Monaldi Archives for Chest Disease最新文献

{"title":"Determinants of delayed pulmonary tuberculosis diagnosis in a rural district of Pakistan.","authors":"Amin Ur Rahman, Zia Qamar, Afnan Fayaz, Bushra Arif, Ihtisham Habib, Wareesha Naeem Aurakzai","doi":"10.4081/monaldi.2026.3782","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3782","url":null,"abstract":"<p><p>Tuberculosis (TB) caused by acid-fast bacilli is one of the leading causes of morbidity and mortality in developing countries. Pakistan has the world's fifth-largest prevalence of TB, with 276/100,000 cases in prevalence and a mortality of 34/100,000. Delayed diagnosis, disruptions in treatment continuity and a lack of awareness are the key issues leading to multidrug-resistant TB. The current study aimed to find out the determinants of delayed pulmonary TB in a rural district of Khyber Pakhtunkhwa Province, Pakistan. The cross-sectional study was conducted in six TB control program centers designated by the National TB Control Program from March to December 2024. Data were collected from 250 eligible patients, and after removal of incomplete questionnaires, the data of 229 patients were analyzed. The study was approved by the district TB officer, and participants' consent was obtained before data collection. A delay of >21 days was considered the cutoff point for delayed TB diagnosis. Among 229 patients, 51.1% were male and 48.9% female participants, with a mean age of 33.31±21.32 years. The mean diagnostic delay was 23.66±14.94 days. Descriptive analysis of data showed 52% of delayed TB diagnosis cases; 92.2% of the studied patients were from rural areas, in which 80% of delayed TB diagnosis cases were reported. Male gender [odds ratio (OR)=2.31], getting treatment from public hospitals (OR=4.13), age group 31-45 years (OR=3.10), presence of acute extrapulmonary symptoms of cough, fever, and weight loss (OR=2.84), perception that the symptoms will be relieved by oneself (OR=9.99), economic constraints (OR=6.58), and perception of the poor quality of healthcare services at hospitals (OR=7.32) were found to be significant factors of delayed TB diagnosis. Primary school- (OR=0.20), college- or university-level education (OR=0.42) and high-income groups (OR=0.39) were significant protective factors against delayed TB diagnosis. Marital status, occupation, residence, comorbidities, distance from healthcare facility, previous exposure to TB patients, fever, weight loss, chronic cough, hemoptysis, fear of diagnosis, fear of social isolation, and bad experience of the healthcare staff behavior were found to be non-significant factors for delayed TB diagnosis. The study only focused on delayed diagnosis and did not report healthcare system-related or total delay in tuberculosis management. The study affirmed the significant impact of patient perceptions and socioeconomic status on delayed TB diagnosis.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801312","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":"Exploring the periodontal health status and level of matrix metalloproteinases in patients with interstitial lung disease: a case control study.","authors":"Prerna S Hirkane, Umesh Pratap Verma, Ajay Kumar Verma, Pavitra Rastogi, Ashutosh Shrivastava, Anjani Kumar Pathak","doi":"10.4081/monaldi.2026.3753","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3753","url":null,"abstract":"<p><p>Periodontitis has been linked to several respiratory diseases such as chronic obstructive pulmonary disease, asthma, and lung cancer; however, the role of periodontal health status and matrix metalloproteinases (MMPs) in interstitial lung diseases (ILDs) remains largely unexplored. The present study aimed to investigate periodontal health and evaluate serum and salivary levels of MMP-7, MMP-8, and tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with ILDs. A total of 75 individuals were included and divided equally into three groups: healthy controls, patients with chronic periodontitis, and patients with ILDs. Demographic factors such as age, gender, and socioeconomic status were recorded, along with clinical parameters including plaque index, gingival index, probing pocket depth, and clinical attachment level. The findings revealed that levels of MMP-7 and MMP-8 were significantly elevated in both the periodontitis and ILD groups compared to healthy controls, while TIMP-1 did not show notable variation among groups. Clinical periodontal parameters were also higher in patients with ILDs as well as those with chronic periodontitis. These results suggest a possible link between ILD and chronic periodontitis, both from clinical and biochemical perspectives. The study provides pioneering evidence in the emerging field of oral-systemic research, emphasizing the need for further investigations with larger sample sizes and interventional designs to strengthen the evidence base and explore possible genetic associations underlying this relationship.