Genshan Zhang, Baolin Han, Yanghui Chen, Wei Jiang, Jie Fu, Xiangshang Xu, Xuelai Luo, Zhixin Cao
{"title":"Genetic insights into visceral obesity with health conditions, from disease susceptibility to therapeutic intervention.","authors":"Genshan Zhang, Baolin Han, Yanghui Chen, Wei Jiang, Jie Fu, Xiangshang Xu, Xuelai Luo, Zhixin Cao","doi":"10.1093/postmj/qgaf004","DOIUrl":"https://doi.org/10.1093/postmj/qgaf004","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the relationship between visceral obesity and various disease traits, as well as to identify potential safe targets for the prevention and treatment of visceral obesity.</p><p><strong>Study design: </strong>Univariable and multivariable Mendelian randomization (MR) analyses were performed to examine the associations between visceral obesity and 1883 disease traits. Furthermore, we assessed the potential effect of 1684 protein expressions on visceral obesity using the available quantitative trait locus data for plasma proteins. To evaluate the potential safety profiles associated with biomarker intervention, we conducted phenome-wide MR using 1883 outcomes, focusing on the significant biomarkers.</p><p><strong>Results: </strong>Visceral obesity was significantly associated with elevated risks of 183 disease traits across multiple systems, such as endocrine, cardiovascular, respiratory, digestive, musculoskeletal, and genitourinary systems. Higher genetically predicted levels of GCKR, CYB5A, ITPKA, and ENTPD6 were found to increase the risk of visceral obesity, while 1433B, SEMA3G, FOXO3, and HAPLN4 were associated with a decreased risk of visceral obesity. The results of the phenome-wide MR analysis indicate that CYB5A, ENTPD6, 1433B, and HAPLN4 can potentially be safe and effective drug targets for visceral obesity treatment.</p><p><strong>Conclusions: </strong>This study indicates visceral obesity is associated with an increased risk of diseases within various physiological systems, such as cardiovascular, respiratory, and endocrine systems. The circulatory proteome reveals eight novel biomarkers for visceral obesity intervention, with CYB5A, ENTPD6, 1433B, and HAPLN4 displaying particular potential as safe and effective drug targets.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mengru Zeng, Linshan Zhou, Xiaojun Chen, Guochun Chen, Li Xiao
{"title":"Effects of sarcopenic obesity on incident chronic kidney disease and rapid kidney function decline: evidence from the China health and retirement longitudinal study.","authors":"Mengru Zeng, Linshan Zhou, Xiaojun Chen, Guochun Chen, Li Xiao","doi":"10.1093/postmj/qgaf007","DOIUrl":"https://doi.org/10.1093/postmj/qgaf007","url":null,"abstract":"<p><strong>Study purpose: </strong>Evidence on the effects of sarcopenic obesity (SO) on incident chronic kidney disease (CKD) and rapid kidney function decline (RKFD) in the Chinese population is limited. This study aimed to prospectively examine the associations of SO with incident CKD and RKFD among middle-aged and older Chinese adults.</p><p><strong>Study design and methods: </strong>This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative longitudinal study of Chinese adults aged 45 and older. The analysis included 4201 individuals from the 2011 wave, with renal outcomes ascertained from the 2015 wave. The effects of SO on incident CKD and RKFD were assessed using logistic regression models. Robustness was tested through subgroup and sensitivity analyses.</p><p><strong>Results: </strong>Over four years of follow-up, 228 cases of incident CKD and 213 cases of RKFD were observed. After multivariable adjustment, participants in the \"sarcopenic obesity\" group showed a 78% increased risk of incident CKD (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.09-2.90) and a 79% increased risk of RKFD (OR 1.79, 95% CI 1.03-3.13), compared to the \"nonsarcopenia without obesity\" group. Consistent results were observed across subgroups stratified by gender, education level, marital status, geographic area, lifestyle factors, and comorbidities, with no significant interactions detected.</p><p><strong>Conclusions: </strong>In a population-based cohort of middle-aged and older Chinese adults, SO was independently associated with elevated risks of incident CKD and RKFD, without interaction effects. These findings underscore the importance of timely intervention for SO to prevent adverse kidney outcomes. Key message What is already known on this topic? The relationship between sarcopenic obesity (SO) and the risk of chronic kidney disease (CKD) and renal function decline has been established in Korean and Japanese individuals with type 2 diabetes mellitus. However, it is uncertain if these findings apply to other populations, particularly those without diabetes. Additionally, the influence of diabetes on these associations needs further exploration, and the link between SO and rapid kidney function decline (RKFD) remains unestablished. Evidence regarding the effects of SO on incident CKD and RKFD in the Chinese population is limited, highlighting the necessity for this study to fill these gaps in