bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcription factors KNAT3 and KNAT4 are essential for integument and ovule formation in Arabidopsis
Authors: Chen Jia-Jun , Wang Wei , Qin Wen-Qi , Men Shu-Zhen , Li Hui-Ling , Mitsuda Nobutaka , Ohme-Takagi Masaru , Wu Ai-Min 
Published: November 2022

Abstract
Integuments form important protective cell layers surrounding the developing ovules in gymno- and angiosperms. Although several genes have been shown to influence the development of integuments, the transcriptional regulatory mechanism is still poorly understood. In this work, we report that the Class II KNOTTED1-LIKE HOMEOBOX (KNOX II) transcription factors KNOTTED1-LIKE HOMEBOX GENE 3 (KNAT3) and KNAT4 regulate integument development in Arabidopsis (Arabidopsis thaliana). KNAT3 and KNAT4 were co-expressed in inflorescences and especially in young developing ovules. The loss-of-function double mutant knat3 knat4 showed an infertility phenotype, in which both inner and outer integuments of the ovule are arrested at an early stage and form an amorphous structure as in the bell1 (bel1) mutant. The expression of chimeric KNAT3- and KNAT4-EAR motif repression domain (SRDX repressors) resulted in severe seed abortion. Protein–protein interaction assays demonstrated that KNAT3 and KNAT4 interact with each other and also with INNER NO OUTER (INO), a key transcription factor required for the outer integument formation. Transcriptome analysis showed that the expression of genes related with integument development is influenced in the knat3 knat4 mutant. The knat3 knat4 mutant also had a lower indole-3-acetic acid (IAA) content, and some auxin signaling pathway genes were downregulated. Moreover, transactivation analysis indicated that KNAT3/4 and INO activate the auxin signaling gene IAA INDUCIBLE 14 (IAA14). Taken together, our study identified KNAT3 and KNAT4 as key factors in integument development in Arabidopsis.
Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England
Authors: Russell Mark D , Roddy Edward , Rutherford Andrew I , Ellis Benjamin , Norton Sam , Douiri Abdel , Gulliford Martin C , Cope Andrew P , Galloway James B 
Published: November 2022

Abstract

Objective
To investigate associations between treat-to-target urate-lowering therapy (ULT) and hospitalizations for gout.

Methods
Using linked Clinical Practice Research Datalink and NHS Digital Hospital Episode Statistics data, we described the incidence and timing of hospitalizations for flares in people with index gout diagnoses in England from 2004–2020. Using Cox proportional hazards and propensity models, we investigated associations between ULT initiation, serum urate target attainment, colchicine prophylaxis, and the risk of hospitalizations for gout.

Results
Of 292 270 people with incident gout, 7719 (2.64%) had one or more hospitalizations for gout, with an incidence rate of 4.64 hospitalizations per 1000 person-years (95% CI 4.54, 4.73). There was an associated increased risk of hospitalizations within the first 6 months after ULT initiation, when compared with people who did not initiate ULT [adjusted Hazard Ratio (aHR) 4.54; 95% CI 3.70, 5.58; P &lt; 0.001]. Hospitalizations did not differ significantly between people prescribed vs not prescribed colchicine prophylaxis in fully adjusted models. From 12 months after initiation, ULT associated with a reduced risk of hospitalizations (aHR 0.77; 95% CI 0.71, 0.83; P &lt; 0.001). In ULT initiators, attainment of a serum urate &lt;360 micromol/l within 12 months of initiation associated with a reduced risk of hospitalizations (aHR 0.57; 95% CI 0.49, 0.67; P &lt; 0.001) when compared with people initiating ULT but not attaining this target.

Conclusion
ULT associates with an increased risk of hospitalizations within the first 6 months of initiation but reduces hospitalizations in the long term, particularly when serum urate targets are achieved.
Sources of Postacute Care Episode Payment Variation After Traumatic Hip Fracture Repair Among Medicare Beneficiaries
Authors: Montgomery John R. , Neiman Pooja U. , Brown Craig S. , Cain-Nielsen Anne H. , Scott John W. , Sangji Naveen F. , Oliphant Bryant W. , Hemmila Mark R. 
Published: November 2022

Objective:
The objective of this study was to evaluate how much variation in postacute care (PAC) spending after traumatic hip fracture exists between hospitals, and to what degree this variation is explained by patient factors, hospital factors, PAC setting, and PAC intensity.

