bluuebunny/crossref_metadata_2025_split huggingface dataset:
The dynamics of stem water storage in the tops of Earth’s largest trees—Sequoiadendron giganteum
Authors: Williams Cameron B , Reese Næsborg Rikke , Ambrose Anthony R , Baxter Wendy L , Koch George W , Dawson Todd E 
Published: June 2021

Abstract
Water stored in tree stems (i.e., trunks and branches) is an important contributor to transpiration that can improve photosynthetic carbon gain and reduce the probability of cavitation. However, in tall trees, the capacity to store water may decline with height because of chronically low water potentials associated with the gravitational potential gradient. We quantified the importance of elastic stem water storage in the top 5–6 m of large (4.2–5.0 m diameter at breast height, 82.1–86.3 m tall) Sequoiadendron giganteum (Lindley) J. Buchholz (giant sequoia) trees using a combination of architectural measurements and automated sensors that monitored summertime diel rhythms in sap flow, stem diameter and water potential. Stem water storage contributed 1.5–1.8% of water transpired at the tree tops, and hydraulic capacitance ranged from 2.6 to 4.1 l MPa−1 m−3. These values, which are considerably smaller than reported for shorter trees, may be associated with persistently low water potentials imposed by gravity and could indicate a trend of decreasing water storage dynamics with height in tree. Branch diameter contraction and expansion consistently and substantially lagged behind fluxes in water potential and sap flow, which occurred in sync. This lag suggests that the inner bark, which consists mostly of live secondary phloem tissue, was an important hydraulic capacitor, and that hydraulic resistance between xylem and phloem retards water transfer between these tissues. We also measured tree-base sap flux, which lagged behind that measured in trunks near the tree tops, indicating additional storage in the large trunks between these measurement positions. Whole-tree sap flow ranged from 2227 to 3752 l day−1, corroborating previous records for similar-sized giant sequoia and representing the largest yet reported for any individual tree. Despite such extraordinarily high daily water use, we estimate that water stored in tree-top stems contributes minimally to transpiration on typical summer days.
A double-ratio method to measure fast, slow and reverse sap flows
Authors: Deng Zijuan , Vice Heather K , Gilbert Matthew E , Adams Mark A , Buckley Thomas N 
Published: June 2021

Abstract
Sap velocity measurements are useful in fields ranging from plant water relations to hydrology at a variety of scales. Techniques based on pulses of heat are among the most common methods to measure sap velocity, but most lack ability to measure velocities across a wide range, including very high, very low and negative velocities (reverse flow). We propose a new method, the double-ratio method (DRM), which is robust across an unprecedented range of sap velocities and provides real-time estimates of the thermal diffusivity of wood. The DRM employs one temperature sensor upstream (proximal) and two sensors downstream (distal) to the source of heat. This facilitates several theoretical, heat-based approaches to quantifying sap velocity. We tested the DRM using whole-tree lysimetry in Eucalyptus cypellocarpa L.A.S. Johnson and found strong agreement across a wide range of velocities.
Vaccine allergy: evidence to consider for COVID-19 vaccines
Authors: Nilsson Lennart , Csuth Ágnes , Storsaeter Jann , Garvey Lene H. , Jenmalm Maria C. 
Published: June 2021

Purpose of review
Whereas the COVID-19 pandemic has changed our lives worldwide, we hope that vaccination can combat the disease. We propose how to evaluate suspected severe allergic reactions to the vaccines so that as many as possible may be safely vaccinated.

Recent findings
Rare cases of severe allergic reactions after COVID-19 vaccination have been observed, seemingly at a higher frequency than for other vaccines. Few excipients are likely to have caused these reactions. IgE-mediated reactions to polyethylene glycol (PEG) and its derivatives are the most suspected, albeit hitherto unproven, causes. We suggest to make a diagnosis based on skin tests with PEG and PEG derivatives and that these be considered in relation to the decisions required before the first and the second vaccine dose. A vaccine without these excipients is available, but published data about its side effects are limited.

