scholarly journals Incidence and Time Point of Sepsis Detection as Related to Different Sepsis Definitions in Severely Burned Patients and Their Accompanying Time Course of Pro-Inflammatory Biomarkers

2021 ◽  
Vol 11 (8) ◽  
pp. 701
Author(s):  
Pia Niggemann ◽  
Daniel Rittirsch ◽  
Philipp Karl Buehler ◽  
Riccardo Schweizer ◽  
Pietro Giovanoli ◽  
...  
Keyword(s):  
Time Course ◽  
Mixed Model ◽  
White Blood Cells ◽  
Total Body Surface Area ◽  
Inflammatory Biomarkers ◽  
Burn Patients ◽  
Mixed Model Analysis ◽  
Burn Center ◽  
Sepsis Definition ◽  
Time Point

Background: Diagnosis of sepsis in burn patients remains difficult for various reasons. One major problem is the definition of sepsis itself. Therefore, previous and current sepsis definitions are a matter of ongoing validation, but a well-defined consensus on which clinical and laboratory parameters to incorporate in such a definition is lacking. The aim of the present study was to compare the incidence and time-related occurrence of septic events according to different definitions as well as their accompanying time course of pro-inflammatory biomarkers. Methods: Across the first 14 days after admission, the incidence and time point of sepsis according to three different definitions (Sepsis-3, Sepsis American Burns Association [ABA] 2007, Sepsis Zurich Burn Center) were assessed on a daily basis in adult burn patients with total body surface area (TBSA) ≥15% admitted to the Zurich Burn Center between May 2015 and October 2018. In order to investigate how well daily drawn proinflammatory biomarkers (white blood cells (WBCs), C-reactive protein (CRP), procalcitonin (PCT), and novel pancreatic stone protein (PSP)) reflect the progression of sepsis depending on its type of definition, a longitudinal mixed model analysis was performed across the first 14 days for septic and non-septic patients. Additionally, the relative increase of biomarker levels 24, 48, and 72 h prior to a septic event was analyzed for each definition used. Results: In our cohort of 90 severely burned patients, Sepsis-3 identified 46 patients (51.1%) as septic, while ABA 2007 and the Zurich Burn Center definition counted 33 patients (36.7%) and 24 patients (26.6%), respectively. Sepsis-3 detected sepsis about 1 day earlier than Sepsis ABA 2007 (p < 0.001) and about 0.5 days earlier than Sepsis Zurich Burn Center (p = 0.04). The course of pro-inflammatory biomarkers was largely unaffected by the type of sepsis definition. Irrespective of the sepsis definition, PSP was the only marker to demonstrate a highly significant interaction between time and group (sepsis versus no sepsis) (p < 0.001) with a 3.3–5.5-fold increase within 72 h before the event of sepsis, whereas CRP, PCT, and WBC showed only mild undulations. Conclusions: Despite the ongoing dilemma of how to define sepsis in burn patients, a continually calculated SOFA score as used in Sepsis-3 is advantageous to early identify a patient’s detrimental progression to sepsis. Inclusion of biomarkers, such as PSP, may help support the burn specialist’s diagnosis of sepsis and could improve the diagnostic performance of current and future definitions in burn patients.

scholarly journals Rate and Determinants of Excessive Fat-Free Mass Loss After Bariatric Surgery

2020 ◽  
Vol 30 (8) ◽  
pp. 3119-3126
Author(s):  
Malou A. H. Nuijten ◽  
Valerie M. Monpellier ◽  
Thijs M. H. Eijsvogels ◽  
Ignace M. C. Janssen ◽  
Eric J. Hazebroek ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Time Course ◽  
Mixed Model ◽  
Linear Regression Analysis ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Fat Free Mass ◽  
Mixed Model Analysis ◽  
Post Surgery ◽  
Post Bariatric Surgery

