Diabetic Medicine最新文献

{"title":"Closing the policy gap in diabetes care for individuals with advanced CKD.","authors":"Hellena Hailu Habte-Asres, Miranda Rosenthal, Dorothea Nitsch, David C Wheeler","doi":"10.1111/dme.15381","DOIUrl":"10.1111/dme.15381","url":null,"abstract":"<p><strong>Aim: </strong>The co-existence of diabetes and CKD poses significant challenges to healthcare systems, current frameworks often inadequately address the complex needs of individuals with both conditions. Recognising these gaps, we introduced a new diabetes care model for people with advanced CKD in renal satellite units.This paper aims to evaluate this new diabetes model care.</p><p><strong>Method: </strong>We conducted a prospective audit of a new integrated diabetes kidney care model. Data were presented as mean ± SD or counts/percentages, and pre- and post-intervention differences were assessed using paired samples t-tests.</p><p><strong>Results: </strong>A total of 291 individuals with diabetes and advanced CKD stages 4 or 5, or undergoing haemodialysis, were included. The mean age was 68.5 (±13.0) years, 58.4% were males. Nearly half of the cohort had four or more long-term conditions, while two-thirds experienced mild/severe frailty. Only 6% were receiving ongoing diabetes care from secondary care diabetes specialist services. For patients with CKD not receiving dialysis, comparing pre- and post-intervention, there were improvements in HbA1c (-13.0 mmol/mol, p < 0.001), SBP (-13.7 mm Hg, p < 0.0001), and weight (-2.9 kg, p < 0.0001). Furthermore, there was an increase in guideline-directed therapies, with notable usage of SGLT2i (62.9%) and GLP1-RA (28.4%), while access to diabetes technology increased to 89%.</p><p><strong>Conclusion: </strong>This new model of care resulted in improved metabolic outcomes, increased utilisation of guideline-directed therapies, and enhanced access to diabetes technologies. However, the model also revealed significant unmet clinical needs in areas such as access to diabetes care, diabetes eye screening and foot surveillance.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15381"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"O-linked β-N-acetylglucosamine (O-GlcNAc) modification: Emerging pathogenesis and a therapeutic target of diabetic nephropathy.","authors":"Bingxue Qi, Yang Chen, Siyang Chai, Xiaodan Lu, Li Kang","doi":"10.1111/dme.15436","DOIUrl":"10.1111/dme.15436","url":null,"abstract":"<p><strong>Aims: </strong>O-Linked β-N-acetylglucosamine (O-GlcNAc) modification, a unique post-translational modification of proteins, is elevated in diabetic nephropathy. This review aims to summarize the current knowledge on the mechanisms by which O-GlcNAcylation of proteins contributes to the pathogenesis and progression of diabetic nephropathy, as well as the therapeutic potential of targeting O-GlcNAc modification for its treatment.</p><p><strong>Methods: </strong>Current evidence in the literature was reviewed and synthesized in a narrative review.</p><p><strong>Results: </strong>Hyperglycemia increases glucose flux into the hexosamine biosynthesis pathway, which activates glucosamino-fructose aminotransferase expression and activity, leading to the production of O-GlcNAcylation substrate UDP-GlcNAc and an increase in protein O-GlcNAcylation in kidney cells. Protein O-GlcNAcylation regulates the function of kidney cells including mesangial cells, podocytes, and proximal tubular cells, and promotes renal interstitial fibrosis, resulting in kidney damage. Current treatments for diabetic nephropathy, such as sodium-glucose cotransporter 2 (SGLT-2) inhibitors and renin-angiotensin-aldosterone system (RAAS) inhibitors, delay disease progression, and suppress protein O-GlcNAcylation.</p><p><strong>Conclusions: </strong>Increased protein O-GlcNAcylation mediates renal cell damage and promotes renal interstitial fibrosis, leading to diabetic nephropathy. Although the full significance of inhibition of O-GlcNAcylation is not yet understood, it may represent a novel target for treating diabetic nephropathy.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15436"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complement anaphylatoxins: Potential therapeutic target for diabetic kidney disease.","authors":"Jingyuan Ma, Wai Han Yiu, Sydney C W Tang","doi":"10.1111/dme.15427","DOIUrl":"10.1111/dme.15427","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD) is the most common cause of kidney failure, characterized by chronic inflammation and fibrosis. The complement system is increasingly implicated in the development and progression of diabetic nephropathy. The important complement anaphylatoxins C3a and C5a are key mediators of the innate immune system, which regulates cellular inflammation, oxidative stress, mitochondrial homeostasis and tissue fibrosis. This review summarizes the involvement of anaphylatoxins in the pathogenesis of diabetic kidney disease, highlights their important roles in the pathophysiologic changes of glomerulopathy, tubulointerstitial damage and immune cell infiltration, and discusses the modulatory effects of new anti-diabetic drugs acting on the complement system. Based on available clinical data and findings from the preclinical studies of complement blockade, anaphylatoxin-targeted therapeutics may become a promising approach for patients with DKD in the future.