Background:
Traumatic hip fracture is a common and costly event. This is particularly relevant given our aging population and that a substantial proportion of these patients are discharged to PAC settings.

Methods:
It is a cross-sectional retrospective study. In a retrospective review using Medicare claims data between 2014 and 2019, we identified PAC payments within 90 days of hospitalization discharges and grouped hospitals into quintiles of PAC spending. The degree of variation present in PAC spending across hospital quintiles was evaluated after accounting for patient case-mix factors and hospital characteristics using multivariable regression models, adjusting for PAC setting choice by fixing the proportion of PAC discharge disposition across hospital quintiles, and adjusting for PAC intensity by fixing the amount of PAC spending across hospital quintiles. The study pool included 125,745 Medicare beneficiaries who underwent operative management for traumatic hip fracture in 2078 hospitals. The primary outcome was PAC spending within 90 days of discharge following hospitalization for traumatic hip fracture.

Results:
Mean PAC spending varied widely between top versus bottom spending hospital quintiles ($31,831 vs $17,681). After price standardization, the difference between top versus bottom spending hospital quintiles was $8,964. Variation between hospitals decreased substantially after adjustment for PAC setting ($25,392 vs $21,274) or for PAC intensity ($25,082 vs $21,292) with little variation explained by patient or hospital factors.

Conclusions:
There was significant variation in PAC payments after a traumatic hip fracture between the highest- and lowest-spending hospital quintiles. Most of this variation was explained by choice of PAC discharge setting and intensity of PAC spending, not patient or hospital characteristics. These findings suggest potential systems-level inefficiencies that can be targeted for intervention to improve the appropriateness and value of healthcare spending.
Built Environments and Cardiovascular Health
Authors: Chandrabose Manoj , den Braver Nicolette R. , Owen Neville , Sugiyama Takemi , Hadgraft Nyssa 
Published: November 2022

Purpose:
This review presents a general overview of the state of evidence on the relationships between neighborhood built environments and cardiovascular health outcomes among adults. We also summarize relevant literature on the associations of built environments with active living behaviors (physical activity [PA] and sedentary behavior), as they are considered as key behavioral pathways.

Review Methods:
We identified recently published systematic reviews assessing associations of built environment attributes with cardiovascular health outcomes or active living behaviors. We summarized findings of the key systematic reviews and presented findings of pertinent empirical studies, where appropriate.

Summary:
Increasing evidence suggests that living in a place supportive of engaging in PA for transportation (eg, walkability features) and recreation (eg, parks) can be protective against cardiovascular disease (CVD) risk. Places conducive to higher levels of sedentary travel (ie, prolonged sitting in cars) may have adverse effects on cardiovascular health. The built environment of where people live can affect how active they are and subsequently their cardiovascular health. Clinical professionals are encouraged to consider the built environment features of where their patients live in counseling, as this may assist them to understand potential opportunities or barriers to active living and to propose a suitable CVD prevention strategy.
Comparison of bispectral index and phase lag entropy during general anesthesia: Sevoflurane or propofol anesthesia
Authors: Yoo Jae Hwa , Ok Si Young , Kim Sang Ho , Chung Ji Won , Park Sun Young , Kim Mun Gyu , Cho Ho Bum , Song Sang Hoon , Choi Sang Jin , Oh Hong Chul 
Published: November 2022

Background:
Phase-lag entropy (PLE) based on functional connectivity between different regions of the brain may be superior to conventional depth of anesthesia (DoA) methods for monitoring changes in consciousness. However, few studies have compared the PLE and bispectral index (BIS) methods for monitoring consciousness during clinical anesthesia, such as total intravenous anesthesia (TIVA) or anesthesia via inhalation. Therefore, we evaluated differences between the PLE and BIS methods in clinical anesthesia, including TIVA using propofol and anesthesia with sevoflurane.

Methods:
The observational trial included 60 patients scheduled for elective surgery under general anesthesia. The BIS and PLE electrodes were placed together on the left temporal-frontal area of all patients. During anesthesia, anesthetic levels were adjusted using the BIS values, which are generally used to monitor the DoA; the level of anesthesia was maintained at between 40 and 60. BIS- and PLE-derived values were recorded continuously. Anesthetic events, the concentration of each anesthetic, and standard monitoring values were recorded. The patients included were divided into 2 groups, the TIVA and sevoflurane groups, with 30 patients in each. For the TIVA group, anesthesia was induced and maintained using propofol and remifentanil target-controlled infusion. For the sevoflurane group, anesthesia was induced using propofol and maintained using sevoflurane and remifentanil.

