"I couldn't carry on taking a drug like that": A qualitative study of patient perspectives on side effects from rheumatology drugs.

OBJECTIVES: There is growing interest in collecting outcome information directly from patients in clinical trials. This study evaluates what patients with rheumatic and musculoskeletal diseases (RMDs) consider important to know about symptomatic side effects they may experience from a new prescription drug. METHODS: Patients with inflammatory arthritis, who had one or more prescribed drugs for their disease for at least 12 months, participated in focus groups and individual interviews. Discussions were analysed using reflexive thematic analysis. RESULTS: We conducted seven focus groups with 34 participants across three continents. We found four overarching and two underpinning themes. The 'impact on life' was connected to participants 'daily life', 'family life', 'work life', and 'social life'. In 'psychological and physical aspects' participants described 'limitation to physical function', 'emotional dysregulation' and 'an overall mental state'. Extra tests, hospital visits and payment for medication were considered a 'time, energy and financial burden' of side effects. Participants explained important measurement issues to be 'severity', 'frequency', and 'duration'. Underpinning these issues, participants evaluated the 'benefit-harm-balance' which includes 'the cumulative burden' of having several side effects and the persistence of side effects over time. CONCLUSIONS: In treatment for RMDs, there seems to be an urgent need for feasible measures of patient-reported bother (impact on life and cumulative burden) from side effects and the benefit-harm-balance. These findings contribute new evidence in support of a target domain-an outcome that represents the patient voice evaluating the symptomatic treatment-related side effects for people with RMDs enrolled in clinical trials.

Fin whale song evolution in the North Atlantic.

Animal songs can change within and between populations as the result of different evolutionary processes. When these processes include cultural transmission, the social learning of information or behaviours from conspecifics, songs can undergo rapid evolutions because cultural novelties can emerge more frequently than genetic mutations. Understanding these song variations over large temporal and spatial scales can provide insights into the patterns, drivers and limits of song evolution that can ultimately inform on the species' capacity to adapt to rapidly changing acoustic environments. Here, we analysed changes in fin whale (Balaenoptera physalus) songs recorded over two decades across the central and eastern North Atlantic Ocean. We document a rapid replacement of song INIs (inter-note intervals) over just four singing seasons, that co-occurred with hybrid songs (with both INIs), and a clear geographic gradient in the occurrence of different song INIs during the transition period. We also found gradual changes in INIs and note frequencies over more than a decade with fin whales adopting song changes. These results provide evidence of vocal learning in fin whales and reveal patterns of song evolution that raise questions on the limits of song variation in this species.

Barriers for why pregnant women do not visit a dentist on a regular basis: using group concept mapping methodology.

OBJECTIVES: Periodontitis in pregnancy represents a significant, but often overlooked challenge due to its association to adverse pregnancy (preeclampsia and gestational diabetes) and birth related outcomes (preterm birth and low birth weight). The overall study aim was to identify, organize, and prioritize barriers influencing dental visits among Danish pregnant women not seeing a dentist on a regularly basis. MATERIALS AND METHODS: Participants were pregnant women screened at weeks 11-13 of gestation, and were recruited if they were not seeing a dentist regularly. The study was conducted at Holbæk and Nykøbing Falster Hospital in Region Zealand, Denmark. The Group Concept Mapping (GCM) approach was applied. The pregnant women participated in brainstorming (n = 18), sorting (n = 20), and rating (n = 17) the seating question 'Thinking as broadly as you can, please list all barriers of importance to you for not seeing a dentist on a regular basis'. RESULTS: A total of 38 unique barriers were identified, organized, and prioritized online. The multidimensional scaling analysis involved 10 iterations and revealed a low stress value of 0.21. A cluster solution with five clusters including 'economic reasons', 'lack of priority', 'lack of time and energy', 'no problems with teeth', and 'dental fear', was discussed and interpreted at a validation meeting. CONCLUSIONS: Five overall clusters explaining barriers for not seeing a dentist regularly were revealed. Of the five clusters, 'economic reasons' and 'lack of priority' were rated as the most important clusters. Accordingly, such barriers should be considered in the planning of future strategies of dental care during pregnancy.

