Journal of Clinical Endocrinology & Metabolism最新文献

{"title":"High-density Lipoprotein Over Midlife and Future Cognition in Women: The SWAN HDL Ancillary Study.","authors":"Meiyuzhen Qi, Jeffrey Billheimer, Chung-Chou H Chang, Imke Janssen, Maria M Brooks, Trevor Orchard, Arun S Karlamangla, Emma Barinas-Mitchell, Carol A Derby, Dan McConnell, Sybil Crawford, Samar R El Khoudary","doi":"10.1210/clinem/dgae697","DOIUrl":"10.1210/clinem/dgae697","url":null,"abstract":"<p><strong>Context: </strong>Limited data provides evidence-based insights on the association between the comprehensive metrics of high-density lipoproteins (HDL) and cognitive performance, especially in midlife women for whom the benefit might be the greatest.</p><p><strong>Objective: </strong>To assess the associations of serum HDL metrics including HDL lipid content [HDL cholesterol, phospholipid (HDL-PL), triglyceride], proteins/subclasses [apolipoprotein A-1 (apoA-1); small, medium, large, total HDL particle (HDL-P); and HDL size], and cholesterol efflux capacity with cognitive performance in midlife women.</p><p><strong>Methods: </strong>This prospective cohort study was conducted among 503 midlife women (1234 observations) from the Study of Women's Health Across the Nation HDL ancillary study. Joint models were applied to examine associations of HDL metrics assessed at midlife (50.2 ± 2.9 years, baseline of the current study) and their changes over midlife (6.1 ± 3.9 years of duration) with subsequent cognitive performance [working memory (Digit Span Backward Test), processing speed (Symbol Digit Modalities Test), and episodic memory immediate and delayed recall (East Boston Memory Test)] assessed repeatedly (maximum 5 times) 1.5 ± 1 years later over 7.72 ± 4.10 years of follow-up.</p><p><strong>Results: </strong>Higher total HDL-P and smaller HDL size at midlife were associated with a better subsequent immediate recall, delayed recall, and/or processing speed. Greater increase in HDL-PL, apoA-1, medium HDL-P, and total HDL-P and less increase in HDL size over midlife were associated with a better subsequent immediate and/or delayed recall.</p><p><strong>Conclusion: </strong>Enhancing specific serum HDL metrics during midlife could be promising in cognitive restoration, particularly memory, the initial and predominant symptom of Alzheimer's disease.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1980-1988"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376266","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":"Testosterone Treatment and Sexual Function in Men: Secondary Analysis of the T4DM (Testosterone for Diabetes) Trial.","authors":"Gary A Wittert, Kristy P Robledo, David J Handelsman, Warrick J Inder, Bronwyn G A Stuckey, Bu B Yeap, Karen Bracken, Carolyn A Allan, David Jesudason, Alicia Jenkins, Andrzej S Januszewski, Mathis Grossmann","doi":"10.1210/clinem/dgaf060","DOIUrl":"10.1210/clinem/dgaf060","url":null,"abstract":"<p><strong>Context: </strong>The combined effects of testosterone treatment and lifestyle intervention on sexual function in men at high risk of type 2 diabetes are unclear.</p><p><strong>Objective: </strong>To assess the effect of testosterone treatment with a lifestyle intervention in men aged 50 to 74 years at high risk of, or newly diagnosed with, type 2 diabetes (via oral glucose tolerance test).</p><p><strong>Design: </strong>A secondary analysis of the Testosterone for the Prevention of Type 2 Diabetes trial, a double-blind, placebo-controlled trial conducted across 6 Australian centers.</p><p><strong>Interventions: </strong>Intramuscular testosterone undecanoate (1000 mg) or placebo, 3 monthly for 2 years alongside a community-based lifestyle program.</p><p><strong>Main outcomes: </strong>Sexual function measured using the International Index of Erectile Function (IIEF)-15 questionnaire.</p><p><strong>Results: </strong>Of 1007 participants, 792 (79%) had complete International Index of Erectile Function-15 data. Baseline domain scores were inversely related to age and waist circumference, but unrelated to serum testosterone or estradiol levels. Testosterone treatment improved all 5 International Index of Erectile Function-15 domain scores, with stronger effects on sexual desire and orgasmic function in older men, and sexual desire in men with higher depression scores. Testosterone had no impact on depression. Independent of treatment, reductions in waist circumference were associated with improved erectile function, and reductions in depression scores correlated with better sexual function. Clinically significant improvement in erectile function and sexual desire occurred in 3% and 10% of men, respectively, and was inversely related to baseline function. Clinically significant improvement improvements in erectile function and sexual desire were greater in younger and older men respectively.