bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two decades of the Eurotransplant Senior Program: the gender gap in mortality impacts patient survival after kidney transplantation
Authors: Schachtner Thomas , Otto Natalie M , Reinke Petra 
Published: August 2019

AbstractBackgroundLong-term outcomes of the Eurotransplant Senior Program (ESP) are urgently needed to improve selection criteria and allocation policies in the elderly.MethodsWe analysed patient and allograft outcomes of 244 ESP-kidney transplant recipients (KTRs) between 1999 and 2019 and assessed quality of living compared with 82 ESP-waitlisted dialysis patients using standardized short form-8.ResultsWe observed 1-, 5- and 10-year patient survival of 91.7, 66.3 and 38.0%, respectively. Mortality risk factors included male gender (P = 0.006) and T-cell-mediated rejection (P &lt; 0.001). Median patient survival of male ESP-KTRs was 80 versus 131 months for female ESP-KTRs (P = 0.006). 1-, 5- and 10-year death-censored allograft survival was 93.3, 82.6 and 70.4%. Risk factors included high body mass index (P &lt; 0.001) and T-cell-mediated rejection (P &lt; 0.001). After re-initiation of dialysis median patient survival was 58 months. Change of estimated glomerular filtration rate showed a mean decline of 2.3 and 6.8 mL/min at 5 and 10 years. Median physical and mental component scores of ESP-KTRs were 40.2 and 48.3, significantly higher compared with dialysis patients (P &lt; 0.05). Of ESP-KTRs, 97.5% who underwent transplantation would again do so.ConclusionsLong-term outcomes of ESP-KTRs ultimately support the effectiveness of an age-matched allocation system. Our data suggest that the survival advantage of women is maintained after kidney transplantation and calls for gender-specific care.
Multilayered Tuning of Dosage Compensation and Z-Chromosome Masculinization in the Wood White (Leptidea sinapis) Butterfly
Authors: Höök Lars , Leal Luis , Talla Venkat , Backström Niclas 
Published: August 2019

AbstractIn species with genetic sex determination, dosage compensation can evolve to equal expression levels of sex-linked and autosomal genes. Current knowledge about dosage compensation has mainly been derived from male-heterogametic (XX/XY) model organisms, whereas less is understood about the process in female-heterogametic systems (ZZ/ZW). In moths and butterflies, downregulation of Z-linked expression in males (ZZ) to match the expression level in females (ZW) is often observed. However, little is known about the underlying regulatory mechanisms, or if dosage compensation patterns vary across ontogenetic stages. In this study, we assessed dynamics of Z-linked and autosomal expression levels across developmental stages in the wood white (Leptidea sinapis). We found that although expression of Z-linked genes in general was reduced compared with autosomal genes, dosage compensation was actually complete for some categories of genes, in particular sex-biased genes, but equalization in females was constrained to a narrower gene set. We also observed a noticeable convergence in Z-linked expression between males and females after correcting for sex-biased genes. Sex-biased expression increased successively across developmental stages, and male-biased genes were enriched on the Z-chromosome. Finally, all five core genes associated with the ribonucleoprotein dosage compensation complex male-specific lethal were detected in adult females, in correspondence with a reduction in the expression difference between autosomes and the single Z-chromosome. We show that tuning of gene dosage is multilayered in Lepidoptera and argue that expression balance across chromosomal classes may predominantly be driven by enrichment of male-biased genes on the Z-chromosome and cooption of available dosage regulators.
Unique DNA Methylation Profiles Are Associated with cis-Variation in Honey Bees
Authors: Yagound Boris , Smith Nicholas M A , Buchmann Gabriele , Oldroyd Benjamin P , Remnant Emily J 
Published: August 2019

