Search

The Green Edge project was designed to investigate the onset, life, and fate of a phytoplankton spring bloom (PSB) in the Arctic Ocean. The lengthening of the ice-free period and the warming of seawater, amongst other factors, have induced major changes in Arctic Ocean biology over the last decades. Because the PSB is at the base of the Arctic Ocean food chain, it is crucial to understand how changes in the Arctic environment will affect it. Green Edge was a large multidisciplinary, collaborative project bringing researchers and technicians from 28 different institutions in seven countries together, aiming at understanding these changes and their impacts on the future. The fieldwork for the Green Edge project took place over two years (2015 and 2016) and was carried out from both an ice camp and a research vessel in Baffin Bay, in the Canadian Arctic. This paper describes the sampling strategy and the dataset obtained from the research cruise, which took place aboard the Canadian Coast Guard ship (CCGS) Amundsen in late spring and early summer 2016. The sampling strategy was designed around the repetitive, perpendicular crossing of the marginal ice zone (MIZ), using not only ship-based station discrete sampling but also high-resolution measurements from autonomous platforms (Gliders, BGC-Argo floats …) and under-way monitoring systems. The dataset is available at https://doi.org/10.17882/86417 (Bruyant et al., 2022).

A 2-year-long time series of currents and acoustic backscatter from an acoustic Doppler current profiler, moored over the eastern Beaufort Sea continental slope from October 2003 to September 2005, were used to assess the dynamics and variability of the sound-scattering layer. It has been shown that acoustic backscatter is dominated by a synchronized diel vertical migration (DVM) of zooplankton. Our results show that DVM timings (i) were synchronous with sunlight and (ii) were modified by moonlight and sea ice, which attenuates light transmission to the water column. Moreover, DVM is modified or completely disrupted during highly energetic current events. Thicker ice observed during winter–spring 2005 lowered the backscatter values but favored extending DVM toward the midnight sun. In contrast to many previous studies, DVM occurred through the intermediate water layer during the ice-free season of the midnight sun in 2004. In 2005, the midnight-sun DVM was likely impacted by a high acoustic scattering generated by suspended particles. During full moon at low cloud cover, the nighttime moonlight illuminance led to zooplankton avoidance of the subsurface layer, disrupting DVM. Moreover, DVM was disrupted by upwelling, downwelling, and eddy passing. We suggest that these deviations are consistent with DVM adjusting to avoid enhanced water dynamics. For upwelling and downwelling, zooplankton likely respond to the along-slope water dynamics dominated by surface- and depth-intensified flow, respectively. This drives zooplankton to adjust DVM by aggregating in the low or upper intermediate water layer for upwelling and downwelling, respectively. The baroclinic eddy reversed DVM below the eddy core.

The Green Edge initiative was developed to investigate the processes controlling the primary productivity and fate of organic matter produced during the Arctic phytoplankton spring bloom (PSB) and to determine its role in the ecosystem. Two field campaigns were conducted in 2015 and 2016 at an ice camp located on landfast sea ice southeast of Qikiqtarjuaq Island in Baffin Bay (67.4797∘ N, 63.7895∘ W). During both expeditions, a large suite of physical, chemical and biological variables was measured beneath a consolidated sea-ice cover from the surface to the bottom (at 360 m depth) to better understand the factors driving the PSB. Key variables, such as conservative temperature, absolute salinity, radiance, irradiance, nutrient concentrations, chlorophyll a concentration, bacteria, phytoplankton and zooplankton abundance and taxonomy, and carbon stocks and fluxes were routinely measured at the ice camp. Meteorological and snow-relevant variables were also monitored. Here, we present the results of a joint effort to tidy and standardize the collected datasets, which will facilitate their reuse in other Arctic studies. The dataset is available at https://doi.org/10.17882/59892 (Massicotte et al., 2019a).

