R. Adiwinata, Andrea Livina, H. Haroen, Linda Rotty, P. Harijanto, A. Nugroho, C. Hendratta, P. Lasut, Christian Kawengian
{"title":"Adverse Cutaneous Drug Reaction Following Granulocyte Colony-Stimulating Factor Administration in Nasopharynx Cancer Patient with Febrile Neutropenia: A Case Report","authors":"R. Adiwinata, Andrea Livina, H. Haroen, Linda Rotty, P. Harijanto, A. Nugroho, C. Hendratta, P. Lasut, Christian Kawengian","doi":"10.33371/ijoc.v16i3.878","DOIUrl":"https://doi.org/10.33371/ijoc.v16i3.878","url":null,"abstract":"Introduction: Several side effects may occur during cancer treatment such as myelosuppression following systemic chemotherapy, which is mainly manifested as neutropenia and is associated with increased infection risk. Febrile neutropenia is associated with a worse prognosis. Granulocyte colony-stimulating factor (G-CSF) may be given prophylactically before chemotherapy in selected cases or as adjuvant therapy in febrile neutropenia. G-CSF administration may be associated with several side effects, including skin manifestation. More rarely, G-CSF administration may induce acute febrile neutrophilic dermatosis is which known as a Sweet syndrome. Case Presentation: A 63-year-old man with nasopharyngeal cancer stage III on chemotherapy and radiotherapy came to our emergency department with a chief complaint of fever, coughing, and shortness of breath. He was diagnosed with community-acquired pneumonia and febrile neutropenia. His white blood cell (WBC) count was 200/mm3 . On the third day of hospitalization and G-CSF administration, he developed a rash and had skin desquamation mainly on his head including the scalp, face, lips, upper trunk, arms, and the surface of both hands. His follow-up laboratory result was WBC 8300/mm3 with a neutrophil count of 87%. Presumable Sweet syndrome diagnosis with differential diagnosis of other drug eruption reactions was made. Systemic and topical were administered, and G-CSF was stopped. Significant improvement was observed. Conclusions: G-CSF administration in febrile neutropenic cancer is generally safe; however, several adverse events may occur. Cutaneous adverse events following G-CSF administration should be recognized and treated accordingly. Sweet syndrome is rare but should be recognized as a possible G-CSF-induced drug skin complication.","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74737234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ventriculography Modality in Detection and Evaluation of Cardiotoxicity in Breast Cancer Patients Receiving Chemotherapy: A Literature Review","authors":"Tatyana Milenia, Budi Darmawan Budi Darmawan, Erwin Affandi Soeriadi Koesomah","doi":"10.33371/ijoc.v16i3.897","DOIUrl":"https://doi.org/10.33371/ijoc.v16i3.897","url":null,"abstract":"Background: Ventriculography or Multigated Acquisition Scanning (MUGA) has been the gold standard for baseline and serial assessment of Left Ventricular Ejection Fraction (LVEF) for cardiotoxicity since 1970. However, several modalities have been proposed to substitute Ventriculography. This study aimed to find out whether Ventriculography can still be considered the gold standard to monitor and detect cardiotoxicity before, during, and after administration of the chemotherapy and compare Ventriculography with Cardiac Magnetic Resonance (CMR) and Echocardiography (Echo).Methods: A literature review was done by searching original literature with keyword combinations on PubMed, Cochrane, and ClinicalKey in the past five years (2016–2021) with language restrictions only in English. Of 1,381 pieces of literature, five pieces are included to review in this study. Results: Ventriculography has high sensitivity and specificity in monitoring and detecting cardiotoxicity. Other modalities are CMR and Echo. CMR is more accurate although it is costly whilst Echo has high interobserver variability. Ventriculography and CMR have not shown interchangeable results. The literature also shows that Ventriculography could evaluate cardiotoxicity by assessing diastolic function. Conclusions: Ventriculography can still be used as the gold standard for monitoring cardiac function and detecting cardiotoxicity at an affordable price and with acceptable side effects. It recommends choosing only one modality for serial monitoring due to not interchangeable results among modalities","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84868641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nisrina Fakhiroh Hidayati Nublah, A. C. Marchianti, S. Winarso