Summary
The underlying immunological mechanisms of the rare severe allergic reactions to the COVID-19 vaccines are poorly understood and need to be clarified. Identifying those who have an undiagnosed allergy to PEG and PEG derivatives is crucial before vaccination, and these substances are found in laxatives, cosmetics and in 30% of all our medications today.
Fibrinogen in traumatic haemorrhage
Authors: Winearls James , Reade Michael C. , McQuilten Zoe , Curry Nicola 
Published: June 2021

Purpose of review
Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy (TIC) have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the role of fibrinogen in normal haemostasis, the effect of trauma and TIC on fibrinogen levels and current evidence for fibrinogen replacement in the management of traumatic haemorrhage.

Recent findings
Fibrinogen is usually the first factor to reach critically low levels in traumatic haemorrhage and hypofibrinogenaemia after severe trauma is associated with increased risk of massive transfusion and death. It is postulated that the early replacement of fibrinogen in severely injured trauma patients can improve outcomes. There is, however, a paucity of evidence to support this, and in addition, there is little evidence to support or refute the effects of cryoprecipitate or fibrinogen concentrate for fibrinogen replacement.

Summary
The important role fibrinogen plays in haemostasis and effective clot formation is clear. A number of pilot trials have investigated different strategies for fibrinogen replacement in severe trauma. These trials have formed the basis of several large-scale phase III trials, which, cumulatively will provide a firm evidence base to harmonise worldwide clinical management of severely injured trauma patients with major haemorrhage.
The Predictive Role of Emotional Intelligence, Resilience, and Personality Traits in Addiction Potential of Students at Arak University of Medical Sciences
Authors: Rezaei Ali M. , Naeim Mahdi , Asadi Reza , Ardebil Fardad D.T.M. , Bayat Mohsen , Khoshroo Kimia 
Published: June 2021

Introduction:
The aim of this study was to examine the predictive role of emotional intelligence, resilience, and personality traits in addiction potential of students at Arak University of Medical Sciences.

Methods:
The study population consisted of students of Arak University of Medical Sciences, of which 200 participants were selected using cluster sampling and filled out the following questionnaires: EI Schutte, Connor-Davidson Resilience Scale (CD-RIS), Personality Inventory (NEO-FFI), and Iranian Addiction Potential Scale. The research design was correlational and data were analyzed using multiple regression and Pearson correlation coefficient.

Results:
The results showed a significant negative correlation between resilience and addiction potential and significant negative relationship between components of emotional intelligence and addiction potential. Among the personality traits, extroversion, agreeableness, conscientiousness, and openness to experience were significantly negatively correlated with addiction potential. However, there was a significant positive relationship between neuroticism and addiction potential. Optimism/emotional regulation, conscientiousness, neuroticism, and appraisal of emotions can predict addiction potential and, in total, explain 48% of the variance in addiction potential.

Conclusions:
The results showed that there was a relationship between personality traits, emotional intelligence, and resilience with addiction potential. On the basis of regression analysis results, it is recommended that to reduce addiction potential, instead of investing on all the mentioned variables, to mainly focus on the variables of optimism/emotion regulation, contentiousness, neuroticism and appraisal of emotions, so that a reduction in addiction potential can be achieved with less time and lower cost.
Bilateral Bispectral Index Monitoring Performance in the Detection of Seizures in Nonanesthetized Epileptic Patients: An Observational Study
Authors: Fàbregas Neus , Valencia Jose F. , Belda Isabel , Tercero Ana , Hervias Adriana , Villafuerte Santiago , Gambús Pedro L. , Carreño Mar , Valero Ricard 
Published: June 2021

Background:
The aim of this observational study was to determine whether bilateral bispectral index (BIS) monitoring can detect seizures in epileptic patients.

Methods:
Four-channel frontal BIS monitoring and standard 40-channel electroencephalography monitoring were conducted in epileptic patients undergoing evaluation for epilepsy surgery. The BIS numerical value, signal quality index, electromyography, suppression ratio, and color density spectral array were continuously recorded. In patients with electroencephalography-confirmed seizures, the mean value and trend (slope of linear regression) of bilateral BIS monitor parameters were analyzed from 1 minute before to 1 minute after seizure onset.