</p><p><strong>Conclusion: </strong>Testosterone treatment enhanced sexual desire and, to a lesser extent, erectile function, particularly in older men and those with higher waist circumference or depressive symptoms. Reduced waist circumference and depression independently improved sexual function.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2157-e2170"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392271","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":"Correction to: \"Insulin Signaling Through the Insulin Receptor Increases Linear Growth Through Effects on Bone and the GH-IGF-1 Axis\".","authors":"","doi":"10.1210/clinem/dgaf186","DOIUrl":"10.1210/clinem/dgaf186","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2434"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774652","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-Term Glycemic Variability Predicts Adverse Outcomes in Diabetic Heart Failure With Preserved Ejection Fraction.","authors":"Jung-Chi Hsu, Yen-Yun Yang, Shu-Lin Chuang, Lian-Yu Lin","doi":"10.1210/clinem/dgae715","DOIUrl":"10.1210/clinem/dgae715","url":null,"abstract":"<p><strong>Context: </strong>Previous studies have shown associations between glycemic variability (GV) and cardiovascular outcomes in patients with type 2 diabetes. However, the effect of GV on outcomes in diabetic patients with heart failure with preserved ejection fraction (HFpEF) has not been investigated.</p><p><strong>Objective: </strong>To investigate the association between increased GV and cardiovascular outcomes in diabetic patients with HFpEF.</p><p><strong>Methods: </strong>Between 2014 and 2019, we conducted a retrospective cohort analysis using the electronic medical records of a tertiary medical center in Taiwan. Diabetic patients with HFpEF were enrolled. Each individual's coefficient of variability of fasting glucose (FGCV) was determined and the FGCVs were categorized into tertiles. Multivariable Cox regression models and the Kaplan-Meier with log-rank test were used to assess the association between the FGCV and the risk of hospitalization for heart failure (HHF), atrial fibrillation (AF), cardiovascular mortality, and overall mortality.</p><p><strong>Results: </strong>In a cohort comprising 74 835 individuals diagnosed with diabetes, a subset of 753 patients was identified with HFpEF and measurement of FGCV. The median follow-up duration was 38.1 months. In the model of full adjustment, the third FGCV tertile was statistically significantly associated with an increased risk of HHF compared to the first tertile (hazard ratio [HR] = 1.32; 95% CI, 1.04-1.69; P = .025). Likewise, the highest FGCV tertile was associated with an increased risk of death (HR 1.65; 95% CI, 1.16-2.35; P = .005), whereas it was not associated with increased of AF and cardiovascular mortality. Kaplan-Meier analyses revealed a statistically significant association between FGCV and both HHF and overall mortality (log-rank P = .022 and <.001, respectively).</p><p><strong>Conclusion: </strong>Our study highlights a significant association between increased GV and a higher incidence of HHF as well as an elevated overall mortality rate in individuals with diabetes and HFpEF.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1929-1937"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394880","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":"Approach to the Patient With Cyclical Cushing Syndrome.","authors":"Amandine Ferriere, Marie-Laure Nunes, Antoine Tabarin","doi":"10.1210/clinem/dgae864","DOIUrl":"10.1210/clinem/dgae864","url":null,"abstract":"<p><p>Cyclical Cushing syndrome (CS) is a subentity of CS, characterized by repeated episodes of excess cortisol (peaks) followed by spontaneous periods of normal or low cortisol secretion (troughs). Although considered rare, its prevalence reaches 70 of 514 to 91 of 514 (14%-18%) in patients with CS according to its definition in some reported series and can concern all etiologies of CS. Physicians should be alert to the presence of cyclical CS in patients with fluctuating symptoms or where the results of biochemical investigations indicate eucortisolism or hypocortisolism in patients with clinical CS. Cyclicity leads to difficulties in establishing the diagnosis of CS and discovering its etiology, since patients may have paradoxical/aberrant results in biochemical investigations, including inferior petrosal sinus sampling. Similarly, cyclicity complicates the interpretation of therapeutic outcomes and interferes with medical treatments for CS. Apart from cyclicity, variability of hypercortisolism is a more common phenomenon seen in CS but can cause similar problems. Since the pathophysiology and molecular basis of cyclical CS are largely unknown, a marked variability in cortisol secretion can be considered as representing a milder aspect of cyclicity within the same continuum. In this issue of \"Approach to the patient,\" the characteristics, main diagnostic and therapeutic pitfalls, as well as strategies for diagnosing and managing cyclicity and marked variability in CS, are discussed from the clinician's perspective using 3 clinical cases.