Thursday, August 31, 2023

Review of Prevalence and Mechanism of Achilles Tendon Injury Among Athletes

 

Review of Prevalence and Mechanism of Achilles Tendon Injury Among Athletes

Introduction

Achilles’ tendon is a thick fibrous tissue that serves as insertion of calf muscle on the calcaneus; it also called the calcaneal ligament. This tendon is the toughest and strongest tendon the body. The Achilles tendon is susceptible to many injuries such as rupture [1] and tendonitis because of excessive usage of the tendon. Injury to the tendon is of great medical importance because of the functions played by this tendon in some movement around the ankle such as planterflexion and evertion which are important during walking and also in weight bearing as the tendon plays a key function in the transfer of weight to the ground while standing. Some previous studies has reported of incidence of Achilles tendon injury among athletes engaged in different forms of sport such as football, sprinting, basketball and others [2-5] and also in among different categories of people such as military personnel [6-9]. Reasons for this may be due to increase activities around the ankles among individuals of this professions thereby leading to increase shear stress on the Achilles tendon resulting mostly into tear injury. This research reviews the prevalence of Achilles tendon injury among athletes and military personnel, looking critically to some associated factors seen in these set of people that predisposes them to this injury.

Methodology

Literature search of articles on reports and incidence of Achilles tendon injury was made on different databases which about 60 articles were collected and about 52 were exclude because they couldn’t meet the inclusion criteria. The inclusion criteria include those cases of Achilles tendon injury shouldn’t be secondary to any cause such trauma, osteoarthritis, indicated drugs such as quinolonoes, congenital or metabolic problems and also the occupation of the subjects must be stated since the research is focused. Some of the articles were discarded because they were duplicate of others or had similar findings to other selected articles. The occupations focusing on athletes engaging in various sporting activities and prevalence in each article are recorded. The Prisma flow chart showing the analysis of processes of articles selection is shown below.

Results

A total of 60 articles were retrieved from different databases and only 8 articles were eventually used in these studies (Figure 1).

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Figure 1: Prisma Flow chart.

Studies on Athletes

In a cross-sectional studies done on 173 athletes reveals that development of Achilles tendon injury in them cannot linked to any identifiable risk factor such as age, sex, height and weight other than that they are athletes who partook in sporting activities which includes track and field athletics [10]. However, the limitation to this study is that athletes with severe Achilles tendon injuries may not have been included due to the fact that the severity of injury might not have allow them to partook in the track and field events where the study was made. The relationship between age and sporting activity involved among athletes with Achilles’ tendon injury was drafted from research carried out to reveal the epidemiology of Achilles tendon injury in the United States between the year 2012 – 2016 [11]. The observations are recorded in Table 1 below.

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Table 1: Showing the prevalence of Achilles tendon injury among athletes with different activities drafted from [11].

Note: *R/H/S = Running/Hiking/Stretching, *SR = Stairs Related, *BS = Ball Sport, *DR = Door Related.

Discussion

The prevalence of Achilles tendon injury seen among athletes [10,11] and military personnel [12] could have resulted from excessive activities around the ankle which resulted to increase tension and shear stress on the tendon leading to either tear of the Achilles tendon or Inflammation (Achilles’ tendonitis). Although, some additional risk was identified in some of the articles reviewed such alcohol intake, obesity, age and sex; we considered them as potentiating factors to development of Achilles tendon injury with the major risk being the nature of their occupation which requires increase activities around their ankles. Compared to the general population with the same potentiating factors (age, sex, weight, height) there is increase risk of development of Achilles tendon injury among athletes [12] with basketball being the most associated sporting activities in the United States [11this may be linked to increase activities such as jumping, bouncing and others that increase the load on Achilles tendon during basketball game professional. There is increase incidence among athletes within ages of 20-39 showing a strong association between age of athletes and development of Achilles tendon injury because athletes within this age bracket are more likely to be doing athletics on full term basis thereby exposing them to longer period of activities.

Mechanism of Injury (Achilles Tendinopathy)

The mechanism of Achilles tendon injury can be described under the following

a) Overuse: Typical Mechanism of Injury: Achilles’ tendinitis usually develops from overuse. This can occur with excessive jumping and landing type activities. Repetitive micro traumas due to overload (Compressive or Tensile) cause inflammation of the tendon sheath, degeneration or combination of both. This can lead to tendinopathy It can also occur as a result of trauma such as from a direct blow to the tendon. (Acute rupture).

b) Decreased arterial blood flow, local hypoxia, decreased metabolic activity, nutrition, and persistent inflammatory response have been suggested as possible factors that could lead to chronic tendon overuse injuries and tendon degeneration.

Other Contributory Factors to Achiles Tendinopathy

Recent research showed older age, higher android fat mass ratio, and waist circumference > 83cm, in men is associated with a higher chance of having Achilles Tendinopathy [13-15]. The presence of t-The presence of the COL5A1 gene variant was also found to be a possible risk factor. This gene is normally responsible for the production of tendon protein, but patients with the condition were shown to have significantly different allele frequencies of the COL5A1 BstUI RFLP compared with normal subjects [16]. Therefore, besides overuse and degeneration, Achilles Tendinopathy was proposed to have a strong metabolic influence due to poor anatomical vascularity, association with body fat, and the genetic factor. A prospective study identified both female sex and the diminished blood flow response after running as significant risk factors for the development of Achilles tendinopathy [17].

