Drugs in Context最新文献

{"title":"Real-world use of a hydrophilic curcumin-based oral formulation in the management of macular oedema: a collection of clinical experiences.","authors":"Davide Allegrini, Giuseppe Covello, Alessandra Mancini, Antonino Mancini, Maura Mancini, Mary Romano, Aldo Vecchiarelli, Mario R Romano","doi":"10.7573/dic.2025-3-3","DOIUrl":"10.7573/dic.2025-3-3","url":null,"abstract":"<p><p>This is a collection of clinical experiences exploring the real-world effectiveness of a hydrophilic curcumin-based oral formulation (CHC, Diabec^®) in the management of macular oedema across diverse retinal conditions, including diabetic macular oedema, central serous chorioretinopathy, branch retinal vein occlusion and Irvine-Gass syndrome. Eight cases reported significant improvements in best-corrected visual acuity and central macular thickness, with complete resolution of oedema in some instances. CHC was well tolerated, with no adverse effects reported. These findings suggest that CHC is a safe and effective adjunct or standalone therapy for chronic or refractory macular oedema, enhancing anatomical and functional outcomes in real-world settings.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12108699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157475","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}

{"title":"Upadacitinib for the treatment of radiographic axial spondyloarthritis - case series and review of the literature.","authors":"Giuseppe Lopalco, Arianna D'Antonio, Maria Sole Chimenti, Florenzo Iannone","doi":"10.7573/dic.2024-12-3","DOIUrl":"10.7573/dic.2024-12-3","url":null,"abstract":"<p><p>Upadacitinib is a Janus kinase (JAK) inhibitor approved for the treatment of different rheumatic diseases, including axial spondyloarthritis (axSpA). In phase III clinical trials, upadacitinib was associated with rapid and significant improvement in disease parameters, including scores for pain, function and mobility, signs of structural damage, and patient-reported outcomes, and had an overall incidence of adverse events similar to that in the placebo group. Improvement in axSpA disease severity was observed in both biologic-naive patients and those with prior biologic exposure, and this improvement was sustained during open-label treatment. Indirect comparisons with other agents suggest that upadacitinib is more effective than biologics and other JAK inhibitors in patients with axSpA and is associated with the lowest number-needed-to-treat. Long-term safety data indicate that upadacitinib is well tolerated in patients with axSpA, with a low rate of infections, malignancies, major adverse cardiovascular events and thromboembolism. Four case studies described here illustrate the effectiveness of upadacitinib in a range of real-world patients with axSpA, including patients with early disease and those who have been pre-treated with biologics.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093032","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}

{"title":"Patterns of treatment and outcomes of patients with metastatic HER2-low breast cancer treated with CDK4/6 inhibitors and hormone therapy.","authors":"Federico Sottotetti, Barbara Tagliaferri, Gianpiero Rizzo, Raffaella Palumbo, Giulia Chessa, Chiara Raso, Lorenzo Perrone, Alberto Malovini, Valentina Tibollo, Laura Deborah Locati, Paolo Pedrazzoli, Angioletta Lasagna","doi":"10.7573/dic.2024-12-1","DOIUrl":"10.7573/dic.2024-12-1","url":null,"abstract":"<p><strong>Background: </strong>The 2018 American Society of Clinical Oncology/College of American Pathologists guidelines classified immunohistochemistry (IHC) 1+ or 2+, FISH-negative breast cancer as HER2-low. To date, only a few studies have investigated the role of HER2-low status in patients with hormone receptor positive/HER2^- (HR⁺/HER2^-) metastatic breast cancer (MBC) during CDK4/6 inhibitor (CDK4/6i) therapy.</p><p><strong>Methods: </strong>This is a multicentre, retrospective cohort study analysing data from patients with HR⁺/HER2-low and HR⁺/HER2-0 MBC treated with CDK4/6i as first-line or second-line therapy at the Oncology Units of IRCCS San Matteo Hospital and ICS Maugeri IRCCS in Pavia, Italy, from January 2017 to October 2023. The aim was to assess the activity and effectiveness of CDK4/6i in a real-life setting.</p><p><strong>Results: </strong>Of the 241 patients included, 240 (99.6%) were women. The median age at diagnosis was 57 years (IQR 48-65 years). Most patients had pM M0 (70.5%). At presentation, 112 (46.5%) had HER2-low and 129 (53.5%) had HER2-0 status. CDK4/6i were administered as first-line therapy in 89.2% of patients and as second-line therapy in 10.8% of patients, with palbociclib (61.4%) being the most common. The median progression-free survival during CDK4/6i therapy was 36.3 months (95% CI 23.6 months to not reached), while the median overall survival was 60.5 months (95% CI 54.4 months to not reached). Progression-free survival differed significantly between palbociclib and abemaciclib/ribociclib (24.4 <i>versus</i> 53.7 months; <i>p</i>=0.0109) and between first-line and second-line therapy (40.5 <i>versus</i> 21.2 months; <i>p</i>=0.0466).</p><p><strong>Conclusion: </strong>CDK4/6i are effective in both HER2-low and HER2-0 MBC, with HER2-low potentially benefiting more from first-line therapy.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093013","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}

