European Journal of Internal Medicine最新文献

{"title":"Effects of calcium channel blockers on GDMT prescription and outcomes according to ejection fraction: IN-HF real world data","authors":"Mauro Gori ,&nbsp;Luca Fazzini ,&nbsp;Jennifer Meessen ,&nbsp;Raul Limonta ,&nbsp;Samuela Carigi ,&nbsp;Matteo Bianco ,&nbsp;Luisa De Gennaro ,&nbsp;Concetta Di Nora ,&nbsp;Paolo Manca ,&nbsp;Maria Vittoria Matassini ,&nbsp;Vittoria Rizzello ,&nbsp;Denitza Tinti ,&nbsp;Aldo Pietro Maggioni ,&nbsp;Francesco Orso ,&nbsp;Marco Gorini ,&nbsp;Renata De Maria","doi":"10.1016/j.ejim.2025.106589","DOIUrl":"10.1016/j.ejim.2025.106589","url":null,"abstract":"<div><h3>Background</h3><div>Dihydropyridine calcium channel blockers (DHP-CCB) are widely used in heart failure (HF), despite the lack of data regarding their safety, especially in patients with reduced ejection fraction (HFrEF). We aimed to evaluate DHP-CCB prescription trends over time, their association with GDMT uptake and related outcomes across the spectrum of EF.</div></div><div><h3>Methods</h3><div>We studied outpatients with chronic HF prospectively enrolled in the nationwide observational IN<img>HF registry from 1998 to 2022. We used Cox regression methods to analyze all-cause mortality and cardiovascular hospitalization at 1-year according to DHP-CCB exposure, applying inverse probability of treatment weighting (IPTW).</div></div><div><h3>Results</h3><div>We included 15785 outpatients. 10829 (69 %) had HFrEF, and 4956(31 %) an EF&gt;40 %. Median age was 69; 26.6 % were females. Overall, 1458 patients (9.1 %) received a DHP-CCB. DHP-CCB administration was twice as prevalent in patients with an EF&gt;40 % than in those with HFrEF (13.9 %¦vs 7.1 %, respectively p&lt;0.001). DHP-CCB prescription rates increased over time (p&lt;0.001). Patients who received DHP-CCB were older, more comorbid, had a higher EF, and were less frequently prescribed GDMT than those who were not on DHP-CCB. After multivariable adjustment, using IPTW analysis, DHP-CCB prescription was associated with a higher risk of the outcome in the overall cohort (HR 1.11, 95 % CI 1.09-1.12, p&lt;0.001), among HFrEF patients (HR 1.14, 95 % CI 1.12-1.16, p&lt;0.001), and those with EF&gt;40 % (HR 1.07, 95 % CI 1.04-1.10, p&lt;0.001).</div></div><div><h3>Conclusion</h3><div>DHP-CCB use in HFrEF was associated with less GDMT prescription and worse outcomes. Additionally, DHP-CCB safety needs to be further explored in HFmrEF/HFpEF.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106589"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524136","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":"Gaps in Glycaemic Monitoring and Underuse of Cardioprotective Glucose-lowering Agents: Challenges of inpatient diabetes care identified by EFIM’s Diabesity Day Survey 2024","authors":"Ann-Kristin Porth ,&nbsp;Anete Palma ,&nbsp;Burcu Sallarel ,&nbsp;Dimitrios Patoulias ,&nbsp;Dirk Müller-Wieland ,&nbsp;Dror Dicker ,&nbsp;Ieva Ruža ,&nbsp;Ilya Davidenko ,&nbsp;Jan Škrha jr. ,&nbsp;Julia Brandts ,&nbsp;Ricardo Gomez-Huelgas ,&nbsp;Shiran Gruber ,&nbsp;Sindija Smirnova ,&nbsp;Theocharis Koufakis ,&nbsp;Yusuf Ziya Sener ,&nbsp;Zuzana Kršáková ,&nbsp;Alexandra Kautzky-Willer ,&nbsp;EFIM Diabetes and Obesity Working Group","doi":"10.1016/j.ejim.2025.106583","DOIUrl":"10.1016/j.ejim.2025.106583","url":null,"abstract":"<div><h3>Background</h3><div>People with diabetes and obesity have an increased risk of hospitalisation and in-hospital complications. Rising prevalence of diabetes and obesity, including their co-occurrence, “diabesity”, make guideline-compliant treatment increasingly important. However, evidence on specific in-hospital diabesity treatment is limited. We aimed to characterise inpatients with diabetes/diabesity and evaluate their in-hospital care to identify challenges in inpatient diabetes/diabesity management.</div></div><div><h3>Methods</h3><div>Cross-sectional data was collected from patient records and ward charts. We analysed differences between inpatients with and without diabesity and explored in-hospital diabetes treatment. We further compared inpatients with type 2 diabetes who started insulin treatment or received cardioprotective glucose-lowering agents to those who did not and used logistic regression to identify predictors of insulin initiation and use of cardioprotective agents.