The Journal of clinical endocrinology and metabolism最新文献

{"title":"Serum Androgen Profile of Elite Athletes.","authors":"David J Handelsman, Stephane Bermon","doi":"10.1210/clinem/dgag196","DOIUrl":"https://doi.org/10.1210/clinem/dgag196","url":null,"abstract":"<p><strong>Introduction: </strong>The binary sex classification protects elite female athletes from the male physical advantages arising from puberty; however, mutations causing XY Disorders of Sex Development (DSD) challenge the binary sex classification. Hormonal features of the most frequent XY DSDs in sports, androgen insensitivity syndrome [AIS] and 5α-reductase type 2 deficiency [5ARD] are not well described.</p><p><strong>Aims: </strong>To define serum androgen profiles in elite Athletics (Track and Field) events.</p><p><strong>Methods: </strong>Serum samples from elite athletes (n=1689; male 889, female 800; n=5516 samples, median 3 per person) were analysed by LCMS for serum testosterone [T], dihydrotestosterone [DHT] and androstenedione in 19 WADA-accredited laboratories. Serum steroids and ratios were analyzed by linear mixed model for repeated measures with adjustment for multiple comparisons and imputation for left-censored (DHT) data. Among females, XY DSD identified by adult male serum T concentrations, had clinical diagnosis of 5ARD, AIS or unclassified (UNCL].</p><p><strong>Results: </strong>XY DSD comprised 12 with 5ARD with two with AIS (1 complete). Excluding pregnancy or androgen doping samples, men had higher serum T (n=2671, 19.7 ± 0.1 nmol/L) and T/DHT ratio (n=1903, 14.4 ± 0.2) than women (n=2793, 1.1 ± 0.1 nmol/L; n=1809, 3.7 ± 0.12, respectively) with XY DSD featuring male-like results (n=52, 28.9 ± 0.8 nmol/L; n=39; 32.0 ± 1.3).</p><p><strong>Conclusions: </strong>The prevalence of XY DSD in elite female athletes greatly exceeds that of the community with a high proportion androgen sensitive 5ARD. Serum T/DHT ratio by LCMS to characterize 5ARD can be extended to elite athletes.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aldosterone Synthase Expression vs. Cross-Sectional Imaging in Lateralized Primary Aldosteronism.","authors":"Livia M Mermejo, Yueting Liu, Elaine Caoili, Desmaré van Rooyen, Juilee Rege, Aaron Udager, William E Rainey, Peeradon Vibhatavata, Adina F Turcu","doi":"10.1210/clinem/dgag194","DOIUrl":"https://doi.org/10.1210/clinem/dgag194","url":null,"abstract":"<p><strong>Context: </strong>Adrenal vein sampling (AVS) is the standard of care for guiding surgery in primary aldosteronism (PA). Because of its technical complexity and limited availability, however, many centers still use cross-sectional imaging for surgical guidance.</p><p><strong>Design: </strong>Single referral-center retrospective cohort study of patients with PA who underwent unilateral adrenalectomy between 2012-2024. Blinded cross-sectional imaging interpretation was corroborated with CYP11B2 immunohistochemistry (IHC) of formalin-fixed paraffin-embedded adrenal tissue.</p><p><strong>Results: </strong>Of 173 patients, age 52.6±11.8 years, 119 (68.8%) were men, 134 (77.5%) White, 30 (17.3%) Black, and 9 (5.2%) other races. CYP11B2 IHC identified a single aldosterone-producing adenoma (APA) or nodule (APN) in 87 (50.3%) and 38 (22.0%) patients, respectively; multiple CYP11B2-positive foci in 45 (26.0%) patients, and no CYP11B2-positive lesions in 3 patients. A single corresponding APA or APN on both IHC and imaging was found in only 53/173 (31%) patients, and an additional 38/173 (22%) patients also had adrenal thickening. Discrepant IHC-imaging findings were observed in 82 (47.4%) patients, including: 1) additional nodule(s) on imaging (ipsilateral non-functional adenoma, n=21; bilateral nodules, n=29; or contralateral nodule(s), n=6); 2) normal adrenals (n=2) or unilateral adrenal hyperplasia (n=4), but discrete CYP11B2-positive foci on IHC; and 3) corresponding APA/APN on imaging-IHC with additional CYP11B2-positive area(s) (n=20). Patients with IHC-imaging concordance had the highest proportion of women and KCNJ5 mutations, while CACNA1D mutations were most frequent in the discordant group.</p><p><strong>Conclusions: </strong>Even in patients with lateralized PA, IHC mapping of aldosterone sources corresponded with imaging findings in approximately half of the cases. These data caution against targeted therapy guided by cross-sectional imaging.