{"title":"Switching from multiple-inhaler triple therapy to single, extrafine-inhaler triple therapy in severe refractory asthma with EGPA: beyond control. Case report and review of the literature.","authors":"Francesco Menzella, Marcello Cottini, Silvia Tonin, Lorenzo Corsi, Annamaria Bosi, Andrea Ballarin, Ariel Floriani, Cristina Dartora, Matteo Tacconi, Carlo Lombardi","doi":"10.7573/dic.2025-2-3","DOIUrl":"https://doi.org/10.7573/dic.2025-2-3","url":null,"abstract":"<p><p>Eosinophilic granulomatosis with polyangiitis is a rare systemic vasculitis associated with asthma, eosinophilia and multi-organ involvement. This case report describes a 69-year-old male with severe, poorly controlled asthma who was diagnosed with eosinophilic granulomatosis with polyangiitis. Despite treatment with mepolizumab 300 mg and optimized inhaled therapies, comprising high-dose inhaled corticosteroids and long-acting β2-agonists and a long-acting muscarinic antagonist in two separate inhalers, the patient exhibited poor asthma control, accompanied by exacerbations of symptoms, increased reliance on oral corticosteroids, and a decline in lung function. Consequently, a comprehensive, multidisciplinary approach targeting comorbidities was deemed necessary, including the management of chronic rhinosinusitis with nasal polyps. Following a switch to a single-inhaler triple therapy, the patient demonstrated significant improvements in terms of asthma control, respiratory function, oscillometric measurements and fractional exhaled nitric oxide reduction. This report underscores the significance of personalized treatment strategies and a treatable-traits approach targeting small airway dysfunction, persistent airflow limitation and type 2 inflammation for effective disease management. A literature review on therapeutic advancements and clinical implications is also presented to provide clinicians with useful insights into managing severe asthma and single-inhaler triple therapy placement.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062654","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}

{"title":"Anxiety disorders, PTSD and OCD: systematic review of approved psychiatric medications (2008-2024) and pipeline phase III medications.","authors":"Emile Tadros, Shirley Keerthana, Samar Padder, Jayant Totlani, Drew Hirsch, Daniel N Kaidbay, Lorena Contreras, Aasim Naqvi, Samuel Miles, Krista Mercado, Ashley Meyer, Sabrina Renteria, Robert N Pechnick, Itai Danovitch, Waguih William IsHak","doi":"10.7573/dic.2024-11-2","DOIUrl":"https://doi.org/10.7573/dic.2024-11-2","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review examines psychiatric medications approved by the FDA for anxiety disorders, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) from 2008 to 2024 and describes the mechanism of action, indications for both labelled and off-label uses, evidence for efficacy, dosing and adverse effects for each medication.</p><p><strong>Methods: </strong>The methodology involved a literature search of the PubMed database for studies published from 1 January 2008 to 31 December 2024 on FDA-approved psychiatric medications and phase III pipeline medications, using the keywords: \"anxiety\" OR \"PTSD\" OR \"OCD\" AND \"psychopharm*\" OR \"medic*\" OR \"pharm*\". The authors conducted independent assessments of the resulting articles and reached a consensus on eligible studies to include in this systematic review.</p><p><strong>Results: </strong>Our review revealed that, in the past 16 years, the FDA approved only two medications for anxiety disorders (a delayed-release form of duloxetine for generalized anxiety disorder and an extended-release form of lorazepam) and none for PTSD or OCD. We also identified 14 pipeline medications for anxiety disorders, eight for PTSD and one for OCD, all of which are currently in phase III clinical trials.</p><p><strong>Conclusion: </strong>Our results showed a paucity of new medications for anxiety disorders and none for PTSD and OCD in the past 16 years. However, phase III psychiatric medications for anxiety disorders, PTSD and OCD seem to show several agents with novel mechanisms of action, various modes of administration, and improved side-effect profiles.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976638","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}