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801325","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":"Hypertension cost in primary health care facilities in Morocco: a cost-of-illness study.","authors":"Soumaya Benmaamar, Moncef Maiouak, Ibtissam El Harch, Angela Christie Filankembo Kava, Passy Conde, Khalid Khilou, Noura Qarmiche, Samira El Fakir, Mohamed Berraho, Nabil Tachfouti","doi":"10.4081/monaldi.2026.3816","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3816","url":null,"abstract":"<p><p>Hypertension in low- and middle-income countries such as Morocco has an economic importance due to its high prevalence and cost. The aim of this study is to estimate direct health costs (DHC) for hypertension patients followed in primary health care facilities in Morocco. A cost of illness prevalence-based study was carried out on hypertension patients followed in public primary health care facilities in Fez. Data were collected using a questionnaire, including sociodemographic and clinical data and healthcare resources utilization: medical tests, medications, and medical visits. DHC was estimated using a bottom-up approach method from a societal perspective and a one-year time horizon. Official prices published by the national agency for health insurance were adopted as unit costs. Cost was compared to annual household income for calculating the catastrophic cost.  Cost is defined as catastrophic if it exceeds 10% of annual household income. We included 146 patients. The mean age was 60.7±11.1 years; 70.5% were men. More than half (54.2%) of participants had uncontrolled hypertension. The direct medical cost was estimated at 368.8±120.8 United States dollars per patient. Costs of medical tests and drugs represented, respectively, 58.6% and 30.5% of total direct cost. The incidence of catastrophic cost was 76.8%. Hypertensive patients incur substantial direct costs. High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure the affordability of hypertension care.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801307","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":"The Italian Community-based Pulmonology Manifesto: a national survey exploring the current state, critical issues, and perspectives for a national reference model.","authors":"Marco Contoli, Marco Biagini, Paolo Onorati, Giovanni Sotgiu, Roberto Trevisan, Walter Castellani","doi":"10.4081/monaldi.2026.4135","DOIUrl":"https://doi.org/10.4081/monaldi.2026.4135","url":null,"abstract":"<p><p>In Italy, demographic aging, increasing multimorbidity, and the growing burden of chronic respiratory conditions have highlighted the need for a reorganization of community-based respiratory services, as outlined by the Italian Ministerial Decree 77/2022, which promotes integrated, proximity-based models of care. Community-based pulmonology care represents a potentially pivotal component of healthcare systems for the management of chronic and complex respiratory diseases. A national, anonymous, web-based survey was conducted among Italian pulmonologists working in territorial and community healthcare settings. The questionnaire explored organizational structures, clinical and diagnostic activities, availability of technological resources, care pathways, continuity of care, and integration with hospital services. A total of 168 valid questionnaires were collected and analyzed using descriptive methods. The survey revealed substantial heterogeneity across regions and healthcare organizations in terms of structural models, availability of diagnostic and interventional procedures, multidisciplinary teams, and access to telemedicine solutions. While several community services provide advanced outpatient and home-based respiratory care, significant gaps persist in standardized care pathways, timely access to functional respiratory diagnostics, and structured follow-up of chronic patients. Limitations in direct access to hospitalization pathways further contribute to fragmentation of care and potentially optimizable use of emergency medical services. This survey provides an initial, comprehensive overview of the current state of community-based pulmonology in Italy. The collected data represent a foundational framework for further in-depth analyses aimed at defining shared minimum standards, strengthening hospital-community integration, and supporting the development of a more equitable, efficient, and patient-centered model of respiratory care.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801333","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":"Impact of self-management interventions initiated during hospitalization on inhaler adherence and functional outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial.","authors":"Krishna Priya C V, Lakshmi Ramamoorthy, Pratap Upadhya, H T Lalthanthuami","doi":"10.4081/monaldi.2026.3695","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3695","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) remains a leading global health burden, with acute exacerbations accelerating functional decline and impairing quality of life. Reduced inhaler adherence is a well-recognized contributor to exacerbations and poorer outcomes in COPD. While self-management interventions are well established in stable COPD, their initiation during acute exacerbations has been inadequately explored. This randomized controlled trial, conducted in a South Indian tertiary hospital between July 2024 and May 2025, evaluated the effectiveness