{"title":"Analysis of Dominant Factors that Effect Delayed Diagnosis in Women with Breast Cancer in Baladhika Husada Hospital Jember","authors":"Nisrina Fakhiroh Hidayati Nublah, A. C. Marchianti, S. Winarso","doi":"10.33371/ijoc.v16i3.883","DOIUrl":"https://doi.org/10.33371/ijoc.v16i3.883","url":null,"abstract":"Background: Delayed diagnosis will have an impact on poor prognosis and complicate the treatment of breast cancer, contributing to low life expectancy for breast cancer patients. The study aims to find the factors that play the most role in influencing the behavior of women with breast cancer as well as dig deeper into the things behind the patient in making decisions that have an impact on delayed diagnosis. Methods: The study uses an analytical observational design with quantitative and qualitative mixed methods. Collecting data was conducted from April until June 2021 on 76 women with breast cancer at Baladhika Husada Hospital Jember based on classification into case and control groups. The sampling method used purposive sampling and the Lemeshow formula. Results: The results showed the factor that dominates the occurrence of delayed diagnosis is alternative medicine (p = 0.013; OR 11.03). Based on the results of the study, patients who undergo alternative medicine are 11 times more at risk of delayed diagnosis of breast cancer compared to patients who do not undergo alternative treatment.Conclusions: The patient’s background in choosing alternative medicine is supported by various reasons including concerns about medical treatment methods, concerns about nominal medical costs, and negative information from the surrounding. Thus, it can be concluded that the dominant factor affecting the delay in the diagnosis of women with breast cancer is alternative medicine.","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89036172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Fadhly, Rachmat Budi Santoso, Edward Usfie Harahap, Dewi Aisiyah Mukarramah, Kasih Rahardjo Djarot, I. A. Bramono, R. Rosalina, K. Kardinah, R. I. Putri
{"title":"The Debulking of Recurrent Right Testicular Seminoma with Anterolateral Thigh Flap Reconstruction","authors":"S. Fadhly, Rachmat Budi Santoso, Edward Usfie Harahap, Dewi Aisiyah Mukarramah, Kasih Rahardjo Djarot, I. A. Bramono, R. Rosalina, K. Kardinah, R. I. Putri","doi":"10.33371/ijoc.v16i3.902","DOIUrl":"https://doi.org/10.33371/ijoc.v16i3.902","url":null,"abstract":"Introduction: Radical orchidectomy is considered both a therapy and a part of the staging procedure. Stage I seminoma may be treated with orchiectomy alone while the remaining 15% to 20% may have a relapse if they receive no additional treatment during the five-year surveillance. Most recurrences occur within the first 2 years after diagnosis, and the location of the recurrence is typically in the retroperitoneum. This article aims to share the experience in the management of testicular seminoma recurrence in a multidisciplinary approach.Case Presentation: We are reporting a case of a 26-year-old male with a growing mass at the right scrotum just two months after right radical orchidectomy. This patient was previously treated with a stage I seminoma and underwent surveillance. Tumor debulking and right inguinoscrotal reconstruction using a pedicled anterolateral thigh (ALT) flap were done through collaborative surgery between urology and plastic surgery. However, according to National Comprehensive Cancer Network (NCCN), with the relapsed mass, this patient can be classified as having a stage III seminoma and considered as having a good-risk disease due to no evidence of non-pulmonary visceral metastasis. With the risk of bleomycin causing lung fibrosis, four cycles of etoposide and cisplatin can be considered the chemotherapy regimens for this patient. Evaluation after chemotherapy should be done by checking tumor markers and imaging studies.Conclusions: The reappearance of testicular seminoma in this patient unexpectedly occurred quite in a short period, that is in two months after surgery. Immediate multidisciplinary intervention by a urologist and plastic surgeon was done through tumor debulking with a wide incision margin and ALT flap reconstruction. Unfortunately, however, after the second month of follow-up, there was a bulging mass growing beneath the flap which needed further evaluation with ultrasonography to confirm the possibility of tumor recurrence or seroma. If tumor recurrence is confirmed, chemotherapy should be scheduled as soon as possible.","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90910598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Lamichhane, Suraj Suwal, R. Rana, S. Baral, Rishikesh Narayan Shrestha
{"title":"Complete Pathological Response in Stage IV Rectal Carcinoma: Proper Planning and Place is a Key","authors":"D. Lamichhane, Suraj Suwal, R. Rana, S. Baral, Rishikesh Narayan Shrestha","doi":"10.33371/ijoc.v16i2.880","DOIUrl":"https://doi.org/10.33371/ijoc.v16i2.880","url":null,"abstract":"Introduction: Liver metastasis is frequently encountered in patients with rectal cancer; it can be synchronous or metachronous. Some selected patients can be treated with curative intent using multimodality therapy under the care of a dedicated team in a comprehensive cancer center. However, the treatment is long and tiring for the treating team, the patient, and the relatives. Treatment is difficult to execute in a country like ours with a limited number of cancer centers. We present a patient from a remote village with stage IV disease, who completed