Underwater sound of three unoccupied aerial vehicles at varying altitudes and horizontal distances.

Unoccupied aerial vehicles (UAVs), or "drones," are increasingly used as a tool for cetacean research, but knowledge about how these tools contribute to underwater sound is lacking. In this study, underwater sound levels of three commonly used UAV models (Mavic Pro Platinum, Phantom 4 Pro v2.0, Inspire 1 Pro) were recorded. For each model, three replicate flights were conducted at 36 positions at standardized horizontal (0-30 m) and vertical (2-40 m) distances from a hydrophone (1 m depth). Median broadband received levels of the Inspire were highest at 96.5 dBrms 141-17 783 Hz re 1 µPa2, followed by the Phantom (92.4 dBrms 141-17 783 Hz re 1 µPa2) and Mavic, which was quietest (85.9 dBrms 141-17 783 Hz re 1 µPa2). Median ambient sound levels in the absence of an UAV were 82.7 dBrms 141-17 783 Hz re 1 µPa2. Significant increases in ambient sound levels associated with UAV flights occurred at higher altitudes than previously reported, and received levels decreased more with increasing horizontal distance of the UAV than with altitude. To minimize potential noise impacts on sensitive marine animal subjects, we recommend increasing horizontal distance to the animal, rather than altitude, and choosing the quietest UAV feasible.

Nrf2 Protein Serum Concentration in Human CKD Shows a Biphasic Behavior.

Oxidative stress contributes to the progression of chronic kidney disease (CKD) and CKD-related mortality. The nuclear factor erythroid 2-related factor 2 (Nrf2) is essential in the regulation of cellular redox status, and Nrf2-activating therapies are under evaluation in several chronic diseases, including CKD. It is therefore inevitable to understand how Nrf2 behaves in advancing CKD. We analyzed Nrf2 protein concentrations in patients with varying extents of CKD but without renal replacement therapy, and in healthy subjects. Compared to healthy controls, Nrf2 protein was upregulated in mild to moderate kidney function impairment (G1-3). Within the CKD population, we found a significant positive correlation between Nrf2 protein concentration and kidney function (estimated glomerular filtration rate). In severe kidney function impairment (G4,5), Nrf2 protein was reduced compared to mild to moderate kidney function impairment. We conclude that Nrf2 protein concentration in severe kidney function impairment is reduced relative to the mild to moderate kidney function impairment where increased Nrf2 protein concentrations prevail. With respect to the implementation of Nrf2 targeted therapies, it will be necessary to explore in which population of patients with CKD such therapies are able to effectively add to the endogenous Nrf2 activity.

Effectiveness of a community-based support programme to reduce social inequality in exclusive breastfeeding: study protocol for a cluster-randomised trial.

BACKGROUND: Breastmilk is the ideal nutrition for infants, and breastfeeding protects infants and mothers from a range of adverse health outcomes. In Denmark, most mothers initiate breastfeeding but many cease within the first months resulting in just 14% reaching the World Health Organization recommendation of six months of exclusive breastfeeding. Furthermore, the low breastfeeding proportion at six months is characterised by a marked social inequality. A previous intervention tested in a hospital setting succeeded in increasing the proportion of mothers breastfeeding exclusively at six months. However, most breastfeeding support is provided within the Danish municipality-based health visiting programme. Therefore, the intervention was adapted to fit the health visiting programme and implemented in 21 Danish municipalities. This article reports the study protocol, which will be used to evaluate the adapted intervention. METHODS: The intervention is tested in a cluster-randomised trial at the municipal level. A comprehensive evaluation approach is taken. The effectiveness of the intervention will be evaluated using survey and register data. Primary outcomes are the proportion of women who breastfeed exclusively at four months postpartum and duration of exclusive breastfeeding measured as a continuous outcome. A process evaluation will be completed to evaluate the implementation of the intervention; a realist evaluation will provide an understanding of the mechanisms of change characterising the intervention. Finally, a health economic evaluation will assess the cost-effectiveness and cost-utility of this complex intervention. DISCUSSION: This study protocol reports on the design and evaluation of the Breastfeeding Trial - a cluster-randomised trial implemented within the Danish Municipal Health Visiting Programme from April 2022 to October 2023. The purpose of the programme is to streamline breastfeeding support provided across healthcare sectors. The evaluation approach is comprehensive using a multitude of data to analyse the effect of the intervention and inform future efforts to improve breastfeeding for all. TRIAL REGISTRATION: Prospectively registered with Clinical Trials NCT05311631 https://clinicaltrials.gov/ct2/show/NCT05311631.