{"title":"Real-world experience with brodalumab in a Portuguese cohort of patients with moderate-to-severe psoriasis.","authors":"Tiago Torres, Pedro Mendes-Bastos, Joana Antunes, Maria João Cruz, Fernando Mota, Paulo Ferreira","doi":"10.7573/dic.2024-11-4","DOIUrl":"10.7573/dic.2024-11-4","url":null,"abstract":"<p><strong>Background: </strong>Brodalumab is a monoclonal antibody directed to the IL-17 receptor A, approved for the treatment of moderate-to-severe psoriasis. In phase III clinical trials, brodalumab showed clinical efficacy and a favourable safety profile. However, real-world data on brodalumab treatment are still limited. This study aimed to evaluate the real-world efficacy and safety of brodalumab treatment in a Portuguese population.</p><p><strong>Methods: </strong>This is a retrospective, observational, multicentre study of patients with moderate-to-severe plaque-type psoriasis treated with brodalumab between January 2019 and August 2022. The follow-up period was 74 weeks. Brodalumab efficacy was accessed by the percentage of patients reaching the Psoriasis Area Severity Index (PASI) 75, 90 and 100 responses and by improvement in absolute PASI and Dermatology Life Quality Index (DLQI) scores. Drug survival of brodalumab treatment, causes of treatment discontinuation and adverse events were also reported.</p><p><strong>Results: </strong>A total of 126 patients were included. Four weeks after treatment initiation, 83%, 57% and 29% of patients reached PASI 75, 90 and 100, respectively. These values increased to 96%, 93% and 66% at 74 weeks. A significant reduction in PASI score was observed after 4 weeks of brodalumab treatment and until week 74 (<i>p</i><0.001). Quality of life measured by DLQI score significantly increased during the treatment period (<i>p</i><0.001). Drug survival of brodalumab treatment was 82.5%, and secondary failure (8.5%) was the main reason for treatment discontinuation. The occurrence of adverse events was low and restricted to non-severe infectious.</p><p><strong>Conclusion: </strong>This real-world data show that brodalumab is effective and safe for the treatment of moderate-to- severe psoriasis.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691564","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}

{"title":"Vericiguat in patients with heart failure and implantable cardioverter-defibrillator.","authors":"Carlos Escobar, Jesús Saldaña, José Luis Merino, Rafael Peinado","doi":"10.7573/dic.2024-10-5","DOIUrl":"10.7573/dic.2024-10-5","url":null,"abstract":"<p><strong>Background: </strong>This analysis assesses the effectiveness and tolerability profile of vericiguat in patients with heart failure with reduced ejection fraction (HFrEF) and implantable cardioverter-defibrillator, with an emphasis on the emergence of ventricular arrhythmias.</p><p><strong>Methods: </strong>Retrospective analysis of patients with HFrEF and implantable cardioverter-defibrillator who started treatment with vericiguat in daily clinical practice in a tertiary university hospital in Spain.</p><p><strong>Results: </strong>The study population comprised 14 patients treated since January 2023. At baseline, mean age was 77.0±7.0 years, 71.4% of patients were men and mean left ventricular ejection fraction was 32.1±5.4%. Regarding heart failure treatments, 13 (92.3%) patients were prescribed renin-angiotensin-aldosterone system inhibitors, mainly sacubitril-valsartan (61.5%), they were all prescribed aldosterone antagonists, 10 (71.4%) were prescribed β-blockers and 10 (71.4%) were prescribed sodium-glucose cotransporter-2 (SGLT2) inhibitors. After a mean duration of treatment with vericiguat of 12.4±5.3 months, two (14.3%) patients presented to the emergency department, one with hypotension and the other with impaired kidney function, and a further two (14.3%) patients were hospitalised, one of whom had decompensated heart failure. At baseline, four (28.6%) patients presented non-sustained/sustained ventricular tachycardia; at study end, this decreased to two patients (50% of patients with ventricular arrhythmias at baseline). Additionally, in one patient (25% of patients with ventricular arrhythmias at baseline), there was a substantial reduction in the number of episodes of ventricular arrhythmia. At study end, seven patients achieved the target dose of 10 mg daily and one patient discontinued vericiguat owing to hypotension.</p><p><strong>Conclusions: </strong>Amongst patients with HFrEF and implantable cardioverter-defibrillator, vericiguat showed a good safety profile in addition to standard heart failure therapy, with low rates of adverse events. Moreover, a potential reduction in the risk of ventricular arrhythmias could also be obtained with vericiguat.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613959","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}