all modalities of treatment with a favorable outcome. Case Presentation: A fifty-five-year-old man from a remote village presented to us with a complaint of per rectal bleeding. He was diagnosed with rectal carcinoma with solitary liver metastases. He received multimodality treatment in the form of chemotherapy, radiotherapy, and surgery. He attained a complete pathological response at both primary and metastatic sites.Conclusions: Good outcomes can be achieved in selected stage IV rectal cancer. This requires multimodality treatment and a proper plan, preferably in a comprehensive cancer center ","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75069293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Mughni, Albert Eko Hendrawijaya, Meira Dewi Kusuma
{"title":"Peutz–Jeghers Syndrome which Develops into Descending Sigmoid Colon Adenocarcinoma","authors":"A. Mughni, Albert Eko Hendrawijaya, Meira Dewi Kusuma","doi":"10.33371/ijoc.v16i2.822","DOIUrl":"https://doi.org/10.33371/ijoc.v16i2.822","url":null,"abstract":"Introduction: Peutz–Jeghers Syndrome (PJS) is an autosomal dominant hereditary condition mainly characterized by hamartomatous gastrointestinal (GI) polyps. Medical treatment is often sought due to complications that arise from the polyps. PJS polyps tend to be accompanied by freckling or hyperpigmentation on the lips, buccal mucosa, vulva, fingers, and toes. PJS is also associated with an increased risk for colorectal or extraintestinal tumors. Case Presentation: A 24-year-old female complained about a lump in her abdomen and constipation. The physical examination found hyperpigmentation on the lips and a hard and mobile mass on the left quadrant abdomen. We found a descending-sigmoid colon tumor with multiple polyps on all colon mucous and performed total colectomy and ileorectal anastomosis on the laparotomy operation. Two months later, Esophagogastroduodenoscopy revealed multiple polyps on Duodenum 1, II, and gaster. The colon tumor pathology result showed welldifferentiated adenocarcinoma. Conclusions: Peutz–Jeghers Syndrome (PJS) can develop into malignant intestinal tumors that require surgery for resection of the tumor. ","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"12 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82885352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bagaswoto Poedjomartono, Alan Anderson Bangun, Rifki Bachtiar
{"title":"Transcatheter Arterial Chemo Infusion/TACI for Breast Cancer Treatment: A Case Series","authors":"Bagaswoto Poedjomartono, Alan Anderson Bangun, Rifki Bachtiar","doi":"10.33371/ijoc.v16i2.874","DOIUrl":"https://doi.org/10.33371/ijoc.v16i2.874","url":null,"abstract":"Introduction: Locally advanced breast cancer (LABC) is a large breast tumor with infiltration to surrounding muscle, skin, and lymph nodes, and sometimes followed by inflammatory breast cancer, a rapidly growing cancer that shows a swollen red lump on the skin. Transcatheter intraarterial chemo infusion (TACI) is considered a palliative therapy for inoperable cancer. This case report shows the qualitative results of TACI on LABC in three patients. Case Presentation: Three female patients with LABC were diagnosed and treated at Dr. Sardjito General Hospital Yogyakarta over three years (2014–2016). The age ranged from 48 to 62 years, with a mean age of 56 years. Clinical features include lumps in breasts, soft tissue swelling, ulcers, dimpling of breast skin, nipple discharge, and pain sensation in the breast area. The three patients underwent the TACI procedure. Therapeutic response was evaluated by observing the clinical morphology of the lesions. Conclusions: TACI showed potency as an efficient and effective alternative palliative therapy in the three LABC cases presented. However, further study is needed to inspect TACI’s efficacy and adverse effects in breast cancer cases to be used as evidence-based medicine.","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76541260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gembong Satria Mahardhika, A. N. Ilmi, I. G. Arinton, Suharno
{"title":"Colchicine as A Potential Therapy in Hepatocellular Carcinoma: A Review","authors":"Gembong Satria Mahardhika, A. N. Ilmi, I. G. Arinton, Suharno","doi":"10.33371/ijoc.v16i2.844","DOIUrl":"https://doi.org/10.33371/ijoc.v16i2.844","url":null,"abstract":"Background: Liver cancer is the seventh most common cancer and the fourth leading cause of cancer death worldwide. Hepatocellular carcinoma (HCC) is a challenging disease to treat and has a poor prognosis. Colchicine is an old drug that was recently found to have anticancer activities towards several cancer cells. This article aimed to review the potential properties of colchicine as chemotherapy for HCC.Methods: The literature review was done by searching databases from PubMed, Cochrane, and ProQuest from June 4th to 26th, 2021. Full-text articles were searched by literature search strategies. The articles were screened by abstract and title. Studies that met the criteria were screened for full text.Results: Forty-six articles were identified, seven articles were screened for titles and abstracts, and three articles were excluded owing to full-text unavailability. Four articles were reviewed.Conclusions: The potential of colchicine as a preventive therapy in HCC needs to be further explored, and additional tests need to be done, especially in vivo. Larger population studies should also be done to evaluate the safety, usefulness, and feasibility of colchicine, especially in HCC.","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85954526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Kisnanto, D. Darlina, Arifin Musthafa, Fielda Djuita, H. N. E. Surniyantoro, I.K.H. Basri