Abstract Purpose Fat-free mass (FFM) loss is a concerning aspect of bariatric surgery, but little is known about its time-course and factors related with excessive FFM loss. This study examined (i) the progress of FFM loss up to 3 years post-bariatric surgery and (ii) the prevalence and determinants of excessive FFM loss. Materials and Methods A total of 3596 patients (20% males, 43.5 ± 11.1 years old, BMI = 44.2 ± 5.5 kg/m2) underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. Bioelectrical impedance analysis was performed preoperatively and 3, 6, 9, 12, 18, 24 and 36 months post-surgery. Changes in body composition were assessed by mixed model analysis. Prevalence of excessive FFM loss (based on three different cutoff values: ≥ 25%, ≥ 30% and ≥ 35% FFM loss/weight loss (= %FFML/WL)) was estimated and its determinants were assessed by linear regression analysis. Results Highest rates of FFM loss were found at 3 and 6 months post-surgery, reflecting 57% and 73% of peak FFM loss, respectively. Prevalence of excessive FFM loss ranged from 14 to 46% at 36 months post-surgery, with an older age (β = 0.14, 95%CI = 0.10–0.18, P < .001), being male (β = 3.99, 95%CI = 2.86–5.12, P < .001), higher BMI (β = 0.13, 95%CI = 0.05–0.20, P = .002) and SG (β = 2.56, 95%CI = 1.36–3.76, P < .001) as determinants for a greater %FFML/WL. Conclusion Patients lost most FFM within 3 to 6 months post-surgery. Prevalence of excessive FFM loss was high, emphasizing the need for more vigorous approaches to counteract FFM loss. Furthermore, future studies should assess habitual physical activity and dietary intake shortly after surgery in relation to FFM loss.

564 Managing California’s Creek Fire Mass Casualty’s Incident

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S132-S132
Author(s):  
Shana M Henry ◽  
Nicole M Kopari ◽  
Mary Wolfe
Keyword(s):  
Operating Room ◽  
Disaster Response ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Rescue Operation ◽  
Burn Victims ◽  
Burn Center ◽  
Response Planning ◽  
Response Team ◽  
Total Body

Abstract Introduction California’s Creek Fire is not only the largest single wildfire in a state known for huge and destructive blazes, it spawned two rare fire tornados with winds over 100mph, a day after the fire started in early September. Huntington Lake and Mammoth Pool were the sites of these rare events leading to hundreds of trapped campers. An air rescue operation airlifted hundreds of trapped people to safety. Twenty days after the start of the fire, it had burned &gt;300,000 acres with only 36% containment by fire crews. This review is an evaluation of our hospitals response team and the events surrounding that night. Methods Our on-call surgeon had called in the back-up surgeon to run a second trauma operating room. It was at this time, the news had reported trapped campers near Mammoth Pool. The burn surgeon was notified and reported to the emergency department (ED) as word of 65 possible victims spread. Local disaster response planning was initiated with an ED physician triaging patients at the regional airport. Initial calls were made to the division chief and burn medical director. The nursing director was notified along with any available nursing staff with 8 ICU nurses volunteering to report. Immediately, lateral transfer orders were placed for all burn patients housed in the burn center which has 10 ICU bed capabilities. Results The first helicopter landed with 5 of the burn victims presenting to our hospital. 4 of the victims were male and 1 female with ages ranging from 17 to 27. Total body surface area burn was estimated on each with 2 minor burns &lt; 10% and 3 moderate sized burns of roughly 25%. These patients were quickly triaged in the ED and traumatic injuries evaluated. 3 of the patients were placed in ICU level care with the 2 remaining patients housed in the ED as word trickled in about another rescue effort with an additional 95 people. By morning, an additional 2 patients were transferred to our burn center from the surrounding hospitals and another 2 patients evaluated for burns sustained in separate events. All patients were taken to the operating room over the next 24–48 hours for excision and autologous spray on skin cells (ASCS) in combination with widely meshed skin grafts or ASCS alone. Conclusions Communication, teamwork, and personnel that are dedicated to the care of burn patients made this tragic incident manageable. The Creek Fire hit home for many of the burn staff not only because of the patients that were cared for, but because this area of California was a beloved respite for many. A debriefing with a chaplain, grief counselor, and psychotherapist, was held within 2 weeks of the incident to provide support to the staff during this devastating time.