</div></div><div><h3>Results</h3><div>We included 207 people with diabetes from eight European hospitals, 50 % with diabesity. Most inpatients had a HbA1c &gt;6.5 % (48 mmol/mol). Among inpatients with type 2 diabetes, one third did not have a recent HbA1c reading, blood glucose levels were monitored &lt;3 times daily, and only 40 % of those with cardiovascular/renal disease received cardioprotective therapies. HbA1c, creatinine and at-home medications predicted insulin initiation, while admission cause and BMI predicted use of cardioprotective agents.</div></div><div><h3>Conclusions</h3><div>We observed an underuse of cardioprotective glucose-lowering therapies, low rates of glycaemic monitoring, and low availability of HbA1c readings, concluding that clinical guidelines are not sufficiently implemented in everyday practice in Europe. Based on this, we advocate for better staff training, involvement of diabetologists, and raising awareness of the benefits of cardioprotective agents in the hospital.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106583"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483578","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":"Both underweight and obese patients are prone to relapse after ablation of paroxysmal atrial fibrillation","authors":"Yu Liao ,&nbsp;Chintan Trivedi ,&nbsp;Michela Casella ,&nbsp;Sanghamitra Mohanty ,&nbsp;Luigi Di Biase ,&nbsp;Selene Cellucci ,&nbsp;Momen Ibrahim ,&nbsp;Tejas S Khurana ,&nbsp;Wilber Su ,&nbsp;J. Peter Weiss ,&nbsp;Michael Zawaneh ,&nbsp;Antonio Dello Russo ,&nbsp;Changsheng Ma ,&nbsp;Claudio Tondo ,&nbsp;Andrea Natale ,&nbsp;Rong Bai","doi":"10.1016/j.ejim.2025.106558","DOIUrl":"10.1016/j.ejim.2025.106558","url":null,"abstract":"<div><h3>Background</h3><div>Being overweight has been associated with arrhythmia recurrence after atrial fibrillation (AF) ablation, but the optimal threshold to identify high risk patients has not been well established. Studies investigating the relationship between underweight and ablation outcome are also limited. This study aimed to investigate the impact of body mass index (BMI) on the recurrence after AF ablation and to determine the optimal cut-off of BMI to identify patients at risk of recurrence.</div></div><div><h3>Methods</h3><div>Paroxysmal AF (PAF) patients undergoing primary ablation with pulmonary vein isolation were enrolled. Patients were grouped based on 3 BMI discretization methods: pre-defined BMI category, BMI quartile and optimal equal hazard cut-off. Atrial tachyarrhythmia recurrence at 12-month after ablation was the study endpoint which was compared between groups by using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>Out of 561 patients (mean BMI 25.5 ± 5.1 kg/m²) enrolled, arrhythmia recurrence at 12-month after ablation was found in 29 (43.9 %) of 66 underweight, 39 (21.7 %) of 180 normal weight, 30 (17.4 %) of 172 overweight, and 50 (35.0 %) of 143 obese patients (Log Rank <em>P</em> &lt; 0.001). BMI presented a “U” shape relationship with arrhythmia-free survival. Hazard-based optimal BMI was 20.00 kg/m² for left cutoff and 29.14 kg/m² for right cutoff. In multivariable analysis, BMI ≤ 20.00 kg/m² (HR=2.258, <em>P</em> &lt; 0.001) or &gt; 29.14 kg/m² (HR=1.702, <em>P</em> = 0.006) was independently associated with arrhythmia recurrence after adjustment of other confounders.</div></div><div><h3>Conclusions</h3><div>The relationship between atrial tachyarrhythmia recurrence after PAF ablation and pre-ablation BMI appeared to be U-shaped. Individuals whose BMI was ≤20.00 kg/m² or &gt;29.14 kg/m² were at high risk of arrhythmia recurrence.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106558"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373278","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":"Advances in syncope: Recent evidence and clinical implications","authors":"Giacomo Ramponi ,&nbsp;Marco Paganuzzi ,&nbsp;Monica Solbiati ,&nbsp;Giorgio Costantino","doi":"10.1016/j.ejim.2025.106635","DOIUrl":"10.1016/j.ejim.2025.106635","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106635"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696495","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":"Understanding the threat of West Nile virus infection. Comment on prevention and therapy","authors":"Salvatore Chirumbolo ,&nbsp;Luigi Valdenassi ,&nbsp;Umberto Tirelli ,&nbsp;Marianno Franzini","doi":"10.1016/j.ejim.2025.106539","DOIUrl":"10.1016/j.ejim.2025.106539","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106539"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276562","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":"Endothelin-1 as dual marker for renal function decline and associated cardiovascular complications in patients with chronic kidney disease","authors":"Laura González-Rodríguez ,&nbsp;Manuel Martí-Antonio ,&nbsp;Sonia Mota-Zamorano ,&nbsp;Celia Chicharro ,&nbsp;Bárbara Cancho ,&nbsp;Enrique Luna ,&nbsp;Álvaro Álvarez ,&nbsp;Zoraida Verde ,&nbsp;Fernando Bandrés ,&nbsp;Nicolás R Robles ,&nbsp;Guillermo Gervasini","doi":"10.1016/j.ejim.2025.106542","DOIUrl":"10.1016/j.ejim.2025.106542","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular (CV) complications are the leading cause of death in patients with chronic kidney disease (CKD). Endothelin-1 (ET-1), a potent vasoconstrictor involved in both renal and vascular dysfunction, may represent a promising biomarker for the disease.</div></div><div><h3>Methods</h3><div>ET-1 plasma levels were quantified in 692 Spanish CKD patients (stages 1–5) and used to stratify individuals into three clusters (cluster 3 meaning highest concentrations). Associations with CKD progression, CVE, and all-cause mortality were assessed over a mean follow-up of 48.6 ± 27.4 months using linear mixed-effects models and Cox regression analyses adjusted for conventional risk factors.</div></div><div><h3>Results</h3><div>ET-1 levels increased with CKD severity (mean±SD: 1.65 ± 0.71 pg/mL for stages 1–2; 1.82 ± 0.71 pg/mL for stage 3; 2.39 ± 1.08 pg/mL for stages 4–5; <em>p</em> &lt; 0.001). Higher ET-1 levels were independently associated with accelerated eGFR decline over 3 years (β = –12.64, <em>p</em> &lt; 0.001 for cluster 2; and β = –11.71, <em>p</em> = 0.034 for cluster 3). Sixty-nine CVE (10.1 %) were recorded. Participants with higher ET-1 levels had significantly lower CV event-free survival [HR = 2.24 (1.12–4.45), <em>p</em> = 0.022, and HR = 2.50 (1.09–5.73), <em>p</em> = 0.03] for clusters 2 and 3, respectively. ET-1 also predicted all-cause mortality (<em>p</em> &lt; 0.001) although the association lost significance after adjusting for age. Random forest models for CV risk and all-cause mortality including the ET-1 cluster produced C-indices of 0.835 and 0.837, respectively.</div></div><div><h3>Conclusions</h3><div>Elevated ET-1 levels are independently associated with both CKD progression and CV complications. ET-1 may serve as a dual biomarker for renal deterioration and CV risk, potentially improving clinical stratification in CKD management.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106542"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276545","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":"Prognostic role of TAPSE/PASP ratio among older patients with acute heart failure and preserved ejection fraction","authors":"Giuseppe De Matteis ,&nbsp;Amato Serra ,&nbsp;Maria Livia Burzo ,&nbsp;Francesco De Vito ,&nbsp;Maria Anna Nicolazzi ,&nbsp;Antonio Iaconelli ,&nbsp;Antonio Gasbarrini ,&nbsp;Francesco Franceschi ,&nbsp;Giovanni Gambassi ,&nbsp;Marcello Covino","doi":"10.1016/j.ejim.2025.106540","DOIUrl":"10.1016/j.ejim.2025.106540","url":null,"abstract":"<div><h3>Objective</h3><div>Right ventricular (RV)-pulmonary circulation (PC) uncoupling is associated with poor outcome in patients with Heart Failure with Preserved Ejection Fraction (HFpEF). Tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) ratio is simple echo-derived indicator of RV-PC uncoupling. This study aimed to investigate the prognostic impact of TAPSE/PASP ratio among patients with HFpEF hospitalized for acute heart failure (AHF).</div></div><div><h3>Methods</h3><div>Single-centre, retrospective study including patients hospitalized for AHF over a 4-year period. Receiver operating character (ROC) curves for the TAPSE/PASP ratio were used to identify the cut-off value for the composite outcome of all-cause in-hospital mortality and hospital readmission.