AbstractDNA methylation is an important epigenetic modification that mediates diverse processes such as cellular differentiation, phenotypic plasticity, and genomic imprinting. Mounting evidence suggests that local DNA sequence variation can be associated with particular DNA methylation states, indicating that the interplay between genetic and epigenetic factors may contribute synergistically to the phenotypic complexity of organisms. Social insects such as ants, bees, and wasps have extensive phenotypic plasticity manifested in their different castes, and this plasticity has been associated with variation in DNA methylation. Yet, the influence of genetic variation on DNA methylation state remains mostly unknown. Here we examine the importance of sequence-specific methylation at the genome-wide level, using whole-genome bisulfite sequencing of the semen of individual honey bee males. We find that individual males harbor unique DNA methylation patterns in their semen, and that genes that are more variable at the epigenetic level are also more likely to be variable at the genetic level. DNA sequence variation can affect DNA methylation by modifying CG sites directly, but can also be associated with local variation in cis that is not CG-site specific. We show that covariation in sequence polymorphism and DNA methylation state contributes to the individual-specificity of epigenetic marks in social insects, which likely promotes their retention across generations, and their capacity to influence evolutionary adaptation.
Bicuspid aortic valve patients show specific epigenetic tissue signature increasing extracellular matrix destruction
Authors: Haunschild Josephina , Schellinger Isabel N , Barnard Sarah J , von Aspern Konstantin , Davierwala Piroze , Misfeld Martin , Petroff David , Borger Michael A , Etz Christian D 
Published: August 2019

AbstractOBJECTIVESPatients with a bicuspid aortic valve (BAV) have an increased risk for developing thoracic aortic aneurysm, which is characterized by the destruction of the elastic media of the aortic wall. Several important enzymes have been characterized to play key roles in extracellular matrix homeostasis, namely matrix metalloproteinases (MMPs). In this study, we investigated MMP-2 levels and their epigenetic regulation via the miR-29 family.METHODSAortic tissue samples from 58 patients were collected during cardiac surgery, of which 30 presented with a BAV and 28 with a tricuspid aortic valve. Polymerase chain reaction, western blot analysis and immunohistochemistry were performed to analyse MMP-2. In addition, enzyme-linked immunosorbent assay measurements were carried out to investigate both MMP-2 and tissue inhibitor of metalloproteinase-2 levels. To examine the epigenetic regulation of aortic extracellular matrix homeostasis, we furthermore studied the expression levels of miR-29 via qRT-PCR.RESULTSPatients with a BAV were significantly younger at the time of surgery, presented significantly less frequently with arterial hypertension and displayed more often with an additional valvular disease. On a molecular level, we found that MMP-2 is increased on gene and protein level in BAV patients. Tissue inhibitor of metalloproteinase-2 levels do not differ between the groups. Interestingly, we also found that only miR-29A is significantly downregulated in BAVs.CONCLUSIONSOur findings highlight the importance of MMP-2 in the context of extracellular matrix destruction in BAV patients. We present new evidence that miR-29A is a crucial epigenetic regulator of these pathomechanistic processes and might hold promise for future translational research.
Destroying Trust in Government: Effects of a Broken Pact among Colombian Ex-Combatants
Authors: Kreutz Joakim , Nussio Enzo 
Published: August 2019

AbstractMistrust between conflict parties after civil war is a major hurdle to sustainable peace. However, existing research focuses on elite interactions and has not examined the trust relationship between government and rank-and-file members of armed groups, despite their importance for postconflict stability. We use the unexpected decision of the Colombian government to extradite top-level former paramilitary leaders to the United States in 2008 to identify how a peace deal reversal influences ex-combatants’ trust in government. In theory, they may lose trust for instrumental reasons, if they suffer personal costs, or for normative reasons, if they think the government is failing its commitments. Using quasi-experimental survey evidence, we find that extradition decreases trust substantially among ex-paramilitaries, but not in a comparison group of ex-guerrillas not part of the same peace deal. Even though paramilitaries are seen as particularly opportunistic, our evidence suggests that normative rather than instrumentalist considerations led to trust erosion.
Legal Gender Beyond the Binary
Authors: Gössl Susanne Lilian , Völzmann Berit 
Published: August 2019

Abstract
The article explores the fundamental rights regarding a person’s status registration as neither male nor female and, thus, gender registrations ‘beyond the binary’. The authors analyse the fundamental rights of the individual as codified in the European Convention on Human Rights (ECHR) and examine ‘third options’ in jurisdictions and recent court decisions in Europe. They analyse to what extent similar results might be achieved at the European Court of Human Rights (ECtHR).
A tubo-ovarian abscess mimicking an appendiceal abscess: a rare presentation of Streptococcus agalactiae
Authors: Taylor Gregory M , Erlich Andrew H , Wallace Laurie C , Williams Vernon , Ali Reehan M , Zygowiec Jonathan P 
Published: August 2019