Continuous Jumps Enhance Twitch Peak Torque and Sprint Performance in Highly Trained Sprint Athletes

2020 ◽  
pp. 1-8
Author(s):  
Haiko B. Zimmermann ◽  
Débora Knihs ◽  
Fernando Diefenthaeler ◽  
Brian MacIntosh ◽  
Juliano Dal Pupo
Keyword(s):  
Time Course ◽  
Mixed Model ◽  
Performance Enhancement ◽  
Peak Torque ◽  
Sprint Performance ◽  
Postactivation Potentiation ◽  
Warm Up ◽  
Mixed Model Analysis ◽  
Post Hoc ◽  
Vertical Jumps

Purpose: The objective of this study was to analyze the effects of a conditioning activity (CA) composed of continuous countermovement jumps on twitch torque production and 30-m sprint times. Methods: A total of 12 sprint athletes, 10 men (23.5 [7.7] y) and 2 women (23.0 [2.8] y), volunteered to participate in this study. The participants were evaluated in 2 sessions as follows: (1) to determine the effects of the CA (3 sets of 5 continuous vertical jumps with a 1-min interval between sets) on 30-m sprint performance over time (2, 4, 6, 8, and 10 min) and (2) to evaluate twitch peak torque to determine the magnitude and time course of the induced postactivation potentiation at the same recovery intervals. Results: Mixed-model analysis of variance with Bonferroni post hoc verified that there was a decrease on the 30-m sprint time at 2 minutes (P = .01; Δ = 2.78%; effect size [ES] = 0.43) and 4 minutes (P = .02; Δ = 2%, ES = 0.30) compared with pre when the CA preceded the sprints. The peak torque of quadriceps also showed significant increase from pretest to 2 minutes (P < .01; Δ = 17.0% [12.2%]; ES = 0.45) and 4 minutes (P = .02; Δ = 7.2% [8.8%]; ES = 0.20). Conclusion: The inclusion of CA composed of continuous countermovement jumps in the warm-up routine improved 30-m sprint performance at 2- and 4-minute time intervals after the CA (postactivation performance enhancement). Since postactivation potentiation was confirmed with electrical stimulation at the time when sprint performance increased, it was concluded that postactivation potentiation may have contributed to the observed performance increases.

scholarly journals Burn recidivism: a 10-year retrospective study characterizing patients with repeated burn injuries at a large tertiary referral burn center in the United States

2019 ◽  
Vol 7 ◽  
Author(s):  
Sarah L. Laughon ◽  
Bradley N. Gaynes ◽  
Lori P. Chrisco ◽  
Samuel W. Jones ◽  
Felicia N. Williams ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
The United States ◽  
Burn Injuries ◽  
Hospital Charges ◽  
Burn Patients ◽  
Burn Center ◽  
Trauma Recidivism

Abstract Background Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma, known as trauma recidivism. The epidemiology of burn recidivism, specifically, has not been described. This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists (RCs) with non-recidivists (NRCs). Methods A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record. Continuous variables were reported using medians and interquartile ranges (IQR). Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic, burn, and hospitalization characteristics between NRCs and RCs. Results A total of 7134 burn patients were admitted, among which 51 (0.7%) were RCs and accounted for 129 (1.8%) admissions. Of the 51 RCs, 37 had two burn injuries each, totaling 74 admissions as a group, while the remaining 14 RCs had between three and eight burn injuries each, totaling 55 admissions as a group. Compared to NRCs, RCs were younger (median age 36 years vs. 42 years, p = 0.02) and more likely to be white (75% vs. 60%, p = 0.03), uninsured (45% vs. 30%, p = 0.02), have chemical burns (16% vs. 5%, p &lt;  0.0001), and have burns that were ≤ 10% total body surface area (89% vs. 76%, p = 0.001). The mortality rate for RCs vs. NRCs did not differ (0% vs. 1.2%, p = 0.41). Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs (75% vs. 15%, p &lt;  0.001). Median total hospital charges per patient were nearly three times higher for RCs vs. NRCs ($85,736 vs. $32,023, p &lt;  0.0001). Conclusions Distinct from trauma recidivism, burn recidivism is not associated with more severe injury or increased mortality. Similar to trauma recidivists, but to a greater extent, burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs. Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.

