Journal of Internal Medicine最新文献

{"title":"Water scarcity and conservation and their role in obesity in nature and in humans.","authors":"Richard J Johnson, Johanna Painer-Gigler, Szilvia Kalgeropoulu, Sylvain Giroud, Paul G Shiels, Mehmet Kanbay, Ana Andres-Hernando, Bernardo Rodriguez-Iturbe, Miguel A Lanaspa, Peter Stenvinkel, Laura G Sánchez-Lozada","doi":"10.1111/joim.70003","DOIUrl":"https://doi.org/10.1111/joim.70003","url":null,"abstract":"<p><p>Increasing temperatures and water scarcity pose threats to animals living in the wild and humans. Here, we review biological mechanisms animals use to prevent dehydration. Fat and glycogen generate water during metabolism that can be used by many animals as a source of water. In hibernating animals, fat production is stimulated in the autumn by a vasopressin-dependent, carbohydrate-based metabolism that leads to thirst, increased water intake, and storage of glycogen and fat. As fall advances, the animals switch to fat-based metabolism with falling vasopressin levels, and actual entrance into torpor can be triggered when water becomes unavailable and/or unpredictable. Once in torpor, metabolic water is generated by fat metabolism along with a suppression of vasopressin and fall in serum osmolality that blocks thirst. We suggest that water production from fat does not keep up with demands, and that respiratory acidosis also develops as a consequence of hypoventilation, and this leads to the necessity of interbout arousals (IBA), in which the animal rewarms with a switch to carbohydrate metabolism that causes a rapid increase in water availability from the breakdown of glycogen that facilitates the ventilation needed to correct the acidemia. The animal then drops its metabolic rate again, allowing fat metabolism to continue. The observation that water deficit may be a stimulus for fat storage in hibernation carries significance for human obesity, especially in response to salt and sugar, as it suggests that hydration may be protective. These studies also provide an understanding of how glucagon-like peptide-1 agonists may cause weight loss.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors’ reply: Systolic blood pressure targets below 120 mmHg are associated with reduced mortality: A meta-analysis","authors":"Felix Bergmann,&nbsp;Markus Zeitlinger,&nbsp;Anselm Jorda","doi":"10.1111/joim.70007","DOIUrl":"10.1111/joim.70007","url":null,"abstract":"<p>Dear Editor,</p><p>We thank Dr. Shamsulddin for his perspective [<span>1</span>] on our meta-analysis on intensive versus standard systolic blood pressure (SBP) control [<span>2</span>]. Although our findings show consistent benefits of intensive SBP control, we agree that identifying individuals who are most likely to benefit or experience harm remains a significant challenge.</p><p>Generalizability is a common limitation of trial-level meta-analyses, particularly when the included studies are geographically concentrated. In our analysis, most participants were enrolled in studies conducted in North America and East Asia. Although heterogeneity across study populations may compromise the precision and interpretability of pooled effect estimates, a certain degree of clinical and methodological variation is essential to support the external validity and applicability of meta-analytic findings. Besides geographical diversity, the included studies enrolled patients with different risk profiles, including diabetes, history of stroke, and cardiovascular disease of varying severity. Nonetheless, our subgroup analyses did not show significant heterogeneity of treatment effect across these clinical strata, suggesting a consistency that could be interpreted as a pragmatic proxy for real-world variability. However, this does not serve as a substitute for specifically designed regional studies, which would be required to confirm the benefits of intensive SBP control in genetically diverse populations and within different healthcare systems.</p><p>Finally, the risk of adverse events, such as the incidence of syncope, acute kidney injury and electrolyte disturbances, may also differ between geographical and clinical subgroups. These aspects of heterogeneity are rarely addressed in clinical trials and meta-analyses, which are often limited to subgroup analyses for efficacy outcomes.</p><p>Although we welcome the call for global validation, we believe our findings provide robust evidence supporting the benefits of intensive blood pressure lowering across diverse populations. Clinicians should use this evidence to guide personalized treatment decisions.