Abstract
A tubo-ovarian abscess (TOA) is a relatively rare medical complication that results from an untreated/unrecognized ascending pelvic infection of the female genital tract. In a right-sided TOA, this clinical entity may mimic appendicitis on computed tomography (CT). In addition, both disease processes can present with pelvic pain, leukocytosis and fever. We present the case of a 47-year-old female with mid right-sided abdominal pain that was diagnosed on CT scan with an appendiceal abscess. She underwent CT-guided percutaneous drainage with interventional radiology. On Day 8, a CT limited study involving a contrast injection was performed to evaluate for abscess resolution. The contrast within the drain filled the fallopian tube, endometrial cavity and contralateral fallopian tube. These findings demonstrated that the initial diagnosis actually represented a TOA. To the authors’ knowledge, this is the only reported case involving a TOA secondary to Streptococcus agalactiae (GBS) mimicking an appendicitis with abscess formation.
A case of protein-losing gastroenteropathy caused by systemic AA amyloidosis secondary to undifferentiated carcinoma of unknown primary origin
Authors: Shiroshita Akihiro , Uegami Wataru , Otsuki Ayumu , Nakashima Kei , Sunagawa Keishin , Fukuoka Junya , Kami Shota , Saito Ayumi , Aoshima Masahiro 
Published: August 2019

Abstract
We report the case of a 61-year-old woman with Kartagener syndrome who presented with a 3-month history of chronic watery diarrhoea and severe hypoalbuminaemia. Histopathological examination of duodenum and large intestine biopsies showed amyloid A (AA) amyloid deposition. Scintigraphy and alpha-1 anti-trypsin clearance evaluations revealed protein-losing gastroenteropathy. Computed tomography with contrast and positron emission tomography showed a pelvic mass with multiple para-aortic lymph node enlargement. We suspected protein-losing gastroenteropathy secondary to AA amyloid produced related to malignant tumours. Following tumour resection, histopathological examination of the lesion revealed undifferentiated carcinoma of unknown origin. Postoperatively, the patient’s nutritional condition improved. There has been no recurrence of protein-losing gastroenteropathy 6 months postoperatively. This is the first report of protein-losing gastroenteropathy and AA amyloidosis secondary to undifferentiated carcinoma. Early recognition and intervention could increase the likelihood of amyloidosis remission.
Do Patients Require Emergency Department Interventions After Prehospital Naloxone?
Authors: Fidacaro G. Anthony , Patel Prarthi , Carroll Gerard , Bartimus Holly , Hunter Krystal , Hong Rick 
Published: August 2019

Objective:
Patients receiving naloxone for suspected opioid overdose in the prehospital setting are typically transported to the emergency department (ED) for further evaluation, regardless of Glasgow Coma Scale (GCS). The objective of our study is to determine whether patients with GCS ≥14 after receiving prehospital naloxone received additional doses of naloxone and medical interventions in the ED compared with those with GCS <14 after prehospital naloxone.

Methods:
Our retrospective observational study included patients ≥18 years old treated with naloxone and transported by an inner-city hospital-based Emergency Medical Services (EMS) to its affiliated ED from January 2, 2016 to December 31, 2016. Investigators collected demographic data, prehospital interventions, GCS, ED interventions, and dispositions. Institutional Review Board approval was obtained. The main outcome measures were repeat doses of naloxone and ED interventions.

Results:
In all, 473 patient encounters were reviewed. Most common route of prehospital naloxone administration was intranasal (68%). Nearly two-thirds (n = 473) of patients had GCS ≥14 upon ED arrival. Repeat naloxone was administered to 3.5% (n = 314) of patients with GCS ≥14 versus 14.6% (n = 159) of patients with GCS <14. ED interventions, such as airway maneuvers, laboratory and radiology testing, and cardiac monitoring, were less common among patients who had improved GCS of 14 or higher (n = 314). There were 8 deaths among patients with GCS <14 (n = 159) and no deaths among patients with GCS ≥14 (n = 314).