Biopsychosocial Rehabilitation for Inflammatory Arthritis and Osteoarthritis Patients: A Systematic Review and Meta-Analysis of Randomized Trials.

OBJECTIVE: To assess the benefits and harms associated with biopsychosocial rehabilitation in patients with inflammatory arthritis and osteoarthritis (OA). METHODS: We performed a systematic review and meta-analysis. Data were collected through electronic searches of Cochrane CENTRAL, MEDLINE, Embase, PsycInfo, and CINAHL databases up to March 2019. Trials examining the effect of biopsychosocial rehabilitation in adults with inflammatory arthritis and/or OA were considered eligible, excluding rehabilitation adjunct to surgery. The primary outcome for benefit was pain and total withdrawals for harm. RESULTS: Of the 27 trials meeting the eligibility criteria, 22 trials (3,750 participants) reported sufficient data to be included in the quantitative synthesis. For patient-reported outcome measures, biopsychosocial rehabilitation was slightly superior to control for pain relief (standardized mean difference [SMD] -0.19 [95% confidence interval (95% CI) -0.31, -0.07]), had a small effect on patient global assessment score (SMD -0.13 [95% CI -0.26, -0.00]), with no apparent effect on health-related quality of life, fatigue, self-reported disability/physical function, mental well-being, and reduction in pain intensity ≥30%. Clinician-measured outcomes displayed a small effect on observed disability/physical function (SMD -0.34 [95% CI -0.57, -0.10]), a large effect on physician global assessment score (SMD -0.72 [95% CI -1.18, -0.26]), and no effect on inflammation. No difference in harms existed in terms of the number of withdrawals, adverse events, or serious adverse events. CONCLUSION: Biopsychosocial rehabilitation produces a significant but clinically small beneficial effect on patient-reported pain among patients with inflammatory arthritis and OA, with no difference in harm. Methodologic weaknesses were observed in the included trials, suggesting low-to-moderate confidence in the estimates of effect.

Breastfeeding trajectories of young and short-term educated mothers and their partners; experiences of a journey facing tailwind and headwind.

OBJECTIVE: To explore needs, experiences and socio-cultural context of young and short-term educated mothers and their partners affecting breastfeeding duration and self-efficacy during pregnancy and the first months following birth. DESIGN: A qualitative study was conducted using Malterud's method of Systematic Text Condensation. SETTING: Data collection took place in two rural regions in Denmark between October and December 2020. PARTICIPANTS: Thirteen interviews (eight mothers and five fathers), four focus group interviews (24 health visitors) and seven observations of home visits by health visitors were performed. The mothers were below 25 years and had short-term education. FINDINGS: Four themes formed the narrative "Setting off and carrying through a breastfeeding journey": 1) Bringing your unique story of life into the breastfeeding journey, 2) Looking forward to a natural breastfeeding, 3) Facing breastfeeding and the intrusive needs of the baby, and 4) Adaptation to breastfeeding or bottle feeding. Each of these describing barriers and facilitators regarding breastfeeding and breastfeeding self-efficacy. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Becoming familiar with breastfeeding and developing a relationship with the baby posed common challenges for the young and short-term educated mothers and their partners. However, the process was embedded in the parents' unique and often fragile socio-cultural everyday life influencing breastfeeding and breastfeeding self-efficacy. The relationship with the health visitor was essential for the parents' benefit of breastfeeding support, which underscores the importance of viewing adequate breastfeeding support as a relational phenomenon including socio-cultural, parent-baby, and health visitor-parent perspectives in young and short-term educated parents.