As part of the international, multidisciplinary project Malina, downward particle fluxes were investigated by means of a drifting multi-sediment trap mooring deployed at three sites in the Canadian Beaufort Sea in late summer 2009. Mooring deployments lasted between 28 and 50 h and targeted the shelf-break and the slope along the Beaufort-Mackenzie continental margin, as well as the edge between the Mackenzie Shelf and the Amundsen Gulf. Besides analyses of C and N, the collected material was investigated for pigments, phyto- and microzooplankton, faecal pellets and swimmers. The measured fluxes were relatively low, in the range of 11–54 mg m−2 d−1 for the total mass, 1–15 mg C m−2 d−1 for organic carbon and 0.2–2.5 mg N m−2 d−1 for nitrogen. Comparison with a long-term trap data set from the same sampling area showed that the short-term measurements were at the lower end of the high variability characterizing a rather high flux regime during the study period. The sinking material consisted of aggregates and particles that were characterized by the presence of hetero- and autotrophic microzooplankters and diatoms and by the corresponding pigment signatures. Faecal pellets contribution to sinking carbon flux was important, especially at depths below 100 m, where they represented up to 25 % of the total carbon flux. The vertical distribution of different morphotypes of pellets showed a marked pattern with cylindrical faeces (produced by calanoid copepods) present mainly within the euphotic zone, whereas elliptical pellets (produced mainly by smaller copepods) were more abundant at mesopelagic depths. These features, together with the density of matter within the pellets, highlighted the role of the zooplankton community in the transformation of carbon issued from the primary production and the transition of that carbon from the productive surface zone to the Arctic Ocean's interior. Our data indicate that sinking carbon flux in this late summer period is primarily the result of a heterotrophic-driven ecosystem.

Abstract Background Patients with Alzheimer’s disease and related dementias (ADRD) and traumatic brain injury (TBI) and their caregivers require cognitive and behavioral symptom management, interdisciplinary care, support for caregivers, and seamless care coordination between providers. Caring for someone with ADRD or TBI is associated with higher rates of psychological morbidity and burden, social isolation, financial hardship, and deterioration of physical health. Tremendous need exists for primary care–based interventions that concurrently address the care needs of dyads and aim to improve care and outcomes for both individuals with ADRD and TBI and their family caregivers. Methods The Aging Brain Care Acquiring New Skills While Enhancing Remaining Strengths (ABC ANSWERS) study is a randomized controlled trial that tests the effectiveness of an intervention based on two evidence-based programs that have been developed for and previously tested in populations with ADRD, TBI, stroke, and late-life depression and/or who have survived an intensive care unit stay. This study includes 200 dyads comprised of a veteran with a diagnosis of ADRD or TBI and the veteran’s primary informal caregiver. Dyads are randomized to receive the ABC ANSWERS intervention or routine Veterans Health Administration (VHA) primary care with a standardized educational and resource information packet. Data collection occurs at baseline and three follow-up time points (3 months, 6 months, and 12 months). The primary outcome is caregiver quality of life (QoL). A secondary measure for the caregiver is caregiver burden. Secondary measures for both the veteran and caregiver include symptoms of depression and anxiety. Discussion The ABC ANSWERS intervention integrates common features of an evidence-based collaborative care model for brain health while concurrently attending to the implementation barriers of delivering care and skills to dyads. We hypothesize that caregivers in dyads randomized to the ABC ANSWERS program will experience higher levels of QoL and lower levels of depression, anxiety, dyadic strain, and caregiver burden at 12 months than those receiving usual VHA primary care. Trial registration ClinicalTrials.gov, NCT03397667 . Registered on 12 January 2018.

There is a lack of evidence to support the effectiveness of long-term opioid therapy in patients with chronic, noncancer pain. Despite these findings, opioids continue to be the most commonly prescribed drug to treat chronic back pain and many patients undergoing spinal surgery have trialed opioids before surgery for conservative pain management. Unfortunately, preoperative opioid use has been shown repeatedly in the literature to negatively affect spinal surgery outcomes. In this review article, we identify and summarize the main postoperative associations with preoperative opioid use that have been found in previously published studies by searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Opioid dependency, postoperative, spinal surgery, specifically (1) increased postoperative chronic opioid use (24 studies); (2) decreased return to work (RTW) rates (8 studies); (3) increased length of hospital stay (LOS) (9 studies); and (4) increased healthcare costs (8 studies). The conclusions from these studies highlight the importance of recognizing patients on opioids preoperatively to effectively risk stratify and identify those who will benefit most from multidisciplinary counseling and guidance., Competing Interests: The authors have no conflicts of interest to disclose, in terms of funding and research support, employment, personal financial interest, patents, and consultation fees within the last five years. One of the authors (FI) is on the editorial board of this journal. Based on journal policy this author was completely excluded from any review of this article., (Copyright © 2023, Fortier et al.)