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 4","pages":""},"PeriodicalIF":9.2,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding: Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta-analysis","authors":"Ahmed B. Shamsulddin","doi":"10.1111/joim.70006","DOIUrl":"10.1111/joim.70006","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;The meta-analysis by Bergmann et al. [&lt;span&gt;1&lt;/span&gt;] published in &lt;i&gt;Journal of Internal Medicine&lt;/i&gt; provides a significant synthesis, concluding that intensive systolic blood pressure (SBP) control (&lt;120 mm Hg) reduces mortality and MACE in high-risk individuals. This finding could reinforce a dominant narrative that “lower is always better” for SBP, universally applicable. However, the “insight” arises when considering the study's own highlighted limitations and the geographical concentration of the included RCTs (primarily North America and East Asia). This prompts a reconsideration of how these important findings are translated into global clinical practice.&lt;/p&gt;&lt;p&gt;Why is this reconsideration needed now? The increasing recognition of global health disparities and the influence of diverse socio-environmental and genetic factors on disease presentation and treatment response means that a one-size-fits-all approach, even for well-established interventions, may fall short. Extant therapeutic guidelines often strive for universality, but the gap in current understanding is how to effectively adapt evidence from specific trial populations to the vast heterogeneity of real-world patients globally. Simply stating a pooled benefit without robustly addressing generalizability overlooks this critical translational step.&lt;/p&gt;&lt;p&gt;This analysis by Bergmann et al., therefore, offers a new framing for future research: Instead of solely focusing on whether intensive SBP control works, the emphasis should shift to for whom, under what conditions, and with what regional adaptations. The generalizability point is not just a caveat; it is a call to extend the literature through trials specifically designed to assess intensive SBP strategies in underrepresented regions (e.g., Middle East, Africa, and South America), potentially incorporating cross-disciplinary thinking from public health and implementation science to understand contextual barriers and facilitators.&lt;/p&gt;&lt;p&gt;Furthermore, the consistent signal of increased adverse events (hypotension, syncope, AKI) [1] is not merely a secondary concern but a primary driver for the practical implication of individualized therapy. The challenge now is to move beyond simply acknowledging this trade-off. Indeed, if the profound cardiovascular benefits demonstrated by Bergmann et al. could be consistently replicated across all global regions and achieved without the burden of these significant adverse effects, it would undoubtedly represent a paradigm shift in cardiovascular prevention. Therefore, the future direction must be proactive: To discover and validate targeted strategies—perhaps guided by pharmacogenomics, precision risk stratification for adverse events, or novel co-therapies—that can uncouple the desired cardiovascular benefits from the concerning harms.&lt;/p&gt;&lt;p&gt;To convince a potentially skeptical audience that this nuance is paramount, I argue that the true advancement lies not just in dem","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 4","pages":"363-364"},"PeriodicalIF":9.2,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pharmacotherapeutic potential of neuropeptide Y for chronic pain","authors":"Al A. Nie,&nbsp;Bradley K. Taylor","doi":"10.1111/joim.20118","DOIUrl":"10.1111/joim.20118","url":null,"abstract":"<p>Chronic pain is a major medical problem that requires new therapeutic options. Discovered by Victor Mutt in 1982, neuropeptide Y (NPY) is rapidly emerging as a master regulator of pain relief. Genetic knockdown of NPY or pharmacological inhibition of its receptors demonstrates that NPY signaling tonically inhibits indices of chronic inflammatory and neuropathic pain. Primary targets of NPY analgesia include neurons in the dorsal horn of the spinal cord and the parabrachial nucleus of the brain that express the Npy1r (Y1) receptor. NPY signaling is enhanced following injury, and endogenous analgesic synergy between Y1 receptors and mu opioid receptors maintain chronic pain sensitization in a latent state of remission. We propose that disruptions to endogenous NPY analgesia may mediate pathological transitions from acute to chronic pain, which could be treated by CNS administration of Y1 agonists or Npy2r (Y2) agonists or antagonists, depending on the pain state. Chemogenetic manipulations or targeted ablations in rodent models of chronic inflammation or peripheral nerve injury establish that spinal Y1-interneurons are necessary and sufficient to elicit behavioral signs of both the sensory and affective dimensions of pain. Transcriptomic and in situ hybridization studies revealed three primary subpopulations of spinal Y1-interneurons that are conserved in higher order mammals, including non-human primates and humans. Spinally directed (intrathecal) administration of Y1-selective pharmacological agonists inhibit pronociceptive neurons that co-express Y1 and gastrin-releasing peptide to inhibit neuropathic pain. To circumvent highly invasive administration routes, ongoing studies are leveraging the intranasal route for delivery of NPY into the brain.