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: \"Automated insulin delivery in young children with type 1 diabetes: a systematic review and meta-analysis\".","authors":"","doi":"10.1210/clinem/dgag191","DOIUrl":"https://doi.org/10.1210/clinem/dgag191","url":null,"abstract":"","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucocorticoid Reduction After Starting Crinecerfont in Pediatric Patients With Classic CAH: Practical Perspectives.","authors":"Natalie J Nokoff, Patricia Y Fechner, Mimi S Kim, Ian Marshall, Deborah P Merke, Kyriakie Sarafoglou, Andrea L Hartzell, Vivian H Lin, Paul Thornton","doi":"10.1210/clinem/dgag192","DOIUrl":"https://doi.org/10.1210/clinem/dgag192","url":null,"abstract":"<p><strong>Context: </strong>New and emerging non-glucocorticoid (GC) therapies for classic congenital adrenal hyperplasia (CAH) can reduce ACTH-mediated androgen production, allowing for GC dose reductions. With the approval of crinecerfont as an adjunctive treatment to GC replacement for classic CAH for patients 4 years of age and older, expert recommendations were developed to provide guidance for GC reduction in pediatric patients after starting crinecerfont.</p><p><strong>Evidence acquisition: </strong>In December 2024, 11 expert endocrinologists participated in a panel to provide input on strategies and considerations when reducing GC doses after introducing crinecerfont. A smaller panel reconvened in January 2025 to review previous discussions and develop recommendations for GC dose reduction after starting crinecerfont in pediatric patients with classic CAH (4-17 years).</p><p><strong>Evidence synthesis: </strong>Approaches to GC reduction should be tailored to individual clinical goals, cortisol needs, and lifestyle. In pediatric patients, GC dose reductions should be guided by androgen concentrations, with the general goal of maintaining androgens near normal range to achieve normal growth and normalize bone age maturation while also minimizing complications from long-term GC exposure. GC doses should be reduced gradually with frequent monitoring and should not be decreased below the dose needed for physiologic cortisol replacement.</p><p><strong>Conclusions: </strong>The approval of crinecerfont has initiated a shift in the treatment approach for classic CAH, in which GCs are used at lower doses predominantly for cortisol replacement. These recommendations will become increasingly relevant as treatment for these patients continues to shift toward a new paradigm of physiologic GC replacement with adjunctive control of androgens.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary Free Cortisol-Based Thresholds for Differentiating ACTH-Dependent Cushing's: A Spanish Validation Study.","authors":"Betina Biagetti, Pedro Marques, Alfonso Soto-Moreno, Rogelio García-Centeno, Laura González-Fernández, María Dolores Ollero García, Ana Irigaray Echarri, Andres Cardona-Arias, María Dolores Moure Rodríguez, Miguel Paja, Ana Castro, Lucía Manzano Valero, Fernando Guerrero-Pérez, Cristina Lamas, Victoria Alcázar Lázaro, Paola Gracía, David Sanchis-Pascual, Cristina Álvarez-Escolá, Claudia Lozano-Aida, Felicia A Hanzu, Marta Araujo-Castro","doi":"10.1210/clinem/dgag187","DOIUrl":"https://doi.org/10.1210/clinem/dgag187","url":null,"abstract":"<p><strong>Context: </strong>Differentiating ectopic ACTH secretion (EAS) from Cushing's disease (CD) remains one of the most challenging steps in the diagnostic workup of ACTH-dependent Cushing's syndrome (CS). Urinary free cortisol (UFC) expressed as times above the upper limit of normal (ULN) has been proposed as a simple, noninvasive discriminator, but external validation in independent populations is lacking.</p><p><strong>Objective: </strong>To validate the diagnostic performance of UFC×ULN for distinguishing EAS from CD and to explore complementary biochemical markers, including late-night salivary cortisol (LNSC×ULN) and hypokalemia.</p><p><strong>Design, setting, and participants: </strong>Multicenter retrospective study from the Spanish Cushing Registry including 269 patients with ACTH-dependent Cushing's syndrome (208 CD, 61 EAS) diagnosed and managed in tertiary referral centers.</p><p><strong>Main outcome measures: </strong>Diagnostic accuracy of UFC×ULN and LNSC×ULN for discriminating EAS from CD, expressed as area under the ROC curve (AUC), sensitivity, specificity, and predictive value.