Conclusion:
Patients with GCS score ≥14 after administration of prehospital naloxone are less likely to receive additional naloxone doses and medical interventions in the ED compared with those with a GCS score <14 after prehospital naloxone and may present an invaluable opportunity for the ED to initiate an addiction treatment program for patients with nonfatal overdose.
Perceived Behavioral Control and Barriers to Cleaning Skin Before Injecting Drugs
Authors: Kenney Shannon R. , Phillips Kristina T. , Herman Debra S. , Keosaian Julia , Anderson Bradley J. , Stein Michael D. 
Published: August 2019

Objectives:
Skin and soft-tissue infections (SSTI) among people who inject drugs (PWID) are common and represent a significant public health burden. In the current study, we examined the relationship between perceived behavioral control and perceived barriers to cleaning skin before injecting drugs.

Methods:
Participants (n = 248; 37.9 [±10.7] years of age, 58.5% male, 59.3% white, 16.1% Hispanic) were patients seeking medical care at a large urban hospital in the northeastern United States. We used ordinary least squares regression to estimate the associations between perceived barriers to skin cleaning with background characteristics and perceived behavioral control.

Results:
Controlling for background and other study variables, greater number of past-year skin abscesses was associated with greater level of perceived barriers to skin cleaning (P < 0.001), whereas higher level of education and higher perceived behavioral control were associated with lower levels of perceived barriers to skin cleaning (P < 0.001).

Conclusions:
Interventions aiming to reduce the likelihood for SSTI among people who inject drugs may benefit from strengthening individual's behavioral control and providing skin cleaning skills training.
Predictive Model for Failed Induction of Labor Among Obese Women
Authors: Rossi Robert M. , Requarth Erin W. , Warshak Carri R. , Dufendach Kevin , Hall Eric S. , DeFranco Emily A. 
Published: August 2019

OBJECTIVE:
To evaluate antenatal risk factors associated with failed induction of labor among obese women to develop a predictive model for induction of labor outcome.

METHODS:
We conducted a population-based cohort study of all obese (body mass index higher than 30.0) women with singleton live births who underwent attempted induction of labor between 37 and 44 weeks of gestation in the United States from 2012 to 2016 using de-identified U.S live birth records. The primary objective was to build a predictive model for the probability of induction of labor failure using antenatal factors. Multivariable logistic regression estimated the association of these factors on risk of failed induction of labor. We performed k-fold cross-validation for internal validation and then externally validated the model using a separate live birth cohort from 2017 (n=197,982). An online calculator was developed after validation, and calibration was performed. The 10 variables selected for inclusion in the model in order of significance were prior vaginal delivery, prior cesarean delivery, maternal height, age, weight at delivery, parity, gestational weight gain, Medicaid insurance, pregestational diabetes, and chronic hypertension.

RESULTS:
Among 19,844,580 live births in the United States between 2012 and 2016, 1,098,981 obese women with singleton pregnancies underwent induction of labor, of which 273,184 (24.9%) were unsuccessful. The receiver operator characteristic curve for the 10 variable model achieved an area under the curve (AUC) of 0.79 (95% CI 0.78–0.79). External validation demonstrated a consistent measure of discrimination, with an AUC curve of 0.77 (95% CI 0.76–0.77).

CONCLUSION:
This model provides valuable estimation as to the cumulative effect of multiple factors on the risk of failed induction of labor among obese parturients. The predictive model identifies women at increased or decreased risk (ie, greater than 75% vs less than 20%) for cesarean delivery. This risk calculator may be a useful tool for practitioners in the counseling, triaging, risk stratifying, and delivery planning for obese women before attempted induction of labor.
Association of Labor With Neonatal Respiratory Outcomes at 36–40 Weeks of Gestation
Authors: Plunkett Beth A. , Sandoval Grecio , Bailit Jennifer L. , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Caritis Steve N. , Prasad Mona , Tita Alan T. N. , Saade George R. , Sorokin Yoram , Rouse Dwight J. , Blackwell Sean C. , Tolosa Jorge E. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: August 2019

OBJECTIVE:
To evaluate whether labor is associated with lower odds of respiratory morbidity among neonates born from 36 to 40 weeks of gestation and to assess whether this association varies by gestational age and maternal diabetic status.

