Rheumatology最新文献

{"title":"Heliotrope-like rash in a febrile child: think of Kawasaki disease.","authors":"Munish Arora, Prabal Barman, Animesh Sahu, Ankur Kumar Jindal, Surjit Singh","doi":"10.1093/rheumatology/kead577","DOIUrl":"10.1093/rheumatology/kead577","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"906-907"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71485457","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":"Comment on: Enhancing current guidance for psoriatic arthritis and its comorbidities: recommendations from an expert consensus panel.","authors":"Maria I Zervou, George N Goulielmos","doi":"10.1093/rheumatology/keae291","DOIUrl":"10.1093/rheumatology/keae291","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"904-905"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958927","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":"A case of refractory IgG4-related disease successfully treated with daratumumab and lenalidomide.","authors":"Denis Coulomb, Vanessa Szablewski, Nicolas Robert, Anne-Marie Dupuy, Rayane Berrahouane, Radjiv Goulabchand, Jérôme Moreaux, Alexandre Thibault Jacques Maria, Charles Herbaux","doi":"10.1093/rheumatology/keae448","DOIUrl":"10.1093/rheumatology/keae448","url":null,"abstract":"","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"895-897"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047072","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":"Comparison of retention of biologics in Japanese patients with elderly-onset rheumatoid arthritis-the ANSWER cohort study.","authors":"Sadao Jinno, Akira Onishi, Shuhei Hattori, Maureen Dubreuil, Yo Ueda, Keisuke Nishimura, Takaichi Okano, Hirotaka Yamada, Wataru Yamamoto, Koichi Murata, Hideo Onizawa, Kosuke Ebina, Yuichi Maeda, Yonsu Son, Hideki Amuro, Ryota Hara, Kenichiro Hata, Hideyuki Shiba, Masaki Katayama, Ryu Watanabe, Motomu Hashimoto, Jun Saegusa","doi":"10.1093/rheumatology/keae081","DOIUrl":"10.1093/rheumatology/keae081","url":null,"abstract":"<p><strong>Objectives: </strong>This multicentre, retrospective study aimed to compare retention and reasons for discontinuation between Janus kinase inhibitors (JAKi) and biologic DMARDs in patients with elderly-onset rheumatoid arthritis (EORA).</p><p><strong>Methods: </strong>Patients with RA enrolled in a Japanese multicentre observational registry between 2015 and 2022 were included. EORA was defined as RA with onset at age 60 or over. To adjust confounding factors by indication for initiation of TNF inhibitors (TNFi), IL-6 inhibitors (IL-6i), cytotoxic T-lymphocyte associated antigen 4 immunoglobulin (CTLA4-Ig) blockers, or JAKi, a propensity score based on baseline characteristics was used to compare drug retention. To assess the reasons for discontinuation, retention rates for ineffectiveness, adverse events and remission were analysed as secondary outcomes.</p><p><strong>Results: </strong>A total of 572 patients with 835 treatment courses were identified (314 TNFi, 175 IL-6i, 228 CTLA4-Ig and 118 JAKi). After adjusting for differences in baseline characteristics, drug retention was significantly higher for IL-6i (hazard ratio [HR] = 0.38; 95% CI: 0.27, 0.55; P < 0.01) as compared with TNFi. Discontinuation due to lack of effectiveness was lower with JAKi (HR = 0.38; 95% CI: 0.22, 0.66; P < 0.01) and IL-6i (HR = 0.29; 95% CI: 0.19, 0.46; P < 0.01) as compared with TNFi although CTLA4-Ig had a similar HR to TNFi. The adjusted incidence of discontinuation due to adverse events was higher for JAKi (HR = 2.86; 95% CI: 1.46, 5.59; P < 0.01) than for TNFi.</p><p><strong>Conclusion: </strong>In EORA patients, IL-6i and JAKi had longer retention and less discontinuation due to ineffectiveness than TNFi. The potential risks of JAKi should be approached with an individualized perspective.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"509-516"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139692843","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":"Diagnostic value of a novel salivary gland ultrasound scoring system in IgG4-related sialadenitis.","authors":"Mingzhu Zhou, Yanying Liu, Shanshan Zhang, Xiaoyan Xie, Wei Li, Li Cui, Hanxue Zhao, Sumei Tang, Xiangdong Hu, Shanshan Wu, Jiajing Peng, Huilian Huang, Wei Ren, Ying Zhang, Ning Xu, Pengfei Sun, Yiqun Liu, Zuyan Zhang, Guangyan Yu, Yin Su","doi":"10.1093/rheumatology/keae121","DOIUrl":"10.1093/rheumatology/keae121","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a novel ultrasound scoring system for the major salivary glands in patients with immunoglobulin G4-related sialadenitis (IgG4-RS) and assess its diagnostic value in a multicentre cohort of Chinese patients.