Journal of Psoriasis and Psoriatic Arthritis最新文献

{"title":"2024 Reviewer Thank You.","authors":"","doi":"10.1177/24755303251319674","DOIUrl":"https://doi.org/10.1177/24755303251319674","url":null,"abstract":"","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303251319674"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383847","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":"Management of Chronic Generalized Pustular Psoriasis: A Review and Expert Opinion.","authors":"Boni Elewski, Mark G Lebwohl","doi":"10.1177/24755303251318976","DOIUrl":"10.1177/24755303251318976","url":null,"abstract":"<p><p><b>Introduction:</b> Generalized pustular psoriasis (GPP) is a rare, chronic inflammatory skin disease characterized by persistent symptoms and sudden flares of painful sterile pustules, sometimes accompanied by systemic inflammation. Patients with GPP experience chronic disease burden even when not experiencing flares. There is an unmet need for guidelines on continuous long-term management of this disease. <b>Areas Covered:</b> This review summarizes existing literature describing the chronic disease burden of GPP, the persistence of symptoms and effects on quality of life (QoL) when patients are not experiencing a flare, the recurring nature of GPP flares, and the high prevalence of chronic comorbidities. We also present an overview of results from the EFFISAYIL® 2 study, which was the first randomized, placebo-controlled clinical trial to systematically evaluate continuous management with subcutaneous spesolimab, a first-in-class anti-interleukin-36 receptor monoclonal antibody specifically designed to treat GPP. <b>Expert Opinion:</b> An unmet need in GPP is the establishment of guidelines for chronic disease management, including measures for treating GPP between flares, flare prevention, and long-term disease control. Treatment strategies should mitigate both the persistent disease burden and potentially life-threatening flare episodes. Intravenous spesolimab is currently the only FDA-approved medication to treat GPP flares, and subcutaneous spesolimab is the only FDA-approved medication to treat GPP when patients are not experiencing a flare. Guidelines should aim to advance the recognition of GPP as a chronic disease and emphasize prompt diagnosis and timely access to FDA-approved therapies according to the diagnostic criteria established by the International Psoriasis Council and the National Psoriasis Foundation.</p>","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303251318976"},"PeriodicalIF":0.0,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190798","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":"Healthcare Resource Utilization Among Patients With Generalized Pustular Psoriasis: The Impact of Flares and Disease Severity.","authors":"Megan H Noe, Layla Lavasani, Lawrence Rasouliyan, Marianne Laouri, Jamie L W Rhoads","doi":"10.1177/24755303251317193","DOIUrl":"10.1177/24755303251317193","url":null,"abstract":"<p><strong>Background: </strong>Generalized pustular psoriasis (GPP) is a rare, chronic, often unpredictable, severe multisystemic autoinflammatory skin disease from which patients can experience flares, episodes of widespread eruptions of painful, sterile pustules often accompanied by systemic symptoms. The impact of GPP flares and underlying GPP severity on the healthcare resource utilization (HCRU) is not well characterized.</p><p><strong>Objective: </strong>To quantify HCRU among US GPP patients by flare status and underlying severity.</p><p><strong>Methods: </strong>Outpatient electronic health record (EHR) data (2017-2023) from the OMNY Health platform were linked with claims. Patients were indexed at first EHR GPP diagnosis code and followed for 1 year. GPP flares were identified from a previously developed algorithm. All-cause hospitalizations, emergency department/urgent care (ED/UC), and outpatient visits were summarized by flare status and underlying severity. Pharmacy and total gross charges were described by number of flares.</p><p><strong>Results: </strong>A total of 335 patients were included. Patients who flared in the follow-up period (n = 205) had more hospitalizations than patients who did not flare (n = 130; 12.2% vs 6.9%; mean: 0.26 vs 0.09). ED/UC visits were similar between groups (22.9% vs 27.7%; mean: 0.54 vs 0.45), while outpatient visits were greater among patients who did not flare (69.8% vs 78.5%; mean: 5.37 vs 6.56). For patients with 0, 1, and ≥2 flares with HCRU, mean pharmacy charges ($19,887, $25,180, and $57,674, respectively) and total gross charges ($29,196, $40,079, and $52,940, respectively) increased monotonically.</p><p><strong>Conclusion: </strong>GPP patients who flared and had more severe disease had greater HCRU and charges.