bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of graft failure after first detection of de novo donor-specific HLA antibodies in kidney transplant recipients
Authors: López del Moral Covadonga , Wu Kaiyin , Naik Marcel , Osmanodja Bilgin , Akifova Aylin , Lachmann Nils , Stauch Diana , Hergovits Sabine , Choi Mira , Bachmann Friederike , Halleck Fabian , Schrezenmeier Eva , Schmidt Danilo , Budde Klemens 
Published: July 2023

ABSTRACT

Background
De novo donor-specific antibodies (dnDSAs) may cause antibody-mediated rejection and graft dysfunction. Little is known about the clinical course after first detection of dnDSAs during screening in asymptomatic patients. We aimed to assess the value of estimated glomerular filtration rate (eGFR) and proteinuria to predict graft failure in patients with dnDSAs and their potential utility as surrogate endpoints.

Methods
All 400 kidney transplant recipients with dnDSAs at our centre (1 March 2000–31 May 2021) were included in this retrospective study. The dates of graft loss, rejection, doubling of creatinine, ≥30% eGFR decline, proteinuria ≥500 mg/g and ≥1000 mg/g were registered from the first dnDSA appearance.

Results
During 8.3 years of follow-up, graft failure occurred in 33.3% of patients. Baseline eGFR and proteinuria correlated with 5-year graft loss (area under the receiver operating characteristics curve 0.75 and 0.80, P &lt; .001). Creatinine doubled after a median of 2.8 years [interquartile range (IQR) 1.5–5.0] from dnDSA and the time from doubling creatinine to graft failure was 1.0 year (IQR 0.4–2.9). Analysing eGFR reduction ≥30% as a surrogate endpoint (148/400), the time from dnDSA to this event was 2.0 years (IQR 0.6–4.2), with a positive predictive value (PPV) of 45.9% to predict graft loss, which occurred after 2.0 years (IQR 0.8–3.2). The median time from proteinuria ≥500 mg/g and ≥1000 mg/g to graft failure was identical, 1.8 years, with a PPV of 43.8% and 49.0%, respectively. Composite endpoints did not improve PPV. Multivariable analysis showed that rejection was the most important independent risk factor for all renal endpoints and graft loss.

Conclusions
Renal function, proteinuria and rejection are strongly associated with graft failure in patients with dnDSA and may serve as surrogate endpoints.
A metabologenomics approach to unlock the metabolome of the novel Antarctic deep-sea isolate Lacinutrix shetlandiensis sp. nov. WUR7
Authors: Vitale Giovanni A , January Grant G , Oppong-Danquah Ernest , Della Sala Gerardo , Palma Esposito Fortunato , Tasdemir Deniz , de Pascale Donatella 
Published: July 2023

Abstract
The South Shetland Trough, Antarctica, is an underexplored region for microbiological and biotechnological exploitation. Herein, we describe the isolation and characterization of the novel bacterium Lacinutrix shetlandiensis sp. nov. WUR7 from a deep-sea environment. We explored its chemical diversity via a metabologenomics approach, wherein the OSMAC strategy was strategically employed to upregulate cryptic genes for secondary metabolite production. Based on hybrid de novo whole genome sequencing and digital DNA–DNA hybridization, isolate WUR7 was identified as a novel species from the Gram-negative genus Lacinutrix. Its genome was mined for the presence of biosynthetic gene clusters with limited results. However, extensive investigation of its metabolism uncovered an unusual tryptophan decarboxylase with high sequence homology and conserved structure of the active site as compared to ZP_02040762, a highly specific tryptophan decarboxylase from Ruminococcus gnavus. Therefore, WUR7's metabolism was directed toward indole-based alkaloid biosynthesis by feeding it with L-tryptophan. As expected, its metabolome profile changed dramatically, by triggering the extracellular accumulation of a massive array of metabolites unexpressed in the absence of tryptophan. Untargeted LC-MS/MS coupled with molecular networking, followed along with chemoinformatic dereplication, allowed for the annotation of 10 indole alkaloids, belonging to β-carboline, bisindole, and monoindole classes, alongside several unknown alkaloids. These findings guided us to the isolation of a new natural bisindole alkaloid 8,9-dihydrocoscinamide B (1), as the first alkaloid from the genus Lacinutrix, whose structure was elucidated on the basis of extensive 1D and 2D NMR and HR-ESIMS experiments. This comprehensive strategy allowed us to unlock the previously unexploited metabolome of L. shetlandiensis sp. nov. WUR7.
Are Richard Wagner’s operas a potential tool to teach medical students and young doctors humanities?
Authors: Wolf Gunter 
Published: July 2023

