Journal of Psoriasis and Psoriatic Arthritis最新文献

{"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":"37-50"},"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":"11-21"},"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":"6-10"},"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}

{"title":"Clinical Disease Measures in Palmoplantar Pustulosis: A Scoping Review","authors":"Alice J. Tan, Marjorie Archila, C. Mita, Maria O Edelen, Megan H. Noe","doi":"10.1177/24755303241253190","DOIUrl":"https://doi.org/10.1177/24755303241253190","url":null,"abstract":"Palmoplantar pustulosis (PPP) is a rare, relapsing, disease characterized by pustules, pain, and fissuring. PPP is often combined with psoriasis, most commonly palmar plantar psoriasis, in clinical trials which further complicates our understanding of treatment response. The objective of this scoping review is to describe all outcome measures (clinician-reported & patient-reported) used in previous PPP clinical trials. A search was conducted in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for clinical trials and prospective cohort studies performed in adults with PPP, with an intervention and pre-determined outcomes collected at pre specified time points. The initial search identified 1839 records, of which 69 met our inclusion criteria. The studies were published between 1970–2023 and included a total of 3301 patients. The most common primary study outcome was the clinician-reported Palmoplantar Pustulosis Psoriasis Area Severity Index (ppPASI) ( n = 39, 56.5%) and an endpoint of 12 weeks ( n = 23, 33.3%). Other common clinician reported outcomes identified were pustule count ( n = 26, 37.7%) and the Physician Global Assessment ( n = 16, 23.2%) The majority of studies ( n = 43, 62.3%) did not include any patient reported outcome measures. Of those that did include patient reported outcome measures, the Dermatology Life Quality Index was most utilized ( n = 17, 24.6%), followed by symptoms-specific instruments measuring pain ( n = 11, 15.9%) and itch ( n = 6, 8.7%). While the clinician-reported ppPASI has become the standard primary outcome in PPP clinical trials, there is still considerable heterogeneity and lack of specificity in the patient reported outcomes used.","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":"60 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972499","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":"Whole-Genome Shotgun Metagenomic Sequencing Reveals Shifts in the Skin Microbiome and Bacteriophages of Psoriasis: An Extended Analysis of Published Data","authors":"Yvonne Nong, Dana M. Walsh, Jessica Maloh, Manoj Dadlani, Raja K Sivamani","doi":"10.1177/24755303241242357","DOIUrl":"https://doi.org/10.1177/24755303241242357","url":null,"abstract":"Psoriasis is an immune-mediated cutaneous disease that may have shifts in the skin microbiome. Prior research on the skin microbiome in psoriasis has been limited to rRNA based approaches that lack resolution of taxonomic and functional level assessment. To further illuminate strain and sub-strain level analysis of psoriatic lesions using the CosmosID-HUB Microbiome pipeline. A previous study completed by Tett et al recruited patients with psoriasis who had skin microbiome samples taken from psoriatic plaques on the ear and the elbow as well as sites on the skin unaffected by psoriasis. They performed whole genome shotgun sequencing and made their dataset publicly available. We analyzed the dataset using the CosmosID-HUB Microbiome pipeline to evaluate the strain and sub-strain taxonomic analysis as well as functional gene profiling. When analyzed with the CosmosID pipeline, both ear and elbow sites in affected areas had decreased alpha diversity compared to unaffected areas. There was an increased relative abundance of Staphylococcus and Corynebacteria at affected sites. We identified distinguishing species and strains of the yeast Malassezia, including M. restricta. that were significantly enriched in healthy elbow samples. Vitamin B12 production genes were not present in psoriatic skin whereas it was present in healthy samples, supporting the notion of relative vitamin B12 deficiency in psoriatic plaques. Phage analysis revealed a greater diversity of Staphylococcus-related phages in unaffected elbow samples. A greater diversity of microbial strains and their functional roles identified in this study may help to tailor treatment for psoriasis.","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":"88 S374","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003321","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":"Patients’ Preferences Regarding Modes of Systemic Psoriasis Treatment – A Qualitative Study","authors":"Mallory L. Zaino, Emily Parks, Jasmine McNeil, S. Feldman","doi":"10.1177/24755303241253200","DOIUrl":"https://doi.org/10.1177/24755303241253200","url":null,"abstract":"Treatment with pathogenesis-directed biologics and oral systemic drugs have made complete clearance of psoriasis a realistic expectation for many patients with psoriasis. Patients’ preferences among these treatments varies. To understand factors impacting psoriasis patients’preferences for injection vs oral medication. Psoriasis patients who receive systemic psoriasis treatment were asked to participate in a semi-structured interview. Sample size was based on achieving saturation with equal number of patients preferring oral vs injectable medications to ensure equal representation of both groups. Qualitative analysis was performed to interpret the results. Twenty-two patients participated in the study, 12 males and 10 females. Ten patients were receiving oral medication (apremilast or methotrexate) and 12 patients were receiving injectables (guselkumab, adalimumab, risankizumab, secukinumab, ixekizumab, or tildrakizumab) due to self-reported preference. Five themes resulted from the analysis: patients receiving injectables more frequently discussed the positive impact of the medication on quality of life compared to patients on oral medication; fear of side effects, particularly fear of immunosuppression, is associated with injection medications; avoidance of needles drives patients away from injection medication and towards oral systemic medication; patients prioritize convenience when selecting systemic therapy, though the definition of convenience is subject to perception; and patients value the medication recommendation of the physician, regardless of the route of administration. Improving medication adherence and disease outcomes through individualized treatment plans, with an emphasis on patients’ preferences using a shared decision-making approach, may be helpful.","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":"6 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004487","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":"Analyzing the Benefits and Costs of the Safe Step Act on Patients, Physicians, and Insurers","authors":"Divya M. Shan, Jonathan D. Greenzaid, Estay Greene, S. Feldman","doi":"10.1177/24755303241253203","DOIUrl":"https://doi.org/10.1177/24755303241253203","url":null,"abstract":"Pharmaceutical expenditures in the United States, particularly in dermatology, have grown rapidly, driven by expensive topical and biologic treatments. Insurers are employing cost-containing strategies such as step therapy, which mandates the use of lower-cost treatments before more expensive medications. The bipartisan Safe Step Act aims to enhance step therapy policies by introducing a transparent process for requesting exceptions and reasonable timelines for the process. However, there is limited analysis on how the Safe Step Act would affect the healthcare environment. We examine the policies of the Safe Step Act and existing literature on prior authorizations and discuss how the bill could affect patients, physicians, and insurers. While the act could expedite access to necessary medications and prevent irreversible harm to patients from delaying efficacious treatment, it falls short in relieving the administrative burdens on dermatology clinics. Although there is no ideal solution for managing healthcare costs, measures like step therapy encourage cost-effective treatments and optimizing care for the population. Curtailing step therapy with the exemptions process of the Safe Step Act might streamline patient access to treatments but could impede cost-containment strategies, weaken the bargaining power of insurers, and result in higher insurance premiums.","PeriodicalId":36656,"journal":{"name":"Journal of Psoriasis and Psoriatic Arthritis","volume":"141 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003034","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}