bluuebunny/crossref_metadata_2025_split huggingface dataset:
Corneal Transplant Follow-up Study II: a randomised trial to determine whether HLA class II matching reduces the risk of allograft rejection in penetrating keratoplasty
Authors: Armitage W John , Winton Helen L , Jones Mark N A , Downward Lewis , Crewe Julie M , Rogers Chris A , Tole Derek M , Dick Andrew D 
Published: December 2020

PurposeA randomised trial to test the hypothesis that human leucocyte antigen (HLA) class II matching reduces the risk of allograft rejection in high-risk penetrating keratoplasty (PK).MethodsAll transplants were matched for HLA class I antigens (≤2 mismatches at the A and B loci) and corneas were allocated to patients by cohort minimisation to achieve 0, 1 or 2 HLA class II antigen mismatches. The corneal transplants (n=1133) were followed for 5 years. The primary outcome measure was time to first rejection episode.ResultsCox regression analysis found no influence of HLA class II mismatching on risk of immunological rejection (HR 1.13; 95% CI 0.79 to 1.63; p=0.51). The risk of rejection in recipients older than 60 years was halved compared with recipients ≤40 years (HR 0.51; 95% CI 0.36 to 0.73; p=0.0003). Rejection was also more likely where cataract surgery had been performed after PK (HR 3.68; 95% CI 1.95 to 6.93; p<0.0001). In univariate analyses, preoperative factors including chronic glaucoma (p=0.02), vascularisation (p=0.01), inflammation (p=0.03), ocular surface disease (p=0.0007) and regrafts (p<0.001) all increased the risk of rejection. In the Cox model, however, none of these factors was individually significant but rejection was more likely where≥2 preoperative risk factors were present (HR 2.11; 95% CI 1.26 to 3.47; p<0.003).ConclusionsHLA class II matching, against a background of HLA class I matching, did not reduce the risk of allograft rejection. Younger recipient age, the presence of ≥2 preoperative risk factors and cataract surgery after PK all markedly increased the risk of allograft rejection.Trial registration numberISRCTN25094892.
Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria
Authors: Duke Roseline Ekanem , Nwachukuw Justin , Torty Chima , Okorie Uche , Kim Min J , Burton Kathryn , Gilbert Clare , Bowman Richard 
Published: December 2020

Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria.MethodsA paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD).Results388 children aged 4–15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included.ConclusionChildren with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.
Topographic heterogeneity of lung microbiota in end-stage idiopathic pulmonary fibrosis: the Microbiome in Lung Explants-2 (MiLEs-2) study
Authors: Valenzi Eleanor , Yang Haopu , Sembrat John C , Yang Libing , Winters Spencer , Nettles Rachel , Kass Daniel J , Qin Shulin , Wang Xiaohong , Myerburg Michael M , Methé Barbara , Fitch Adam , Alder Jonathan K , Benos Panayiotis V , McVerry Bryan J , Rojas Mauricio , Morris Alison , Kitsios Georgios D 
Published: December 2020

BackgroundLung microbiota profiles in patients with early idiopathic pulmonary fibrosis (IPF) have been associated with disease progression; however, the topographic heterogeneity of lung microbiota and their roles in advanced IPF are unknown.MethodsWe performed a retrospective, case-control study of explanted lung tissue obtained at the time of lung transplantation or rapid autopsy from patients with IPF and other chronic lung diseases (connective tissue disease-associated interstitial lung disease (CTD-ILD), cystic fibrosis (CF), COPD and donor lungs unsuitable for transplant from Center for Organ Recovery and Education (CORE)). We sampled subpleural tissue and airway-based specimens (bronchial washings and airway tissue) and quantified bacterial load and profiled communities by amplification and sequencing of the 16S rRNA gene.FindingsExplants from 62 patients with IPF, 15 patients with CTD-ILD, 20 patients with CF, 20 patients with COPD and 20 CORE patients were included. Airway-based samples had higher bacterial load compared with distal parenchymal tissue. IPF basilar tissue had much lower bacterial load compared with CF and CORE lungs (p<0.001). No microbial community differences were found between parenchymal tissue samples from different IPF lobes. Dirichlet multinomial models revealed an IPF cluster (29%) with distinct composition, high bacterial load and low alpha diversity, exhibiting higher odds for acute exacerbation or death.InterpretationIPF explants had low biomass in the distal parenchyma of all three lobes with higher bacterial load in the airways. The discovery of a distinct subgroup of patients with IPF with higher bacterial load and worse clinical outcomes supports investigation of personalised medicine approaches for microbiome-targeted interventions.
Extending the Shared Socioeconomic Pathways at the City Scale to Inform Future Vulnerability Assessments — The Case of Boston, Massachusetts
Authors: Lino Jayne , Rohat Guillaume , Kirshen Paul , Dao Hy 
Published: December 2020

