bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Misoprostol alone versus oral misoprostol followed by oxytocin for labour induction in women with hypertension in pregnancy (MOLI): protocol for a randomised controlled trial
Authors: Bracken Hillary , Lightly Kate , Mundle Shuchita , Kerr Robbie , Faragher Brian , Easterling Thomas , Leigh Simon , Turner Mark , Alfirevic Zarko , Winikoff Beverly , Weeks Andrew 
Published: July 2021

Abstract
Background
Every year approximately 30,000 women die from hypertensive disease in pregnancy. Magnesium sulphate and anti-hypertensives reduce morbidity, but delivery is the only cure. Low dose oral misoprostol, a prostaglandin E1 analogue, is a highly effective method for labour induction. Usually, once active labour has commenced, the misoprostol is replaced with an intravenous oxytocin infusion if ongoing stimulation is required. However, some studies have shown that oral misoprostol can be continued into active labour, a simpler and potentially more acceptable protocol for women. To date, these two protocols have never been directly compared.

Methods
This pragmatic, open-label, randomised trial will compare a misoprostol alone labour induction protocol with the standard misoprostol plus oxytocin protocol in three Indian hospitals. The study will recruit 520 pregnant women being induced for hypertensive disease in pregnancy and requiring augmentation after membrane rupture. Participants will be randomised to receive either further oral misoprostol 25mcg every 2 h, or titrated intravenous oxytocin. The primary outcome will be caesarean birth. Secondary outcomes will assess the efficacy of the induction process, maternal and fetal/neonatal complications and patient acceptability. This protocol (version 1.04) adheres to the SPIRIT checklist. A cost-effectiveness analysis, situational analysis and formal qualitative assessment of women’s experience are also planned.

Discussion
Avoiding oxytocin and continuing low dose misoprostol into active labour may have a number of benefits for both women and the health care system. Misoprostol is heat stable, oral medication and thus easy to store, transport and administer; qualities particularly desirable in low resource settings. An oral medication protocol requires less equipment (e.g. electronic infusion pumps) and may free up health care providers to assist with other aspects of the woman’s care. The simplicity of the protocol may also help to reduce human errors associated with the delivery of intravenous infusions. Finally, women may prefer to be mobile during labour and not restricted by an intravenous infusion. There is a need, therefore, to assess whether augmentation using oral misoprostol is superior clinically and economically to the standard protocol of intravenous oxytocin.

Trial registration
Clinical Trials.gov, NCT03749902, registered on 21st Nov 2018.
Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge
Authors: Wang Peng , Lin Fang , Ma Yunhong , Wang Jianbing , Zhou Ming , Rui Yongjun 
Published: July 2021

Abstract
Background
Soft tissue defects in the distal third of the leg and malleolus are difficult to cover and often require free tissue transfer, even for small-sized defects. Propeller flaps were designed as an alternative to free tissue transfer, but are reportedly associated with high complication rates. The aim of our study was to assess our institutional experience with the propeller flap technique and to predict its outcome in lower-limb reconstruction.

Methods
All patients who had undergone propeller flap reconstruction of a distal leg defect between 2013 and 2018 were included. Demographic, clinical, and follow-up data were analyzed.

Results
Complications occurred in 17 of 82 propeller flaps (20.7%), comprising 11 cases of partial necrosis and six of total necrosis. There were no significant differences in age, sex, body mass index smoking, diabetes mellitus, and soft tissue defect sites between the groups of patients with versus without flap necrosis (p > 0.05). In univariate analysis, there were also no significant differences between these two groups in the length and width of the fascial pedicle, and the ratio of the flap length to the flap width (p > 0.05). Interestingly, there were significant differences between the two groups in the distance between the flap perforator, the shortest distance from the perforator to the defect location, and the rotation angle of the flap (p < 0.05). In multivariable logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (95% CIs), the shortest distance from the perforator to the defect location was a significant risk factor for flap complications (p = 0.000; OR = 0.806). Receiver operating characteristic curve analysis showed that when the shortest distance from the flap to the wound was less than 3.5 cm, the necrosis rate of the flap was markedly increased (AUC = 76.1); this suggests that the effective safe flap–wound distance was 3.5 cm.