knowledge. What this study adds This study is the first to prospectively explore the association of SO with incident CKD and RKFD in middle-aged and older Chinese adults. We identified SO as a significant risk factor for increased incidence of both CKD and RKFD. These findings expand the understanding of the impact of SO beyond individuals with diabetes mellitus, indicating that SO is a universal risk factor for adverse kidney outcomes in aging populations, irrespective of demographic","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Contribution of nebulized budesonide before bronchoscopy, a prospective clinical study.","authors":"Guoxin Zhang, Hu Yu, Li Zhang, Xiaoyun Zhao","doi":"10.1093/postmj/qgae196","DOIUrl":"https://doi.org/10.1093/postmj/qgae196","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the efficacy of adding budesonide to nebulized lidocaine in patients undergoing flexible bronchoscopy (FB) under topical anaesthesia.</p><p><strong>Study design: </strong>Patients aged ≥18 years, scheduled for FB under topical anaesthesia were randomized into two groups: the combination group received a pre-treatment of 2 ml 1 mg budesonide with 5 ml 2% lidocaine, whilst the lidocaine group received 5 ml 2% lidocaine with 2 ml saline solution, both administered via nebulization. Blood pressure (BP), heart rate, and percutaneous oxygen saturation were recorded before, during, and 10 min after FB. The Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale (FPS-R) were used to evaluate cough severity, discomfort, willingness to accept reoperation, and the operator's satisfaction with patient cooperation. In addition, the duration of the procedure, total lidocaine dosage instilled through the bronchoscope during the procedure, and types of procedures performed were documented.</p><p><strong>Results: </strong>Compared to the lidocaine group, the combination group showed lower maximum systolic and diastolic BP, higher minimum percutaneous oxygen saturation, and lower cough and discomfort severity scores. Operator's satisfaction, as measured via the VAS or FPS-R, was greater in the combination group, which also exhibited shorter procedure times and required lower lidocaine dosages. There were no significant differences between the groups in terms of willingness to accept reoperation or types of procedures performed.</p><p><strong>Conclusions: </strong>In patients undergoing FB with topical anaesthesia, pre-treatment with a combination of nebulized lidocaine and budesonide is more effective than nebulized lidocaine alone. Key message What is already known on this topic? Flexible bronchoscopy (FB) with topical anaesthesia remains a common practice in many settings, although it can cause significant discomfort for patients. What this study adds? Pre-treatment with a combination of nebulized budesonide and lidocaine was more effective and safer than nebulized lidocaine alone for improving patient tolerance during FB. How this study might affect research, practice, or policy? In settings where conscious sedation is not feasible, the combined nebulization of lidocaine and budesonide may offer an optimized approach for FB, enhancing patient comfort and procedural efficiency.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"We are all flawed. Fewer are less flawed than others.","authors":"Philip D Welsby","doi":"10.1093/postmj/qgaf002","DOIUrl":"https://doi.org/10.1093/postmj/qgaf002","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correlation between cathepsins and the likelihood of renal cancer: a Mendelian randomization study.","authors":"Tuo Peng, Tian Li, Caihua Zhang","doi":"10.1093/postmj/qgaf003","DOIUrl":"https://doi.org/10.1093/postmj/qgaf003","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have established a relationship between cathepsins and renal cancer. Nonetheless, the specific causal connection between the two factors continues to be ambiguous. The aim of this study is to evaluate the causal relationship between cathepsins and renal cancer via employing Mendelian randomization (MR).</p><p><strong>Methods: </strong>The summary data of genome-wide association study were used for univariable MR (UVMR), reverse MR, and multivariable MR (MVMR) analyses. The primary MR method used in this study was Inverse variance weighting.</p><p><strong>Results: </strong>UVMR analysis showed that cathepsin Z increased the overall risk of renal cancer and cathepsin F were observed increased the risk of clear cell renal cell carcinoma. Furthermore, the concentration of cathepsin S had a significant positive correlation with the risk of papillary renal cell carcinoma (pRCC), whereas that of cathepsin G was negatively correlated with the risk of pRCC. Reverse MR analysis showed that renal cancer reduced the concentration of cathepsin H. MVMR analysis showed that the concentration of cathepsin B had a significant positive correlation with overall risk of renal cancer and pRCC. In addition, a higher concentration of cathepsin S was significantly associated with an increased risk of pRCC.