Abstract There is an increasing interest in using poems and novels as a powerful resource to teach medical students ethical and professional behavior, virtues, and to illustrate the complexity of the doctor–patient relationship. This approach as part of a narrative medicine provides a framework for approaching a patient’s problems more holistically and also offers a method for addressing existential inner qualities such as grief, hope, and despair that are part of illnesses. Occasionally, operas (mainly Italian) have also been used for this purpose. I however, propose that medical students may learn a lot from a deeper confrontation with the operas from the German composer Richard Wagner (1813–1883). Certainly, Wagner had a rather self-centered personality, also known for his notorious nationalistic and anti-Semitic essays, but his complete Gesamtkunstwerk (total work of art) encompasses almost every human feeling, conflict, and psychological problem including suffering, compassion, redemption, etc. Wagner’s opera somewhat reflected his unsteady life. Wagner was convinced that his art could fill the void left by the retreat of traditional religion, suggesting that humanity may achieve freedom through the perception of beauty uniting communities through shared aesthetic experience. Not a very modest approach and not a very likable character, but a great composer. After a short biography, I will provide some (because of the complexity of the subject, naturally limited) arguments on what medical students can learn from Wagner operas, even though I am convinced that Wagner and his music are not easy to digest, even for experienced opera lovers.Key messages
ChatGPT: the threats to medical education
Authors: Armitage Richard C 
Published: July 2023

Abstract
While it offers abundant advantages, ChatGPT threatens to significantly harm the educational attainment, and the intellectual life, of students of medicine and the subjects that compliment it. This technology poses a serious threat to the ability of such students to deliver safe and effective medical care once they graduate to clinical practice. Institutions that providemedical education must react to the existence, availability, and rapidly increasing competency of GPT models. This article suggests an intervention by which this could be, at least partially, achieved.
Therapeutic Exercise Parameters, Considerations, and Recommendations for Migraine Treatment: An International Delphi Study
Authors: Reina-Varona Álvaro , Madroñero-Miguel Beatriz , Gaul Charly , Hall Toby , Oliveira Arão B , Bond Dale S , Fernández-de las Peñas César , Florencio Lidiane L , Carvalho Gabriela F , Luedtke Kerstin , Varkey Emma , Krøll Lotte S , Bevilaqua-Grossi Debora , Kisan Ravikiran , La Touche Roy , Paris-Alemany Alba 
Published: July 2023

Abstract

Objective
The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for prescribing exercise to patients with migraine.

Methods
This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index ≥ 0.7 was obtained.

Results
The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients’ exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions.

Conclusion
From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients’ preferences and psychological considerations, level of physical activity, and possible adverse effects.

Impact
The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients’ psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.
Trust in Risk Sharing: A Double-Edged Sword
Authors: Cole Harold L , Krueger Dirk , Mailath George J , Park Yena 
Published: July 2023

Abstract
We analyse efficient risk-sharing arrangements when the value from deviating is determined endogenously by another risk-sharing arrangement. Coalitions form to insure against idiosyncratic income risk. Self-enforcing contracts for both the original coalition and any coalition formed (joined) after deviations rely on a belief in future cooperation which we term “trust”. We treat the contracting conditions of original and deviation coalitions symmetrically and show that higher trust tightens incentive constraints since it facilitates the formation of deviating coalitions. As a consequence, although trust facilitates the initial formation of coalitions, the extent of risk sharing in successfully formed coalitions is declining in the extent of trust and efficient allocations might feature resource burning or utility burning: trust is indeed a double-edged sword.
Evaluation of dietary arginine supplementation to increase placental nutrient transporters in aged mares
Authors: Martinez Rafael E , Leatherwood Jessica L , Bradbery Amanda N , Paris Brittany L , Hammer Carolyn J , Kelley Dale , Bazer Fuller W , Wu Guoyao 
Published: July 2023