Conclusions
Propeller flaps are a reliable option for reconstruction in carefully selected patients with traumatic defects of the lower limb and malleolus. We found that the effective safe distance was 3.5 cm from the flap to the wound.
Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study
Authors: Weng Jie , Hou Ruonan , Zhou Xiaoming , Xu Zhe , Zhou Zhiliang , Wang Peng , Wang Liang , Chen Chan , Wu Jinyu , Wang Zhiyi 
Published: July 2021

Abstract
Background
Early and accurate identification of septic patients at high risk for ICU mortality can help clinicians make optimal clinical decisions and improve the patients’ outcomes. This study aimed to develop and validate (internally and externally) a mortality prediction score for sepsis following admission in the ICU.

Methods
We extracted data retrospectively regarding adult septic patients from one teaching hospital in Wenzhou, China and a large multi-center critical care database from the USA. Demographic data, vital signs, laboratory values, comorbidities, and clinical outcomes were collected. The primary outcome was ICU mortality. Through multivariable logistic regression, a mortality prediction score for sepsis was developed and validated.

Results
Four thousand two hundred and thirty six patients in the development cohort and 8359 patients in three validation cohorts. The Prediction of Sepsis Mortality in ICU (POSMI) score included age ≥ 50 years, temperature < 37 °C, Respiratory rate > 35 breaths/min, MAP ≤ 50 mmHg, SpO2 < 90%, albumin ≤ 2 g/dL, bilirubin ≥ 0.8 mg/dL, lactate ≥ 4.2 mmol/L, BUN ≥ 21 mg/dL, mechanical ventilation, hepatic failure and metastatic cancer. In addition, the area under the receiver operating characteristic curve (AUC) for the development cohort was 0.831 (95% CI, 0.813–0.850) while the AUCs ranged from 0.798 to 0.829 in the three validation cohorts. Moreover, the POSMI score had a higher AUC than both the SOFA and APACHE IV scores. Notably, the Hosmer–Lemeshow (H–L) goodness-of-fit test results and calibration curves suggested good calibration in the development and validation cohorts. Additionally, the POSMI score still exhibited excellent discrimination and calibration following sensitivity analysis. With regard to clinical usefulness, the decision curve analysis (DCA) of POSMI showed a higher net benefit than SOFA and APACHE IV in the development cohort.

Conclusion
POSMI was validated to be an effective tool for predicting mortality in ICU patients with sepsis.
Expression of SARS-CoV-2-related receptors in cells of the neurovascular unit: implications for HIV-1 infection
Authors: Torices Silvia , Cabrera Rosalba , Stangis Michael , Naranjo Oandy , Fattakhov Nikolai , Teglas Timea , Adesse Daniel , Toborek Michal 
Published: July 2021

Abstract
Background
Neurological complications are common in patients affected by COVID-19 due to the ability of SARS-CoV-2 to infect brains. While the mechanisms of this process are not fully understood, it has been proposed that SARS-CoV-2 can infect the cells of the neurovascular unit (NVU), which form the blood-brain barrier (BBB). The aim of the current study was to analyze the expression pattern of the main SARS-CoV-2 receptors in naïve and HIV-1-infected cells of the NVU in order to elucidate a possible pathway of the virus entry into the brain and a potential modulatory impact of HIV-1 in this process.

Methods
The gene and protein expression profile of ACE2, TMPRSS2, ADAM17, BSG, DPP4, AGTR2, ANPEP, cathepsin B, and cathepsin L was assessed by qPCR, immunoblotting, and immunostaining, respectively. In addition, we investigated if brain endothelial cells can be affected by the exposure to the S1 subunit of the S protein, the domain responsible for the direct binding of SARS-CoV-2 to the ACE2 receptors.

Results
The receptors involved in SARS-CoV-2 infection are co-expressed in the cells of the NVU, especially in astrocytes and microglial cells. These receptors are functionally active as exposure of endothelial cells to the SARS CoV-2 S1 protein subunit altered the expression pattern of tight junction proteins, such as claudin-5 and ZO-1. Additionally, HIV-1 infection upregulated ACE2 and TMPRSS2 expression in brain astrocytes and microglia cells.