scholarly journals Soluble CD163: A novel biomarker for the susceptibility to sepsis in severe burn injuries

2011 ◽  
Vol 44 (01) ◽  
pp. 118-124
Author(s):  
Andrzej Piatkowski ◽  
Gerrit Grieb ◽  
Rittuparna Das ◽  
Ahmet Bozkurt ◽  
Dietmar Ulrich ◽  
...  
Keyword(s):  
Time Course ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Serum Levels ◽  
Burn Injuries ◽  
Burn Patients ◽  
Serum Samples ◽  
Soluble Cd163 ◽  
Bivariate Correlation ◽  
Total Body

ABSTRACT Objective: Soluble CD163 (sCD163) has been previously shown to play a role in inflammatory and infectious diseases. This study, for the first time, investigates the characteristics and potential values of sCD163 in burn patients. A first look is taken on the changes of sCD163 levels in burn patients by comparing predefined subgroups at single time points. Materials and Methods: Serum samples of 18 patients with burn injuries were collected for biochemical analysis at the time of admission and in a chronological sequence of 12, 24, 48 and 120 h after the injury and were matched to clinical parameters. Statistical analysis was performed using the Mann-Whitney test, Wilcoxon signed rank and Pearson bivariate correlation. Results: Patients with sepsis showed a significant increase of sCD163 levels. sCD163 was correlated with leukocytes (P=0.035) over the time course of 120 h. Patients characterized by a burn size exceeding 25% of the total body surface area (TBSA) showed a significant increase of sCD163 between 12 and 48 h after burn injury (P=0.038). Conclusions: The first view on the characteristics of sCD163 in the serum of burn patients points out that sCD163 seems to be an early indicator for the susceptibility to sepsis. Furthermore, the changes in sCD163 serum levels within the first hours after burn trauma have great potential for early prediction of organ failure after burn injury.

scholarly journals The Effect of Transfer on Outcomes in Burns

2021 ◽  
Author(s):  
Nathan E Bodily ◽  
Elizabeth H Bruenderman ◽  
Neal Bhutiani ◽  
Selena The ◽  
Jessica E Schucht ◽  
...  
Keyword(s):  
Total Body Surface Area ◽  
Infectious Complications ◽  
Burn Injuries ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Center ◽  
Field Versus ◽  
High Acuity ◽  
Total Body ◽  
Inhalation Burn

Abstract Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts – those directly admitted to a burn center from the field, versus those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percent total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs. 8 hours, p &lt, 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p &lt, 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p &lt, 0.01), and develop infectious complications (14 vs. 5, p = 0.04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met ABA criteria for transfer were not affected by short delays in transfer to definitive burn care.

Total Body Surface Area Overestimation at Referring Institutions in Children Transferred to a Burn Center

2015 ◽  
Vol 81 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Douglas S. Swords ◽  
Edmund D. Hadley ◽  
Katrina R. Swett ◽  
Thomas Pranikoff
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Trauma Registry ◽  
Total Body Surface Area ◽  
Demographic Variables ◽  
Adverse Outcomes ◽  
Burn Patients ◽  
Burn Center ◽  
Total Body