Preeclampsia is a serious condition responsible for much pregnancy-related morbidity and mortality. Diagnosis of preeclampsia is difficult due to the non-specific and subjective nature of symptoms of the disease. To reduce the subjective decision making and management of preeclampsia, we identified a panel of biomarkers representing multiple and different pathogenic pathways implicated in the etiology of preeclampsia, and developed a test referred to as Preecludia™. An algorithm based on eight biomarkers (cluster of differentiation 274 (CD274), decorin, endoglin, fibroblast growth factor-21 (FGF21), soluble fms-related tyrosine kinase 1 (sFlt-1), kidney injury molecule-1 (KIM-1), free placental growth factor (PlGF), and total PlGF) and gestational age at the time of sample collection was constructed to rule out preeclampsia in women presenting with signs and symptoms of preeclampsia. The analytical performance of each of the individual biomarker assays that comprise the Preecludia™ test was evaluated. Herein we report the test's precision, analytical range, analytical sensitivity, parallelism, linearity, interference, analytical specificity, analytical accuracy, and stability. The data indicate that these biomarker assays exhibit a high level of inter-run precision of less than 15%, with minimal interference., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The objective of this study was to determine the effects of an oral, commercially available, marine based omega-3 fatty acid (n3-FA) supplement on fatty acid characteristics in horse whole blood. Fifty healthy, adult horses of various light breeds were assigned to one of two treatment groups: Group 1 receiving 7.5g/day of the test supplement, and Group 2 receiving 15g/day of the test supplement. The supplement contained 0.092g docosahexaenoic acid (DHA) and 0.148g eicosapentaenoic acid (EPA) per gram. Therefore, Group 1 received 1.11g of EPA and 0.69g of DHA daily, while Group 2 received 2.22g of EPA and 1.38g DHA daily. Blood was taken at time of enrollment and after 6 and 12 weeks of supplementation. Blood was subjected to gas chromatography to quantify the fatty acid characteristics of whole blood. At both 6 and 12 weeks following supplementation, there was a significant increase in all n3-FAs evaluated, including DHA and EPA, compared to baseline values, with Group 2 significantly increased compared to Group 1 at both time points. There was also a significant decrease in omega-6 fatty acids (n6-FAs) between baseline and 6 weeks of supplementation in both groups, with a larger decrease seen in Group 2. The dose-dependent increases in concentration of all n3-FAs evaluated at all-time points validates the use of this product as a n3-FA targeted supplement in horses. These findings also suggest that dose of supplement has a greater effect on increasing whole blood n3-FAs compared to duration of treatment., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective . BioCartilage is a desiccated, particulated cartilage allograft used for repair of focal cartilage defects. It is mixed with a biologic such as bone marrow concentrate (BMC), pressed into a contained defect, and sealed with fibrin glue. The objective of this study was to assess if BioCartilage could serve as a bioactive scaffold by affecting cellular adhesion, cellular migration, or the release interleukin-1 receptor antagonist protein (IL-1RA), and to identify its full proteomic makeup. Design . Cartilage explants were used to model confined defects. BioCartilage was mixed with BMC, grafted into defects, and sealed with 1 of 5 fibrin glues. Constructs were cultured for 24 or 48 hours and then processed for live/dead microscopy. Chondrocyte and mesenchymal stem cell (MSC) adhesion on BioCartilage was assessed using scanning electron microscopy. Conditioned medium from cultures and the biologics used in the study were assayed for IL-1RA. The protein footprint of BioCartilage was determined using bottom-up proteomics. Results . BioCartilage supported chondrocyte and MSC attachment within 24 hours, and cell viability was retained in all constructs at 24 and 48 hours. Fibrin glue did not inhibit cell attachment. BMC had the highest concentration of IL-1RA. Proteomics yielded 254 proteins, including collagens, proteoglycans, and several bioactive proteins with known anabolic roles including cartilage oligomeric matrix protein. Conclusions . This study suggests that BioCartilage has the chemical composition and architecture to support cell adherence and migration and to provide bioactive proteins, which together should have biologics advantages in cartilage repair beyond its role as a scaffold.