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2338-e2346"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865977","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":"Machine Learning Prediction of Pancreatitis Risk With Antithyroid Drugs: A Nationwide Retrospective Observational Study.","authors":"Muhammed Kizilgul, Talip Yigit, Naim Ata, Ahmet Celik, Bekir Ucan, Mustafa Sahin, M Mahir Ulgu, Suayip Birinci","doi":"10.1210/clinem/dgae628","DOIUrl":"10.1210/clinem/dgae628","url":null,"abstract":"<p><strong>Background: </strong>In recent years, there has been increasing data showing that the risk of acute pancreatitis (AP) is increased in patients using methimazole (MMI). The aim of this population-based study was to investigate the association between drugs used in the treatment of hyperthyroidism (MMI, propylthiouracil, propranolol) and the diagnosis of AP.</p><p><strong>Material and methods: </strong>The database consisted of more than 85 million citizen records between January 1, 2017, and December 31, 2022. Within the scope of the study, the data were examined of patients diagnosed with hyperthyroidism and the individuals who developed acute pancreatitis after being diagnosed with hyperthyroidism, which was accomplished using the International Classification of Diseases, Tenth Revision codes. Analyses were carried out using R Studio 4.2.0 software. The test-train technique as a machine learning method was used in Cox regression models.</p><p><strong>Results: </strong>A total of 1 329 934 individuals diagnosed with hyperthyroidism were examined. Of these, 10 815 (0.81%) patients developed AP after being diagnosed with hyperthyroidism. The use of propylthiouracil was determined to increase the probability of experiencing AP diagnosis 0.10-fold (10%) (P .0009), and the use of propranolol decreased the probability of experiencing AP 0.5-fold (5%) (P .032), with a 52.2% predictive success rate. There is no any statistically significant association between MMI use and the probability of experiencing AP according to the model we built.</p><p><strong>Conclusion: </strong>Although the risk of experiencing AP was not increased by MMI use, propylthiouracil use increased and propranolol use decreased the risk of experiencing AP in patients with hyperthyroidism. Although drug-induced AP is relatively rare, a firm understanding of the drugs associated with the condition should alert the clinician to appropriately diagnose and treat patients.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"2024-2030"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331513","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":"Cancer-related Fear and Worry in Patients With Low-risk Thyroid Cancer: A Longitudinal Cohort Study.","authors":"Stephanie S Lee, Alexis G Antunez, Brandy Sinco, Megan C Saucke, Kyle J Bushaw, Sophie Dream, Abbey Fingeret, Masha J Livhits, Aarti Mathur, Alexandria D McDow, Sanziana Roman, Corrine I Voils, Susan C Pitt","doi":"10.1210/clinem/dgae688","DOIUrl":"10.1210/clinem/dgae688","url":null,"abstract":"<p><strong>Context: </strong>Little is known about how patients' emotions impact the choice between hemi- and total thyroidectomy (TT) for low-risk thyroid cancer (LR-TC) and how these emotions change after treatment.</p><p><strong>Objective: </strong>To investigate thyroid cancer-specific fear and worry both before and after treatment of LR-TC with hemi- or TT.</p><p><strong>Methods: </strong>This prospective cohort study enrolled adults with confirmed or likely LR-TC at 15 institutions. Participants completed measures of thyroid cancer-related fear and worry at the time of their treatment decision and 9 months later. Participants were categorized as having low, medium, or high levels of fear and worry in accordance with the literature. Those choosing hemithyroidectomy were compared to those choosing TT.</p><p><strong>Results: </strong>Of 177 eligible patients, 125 (70.6%) enrolled and 114 completed both surveys (91.2% retention). Overall, 41 (36.0%) participants chose hemithyroidectomy and 73 (64.0%) chose TT. Across all participants, thyroid cancer-related fear and worry both decreased significantly after surgery (fear, 25.8 ± 6.4 to 23.1 ± 7.4; worry, 8.2 ± 2.4 to 5.4 ± 2.1, P < .001). The proportion of participants with high fear decreased from 64.9% to 50.9%, whereas the proportion with high worry decreased from 75.4% to 41.2% (P < .001 for both). At both time points, no differences existed between those choosing hemi- and TT in levels of worry or fear.