Staging of Injury (The Tendon continuum)

Stages of Tendon Pathophysiology includes

• Reactive tendinopathy

• Tendon disrepair

• Degenerative tendinopathy

Achilles’ tendinopathy can be described as an insertional or mid-portion, the difference is in the localization. The insertional form is situated at the level of transition between the Achilles tendon and the bone, the mid-portion form is located at the level of the tendon body [18].

a) Reactive Tendon: 1st stage on the tendon continuum and is a non-inflammatory proliferative response in the cell matrix. This is as a result of compressive or tensile overload. Straining the tendon during physical exercise has been seen as one of the biggest pathological stimuli and systematic overloading of the Achilles tendon above the physiological limit can cause a micro-trauma.

b) Tendon Disrepair: The progression of the reactive tendinopathy to TENDON DYSREPAIR can occur if the tendon is not offloaded and allowed to regress back to the normal state. During this phase, there is the continuation of increased protein production which has been shown to result in separation of the collagen and disorganization within the cell matrix. This is the attempt of tendon healing as with the 1st phase but with greater involvement and breakdown physiologically.

c) Degenerative Tendinopathy: is the final stage on the continuum and it is suggested that at this stage there is a poor prognosis for the tendon and changes are now irreversible. Often, tendon degeneration is found in combination with peri-tendinous adhesions, but this does not mean that one condition causes the other one.

Sex Differences in Achilles Tendinopathy

The incidence of Achilles tendon rupture has been rising over the past few decades in both men and women, with about 84 percent of cases occurring in men. Some studies have suggested that- female hormones like estrogen reduce the risk of rupture in women, but the hormones’ precise role has been unclear. In addition, some scientists have argued that the typically larger, stronger calf muscles in men would exert greater forces on the tendon and increase the risk of rupture. To gain a better understanding of the factors influencing sex-specific differences in vulnerability to damage, a team of investigators led by Louis J. Soslowsky, Ph.D., of the University of Pennsylvania, compared the material properties of the Achilles tendon/muscle unit in male and female rats. To specifically test for effects of female sex hormones, they also studied female rats that had been made estrogen-deficient by having their ovaries removed [19]. Their measurements showed that while Achilles tendons from males are larger, those from females are stronger and remain more elastic during movement. They also noted that muscle fibers were larger in male rats compared to females, as expected. These findings suggest that inferior properties of the tendon coupled with greater muscle size could explain men’s increased susceptibility to Achilles’ tendon ruptures [19].

Conclusion

This research reveals the relationship between being athlete or military personnel and development of Achilles tendon injury as seen in the prevalence of the condition among individuals with these professions.


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Monday, August 28, 2023

On Politics, Bad Science, and the End that Justifies the Means: The Case Against Forced Vaccinations in Previously COVID-19-Infected and Recovered Individuals

 

On Politics, Bad Science, and the End that Justifies the Means: The Case Against Forced Vaccinations in Previously COVID-19-Infected and Recovered Individuals

Introduction

Validity is the ability of a research tool or experiment to accurately measure a predefined endpoint in order to assess a rational hypothesis. But, when erroneous conclusions are drawn based on a convoluted study design that lacks validity, this becomes bad science. Worse yet, when the scientific process is undertaken teleologically with a predetermined outcome as its goal, it becomes misconduct. If teleological “science” is intentionally generated to help promote a politically or financially biased narrative, serious harm to individuals and society at large may ensue. In line with those definitions, the paper recently published by the Centers for Disease Control and Prevention (CDC) in their Morbidity and Mortality Weekly Report, which claims superiority of vaccine immunity over natural immunity, represents the textbook definition of poor validity and, at the very least, bad science [1].

Background: A Teleological Emergency?

Through a systematic review and pooled analysis of the literature, we recently compiled the best available scientific evidence comparing the effectiveness of natural immunity and vaccine immunity to COVID-19 [2]. Using stringent inclusion criteria, we limited our analysis to 7 high-quality publications, including a total of 279,107 patients and 56,161 patient-years of follow-up. Compared with the unvaccinated COVID-19-naive cohort, vaccinated patients (i.e. the “vaccine immunity cohort”) had a significantly reduced infection rate (0.9% vs. 4.7% per personyear), yielding a number needed to treat (NNT) of only 6.5 patients to prevent 1 COVID-19 infection per year. Similarly, the previously infected, unvaccinated cohort (i.e., the “natural immunity cohort) had a significantly reduced risk of reinfection (0.25% per personyear) compared with the same COVID-19- naive cohort. When compared head-to-head with the natural immunity group, the vaccine immunity cohort had a 1.86 relative risk (RR) of infection, which was found to be non-statistically significant, but a 0.049% absolute risk (AR) increase, which was statistically significant. Thus, natural immunity against COVID-19 was found to be at least equivalent to vaccine immunity in conferring protection against infection or reinfection. Among all groups, the risk of COVID-19 infection/reinfection was lowest (0.15% per person-year) in previously infected, vaccinated individuals, suggesting a marginal but statistically significant incremental benefit of vaccination in the previously infected and recovered population (RR: 1.82, AR reduction: 0.0039%).

This small benefit of vaccination translated into a very high NNT of 218 in the previously infected and recovered cohort, raising serious doubts about the favorability of the risk-benefit ratio of routine vaccination in this population, even if only well-established, short-term risks of vaccination are taken into account (potential long-term risks, especially in young people, remain unknown at this point). Almost immediately following the publication of our study after in-depth peer review, the CDC released a paper in their Morbidity and Mortality Weekly Report (MMWR), reporting on a cross-sectional study of hospitalized patients with “COVID-19- like illness” within a network of several US hospitals (the “VISION Network”), which putatively demonstrates the superiority of vaccine immunity over natural immunity, thereby attempting to negate the findings of our study [1]. Not surprisingly, the CDC paper was immediately and heavily publicized by media companies and on social media, claiming that vaccines are five times as effective as natural immunity in this regard and that the debate on this issue has essentially been settled in favor of vaccines [3-9]. The implications of this study, according to CDC, is that “all eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2” [1]. Unfortunately, as stated above and detailed below, the CDC paper represents bad science, of the kind we warn our youngest and most inexperienced research students to avoid at all costs, as they start learning the basics of medical and clinical research. Political analysis and opinions remain beyond the scope of this letter. Specifically, the reasons and exact circumstances underlying this scientific mishap by the CDC, traditionally a highly respected and credible source of medical information, will not be discussed here. Only the merits (lack thereof) of their paper will be discussed.