Pediatric inpatient and intensive care specialists working outside of tertiary medical centers confront difficult clinical scenarios related to how best to care for extremely ill children who may or may not benefit from advanced medical technology, and these clinicians are often faced with limited local availability. Extracorporeal membrane oxygenation (ECMO) is a technology that is only available at a subset of tertiary care centers, and the decision to risk the transfer of a child for the potential benefit of ECMO is challenging. This article is aimed at addressing the main factors and ethical principles related to this decision-making: (1) whether ECMO is the standard of care, (2) clinical decision analysis of the risks and benefits, (3) informed consent and education of the parents and/or guardians, and (4) institutional leadership decision-making. A decisional framework is proposed that incorporates a thoughtful shared decision-making algorithm., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Background: Reviews and meta-analyses suggest that substance use and suicidality (i.e., suicidal ideations and attempts) are associated in youth, but the direction of this association remains unclear. Theoretically, the secondary psychiatric disorder hypothesis (SPDH) posits that substance use leads to suicidality, while the secondary substance use disorder hypothesis (SSUDH) posits that suicidality leads to substance use. To clarify these associations, this meta-analysis systematically reviewed studies that examined the prospective associations between SUDs and suicidality in youth (age 25 and younger) and compared results according to the direction of the association., Methods: Web of Science, Embase, PsycINFO, PubMed, Medline and ProQuest Dissertations & Theses Global were searched from inception to March 8, 2020, and 55 effect sizes from 23 samples were included and analyzed using a three-level meta-analysis., Results: SUDs significantly predicted subsequent suicidality (OR = 2.16, 95%CI 1.57-2.97), suicidality significantly predicted subsequent SUDs (OR = 2.16, 95%CI 1.53-3.04), and these effect sizes did not differ (p = 0.49)., Conclusions: Considering that 65% of reviewed studies only examined the SPDH, this review highlights that more attention should be given to the SSUDH, and that studies should examine bidirectional associations between SUDs and suicidality across time. Clinically, because SUDs and suicidality were found to influence each other, results suggest that mental health and SUDs should ideally be detected and treated early, and that co-occurring disorders should be assessed and treated concomitantly., Competing Interests: The authors have declared that no competing interests exist.

Idiopathic pulmonary fibrosis (IPF) is a debilitating and fatal condition that causes severe scarring of the lungs. While the pathogenesis of IPF continues to be extensively studied and several factors have been considered, an exact cause has yet to be established. With inadequate treatment options and no cure available, overall disease prognosis is still poor. Existing oral therapies, pirfenidone and nintedanib, may attempt to improve the patients' quality of life by mitigating symptoms and slowing disease progression, however chronic doses and systemic deliveries of these drugs can lead to severe side effects. The lack of effective treatment options calls for further investigation of restorative as well as additional palliative therapies for IPF. Nanoparticle-based sustained drug delivery strategies can be utilized to ensure targeted delivery for site-specific treatment as well as long-acting therapy, improving overall patient compliance. This review provides an update on promising strategies for the delivery of anti-fibrotic agents, along with an overview of key therapeutic targets as well as relevant emerging therapies currently being evaluated for IPF treatment., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Context: The International Association for the Study of Pain (IASP) defines chronic pain as pain that persists or recurs for longer than 3 months. Chronic pain has a significant global disease burden with profound effects on health, quality of life, and socioeconomic costs., Evidence Acquisition: Narrative review., Results: There are several treatment options, including pharmacological therapy, physical rehabilitation, psychological therapies, and surgical interventions, for chronic pain management. Magnesium has been FDA-approved for several indications including hypomagnesemia, arrhythmia, prevention of seizures in eclampsia/preeclampsia, and constipation. Magnesium has been used for numerous off-label uses, notably for acute and chronic pain management. The mechanism of magnesium in pain management is primarily through its action as a voltage-gated antagonist of NMDA receptors, which are involved in pain transduction., Conclusions: This narrative review will focus on the current evidence and data surrounding the utilization of magnesium as a treatment option for chronic pain., Competing Interests: Conflict of Interests: None., (Copyright © 2021, Author(s).)