Conclusions
These findings provide key insight into SARS-CoV-2 recognition by cells of the NVU and may help to develop possible treatment of CNS complications of COVID-19.
Modelling the impact of delaying vaccination against SARS-CoV-2 assuming unlimited vaccine supply
Authors: Amaku Marcos , Covas Dimas Tadeu , Coutinho Francisco Antonio Bezerra , Azevedo Raymundo Soares , Massad Eduardo 
Published: July 2021

AbstractBackgroundAt the moment we have more than 177 million cases and 3.8 million deaths (as of June 2021) around the world and vaccination represents the only hope to control the pandemic. Imperfections in planning vaccine acquisition and difficulties in implementing distribution among the population, however, have hampered the control of the virus so far.MethodsWe propose a new mathematical model to estimate the impact of vaccination delay against the 2019 coronavirus disease (COVID-19) on the number of cases and deaths due to the disease in Brazil. We apply the model to Brazil as a whole and to the State of Sao Paulo, the most affected by COVID-19 in Brazil. We simulated the model for the populations of the State of Sao Paulo and Brazil as a whole, varying the scenarios related to vaccine efficacy and compliance from the populations.ResultsThe model projects that, in the absence of vaccination, almost 170 thousand deaths and more than 350 thousand deaths will occur by the end of 2021 for Sao Paulo and Brazil, respectively. If in contrast, Sao Paulo and Brazil had enough vaccine supply and so started a vaccination campaign in January with the maximum vaccination rate, compliance and efficacy, they could have averted more than 112 thousand deaths and 127 thousand deaths, respectively. In addition, for each month of delay the number of deaths increases monotonically in a logarithmic fashion, for both the State of Sao Paulo and Brazil as a whole.ConclusionsOur model shows that the current delay in the vaccination schedules that is observed in many countries has serious consequences in terms of mortality by the disease and should serve as an alert to health authorities to speed the process up such that the highest number of people to be immunized is reached in the shortest period of time.
A feasibility trial of an intervention in alcohol dependence for structured preparation before detoxification versus usual care: the SPADe trial results
Authors: Kouimtsidis Christos , Houghton Ben , Gage Heather , Notley Caitlin , Maskrey Vivienne , Clark Allan , Holland Richard , Lingford-Hughes Anne , Punukollu Bhaskar , Touray Morro , Duka Theodora 
Published: July 2021

Abstract
Background
Individuals who are ‘moderately’ or ‘severely’ dependent consume alcohol at levels that are likely to have a severe impact on their own health and mortality, the health and behaviours of others (family members) and to have economic and social implications. Treatment guidelines suggest that treatment needs to be planned with medically assisted withdrawal (also referred to as detoxification), and aftercare support but outcomes are poor with low proportions engaging in after care and high relapse rates. An approach of structured preparation before alcohol detoxification (SPADe) puts an emphasis on introducing lifestyle changes, development of coping strategies for cravings, stress and emotions as well as introducing changes to the immediate family and social environment in advance of alcohol cessation. Such a pre-habilitation paradigm compliments the established treatment approach. The key research question was: can we design a large scale, randomised controlled trial (RCT) that will answer whether such an approach is more effective than usual care in helping individuals to maintain longer periods of alcohol abstinence?

Methods
This is a pragmatic, parallel, two-arm, feasibility RCT comparing SPADe and usual care against usual care only in maintaining alcohol abstinence in adults with alcohol dependence receiving care in two community addiction services in London. Feasibility outcomes, exploration of primary and secondary clinical outcomes and health economic outcomes are analysed. The trial follows the guidelines of phase 2 of the Medical Research Council (MRC) for complex interventions.

Results
We were able to recruit 48/50 participants during a period of 9 months. Retention in the trial for the whole period of the 12 months was 75%. Treatment compliance was overall 44%. Data completion for the primary outcome was 65%, 50% and 63% at 3, 6 and 12 months, respectively. The intervention group had more days abstinent in the previous 90 days at the 12 months (n = 54.5) versus control (n = 41.5).

Conclusions
The results of this feasibility trial indicate that with the appropriate modifications, a full multicentred trial would be possible to test the effectiveness and cost-effectiveness of a pre-habilitation approach such as the SPADe group intervention in addition to usual care against usual care only.