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15427"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of vascular ageing and the effect of novel cardio-renal protective medications in preventing progression of chronic kidney disease in people living with diabetes.","authors":"Nikolaos Fountoulakis, Yoshihisa Miyamoto, Meda E Pavkov, Janaka Karalliedde, Giuseppe Maltese","doi":"10.1111/dme.15464","DOIUrl":"10.1111/dme.15464","url":null,"abstract":"<p><strong>Aim: </strong>Among people with diabetes those with chronic kidney disease (CKD) have a reduced life expectancy with increased risk of cardiovascular disease (CVD) a major contributor to morbidity and mortality. CKD related to diabetes is growing worldwide and is one of the leading causes of kidney failure globally. Diabetes is associated with accelerated vascular ageing and the related mechanisms and mediators that drive the progression of CKD and CVD disease in people with diabetes may help provide insights into the pathophysiology of cardio-renal complications and guide treatment interventions in people with diabetes.</p><p><strong>Methods: </strong>We conducted a narrative review of the literature using PubMed for English language articles that contained keywords that related to diabetes, chronic or diabetic kidney disease, ageing, cellular senescence, arterial stiffness, Klotho and sirtuins, sodium-glucose co-transporter-2 (SGLT-2) inhibitors, renin angiotensin aldosterone system (RAAS) and glucagon-like peptide-1 (GLP-1) receptor agonists.</p><p><strong>Results: </strong>Progressive kidney disease in diabetes is associated with accelerated ageing driven in part by multiple processes such as cellular senescence, inflammation, oxidative stress and circulating uremic toxins. This accelerated ageing phenotype contributes to increased arterial stiffness, endothelial dysfunction, cognitive decline and muscle wasting, thereby elevating morbidity and mortality in individuals with diabetes and CKD. Deficiency of the kidney-derived anti-ageing hormone Klotho and reduced sirtuin levels play pivotal roles in these ageing pathways. Dietary, lifestyle and pharmacological interventions targeting vascular ageing may help reduce the progression of CKD and associated CVD in people with diabetes. The current standard of care and pillars of treatment for kidney disease such as RAAS inhibitors, SGLT-2 inhibitors and GLP-1 receptor agonists all influence pathways involved in vascular ageing.</p><p><strong>Conclusions: </strong>A multifactorial intervention to prevent the development of CKD by targeting traditional risk factors as well as treatment with novel agents with cardio-renal beneficial effects can prevent accelerated ageing and extend lifespan in people with diabetes.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15464"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare professional views of a diabetes review postal box: A qualitative study.","authors":"Jack Colley, Sian Holt, Lucy Smith, Glenn Simpson, Hajira Dambha-Miller, Hermione Price","doi":"10.1111/dme.70001","DOIUrl":"https://doi.org/10.1111/dme.70001","url":null,"abstract":"<p><strong>Background: </strong>Non-attendance at diabetes appointments is common, ^1-4 and associated with higher HbA1c levels, reduced medication taking, and increased complications. ^1-45 Barriers to attendance are multifactorial including both logistical and psychosocial factors. ^6-11 A proposed solution is the implementation of a postal diabetes annual review box enabling self-collection of blood and urine samples, and measurement of blood pressure and weight.</p><p><strong>Aim: </strong>To explore the views of Healthcare Professionals (HCPs) who are involved in the organisation or delivery of diabetes care regarding the acceptability and implementation of a postal box as part of the diabetes annual review.</p><p><strong>Method: </strong>We conducted a qualitative study recruiting HCPs into semi-structured interviews and focus groups. Collected data were analysed using an inductive approach and following the principles of reflexive thematic analysis¹².