The Fundamental Problem: Study Validity (Lack Thereof)

The fundamental and primordial problem with the CDC study is its total lack of validity. The CDC sought to compare protection against COVID-19 infection/reinfection between vaccinated patients and those unvaccinated, but with natural immunity from a previous infection. Unfortunately, what they ended up measuring in this study was a totally unrelated and quite irrelevant endpoint. Rather than using a longitudinal, population-based (community + hospital) observational cohort design to help answer this research question, the authors relied on an awkward hospital-based crosssectional design, looking at all patients within their VISION Network hospitals who, in the first 8 months of calendar year 2021 (January 1 - September 2):
1) Were admitted with a COVID-19-like illness (i.e., largely a population of patients with various flu syndromes),
2) Underwent molecular testing for COVID-19, and
3) Had, 3-6 months earlier, either had a laboratory-proven COVID-19 infection or completed a two-dose vaccination with an FDA-approved mRNA vaccine.

Interestingly, of an initial grand total of 201,269 hospitalizations, only 7,348 patients (3.7% of the entire cohort), 6,328 in the vaccine immunity group and 1,020 in the natural immunity group, satisfied the inclusion criteria and were analyzed. The authors compared the proportions of COVID-19 positive tests in the two groups of patients and found a higher rate of COVID-19 positivity in the unvaccinated, previously infected group, with a crude odds ratio of 1.77 (8.7% vs. 5.1%). Using ill-defined, seemingly acrobatic, and largely opaque statistical adjustments and propensity-based calculations (not detailed or explained in the paper), the authors present a final adjusted odds ratio of 5.49 in favor of vaccines. Those and other methodological red flags and flaws will be discussed below. However, the most fundamental flaw of this paper, its absolute lack of validity, needs to be addressed first. In fact, what the authors claim they have proven is not at all what their data has actually shown. At best, the authors can conclude that a hospitalized patient with clinical symptoms suspicious for COVID-19 who [3-6] months ago, had prior infection with SARS-CoV-2, would be more likely (1.8- 5.5x) to test positive for COVID- 19, but less likely to test positive for other flu viruses or respiratory infections than an otherwise similar patient that, 3-6 months ago, received an mRNA vaccine. In other words, what the authors measure here is merely the rate of COVID-19 positivity relative to other infectious agents with similar clinical presentation in each of those two patient populations. Given the lack of longitudinal follow-up, this does not at all mean that vaccinated patients developed less COVID-19 infections than their naturally immune counterparts. For instance, one could potentially argue that mRNA vaccines might have led to higher rates of viral illnesses and hospitalizations relative to natural immunity, but that its negative impact on non-COVID-19 infections might have been even worse than that on COVID-19, hence a lower proportion of in-hospital SARS-CoV-2 positivity relative to other infectious agents. If that assumption was true, then increased rates of both COVID-19 and COVID-19-like illnesses and related hospitalizations would be accurately uncovered by a longitudinal observational cohort study. In contrast, a cross-sectional study design would lead to the erroneous conclusion that the relative rate of COVID-19 is lower in the vaccinated group. Interestingly enough, in the CDCanalyzed in-hospital cohort, the absolute number of patients with COVID-19-like illnesses who were previously vaccinated is over 6 times larger than that of patients with natural immunity (6,328 vs. 1,020). Even the absolute number of hospitalized patients with laboratory-proven COVID-19 is over 3.5 times higher in the vaccinated group (324 vs. 89). Such ratios (6:1 and 3.5:1) are way out of proportion to the rates of vaccination in the US population. Perhaps, one would rather conclude from this study that, in sharp contrast to the authors’ claim, patients with natural immunity tend to stay healthier and away from hospitals compared with those who received mRNA vaccines.

More Methodological Frailty: Flaws, Biases, and Red Flags

Aside from the fundamental validity problem presented above, the CDC study is replete with methodological mishaps, which we summarize below.

Selection Bias: The analyzed patient cohort is relatively very small, representing only 3.7% of the original cohort of hospitalized patients with COVID-19-like illness. While large numbers of patients had to be excluded based on the authors’ (otherwise reasonable) inclusion criteria, such a large number of excluded patients almost invariably introduces significant selection biases into the statistical analysis.

Subject Misclassification: To be included in the vaccine immunity cohort, a patient had to have had at least 1 negative molecular COVID-19 test, at least 14 days prior to the index hospitalization. Given that a single negative test does not cover the entire 3 to 6-month period preceding the index hospitalization, it is entirely possible that many patients with prior undiagnosed COVID-19 infections were mistakenly misclassified into the vaccine immunity group, which could potentially affect the results of the study.

Unorthodox Statistical Adjustments: The questionable, poorly defined, very opaque statistical adjustments and propensitybased calculations performed by the authors managed to convert a crude odds ratio of only 1.77 into an “adjusted” odds ratio of 5.5 in favor of vaccines, which has since been widely publicized by the media (i.e. vaccines are being advertised as “five times more effective” than natural immunity) [3-9]. For instance, propensity score matching should generally not be used in groups with very little overlap, since it can introduce significant error. Yet, their data set falls precisely under this category. For the sake of transparency and credibility, we invite the authors to publish a follow-up publication detailing their statistical methodology and presenting their raw data.