Results:
Of 48 patients included in the study, 21 (43.8%) had at least 1 seizure. BIS numerical value was not able to detect focal or focal to bilateral tonic-clonic seizures. Considering all seizures, the only significant differences between recordings 1 minute before and 1 minute after seizure onset were a decrease in the signal quality index slope from 1 hemisphere (0.039±0.297 vs. −0.085±0.321, respectively; P=0.029) and in the mean signal quality index recorded from both hemispheres (left hemisphere: 65.775±30.599 vs. 61.032±26.285; P=0.016 and right hemisphere: 63.244±31.985 vs. 59.837±27.360; 0.029); these differences were not maintained after Hochberg adjustment for multiple comparisons. In seizures occurring during sleep, there was a change in the electromyography slope of 1 hemisphere before and after seizure onset (−0.141±0.176 vs. 0.162±0.140, respectively; P=0.038). There were variable responses in BIS parameters in the 3 patients who developed focal nonconvulsive seizure clusters.

Conclusion:
Bilateral BIS monitoring was not able to detect the occurrence of seizures in epileptic patients.
Local Bone Grafting Is Sufficient for Instrumented Adolescent Idiopathic Scoliosis Surgery: A Preliminary Study
Authors: Yataganbaba Alper , Gahukamble Abhay , Antoniou Georgia , Freeman Brian J.C. , Cundy Peter J. 
Published: June 2021

Background:
Several options for grafting exist; iliac crest bone grafting, allografts, and bone substitutes. Local bone graft (LBG) offers high-quality bone graft and no commercial cost. The aim of this study was to assess the clinical and radiologic results of adolescent idiopathic scoliosis (AIS) surgery with posterior instrumentation and fusion (PIF) in patients using only LBG and to measure the quantities harvested.

Methods:
A total of 218 AIS patients who underwent pedicle screw PIF surgery using only LBG with a minimum 1-year follow-up were reviewed. Bone was harvested during surgery from the excised facet joints, spinous processes (not from the end instrumented vertebrae) and decortication of laminae and transverse processes in the operative field. The harvested bone graft weight of 127 patients was recorded prospectively and then computed to graft weight per kilogram body weight (GWPK) and graft weight per motion segment (GWPMS).

Results:
The median follow-up time was 24.7 months (12.1 to 133 mo) with 128 of the 218 patients having over 2 years follow-up. A total of 280 curves were fused. One hundred fifty-six of the patients had single curve instrumentation and 62 had double curve surgery. The median preoperative primary Cobb angle was 57.0 (31 to 100) degrees and postoperatively was 20.0 (0 to 66) degrees, indicating a median correction of 65.3% (17.5% to 100%). The median graft weight was 30 g (14 to 62 g), GWPK was 0.54 g/kg (0.24 to 1.29 g/kg) and GWPMS was 3.3 g/motion segments (2.3 to 10.0 g/kg). Twelve of 218 patients (5.5%) required subsequent surgery. Only 2 patients developed pseudarthrosis (0.91%), noting that modern segmental instrumentation warrants longer follow-up for increased confidence of complete fusion.

Conclusions:
LBG achieved successful fusion in over 99% of patients undergoing PIF for AIS. The described terms GWPK and GWPMS can be insightful for future studies. LBG offers a safe and low-cost solution for bone grafting in AIS surgery.

Level of Evidence:
Level IV.
Has There Been a Change in the Age of Presentation of Patients With DDH After the Implementation of a Dedicated Ultrasound-screening Program?
Authors: Roof Mackenzie A. , Gibon Emmanuel , Rios-Ruíz Gilberto , Castañeda Pablo 
Published: June 2021

Background:
We sought to determine if the age of patients presenting to a tertiary subspecialty hospital dedicated to pediatric orthopaedics has changed over the last 21 years and determine if a dedicated ultrasound-screening program implemented in 2006 made any difference.

Methods:
We reviewed the hospital charts for 9299 patients diagnosed with developmental dysplasia of the hip (DDH) and determined the age at the time of presentation; this was a consecutive series of all patients presenting between 1998 and 2019. We determined the diagnosis and age from the chart, 8011 were female (86.15%), and 1288 were male (13.85%). The left hip was affected in 4588 cases (49.34%), the right hip in 1824 cases (19.62%), and there were 2887 bilateral cases (31.05%).