Background: Twelfth rib syndrome, or slipping of the 12th rib, is an often overlooked cause for chronic chest, back, flank, and abdominal pain from irritation of the 12th intercostal nerve. Diagnosis is clinical and follows the exclusion of other causes of pain. This syndrome is usually accompanied by long-suffering, consequent psychiatric comorbidities, and increased health care costs, which are secondary to the delayed diagnosis., Objectives: This manuscript is a review of twelfth rib syndrome and its management options. The review provides etiology, pathophysiology, and epidemiology of twelfth rib syndrome. Additionally, diagnosis and current options for treatment and management are presented., Study Design: This is a narrative review of twelfth rib syndrome., Setting: A database review., Methods: A PubMed search was conducted to ascertain seminal literature regarding twelfth rib syndrome., Results: Conservative treatment is usually the first line, including local heat or ice packs, rest, and oral over-the-counter analgesics. Transcutaneous stimulation and 12th intercostal nerve cryotherapy have also been described with some success. Nerve blocks can additionally be tried and are usually effective in the immediate term; there is a paucity of evidence to suggest long-term efficacy. Surgical removal of all or part of the 12th rib and possibly the 11th rib, as well as the next line of therapy, may provide long-lasting relief of pain., Limitations: Further large scale clinical studies are needed to assess the most effective management of twelfth rib syndrome., Conclusions: Twelfth rib syndrome is usually diagnosed late and causes significant morbidity and suffering. The actual epidemiology is unclear given the difficulty of diagnosis. Nerve blocks and surgical rib resection appear to be effective in treating this syndrome, however, further evidence is required to properly evaluate them. Familiarity with this syndrome is crucial in reaching a prompter diagnosis.

It is widely believed that during winter and spring, Arctic marine phytoplankton cannot grow until sea ice and snow cover start melting and transmit sufficient irradiance, but there is little observational evidence for that paradigm. To explore the life of phytoplankton during and after the polar night, we used robotic ice-avoiding profiling floats to measure ocean optics and phytoplankton characteristics continuously through two annual cycles in Baffin Bay, an Arctic sea that is covered by ice for 7 months a year. We demonstrate that net phytoplankton growth occurred even under 100% ice cover as early as February and that it resulted at least partly from photosynthesis. This highlights the adaptation of Arctic phytoplankton to extreme low-light conditions, which may be key to their survival before seeding the spring bloom., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

Purpose of Review: This is a comprehensive review of the literature about the use of bupivacaine hydrochloride for the treatment of post-herpetic neuralgia (PHN). It briefly reviews the background, biology, diagnosis and conventional treatment for PHN, and then introduces and compares the recent evidence for the use of topical bupivacaine., Recent Findings: PHN is defined by pain lasting 90 days or more after the initial presentation of herpes zoster ("Shingles", HZ) rash and is the most common complication of this disease. A product of re-activation of the Varicella-Zoster virus (VZV), HZ is diagnosed more than 1 million times annually in the United States. Approximately 20% of patients with HZ will experience PHN and will continue to suffer intermittent neuropathic symptoms, including itching and pain, that is sharp, stabbing, throbbing or burning, with the pain localized to the site of their original rash. This long-lasting pain compares with the severity of long-standing rheumatics and osteo-arthritis and is accompanied by severe allodynia causing significant suffering, and a financial burden that is manifested in both healthcare costs and loss of quality-adjusted life years. Prevention of PHN may be achieved with the Zoster vaccine, although there is still a large segment of unvaccinated population. Moreover, the Zoster vaccine is not always effective for prevention. Current treatment includes medical (systemic tricyclic antidepressants, anticonvulsants and opioids, topical lidocaine and capsaicin) and interventional (subcutaneous Botox injections, nerve blocks and nerve stimulation) therapies. These therapies are not always effective, and each carries their own profile of side effects and risks. Moreover, up to 50% of patients with PHN are refractory to management. Recent evidence is emerging to support the use of topical local anesthetics for the treatment of PHN. Two small studies recently found topical lidocaine spray to be effective in treating paroxysmal pain attacks associated with PHN. Bupivacaine is a longer-lasting local anesthetic, and a film-forming formulation allows easy and durable application to the affected skin. Recent studies show that topical film-forming bupivacaine is safe and as effective as lidocaine for the treatment of PHN. PHN is an important though common complication of HZ and can cause long-lasting pain and disability. Current treatment for PNH is limited by efficacy and safety profiles of individual therapies. Recent evidence points to topical local anesthetics as an effective and safe alternative to conventional therapy. Film-forming bupivacaine may offer a durable and safe option for this otherwise difficult to treat syndrome.