Selective Time Filtering: The authors excluded patients with prior COVID-19 infection 14-90 days before the index hospitalization and those with mRNA vaccinations over 6 months prior. This convenient cherry-picking is likely to favor vaccine immunity by design, given that natural immunity is typically robust in the weeks following COVID-19 infection, while vaccine immunity has been shown to wane after 6 months [10-14].

Exclusion of Janssen Vaccine Recipients: It is a blaring fact that the authors entirely excluded recipients of the Janssen vaccine, which is generally known to be the least effective of the 3 FDA-approved COVID-19 vaccines. Excluding this small subset of vaccinated subjects from the analysis is an undeniable “fudge factor” in this paper, which is likely to skew the analysis even further in favor of vaccine immunity.

Conclusion

The paper recently published by the CDC has little, if any, merits and should have no impact whatsoever on the decision to vaccinate previously COVID-19-infected and recovered individuals, let alone mandate and force such vaccinations on them [1]. We urge the CDC to retract this paper or, at the very least, issue a clear and unequivocal statement acknowledging its severe methodological limitations. This agency’s credibility is truly at stake here. The CDC has to strive to free itself from overreaching politics, regain the trust of the population, and restore its image as a uniquely credible and authoritative public health resource for America and the world. Finally, we would like to reiterate that, to date, the best available evidence on the topic of natural vs. vaccine COVID-19 immunity is clearly laid out in our recent systematic review [2], and its conclusions are clear:
1) Natural immunity to COVID-19 is at least equivalent, if not superior, to that conferred by vaccines.
2) Administering vaccines to previously infected and recovered individuals may provide a slim benefit, but one so slim it would likely be outweighed by the known short-term risks of vaccination, as well as its unknown potential long-term risks in young people.
3) The decision to receive added vaccination in the naturally immune must be left to remain a matter of personal choice and individual consent, in line with the person’s right to bodily autonomy, a basic and sacred tenet of medical ethics.


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Friday, August 25, 2023

Foliar Versus Soil Biofortification of Zn in Citrus (Citrus Reticulata Blanco) Effect on Mineral Nutrition and Fruit Yield and Quality

 

Foliar Versus Soil Biofortification of Zn in Citrus (Citrus Reticulata Blanco) Effect on Mineral Nutrition and Fruit Yield and Quality

Introduction

Gaining maximum yield and benefit with optimum use of nutrients source is the common objective of the growers worldwide. Most of the nutrient element are soil applied whereas few are applied on the foliage. Soil application needs higher dose and is more often and most effective for the nutrients (Fageria et al. [1]). However there are few circumstances that foliar application of nutrient is more economic and effective. Application of soil fertilizers is done on the basis of soil test where as foliar application is done on the basis of visible cues or detailed plant tissue examination. So correct diagnosis of the nutrient deficiency is the fundamental for the successful foliar fertilization (Fageria, et al. [1]). Moreover some peculiar traits which are required for foliar application of nutrient elements are higher leaf area index so as to absorb nutrients elements instantly. The nutrient elements should be applied more than once based on the severity symptoms. Highly soluble fertilizer can be applied in the optimum temperature and sunshine avoiding leaf burning. Foliar application of the fertilizer can complement to the soil application. Such foliar application can be sprayed in combination with insecticides, postemergence herbicides or fungicides with increased the net benefit by reducing the cost of application (Fageria, et al. [1]). Moreover multiple nutrient elements such as Fe, Zn and Cu can be mixed and sprayed together which saves both time and money (Bhantana, et al. [2]).
The growth and development of plant is enhanced by effective application of proper amount of nutrient in the root zone. And adverse effect on plant growth and development is appeared due to failure to apply balanced fertilization. So not only Zn but also each and every nutrient required for balanced fertilization i.e. an application of macro and micro nutrient elements such as N, P, K, Ca, Mg, S, Fe, Mn, Zn, B, Mo, Cu, Cl, Ni etc in proper amount (Kumar, et al. [3]). Zn is an important micronutrient for plants. Zinc in soil and plant nutrition is becoming major concern over the more than forty different countries worldwide (Alloway [4]). Some examples of soil which are deficient in Zn are calcareous soil, sandy soil, tropical weathered soil, saline soil, waterlogged soil and heavy clay soil etc. (Alloway [4]). In the soil solution there is decrease in Zn by 30 fold with each unit increase in pH from 5- 7. When soil pH is higher than 8 the zinc bound more strongly causing poor availability of the Zn in soil solution (Cakmak, et al. [5]). Heavy fertilization with nitrogen is reported to have Zn deficiency in citrus of Florida. This is because that the application of nitrogen increases tissues numbers and sizes and eventually increases Zn hunger, the dilution effect. Similarly nitrogenous fertilizer increase acidity in the soil which increases Zn availability (Swietlik [6]). So a study of physiological response of Zn on fruit yield and quality parameters is taken for this study. Lack of Zn supplementation in daily diet is the major issue for the health of the global citizen (Bhantana et al. [2]). In the present scenario more than 1.1 billion people are suffering from lack of Zn nutrition (Kumssa, et al. [7]). Zinc can be applied to the soil or foliage respectively. There is a huge gap between the Zn supply and Zn requirement. Combined application of both soil and foliar application of Zn is practiced from the time ahead to minimize the gap (Bhantana et al. [2]). Inadequate supply of Zn in human food cause to lead several symptoms. Major symptoms of the Zn deficiency are growth retardation, delayed sexual and mental development, eczema and hair loss (Barokah, et al. [8]). And it is also reported that about 300 proteins in the human body are Zn dependent (Krezel, et al. [9]).
Some agronomic, breeding and biotechnological aspect of biofortification are essential to acquire the diversification of food. Monoculture is the key aspect of the reduced Zn fortification to the crop and their final product. Similarly people in the developing countries are highly dependent on plant based food rather than animal based diets (Cakmak, et al. [5]). A gap between daily requirement (40-50 mg Kg-1) and supplement (20 mg Kg- 1) is observed (Cakmak, et al. [5]). This is how an agronomic biofortification of cereals and fruits needs to be done. In this study both crop hunger with Zn and Zn hunger for food for the humans is addressed. In citrus orchard Zn is the most frequently occurring nutritional disorder. This is how two conventional used methods soil and foliar application are concurrently practiced. After N, Zn is the most widespread nutritional element frequently threatening the citrus industry. Both flowering and fruit set are affected by the Zn fertilization. Superiority of foliar application over soil application increase the fruit number and weight (Srivastava [10]). So both the methods and amount of application of Zn pertains importance over citrus quality and production (Razzaq, et al. [11]). Use of foliar spray with 0.6% increase tree height, crown width and stem girth. Also fruit diameter, fruit weight, vitamin C and total phenolics is increased in treated plant than untreated (Razzaq, et al. [11]). Hence the use of soil or foliar application solely in agreement to the field condition is practiced in this research. This is how this project is specially focused to deal with crop hunger and human hunger for the Zn.