</p><p><strong>Methods: </strong>Twenty clinicians (rheumatologists, stomatologists and radiologists) participated. The study was conducted in four steps: (i) defining the ultrasonography (US) elements, (ii) developing a novel ultrasound scoring system for US of the salivary glands, (iii) evaluation of inter- and intra-reader reliabilities using the new ultrasound scoring system, and (iv) assessing the diagnostic value of this novel ultrasound scoring system in IgG4-RS patients in a Chinese multicentre cohort.</p><p><strong>Results: </strong>A novel ultrasound scoring system for the salivary glands was developed, with total scores ranging from 0 to 34. The inter- and intra-reader reliabilities of the ultrasound scoring system were excellent (0.972 and 0.940, respectively). A total of 470 people were recruited in this study; 187 patients were diagnosed with IgG4-RS, and the remaining 283 people were diagnosed with non-IgG4-RS. Patients with IgG4-RS group had significantly higher US scores than the non-IgG4-RS group (mean US score = 16 vs 4, P < 0.001). The calculated area under the curve for the total US score was 0.852 (95% CI: 0.814, 0.891). The total US scores ≥9 showed a sensitivity of 75.4% and a specificity of 91.9%. Association analysis showed a positive correlation between total US scores and serum IgG4 levels and hypocomplementaemia (r = 0.221 and r = 0.349, respectively; P = 0.002 and P < 0.001, respectively) and a negative correlation between total US scores and serum C3 and C4 levels (r = -0.210 and r = -0.303, respectively; P = 0.005 and P < 0.001, respectively).</p><p><strong>Conclusion: </strong>A novel semiquantitative ultrasound scoring system for patients with IgG4-RS was developed, with good diagnostic performance. The inter- and intra-reader reliabilities were excellent. US scores were correlated with IgG4, C3 and C4 levels and hypocomplementaemia.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"747-755"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013179","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":"A new ex vivo human model of osteoarthritis cartilage calcification.","authors":"Elodie Faure, Julien Wegrzyn, Ilaria Bernabei, Guillaume Falgayrac, Nicolas Bertheaume, Tristan Pascart, Thomas Hugle, Nathalie Busso, Sonia Nasi","doi":"10.1093/rheumatology/keae064","DOIUrl":"10.1093/rheumatology/keae064","url":null,"abstract":"<p><strong>Objective: </strong>Cartilage pathologic calcification is a hallmark of osteoarthritis (OA). Here, we aimed to describe a new ex vivo human model to study the progression of cartilage calcification.</p><p><strong>Method: </strong>Cartilage explants (n = 11), as well as primary chondrocytes (n = 3), were obtained from OA patients undergoing knee replacement. Explants and chondrocytes were cultured in control (NT) or calcification (CM) medium (supplemented with ascorbic acid and β-glycerophosphate). Calcification was evaluated by micro-CT scan at day 0 and 21 in explants, and by Alizarin red staining in chondrocyte monolayers. Raman spectrometry allowed characterization of the crystal type. Interleukin-6 (IL-6) secretion in explant and cell supernatants was measured by ELISA. Finally, matrix degradation was evaluated by Safranin-O staining of explant sections and by glycosaminoglycans (GAG) released in supernatants.</p><p><strong>Results: </strong>Micro-CT scan showed calcifications in all explants at baseline (day 0), which in the CM group increased significantly in number and size after 21 days compared with the NT group. Raman spectrometry revealed that crystals were exclusively basic calcium phosphate crystals (carbonated hydroxyapatite) both in NT and CM. IL-6 secretion was significantly increased in calcifying conditions. Finally, CM significantly increased cartilage catabolism as assessed by decreased Safranin-O staining of tissue explants and increased GAG release in supernatants. CM effects (enhanced calcification, IL-6 secretion and proteoglycans turn-over) were recapitulated in vitro in OA chondrocytes.</p><p><strong>Conclusions: </strong>We have described a new ex vivo human model of cartilage calcification that can summarize the triad of events seen during osteoarthritis progression, i.e. calcification, inflammation and cartilage degradation. This model will allow the identification of new anti-calcification compounds.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"880-885"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642858","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":"Seven-year follow-up atherosclerotic plaque progression in patients with antiphospholipid syndrome versus diabetes mellitus and healthy controls.","authors":"Gerasimos Evangelatos, Nikolaos Tentolouris, Petros P Sfikakis, Maria G Tektonidou","doi":"10.1093/rheumatology/keae097","DOIUrl":"10.1093/rheumatology/keae097","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with antiphospholipid syndrome (APS) carry a substantial burden of cardiovascular disease and subclinical atherosclerosis. We aimed to assess a 7-year follow-up atherosclerotic plaque progression in APS patients versus diabetes mellitus (DM) and healthy controls (HC).