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 4","pages":"280-296"},"PeriodicalIF":9.2,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-protein diet for chronic kidney disease: Evidence, controversies, and practical guidelines","authors":"Denise Mafra,&nbsp;Isabela Brum,&nbsp;Natália A. Borges,&nbsp;Viviane O. Leal,&nbsp;Denis Fouque","doi":"10.1111/joim.20117","DOIUrl":"10.1111/joim.20117","url":null,"abstract":"<p>The benefits of a low-protein diet (LPD) in patients with altered kidney function remain controversial. Dietary intake studies are inherently complex and may present numerous biases that must be understood and controlled. Due to these challenges, the scientific evidence in this area remains limited and is subject to dispute. However, there is abundant literature showing that excessive protein intake in these patients is linked to cardiovascular issues, oxidative stress, hyperphosphatemia, bone mineral disease, metabolic acidosis, inflammation, and gut dysbiosis, contributing to kidney damage and other concurrent systemic disorders. An LPD remains a valuable recommendation for non-dialysis chronic kidney disease (CKD) patients if age, nutritional status, and disease complications are carefully considered to ensure optimal outcomes. On the one hand, excessive protein intake may lead to the accumulation of nitrogenous waste products, thereby burdening renal function. On the other hand, overly restrictive protein consumption can lead to muscle mass loss, potentially worsening clinical outcomes and patient prognosis. This narrative review highlights the harmful impact of a high-protein diet on kidney function, particularly for those with preexisting kidney impairment or a predisposition to CKD. It also discusses the importance of an individualized and well-monitored protein intake strategy to balance the benefits of protein restriction with the risks of malnutrition.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 4","pages":"319-335"},"PeriodicalIF":9.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remnant cholesterol as a driver for atherosclerosis in patients with type 2 diabetes: Insights from a long-term prospective cohort study","authors":"Heinz Drexel,&nbsp;Laura Schnetzer,&nbsp;Andreas Leiherer,&nbsp;Peter Fraunberger,&nbsp;Arthur Mader,&nbsp;Christoph H. Saely,&nbsp;Andreas Festa","doi":"10.1111/joim.70001","DOIUrl":"https://doi.org/10.1111/joim.70001","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 3","pages":"268-272"},"PeriodicalIF":9.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic innovations to counter antimicrobial-resistant infections and antimicrobial peptides","authors":"Antonio Vitiello","doi":"10.1111/joim.70005","DOIUrl":"10.1111/joim.70005","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Antimicrobial resistance (AMR) is the phenomenon that occurs when infections are no longer sensitive to commercially available antimicrobials. Today, it is considered to be among the major global health problems. Among the most important strategies to counter the AMR phenomenon is to find alternative therapeutic strategies to common antimicrobials. Antimicrobial peptides (AMPs) are a class of naturally occurring molecules that act as crucial components of the innate immune system in a wide range of organisms, including humans, animals, plants and microorganisms. These peptides exhibit broad-spectrum antimicrobial properties, enabling them to target and neutralize a variety of pathogens, including bacteria, fungi, viruses and parasites. Recently, AMPs have been increasingly studied as potential therapeutic alternatives to conventional antibiotics. However, there are still many questions to be answered before their established use in clinical practice. The unique structure and different modes of action of AMP make them promising candidates for therapeutic development [&lt;span&gt;1, 2&lt;/span&gt;]. The mechanisms of action of AMP are multiple, such as membrane disruption and potential intracellular targeting. Furthermore, through their amphipathic nature and cationic charge, AMPs selectively interact with negatively charged microbial membranes, distinguishing them from host cells. Upon binding, they insert into the lipid bilayer, leading to the formation of pores, thinning of the membrane or its complete disintegration, resulting in ion leakage, loss of membrane potential and eventual cell lysis. In addition to membrane disruption, some AMPs penetrate microbial cells to inhibit vital