Materials and Methods

The research was carried out in the Huazhong Agricultural University (HZAU; 30°28′26″N, 114°20′51″E), Wuhan, China. A study on the response of foilar cum soil biofortification of Zn on citrus trees was done in the two varieties namely Wenzhou and Nanfeng in the five year old orchard. Similarly the SPAD (Soil Plant Analysis Development) value of the five leaves per tree were measured as described in the (Ling, et al. [12]). Twenty seedlings of ‘Wenzhou’ and ‘Nanfeng’ each were planted in the plant nutrition research block in the year 2014. The treatment consisted of three different levels of Zn application. The three different concentrations of foliar Zn application were 0, 0.5 and 1.0 percentage and the three different concentration of soil applied Zn were 0, 40 and 80 g/tree. Chlorophyll concentration, including Chlorophyll A, Chlorophyll B and caretenoids were measured by treating with 95% ethanol based on the following equation with spectrophotometric observation (Sumanta, et al. [13]).

Similarly the data on SPAD was measured on three different dates 13 May 2019, 10 June, 2019 and 20 July 2019. For the determination of NPK concentration in plant samples, plant samples were dried in forced air oven at 70oC to constant weight. Grinding and sieving of dried samples were done through 0.5 mm screen. 0.12g of finely grounded samples were mixed with 5ml of sulphuric acid (H2SO4) and wait for 12 hour for digestion. Then the samples were digested in digestion system of fume hood. The samples were heated to 180oC for 3 hour with addition of H202. After fully digested samples to clear white are transferred to 50 ml volumetric flask and dilute to 50 ml with deionized water. The Barbano and Clark 1990; method is used for the determination of N by using Kjeldahl apparatus. Similarly, colorometric method (Lu, [14]) was used to determine the concentration of P after digestion of the plant samples in H2SO4-H2O2. Moreover flame photometric technique was used for the determination of K in plant samples after the samples were completely digested in H2SO4-H2O2. The digested solution were distillated, filtrated and transferred to 50 ml volumetric flask and diluted to 50 ml with deionized water. The Zn in plant tissue in this study was determined by DTPA (Diethyltriamine pentaacetic acid) extraction-atomic absorption spectrophotometer method as described in (Katyal, et al. [15]). Similarly the vitamin C was measured by titration with 20% oxalic acid as quoted in (Najwa, et al. [16]) and hand held refractrometer was used for the measurement of total soluble solids as described in Echeverria, University of Florida, IFAS. Similarly titrable acididty was measured by titration of fruit juice with NaOH as described in the (Islam, et al. [17,18]).

Results

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Figure 1: Microgram per litre (μg/L) concentration of chlorophyll A, Chlorophyll B and caretenoids in varying level of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou.

The determination of chlorophyll A, chlorophyll B and caretenoids of the variety Wenzhou are shown in the –(Figures 1A-1B)) with foliar spray of 0, 0.5 and 1 percentages and soil application of 0, 40 and 80 g/tree ZnSO4 respectively. In both figure Chlorophyll A is appeared on the top, Chlorophyll B in the middle and caretenoids in the bottom. Similarly, the determination of chlorophyll A, chlorophyll B and caretenoids of the variety Nanfemg are shown in the (Figures 2A-2B)) with foliar spray of 0, 0.5 and 1 percentages and soil application of 0, 40 and 80 g/tree ZnSO4 respectively. Again in the both figures Chlorophyll A is appeared in the top, Chlorophyll B in the middle and caretenoids in the bottom. The concentration of chlorophyll A, chlorophyll B and caretenoids in Wenzhou and Nanfeng as expressed in μg/L showed similar results. The data on soil plant analysis development (SPAD) is shown of in the Figures 3 & 4. The data were recorded in three different dates 13-May, 10-June and 20-July 2019 respectively. More mature the leaf the higher the reading of the SPAD. These SPAD values were arranged in ascending order 13-May, 10-June and 20-July. Besides the SPAD values in two varieties of citrus was observed similar. Also it appeared that the SPAD values observed similar with foliar application 0, 0.5 and 1 percentages and soil application of 0, 40 and 80 g ZnSO4 per tree (Figures 3 & 4). In most of the cases on an average the value of SPAD varied between 40-85. There is no distinct variation in SPAD values with foliar application of ZnSO4 0, 0.5 and 1% and soil application of ZnSO4 0, 40 and 80 g/tree respectively. Based on the chlorophyll measurement (Figures 1 & 2) and SPAD value (Figures 3 & 4) and that there is not a significant variation in Wenzhou and Nanfeng. Similarly there is no difference between foliar application and soil application of ZnSO4 in this attributes. Percentages of N, P, K with application of Zn as foliar spray or soil application is shown in the (Figures 4A & 4B)) of the respective (Figures 5-7) respectively. The concentration of nitrogen is higher in Nanfeng than Wenzhou in the parameter N in the study (Figure 5). Conversely the parameter Wenzhou is higher than Nanfeng in the parameter P study (Figure 6).