Occurrence of long-finned pilot whales (Globicephala melas) and killer whales (Orcinus orca) in Icelandic coastal waters and their interspecific interactions.

Long-finned pilot whales and killer whales are widely distributed across the North Atlantic, but few studies have reported their occurrence in Icelandic coastal waters. Here, we use sightings data from research platforms and whale watching tours in six regions of Iceland from 2007 to 2020 to show that the occurrence of long-finned pilot and killer whales varied with region and season. Killer whales were regularly encountered in the south of Iceland during summer and west of Iceland during winter/spring. Long-finned pilot whales were only seen during the summer and were most often encountered in the south, west, and northwest of Iceland. Long-finned pilot whale occurrence in the south of Iceland appeared to increase during the study period but killer whale occurrence showed no noticeable changes. Long-finned pilot whales were sighted often in the areas that were also frequented by killer whales and interspecific interactions were commonly observed when both species co-occurred. Interactions appeared to be antagonistic, with killer whales often avoiding long-finned pilot whales and sometimes fleeing at high speed, similar to what has been described elsewhere in the North Atlantic. In the majority of interactions observed (68%), killer whales avoided long-finned pilot whales by moving away, but in 28% avoidance was at high speed with both species porpoising. This variability in the type of behavioural responses indicates that interactions may be more complex than previously described. We discuss regional trends in long-finned pilot whale and killer whale sightings and potential drivers of the observed interactions. Supplementary Information: The online version contains supplementary material available at 10.1007/s10211-022-00394-1.

Acoustic differentiation and classification of wild belugas and narwhals using echolocation clicks.

Belugas (Delphinapterus leucas) and narwhals (Monodon monoceros) are highly social Arctic toothed whales with large vocal repertoires and similar acoustic profiles. Passive Acoustic Monitoring (PAM) that uses multiple hydrophones over large spatiotemporal scales has been a primary method to study their populations, particularly in response to rapid climate change and increasing underwater noise. This study marks the first acoustic comparison between wild belugas and narwhals from the same location and reveals that they can be acoustically differentiated and classified solely by echolocation clicks. Acoustic recordings were made in the pack ice of Baffin Bay, West Greenland, during 2013. Multivariate analyses and Random Forests classification models were applied to eighty-one single-species acoustic events comprised of numerous echolocation clicks. Results demonstrate a significant difference between species' acoustic parameters where beluga echolocation was distinguished by higher frequency content, evidenced by higher peak frequencies, center frequencies, and frequency minimums and maximums. Spectral peaks, troughs, and center frequencies for beluga clicks were generally > 60 kHz and narwhal clicks < 60 kHz with overlap between 40-60 kHz. Classification model predictive performance was strong with an overall correct classification rate of 97.5% for the best model. The most important predictors for species assignment were defined by peaks and notches in frequency spectra. Our results provide strong support for the use of echolocation in PAM efforts to differentiate belugas and narwhals acoustically.

Comparative genomics provides insights into the aquatic adaptations of mammals.