</p>","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303251317193"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047793","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":"Criteria for Identifying Candidates for Systemic Psoriasis Treatment in the Real World: Application of the International Psoriasis Council Guidelines in Patients in North America.","authors":"Bruce Strober, Yichen Zhong, Adam Sima, Alicia Beeghly, Thomas Eckmann, Eugene Balagula, Joe Zhuo, Mark Lebwohl","doi":"10.1177/24755303241302070","DOIUrl":"10.1177/24755303241302070","url":null,"abstract":"<p><strong>Background: </strong>The International Psoriasis Council (IPC) updated the classification of psoriasis severity to guide clinical decision-making. According to IPC guidelines, patients are considered candidates for systemic therapy when body surface area (BSA) is >10%, when lesions affect special body areas (ie, face, palms, soles, genitals, scalp, or nails), or when topical therapy fails to control symptoms.</p><p><strong>Objective: </strong>To evaluate patient candidacy for systemic therapy in real-world settings, according to disease severity criteria.</p><p><strong>Methods: </strong>This cross-sectional study included systemic treatment-naive patients from the CorEvitas Psoriasis Registry who initiated systemic treatment at Registry visits between April 2015 and April 2023. Based on IPC criteria, systemic therapy candidates were identified, and data on demographics and clinical characteristics, including disease severity indicators (ie, BSA and Psoriasis Area Severity Index [PASI] scores) and patient-reported outcome measures, were collected and descriptively summarized.</p><p><strong>Results: </strong>The analysis included 2739 systemic therapy initiators with plaque psoriasis, of whom 82.7% met IPC criteria for systemic therapy. Of the 2265 systemic therapy candidates, 56.2% had a BSA >10%, 53.2% had a history of psoriasis affecting special areas, and 55.2% had prior but not current use of topical therapy. Notably, 71.0% of candidates for systemic therapy had PASI scores ≤12.</p><p><strong>Conclusion: </strong>In this large real-world study, most patients with psoriasis who initiated systemic therapy met the IPC disease severity criteria to do so. Disease severity categorization based on PASI scores and BSA percentage alone may not adequately capture all patients who might be candidates for systemic psoriasis treatment.</p><p><strong>Clinicaltrialsgov: </strong>NCT02707341.</p>","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303241302070"},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710205","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":"The FORWARD Psoriasis Registry: Patient-Reported Outcomes in a Novel Psoriasis Registry and Comparison of Traditional, Dermatologist-Led Enrollment With Web-Based Patient Enrollment.","authors":"William B Song, Kaleb Michaud, Sarah L Lonowski, Mark Kaufmann, Ryan Pearson, James Q Del Rosso, Rebecca Schumacher, Alexis R Ogdie, Joel M Gelfand","doi":"10.1177/24755303241303089","DOIUrl":"10.1177/24755303241303089","url":null,"abstract":"<p><strong>Background: </strong>Real-world evidence describing the natural history of all manifestations and severities of psoriasis is needed, as existing studies often recruit from a restricted patient population, and treatment failure and dissatisfaction is common. The FORWARD Psoriasis Registry collects patient-reported data directly online from participants independent of clinician involvement.</p><p><strong>Objective: </strong>To test the feasibility of this new registry design and compare baseline characteristics, patient-reported disease outcomes, and treatment utilization between participants enrolling through their clinician (primary enrollment group) and participants self-enrolling online (secondary).</p><p><strong>Methods: </strong>We summarized cross-sectional enrollment data from adults with clinician-diagnosed psoriasis who enrolled in the registry from September 2023 through June 2024 and compared baseline characteristics between enrollment groups.</p><p><strong>Results: </strong>The registry enrolled 1560 adults with clinician-diagnosed psoriasis from 42 states and territories in the United States. In the primary enrollment group, 68% were female, mean age was 51 years, 34% of participants had moderate or severe psoriasis based on PREPI, and 27% reported clinician-diagnosed psoriatic arthritis. Forty six percent actively used systemic therapies while 65% used topical therapies for psoriasis, and 20% were dissatisfied or very dissatisfied with their treatment. Comparatively, the secondary enrollment group reported statistically significantly worse psoriasis burden for nearly all disease outcomes.</p><p><strong>Conclusion: </strong>The FORWARD Psoriasis Registry rapidly enrolled a large, national cohort of participants with psoriasis, demonstrating feasibility of participant-driven data collection. We found important differences between participants enrolling through their clinician and self-enrolled participants, highlighting the need to collect real-world evidence to understand psoriasis regardless of access to clinical care.