processes, including DNA/RNA synthesis, protein translation and enzyme activity, such as blocking cell wall biosynthesis. This dual mechanism of membrane attack and intracellular action enhances their broad-spectrum efficacy against bacteria, fungi, viruses and even drug-resistant strains, minimizing the development of resistance. In addition, an immunomodulatory role has been demonstrated for some AMPs, further enhancing host defence. Their versatility makes them promising candidates for the next generation of antimicrobial therapies [&lt;span&gt;3&lt;/span&gt;]. Human defensin HBD 2, for instance, is being studied for its potential in the treatment of skin infections, respiratory tract infections and even inflammatory diseases [&lt;span&gt;4&lt;/span&gt;]. Cathelicidins are another group of AMPs that demonstrate strong antimicrobial properties. The human cathelicidin, LL-37, is particularly effective against Gram-positive bacteria and has shown potential in the treatment of skin wounds and respiratory infections. LL-37 is also known for its immunomodulatory properties, which help regulate immune responses and promote wound healing. Melittin, derived from bees, is another potent AMP that acts by disrupting bacterial cell membranes. It has shown promise in the treatment of bacteria","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 4","pages":"361-362"},"PeriodicalIF":9.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors reply: Simple step-counting captures comparable health information to complex accelerometer measurements","authors":"Jonatan Fridolfsson,&nbsp;Anders Raustorp,&nbsp;Mats Börjesson,&nbsp;Elin Ekblom-Bak,&nbsp;Örjan Ekblom,&nbsp;Daniel Arvidsson","doi":"10.1111/joim.20121","DOIUrl":"10.1111/joim.20121","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 3","pages":"276-278"},"PeriodicalIF":9.2,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long sleep duration pattern is associated with increased cardiovascular recurrence: Effect of long-term Mediterranean diet from the CORDIOPREV study","authors":"Antonio García-Ríos,&nbsp;Juan Luis Romero-Cabrera,&nbsp;Juan Francisco Alcalá-Díaz,&nbsp;Gracia M. Quintana-Navarro,&nbsp;Laura Martín-Piedra,&nbsp;Antonio Pablo Arenas-de Larriva,&nbsp;Jose David Torres-Peña,&nbsp;Fernando Rodriguez-Cantalejo,&nbsp;Stefanos N. Kales,&nbsp;José M. Ordovás,&nbsp;Pablo Pérez-Martínez,&nbsp;Javier Delgado-Lista,&nbsp;José López-Miranda","doi":"10.1111/joim.20119","DOIUrl":"10.1111/joim.20119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evidence suggests interactions between sleep and diet that could modify coronary heart disease (CHD) risk. This study aims to investigate the association between sleep duration and incidence of major cardiovascular events (MACE) and the impact of dietary interventions (Mediterranean or low-fat diet) from the Coronary Diet Intervention with Olive Oil and Cardiovascular Prevention (CORDIOPREV) study (NCT00924937).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 952 subjects were stratified into reference (&gt;6 to &lt;8 h per night), short (≤6 h), and long sleep duration pattern (≥8 h) based on self-reported data from the Minnesota Leisure-Time Physical Activity questionnaire over 7 years. The main outcome was the incidence of MACE (myocardial infarction, revascularization procedures, ischemic strokes, peripheral artery disease, and cardiovascular mortality).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MACE occurred in 189 participants: 18.1% in the reference group, 17.7% in the short group, and 29% in the long sleep duration group. Accordingly, the long sleep duration group had a higher risk of MACE compared to the reference and short sleep groups (log-rank <i>p </i>&lt; 0.01, hazard ratio [HR]: 1.59 [95% CI: 1.12–2.26]). Participants assigned to a low-fat diet with long sleep duration had a higher risk of MACE (HR: 1.74 [95% CI: 1.11–2.73]), whereas those assigned to a Mediterranean diet did not show significant differences in risk (HR: 1.35 [95% CI: 0.76–2.41]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A long sleep duration pattern is associated with a higher risk of MACE among CHD patients. Long-term adherence to a Mediterranean diet may mitigate this association. These findings highlight the importance of considering sleep as a cardiovascular risk factor in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 3","pages":"237-250"},"PeriodicalIF":9.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding: Simple step counting captures comparable health information to complex accelerometer measurements","authors":"Yingjian Ye,&nbsp;Jinfang Yang,&nbsp;Junyan Zhang,&nbsp;Peng An","doi":"10.1111/joim.20120","DOIUrl":"10.1111/joim.20120","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 3","pages":"273-275"},"PeriodicalIF":9.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}