</p><p><strong>Results: </strong>Twenty-one HCPs participated in the study. HCPs felt that a postal box could overcome many individual and service factors contributing to non-attendance. They felt the box could encourage self-management behaviours and could be used as a tool for communication. HCPs recognised that the postal box could free up time in appointments to focus on holistic care delivery without further stretching limited resources. HCPs were concerned about the possible additional administrative burden a postal box might create, and the public perception of an intervention which could reduce face-to-face care.</p><p><strong>Conclusion: </strong>Healthcare professionals seem receptive to the idea of a postal diabetes annual review box and feel it has the potential to offer people with diabetes an improved quality of care.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70001"},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large group onboarding of Omnipod 5 automated insulin delivery system-Experience from a UK secondary care diabetes service.","authors":"A Chapman, S McGriskin, L Findlow, A Urwin, S Ohol, S Thomas, R Obsiye, J Schofield, H Thabit","doi":"10.1111/dme.70000","DOIUrl":"https://doi.org/10.1111/dme.70000","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e70000"},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of a real-world prospective study using Dexcom ONE continuous glucose monitoring in people with diabetes treated with two or more insulin injections per day.","authors":"Jackie Elliott, Chloe Husband, Heydar Khadem, Hoda Nemat, Lucy Cardno, Laura Currin, Susan Hudson","doi":"10.1111/dme.15519","DOIUrl":"https://doi.org/10.1111/dme.15519","url":null,"abstract":"<p><strong>Aims: </strong>This study assessed real-world glycaemic outcomes associated with the use of Dexcom ONE in adults with suboptimally controlled diabetes.</p><p><strong>Methods: </strong>In this single-site prospective study, adults with type 1 (T1D) or type 2 diabetes (T2D) taking two or more insulin injections per day initiated Dexcom ONE CGM use and attended follow-up data collection visits after 3 and 6 months. During the study, participants received usual diabetes care. Primary outcome was a change in HbA1c at 6 months. Additional outcomes included change in participant-reported outcomes and CGM-derived time in glucose range 3.9-10 mmol/L (TIR), time above range >10 mmol/L (TAR), and time below range <3.9 mmol/L (TBR).</p><p><strong>Results: </strong>There were 110 adults enrolled [T1D (n = 34): mean age 36.6 years, 55.9% female; T2D (n = 76): mean age 54.9 years, 38.2% female]. Mean HbA1c significantly decreased from 90 mmol/mol (10.3%) to 79 mmol/mol (9.4%) at 6 months (∆-12 mmol/mol, p < 0.001) in T1D users and from 86 mmol/mol (10.1%) to 67 mmol/mol (8.3%) in T2D users (∆-18 mmol/mol, p < 0.001). Perception of health and diabetes distress improved at 6 months for both groups. T1D users had modest improvement in TBR. T2D users exhibited a clinically meaningful increase in TIR (∆ + 9.0%).</p><p><strong>Conclusion: </strong>Real-world Dexcom ONE use was associated with clinically significant reductions in mean HbA1c after 6 months, along with meaningful improvements in participant-reported outcomes. CGM-derived outcomes also improved, with the possibility of there being greater improvement than could be captured in this study. These findings support expanding access to this real-time CGM system.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15519"},"PeriodicalIF":3.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic features of active Charcot neuro-osteoarthropathy: A case series.","authors":"Jennifer A Pallin, Michael Lockhart, Aonghus O'Loughlin, David Gallagher, Stephen R Kearns, Sean F Dinneen, Diane Bergin","doi":"10.1111/dme.15517","DOIUrl":"https://doi.org/10.1111/dme.15517","url":null,"abstract":"<p><strong>Aims: </strong>To describe the sonographic features of active Charcot neuro-osteoarthropathy (CNO) and assess the potential role of ultrasound in identifying those with active CNO.</p><p><strong>Methods: </strong>Using a prospective case-series study design we assessed the sonographic features of 14 patients with a diagnosis of diabetes presenting with clinical signs and symptoms suspicious for active CNO. Patients had standard weight-bearing plain X-Ray and, where possible, MRI to evaluate the presence of active CNO. Ultrasound was performed bilaterally to assess for subcutaneous oedema, intra-articular and peri-articular colour flow. The spectral waveform morphology, peak systolic velocity and resistive index of the dorsalis pedis arteries of both feet were also documented.