bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shift of root nitrogen-acquisition strategy with tree age is mediated by root functional traits along the collaboration gradient of the root economics space
Authors: Ren Hao , Gao Guoqiang , Ma Yaoyuan , Li Zuwang , Wang Siyuan , Gu Jiacun 
Published: April 2023

AbstractRoot nitrogen (N)-uptake rate and uptake preference, and their association with root morphological and chemical traits are important to characterize root N-acquisition strategies of trees. However, how the root N-acquisition strategy varies with tree age, especially for those species that coexist at a common site, remains unknown. In this study, a field isotopic hydroponic method was used to determine the uptake rate and contribution of NH4+, NO3− and glycine, for three coexisting ectomycorrhizal coniferous species [Pinus koraiensis (Korean pine), Picea koraiensis (Korean spruce) and Abies nephrolepis (smelly fir)] at three age classes (young, middle-aged and mature) in a temperate forest. Concurrently, root morphological and chemical traits, as well as mycorrhizal colonization rate were determined. Our results show that the root uptake rate of total N and NH4+ gradually decreased across all three species with increasing tree age. The three species at all age classes preferred NH4+, except for middle-aged Korean spruce and mature smelly fir, which preferred glycine. In contrast, all three species showed the lowest acquisition of NO3−. According to the conceptual framework of ‘root economics space’, only a ‘collaboration’ gradient (i.e. dimension of root diameter vs specific root length or area) was identified for each species, in which root N-uptake rate loaded heavily on the side of ‘do-it-yourself’ (i.e. foraging N more by roots). Young trees of all species tended to exhibit the ‘do-it-yourself’ strategy for N uptake, and mature trees had an ‘outsourcing’ strategy (i.e. foraging N by a mycorrhizal partner), whereas middle-aged trees showed a balanced strategy. These findings suggest that shifts of root N-acquisition strategy with tree age in these species are mainly mediated by root traits along the ‘collaboration’ gradient, which advances our understanding of belowground competition, species coexistence and N cycling in temperate forests.
Healthcare practitioners' knowledge of snakebite management and associated factors in high-burden, low-resource settings in Uganda
Authors: Wafula Solomon T , Mugume Innocent B , Namakula Lydia N , Nalugya Aisha , Naggayi Vencia , Walekhwa Abel W , Musoke David 
Published: April 2023

ABSTRACT

Background
Snakebites cause significant morbidity and mortality in Uganda. Effective management of snakebites requires knowledge of the appropriate first aid measures, as well as knowledge of the appropriate antivenom to use, but little is known about familiarity with effective snakebite management techniques and associated factors among healthcare practitioners (HCPs) in Uganda.

Methods
In May 2022, we collected data on sociodemographic characteristics, knowledge of snakebite first aid, envenomation signs, diagnosis and antivenom administration among 311 HCPs from two snakebite high-incidence districts in Uganda using a semi-structured questionnaire.

Results
Of the 311 HCPs, 64.3% had ever treated snakebite cases, 87.1% were confident to provide supportive treatment, but only 9.6% had ever been trained on snakebite management. Overall, 22.8% of HCPs had high knowledge of snakebite management. Higher education (at least degree vs certificate; PR=2.21 95% CI 1.508 to 4.56), older age (30–45 vs &lt;30 y; PR=1.97, 95% CI 1.22 to 3.21) and previous training (PR=1.82, 95% CI 1.08 to 3.05) were associated with high knowledge of snakebite diagnosis and management.

Conclusions
Overall, knowledge of snakebite management was limited. Training, level of education and age of the HCP all had an impact on knowledge. Deliberate efforts are required to increase HCPs' knowledge of snakebite case care in high-burden regions to manage incident cases.
Assessing HeartSong as a Neonatal Music Therapy Intervention
Authors: van Dokkum Nienke H. , Fagan Lauren J. , Cullen Marie , Loewy Joanne V. 
Published: April 2023

Background:
The music therapy HeartSong intervention pairs newborn infant heartbeats with parents' Song of Kin. Formal evidence on professional and personal caregiver perspectives of this intervention is lacking.

Purpose:
This survey study evaluates the HeartSong music therapy intervention from parent and staff perspectives.

Methods:
A qualitative study assessing inclusion of HeartSong for family neonatal intensive care unit (NICU) care surveyed 10 professional caregivers comprising medical and psychosocial NICU teams anonymously reflecting their impressions of the intervention. Digital survey of parents/guardians contacted through semistructured phone interviews relayed impressions of recordings: subsequent setup, Song of Kin selection, and use of HeartSong, including thoughts/feelings about it as an intervention.