Results:
From loss of consciousness until the anesthetic maintenance period, PLE values were higher than BIS values at several time points. During the recovery period, BIS values were higher than PLE values (all P < .001). Spaghetti plots showed that there was more variation among the BIS values than among the PLE values.

Conclusions:
For monitoring DoA during general anesthesia and surgery, PLE values vary less than BIS values; thus, PLE may be more reliable for monitoring changes in consciousness. However, further studies are needed to evaluate the clinical application of these methods in general anesthesia.
Ovarian remnant syndrome with paraintestinal ovarian serous cystadenofibroma arose 30 years after bilateral salpingo-oophorectomy: A case report
Authors: Tien Chin-Tzu , Cheng Chiu-Hsuan , Ding Dah-Ching 
Published: November 2022

Rationale:
Ovarian cystadenofibroma is a relatively rare benign ovarian tumor. Ovarian remnant syndrome (ORS) is a rare complication of bilateral salpingo-oophorectomy (BSO). We report a rare case of ORS with paraintestinal ovarian serous cystadenofibroma that developed 30 years after total abdominal hysterectomy and BSO in a 73-year-old woman.

Patient concerns:
A 73-year-old woman complained of long-term lower abdominal discomfort.

Diagnosis:
She was diagnosed with a cystic lesion in the lower abdomen on transabdominal ultrasonography. Further diagnostic imaging and laboratory tests could not exclude a diagnosis of malignancy.

Interventions:
The patient underwent laparoendoscopic single-site surgery. We found one cystic lesion 5 cm in size with multiple septa that was adhered to the small bowel. We consulted a general surgeon for tumor resection. Dissection was performed and the specimen was then removed from the umbilical wound.

Outcomes:
Histopathological examination revealed an ovarian serous cystadenofibroma. The postoperative recovery was uneventful.

Lessons:
Patients with lower abdominal pain after a previous hysterectomy and BSO should be examined with transabdominal sonography for ORS.
Rapid correction of severe hyponatremia and control of subsequent overcorrection in operative hysteroscopy intravascular absorption syndrome: A case report
Authors: Yoo Seon Woo , Ki Min-Jong , Oh Yu Jin , Kim Taehoon , Nam Seonhwa , Lee Jeongwoo 
Published: November 2022

Rationale:
Operative hysteroscopy intravascular absorption syndrome (OHIAS) results from systemic absorption of hypotonic solution during hysteroscopy, which may induce severe hyponatremia within hours. Depending on the serum sodium (Na+) level, this can be life-threatening and requires prompt and careful remedial treatment.

Patient concerns and diagnoses:
A 53-year-old woman underwent hysteroscopic myomectomy for submucosal leiomyoma. Approximately 3 hours postoperatively, the serum Na+ level decreased to 82 mM/L, accompanied by pulmonary edema and lactic acidosis. The patient was strongly suspicious of OHIAS.

Interventions and outcomes:
A rapid correction was made using 3% NaCl to prevent brain edema as an initial response. After the serum Na+ level reached 120 mM/L, gradual correction was performed considering osmotic demyelination syndrome, and desmopressin was administered to prevent overcorrection caused by excessive water diuresis. Serum Na+ level normalized in 4 days and the patient recovered without any specific sequelae.

Lessons:
The detection of OHIAS may be delayed under general anesthesia, and prior vigilance is important if the operation time is prolonged. In severe hyponatremia with an apparently rapid onset, such as OHIAS, a two-step correction process may be safe and useful: rapid correction followed by more gradual correction.
Myxoid pleomorphic liposarcoma in the teres minor muscle: A case report
Authors: Choi Jun Ho , Lee Soo Hyuk , Kim Kwang Seog , Choi Yoo Duk , Hwang Jae Ha , Lee Sam Yong 
Published: November 2022

Rationale:
Myxoid pleomorphic liposarcoma (MPL) is a rare aggressive adipocytic tumor that mainly presents in children and adolescents. It is most frequently observed in the mediastinum and rarely in the head and neck, perineal region, or back. Herein, we report the first published case of MPL of the teres minor muscle.