Climate change will impact cities’ infrastructure and urban dwellers, who often show differentiated capacity to cope with climate-related hazards. The Shared Socioeconomic Pathways (SSPs) are part of an emerging research field which uses global socioeconomic and climate scenarios, developed by the climate change research community, to explore how different socioeconomic pathways will influence future society’s ability to cope with climate change. While the SSPs have been extensively used at the global scale, their use at the local and urban scale has remained rare, as they first need to be contextualized and extended for the particular place of interest. In this study, we present and apply a method to develop multi-scale extended SSPs at the city and neighborhood scale. Using Boston, Massachusetts, as a case study, we combined scenario matching, experts’ elicitation, and participatory processes to contextualize and make the global SSPs relevant at the urban scale. We subsequently employed the extended SSPs to explore future neighborhood-level vulnerability to extreme heat under multiple plausible socioeconomic trajectories, highlighting the usefulness of extended SSPs in informing future vulnerability assessments. The large differences in outcomes hint at the enormous potential of risk reduction that social and urban planning policies could trigger in the next decades.
Global and Regional Patterns in High Ice Water Content Conditions
Authors: Rugg Allyson , Haggerty Julie , Protat Alain 
Published: December 2020

AbstractConditions of high ice water content (HIWC; defined herein as at least 1.0 g m−3) are often found in the anvils of convective systems and can cause engine damage and/or failure in aircraft. We use ice water content (IWC) retrievals from satellite-borne radar and lidar (CloudSat and CALIOP) to provide the first analysis of global HIWC frequency using 11 years of data (2007–17). Results show that HIWC is generally present in 1%–2% of CloudSat and CALIOP IWC retrievals between flight level 270 (FL270; 27 000 ft or 8.230 km) and FL420 (42 000 ft or 12.801 km) in areas with frequent convection. Similar rates of HIWC are found over midlatitude oceans at relatively low altitudes (below FL270). Possible nonconvective mechanisms for the formation of this low-level HIWC are discussed, as are the uncertainties suggesting that the results at these low altitudes are an overestimation of the true threat of HIWC to aircraft engines. The satellite IWC retrievals are also used to validate an HIWC diagnostic tool that provides storm-scale statistics on HIWC over the contiguous United States (CONUS) during the summer convective season (May–August from 2012 to 2019). Results over the CONUS suggest that HIWC over the Great Plains is highest in June, when a point in the region is under HIWC conditions for approximately 25 h of 30 days on average. The mean area-equivalent diameters of HIWC conditions in some areas of the Great Plains exceed 350 km, and the conditions can persist for 4–5 h.
Moose genomes reveal past glacial demography and the origin of modern lineages
Authors: Dussex Nicolas , Alberti Federica , Heino Matti T. , Olsen Remi-Andre , van der Valk Tom , Ryman Nils , Laikre Linda , Ahlgren Hans , Askeyev Igor V. , Askeyev Oleg V. , Shaymuratova Dilyara N. , Askeyev Arthur O. , Döppes Doris , Friedrich Ronny , Lindauer Susanne , Rosendahl Wilfried , Aspi Jouni , Hofreiter Michael , Lidén Kerstin , Dalén Love , Díez-del-Molino David 
Published: December 2020

