International Forum of Allergy & Rhinology最新文献

{"title":"V-Y advancement flap for the repair of localized cutaneous defects following nasal closure in severe hereditary hemorrhagic telangiectasia.","authors":"Guled M Jama, Simon Gane","doi":"10.1002/alr.23415","DOIUrl":"https://doi.org/10.1002/alr.23415","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Rhinologic Society Expert Practice Statement: Indications and Recommendations for Septoplasty in Children","authors":"Austin S. Rose MD, MBA,&nbsp;Chadi A. Makary MD,&nbsp;Zachary M. Soler MD,&nbsp;Adam J. Kimple MD, PhD,&nbsp;Aaron N. Pearlman MD,&nbsp;Uma S. Ramaswamy MD,&nbsp;Michael Setzen MD,&nbsp;David A. Gudis MD","doi":"10.1002/alr.23397","DOIUrl":"10.1002/alr.23397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>The goal of this American Rhinologic Society Expert Practice Statement (EPS) is to provide recommendations and guidance through evidence-based consensus statements regarding pediatric septoplasty. This EPS was developed following the previously published methodology and approval process. The topics of interest included appropriate indications, safety and efficacy, timing, relevant quality of life instruments, and surgical techniques. Following a modified Delphi approach, six statements were developed, five of which reached consensus and one that did not. These statements and accompanying evidence are summarized along with an assessment of future needs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 8","pages":"1363-1374"},"PeriodicalIF":7.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-institutional validation of an AI-based sinus CT analytic platform with olfactory assessments","authors":"Conner J. Massey MD,&nbsp;Stephen M. Humphries PhD,&nbsp;Jess C. Mace MPH,&nbsp;Timothy L. Smith MD, MPH,&nbsp;Zachary M. Soler MD, MSc,&nbsp;Vijay R. Ramakrishnan MD","doi":"10.1002/alr.23410","DOIUrl":"10.1002/alr.23410","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key points</h3>\u0000 \u0000 <div>\u0000 <ul>\u0000 \u0000 <li>\u0000 <p>AI-based CT sinus analysis may have advantages over visual based systems, for example, Lund–Mackay score.</p>\u0000 </li>\u0000 \u0000 <li>\u0000 <p>Here, we show multi-institutional validation of an AI algorithm using novel OMC classification.</p>\u0000 </li>\u0000 \u0000 <li>\u0000 <p>Significant, robust correlations are seen between algorithm outputs and clinical outcomes.</p>\u0000 </li>\u0000 </ul>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 11","pages":"1806-1809"},"PeriodicalIF":7.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Rhinologic Society expert practice statement part 2: Postoperative precautions and management principles following endoscopic skull base surgery","authors":"Jennifer E. Douglas MD,&nbsp;Nithin D. Adappa MD,&nbsp;Garret Choby MD,&nbsp;Corinna G. Levine MD, MPH,&nbsp;Mindy R. Rabinowitz MD,&nbsp;Raj Sindwani MD,&nbsp;Eric W. Wang MD,&nbsp;Bradford A. Woodworth MD,&nbsp;Edward C. Kuan MD, MBA","doi":"10.1002/alr.23406","DOIUrl":"10.1002/alr.23406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence regarding postoperative precautions for patients following endoscopic skull base surgery for intradural pathology. These topics include the administration of postoperative nasal hygiene; patient mobilization and activity level; the resumption of continuous positive airway pressure in patients with obstructive sleep apnea; and the timing and capacity with which a patient may be subjected to barotrauma, such as air travel postoperatively. This EPS was developed following the recommended methodology and approval process as previously outlined. Given the diverse practices and limited agreement on the accepted principles regarding postoperative precautions for patients following skull base surgery, this EPS seeks to summarize the existing literature and provide clinically relevant guidance to bring clarity to these differing practice patterns. Following a modified Delphi approach, four statements were developed, all of which reached consensus. Because of the paucity of literature on these topics, these statements represent a summation of the limited literature and the experts’ opinions. These statements and the accompanying evidence are summarized below, along with an assessment of future needs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 11","pages":"1724-1738"},"PeriodicalIF":7.2,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/alr.23406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chitosan-based crosslinking for controlled topical drug release in rhinosinusitis","authors":"Do-Yeon Cho MD,&nbsp;Dong Jin Lim PhD,&nbsp;Olivia J. Kelly,&nbsp;Daniel Skinner BS,&nbsp;Shaoyan Zhang PhD,&nbsp;Martin P. Jones BS,&nbsp;Jessica Grayson MD,&nbsp;Bradford A. Woodworth MD","doi":"10.1002/alr.23413","DOIUrl":"10.1002/alr.23413","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key points</h3>\u0000 \u0000 <div>\u0000 <ul>\u0000 \u0000 <li>Chitosan is a promising drug delivery vector for therapeutics owing to its biocompatibility.