Patient concerns:
A 24-years-old woman presented with a painless palpable mass in her right shoulder.

Diagnoses:
Magnetic resonance imaging identified a 9.0 × 7.0 × 4.0 cm mass suspected to be a sarcoma in the teres minor muscle. Positron emission tomography/computed tomography revealed no evidence of distant metastasis. Histopathological examination revealed the mass to be an MPL, which was assigned a histologic grade of 3 according to the French Federation of Cancer Centers Sarcoma Group system. No tumor cells were observed along the resected margins.

Interventions:
Under general anesthesia, the right teres minor muscle containing the mass was excised en bloc and frozen biopsy confirmed that the tumor cells did not invade the surrounding tissues.

Outcomes:
The patient underwent radiotherapy and was followed up for 6 months without complications.

Lessons:
Although MPL in the teres minor muscle is rare, it should be considered in the differential diagnosis in patients with a mass in the teres minor muscle due to its poor prognosis.
HELLP syndrome manifesting as abnormal fetal umbilical artery blood flow and rapidly worsening laboratory indexes: A case report
Authors: Cheng Lin-bo , Wei Qiang , Zhang Li , Cao Qin-yan 
Published: November 2022

Rationale:
HELLP syndrome, a rare but serious obstetric complication, is often overdiagnosed due to its nonspecific symptoms and inappropriate clinical testing.

Patient concerns:
A 30-year-old nulliparous pregnant Chinese woman at gestational age of 28+1 weeks was admitted to our hospital because Doppler ultrasonography at a local hospital had detected loss of fetal umbilical artery end-diastolic blood flow lasting 12 hours. On admission to our hospital, the patient showed elevated blood pressure (148/84 mm Hg), but blood pressure and laboratory indicators after admission were normal. However, the patient developed abdominal pain during hospitalization.

Interventions:
Dexamethasone was given after admission to our hospital to promote fetal lung maturation, magnesium sulfate was given to protect fetal brain nerves, and maternal blood pressure was closely monitored. In addition, fetal umbilical artery blood flow was dynamically monitored. After three days in hospital with normal blood pressure, the patient developed abdominal pain accompanied by diarrhea. She was positive for Murphy’s sign and laboratory tests showed no obvious abnormalities. Acute cholecystitis was suspected, but symptomatic and supportive treatment did not relieve abdominal pain and her blood pressure increased progressively to 212/130 mm Hg. Magnesium sulfate was given immediately to prevent spasm, and nitroglycerin was administered intravenously against hypertension. Liver enzymes, blood coagulation, and routine urinalysis were abnormal. The patient was diagnosed with HELLP syndrome, and an emergency cesarean section was performed.

Diagnosis:
HELLP syndrome.

Outcomes:
After the cesarean section, platelet (PLT) count continuously decreased and transaminase and bilirubin levels continously increased. The newborn was transferred to the neonatal intensive care unit after birth and discharged at a corrected gestational age of 34 weeks. By postoperative day 6, laboratory indicators had returned to normal and the patient was discharged.

Lessons subsections:
Our case highlights that HELLP syndrome is a serious complication, and it should be diagnosed carefully and not arbitrarily on the basis of some abnormal indicators and stable clinical manifestations. Accurate early identification, active monitoring and management are essential for improving prognosis and avoiding maternal or infant mortality.
Analysis of prescription medication rules of traditional Chinese medicine for bradyarrhythmia treatment based on data mining
Authors: Wang Xujie , Zhang Xuexue , Li Jiaxi , Hu Biaoyan , Zhang Jiwei , Zhang Wantong , Weng Weiliang , Li Qiuyan 
Published: November 2022