Results:
Over the 21 years, the mean age of presentation was 2.36 years (range, 0.1 to 17 y). In 1998, the mean age was 2.49 years (range, 0.1 to 16 y). In 2006, a dedicated ultrasound-screening clinic was instituted. The mean age decreased to 1.70 years in 2019 (range, 0.1 to 14 y). The mean age at presentation decreased significantly from 2.65 years, between 1998 and 2005, to 2.19 between 2006 and 2019 (P=0.0067).

Conclusions:
The implementation of a dedicated ultrasound-screening protocol was significantly correlated with a decrease in the mean age of diagnosis of DDH. The results of treatment of DDH are known to be better the sooner the diagnosis is made. Given that the age of presentation remains a challenge, especially in developing countries, a dedicated ultrasound-screening program is one step to improve our ability to detect DDH in patients at a younger age.

Level of Evidence:
Level IV—diagnostic.
Modified Oxford Bone Scores Are Reduced in Patients With Slipped Capital Femoral Epiphysis Compared With Healthy Controls
Authors: Pflug Emily M. , Herrero Christina , Zhong Jack R. , Castañeda Pablo 
Published: June 2021

Background:
The etiology and pathogenesis of slipped capital femoral epiphysis (SCFE) are attributable to abnormalities of the proximal femoral epiphysis. This study aimed to examine if there is a difference in the bone age of patients diagnosed with SCFE compared with patients without hip pathology.

Methods:
We identified a consecutive series of patients treated for SCFE between December 2012 and December 2019 from a departmental database. Retrospective chart review was performed to collect demographic information and patient medical history. We then obtained a control group of statistically similar patients based on age and sex. These patients did not have hip pathology or medical comorbidities that could alter their bone age. The modified Oxford bone score (mOBS) was calculated for both groups by 3 blinded reviewers. We excluded patients with unstable slips, endocrine disorders, and inadequate imaging.

Results:
We identified 60 patients with stable idiopathic SCFE during the study period; 45 met inclusion criteria and were included in the final analysis. There were 27 males and 18 females. The average age of patients with SCFE was higher in males than females (12.6 vs. 11.1, P<0.01). Patients in the comparison cohort did not differ significantly from the SCFE cohort in terms of age (11.6 vs. 12.0, P=0.06) or sex (P=0.52). The comparison group’s median mOBS was significantly higher than the SCFE group (22.5 vs. 20.5, P<0.01). The difference in the mOBS between male and female patients in the SCFE group approached significance (20.0 vs. 21.0, P=0.05). The weighted κ coefficient was 0.93.

Conclusions:
Patients with SCFE have a decreased bone age compared with patients without hip pathology. Male patients with SCFE were more likely to be older compared with female patients.

Level of Evidence:
Level IV—retrospective study.
Anterior Vertebral Body Tethering for Treatment of Idiopathic Scoliosis in the Skeletally Immature
Authors: Rushton Paul R.P. , Nasto Luigi , Parent Stefan , Turgeon Isabelle , Aldebeyan Sultan , Miyanji Firoz 
Published: June 2021

Study Design.
Prospective case series.

Objective.
Determine the efficacy of anterior vertebral body tethering (AVBT) in skeletally immature patients.

Summary of Background Data.
The value of AVBT is currently unclear given the paucity of available data.

Methods.
Consecutive skeletally immature patients with idiopathic scoliosis were treated with AVBT between 2012 and 2018 by one of two surgeons working at two independent centers and followed up for >2 years. Data were collected prospectively and supplemented retrospectively where necessary. Outcomes were measured preoperatively, at first erect radiograph (FE), 1-year postoperatively and at most recent follow up (FU).