Total body surface area (TBSA) burned is a powerful descriptor of burn severity and influences the volume of resuscitation required in burn patients. The incidence and severity of TBSA overestimation by referring institutions (RIs) in children transferred to a burn center (BC) are unclear. The association between TBSA overestimation and overresuscitation is unknown as is that between TBSA overestimation and outcome. The trauma registry at a BC was queried over 7.25 years for children presenting with burns. TBSA estimate at RIs and BC, total fluid volume given before arrival at a BC, demographic variables, and clinical variables were reviewed. Nearly 20 per cent of children arrived from RIs without TBSA estimation. Nearly 50 per cent were overestimated by 5 per cent or greater TBSA and burn sizes were overestimated by up to 44 per cent TBSA. Average TBSA measured at BC was 9.5 ± 8.3 per cent compared with 15.5 ± 11.8 per cent as measured at RIs ( P < 0.0001). Burns between 10 and 19.9 per cent TBSA were overestimated most often and by the greatest amounts. There was a statistically significant relationship between overestimation of TBSA by 5 per cent or greater and overresuscitation by 10 mL/kg or greater ( P = 0.02). No patient demographic or clinical factors were associated with TBSA overestimation. Education efforts aimed at emergency department physicians regarding the importance of always calculating TBSA as well as the mechanics of TBSA estimation and calculating resuscitation volume are needed. Further studies should evaluate the association of TBSA overestimation by RIs with adverse outcomes and complications in the burned child.

53 Regulation of Glycolysis and the Warburg Effect in Keloids

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S35-S35
Author(s):  
Roohi Vinaik ◽  
Dalia Barayan ◽  
Marc G Jeschke
Keyword(s):  
Risk Factors ◽  
Time Course ◽  
Normal Skin ◽  
Total Body Surface Area ◽  
Glycolytic Enzymes ◽  
Burn Patients ◽  
Keloid Scarring ◽  
Altered Glucose ◽  
Gene And Protein Expression ◽  
Glut1 Expression

Abstract Introduction Hypertrophic and keloid scarring are considered as major determinants for long-term outcomes and quality of life for burn survivors. Keloid development is predicated on prolonged local inflammation and altered glucose metabolism. Owing to its tumor-like dependence on glucose, we hypothesized that keloids would display the bioenergetics of cancer cells; namely, increased glucose uptake via Glut1 and upregulation of key glycolytic enzymes. Furthermore, burn patients who develop keloids potentially demonstrate early evidence of the aforementioned features compared to non-keloid patients. Therefore, elevated Glut1 expression could serve as a marker for keloid development in burn patients. Methods We enrolled 27 control burn patients with 39% ± 4% total body surface area (TBSA) burns. The keloid burn group included 9 burn patients with 47% ± 9% TBSA burns. Skin was obtained for histology, gene and protein expression at 0–17 days post-burn. Results Keloids have higher Glut1 expression compared to normal and burn skin (7.72 vs. 0.15, p&lt; 0.001; 7.72 vs. 2.35, p&lt; 0.05). Keloids also exhibit enhanced expression of critical glycolytic enzymes compared to burn skin at 7–10 days post-burn (HK2: 4.14 vs. 2.36, p&lt; 0.001; PFK1: 6.51 vs. 3.83, p&lt; 0.001; PFK2: 5.35 vs. 1.27, p&lt; 0.001; PDK1: 5.50 vs. 4.31, p&lt; 0.05; PKM2: 7.58 vs. 2.98, p&lt; 0.001). A Glut1 time-course analysis in burn skin from non-keloid patients indicated a significant elevation at 7–10 days post-burn compared to normal skin (3.22 vs. 0.20, p&lt; 0.01). Skin from keloid burn patients prior to development of keloids demonstrate higher Glut1 expression compared to skin from non-keloid controls when matched by days post-burn (40.5 vs. 0.58 at 0–2 days, p&lt; 0.05). Conclusions Patients who develop post-burn keloids exhibit early risk factors prior to the development of keloids (e.g. elevated skin Glut1). Keloids have an augmented reliance on glycolysis compared to burn skin. Therefore, early identification and targeting glycolysis in susceptible patients is key. Applicability of Research to Practice Upregulation of glycolytic enzymes and transporters such as Glut1 may serve as keloid predictive markers. Identification of at-risk patients allows for a tailored treatment regimen that targets dysregulated glycolysis in these patients. Pharmaceutical agents like shikonin suppress multiple glycolytic steps, serving as an effective means to interfere with the proliferative capacity of keloids. Potentially, local shikonin administration could serve as a therapy in select patients exhibiting keloid risk factors.