</p><p><strong>Results: </strong>EAS patients were older (median 59.0 vs 44.9 years; P<0.001) and showed higher UFC×ULN (16.6 vs 3.6; P<0.001) and LNSC×ULN (9.3 vs 1.5; P<0.001). UFC×ULN and LNSC×ULN achieved excellent discriminative performance (AUC 0.90 and 0.92). No EAS occurred with UFC×ULN < 3×ULN, while 40.5% of patients with UFC ≥ 10×ULN had EAS. The combination of severe hypercortisolism (UFC ≥ 10×ULN and LNSC ≥ 9×ULN) plus hypokalemia identified 75% of EAS with 98% specificity.</p><p><strong>Conclusions: </strong>UFC×ULN thresholds reliably stratify the probability of EAS versus CD. Severe hypercortisolism and hypokalemia strongly predict EAS, supporting a pragmatic diagnostic approach that prioritizes whole-body imaging in high-risk patients and pituitary-centered evaluation in mild cases.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct plasma protein profiles after long-term remission of Cushing's disease.","authors":"Britte F van der Vliet, Eleonora Camilleri, Ticiana Paes, Maxim Treep, Natasja Dolezal, Robert A Cordfunke, Jan Wouter Drijfhout, Nienke R Biermasz, Mettine H A Bos, Suzanne C Cannegieter, Frits R Rosendaal, Astrid van Hylckama Vlieg, Olaf M Dekkers, Onno C Meijer, Alberto M Pereira, Leo J Hofland, L Renee Ruhaak, Frederikus A Klok, Bart J M van Vlijmen, Richard A Feelders","doi":"10.1210/clinem/dgag120","DOIUrl":"https://doi.org/10.1210/clinem/dgag120","url":null,"abstract":"<p><strong>Objective: </strong>Cortisol excess in Cushing's disease (CD) induces widespread plasma protein alterations, affecting various pathways including coagulation and lipid metabolism. The extent to which these abnormalities normalize during long-term remission remains unclear.</p><p><strong>Design: </strong>Cohort study investigating plasma protein profiles in CD patients before, and during long-term remission.</p><p><strong>Methods: </strong>EDTA plasma samples of 26 CD patients were collected during active disease and during long-term remission (median 4.4 years, interquartile range 3.3-5.1). Plasma protein profiles were generated using quantitative protein mass spectrometry for 159 proteins, including 21 coagulation-related proteins, 18 complement proteins, 15 transport proteins, and 14 apolipoproteins. Protein levels before and after remission were compared with 80 controls (false discovery rate-adjusted t-test) with similar age and sex distribution.</p><p><strong>Results: </strong>During active CD, 78 out of 159 proteins differed from controls, including 11 coagulation proteins, 10 transport proteins, and 3 apolipoproteins. Gelsolin and extracellular matrix protein-1 were most significantly changed. Following remission, 69 proteins changed significantly relative to active disease, but normalization was incomplete. Of the 78 proteins initially altered, 56 were similar to controls upon remission. After remission, 31 proteins remained different from controls, including coagulation proteins factor IX and factor XIII A chain, apolipoprotein A-II, several complement factors and extracellular matrix protein-1.</p><p><strong>Conclusion: </strong>Active CD is associated with profound alterations in plasma protein profiles across various functional domains. Long-term remission is accompanied by substantial, but incomplete normalization of plasma proteins. Sustained plasma protein abnormalities may contribute to persistent morbidities and ongoing adverse health risks after remission of CD.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147826327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Acromegaly.","authors":"Divya Yogi-Morren, Philippe Chanson","doi":"10.1210/clinem/dgag189","DOIUrl":"https://doi.org/10.1210/clinem/dgag189","url":null,"abstract":"<p><p>The clinical presentation of acromegaly reflects systemic effects of chronic GH and IGF-I excess. Diagnostic delay frequently ranges from 6 to 10 years. While classical manifestations such as acral enlargement and facial coarsening are diagnostically important, many patients initially develop nonspecific symptoms, including sleep apnea, carpal tunnel syndrome, arthralgia, and metabolic disturbances. The lack of symptom/comorbidity specificity highlights the need for improved screening strategies, particularly for patients without overt acral changes. Comorbidity cluster analyses, potentially supported by artificial intelligence, may facilitate earlier identification, prompting biochemical confirmation of the diagnosis. Biochemical evaluation has benefited from advances in hormone assay harmonization and establishment of robust age-adjusted reference ranges. Serum IGF-I is the preferred initial screening test due