{"title":"Lecanemab for mild Alzheimer disease - is there a way forward?","authors":"Rajesh R Tampi","doi":"10.7573/dic.2024-12-2","DOIUrl":"10.7573/dic.2024-12-2","url":null,"abstract":"<p><p>This Editorial reviews data on the efficacy and adverse effects of lecanemab amongst individuals with mild Alzheimer disease. Additionally, the recent controversy regarding the rejection by the EMA of a marketing authorization request for lecanemab, followed by its subsequent approval, is also discussed. The need for thoughtful discussions regarding the risks and benefits of this medication as well as the importance of developing Appropriate Use Recommendations and/or national guidelines for the use of lecanemab are also highlighted.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613957","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}

{"title":"Is carvedilol superior to propranolol in patients with cirrhosis with portal hypertension: a systematic and meta-analysis.","authors":"Siddheesh Rajpurohit, Balaji Musunuri, Pooja Basthi Mohan, Ganesh Bhat, Shiran Shetty","doi":"10.7573/dic.2024-11-3","DOIUrl":"10.7573/dic.2024-11-3","url":null,"abstract":"<p><strong>Background: </strong>Carvedilol has shown greater potency than propranolol as a β-blocker in managing cardiac conditions. However, its efficacy in reducing portal hypertension (PHTN) in patients with cirrhosis remains unclear. This study evaluates the efficacy and safety of carvedilol compared with propranolol in managing PHTN.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted using PubMed, Scopus and Embase databases. Randomized controlled trials comparing carvedilol and propranolol were included. Primary outcomes were changes in hepatic venous pressure gradient, wedge hepatic venous pressure and free hepatic venous pressure. Secondary outcomes included heart rate, cardiac output and mean arterial pressure. Tertiary outcomes assessed adverse event incidences.</p><p><strong>Results: </strong>Six randomized controlled trials involving 336 patients (171 carvedilol, 165 propranolol) were analysed. Carvedilol significantly reduced hepatic venous pressure gradient (mean difference (MD): 2.22 (95% CI 1.82-2.62); <i>p</i><0.00001) and wedge hepatic venous pressure (MD: 2.38 (95% CI 1.92-2.84); <i>p</i><0.00001). Propranolol significantly reduced cardiac output (MD: -0.60 (95% CI -0.74 to -0.45); <i>p</i><0.00001). Mean arterial pressure was significantly lower in the carvedilol group (MD: 1.79 (95% CI 0.38-3.20); <i>p</i>=0.01). Adverse events, such as orthostatic hypotension and increased diuretic use, were more frequent in the carvedilol group but were manageable.</p><p><strong>Conclusion: </strong>Carvedilol demonstrates superior efficacy in reducing PHTN compared with propranolol, with a slightly higher but tolerable adverse event profile. It may be considered the first-line treatment for PHTN. Further research is needed to validate long-term benefits and safety.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523038","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}

{"title":"Obinutuzumab in membranous nephropathy: a potential game-changer in treatment.","authors":"Concetto Sessa, Dario Galeano, Luca Zanoli, Marco Delsante, Giovanni Maria Rossi, Walter Morale","doi":"10.7573/dic.2024-9-1","DOIUrl":"10.7573/dic.2024-9-1","url":null,"abstract":"<p><p>Membranous nephropathy (MN) is a kidney disease characterized by thickening of the glomerular basement membrane due to immune complex deposition, often leading to nephrotic syndrome and potentially progressing to end-stage renal disease. Traditional treatments, including corticosteroids and immunosuppressive agents, have significant side-effects and variable efficacy. Recently, obinutuzumab, a fully humanized monoclonal antibody targeting CD20, has emerged as a promising therapeutic option for MN. Herein, we review the pathophysiology of MN, the mechanism of action of obinutuzumab, clinical data supporting its use and highlight its potential as a game changer in MN treatment.</p>","PeriodicalId":11362,"journal":{"name":"Drugs in Context","volume":"14 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523040","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}