The ancestors of marine mammals once roamed the land and independently committed to an aquatic lifestyle. These macroevolutionary transitions have intrigued scientists for centuries. Here, we generated high-quality genome assemblies of 17 marine mammals (11 cetaceans and six pinnipeds), including eight assemblies at the chromosome level. Incorporating previously published data, we reconstructed the marine mammal phylogeny and population histories and identified numerous idiosyncratic and convergent genomic variations that possibly contributed to the transition from land to water in marine mammal lineages. Genes associated with the formation of blubber (NFIA), vascular development (SEMA3E), and heat production by brown adipose tissue (UCP1) had unique changes that may contribute to marine mammal thermoregulation. We also observed many lineage-specific changes in the marine mammals, including genes associated with deep diving and navigation. Our study advances understanding of the timing, pattern, and molecular changes associated with the evolution of mammalian lineages adapting to aquatic life.

Vertical sonar beam width and scanning behavior of wild belugas (Delphinapterus leucas) in West Greenland.

Echolocation signals of wild beluga whales (Delphinapterus leucas) were recorded in 2013 using a vertical, linear 16-hydrophone array at two locations in the pack ice of Baffin Bay, West Greenland. Individual whales were localized for 4:42 minutes of 1:04 hours of recordings. Clicks centered on the recording equipment (i.e. on-axis clicks) were isolated to calculate sonar parameters. We report the first sonar beam estimate of in situ recordings of wild belugas with an average -3 dB asymmetrical vertical beam width of 5.4°, showing a wider ventral beam. This narrow beam width is consistent with estimates from captive belugas; however, our results indicate that beluga sonar beams may not be symmetrical and may differ in wild and captive contexts. The mean apparent source level for on-axis clicks was 212 dB pp re 1 µPa and whales were shown to vertically scan the array from 120 meters distance. Our findings support the hypothesis that highly directional sonar beams and high source levels are an evolutionary adaptation for Arctic odontocetes to reduce unwanted surface echoes from sea ice (i.e., acoustic clutter) and effectively navigate through leads in the pack ice (e.g., find breathing holes). These results provide the first baseline beluga sonar metrics from free-ranging animals using a hydrophone array and are important for acoustic programs throughout the Arctic, particularly for acoustic classification between belugas and narwhals (Monodon monoceros).

OMERACT consensus-based operational definition of contextual factors in rheumatology clinical trials: A mixed methods study.

OBJECTIVES: To develop an operational definition of contextual factors (CF) [1]. METHODS: Based on previously conducted interviews, we presented three CF types in a Delphi survey; Effect Modifying -, Outcome Influencing - and Measurement Affecting CFs. Subsequently, a virtual Special Interest Group (SIG) session was held for in depth discussion of Effect Modifying CFs. RESULTS: Of 161 Delphi participants, 129 (80%) completed both rounds. After two rounds, we reached consensus (≥70% agreeing) for all but two statements. The 45 SIG participants were broadly supportive. CONCLUSION: Through consensus we developed an operational definition of CFs, which was well received by OMERACT members.

Evidence of unidirectional hybridization and second-generation adult hybrid between the two largest animals on Earth, the fin and blue whales.

Biodiversity in the oceans has dramatically declined since the beginning of the industrial era, with accelerated loss of marine biodiversity impairing the ocean's capacity to maintain vital ecosystem services. A few organisms epitomize the damaging and long-lasting effects of anthropogenic exploitation: Some whale species, for instance, were brought to the brink of extinction, with their population sizes reduced to such low levels that may have caused a significant disruption to their reproductive dynamics and facilitated hybridization events. The incidence of hybridization is nevertheless believed to be rare, and very little information exists on its directionality. Here, using genetic markers, we show that all but one whale hybrid sample collected in Icelandic waters originated from the successful mating of male fin whale and female blue whale, thus suggesting unidirectional hybridization. We also demonstrate for the first time the existence of a second-generation adult (male) hybrid resulting from a backcross between a female hybrid and a pure male fin whale. The incidence of hybridization events between fin and blue whales is likely underestimated and the observed unidirectional hybridization (for F1 and F2 hybrids) is likely to induce a reproductive loss in blue whale, which may represent an additional challenge to its recovery in the Atlantic Ocean compared to other rorquals.

Fission-fusion dynamics of a pelagic delphinid in the arctic: the white-beaked dolphin (Lagenorhynchus albirostris).