Abstract
Nine pregnant mares (18.2 ± 0.7 yr; 493.82 ± 12.74 kg body weight [BW]) were used to test the hypothesis that dietary supplementation of l-arginine would enhance placental vascularity and nutrient transport throughout gestation in aged mares. Mares were balanced by age, BW, and stallion pairing, and assigned randomly to dietary treatments of either supplemental l-arginine (50 mg/kg BW; n = 7) or l-alanine (100 mg/kg BW; n = 6; isonitrogenous control). Mares were individually fed concentrate top-dressed with the respective amino acid treatment plus ad libitum access to Coastal Bermudagrass hay. Treatments began on day 14 of gestation and were terminated at parturition. Mare BW, body condition score (BCS), and rump fat were determined, and body fat percentage was calculated every 28 d and concentrate adjusted accordingly. Doppler blood flow measurements including resistance index (RI) and pulsatility index for uterine artery ipsilateral to the pregnant uterine horn were obtained beginning on day 21 and continued every 7 d until day 154 of gestation, and prior to parturition. Parturition was attended with foaling variables and placental measures recorded. Placental tissue from the pregnant horn was analyzed histologically to assess cell-specific localization of vascular endothelial growth factor (VEGF) and cationic amino acid transporter 1 (SLC7A1) proteins. Semiquantitative analyses were performed using 10 nonoverlapping images per sample fixed in a 10× field (Fiji ImageJ v1.2). Mare performance data were analyzed using PROC MIXED in SAS and foaling and placental data were analyzed using PROC GLM. Gestation length at parturition was not influenced (P &gt; 0.05) by supplemental arginine. Compared with arginine-supplemented mares, control mares had a thicker rump fat layer (P &lt; 0.01) and greater percent body fat (P = 0.03), and BCS (P &lt; 0.01) at parturition. Arginine-supplemented mares had a lower RI than control mares prior to parturition (P &lt; 0.01). Body length, height, and BW of foals at birth, as well as placental weight and volume, and immunohistochemical staining for VEGF and SLC7A1 at parturition, were not affected (P &gt; 0.05) by maternal arginine supplementation. These results indicate that dietary arginine supplementation (50 mg/kg BW) is safe for gestating mares. A larger number of mares is required to extend knowledge of effects of supplemental arginine on embryonic/fetal survival and growth in mares.
Phylogeographic patterns of genetic diversity in Pontastacus leptodactylus (Decapoda: Astacidae): is the hypothesis of the taxonomically rich genus Pontastacus true?
Authors: Bláha Martin , Patoka Jiří , Policar Tomáš , Śliwińska Karolina , Alekhnovich Anatoly , Berezina Nadezhda , Petrescu Ana-Maria , Mumladze Levan , Weiperth András , Jelic Mišel , Kozák Pavel , Maguire Ivana 
Published: July 2023

Abstract
The narrow-clawed crayfish Pontastacus leptodactylus is a large native European astacid crayfish species distributed in the drainage area of the Azov, Black and Caspian Seas. The species shows immense morphological diversity across its range. Various species and subspecies have been described and, recently, eight species and two subspecies were confirmed in the updated classification of freshwater crayfishes. However, genetic diversity studies of the species are scarce, mostly from limited geographical areas. Therefore, we aimed to analyse the genetic diversity of this species using mtDNA and nuDNA from across their distributional range to verify the presence of described species. Analyses of individuals from 65 populations and 14 countries confirmed the existence of three divergent mtDNA phylogroups corresponding to the geographical area of Central and Southern Europe, Eastern Europe and Asia, and Turkey. Analysis of ancestral ranges revealed the Black Sea basin as the most likely area of origin. The nuDNA analysis showed low diversity partially corresponding to the mtDNA pattern. All analyses showed mitonuclear discordance indicating the existence of a single species. Therefore, we point out the possibility of taxonomic inaccuracy with the current number of valid species within the P. leptodactylus species complex.
Analysis of Hairline and Forehead Sexual Dimorphic Aesthetics in 60 Celebrities Using Artificial Intelligence
Authors: Salinas Cristina A. , Liu Alice , Sharaf Basel A. 
Published: July 2023