</div></div><div><h3>Results</h3><div>Overall, 398 patients were included (median age 83 years, 56.0% females). According to ROC curve analysis, we calculated an ideal cut-off of 0.36 mm/mmHg for TAPSE/PASP ratio. Patients were divided into two categories, preserved RV-PC coupling (TAPSE/PASP ratio &gt; 0.36) and RV-PC uncoupling (TAPSE/PASP ratio ≤ 0.36). Overall, both in-hospital mortality and readmission rate were higher among HFpEF patients with TAPSE/PASP ratio ≤ 0.36 compared to those with TAPSE/PASP ratio &gt; 0.36 (31.4 % vs 20.3%; <em>p</em> = 0.008). At multivariate analysis, TAPSE/PASP ratio ≤ 0.36 emerged as an independent risk factor both for death (HR 2.18 [1.08 – 4.42]; <em>p</em> = 0.03) and the composite outcome (HR 1.95 [1.22 – 3.12]; <em>p</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>Among patients with HFpEF and hospitalized for AHF, the RV-PC uncoupling was associated with a more than two-fold increased risk of in-hospital mortality.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106540"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253577","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":"Bridging the gap: Phenotype-specific considerations for rituximab therapy in IgG4-related disease","authors":"Jingyi Li ,&nbsp;Jiamin Wang","doi":"10.1016/j.ejim.2025.106588","DOIUrl":"10.1016/j.ejim.2025.106588","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106588"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534950","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":"Critical considerations on uric acid in HFmrEF: from biomarker to metabolic integrator","authors":"Xizhuang Gao ,&nbsp;Qi Sun","doi":"10.1016/j.ejim.2025.106634","DOIUrl":"10.1016/j.ejim.2025.106634","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106634"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696446","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":"Multidisciplinary strategies and new technologies in the management of sarcoidosis","authors":"Claudio Tana ,&nbsp;Marjolein Drent ,&nbsp;Ogugua Ndili Obi ,&nbsp;Francesco Cinetto ,&nbsp;Nicol Bernardinello ,&nbsp;Livia Moffa ,&nbsp;Marco Tana ,&nbsp;Dominique Israël Biet ,&nbsp;Paolo Spagnolo","doi":"10.1016/j.ejim.2025.106576","DOIUrl":"10.1016/j.ejim.2025.106576","url":null,"abstract":"<div><div>Sarcoidosis exemplifies the complexity of modern internal medicine, requiring comprehensive, system-based management. The disease is characterized by non-caseating granulomas and can affect virtually any organ, with pulmonary involvement in over 90 % of patients and extrapulmonary manifestations in up to 70 %. Its heterogeneous spectrum, variable course, and risk of organ damage make early recognition and multidisciplinary collaboration essential.</div><div>This narrative review outlines the clinical manifestations of sarcoidosis, emphasizing organ-specific and systemic non-organ specific symptoms such as fatigue and small fiber neuropathy, which substantially impair quality of life (QoL). Advances in imaging, including cardiac MRI and 18F-FDG PET/CT, together with biomarkers such as soluble IL-2 receptor, have improved diagnostic accuracy, risk stratification, and monitoring. Yet, histological confirmation is almost invariably needed.</div><div>Therapeutic strategies continue to evolve from the classical glucocorticoid-centered step-up approach toward more personalized regimens. Steroid-sparing agents such as methotrexate, azathioprine, and leflunomide are widely used, while biologics, particularly anti-TNF agents, and emerging small-molecule inhibitors (e.g., JAK and mTOR inhibitors) offer additional options in refractory disease. New investigational therapies, including efzofitimod, are under evaluation.</div><div>Beyond pharmacology, sarcoidosis management increasingly relies on multidisciplinary teams, integration of primary and tertiary care, and attention to comorbidities and QoL. Digital health tools, telemedicine, and mindfulness-based interventions show promise in supporting patient-centered care. Artificial intelligence and multi-omics approaches may further enhance diagnostic accuracy, phenotyping, and precision medicine in the near future.</div><div>In conclusion, sarcoidosis stands as a paradigm of complexity in internal medicine, underscoring the need for holistic care, innovation, and collaboration to improve long-term outcomes.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"144 ","pages":"Article 106576"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427052","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}