AbstractBackgroundNumerous megafauna species from northern latitudes went extinct during the Pleistocene/Holocene transition as a result of climate-induced habitat changes. However, several ungulate species managed to successfully track their habitats during this period to eventually flourish and recolonise the holarctic regions. So far, the genomic impacts of these climate fluctuations on ungulates from high latitudes have been little explored. Here, we assemble ade-novogenome for the European moose (Alces alces) and analyse it together with re-sequenced nuclear genomes and ancient and modern mitogenomes from across the moose range in Eurasia and North America.ResultsWe found that moose demographic history was greatly influenced by glacial cycles, with demographic responses to the Pleistocene/Holocene transition similar to other temperate ungulates. Our results further support that modern moose lineages trace their origin back to populations that inhabited distinct glacial refugia during the Last Glacial Maximum (LGM). Finally, we found that present day moose in Europe and North America show low to moderate inbreeding levels resulting from post-glacial bottlenecks and founder effects, but no evidence for recent inbreeding resulting from human-induced population declines.ConclusionsTaken together, our results highlight the dynamic recent evolutionary history of the moose and provide an important resource for further genomic studies.
Distribution and prognostic value of left ventricular global longitudinal strain in elderly patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement
Authors: Povlsen Jonas Agerlund , Rasmussen Vibeke Guldbrand , Vase Henrik , Jensen Kaare Troels , Terkelsen Christian Juhl , Christiansen Evald Høj , Tang Mariann , Pedersen Anders Lehmann Dahl , Poulsen Steen Hvitfeldt 
Published: December 2020

Abstract
Aims
The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival.

Methods
We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available.

Results
Mean age was 80.1 ± 7.1 years and aortic valve area (AVA) index 0.4 ± 0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50 ± 13% and mean LVGLS was − 14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS > − 18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS > − 14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient > 30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS > − 14% (HR 1.79 [1.02–3.14], p = 0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS > − 14% in the total population (p < 0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p = 0.006).

Conclusions
In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS > − 14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS > − 14%.
Patients with hip fracture and total hip arthroplasty surgery differ in anthropometric, but not cardiovascular screening abnormalities
Authors: Csanády-Leitner Regina , Seibert Franz J. , Perchtold-Stefan Corinna M. , Maurer-Ertl Werner , Hilgarter Kathrin , Lackner Helmut K. 
Published: December 2020

Abstract
Background
With the rising number of hip surgeries, simple and cost-effective tools for surgery risk assessment are warranted. The analysis of heart rate variability (HRV) may not only provide critical insights into the general frailty of patients with hip surgery, but also allow for better differentiation of health profiles in different hip surgery groups. Using HRV analysis, the present study compared cardiovascular as well as anthropometric parameters between patients with hip surgery, the hip fracture surgery group (HFS) and the total hip arthroplasty group (THA), and a control group.

Methods
71 participants (56.3% women), aged 60–85 years, took part, divided into three groups—patients after hip surgery (21 HFS and 30 THA patients) and a control group (20 participants). Electrocardiogram was recorded at baseline and after the application of a physical stressor (grip strength). A 3 (group) × 2 (time) repeated measures ANOVA, and a chi square test were carried out to test for group differences.

Results
Higher weight (p = .002), body mass index (p = .001), and systolic blood pressure (p = .034) were found in THA patients compared to HFS patients. Lower calf circumference (p = .009) and diastolic blood pressure (p = .048) were observed for the HFS group compared to the control group. For cardiovascular parameters, significant differences emerged between the HFS group and the control group in HR (p = .005), SDNN (p = .034) and SD2 (p = .012). No significant differences in cardiovascular parameters were observed between the two hip surgery groups: neither at baseline nor during stressor recovery.

Conclusions
While HRV seems to differentiate well between HFS patients and controls, more research with larger samples is needed to scrutinize similaritites and differences in cardiovascular profiles between HFS and THA patients.
Epidemiology, risk factors, and clinical impact of early post-transplant infection in older kidney transplant recipients: the Korean organ transplantation registry study
Authors:   the Korean Organ Transplantation Registry Study Group, Kim Jin Sug , Jeong Kyung Hwan , Lee Dong Won , Lee Sam Yeol , Lee Sang Ho , Yang Jaeseok , Ahn Curie , Hwang Hyeon Seok 
Published: December 2020

Abstract
Background
As in younger recipients, post-transplant infection is a frequent and devastating complication after kidney transplantation (KT) in older recipients. However, few studies have analyzed characteristics of post-transplant infection in older kidney recipients. In this study of a nation-wide cohort of older kidney recipients, we investigated the current epidemiology, risk factors, and clinical impacts of early post-transplant infection, which was defined as infectious complications requiring hospitalization within the first 6 months after KT.