Background:
Upper facial third morphometrics are an important consideration in aesthetic facial surgery and facial gender-affirming surgery. Although there are generally accepted sexual dimorphic differences, an in-depth analysis of forehead morphometrics in attractive individuals is lacking.

Methods:
Thirty white female and 30 white male celebrities were included. Three full-face front-view photographs of each celebrity were evaluated by a facial analysis program, using Vision framework and MATLAB. After converting pixel distances to absolute distances, midline and lateral forehead heights were calculated and compared between men and women.

Results:
Forehead height was similar between attractive men and women, but forehead width was shorter in women. Analysis of forehead height at various points along the hairline demonstrated that forehead measurements above the lateral brow and brow peak were significantly greater in men. Mean forehead height above the lateral eyebrow was 3.51 cm in women and 4.16 cm in men (P = 0.017). Forehead height above the eyebrow peak was 4.34 cm in women and 5.55 cm in men (P < 0.001). Medial forehead height was similar between men and women, indicating that the greatest difference in attractive male and female foreheads is in the lateral forehead and forehead width.

Conclusions:
Analysis of attractive white celebrities demonstrated no significant differences in central forehead heights between men and women. Forehead width and lateral forehead height were significantly smaller in women, with an overall downward slanting contour. Male hairlines were more horizontal and slanting upward laterally. These results have implications in facial rejuvenation and facial gender-affirming surgery.
Virologic Outcomes and ARV Switch Profiles 2 Years After National Rollout of Dolutegravir to Children Less Than 15 Years in Southern Mozambique
Authors: Gill Michelle M. , Herrera Nicole , Guilaze Rui , Mussa Abdul , Dengo Nataniel , Nhangave Amancio , Mussá Jaciara , Perez Patricia , Bhatt Nilesh 
Published: July 2023

Background:
Dolutegravir (DTG) was scaled up globally to optimize treatment for children living with HIV. We evaluated the rollout and virological outcomes after DTG introduction in Mozambique.

Methods:
Data from children 0–14 years with visits from September 2019 to August 2021 were extracted from records in 16 facilities in 12 districts. Among children ever on DTG, we report treatment switches, defined as changes in anchor drug, regardless of changes to nucleoside reverse transcriptase inhibitor (NRTI) backbones. Among those on DTG for ≥6 months, we described viral load suppression rates by children newly initiating and switching to DTG and by the NRTI backbone at the time of the DTG switch.

Results:
Overall, 3,347 children were ever on DTG-based treatment (median age 9.5 years; 52.8% female). Most children (3,202, 95.7%) switched to DTG from another antiretroviral regimen. During the 2-year follow-up, 9.9% never switched from DTG; 52.7% had 1 regimen change, of which 97.6% were switched to DTG. However, 37.2% of children experienced ≥2 anchor drug changes. Overall median time on DTG was 18.6 months; nearly all children ≥5 years (98.6%) were on DTG at the last visit. Viral suppression was 79.7% (63/79) for children newly initiating DTG and 85.8% (1,775/2,068) for those switching to DTG. Suppression rates were 84.8% and 85.7% among children who switched and maintained NRTI backbones, respectively.