Trial registration
Name of registry: ISRCTN; Trial Registration Number: 14621127; Date of Registration: 22/02/2017.
Dolphin whistles can be useful tools in identifying units of conservation
Authors: Papale Elena B. , Azzolin Marta A. , Cascão Irma , Gannier Alexandre , Lammers Marc O. , Martin Vidal M. , Oswald Julie N. , Perez-Gil Monica , Prieto Rui , Silva Mónica A. , Torri Marco , Giacoma Cristina 
Published: July 2021

AbstractBackgroundPrioritizing groupings of organisms or ‘units’ below the species level is a critical issue for conservation purposes. Several techniques encompassing different time-frames, from genetics to ecological markers, have been considered to evaluate existing biological diversity at a sufficient temporal resolution to define conservation units. Given that acoustic signals are expressions of phenotypic diversity, their analysis may provide crucial information on current differentiation patterns within species. Here, we tested whether differences previously delineated within dolphin species based on i) geographic isolation, ii) genetics regardless isolation, and iii) habitat, regardless isolation and genetics, can be detected through acoustic monitoring. Recordings collected from 104 acoustic encounters ofStenella coeruleoalba, Delphinus delphisandTursiops truncatusin the Azores, Canary Islands, the Alboran Sea and the Western Mediterranean basin between 1996 and 2012 were analyzed. The acoustic structure of communication signals was evaluated by analyzing parameters of whistles in relation to the known genetic and habitat-driven population structure.ResultsRecordings from the Atlantic and Mediterranean were accurately assigned to their respective basins of origin through Discriminant Function Analysis, with a minimum 83.8% and a maximum 93.8% classification rate. A parallel pattern between divergence in acoustic features and in the genetic and ecological traits within the basins was highlighted through Random Forest analysis. Although it is not yet possible to establish a causal link between each driver and acoustic differences between basins, we showed that signal variation reflects fine-scale diversity and may be used as a proxy for recognizing discrete units.ConclusionWe recommend that acoustic analysis be included in assessments of delphinid population structure, together with genetics and ecological tracer analysis. This cost-efficient non-invasive method can be applied to uncover distinctiveness and local adaptation in other wide-ranging marine species.
The impact of partisan politics on migration policies: the case of healthcare provision for refugees by German states
Authors: Günther Wolfgang , Kurrek Dennis , Töller Annette Elisabeth 
Published: July 2021

AbstractComparative migration policy research has increasingly dealt with the question of whether partisan differences in government can explain differences between migration policies. The empirical findings, however, for both, European states and states of the USA, are inconsistent as governing parties’ positions on integration policies do not in all cases explain the differences in migration legislation. This article investigates the conditions under which German states opt for a permissive model of healthcare provision for asylum seekers as an alternative to the existing restrictive bureaucratic model. Using a fuzzy-set qualitative comparative analysis (fsQCA), we find that a left-of-center state government is a necessary condition for the introduction of the alternative model. Full cost reimbursement by the state is the sufficient condition, i.e. the permissive alternative model is fully implemented only in those states with a left-of-center state government and where municipalities do not bear the risk of potentially higher costs for healthcare provision. With this unambiguous partisan effect, this article represents an important contribution to the international debate.
The mediating role of emotion regulation strategies in the relationship between family of origin violence and intimate partner violence
Authors: Orozco-Vargas Arturo Enrique , Venebra-Muñoz Arturo , Aguilera-Reyes Ulises , García-López Georgina Isabel 
Published: July 2021