{"title":"Adaptive Response of Peripheral Blood Lymphocytes in Medical Radiation Workers using the Comet Assay: A Preliminary Studyomet Assay: A Preliminary Study","authors":"T. Kisnanto, D. Darlina, Arifin Musthafa, Fielda Djuita, H. N. E. Surniyantoro, I.K.H. Basri","doi":"10.33371/ijoc.v16i2.854","DOIUrl":"https://doi.org/10.33371/ijoc.v16i2.854","url":null,"abstract":"Background: Gamma irradiation can cause DNA damage in single and double-strand breaks (SSBs & DSBs), especially in peripheral blood lymphocytes. Radiotherapy medical radiation workers can be exposed to gamma radiation related to their daily work. The comet assay is a sensitive method for analyzing DNA damage, especially SSBs. This study explores DNA damage in medical radiation workers’ peripheral blood lymphocytes as an adaptive response using the comet assay.Methods: Blood samples were obtained from four radiotherapy medical radiation workers as a case study (MRW) and two non-medical radiation workers as controls, and then irradiated with various doses of 0, 1, 1.5, and 2 Gy. Lymphocytes were isolated by histopaque and processed by comet assay on the slide under alkaline conditions. The imaging results were analyzed using the Casplab_1.2.3b2 software. The comet assay parameters observed were Tail Length (TL), % Tail DNA (T.DNA), Tail Moment (TM), and Olive Tail Moment (OTM). The one-way ANOVA method was used to analyze statistically between treatment groups. Results: Based on the study results, an increase in TL, T.DNA, TM, and OTM values in all samples was directly proportional to the increase in radiation dose. However, there was no significant difference (P > 0.05) between the MRW group and the control group on each parameter of the comet assay.Conclusions: From this study, it can be concluded that the level of DNA damage of lymphocyte cells as part of the adaptive response in the MRW and control groups was relatively similar after exposure at doses of 0, 1, 1.5, and 2 Gy.","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79242813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Indira Meidina Nafisa, Marhendra Satria Utama, M. Sunardi, Antony A. Adibrata
{"title":"Profile of Nasopharyngeal Cancer Patients who Underwent Radiotherapy in Dr. Hasan Sadikin General Hospital Bandung","authors":"Indira Meidina Nafisa, Marhendra Satria Utama, M. Sunardi, Antony A. Adibrata","doi":"10.33371/ijoc.v16i2.869","DOIUrl":"https://doi.org/10.33371/ijoc.v16i2.869","url":null,"abstract":"Background: Nasopharyngeal cancer (NPC) is a malignant epithelial tumor located in the nasopharynx and is the most common head and neck malignancy. This study aimed to find and describe the profile of NPC patients who undergo radiotherapy at Dr. Hasan Sadikin General Hospital, Bandung.Methods: This study was a descriptive study conducted at the Department of Radiology of Dr. Hasan Sadikin General Hospital, Bandung. This study employed a total sampling method and was done by observing patients’ status/medical records from January 1, 2018, to December 31, 2019, which was registered based on the Hospital-Based Cancer Registry (HBCR). The inclusion criteria were all patients diagnosed with NPC and undergone radiotherapy.Results: There were 274 records (19.74%) included as NPC from 1,388 records. This cancer was more frequent in men (70.4%), in the age group of 45–54 years (35.0%), non-active smokers (58.8%), entrepreneurs (23.0%), and those who came from West Priangan (36.1%). The most common chief complaint was an enlargement of neck lymph nodes (55.1%) at stage IVB (42.8%). Histopathological findings were dominated by undifferentiated squamous cell carcinoma (WHO III) (74.4%). Most of the patients were treated with chemoradiation (64.3%).Conclusions: NPC could happen to anyone with different background. This study found it was more frequent in men than women (2.3:1), in the fourth and fifth decade of life, in entrepreneurs followed by housewives, and even in non-active smokers. It also could happen in children to the elderly. Most patients came with an enlargement of neck lymph nodes as their chief complaint in the advanced stage and need chemoradiation as their treatment.","PeriodicalId":13489,"journal":{"name":"Indonesian Journal of Cancer","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90487795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}