Results:
Professional and personal caregivers valued the HeartSong intervention for bereavement support, family support, including parental, extended family/infant support, and to enhance bonding. Emergent themes: memory-making, connectedness/closeness, support of parent role, processing mental health needs of stressful NICU days, and subsequent plans for lifelong HeartSong use. Therapeutic experience was named as a crucial intervention aspect and participants recommended the HeartSong as a viable, accessible NICU intervention.

Implications for Practice and Research:
HeartSong's use showed efficacy as a clinical NICU music therapy intervention for families of critically ill and extremely preterm infants, when provided by trained, specialized, board-certified music therapists. Future research focusing on HeartSong in other NICU populations might benefit infants with cardiac disease, parental stress, and anxiety attending to parent–infant bonding. Costs and time benefits related to investment are needed before implementation is considered.
Patient-Reported Outcome Measures for Use in Women With Pelvic Organ Prolapse
Authors: Dieter Alexis A. , Halder Gabriela E. , Pennycuff Jon F. , Singh Ruchira , El-Nashar Sherif A. , Lipetskaia Lioudmila , Orejuela Francisco J. , Jeppson Peter C. , Sleemi Ambereen , Raman Sonali V. , Balk Ethan M. , Rogers Rebecca G. , Antosh Danielle D. ,   for the Society of Gynecologic Surgeons Systematic Review Group
Published: April 2023

OBJECTIVE:
To describe the psychometric properties of existing patient-reported outcome measures for women with prolapse using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) framework. Additional objectives were to describe the patient-reported outcome scoring method or interpretation, methods of administration, and to compile a list of the non-English languages in which the patient-reported outcomes are reportedly validated.

DATA SOURCES:
PubMed and EMBASE was searched through September 2021. Study characteristics, patient-reported outcome details, and psychometric testing data were extracted. Methodologic quality was assessed with COSMIN guidelines.

METHODS OF STUDY SELECTION:
Studies reporting the validation of a patient-reported outcome in women with prolapse (or women with pelvic floor disorders that included a prolapse assessment) and reporting psychometric testing data on English-language patient-reported outcome for at least one measurement property per COSMIN and the U.S. Department of Health and Human Services definitions were included, as well as studies reporting the translation of an existing patient-reported outcome into another language, a new method of patient-reported outcome administration, or a scoring interpretation. Studies reporting only pretreatment and posttreatment scores, only content or face validity, or only findings for nonprolapse domains of the patient-reported outcome were excluded.

TABULATION, INTEGRATION, AND RESULTS:
Fifty-four studies covering 32 patient-reported outcomes were included; 106 studies assessing translation into a non-English language were excluded from the formal review. The number of validation studies per patient-reported outcome (one version of one questionnaire) ranged from 1 to 11. Reliability was the most reported measurement property, and most measurement properties received an average rating of sufficient. The condition-specific patient-reported outcomes had on average more studies and reported data across more measurement properties compared with adapted and generic patient-reported outcomes.

CONCLUSION:
Although measurement property data vary on patient-reported outcomes for women with prolapse, most data were of good quality. Overall, condition-specific patient-reported outcomes had more studies and reported data across more measurement properties.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42021278796.
Not All Proximal Humerus Fractures Do Well Without Surgery: Anterior Translation Predicts the Need for Surgery
Authors: Shahien Amir , Likine Elive F. , Soles Gillian , Samborski Steven , Mehta Siddhant K. , Ryan Scott Patrick , Leroy Taryn E. , Mullis Brian , Spitler Clay A. , Tornetta Paul 
Published: April 2023

Objectives:
To evaluate the effect of translation on a large series of low-energy proximal humerus fractures initially treated nonoperatively.

Design:
Retrospective multicenter analysis.

Setting:
Five level-one trauma centers.

Patients/Participants:
Two hundred ten patients (152 F; 58 M), average age 64, with 112 left- and 98 right-sided low-energy proximal humerus fractures (OTA/AO 11-A-C).

Intervention:
All patients were initially treated nonoperatively and were followed for an average of 231 days. Radiographic translation in the sagittal and coronal planes was measured. Patients with anterior translation were compared with those with posterior or no translation. Patients with ≥80% anterior humeral translation were compared with those with <80% anterior translation, including those with no or posterior translation.

Main Outcomes:
The primary outcome was failure of nonoperative treatment resulting in surgery and the secondary outcome was symptomatic malunion.

Results:
Nine patients (4%) had surgery, 8 for nonunion and 1 for malunion. All 9 patients (100%) had anterior translation. Anterior translation compared with posterior or no sagittal plane translation was associated with failure of nonoperative management requiring surgery (P = 0.012). In addition, of those with anterior translation, having ≥80% anterior translation compared with <80% was also associated with surgery (P = 0.001). Finally, 26 patients were diagnosed with symptomatic malunion, of whom translation was anterior in 24 and posterior in 2 (P = 0.0001).