of a structured self-management program initiated during hospitalization for acute exacerbation of COPD. The intervention included individualized counseling, family engagement, structured telephonic follow-ups (weekly for 3 months, then monthly for 3 months), and scheduled outpatient reviews, while controls received standard care. Primary outcomes were inhaler adherence assessed by the Test of Adherence to Inhalers, health-related quality of life (HRQoL) measured with the St. George's Respiratory Questionnaire (SGRQ), and functional capacity assessed by the six-minute walk test. At six months, good inhaler adherence was observed in 66.7% of the intervention group compared to 10% of controls (p<0.001). The mean between-group difference in six-minute walk distance at six months was 92.8 meters [95% confidence interval (CI): 58.1 to 127.6; p<0.001], favoring the intervention group. HRQoL also improved significantly, with a mean between-group difference in SGRQ score of -38.2 (95% CI: -46.7 to -29.8; p<0.001). These findings indicate that initiating structured self-management during hospitalization for acute exacerbation of COPD results in significant improvements in inhaler adherence, functional capacity, and quality of life. Integrating self-management into acute care pathways may therefore optimize patient-centered outcomes in this high-risk population.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563556","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":"From benign airway lesions to bioengineered solutions: 3D bioprinting in tracheobronchopathia osteochondroplastica.","authors":"Haris Hanif","doi":"10.4081/monaldi.2026.3846","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3846","url":null,"abstract":"<p><p>Tracheobronchopathia osteochondroplastica is a rare benign lesion of the airways often managed conservatively. However, advanced obstruction requires reconstruction. This brief commentary explores the emerging role of 3D bioprinting as a curative solution, analyzing recent findings regarding mesenchymal stem cell-laden grafts and identifying vascularization as the critical hurdle preventing clinical translation.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551372","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":"Amiodarone-induced pulmonary toxicity: case series and review of clinical-radiological correlations.","authors":"Vincenzo Zagà, Abdullah Al-Suhaim, Lojain Khoj, Alberto Fantin, Matthew J Cecchini, Maurizio Zompatori, Marco Mura","doi":"10.4081/monaldi.2026.3936","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3936","url":null,"abstract":"<p><p>Amiodarone is an effective and commonly used anti-arrhythmic drug. The radiographic presentations of amiodarone-induced pulmonary toxicity (AIPT) include a broad spectrum of patterns. Three main clinical-radiographic presentations are described with AIPT: isolated reduction of diffusing lung capacity with no clinical implications; alveolar-interstitial pneumonia, which usually requires amiodarone discontinuation and corticosteroid treatment; and acute respiratory distress syndrome, which can obviously be life-threatening. We report 6 cases that depict the described range of clinical and radiographic presentations. The analysis of the cases and of the published review suggests that the computed tomography scan pattern on presentation predicts well the clinical course. The correlation between radiographic and clinical findings can therefore guide the clinician in the management of AIPT.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474180","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":"Corticosteroids in severe pediatric community-acquired pneumonia:insights from a case-based narrative review.","authors":"Daniela Milanova-Ilieva, Atilla Genc, Kostadin Ketev","doi":"10.4081/monaldi.2026.3883","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3883","url":null,"abstract":"<p><p>Pediatric community-acquired pneumonia (CAP) remains a leading cause of hospitalization worldwide. Although antimicrobial therapy is the cornerstone of treatment, severe and complicated cases are frequently characterized by an exaggerated inflammatory response that may not resolve with antibiotics alone. In this narrative review, we summarize current evidence on the use of systemic corticosteroids as adjunctive therapy in pediatric CAP and illustrate their potential role through a representative clinical case. Available data from randomized trials, observational studies, and meta-analyses suggest that corticosteroids may shorten fever duration, improve oxygenation, and reduce length of hospital stay in selected pediatric patients, particularly those with hyperinflammatory features, parapneumonic effusions, or macrolide-refractory Mycoplasma pneumoniae infections. Some studies also indicate a reduced need for surgical intervention in complicated pneumonia. However, results remain heterogeneous, and current guidelines do not support routine corticosteroid use. Adverse effects are generally mild with short treatment courses and include hyperglycemia and transient behavioral changes. In the presented clinical case, adjunctive corticosteroid therapy was associated with rapid clinical and radiological improvement in a child with severe hyperinflammatory pleuropneumonia. Corticosteroids may represent a potential adjunctive option in carefully selected children with severe or complicated CAP; however, current evidence remains limited and heterogeneous, and further prospective pediatric studies are required.