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Figure 2: Microgram per litre (μg/L) concentration of chlorophyll A, Chlorophyll B and caretenoids in varying level of Zn application.
(A) Foliar application and
(B) Soil Application in the variety Nanfeng.

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Figure 3: SPAD values recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou.

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Figure 4: SPAD values recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Nanfeng.

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Figure 5: Percentages of N recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

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Figure 6: Percentages of P recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

Moreover an interaction between Wenzhou and Nanfeng is observed in the (Figure 7) with percentages of K application. When the values of Nanfeng is higher the Wenzhou is lower and vice versa. As shown in all the figures from (Figures 1 & 7) that there is no significant difference in between Nanfeng and Wenzhou varieties. Similarly, the mg of Zn per Kg DM is shown in the (Figure 8). Both in the foliar application and the soil appliation, the Zn content in the Nanfeng is higher than Wenzhou. In the (Figure 8), it seemed a weak interaction between these two varieties for the parameter Zinc concentration. At zero concentration the Nanfeng has higher value of Zn supply than Wenzhou and other higher concentrations for example at 0.5 and 1 percentages of the foliar spray or 40 and 80 g/tree of soil application of ZnSO4. Likewise total fruit yield t/ ha is shown in (Figure 9). The fruit yield varied between 30-10 t/ ha in Wenzhou and it varied between 10-5 t/ha in Nanfeng. Also the vitamin C content in relation to the soil and foliar application in the foliar versus soil application of Zn is shown in the (Figure 10). However the analyzed data are not significant the value of vitamin C is higher in case of the variety Wenzhou than Nanfeng. It is observed that at zero concentration of foliar application of ZnSO4 and at Zero concentration of soil application the vitamin c amount is higher than other amount. Even more the total soluble sugars (TSS) is presented in the (Figure 11). The data are not statistically significant the presented values are similar with the application of foliar or soil applied Zn. Last but not the least another parameters for the study of Zn response is titrable acidity (TA). There is interaction between two varieties for the TA. In the variety Nanfeng there is higher value of TA with application of 0.5% foliar applied Zinc and 40 g/tree application of ZnSO4. In the variety Wenzhou the response soil cum foliar application in TA of Zn is the straight line (Figure 12).

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Figure 7: Percentages of K recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

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Figure 8: Milligram of Zn per Kg dry matter recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

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Figure 9: Total fruit yield (t/ha) recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

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Figure 10: Vitamin C (mg/100g) recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

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Figure 11: Total soluble solids (oBrix) recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

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Figure 12: Titrable Acidity (%) recorded in varying levels of Zn application
(A) Foliar application and
(B) Soil Application in the variety Wenzhou and Nanfeng.