Conclusions:
In a multicenter series of proximal humerus fractures, anterior translation of >80% was associated with failure of nonoperative care resulting in nonunion, symptomatic malunion, and potential surgery.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial
Authors: Thakeb Mootaz F. , Kozman Michael A. , ElGebeily Mohamed A. , Baraka Mostafa M. , Al Kersh Mohamed A. 
Published: April 2023

Objectives:
To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in the management of infected long-bone defects.

Design:
Prospective, randomized, controlled study.

Setting:
Tertiary-level center.

Participants:
Thirty patients with infected nonunited long-bone fractures of lower limbs were included.

Intervention:
Fifteen patients were treated by BTM in group A, and 15 patients were treated by BT in group B.

Outcome Measurements:
The outcome measures were external fixation time, external fixation index, and docking time. Bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov scoring system. Postoperative complications were evaluated according to the Paley classification.

Results:
The mean docking time was significantly lower in the BTM group than in the BT group (3.6 ± 0.82 months vs. 4.8 ± 0.86 months, respectively; P value 0.001). Docking site nonunion and infection recurrence were significantly lower in the BTM group than in the BT group (0% vs. 40%; P value 0.02 and 0% vs. 33.3%; P value 0.04, respectively), with no significant difference in the external fixation index (P value 0.08).

Conclusions:
This is the first prospective, randomized, controlled study comparing BTM and BT techniques, showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site nonunion and infection recurrence rates, and lower number of additional procedures needed at the expense of 2-staged operation in comparison with BT.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Evolving Trends in the Use of Sacroiliac Fusion From 2015 to 2020
Authors: Halperin Scott J. , Dhodapkar Meera M. , Jiang Will , Elaydi Ali , Jordan Yusef J. , Whang Peter G. , Grauer Jonathan N. 
Published: April 2023

Study Design.
Retrospective cohort analysis.

Objective.
To assess the evolution of patients undergoing sacroiliac (SI) fusion with minimally invasive surgery (MIS) relative to open approaches.

Summary of Background Data.
The SI joint can be a contributor to lumbopelvic symptoms. The MIS approach to SI fusion has been shown to have fewer complications compared with the open approach. Recent trends and evolved patient populations have not been well-characterized.

Materials and Methods.
Data were abstracted from the large, national, multi-insurance, administrative 2015-2020 M151 PearlDiver database. The incidence, trends, and patient characteristics of MIS, as well as open, SI fusions for adult patients with degenerative indications, were determined. Univariable and multivariable analyses were then performed to compare the MIS relative to open populations. The primary outcome was to assess the trends of MIS and open approaches for SI fusions.

Results.
In total, 11,217 SI fusions were identified (of which 81.7% were MIS), with a clear increase in numbers over the years from 2015 (n=1318, 62.3% of which were MIS) to 2020 (n=3214 86.6% of which were MIS). Independent predictors of MIS (as opposed to open) SI fusion included: older age (odds ratio [OR] 1.09 per decade increase), higher Elixhauser-Comorbidity Index (OR 1.04 per two-point increase), and geographic region (relative to South, Northeast OR 1.20 and West OR 1.64). As might be expected, 90-day adverse events were lower for MIS than open cases (OR 0.73).

Conclusion.
The presented data quantify the increasing incidence of SI fusions over the years, with the increase being driven by MIS cases. This was largely related to an expanded population (those who are older and with greater comorbidity), fitting the definition of disruptive technology with lesser adverse events than open procedures. Nonetheless, geographic variation highlights the differential adoption of this technology.
Effect of Clinical and Radiographic Degenerative Spondylolisthesis Classification on Patient-reported Outcomes and Spinopelvic Parameters for Patients With Single-level L4–L5 Degenerative Spondylolisthesis After Lumbar Fusion
Authors: Karamian Brian A. , Levy Hannah A. , DiMaria Stephen L. , Ju Derek G. , Canseco Jose A. , Yen Winston , Maheu Arlene , Mangan John J. , Goyal Dhruv K.C. , Radcliff Kris E. , Kaye I. David , Rihn Jeffrey A. , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: April 2023

Study Design:
Retrospective cohort study.

Objectives:
To determine whether preoperative clinical and radiographic degenerative spondylolisthesis (CARDS) classification is associated with differences in patient-reported outcomes and spinopelvic parameters after posterior decompression and fusion for L4–L5 degenerative spondylolisthesis (DS).

Summary:
The CARDS classification for lumbar DS, an alternative to the Meyerding system, considers additional radiographic findings such as disc space collapse and segmental kyphosis and stratifies DS into 4 radiographically distinct classes. Although CARDS has been shown to be a reliable and reproducible method for classifying DS, very few studies have assessed whether the CARDS types represent distinct clinical entities.