</p><p><strong>Conclusion: </strong>This study confirmed a direct link between cathepsins and the risk of renal cancer. Specifically, cathepsin S has a significant positive correlation with the risk of pRCC. The findings of our research could provide significant contributions to both fundamental and clinical investigations pertaining to renal cancer. Key message What is already known on this topic? - Previous studies have suggested the role of some cathepsins in renal cancer occurrence and progression. However, the causal link between different cathepsins and renal cancer is unknown. What this study adds? - Our Mendelian randomization (MR) study revealed that the effects of different cathepsins on the risk of renal cancer. Remarkably, both univariable MR and multivariable MR demonstrated that the levels of cathepsin S increases the risk of papillary renal cell carcinoma. How this study might affect research, practice or policy? - The findings offer novel insights into the relationship between cathepsins and renal cancer, which may have implications for the prevention and management of renal cancer.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isaac Oluwatobi Akefe, Victoria Aderonke Adegoke, Elijah Akefe
{"title":"Strategic tips to successfully undertake research: a comprehensive roadmap for medical trainees.","authors":"Isaac Oluwatobi Akefe, Victoria Aderonke Adegoke, Elijah Akefe","doi":"10.1093/postmj/qgaf001","DOIUrl":"https://doi.org/10.1093/postmj/qgaf001","url":null,"abstract":"<p><p>Engaging in research during medical training is crucial for fostering critical thinking, enhancing clinical skills, and deepening understanding of medical science. Despite its importance, the shortage of physician-scientists lingers with many trainees and junior doctors encountering challenges navigating the research process. Drawing on current literature, this article provides a comprehensive roadmap, categorising 12 actionable strategies into five themes, to help medical trainees overcome common obstacles and optimise their research experience. The strategies include early planning, research conduct and integrity, productivity and time management, collaboration and dissemination, and personal growth and development. By implementing these evidence-based recommendations, derived from current literature and expert insights, medical trainees can refine their research skills, produce high-quality outputs, and contribute meaningfully to the scientific community, ultimately enriching their medical training and future careers.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pregnancy among thyroid cancer survivors: do thyroidectomy and radioactive iodine matter?","authors":"Chung-Jen Teng, Chiu-Mei Yeh, Chia-Jen Liu, Tzeng-Ji Chen, Nicole Huang, Yiing-Jenq Chou","doi":"10.1093/postmj/qgae197","DOIUrl":"https://doi.org/10.1093/postmj/qgae197","url":null,"abstract":"<p><strong>Background: </strong>Thyroid cancer primarily affects young women and raises concerns about future fertility due to treatments of thyroidectomy and radioactive iodine (RAI) therapy. This study investigated the effects of these treatments on pregnancy probability in young female patients post-diagnosis.</p><p><strong>Methods: </strong>A nationwide, population-based study using data from Taiwan's National Health Insurance Research Database (2000-2017) examined pregnancy likelihood in women ≤45 years with thyroid cancer. The effects of thyroidectomy and RAI therapy on pregnancy were analyzed using logistic regression and Cox proportional-hazards models.</p><p><strong>Results: </strong>In a cohort of 10 937 patients with thyroid cancer, 7022 (64.2%) underwent total thyroidectomy, with 718 receiving RAI treatment. The type of thyroidectomy and RAI treatment, even at doses exceeding 120 millicuries, did not reduce the likelihood of pregnancy. Age was identified as the most critical factor influencing pregnancy; women aged >30 years had a significantly lower likelihood of becoming pregnant than younger women did. Other factors associated with a reduced likelihood of pregnancy included comorbidity with diabetes (HR = 0.65, P = .002) and higher socioeconomic status (HR = 0.69, P = .085).</p><p><strong>Conclusions: </strong>Thyroidectomy and RAI therapy do not diminish pregnancy probability in young women with thyroid cancer. Age remains a crucial factor, with younger women more likely to conceive. These findings are critical for fertility counseling and treatment planning. Key message What is already known on this subjec? Thyroid cancer primarily affects young women, and its standard treatments, including thyroidectomy and radioactive iodine (RAI) therapy, have raised concerns about their potential impact on fertility. Previous studies have shown that RAI treatment may temporarily affect ovarian function but typically does not have a significant long-term effect on fertility. What this study adds? This nationwide population-based study found that neither total nor partial thyroidectomy, nor RAI treatment, adversely affects the likelihood of pregnancy in young women with thyroid cancer. Age was identified as the most significant factor influencing pregnancy, with younger women having