Delphinids exhibit great variability in their social structures. It is therefore important to document lesser known species, in extreme changing habitats, to compare and contrast mechanisms driving sociality. Here, we describe the first long-term assessment of social structure of white-beaked dolphins (Lagenorhynchus albirostris) using a compiled version of SOCPROG 2.8 and an 11-year photo-identification dataset (2002-2013) collected from whale-watching vessels at 2 sites (Faxaflói and Skjálfandi bays) off Iceland. We identified a total of 487 dolphins which are suggested to be part of an open population as shown by the discovery curve obtained analyzing photo-id data. The social analyses were restricted to 35 adults which were sighted on ≥5 different days. The mean residency time of white-beaked dolphins in our 2 study areas was of 95 days (SE = 35.63; 95% CI: 23-171), with the "migration-full interchange" model best describing movements of dolphins in and out of our 2 study sites. Social differentiation in this population was high (Likelihood: S = 0.87, SE = 0.04; r = 0.31, SE = 0.03) indicating diverse, non-random social relationships. Temporal associations best fit the model of "casual acquaintances" against the standardized lagged association rates with the majority of white-beaked dolphin associations being short-term, but with a few long-term across years. Testing for preferred companionship, long-term associations are favored over short-term. In this study, associations among white-beaked dolphins are short-term but with desirably long-term associations fitting into a society with fission-fusion dynamics. This information expands the latitudinal range for which social structure has been described for oceanic dolphin species.

Liraglutide after diet-induced weight loss for pain and weight control in knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Weight loss is critical for preventing and managing obesity-related diseases. There is a notable lack of valid and reliable means to manage patients with overweight/obesity and knee osteoarthritis (KOA). OBJECTIVE: To determine the efficacy and safety of liraglutide in a 30 mg/d dosing in patients with overweight/obesity and KOA. METHODS: The trial was designed as a randomized controlled trial including patients between the age of 18 and 74 y with KOA and a BMI ≥27 (measured in kg/m2).Patients underwent a pre-random assignment diet intervention (week -8 to 0). At week 0, patients having lost >5% of their body weight were randomly assigned to liraglutide 3 mg/d or placebo for 52 wk. The coprimary outcomes were changes in body weight and the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale from week 0 to 52. RESULTS: In total, 168 patients enrolled and 156 were randomly assigned to receive liraglutide or placebo. Patients experienced a significant reduction in body weight and KOOS pain during the pre-random assignment dietary intervention period (week -8 to 0). From week 0 to 52 there was a significant difference in body weight between the liraglutide and placebo group (mean changes: -2.8 and +1.2 kg, respectively; group difference, 3.9 kg; 95% CI: -6.9, -1.0; P = 0.008). There was, however, no group difference in KOOS pain (mean changes: 0.4 and -0.6 points, respectively; group difference, 0.9 points; 95% CI: -3.9, 5.7; P = 0.71). Treatment-emergent adverse events related to the gastrointestinal system were experienced by 50.2% and 39.2% of patients in the liraglutide and placebo groups, respectively. CONCLUSIONS: In patients with KOA and overweight/obesity liraglutide added after an 8-wk pre-random assignment diet induced a significant weight loss at >52 wk but did not reduce knee pain compared to placebo. This trial was registered at clinicaltrials.gov as NCT02905864.

Are Icelandic harbor seals acoustically cryptic to avoid predation?

Male harbor seals (Phoca vitulina) produce stereotypic underwater roars during the mating season. It remains unclear to what extent roar structures vary due to predation levels. Here, seal roars from waters with many (Iceland) and few (Denmark and Sweden) predators were compared. Most Icelandic roars included a long pulse train and a pause. Icelandic roars occurred less frequently, lasted longer (20.3 ± 6.5 s), and were recorded with lower received sound levels (98.3 ± 8.9 dB re 1 µPa root mean square) than roars from Denmark and Sweden. Local extrinsic factors may shape sound production in harbor seals more than previously reported.