Discussion

Micronutrient like Zn plays pivotal role in the growth and development of plant and occupy an important position due to its essentiality (Dewal, et al. [19]). Even more the role of Zn in plant nutrition and increasing soil productivity increase the importance greater. With regards to increase cropping intensity, intensive cropping with high yielding crop and their varieties even increasing the importance of the micronutrient like Zn in agriculture (Dewal, et al. [19]). The present era farming is highly focused to top yield and quality so the attempt has to be paid for the application of Zn. An emphasis in soil or foliar application or combined application of Zn enhanced plant growth, grain yield and the components of grain quality. Zn is an essential attribute of the plant hormones, green chlorophyll and cytochrome (Dewal, et al. [19]). Similarly Zinc is one of the key nutrient element for the growth and production of plant. It helps in the production of chlorophyll pigment in the crop. There are instances to which production of chlorophyll, caretenoids and increase in yield and quality is achieved by application of Zn (Kandoliya, et al. [20]). For example increase in the chlorophyll is achieved at 45 and 70 days after sowing (DAS) (Kandoliya, et al. [20]). Not only foliar application also soil application of Zn increase the grain yield, protein and gluten content of wheat. This is due to increased photosynthesis with the help of increasing leaf pigment and enhanced mineral nutrition (Kandoliya, et al. [20]). The highest Zn content in straw and grain is recorded in chelated Zn treatments. Regarding plant nutrition content the chelated Zn appeared highest than the soil application. Similarly, the use of foliar spray increased the fertilizer use efficiency and wheat nutrient content (Kandoliya, et al. [21]).
But in this research as shown in Figures 1 & 2, the chlorophyll A, Chlorophyll B and Caretenoids did not differ in relation to soil and foliar application of the nutrients. Both variety used in the study showed similar response for the chlorophyll A, chlorophyll B and caretenoids (Kandoliya, et al. [21]). SPAD stands for the soil plant analysis development. SPAD is a hand held device used for the rapid, accurate and non-destructive measurement of leaf chlorophyll concentrations. SPAD is used extensively both in the research and agricultural operation with a range of plant species (Ling, et al. [12]). There are a number of scientific papers published in the area of using SPAD measurement (Uddling, et al. [22]). The SPAD meter (Konica- Minolta, Japan) provides alternative to the data provided through the destructive measurement of ethanol based formulation of leaf chlorophyll as shown in the Figures 1 & 2. This alternative method accounts for overcoming the disadvantages of leaf chlorophyll measurement. SPAD is a tool not very expensive, hand held device based on two light-emitting diodes. Measurement of a silicon photodiode receptor with the measurement of leaf transmittance in the red 650 nm wavelength and 940 nm. The transmittance values are used to derive the relative SPAD meter value are in between 0-50 which is proportional to the chlorophyll concentration in the leaf sample (Uddling, et al. [22]). But in our case the SPAD values varied between 40-80. The recording of the SPAD value differed by the age of the leaf, solar radiation, time of the day, cloudiness etc. Leaf chlorophyll concentration is an important parameter that frequently measures as an indicator of chloroplast development, nitrogen content, photosynthetic capacity or plant health. As mentioned in the (Figures 1 & 2), leaf chlorophyll is destructively quantified in the laboratory. Leaf chlorophyll concentration is an important parameter which correlated with SPAD readings in this study. So in vivo measurement of chlorophyll by SPAD should be focused. Yield and quality of the citrus fruit are subjected to balanced fertilization. New shoots in citrus are correlated with fruit yield. Citrus leaves accounts for 21% and 31-44 % of the above ground biomass and above ground nutrients respectively (Roccuzzo, et al. [23]). Earlier study showed distribution of N in different parts of the citrus such as shoots, leaves and fruits (Roccuzzo, et al. [24]). Measurement of the top shoot leaf nitrogen prior to start of the experiment is 1.72% (Wenzhou) and 2.11% (Nanfeng) (Unpublished data). Similarly in the study after application of Zn varied in between 1.18 to 2.25 in both of the varieties either with the application of foliar nutrition or soil. Mineral nutrients composition in the citrus fruits is optimized by application of balanced nutrition. Concentration of nutrients in citrus fruit varied with amount of N(52.70–71.4%), P (66.5–80.4%) and K (68.9–85.9%) (Fan, et al. [25]).
Furthermore, the nutrient requirements per unit of newly developed shoots and fruits were gradually decreased and increased. These information is useful for the pruning and fruit thinning of the citrus orchard (Fan, et al. [25]). Moreover, the concentration of N and K is increased highly in the citrus fruit. Whereas the P is required for the tree growth (Zambrosi, et al. [26]). As presented in the (Figure 5). the concentration of N is higher in the variety Nanfeng in comparison to Wenzhou. The value of N percentage is significant at 0.5% of the foliar application than Wenzhou as shown in the (Figure 5A). In addition an alternate bearing is closely looked and the citrus tree fetched great amount of nutrition which is still unresolved (Martinez-Alcantara, et al. [27,28]. China is one of the key producers of citrus but still there is problematic situation due to low yield, excessive fertilization and alternate bearing. Practice of rational fertilization, quantification of new tissues, nutrient demand rules are suggested for the improvement. Moreover high and stable yield, and high citrus quality in citrus plantation can be achieved (Li, et al. [29]). Application of 180 lb N ac-1yr-1 is recommended to sustain optimal tree growth, maintain high fruit quality and production in the citrus orchard of the Florida (Alva, et al. [30]). The rate, placement and timing is essential to meet the proper application of the fertilizer. Also organic sources of nutrient for example the leaf litter can be incorporated as fertilizer. However the leaf analysis showed important parameter for the evaluation of nutritional status of the trees an identification of the nutrient budget is important. Measurement of nutrient budget is one of the way to the fertilizer recommendation for the nutrient uptake efficiency (Alva, et al. [30]). The composition of mineral nutrients for example N, P and K in the fruits varied from 1-1.19, 0.14-0.16 and 1.19 to 1.26 respectively (Alva, et al. [31]). The citrus production is higher than other tropical and subtropical fruits including Banana, Mango, Apple , Pear and Peach (Alva et al., 2006). China alone occupies the highest production of citrus fruit in the world (Li, et al. [29]). Citrus production is mainly suited to sandy to clay loam soil. Soil pH of 6.0 is optimal for citrus production however the pH value between 5.5-7.5 is also adequate based on the different rootstock (Alva, et al. [30]). China ranked the first in position to the production of citrus both in the area and yield.