</p>","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303241303089"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710385","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":"Patient-Identified Treatment Goals for Psoriatic Disease: Results From a US Patient Survey.","authors":"April Armstrong, Noah A Levit, Beth Schneider, Richard Seiden, Linyu Shi, Blair Kaplan, Jashin J Wu","doi":"10.1177/24755303241290495","DOIUrl":"10.1177/24755303241290495","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in the treatment landscape for psoriasis (PsO) and psoriatic arthritis (PsA), some patients may not achieve the desired disease improvement due to undertreatment. Understanding patient perspectives on treatment expectations can inform patient-centered decisions and enhance treatment satisfaction.</p><p><strong>Objective: </strong>To describe patient-identified treatment goals and expectations for managing psoriatic disease.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using a survey through MyPsoriasisTeam, an online social community. The survey was available to its US-based patients aged ≥21 years with self-reported diagnoses of PsO and/or PsA. The study assessed patients' treatment goals, satisfaction with treatment outcomes, and satisfaction with health care providers (HCPs). Responses were summarized using descriptive statistics.</p><p><strong>Results: </strong>This analysis included 386 patients (PsO, n = 130; PsA with/without PsO, n = 256). Treatment goals varied by psoriatic disease type. The top 3 treatment goals for PsO were reduce itching (73.1%), reduction in size/thickness (68.5%), and reduction in the number of plaques (63.1), and for PsA, were reducing joint pain (77.7%), lessening fatigue (64.8%), and reducing joint stiffness (62.1%). Patient satisfaction with treatment outcomes was low (extremely/very satisfied: PsO, 7.5%/8.5% and PsA, 9.2%/20.2%). Overall, 73.1% with PsO were treated by a dermatologist, and a dermatologist or rheumatologist treated 74.6% with PsA. Overall, patient satisfaction with HCPs who treated their disease was lacking (PsO, 19.3% and 19.3%; PsA, 27.3% and 33.6% were extremely and very satisfied, respectively).</p><p><strong>Conclusion: </strong>These findings suggest the need for enhanced communication between patients and HCPs to align treatment goals and expectations and to improve treatment satisfaction and disease management.</p>","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303241290495"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629709","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":"Tackling Multiple Biologic Failure in Psoriasis: Research and Advocacy Perspectives.","authors":"Kathryn Haran, George Gondo, Payton Smith, Chandler Johnson, Allison Kranyak, Tina Bhutani, Wilson Liao","doi":"10.1177/24755303241288536","DOIUrl":"10.1177/24755303241288536","url":null,"abstract":"<p><p>Psoriasis is an immune-mediated skin disease commonly treated with biologic therapies. While there are currently 12 different biologics approved for psoriasis, there still exists a challenging subset of patients who have tried and failed biologics from multiple classes. In this commentary, we discuss the research and advocacy-based efforts by the National Psoriasis Foundation (NPF) and academic collaborators to understand and better support multiple biologic failure (MBF) psoriasis patients. The NPF MBF registry will gather clinical and demographic information on MBF patients to improve therapeutic outcomes, while legislative efforts through NPF Capitol Hill Day aim to advance federal laws in support of all psoriasis patients, with a recent focus on access to biologic therapy. Together, these 2 efforts will improve the care for all people living with psoriasis, including those experiencing MBF.</p>","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303241288536"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629784","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":"Evaluating the Femoral Atherosclerotic Plaque in Psoriasis Patients and Controls: A Case-Control Study.","authors":"Vinh Minh Ngo, Hoang Xuan Ngo, Hao Trong Nguyen","doi":"10.1177/24755303241288541","DOIUrl":"10.1177/24755303241288541","url":null,"abstract":"<p><strong>Background: </strong>Psoriasis is a chronic inflammatory disease that can affect the skin or the cardiovascular system. The presence of femoral atherosclerotic plaque could be a promising sign in predicting cardiovascular risk for these patients.</p><p><strong>Objective: </strong>The study aims to evaluate the prevalence of femoral atherosclerotic plaque between psoriasis and control individuals.</p><p><strong>Methods: </strong>This case-control study involved 40 patients diagnosed with vulgaris psoriasis and 40 non-psoriasis individuals matched by age group and gender. We used clinical signs and symptoms to diagnose psoriasis and evaluated the disease's severity using the Psoriasis Area and Severity Index (PASI). The atherosclerotic plaque on the femoral artery was detected using Doppler ultrasound to measure the femoral artery intima-media thickness (fIMT). Data were analyzed by SPSS 25.