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474218","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":"Balancing control and safety: hypothalamic-pituitary-adrenal axis effects of dual-route fluticasone in unified airway disease.","authors":"Ramakant Dixit, Mukesh Goyal","doi":"10.4081/monaldi.2026.3521","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3521","url":null,"abstract":"<p><p>The concurrent presence of allergic rhinitis and bronchial asthma, known as unified airway disease, often requires combined therapeutic approaches. This prospective study investigates the clinical efficacy and safety of combined inhaled and intranasal fluticasone propionate in such patients. A total of 25 adult patients with moderate to severe allergic rhinitis and bronchial asthma were enrolled. After excluding 2 lost-to-follow-up patients, 23 patients completed the study. Participants received combined inhaled and intranasal fluticasone propionate for four weeks. Clinical outcomes were assessed using Total Nasal Symptom Score (TNSS), Asthma Control Test (ACT), spirometry, and 24-hour urinary free cortisol levels pre- and post-treatment. Significant improvements were observed in TNSS (9.09±2.89 to 2.13±1.62; p<0.0001) and ACT scores (20.48±3.07 to 24.09±1.12; p<0.0001). Pulmonary function tests showed significant increases in forced vital capacity from 3.16±0.73 L to 3.75±0.63 L (p=0.0053) and forced expiratory volume in 1 second from 2.18±0.75 L to 2.71±0.80 L (p=0.0252). Mean urinary free cortisol levels decreased from 31.35±9.35 mcg/24 h to 28.02±9.14 mcg/24 h, though the change was not statistically significant (p=0.2295). Combined inhaled and intranasal fluticasone propionate therapy significantly improves symptom control and pulmonary function in patients with allergic rhinitis and bronchial asthma. No significant suppression of the hypothalamic-pituitary-adrenal axis was observed, indicating a favorable safety profile for short-term use.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426010","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":"Unmet needs and polypharmacy as key drivers of drug therapy problems among cardiac patients at a tertiary hospital: a cross-sectional study.","authors":"Eshetu Ayele Alaro, Temesgen Sidamo, Ashebir Tesfaye Tufa, Hailu Chare Koyra","doi":"10.4081/monaldi.2026.3832","DOIUrl":"https://doi.org/10.4081/monaldi.2026.3832","url":null,"abstract":"<p><p>Drug therapy problems (DTPs), unintended events in pharmacotherapy that impede therapeutic goals and risk patient harm, are critical barriers to effective cardiovascular disease (CVD) management. Ambulatory cardiac patients are highly vulnerable to DTPs primarily due to complex comorbidities, but the prevalence and specific drivers of these problems within chronic care settings in Ethiopia are poorly characterized. Therefore, this study aimed to determine the prevalence and predictors of DTPs among adult ambulatory CVD patients at Wolaita Sodo University Comprehensive Specialized Hospital from May 9 to July 8, 2022. We conducted an institution-based cross-sectional study among ambulatory cardiac patients receiving chronic care. Data were collected through structured patient interviews and comprehensive medical record reviews. DTPs were systematically identified and classified using Cipolle's validated methodology, adapted for the local patient population. Binary logistic regression was used to assess the associations between predictor variables and DTPs, followed by multiple logistic regression to control for potential confounders. Statistical significance was determined at p≤0.05, with 95% confidence intervals used to estimate precision of effect measures. Among 195 ambulatory CVD patients, hypertension (59.5%, n=116) and heart failure (47.2%, n=92) were the most prevalent conditions. The study identified DTPs in 69.7% of patients (n=136), totaling 168 DTPs (mean: 1.3, standard deviation: 0.461) per affected patient. Unmet therapeutic needs (41.0%) and medication non-adherence (24.4%) emerged as the most common DTP categories. ASCVD risk assessment classified 40% of evaluated patients as high-risk (10-year risk ≥20%). Significant predictors of DTPs included polypharmacy [adjusted odds ratio (AOR): 3.48, 95% confidence interval: 1.47-8.24] and age (25-64 years: AOR=16.38), while prior hospitalization (AOR: 0.31) demonstrated protective effects. This study identifies unmet therapeutic needs and medication non-adherence as the predominant DTPs and polypharmacy as the most significant predictor among ambulatory CVD patients at Wolaita Sodo University Comprehensive Specialized Hospital, calling for systematic medication reviews, pharmacist-led interventions for high-risk groups, and enhanced adherence support programs to optimize treatment outcomes.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426037","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}