Results.
One hundred twelve patients underwent 116 primary tethering procedures (108 thoracic and eight lumbar tethers). Four patients had primary tethering of both lumbar and thoracic curves. At surgery mean age was 12.7 ± 1.4 years (8.2–16.7) and Risser 0.5 ± 0.9 (0–3). Follow up was mean 37 ± 9 months (15–64). Preoperative mean coronal Cobb angle of the 130 tethered curves was 50.8° ± 10.2 (31–81) and corrected significantly to 26.6° ± 10.1 (−3–61) at FE radiograph (P < 0.001). Further significant improvement was seen from FE to 1-year, to mean 23.1° ± 12.4 (−37–57) (P < 0.001). There was a small but significant increase between 1-year and FU to 25.7° ± 16.3 (−32–58) (P < 0.001), which appeared to reflect tether breakage. Untethered minor curves were corrected from 31.0° ± 9.5 (3–57) to 20.3° ± 10.3 (0–52) at FU (P < 0.001). Rib hump was corrected from 14.1 ± 4.8 (0–26) to 8.8° ± 5.4 (0–22) at FU (P < 0.01). Twenty-five patients (22%) had 28 complications. Fifteen patients (13%) requiring 18 revision operations including six completed and one awaited fusions.

Conclusion.
AVBT of immature cases is associated with satisfactory deformity correction in the majority of cases. However, complication and revision rates suggest the need for improved implants and patient selection. Long-term follow-up remains crucial to establish the true efficacy of this procedure.

Level of Evidence: 3
What Is the Comparison in Robot Time per Screw, Radiation Exposure, Robot Abandonment, Screw Accuracy, and Clinical Outcomes Between Percutaneous and Open Robot-Assisted Short Lumbar Fusion?
Authors: Lee Nathan J. , Buchanan Ian A. , Zuckermann Scott L. , Boddapati Venkat , Mathew Justin , Geiselmann Matthew , Park Paul J. , Leung Eric , Buchholz Avery L. , Khan Asham , Mullin Jeffrey , Pollina John , Jazini Ehsan , Haines Colin , Schuler Thomas C. , Good Christopher R. , Lombardi Joseph M. , Lehman Ronald A. 
Published: June 2021

Study Design.
Multicenter cohort.

Objective.
To compare the robot time/screw, radiation exposure, robot abandonment, screw accuracy, and 90-day outcomes between robot-assisted percutaneous and robot-assisted open approach for short lumbar fusion (1- and 2-level).

Summary of Background Data.
There is conflicting literature on the superiority of robot-assisted minimally invasive spine surgery to open techniques. A large, multicenter study is needed to further elucidate the outcomes and complications between these two approaches.

Methods.
We included adult patients (≥18 yrs old) who underwent robot-assisted short lumbar fusion surgery from 2015 to 2019 at four independent institutions. A propensity score matching algorithm was employed to control for the potential selection bias between percutaneous and open surgery. The minimum follow-up was 90 days after the index surgery.

Results.
After propensity score matching, 310 patients remained. The mean (standard deviation) Charlson comorbidity index was 1.6 (1.5) and 53% of patients were female. The most common diagnoses included high-grade spondylolisthesis (grade >2) (48%), degenerative disc disease (22%), and spinal stenosis (25%), and the mean number of instrumented levels was 1.5(0.5). The operative time was longer in the open (198 min) versus the percutaneous group (167 min, P value = 0.007). However, the robot time/screw was similar between cohorts (P value > 0.05). The fluoroscopy time/ screw for percutaneous (14.4 s) was longer than the open group (10.1 s, P value = 0.021). The rates for screw exchange and robot abandonment were similar between groups (P value > 0.05). The estimated blood loss (open: 146 mL vs. percutaneous: 61.3 mL, P value < 0.001) and transfusion rate (open: 3.9% vs. percutaneous: 0%, P value = 0.013) were greater for the open group. The 90-day complication rate and mean length of stay were not different between cohorts (P value > 0.05).

Conclusion.
Percutaneous robot-assisted spine surgery may increase radiation exposure, but can achieve a shorter operative time and lower risk for intraoperative blood loss for short-lumbar fusion. Percutaneous approaches do not appear to have an advantage for other short-term postoperative outcomes. Future multicenter studies on longer fusion surgeries and the inclusion of patient-reported outcomes are needed.

Level of Evidence: 3