Towards consensus in defining and handling contextual factors within rheumatology trials: an initial qualitative study from an OMERACT working group.

OBJECTIVES: The Outcome Measures in Rheumatology Initiative established the Contextual Factors Working Group to guide the understanding, identification and handling of contextual factors for clinical trials. In clinical research, different uses of the term 'contextual factors' exist. This study explores the perspectives of researchers (including clinicians) and patients in defining 'contextual factor' and its related terminology, identifying such factors and accounting for them in trials across rheumatology. METHODS: We conducted individual semistructured interviews with researchers (including clinicians) who have experience within the field of contextual factors in clinical trials or other potentially relevant areas, and small focus group interviews with patients with rheumatic conditions. We transcribed the interviews and applied qualitative content analysis. RESULTS: We interviewed 12 researchers and 7 patients. Researcher's and patient's descriptions of contextual factors were categorised into two broad themes, each comprising two contextual factors types. The 'treatment effect' theme focused on factors explaining variations in treatment effects (A) among patients and (B) among studies. The 'outcome measurement' theme focused on factors that explain (C) variations in the measurement result itself (apart from actual changes/differences in the outcome) and (D) variations in the outcome itself (beside treatment of interest). Methods for identifying and handling contextual factors differed among these themes and types. CONCLUSIONS: Two main themes for contextual factors with four types of contextual factors were identified based on input from researchers and patients. This will guide operationalisation of contextual factors. Further research should refine our findings and establish consensus among relevant stakeholders.

Prospective Study of Long Noncoding RNA, MGAT3-AS1, and Viremia of BK Polyomavirus and Cytomegalovirus in Living Donor Renal Transplant Recipients.

INTRODUCTION: Viremia after renal transplantation is a major cause of morbidity and mortality and treatment opportunities are limited. Tests to determine the increased risk for viremia would be preferable. METHODS: In a prospective, single-center study, we conducted follow-up of 163 renal transplant recipients after incident living donor renal transplantation. We determined a long noncoding RNA, ß-1,4-mannosylglycoprotein 4-ß-N-acetylglucosaminyltransferase-antisense1 (MGAT3-AS1/beta-actin ratio), in peripheral blood mononuclear cells. Viremia of BK polyomavirus and cytomegalovirus was diagnosed with more than 1000 plasma copies/ml within the first 3 postoperative months. The MGAT3-AS1/beta-actin ratio was assessed before viremia was determined. RESULTS: Receiver operator characteristics curve analysis showed a median MGAT3-AS1/beta-actin ratio cutoff value of 4.45 × 10-6 to indicate viremia after transplantation. Samples for 11 of 66 renal transplant recipients (17%) with MGAT3-AS1/beta-actin ratios below 4.45 × 10-6 showed viremia of BK polyomavirus and cytomegalovirus compared with only 6 of 97 renal transplant recipients (6%) with higher MGAT3-AS1/beta-actin ratios (odds ratio [OR]: 3.03; 95% confidence interval [CI]: 1.06-8.67 by Fisher exact test). Furthermore, samples for 6 of 66 renal transplant recipients (9%) with MGAT3-AS1/beta-actin ratios below 4.45 × 10-6 showed BK polyomavirus viremia compared with none of 97 renal transplant recipients (0%) with higher MGAT3-AS1/beta-actin ratios (OR: 20.95; 95% CI, 1.16-378.85 by Fisher exact test). Multivariate logistic regression analysis confirmed that MGAT3-AS1/beta-actin ratios below the cutoff level remained significantly associated with viremia after transplant. Lower MGAT3-AS1/beta-actin ratios occurred with rituximab-containing induction therapy. CONCLUSIONS: A low MGAT3-AS1/beta-actin ratio indicates an increased risk for viremia of BK polyomavirus and cytomegalovirus in living donor renal transplant recipients.