Patients and Methods:
A retrospective cohort analysis was conducted on patients with L4–L5 DS who underwent posterior lumbar decompression and fusion. Changes in spinopelvic alignment and patient-reported outcomes measures, including recovery ratios and percentage of patients achieving the minimal clinically important difference, were compared among patients in each CARDS classification 1-year postoperatively using analysis of variance or Kruskal-Wallis H with Dunn post hoc analysis. Multiple linear regression determined whether CARDS groups significantly predicted patient-reported outcomes measures, lumbar lordosis (LL), and pelvic incidence-lumbar lordosis mismatch (PI-LL) while controlling for demographic and surgical characteristics.

Results:
Preoperative type B spondylolisthesis predicted decreased improvement in “physical component and mental component score of the short form-12” compared with type A spondylolisthesis (β-coefficient = −5.96, P = 0.031) at 1 year. Significant differences were found between CARDS groups with regards to ΔLL (A: −1.63 degrees vs B: −1.17 degrees vs C: 2.88 degrees vs D: 3.19 degrees, P = 0.010) and ΔPI-LL (A: 1.02 degrees vs B: 2.09 degrees vs C: −2.59 degrees vs D: −3.70 degrees, P = 0.012). Preoperative type C spondylolisthesis was found to predict increased LL (β-coefficient = 4.46, P = 0.0054) and decreased PI-LL (β-coefficient = −3.49, P = 0.025) at 1 year compared with type A spondylolisthesis.

Conclusions:
Clinical and radiographic outcomes differed significantly by preoperative CARDS classification type for patients undergoing posterior decompression and fusion for L4–L5 DS.

Level of Evidence:
Level III.
Diagnostic value of ACR TI-RADS combined with three-dimensional shear wave elastography in ACR TI-RADS 4 and 5 thyroid nodules
Authors: Hao Lijun , Liu Peiqing , Ding Changwei , Li Jing , Zhang Yingchun 
Published: April 2023

Abstract

Background:
Three-dimensional shear wave elastography ((3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules recently. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.

Methods:
All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young's modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t-test and Mann–Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.

Results:
Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young's modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.

Conclusions:
Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.
Somatosensory Stimulation Therapy in Patients with Somatosensory Tinnitus: A Pilot Study
Authors: Hong Guowei 
Published: April 2023

Objective
To explore the efficacy and safety of EMS (Exercise to improve muscle strength, Motion of joints, and Stretch training) in somatosensory tinnitus symptoms.

Study Design
A randomized delayed-start controlled trial.

Setting
At the Department of Otorhinolaryngology, Eye and Ear, Nose, and Throat Hospital between February 2019 and May 2019.

Patients
Patients with somatosensory tinnitus.

Intervention(s)
In the immediate-start group, the participants received EMS somatosensory stimulation therapy for 3 weeks and were followed up for 3 weeks. In the delayed-start group, the participants first waited for 3 weeks and were treated with EMS somatosensory stimulation therapy for 3 weeks.

Main Outcome Measure(s)
The primary endpoint was the changes in Tinnitus Handicap Inventory (THI) and the visual analog scale (VAS) scores after 3 weeks of treatment. The secondary endpoint was the proportion of patients achieving improvements in VAS and THI scores. THI and VAS were collected at baseline and at 3, 6, 9, and 12 weeks.

Results
Sixty-four patients were randomized to the immediate-start group and delayed-start treatment with each 32. After the 3-week treatment, the immediate-start group showed significant lower in VAS (25.7 ± 3.3 versus 38.9 ± 5.8, p < 0.001) and THI (29.1 ± 5.1 versus 42.8 ± 6.6, p < 0.001). There were no differences in VAS and THI between the two groups after treatment (i.e., at weeks 6, 9, and 12). All patients were followed up for 6, 9, and 12 weeks, and the therapeutic effect was stable.

Conclusion
The EMS somatosensory stimulation therapy might be an effective and safe treatment for improving symptoms, and the therapeutic effect was still stable in 3, 6, 9, and 12 weeks.

Clinical trial registration number
ChiCTR1900020746.
Ultrastructure of the nebenkern during spermatogenesis in the praying mantidHierodula membranacea
Authors: Köckert Maria , Okafornta Chukwuebuka William , Hill Charlice , Ryndyk Anne , Striese Cynthia , Müller-Reichert Thomas , Paliulis Leocadia , Fabig Gunar 
Published: April 2023

AbstractSpermatogenesis leads to the formation of functional sperm cells. Here we have applied high-pressure freezing in combination with transmission electron microscopy (TEM) to study the ultrastructure of sperm development in subadult males of the praying mantidHierodula membranacea. We show the ultrastructure of different stages of sperm development in this species. In addition, we have applied serial-section electron tomography of the nebenkern to demonstrate in three dimensions (3D) that this organelle is composed of two interwoven segments that are connected by a zipper-like structure at opposing positions. Our approach will enable further ultrastructural analyses of the nebenkern also in other organisms.