</p><p><strong>Conclusion: </strong>Patients with LR-TC report lower levels of fear and worry 9 months after surgery regardless of the extent of surgery, suggesting that both surgeries provide an emotional benefit to some patients. Thyroid cancer-related fear and worry do not appear to influence patients' decisions to undergo hemi- or TT.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1881-1887"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479542","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":"Selective Use of Radioiodine in Pediatric Thyroid Cancer-a Paradigm Shift.","authors":"Eyal Robenshtok","doi":"10.1210/clinem/dgae656","DOIUrl":"10.1210/clinem/dgae656","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2403-e2404"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299909","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":"Letter to the Editor From Bai and Zhang: \"Cognitive Risk Stratification Score in Middle-aged and Older Adults With Type 2 Diabetes: A Cross-sectional Study\".","authors":"Yan Bai, Fan Zhang","doi":"10.1210/clinem/dgaf240","DOIUrl":"10.1210/clinem/dgaf240","url":null,"abstract":"","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"e2420-e2421"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037078","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":"Diagnostic Performance of Ultrasound vs Ultrasound-Guided FNAC in Thyroid Nodules: Data From the ElaTION Trial.","authors":"Hisham Mehanna, Paul Nankivell, Kristien Boelaert, Rebecca Woolley, Neil Sharma, Paul S Sidhu, Gitta Madani, Philip Da Forno, Catherine Moreman, Andrew Palmer, Tessa Fulton-Lieuw, Judith Taylor, Kanchana Rajaguru, Jasper Bekker, Ram Vaidhyanath, Thaj Rehman, Jon Deeks","doi":"10.1210/clinem/dgae682","DOIUrl":"10.1210/clinem/dgae682","url":null,"abstract":"<p><strong>Introduction: </strong>ElaTION is a large multicenter pragmatic randomized controlled trial, performed in 18 secondary/tertiary hospitals across England, comparing elastography ultrasound-guided fine needle aspiration cytology (EUS-FNAC) with ultrasound-guided FNAC (US-FNAC) alone in the diagnostic assessment of thyroid nodules. Secondary trial outcomes, reported here, assessed the accuracy of ultrasound alone (US) compared with US-FNAC to inform and update current practice guidelines.</p><p><strong>Methods: </strong>Adults with single or multiple thyroid nodules who had not undergone previous FNAC were eligible. Radiologists assessed all thyroid nodules using US alone, thereby enabling assessment of its accuracy (sensitivity and specificity) vs US-FNAC.</p><p><strong>Results: </strong>Of the 982 participants, a final definitive diagnosis was obtained in 688, who were included in the final analyses. The sensitivity of US alone was the same as US-FNAC (0.91 [95% CI, 0.85-0.97] vs 0.87 [95% CI, 0.80-0.95] P = .37). US alone had statistically significant lower specificity than US-FNAC alone (0.48 vs 0.67 respectively, P < .0001). The malignancy rate on histology in a nodule classified as benign on ultrasound (U2) was 9/263 (3.42%) and on cytology (Thy2) was 15/353 (4.25%), whereas the malignancy rate in a nodule that was benign on both (U2, Thy2) was 3/210 (1.43%). Malignancy risk for U3, U4, and U5 nodules was 68/304 (22.4%), 43/83 (51.8%), and 29/38 (76.3%), respectively (P < .0001). Yet 80/982 (8%) patients were discharged despite having U3-U5 scans with Thy1 (nondiagnostic) FNAC and no definitive diagnosis.Malignancy risk was higher in smaller nodules: < 10 mm 23/60 (38.3%), 10-20 mm 46/162 (28.4%), and >20 mm 80/466 (17.2%) (P < .0001). Nodules with indeterminate cytology with atypical features (Thy3a) carried a similar malignancy risk to those with indeterminate cytology (Thy3/3f): 27/95 (28.4%) vs 42/113 (37.2%) respectively (P = .18).</p><p><strong>Conclusion: </strong>Ultrasound alone appears to be an effective diagnostic modality in thyroid nodules, confirming the recommendations of recent guidelines and the British Thyroid Association classification. However, findings also suggest caution regarding existing recommendations for conservative management of nondiagnostic (Thy1/Bethesda I) and atypical (Thy3a/Bethesda III) nodules. In those cases, ultrasound (U3-U5) features may help identify high-risk subgroups for more proactive management.</p>","PeriodicalId":50238,"journal":{"name":"Journal of Clinical Endocrinology & Metabolism","volume":" ","pages":"1997-2006"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367278","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}