Conclusions:
Viral suppression rates of ≥80% with minor variations by backbone were achieved during the 2-year DTG rollout. However, there were multiple anchor drug switches for over one-third of children, which may be attributable in part to drug stockouts. Long-term pediatric HIV management will only be successful with immediate and sustainable access to optimized child-friendly drugs and formulations.
Preoperative Workup of Patients With Excessive Central Airway Collapse
Authors: Pan Jennifer M. , Ospina-Delgado Daniel , Kaul Sumedh , Parikh Mihir S. , Wilson Jennifer L. , Majid Adnan , Gangadharan Sidhu P. 
Published: July 2023

Background:
Tracheobronchoplasty (TBP) is a definitive anatomic intervention for patients with severe symptomatic expiratory central airway collapse. Although stent evaluations have been described for surgical workup, current literature does not address if improvement during stent evaluation is sustained after TBP. We compared health-related quality of life (HRQOL) and functional status responses after airway stenting to those post-TBP.

Methods:
A retrospective review was performed in patients with severe expiratory central airway collapse who underwent stent evaluation followed by TBP from January 2004 to December 2019. Baseline, poststent, 3- and 12-month postoperative HRQOL scores, and functional status were analyzed with statistical tests as appropriate.

Results:
One hundred twenty patients underwent a stent evaluation and TBP. Baseline and stent evaluation measurements were compared with statistically and clinically significant differences in the Cough Quality-of-life Questionnaire (CQLQ) (55 vs. 68, P<0.01), Modified Medical Research Council (mMRC) 0 to 2 (90% vs. 47%, P<0.01), 6-minute walk test (6MWT) (1301 ft vs. 1138 ft, P<0.01). Improvements in the HRQOL and functional status were maintained from stent evaluation to 3 months postoperatively [CQLQ 55 vs. 54, P=0.63; mMRC 0 to 2 (87% vs. 84%), P=0.39; 6MWT 1350 ft vs. 1314 ft, P=0.33], and 12 months postoperatively [CQLQ 54 vs. 54, P=0.91; mMRC 0 to 2 (95% vs. 86%), P=0.74; 6MWT 1409 ft vs. 1328 ft, P=0.13]. The magnitude of change between the data was not significantly different between the stent evaluation, 3-, and 12 months postoperative. Predicted forced expiratory volume in 1-second measurements at baseline, after stent placement, 3 months, and 12 months post-TBP were 74%, 79%, 73%, and 73%, respectively, and not clinically significant.

Conclusions:
Improvement after stent evaluation and the magnitude of improvement may be predictive of postoperative outcomes up to 1 year after surgery.
Evaluation of hypertension control among hemodialysis patients in Pakistan: a prospective follow-up study
Authors: Hameed Kiran , Chinnam Sampath , Khan Khanzada Sheraz , Mushtaq Saima , Ahmad Nafees , Jaber Ammar Ali Saleh , Anwar Zeeshan , ur-Rehman Inayat , Khan Amjad 
Published: July 2023

Background
Hypertension is highly prevalent and uncontrolled among hemodialysis patients. In Pakistan published data does not provide enough information about the management and factors associated with uncontrolled hypertension in hemodialysis patients.

Objective
This study was conducted to evaluate the factors influencing the pharmacotherapeutic management and control of hypertension in hemodialysis patients.

Methods
A prospective follow-up study was conducted on hemodialysis patients who were enrolled at study sites between 1 June 2020 and 31 December 2020. The predialysis blood pressure (BP) readings were recorded as mean SBP and DBP at baseline and for each of 6 months. Multivariate analyses were applied to analyze the factors associated with uncontrolled hypertension in hemodialysis patients.

Results
The average predialysis BP (SBP and DBP) of study participants at baseline visit was 158.41 and 87.22 mmHg respectively. After 6 months the study participants have 150.27 mmHg and 80.03 mmHg average predialysis SBP and DBP respectively. Only 28.1% of hemodialysis patients were on target BP after 6 months. Results of multivariate analysis have shown that the use of beta-blockers and calcium channel blockers (CCBs) were significantly associated with hypertension control at baseline [odds ratio (OR) = 1.432, P value = 0.034] (OR = 1.499, P value = 0.045) and at after 6 months (OR = 2.824, P value = 0.015) (OR = 1.883, P value = 0.032).

Conclusion
This study revealed that among the antihypertensive drugs, CCBs and beta-blockers provided better management in controlling hypertension among hemodialysis patients.