to its stability and reflection of integrated GH secretion. However, interpretation of assay values should consider age, sex, assay variability, and confounding conditions such as diabetes, liver or renal disease, obesity, pregnancy, and estrogen exposure. For discordant biochemical and clinical findings, it is recommended to repeat IGF-I and to measure GH during oral glucose tolerance test (OGTT). Although random GH levels are often elevated and correlate with somatotroph adenoma size, GH suppression during OGTT is the gold-standard confirmatory test, especially in patients with borderline results. The use of ultrasensitive GH assays has lowered the recommended nadir GH cut-off threshold to ∼0.4 µg/L, with assay-specific considerations. Advances in high-resolution MRI and PET/MRI, alongside AI-driven facial recognition, electronic medical record analysis, and radiomics, offer promising avenues for earlier and more accurate diagnosis of acromegaly.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: \"Fasting vs Nonfasting, Dose-adjusted Levothyroxine Ingestion in Hypothyroidism: A Randomized Clinical Trial\".","authors":"","doi":"10.1210/clinem/dgag166","DOIUrl":"https://doi.org/10.1210/clinem/dgag166","url":null,"abstract":"","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quick Determination of Adrenal Venous Selectivity for the Determination of Unilateral Aldosteronism.","authors":"Celso E Gomez-Sanchez","doi":"10.1210/clinem/dgag190","DOIUrl":"https://doi.org/10.1210/clinem/dgag190","url":null,"abstract":"","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Enabled Analysis of Radiology Reports: Epidemiology and Outcomes of Incidental Thyroid Findings.","authors":"Felipe Larios, Mariana Borras-Osorio, Yuqi Wu, Ana Gabriela Claros, David Toro-Tobon, Esteban Cabezas, Ricardo Loor-Torres, Maria Mateo Chavez, Kerly Guevara Maldonado, Luis Vilatuna Andrango, Maria Lizarazo Jimenez, Ivan Mateo Alzamora, Misk Al Zahidy, Marcelo Montero, Ana Cristina Proano, Cristian Soto Jacome, Jungwei W Fan, Oscar J Ponce-Ponte, Megan E Branda, Naykky Singh Ospina, Juan P Brito","doi":"10.1210/clinem/dgag186","DOIUrl":"https://doi.org/10.1210/clinem/dgag186","url":null,"abstract":"<p><strong>Context: </strong>Incidental thyroid findings (ITFs) are increasingly detected on imaging performed for non-thyroid indications. Their prevalence, features, and consequences remain undefined.</p><p><strong>Objective: </strong>To develop, validate, and deploy a natural language processing (NLP) pipeline to identify ITFs in radiology reports and assess their prevalence, features, and clinical outcomes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Mayo Clinic sites (Rochester, Arizona, Florida, Mayo Clinic Health System).</p><p><strong>Participants: </strong>Adults without prior thyroid disease undergoing thyroid-capturing imaging from July 1, 2017, to September 30, 2023. A transformer-based NLP pipeline identified ITFs and extracted nodule characteristics from image reports from multiple modalities and body regions.</p><p><strong>Outcomes: </strong>ITF prevalence, downstream thyroid ultrasound, biopsy, thyroidectomy, and cancer diagnosis. Logistic regression identified demographic and imaging-related factors.</p><p><strong>Results: </strong>Among 115,683 patients (mean age, 56.8 [SD 17.2]; 52.9% women), 9,077 (7.8%) had an ITF (92.9% nodular). ITFs were more likely in women, older adults, higher BMI, and in imaging ordered by specialties different from Emergency Medicine. Compared with chest CT, ITFs were more likely via neck CT, PET, and nuclear medicine scans. Nodule characteristics were poorly documented, with size reported in 44% and other features in fewer than 15%. Compared with patients without ITFs, those with ITFs had higher odds of thyroid nodule diagnosis (OR 45, 95%CI 41.1-49.3) biopsy (OR 46.8, 95%CI 39.0-56.2) thyroidectomy (OR 55.8, 95%CI 31.3-99.3) and thyroid cancer diagnosis (OR 61.7, 95%CI 38.6-98.5). Most cancers were papillary (88.5%), and larger when detected after ITFs (2 cm-SD 1.4) vs no ITF (1.3 cm-SD 0.8).</p><p><strong>Conclusions: </strong>ITFs were common and strongly associated with cascades leading to detection of small, low-risk cancers, highlighting their role in overdiagnosis and the need for standardized reporting and more selective follow-up.</p>","PeriodicalId":520805,"journal":{"name":"The Journal of clinical endocrinology and metabolism","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}