</li>\u0000 \u0000 <li>Once crosslinked with chitosan, prolonged drug release was noted regardless of hydrophilicity.</li>\u0000 \u0000 <li>Hydrophilic drugs may require different strategies to obtain a sustained release profile.</li>\u0000 </ul>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 11","pages":"1802-1805"},"PeriodicalIF":7.2,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding “An eosinophil peroxidase activity assay predicts acute exacerbations in post-operative chronic rhinosinusitis”","authors":"Sanjeev Yadav MBBS, MS, DNB","doi":"10.1002/alr.23408","DOIUrl":"10.1002/alr.23408","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 8","pages":"1406-1407"},"PeriodicalIF":7.2,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"30° anteriorly tilted CT for visualizing the drainage pathway of the frontal sinus","authors":"Tomotaka Hemmi MD, PhD,&nbsp;Kazuhiro Nomura MD, PhD,&nbsp;Mitsuru Sugawara MD, PhD,&nbsp;Ryoukichi Ikeda MD, PhD","doi":"10.1002/alr.23404","DOIUrl":"10.1002/alr.23404","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key points</h3>\u0000 \u0000 <div>\u0000 <ul>\u0000 \u0000 <li>The optimal tilt for anteriorly tilted coronal CT was examined.</li>\u0000 \u0000 <li>A 30° anteriorly tilted coronal CT best visualized the frontal sinus drainage pathway.</li>\u0000 </ul>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 10","pages":"1656-1658"},"PeriodicalIF":7.2,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Matrix metalloproteinase-11 regulates inverted papilloma epithelial cell migration and invasion","authors":"Kush Panara MD,&nbsp;Tan Li Hui PhD,&nbsp;Deepa Keshari PhD,&nbsp;Charles C. L. Tong MD,&nbsp;James N. Palmer MD,&nbsp;Nithin D. Adappa MD,&nbsp;Jennifer E. Douglas MD,&nbsp;Noam A. Cohen MD, PhD,&nbsp;Michael A. Kohanski MD, PhD","doi":"10.1002/alr.23405","DOIUrl":"10.1002/alr.23405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inverted papilloma (IP) is a benign tumor characterized by epithelial proliferation, which has the potential for malignant transformation. However, the mechanisms driving this transformation are poorly defined. Matrix metalloproteinase-11 (MMP-11), a regulator of the tumor microenvironment that degrades extracellular matrix, is upregulated in IP with dysplasia. Here, we aim to investigate the role of MMP-11 in IP epithelial migration and invasion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Human IP and contralateral normal sinus mucosa (control) samples were obtained. IP-derived epithelial cultures and normal mucosa-derived epithelial cultures were grown in air‒liquid interface, followed by immunostaining to assess MMP-11 expression in IP. Migration and invasion assays were used to evaluate the role of an anti-MMP-11 antibody on IP and control epithelial cultures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>IP-derived cultures demonstrated strong MMP-11 expression compared to controls. Treatment with anti-MMP-11 blocking antibody significantly reduced epithelial migration only in IP-derived cells compared to non-treated IP cells, as seen by incomplete wound closure and reduced transepithelial resistance. In addition, inhibition of MMP-11 reduced IP epithelia's ability to invade through collagen-coated transwells, suggesting that MMP-11 plays a role in invasion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We established an in vitro model to study IP-derived epithelial cells. MMP-11 is uniquely expressed in IP epithelial cultures compared to control epithelial cultures. Inhibition of MMP-11 limits IP epithelial migration and invasion to levels similar to that of normal sinus mucosa. MMP-11 does not appear to have a functional role in normal sinus epithelium, suggesting that MMP-11 has a role in malignant transformation of IP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 11","pages":"1714-1723"},"PeriodicalIF":7.2,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/alr.23405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis","authors":"Ethan J. Han BS,&nbsp;Christine M. Liu BS,&nbsp;Jakob L. Fischer MD,&nbsp;Jess C. Mace MPH, CCRP,&nbsp;Karolin Markarian BS,&nbsp;Jeremiah A. Alt MD, PhD,&nbsp;Todd E. Bodner PhD,&nbsp;Naweed I. Chowdhury MD, MPH,&nbsp;Patricia H. Eshaghian MD,&nbsp;Yuqing A. Gao MD,&nbsp;Anne E. Getz MD,&nbsp;Peter H. Hwang MD,&nbsp;Ashoke Khanwalkar MD,&nbsp;Adam J. Kimple MD, PhD,&nbsp;Jivianne T. Lee MD,&nbsp;Douglas A. Li MD,&nbsp;Meghan Norris PA,&nbsp;Jayakar V. Nayak MD, PhD,&nbsp;Cameran Owens PA,&nbsp;Zara M. Patel MD,&nbsp;Katie Poch BS,&nbsp;Rodney J. Schlosser MD,&nbsp;Kristine A. Smith MD,&nbsp;Timothy L. Smith MD, MPH,&nbsp;Zachary M. Soler MD, MSc,&nbsp;Jeffrey D. Suh MD,&nbsp;Grant A. Turner MD,&nbsp;Marilene B. Wang MD,&nbsp;Jennifer L. Taylor-Cousar MD, MSCS,&nbsp;Milene T. Saavedra MD,&nbsp;Daniel M. Beswick MD","doi":"10.1002/alr.23402","DOIUrl":"10.1002/alr.23402","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sociodemographic status (SDS) including race/ethnicity and socioeconomic