AbstractThe effects of family of origin violence and intimate partner violence have been extensively documented; however, very few studies have examined the interaction with emotion regulation strategies. Thus, the objective of this research was to analyze whether different types of emotion regulation strategies, both adaptive and maladaptive, mediate the relationship between family of origin violence and intimate partner violence in the Mexican population. A total of 838 participants (45.9% men and 54.1% women) responded to instruments addressing family of origin violence, emotion regulation strategies, and intimate partner violence. The results revealed that both structural models were significant. For women, the model showed an adequate fit X2 (11, N = 838) = 22.75, p = .288, GFI = .95, AGFI = .91, NFI = .98, CFI = .97, RMSEA = .05. Likewise, we found similar indexes for men X2 (11, N = 838) = 28.20, p = .348, GFI = .97, AGFI = .93, NFI = .97, CFI = .95, RMSEA = .04. Specifically, the direct effects of adaptive strategies on intimate partner violence were statistically significant. Meanwhile, the direct effects of family of origin violence on maladaptive emotion regulation strategies were significant, as were the direct effects of maladaptive strategies on intimate partner violence. In turn, the indirect effects of family of-origin violence were significantly related to intimate partner violence via maladaptive emotion regulation strategies. In addition, the results clearly showed that men reported higher levels of aggression against women. Finally, regarding the selection of emotion regulation strategies, while women employed more adaptive emotion regulation, men showed a more definite tendency to use maladaptive emotion regulation.
Matrix 3D ultrasound-assisted thyroid nodule volume estimation and radiofrequency ablation: a phantom study
Authors: Boers T. , Braak S. J. , Versluis M. , Manohar S. 
Published: July 2021

Abstract
Background
Two-dimensional (2D) ultrasound is well established for thyroid nodule assessment and treatment guidance. However, it is hampered by a limited field of view and observer variability that may lead to inaccurate nodule classification and treatment. To cope with these limitations, we investigated the use of real-time three-dimensional (3D) ultrasound to improve the accuracy of volume estimation and needle placement during radiofrequency ablation. We assess a new 3D matrix transducer for nodule volume estimation and image-guided radiofrequency ablation.

Methods
Thirty thyroid nodule phantoms with thermochromic dye underwent volume estimation and ablation guided by a 2D linear and 3D mechanically-swept array and a 3D matrix transducer.

Results
The 3D matrix nodule volume estimations had a lower median difference with the ground truth (0.4 mL) compared to the standard 2D approach (2.2 mL, p < 0.001) and mechanically swept 3D transducer (2.0 mL, p = 0.016). The 3D matrix-guided ablation resulted in a similar nodule ablation coverage when compared to 2D-guidance (76.7% versus 80.8%, p = 0.542). The 3D mechanically swept transducer performed worse (60.1%, p = 0.015). However, 3D matrix and 2D guidance ablations lead to a larger ablated volume outside the nodule than 3D mechanically swept (5.1 mL, 4.2 mL (p = 0.274), 0.5 mL (p < 0.001), respectively). The 3D matrix and mechanically swept approaches were faster with 80 and 72.5 s/mL ablated than 2D with 105.5 s/mL ablated.

Conclusions
The 3D matrix transducer estimates volumes more accurately and can facilitate accurate needle placement while reducing procedure time.
The optimization of ultrasonic-microwave assisted synergistic extraction of Lotus plumule extract rich in flavonoids and its hypoglycemic activity
Authors: Li Qiuzhe , Li Xiaoqing , Zheng Baodong , Zhao Chao 
Published: July 2021

AbstractLotus (Nelumbo nucifera Gaertn), a kind of perennial aquatic plant, is widely cultivated and consumed by people in Asian countries. Lotus plumule flavonoids (LPF) have been recognized as a hypoglycemic agent. LPF was optimally obtained using novel ultrasonic-microwave assisted synergistic extraction (UMSE) method by response surface methodology (RSM) on the basis of the results of single-factor experiments. Furthermore, the hypoglycemic activity of LPF was investigated by measuring the body weight, fasting blood glucose (FBG) level, and oral glucose tolerance test (OGTT) and analyzing the physiological indexes in streptozotocin-diabetic mice model. The optimum extraction conditions consisted of microwave power 355 W, ultrasonic power 423 W, extraction time 15 min, solid-liquid ratio 1:40, ultrasound/interval time 1/0, and ethanol concentration 70% with the maximum LPF yield of 2.62%. LPF supplementation significantly decreased the body weight, FBG, OGTT, serum total cholesterol (TC), serum total triglycerides (TG), and insulin levels, indicating the antidiabetic activity of LPF. This research verified that the UMSE technique was highly efficient to extract LPF to the maximum extent and the flavonoids from L. plumule exhibited hypoglycemic activity, which showed broad development and application prospects.