</p><p><strong>Methods: </strong>Eighty-six patients with thrombotic APS, 86 with DM and 86 HC (all age- and sex-matched) who underwent a baseline ultrasound of carotid and femoral arteries were invited for a 7-year follow-up ultrasonography examination. We compared atherosclerosis progression among the three groups and examined determinants of plaque progression in APS patients.</p><p><strong>Results: </strong>Sixty-four APS patients (75% females, 43.8% with primary APS), 58 patients with DM and 66 HC were included in the 7-year ultrasound re-evaluation. New plaque was detected in 51.6%, 36.2% and 25.8% of APS, DM and HC subjects, respectively. After adjusting for traditional cardiovascular risk factors (CVRFs) and baseline plaque presence, APS patients showed a 3-fold (OR = 3.07, P = 0.007) higher risk for atherosclerosis progression versus HC and 2-fold (OR = 2.25, P = 0.047) higher risk than DM patients. In multivariate analysis in the APS group, plaque progression was independently associated with systemic lupus erythematosus (SLE) co-existence (OR = 7.78, P = 0.005) and number of CVRFs (OR = 3.02, P = 0.002), after adjusting for disease-related parameters and CVRF-related medications. Sustained low-density lipoprotein target attainment reduced plaque progression risk (OR = 0.34, P = 0.021).</p><p><strong>Conclusion: </strong>Half of APS patients develop new atherosclerotic plaques over a 7-year follow-up, having a three-times higher risk versus HC. Concomitant SLE and number of traditional CVRFs are associated with plaque progression, supporting the need for thorough CVRF assessment and control.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"836-841"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698185","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":"Improvement of high-density lipoprotein atheroprotective properties in patients with systemic lupus erythematosus after belimumab treatment.","authors":"Anastasia-Georgia Dedemadi, Christina Gkolfinopoulou, Dimitra Nikoleri, Myrto Nikoloudaki, Hanna Ruhanen, Minna Holopainen, Reijo Käkelä, Georgia Christopoulou, Stavros Bournazos, Pantelis Constantoulakis, Prodromos Sidiropoulos, George Bertsias, Angeliki Chroni","doi":"10.1093/rheumatology/keae192","DOIUrl":"10.1093/rheumatology/keae192","url":null,"abstract":"<p><strong>Objective: </strong>Chronic inflammatory diseases, like Systemic Lupus Erythematosus (SLE), carry an increased risk for atherosclerosis and cardiovascular events, accompanied by impairment of atheroprotective properties of high-density lipoprotein (HDL). In SLE, serum B cell-activating factor (BAFF), a cytokine implicated in disease progression, has been correlated with subclinical atherosclerosis. We investigated the impact of treatment with belimumab -an anti-BAFF monoclonal antibody- on HDL atheroprotective properties and composition in SLE patients.</p><p><strong>Methods: </strong>Serum samples were collected from 35 SLE patients with active disease despite conventional therapy, before and after 6-month add-on treatment with belimumab, and 26 matched healthy individuals. We measured cholesterol efflux and antioxidant capacities, paraoxonase-1 (PON1) activity, serum amyloid A1 (SAA1), myeloperoxidase (MPO) and lipid peroxidation product levels of HDL. LC-MS/MS was performed to analyse the HDL lipidome.</p><p><strong>Results: </strong>Following treatment with belimumab, cholesterol efflux and antioxidant capacities of HDL were significantly increased in SLE patients and restored to levels of control subjects. HDL-associated PON1 activity was also increased, whereas lipid peroxidation products were decreased following treatment. HDL cholesterol efflux and antioxidant capacities correlated negatively with the disease activity. Changes were noted in the HDL lipidome of SLE patients following belimumab treatment, as well as between SLE patients and healthy individuals, and specific changes in lipid species correlated with functional parameters of HDL.</p><p><strong>Conclusions: </strong>HDL of SLE patients with active disease displays impaired atheroprotective properties accompanied by distinct lipidomic signatures compared with controls. Belimumab treatment may improve the HDL atheroprotective properties and modify the HDL lipidomic signature in SLE patients, thus potentially mitigating atherosclerosis development.