status as approximated by education, income, and insurance status impact pulmonary disease in people with cystic fibrosis (PwCF). The relationship between SDS and chronic rhinosinusitis (CRS) remains understudied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a prospective, multi-institutional study, adult PwCF completed the 22-Question SinoNasal Outcome Test (SNOT-22), Smell Identification Test (SIT), Questionnaire of Olfactory Disorder Negative Statements (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Lund–Kennedy scores, sinus computed tomography, and clinical data were collected. Data were analyzed across race/ethnicity, sex, and socioeconomic factors using multivariate regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-three PwCF participated with a mean age of 34.7 ± 10.9 years and 49 (67.1%) were female. Linear regression identified that elexacaftor/tezacaftor/ivacaftor (ETI) use (<i>β</i> = ‒4.09, 95% confidence interval [CI] [‒6.08, ‒2.11], <i>p</i> &lt; 0.001), female sex (<i>β</i> = ‒2.14, 95% CI [‒4.11, ‒0.17], <i>p</i> = 0.034), and increasing age (<i>β</i> = ‒0.14, 95% CI [‒0.22, ‒0.05], <i>p</i> = 0.003) were associated with lower/better endoscopy scores. Private health insurance (<i>β</i> = 17.76, 95% CI [5.20, 30.32], <i>p</i> = 0.006) and &gt;16 educational years (<i>β</i> = 13.50, 95% CI [2.21, 24.80], <i>p</i> = 0.020) were associated with higher baseline percent predicted forced expiratory volume in one second (ppFEV₁). Medicaid/Medicare insurance was associated with worse endoscopy scores, CFQ-R respiratory scores, and ppFEV₁ (all <i>p</i> &lt; 0.017), and Hispanic/Latino ethnicity was associated with worse SNOT-22 scores (<i>p</i> = 0.047), prior to adjustment for other cofactors. No other SDS factors were associated with SNOT-22, QOD-NS, or SIT scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Differences in objective measures of CRS severity exist among PwCF related to sex, age, and ETI use. Variant status and race did not influence patient-reported CRS severity measures or olfaction in this study. Understanding how these factors impact response to treatment may improve care disparities among PwCF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trials</h3>\u0000 \u0000 <p>NCT04469439</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 11","pages":"1700-1713"},"PeriodicalIF":7.2,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of elexacaftor/tezacaftor/ivacaftor CFTR modulator therapy on rates of endoscopic sinus surgery in cystic fibrosis","authors":"Graham Pingree BA,&nbsp;Mihai Bentan BS,&nbsp;Thomas Fitzpatrick MD,&nbsp;Theodore Schuman MD","doi":"10.1002/alr.23400","DOIUrl":"10.1002/alr.23400","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Elexacaftor/tezacaftor/ivacaftor (ETI), a combination cystic fibrosis transmembrane receptor (CFTR) modulator, has demonstrated improved pulmonary outcomes in individuals with cystic fibrosis (CF). However, ETI's impact on functional endoscopic sinus surgery (FESS) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The TriNetX Analytics Research Network, consisting of 120 million global de-identified electronic medical records, was queried from 2012 to 2023 for subjects with CF who underwent sinus surgery.¹ Patients on ETI prior to FESS (<i>n</i> = 6,056) were propensity score matched to control individuals with CF not on CFTR modulators (<i>n</i> = 37,906) and those on other FDA-approved CFTR modulators (tezacaftor/ivacaftor, lumacaftor/ivacaftor, and ivacaftor) (<i>n</i> = 2437) based on relevant factors. The primary outcome was the absolute risk reduction (ARR) of undergoing FESS. Secondary outcomes included ARR of CF-related pulmonary exacerbations and hospital admission from 0 to 6, 6 to 12, and 12 to 24 months following FESS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ETI use demonstrated a significant ARR for FESS when compared to CF patients not on CFTR modulators (2.12%; 95% confidence interval [CI] 1.5–2.75; <i>p</i>-value &lt; 0.0001) and those on other CFTR modulators (4.7%; 95% CI 3.54–5.85; <i>p</i>-value &lt; 0.0001). No significant differences occurred in secondary outcomes between ETI and non-CFTR modulator groups, except for reduced CF-related pulmonary exacerbations from 0 to 6 months post-FESS. Additionally, a significant reduction in pulmonary exacerbations was observed at all time points and hospital admissions within 6 months following FESS compared to those using other CFTR modulators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a large dataset, CF patients on ETI demonstrated significantly reduced risk of FESS, pulmonary exacerbations, and hospital admission compared to patients not on CFTR modulators or those on other CFTR modulators, suggesting improved sinonasal disease and overall health status in CF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 11","pages":"1692-1699"},"PeriodicalIF":7.2,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/alr.23400","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}