</p><p><strong>Results: </strong>Male patients accounted for the proportion of 72.5%. In the psoriatic group, the mean value of PASI was 12.91 ± 6.73 (points). The proportion of femoral atherosclerotic plaque was significantly higher in the psoriasis compared to the controls (32.5% vs 10%; <i>P</i> = 0.014). Some factors associated with the femoral atherosclerotic plaque include age, smoking, and hypertension (<i>P</i> < 0.05). Hypertension was an independent risk factor for femoral atherosclerotic after regression analysis.</p><p><strong>Conclusion: </strong>Femoral atherosclerotic plaque is higher in psoriasis patients. This result emphasizes the need to screen for cardiovascular comorbidities in these patients.</p>","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" ","pages":"24755303241288541"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629687","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":"Addressing Cardiovascular Risk in People With Psoriatic Disease Using a Care Coordinator Model: A Qualitative Analysis of a Pilot Study","authors":"Jennifer B. Mason, Christina Johnson, Nkiru Ogbuefi, Sonia Wang, April Armstrong, John S. Barbieri, Jordana B. Cohen, Ethan T. Craig, R. Fitzsimmons, Micheal Garshick, Adina Lieberman, Neha N Mehta, Alexis R. Ogdie, Maryte Papadopoulos, Daniel B. Shin, Suzette Baez Vanderbeek, J. Gelfand, Rinad S. Beidas","doi":"10.1177/24755303241257906","DOIUrl":"https://doi.org/10.1177/24755303241257906","url":null,"abstract":"Background: Risk for cardiovascular events is elevated in people with psoriatic disease. Our team developed a care coordination model to assist in managing cardiovascular risk in people with psoriatic disease. We piloted this model and study procedures prior to launching a fully powered prospective clinical trial. Objective: This study used qualitative methods to gather feedback on the care coordinator model from constituents (clinicians, patients, and care coordinators) who participated in the pilot trial to optimize the approach. Methods: We conducted 42 total interviews with people with psoriatic disease, referring clinicians (dermatologists and rheumatologists), primary care providers, and care coordinators who participated in the pilot study. A rapid qualitative analysis approach was used. Results: Perceptions of the care coordinator model were highly positive. Participants noted that the model raised their awareness of cardiovascular risk in people with psoriatic disease. They found it easy to follow the recommendations provided by the care coordinator. Participants identified areas for improvement related to eligibility criteria, increased personalization of materials and goal-setting, and clarification regarding next steps and responsibilities for follow-up after patients concluded participation. Additional feedback highlighted concerns about the intervention content overly focusing on statin medication therapy. Conclusion: Constituent recommendations gleaned via interviews were incorporated into the care coordinator model and adjustments were made to trial procedures. Insights from these interviews may also be relevant to those seeking to close care gaps for identification and treatment of cardiovascular risk in people with psoriatic disease using other interventions.","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":"37 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141819463","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":"Review of Generalized Pustular Psoriasis: Prevalence, Diagnosis, and Treatment Options","authors":"Yuliya Kozina, Amy C. M. Musiek, Milan J. Anadkat","doi":"10.1177/24755303241257900","DOIUrl":"https://doi.org/10.1177/24755303241257900","url":null,"abstract":"Background: Generalized pustular psoriasis (GPP) is a diagnostic challenge for clinicians and is relatively rare. Prevalence is currently reported to be higher in Asian countries and among female patients; peak age of onset is variable across studies. Objective: This article provides clinicians with an overview of the global prevalence of GPP, common clinical presentation and diagnostic criteria, pathogenesis, and evolving treatment options. Discussion: Clinical presentation is characterized by onset of generalized sterile pustules with erythema, and may include systemic inflammatory signs including fever and lab abnormalities. Diagnostic criteria vary globally. European Rare and Severe Psoriasis Expert Network (ERASPEN) criteria present a clinical diagnosis while Japanese criteria include a biopsy. Advancements in understanding of pathogenesis have uncovered the role of IL-36 as a driver of disease, and this is the target of new treatments including spesolimab, an anti-IL-36 receptor antibody.","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":" 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141375019","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}