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"648-657"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185445","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":"Lupus Low Disease Activity State and organ damage in relation to quality of life in systemic lupus erythematosus: a cohort study with up to 11 years of follow-up.","authors":"Ioannis Parodis, Thomas Haugli-Stephens, Annica Dominicus, Daniel Eek, Christopher Sjöwall","doi":"10.1093/rheumatology/keae120","DOIUrl":"10.1093/rheumatology/keae120","url":null,"abstract":"<p><strong>Objectives: </strong>Beyond prevention of organ damage, treatment goals in SLE include optimization of health-related quality of life (HRQoL). The Lupus Low Disease Activity State (LLDAS) has received increasing attention as a goal whenever remission cannot be achieved. How SLE disease activity, organ damage and LLDAS attainment relate to patient-reported outcomes (PROs) is not fully explored, which formed the scope of this investigation.</p><p><strong>Methods: </strong>We included 327 patients with SLE from a tertiary referral centre. Longitudinal registrations of disease activity using SLEDAI-2K and physician global assessment (PhGA), organ damage using the SLICC/ACR damage index (SDI), pharmacotherapies, EQ-5D-3L data, as well as visual analogue scale (VAS) scores for fatigue, pain and overall SLE-related health state over a median follow-up time of 8.5 years were analysed.</p><p><strong>Results: </strong>In the overall population, as well as subgroups of patients with recent-onset SLE and those with clinically active, autoantibody-positive disease, LLDAS attainment, lower PhGA and lower clinical SLEDAI-2K scores were associated with favourable HRQoL by EQ-5D-3L and VAS assessments, while increasing SDI scores were associated with poor PROs except for fatigue in the overall population. PROs were further enhanced by being in LLDAS sustainedly. In fully adjusted models of the entire study population, LLDAS attainment and lower disease activity were associated with favourable PROs, irrespective of SDI.</p><p><strong>Conclusion: </strong>In one of the longest observational studies to date, we demonstrated that low disease activity and being sustainedly in LLDAS were coupled with favourable HRQoL, pain, fatigue and overall health experience, irrespective of organ damage.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"639-647"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139944385","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":"Enhancing current guidance for psoriatic arthritis and its comorbidities: recommendations from an expert consensus panel.","authors":"Laura C Coates, Marwan Bukhari, Antoni Chan, Ernest Choy, James Galloway, Nicola Gullick, Alison Kent, Laura Savage, Stefan Siebert, William Tillett, Natasha Wood, Philip G Conaghan","doi":"10.1093/rheumatology/keae172","DOIUrl":"10.1093/rheumatology/keae172","url":null,"abstract":"<p><strong>Objectives: </strong>The existing guidelines for PsA cover many aspects of management. Some gaps remain relating to routine practice application. An expert group aimed to enhance the current guidance and develop recommendations for clinical practice that are complementary to the existing guidelines.</p><p><strong>Methods: </strong>A steering committee comprising experienced, research-active clinicians in rheumatology, dermatology and primary care agreed on themes and relevant questions. A targeted literature review of PubMed and Embase following a PICO framework was conducted. At a second meeting, recommendations were drafted, and subsequently an extended faculty comprising rheumatologists, dermatologists, primary care clinicians, specialist nurses, allied health professionals, non-clinical academic participants and members of the Brit-PACT patient group, was recruited. Consensus was achieved via an online voting platform at which 75% of respondents agreed in the range of 7-9 on a 9-point scale.</p><p><strong>Results: </strong>The guidance comprised 34 statements covering four PsA themes. Diagnosis focused on strategies for identifying PsA early and referring appropriately, assessment of diagnostic indicators, use of screening tools and use of imaging. Disease assessment centred on holistic consideration of disease activity, physical functioning and impact from a patient perspective, and on how to implement shared decision-making. For comorbidities, recommendations included specific guidance on high-impact conditions such as depression and obesity. Management statements (which excluded extant guidance on pharmacological therapies) recommended multidisciplinary team working, implementation of lifestyle modifications and treat-to-target strategies. Minimizing CS use was recommended where feasible.</p><p><strong>Conclusion: </strong>The consensus group have made evidence-based best-practice recommendations for the management of PsA to enhance the existing guidelines.</p>","PeriodicalId":21255,"journal":{"name":"Rheumatology","volume":" ","pages":"561-573"},"PeriodicalIF":4.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137217","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}