Citrus is one of the key commodity fruit in terms of farmers income, industrialization, poverty alleviation and provides occupation to needy farmers in the south China mountainous region (Li, et al. [29]). Increment in the fruit quality parameters namely yield and quality, vitamin C, total soluble solids, TA, etc with increased application of N, P and K is recorded (Han, et al. [1]). Application of urea 1.75 Kg plant-1 affect the quality of citrus fruit increasing the content of invert sugar by 12.2% and by reducing the vitamin C by 13.3% (Li, et al. [29]). So it has been observed that application of P increase fruit yield but decrease total soluble solids (Obreza, et al. [32]). Despite the numerous attempts has been paid towards the application of N, P, K on citrus fertilization yields mainly depend on cultivar, age, climate and soil physiochemical properties. In Brazil increase application of P increase the yield of lemons (Obreza, et al. [32]). Increase in the size of the fruit and number are accredited to the increased yield in citrus fruit. Firstly balanced fertilization application increase the number of fruits per tree and secondly the increment in the fruit size is recorded (Li, et al. [29]). An speculation was made towards decrease in aluminium toxicity in the soil with an amount of surplus P fertilization (Nakagawa, et al. [33]). P amendment increase TSS in citrus fruit. Application of P increase the citrus yield and quality (Quaggio, et al. [34]). So application of P increase the yield of citrus by 32.6% with increase both in number and size of the fruit. But the mineral nutrients N and P do not have effect on TSS (Li, et al. [29]). Due to limitation of rootstock and plant growth; a high application for P uptake are desirable. So an experiment was designed for the application of 20, 40 an 80 mg Kg-1 P. Increased in the root growth, shoot growth, P nutrition by the uptake of greater number of other nutrients. In case of Rangpur lime there is increase uptake of P by 13-126%. So P use efficiency of citrus tree can be increased by applying the P in the deeper strata of the soil and use of better rootstock (Zambrosi, et al.
[26]). Potassium has important contribution in yield and quality of the citrus fruit. High amount of K application increase the fruit size and thick and coarse peel. Whereas low amount reduced the size of the fruit with thin peel (Alva, et al. [31]). Similarly the juice acidity is directly proportional to K concentration in the fruit. High acidity is caused by high amount of K and vice versa. Highly available K in soil enduce the uptake of some ions such as magnesium, calcium and ammonium ions (Alva, et al. [31]). The concentration of K in leaf tissue varied between 0.30 to 0.37% before initiation of the treatment (Data not shown). But after initiation of the treatment the value changes to 0.4 to 0.8% in the variety Wenzhou and Nanfeng respectively (Figures 7A & 7B)) in foliar cum soil application of nutrients.
These figures are quiet similar to the data observed in this study. In combined application of 1% urea and 0.8% Zinc sulphate in a every two week interval applied for six year increase the yield and quality of 15 year old apple trees. Increase in yield is solely due to the increase in the mean fruit size (Amiri, et al. [35]). The highest yield observed is 49 Kg/tree with the maximum fruit size (202g). Whereas the lowest yield recorded was 35 Kg/tree with the maximum fruit size 175 g (Amiri, et al. [35]). Lower record of the fruit in the control treatment is due to pre-harvest fruit drop and smaller size of the fruit. As shown in the (Figure 9A); in this study the fruit yield varied from 30 to 15 t/ha in Wenzhou and 5 to 15 t/ha in Nanfeng respectively in the foliar application. But in the (Figure 9B) with soil application of Zn fertilizer increased the yield in Wenzhou to 15-35 t/ha. These Figures also showed the fruit yield in the Nanfeng with foliar or soil application of Zn. The differences in the yield observed is varietal and has not any relation with the Zn application under both soil and foliar application. The concentration of P in top shoot samples prior to start of the experiment are 0.17 and 0.16% in the top shoots of oranges respectively (unpublished data). And in the current study the P concentration varied between 0.15-0.35% respectively. The amount of vitamin C quantified in the concentration of mg per 100 g of fruit is presented in the Figure 10. The vitamin C is measured with titration method. As shown in the Figures 10A & 10B, the vitamin C ranges from 10-25 mg/100 g of the fruit. According to the Najwa and Azrina, 2016, the vitamin C content of the orange, grapefruit, lemon, kaffir lime, lime and musk lime are 58.3, 49.15, 43.96, 37.24, 27.78 and 18.62 mg per 100g respectively. The finding of our research is below than the aforementioned value except in musk lime. However the different method used in the determination has different values for the vitamin C. The use of HPLC method is closely suited to our values as determined by (Najwa, et al. [36]). In the HPLC the 43.61, 31.33, 26.4, 22.36, 21.58 and 16.78 mg/100 g of orange, lemon, grapefruit, lime, kaffir lime and musk lime is observed respectively. Significant variation is observed in the study of vitamin C of samples by both methods. Both of the methods are suitable for the determination of vitamin C, however the HPLC method is more accurate, precise and specific (Najwa, et al. [36]).
TSS value as measured by the hand refractrometer is shown in the Figure 11. Similarly the value of TA is shown in the Figure 12 by titration with 0.1 N sodium hydroxide solution and phenolphthalein indicator (Suszek, et al. [37]). Total fruit yield ranges from 2.04 to 11.70 Kg/tree in the year 2009 and 5.52 to 32.94 Kg/tree in the year 2010 (Suszek, et al. [37]). Occurrence of drought spell in flowering and fruiting time may cause the difference in the yield. Smaller size of the fruit in the year 2009 cause lower yield. The average size of the fruit as observed was 323g and 310g respectively in the year 2010 and 2009 respectively. The value of TSS in the year 2009 is 6.23 to 8.65 oBrix and in the year 2010 is 6.18 to 9.11 oBrix (Suszek, et al. [37]). These values are close to the values presented in the (Figure 11). Similarly the value of titrable acidity (TA) as observed in this study is shown in the Figure 12. The TA value ranges from 0.53-0.99 % in the year 2009 and 0.40-0.71 % in the year 2010 (Suszek, et al. [37]). These values are in close connection with the data presented in the (Figure 12). Soil Zn concentration measured by DTPA method in mg per kg dry matter is 22.35 (unpublished data) before start of the experiment. This value is higher than the critical value of the Zn in soil. So the plant do not experience Zn deficiency in the treatment. As shown in Figure 9, the yield of two varieties as known as Wenzhou and Nanfeng under foliar as well as soil application of Zn do not differed each other. Symptoms of chlorosis is appeared in some instances but not so severe. So there is no significant difference in the foliar cum soil application of Zn in this study. Based on the feasibility farmers are recommended to choose foliar application Zn than soil application. Since there is not significant variation in the yield and yield attributing parameters in these two treatment in the citrus trees of Wuhan.

Conclusion

Zinc is not only an essential nutrient element but also a heavy metal. So, in spite of the ameliorating effect, Zn has a deleterious effect when applied in excess. This is how due care has to be paid for the successful incorporation of Zn in cropping system. Soil test values are required to judge the concentration of the Zn in soil. Similarly the evaluation of Zn in plant tissue are required. However Zn value differed from soil types, plants and their varieties and crop growth stages. The critical limit for the Zn concentration from the soil in Wuhan, China is 22.35 mg Kg-1. So attention has to be paid for successful incorporation of Zn in an agro ecosystem. In regards to the critical limit research has to be carried out more frequently to access the ground reality in connection with the published literature. Moreover fruit yield and quality like vitamin C, total soluble solids, titrable acidity etc are increased with the application of Zn in different crops grown. So the human demand for Zn and crop hunger can be satisfied (Krezel, A et al. [38]).


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