scholarly journals Clinical efficacy of nanohydroxyapatite-containing toothpaste at relieving dentin hypersensitivity: an 8 weeks randomized control trial

BDJ Open ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Bennett Tochukwu Amaechi ◽  
Kelly C. Lemke ◽  
Shyamali Saha ◽  
Minh N. Luong ◽  
Jonathan Gelfond
Keyword(s):  
Mixed Model ◽  
Potassium Nitrate ◽  
Post Treatment ◽  
Dentin Hypersensitivity ◽  
Double Blind ◽  
Mixed Model Analysis ◽  
Random Intercept ◽  
Parallel Group ◽  
Randomized Control ◽  
Time Point

Abstract Objective The objective of this study was to investigate and compare the effectiveness of several toothpastes containing nanohydroxyapatite (nano-HAP) to relieve dentin hypersensitivity (DHS) with that of a commercial desensitizing dentifrice containing calcium sodium phosphosilicate (CSPS). Materials and methods In this double-blind, randomized, parallel-group clinical trial, patients diagnosed with DHS and qualified to participate were randomized into four groups: toothpaste containing 10% nano-HAP (10%nano-HAP), 15% nano-HAP (15%nano-HAP), 10% nano-HAP supplemented with potassium nitrate (KNO3) (10%nano-HAPKN), or CSPS. Subjects’ baseline and post-treatment sensitivities were assessed using visual analog scale (VAS) after the application of ice-cold and air stimuli. Subjects used their assigned toothpaste for routine toothbrushing twice daily. Post-treatment sensitivity was assessed every 2 or 8 weeks. Mean change in VAS (mm) from baseline at each time point were compared using random-intercept, mixed-model analysis and Duncan test (P < 0.05). Results With either air or cold stimulus, VAS indicated a significant (P < 0.001) reduction from baseline DHS at each time point with all test toothpastes. Among the nano-HAP toothpastes, 15%nano-HAP and 10%nano-HAPKN were consistent in DHS reduction with both stimuli. With either stimuli, the CSPS did not significantly differ from 15%nano-HAP and 10%nano-HAPKN at any time point. Conclusions Toothpaste containing nano-HAP (10 or 15%) alone or supplemented with KNO3 was as effective as CSPS for relief of DHS symptoms when used at least twice daily.

scholarly journals Growth of Container-grown Cork Oak Seedlings as Affected by Foliar and Soil Application of Paclobutrazol

HortScience ◽  
2005 ◽  
Vol 40 (6) ◽  
pp. 1773-1776 ◽  
Author(s):  
Marta Pardos ◽  
Rafael Calama ◽  
Gregorio Montero ◽  
José A. Pardos
Keyword(s):  
Time Course ◽  
Mixed Model ◽  
Growth Traits ◽  
Foliar Spray ◽  
Plant Size ◽  
Quercus Suber ◽  
Cork Oak ◽  
Shoot Height ◽  
Mixed Model Analysis ◽  
Soil Drench

Four concentrations of paclobutrazol (PBZ) and two application methods (foliar spray–soil drench) were tested on 3-month-old container-grown cork oak (Quercus suber L.) seedlings. Shoot height was affected by PBZ concentration and application technique. Time course of height was modelled by nonlinear mixed model analysis. Reduced shoot height was the result of shortened and fewer internodes. A 25 to 625 ppm soil drench or 625 to 15,000 ppm foliar spray controlled over vegetative growth, resulting in a reduction between 13% and 90% in plant size relative to untreated controls. Seedlings responded to soil drench at a lower PBZ concentration than for a foliar spray, but the danger of irreversible overdosing seems greater for a soil drench. Soil drench—and foliar spray to a lesser extent—also affected other shoot and root growth traits. PBZ dose decreased root volume and dry weights in a quadratic fashion with increasing dose, but decreased diameter and number of leaves linearly.

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