METHODS:
We conducted a secondary analysis of women in the Assessment of Perinatal Excellence obstetric cohort who delivered across 25 U.S. hospitals over a 3-year period. Women with a singleton liveborn nonanomalous neonate who delivered from 36 to 40 weeks of gestation were included in our analysis. Those who received antenatal corticosteroids, underwent amniocentesis for fetal lung maturity, or did not meet dating criteria were excluded. Our primary outcome was composite neonatal respiratory morbidity, which included respiratory distress syndrome, ventilator support, continuous positive airway pressure, or neonatal death. Maternal characteristics and neonatal outcomes between women who labored and those who did not were compared. Multivariable logistic regression models were used to evaluate the association between labor and the primary outcome. Interactions between labor and diabetes mellitus and labor and gestational age were tested.

RESULTS:
Our analysis included 63,187 women who underwent labor and 10,629 who did not. There was no interaction between labor and diabetes mellitus (P=.90). However, there was a significant interaction between labor and gestational age (P=.01). In the adjusted model, labor was associated with lower odds of neonatal respiratory morbidity compared with no labor for neonates delivered from 36–39 weeks of gestation. A 1-week increase in gestational age was associated with a 1.2 times increase in the adjusted odds ratio for the neonatal outcome comparing labor and no labor.

CONCLUSION:
Labor was associated with lower odds of the composite outcome among neonates delivered from 36–39 weeks of gestation. The magnitude of this association varied by gestational age. The association was similar for women with or without diabetes mellitus.
Transfer of Candesartan Into Human Breast Milk
Authors: Coberger Elle Dagmar , Jensen Berit Packert , Dalrymple Judith Maree 
Published: August 2019

BACKGROUND:
There are currently no data regarding the transfer of candesartan into human milk. This report provides data on this transfer, an estimation of the amount breastfed infants receive, and plasma concentrations from two breastfed infants.

CASES:
Three breastfeeding mothers, all stabilized on candesartan (8–32 mg/d), provided milk and plasma samples over one dosing interval (24 hours). Two infant plasma samples were obtained. The amount the infants ingested was estimated to be 0.09% (95% CI 0.07–0.11) of the maternal dose (weight-adjusted). Candesartan was undetectable (less than 0.2 micrograms/L) in infant plasma samples.

CONCLUSION:
A relative infant dose of 0.09% suggests that maternal benefit from candesartan at standard therapeutic doses may outweigh risk in breastfeeding healthy, term infants.
Spectrum of Current Management of Pediatric Pulmonary Hypertensive Crisis
Authors: Bernier Meghan L. , Romer Lewis H. , Bembea Melania M. 
Published: August 2019

Objectives:
Pulmonary hypertension is a growing pediatric problem and children may present with pulmonary hypertensive crisis—a life-threatening emergency requiring acute interventions. The aim of this study was to characterize the broad spectrum of care provided in North American PICUs for children who present with pulmonary hypertensive crisis.

Design:
Electronic cross-sectional survey. Survey questions covered the following: demographics of the respondents, institution, and patient population; pulmonary hypertension diagnostic modalities; pulmonary hypertension-specific pharmacotherapies; supportive therapies, including sedation, ventilation, and inotropic support; and components of multidisciplinary teams.

Setting:
PICUs in the United States and Canada.

Subjects:
Faculty members from surveyed institutions.

Interventions:
None.

Measurement and Main Results:
The response rate was 50% of 99 identified institutions. Of the respondents, 82.2% were pediatric intensivists from large units, and 73.9% had over a decade of experience beyond training. Respondents provided care for a median of 10 patients/yr with acute pulmonary hypertensive crisis. Formal echocardiography protocols existed at 61.1% of institutions with varying components reported. There were no consistent indications for cardiac catheterization during a pulmonary hypertensive crisis admission. All institutions used inhaled nitric oxide, and enteral phosphodiesterase type 5 inhibitor was the most frequently used additional targeted vasodilator therapy. Milrinone and epinephrine were the most frequently used vasoactive infusions. Results showed no preferred approach to mechanical ventilation. Fentanyl and dexmedetomidine were the preferred sedative infusions. A formal pulmonary hypertension consulting team was reported at 51.1% of institutions, and the three most common personnel were pediatric cardiologist, pediatric pulmonologist, and advanced practice nurse.

Conclusions:
The management of critically ill children with acute pulmonary hypertensive crisis is diverse. Findings from this survey may inform formal recommendations - particularly with regard to care team composition and pulmonary vasodilator therapies - as North American guidelines are currently lacking. Additional work is needed to determine best practice, standardization of practice, and resulting impact on outcomes.