional and hemodynamic impairment was substantial.</div></div><div><h3>Conclusions</h3><div>A stepwise workflow—DVT assessment, V/Q to exclude CTEPH, and targeted CTPA morphology interpreted with hemodynamics—facilitates accurate classification of in situ PAT and avoids misdirected CTEPH interventions. Therapy should begin with PAH-targeted treatment; anticoagulation should be individualized according to phenotype, bleeding risk, and clinical course.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"51 1","pages":"Article 103209"},"PeriodicalIF":3.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534990","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}
Pub Date : 2025-10-30DOI: 10.1016/S0146-2806(25)00218-X
{"title":"Guidelines for Authors","authors":"","doi":"10.1016/S0146-2806(25)00218-X","DOIUrl":"10.1016/S0146-2806(25)00218-X","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103199"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418061","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}
Pub Date : 2025-10-30DOI: 10.1016/S0146-2806(25)00220-8
{"title":"Information for Readers","authors":"","doi":"10.1016/S0146-2806(25)00220-8","DOIUrl":"10.1016/S0146-2806(25)00220-8","url":null,"abstract":"","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 12","pages":"Article 103201"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418048","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}
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