a higher probability of becoming pregnant after treatment. How this study might affect research, practice, or policy? Clinicians should recognize that age, rather than the type of thyroidectomy or RAI treatment, is the most critical factor influencing fertility in young women with thyroid cancer. This insight can guide personalized fertility counseling and treatment planning to optimize outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Higher dietary zinc intake increases the risk of autoimmune thyroiditis.","authors":"Lijun Chen, Changjian Yan, Chunling Huang, Zhengrong Jiang, Ruhai Lin, Xiaohong Wu, Huibin Huang","doi":"10.1093/postmj/qgae202","DOIUrl":"https://doi.org/10.1093/postmj/qgae202","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune thyroiditis (AIT), encompassing Hashimoto's thyroiditis (HT), is a prevalent chronic autoimmune disorder characterized by lymphocytic infiltration and the presence of anti-thyroid antibodies. It is the primary cause of primary hypothyroidism and affects women more frequently than men. Nearly 95% of individuals with HT exhibit thyroid peroxidase antibodies or thyroglobulin antibodies. Dietary factors, including vitamins and trace elements such as zinc, play a significant role in thyroid health; yet, clinical guidelines lack explicit dietary recommendations for AIT.</p><p><strong>Methods: </strong>This study investigates the relationship between dietary zinc intake (Zinc) and AIT using data from the 2007-2008 National Health and Nutrition Examination Survey. A total of 5467 participants were analyzed, including 273 individuals with AIT and 5194 without AIT. Clinical characteristics, dietary Zinc, and other relevant variables were assessed. Multivariate logistic bidirectional stepwise regression analysis was conducted to identify independent risk factors for AIT, and a risk prediction model was developed.</p><p><strong>Results: </strong>The prevalence of AIT was 5%. Individuals with AIT were older, had a higher proportion of females, and showed elevated levels of various biomarkers, including zinc. Dietary Zinc was significantly higher in the AIT group (22.6 mg vs. 15.3 mg, P < .001). The regression analysis identified dietary Zinc, along with other factors, as an independent risk factor for AIT. The risk prediction model, including zinc, demonstrated a better performance (area under the curve = 0.8) compared to the model without zinc.</p><p><strong>Conclusion: </strong>The findings indicate that higher dietary Zinc is positively correlated with the risk of AIT and serves as an independent risk factor. Excessive Zinc may disrupt immune balance, potentially increasing the risk of autoimmune diseases. These results suggest that dietary Zinc should be carefully considered in the management of AIT, and further research is needed to explore the causal relationship and determine safe zinc consumption levels to avoid increasing the risk of autoimmune diseases.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effect of abnormal placental cord insertion on hemodynamic change of umbilical cord in a tertiary center: a prospective cohort study.","authors":"Xiu-Qin Wu, Ying Miao, Xiao-Feng Yang, Yong-Qiang Hong, Liang-Cheng Wang, Wei-Hsiu Chiu","doi":"10.1093/postmj/qgae193","DOIUrl":"https://doi.org/10.1093/postmj/qgae193","url":null,"abstract":"<p><strong>Background: </strong>Our study aims to evaluate the umbilical vein (UV) hemodynamic change in the prenatal cohort of pregnancies diagnosed with abnormal placental cord insertion (aPCI).</p><p><strong>Methods: </strong>From January 2022 to December 2022, the fetal umbilical cord insertion site was sonographically examined in singleton fetuses, and umbilical cord blood flow was calculated. The umbilical artery and UV Doppler flow indexes were assessed in cases of normal and abnormal cord insertion.</p><p><strong>Results: </strong>Among 570 singleton fetuses between 18 + 0 and 40 + 6 weeks of gestation in the final study, the umbilical vein blood flow (UVBF) in the 3 groups of normal umbilical cord insertions, marginal umbilical cord insertions, and velamentous umbilical cord insertions was 145.39 ml/min, 146.18 ml/min, and 93.96 ml/min, respectively. UVBF was significantly lower in the velamentous cord insertion (VCI) group than in the other groups (P < 0.05). Compared with the normal cord insertions group, lower birth weight (2820 ± 527 g vs. 3144 ± 577 g, P < 0.05), delivery at an earlier gestational age (38.0 ± 1.55 weeks vs. 38.8 ± 2.34 weeks, P < 0.05), higher bicarbonate (25.08 ± 1.72 mmol/L vs. 22.66 ± 4.05 mmol/L, P < 0.05), and higher standard base excess (-1.14 ± 1.50 mmol/L vs. -3.30 ± 3.22 mmol/L, P < 0.05) were found in the VCI group.</p><p><strong>Conclusions: </strong>We observed lower UVBF volume with aPCI. Hence, we propose UVBF analysis to evaluate fetal aPCI according to UV hemodynamics as an advisory in prenatal care. This would be useful and improve obstetricians' clinical explanation about the potential prenatal consequences so that parents can opt for future prenatal care during pregnancy.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}