</p><p><strong>Results: </strong>Following clinical and radiological (X-ray and MRI) assessment, 50% (n = 7) were diagnosed with active CNO. Of those with a confirmed diagnosis, ≥3 sonographic features suggestive of active CNO were observed.</p><p><strong>Conclusions: </strong>Ultrasound combined with clinical presentation and medical history may support decision making around the diagnosis of CNO at the bedside.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15517"},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring low-dose glucagon for exercise-induced hypoglycaemia in type 1 diabetes: A randomised controlled trial.","authors":"Sissel Banner Lundemose, Christian Laugesen, Ajenthen Gayathri Ranjan, Kirsten Nørgaard","doi":"10.1111/dme.15512","DOIUrl":"https://doi.org/10.1111/dme.15512","url":null,"abstract":"<p><strong>Aims: </strong>This study was designed to compare the effectiveness of a single subcutaneous (s.c.) glucagon dose versus the same total dose split into a dose before and after and placebo (PBO) in preventing exercise-induced hypoglycaemia in adults with type 1 diabetes (T1D).</p><p><strong>Methods: </strong>Twenty-two adults with T1D participated in a randomised, single-blinded, three-arm crossover study. Participants underwent a 60-min bout of moderate-intensity cycle ergometry (~50% HRmax) in fasted state, followed by 2 h of rest. Plasma glucose (PG) concentrations were monitored at 5- and 15-minute intervals. Participants were randomly assigned to receive two separate injections before (t = 0 min) and just after (t = 60 min) exercise: (i) 150 μg s.c. glucagon (G150) before and PBO after; (ii) 75 μg s.c. glucagon (G75*2) before and after; or (iii) PBO before and after. Insulin pump users reduced their basal insulin rate by 50% during cycling.</p><p><strong>Results: </strong>The occurrence of hypoglycaemia did not significantly differ between arms (G150: 7, G75*2: 5 and PBO: 6 events, p = 0.078). Mean PG levels throughout the trial were lower in the PBO arm compared to both glucagon arms (G150: 8.6 ± 2.9, G75*2: 8.9 ± 3.4 and PBO: 7.3 ± 2.6 mmol/L, p = 0.015). Time spent with PG in target range (3.9-10.0 mmol/L) was higher in the PBO arm versus both glucagon arms (G150: 63.9 ± 38.9%, G75*2: 60.0 ± 34.1% and PBO: 82.7 ± 29.6%, p = 0.005), driven by less time above range (G150: 32.9 ± 41.3%, G75*2: 35.9 ± 36.4% and PBO: 13.2 ± 30.2%, p = 0.007).</p><p><strong>Conclusions: </strong>Low-dose native glucagon did not offer any advantages in preventing exercise-induced hypoglycaemia in individuals with T1D, regardless of glucagon dosing variations.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15512"},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes visits in paediatric versus adult clinics for young adults (YA) with T1D: Pre-pandemic and pandemic care.","authors":"Amit Shapira, Liane J Tinsley, Elena Toschi, Lori M Laffel","doi":"10.1111/dme.15509","DOIUrl":"https://doi.org/10.1111/dme.15509","url":null,"abstract":"<p><strong>Background: </strong>Young adults (YA) with type 1 diabetes mellitus (T1D) are at high risk of worsening glycated haemoglobin (HbA1c) with fewer follow-up visits. We examined the association of demographic and diabetes characteristics with care utilization, including in-person and telehealth visits, pre- (1 April 2019 to 15 March 2020) and during the COVID-19 pandemic (30 March 2020 to 15 March 2021) for YA (ages: 18-30) with T1D, comparing those seen in paediatric versus adult diabetes clinics at a single diabetes centre.</p><p><strong>Methods: </strong>Data were obtained from the electronic health record for YA with a pre-pandemic HbA1c. We performed descriptive statistics to describe the sample and paired t-tests to compare visits before and during the pandemic.</p><p><strong>Results: </strong>Data from 1762 YA (54% male; age 24.0 ± 3.6 (M ± SD) years; HbA1c 66 ± 18 mmol/mol (8.2 ± 1.6%) revealed that in the full sample, mean pre-pandemic visit frequency was 3.5 ± 3.4 and mean pandemic visit frequency was 3.1 ± 4.1 (p < 0.0001). Furthermore, the pandemic visit frequency declined in the adult clinic regardless of sex, pump therapy, CGM use, and pre-pandemic HbA1c, whereas in the paediatric clinic, visit frequency was only reduced for those with HbA1c <53 mmol/mol (<7%) but was otherwise maintained.</p><p><strong>Conclusions: </strong>In this diabetes centre, the paediatric clinic maintained diabetes care delivery during the pandemic (30 March 2020 to 15 March 2021) to YA with glycaemic control above target, suggesting that preservation of remote care delivery should be considered in this high-risk group.</p>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":" ","pages":"e15509"},"PeriodicalIF":3.2,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}