Background:Multiple studies have revealed that Traditional Chinese Medicine (TCM) prescriptions can provide protective effect on the cardiovascular system, increase the heart rate and relieve the symptoms of patients with bradyarrhythmia. In China, the TCM treatment of bradyarrhythmia is very common, which is also an effective complementary therapy. In order to further understand the application of Chinese medicines in bradyarrhythmia, we analyzed the medication rules of TCM prescriptions for bradyarrhythmia by data mining methods based on previous clinical studies.Methods:We searched studies reporting the clinical effect of TCM on bradyarrhythmia in the PubMed and Chinese databases China National Knowledge Infrastructure database, and estimated publication bias by risk of bias tools ROB 2. Descriptive analysis, hierarchical clustering analysis and association rule analysis based on Apriori algorithm were carried out by Microsoft Excel, SPSS Modeler, SPSS Statistics and Rstidio, respectively. Association rules, co-occurrence and clustering among Chinese medicines were found.Results:A total of 48 studies were included in our study. Among the total 99 kinds of Chinese medicines, 22 high-frequency herbs were included. Four new prescriptions were obtained by hierarchical cluster analysis. 81 association rules were found based on association rule analysis, and a core prescription was intuitively based on the grouping matrix of the top 15 association rules (based onconfidencelevel), of which Guizhi, Zhigancao, Wuweizi, Chuanxiong, Danshen, Danggui, Huangqi, Maidong, Dangshen, Rougui were the most strongly correlated herbs and in the core position.Conclusion:In this study, data mining strategy was applied to explore the TCM prescription for the treatment of bradyarrhythmia, and high-frequency herbs and core prescription were found. The core prescription was in line with the treatment ideas of TCM for bradyarrhythmia, which could intervene the disease from different aspects and adjust the patient’s Qi, blood, Yin and Yang, so as to achieve the purpose of treatment.
Pregnancy complicated with aortic dissection: Two cases report
Authors: Wang Xiaoli , Liu Xi , Liao E. , Ge Ning , Hu Yaping 
Published: November 2022

Rationale:
This study aims to investigate the characteristics of pregnancy complicated with aortic dissection (AD), diagnosis and treatment plan, and maternal and infant outcomes.

Patient concerns:
Two pregnant women suffered persistent back pain were admitted to Hubei Maternal and Child Health Hospital from December 2019 to December 2020.

Diagnosis:
Pregnant women with chest and back pain and especially hypertension should be highly suspected of AD. However, to confirm diagnosis results, laboratory tests such as D-dimer, fibrinogen and white blood cells, and even some Special examination, cardiac ultrasound, computed tomographic angiography (CTA), magnetic resonance angiography (MRA), are required. Early diagnosis and intervention can improve maternal and infant outcomes.

Interventions:
Cesarean sections were performed in both patients. Case 1 underwent thoracic aortic stent implantation one day after the onset of AD symptoms. Case 2 received endovascular repair of AD 4 days after the onset of AD symptoms.

Outcomes:
In these two cases, good maternal and infant outcomes were obtained through effective early identification and treatment.

Lessons:
AD is characterized with an acute onset, and the rates of misdiagnosis and missed diagnosis are high, which seriously endangers the life of mother and child. Hypertension is one of the high-risk factors causing AD. Good maternal and infant outcomes can be achieved by early identification, multidisciplinary collaboration and timely cardiac surgical intervention.
Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial
Authors: Lee Junekyung , Chun Min Ho , Seo Yu Jin , Lee Anna , Choi Junho , Son Choonghyun 
Published: November 2022

Background:
The effect of robot-assisted gait training has been demonstrated to improve gait recovery in patients with stroke. The aim of this study was to determine effects of robot-assisted gait training with various training modes in patients post stroke.

Methods:
Forty-seven patients post stroke were randomly assigned to one of 4 groups: Healbot T with pelvic off mode (pelvic off group; n = 11); Healbot T with pelvic control mode (pelvic on group; n = 12); Healbot T with constraint-induced movement therapy (CIMT) mode (CIMT group; n = 10); and conventional physiotherapy (control group; n = 10). All patients received a 30-minute session 10 times for 4 weeks. The primary outcomes were the 10-meter walk test (10MWT) and Berg Balance Scale (BBS). The secondary outcomes were functional ambulation category, timed up and go (TUG), and motricity index of the lower extremities (MI-Lower).

Results:
The pelvic off group showed significant improvements in BBS, TUG, and MI-Lower (P < .05). The pelvic on and CIMT groups showed significant improvement in 10MWT, BBS, TUG, and MI-Lower (P < .05). Compared with control group, the pelvic on group showed greater improvement in the TUG and BBS scores; the CIMT group showed greater improvement in 10MWT and MI-Lower (P < .05).

Conclusion:
This study suggested that Healbot T-assisted gait training benefited patients with stroke. The Healbot T with pelvic motion and CIMT modes were more helpful in improving balance and walking ability and lower limb strength, respectively, compared with conventional physiotherapy.