Methods
Three thousand seven hundred thirty-eight kidney recipients registered in the Korean Organ Transplantation Registry between 2014 and 2017 were enrolled. Recipients were divided into two groups, younger (n = 3081) and older (n = 657), with a cutoff age of 60 years. We observed characteristics of early post-transplant infection, and investigated risk factors for the development of infection. We also analyzed the association of early post-transplant infection with clinical outcomes including cardiac events, rejection, graft loss, and all-cause mortality.

Results
The incidence of early post-transplant infection was more frequent in older recipients (16.9% in younger group and 22.7% in older group). Bacteria were the most common causative pathogens of early post-transplant infection, and the most frequent site of infection was the urinary tract in both older and younger recipients. Older recipients experienced more mycobacterial infections, co-infections, and multiple site infections compared with younger recipients. In older recipients, female sex (HR 1.398, 95% CI 1.199–1.631), older donor age (HR 1.010, 95% CI 1.004–1.016), longer hospitalization after KT (HR 1.010, 95% CI 1.006–1.014), and experience of acute rejection (HR 2.907, 95% CI 2.471–3.419) were independent risk factors for the development of early post-transplant infection. Experiencing infection significantly increases the incidence of rejection, graft loss, and all-cause mortality.

Conclusion
Our results illustrate current trends, risk factors, and clinical impacts of early post-transplant infection after KT in older recipients. Considering the poor outcomes associated with early post-transplant infection, careful screening of recipients at high risk for infection and monitoring of recipients who experience infection are advised. In addition, since older recipients exhibit different clinical characteristics than younger recipients, further studies are needed to establish effective strategies for treating older recipients.
Risk factors for perineal and vaginal tears in primiparous women – the prospective POPRACT-cohort study
Authors: Jansson Markus Harry , Franzén Karin , Hiyoshi Ayako , Tegerstedt Gunilla , Dahlgren Hedda , Nilsson Kerstin 
Published: December 2020

Abstract
Background
The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.

Methods
All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.

Results
A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively).

Conclusion
The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.
Morphofunctional cardiac changes in singleton and twin pregnancies: a longitudinal cohort study
Authors: Umazume Takeshi , Yamada Takahiro , Furuta Itsuko , Iwano Hiroyuki , Morikawa Mamoru , Watari Hidemichi , Minakami Hisanori 
Published: December 2020

Abstract
Background
This study aimed to compare the echocardiographic changes and cardiac biomarkers between women with singleton and twin pregnancies.

Methods
From April 2014 to March 2016, this longitudinal cohort study invited pregnant women who were scheduled to give birth at Hokkaido University Hospital. We analyzed prospectively collected data on simultaneously determined echocardiographic parameters and blood cardiac markers of 44 women with singleton and 22 women with twin pregnancies. Furthermore, we tested the mixed-effect models for echocardiographic parameters and cardiac biomarkers.

Results
During the third trimester and immediately postpartum (within 1 week after childbirth), the mean left atrial volume index and brain natriuretic peptide (BNP) level were significantly higher in women with twin pregnancies than in those with singleton pregnancies. Women with twin pregnancies also had significantly smaller second-trimester inferior vena cava diameters and significantly higher third−trimester creatinine levels than those with singleton pregnancies. BNP positively correlated with the left atrial volume index (β = 0.49, p < 0.01) and the ratio of early diastolic transmitral to mitral annular velocity (E/e’) (β = 0.41, p < 0.01). At 1 month after childbirth in women with singleton pregnancies, BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum negatively correlated with the later E/e’ (r = − 0.33, p = 0.02 and r = − 0.36, p < 0.01, respectively).

Conclusions
The intravascular cardiac load reached maximum within 1 week after childbirth and was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP significantly positively correlated with LA volume index and E/e’. In women with singleton pregnancies, BNP secreted immediately after childbirth might improve the diastolic functions 1 month after childbirth.