Understanding the feeding ecology of polar cod ( Boreogadus saida ) during its first year of life is crucial to forecasting its response to the ongoing borealization of Arctic seas. We investigated the relationships between diet composition and feeding success in 1797 polar cod larvae and juveniles 4.5-55.6 mm standard length (SL) collected in five Arctic seas from 1993 to 2009. Prey were identified to species and developmental stages when possible, measured, and their carbon content was estimated using taxon-specific allometric equations. Feeding success was defined as the ratio of ingested carbon to fish weight. Carbon uptake in polar cod larvae < 15 mm was sourced primarily from calanoid copepods eggs and nauplii which were positively selected from the plankton. With increasing length, carbon sources shifted from eggs and nauplii to the copepodites of Calanus glacialis , Calanus hyperboreus and Pseudocalanus spp. Calanus glacialis copepodites were the main carbon source in polar cod > 25 mm and the only copepodite positively selected for. Pseudocalanus spp. copepodites became important replacement prey when C. glacialis left the epipelagic layer at the end of summer. Calanus glacialis was the preferred prey of polar cod, contributing from 23 to 84% of carbon uptake at any stage in the early development. Feeding success was determined by the number of prey captured in larvae < 15 mm and by the size of prey in juveniles > 30 mm. As Arctic seas warm, the progressive displacement of C. glacialis by the smaller Calanus finmarchicus could accelerate the replacement of polar cod, the dominant Arctic forage fish, by boreal species., Competing Interests: Conflict of interestThe authors declare that they have no conflicts of interest., (© The Author(s) 2020.)

Zooplankton play a central role in marine food webs, dictating the quantity and quality of energy available to upper trophic levels. They act as "keystone" species in transfer of mercury (Hg) up through the marine food chain. Here, we present the first Pan-Arctic overview of total and monomethylmercury concentrations (THg and MMHg) and stable isotope ratios of carbon (δ(13)C) and nitrogen (δ(15)N) in selected zooplankton species by assembling data collected between 1998 and 2012 from six arctic regions (Laptev Sea, Chukchi Sea, southeastern Beaufort Sea, Canadian Arctic Archipelago, Hudson Bay and northern Baffin Bay). MMHg concentrations in Calanus spp., Themisto spp. and Paraeuchaeta spp. were found to increase with higher δ(15)N and lower δ(13)C. The southern Beaufort Sea exhibited both the highest THg and MMHg concentrations. Biomagnification of MMHg between Calanus spp. and two of its known predators, Themisto spp. and Paraeuchaeta spp., was greatest in the southern Beaufort Sea. Our results show large geographical variations in Hg concentrations and isotopic signatures for individual species related to regional ecosystem features, such as varying water masses and freshwater inputs, and highlight the increased exposure to Hg in the marine food chain of the southern Beaufort Sea., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Leukocyte-poor platelet-rich plasma (LP-PRP) is hypothesized to be more suitable for intra-articular injection than leukocyte-rich PRP (LR-PRP) in the treatment of knee osteoarthritis., Purpose: To compare clinical outcomes and rates of adverse reactions between LP-PRP and LR-PRP for this application., Study Design: Meta-analysis., Methods: The MEDLINE, EMBASE, and Cochrane databases were reviewed. The primary outcome was the incidence of local adverse reactions. Secondary outcomes were the changes in International Knee Documentation Committee (IKDC) subjective score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between baseline and final follow-up measurements. A Bayesian network meta-analysis was performed, with a post hoc meta-regression to correct for baseline differences in WOMAC scores. Treatment rankings were based on surface under the cumulative ranking (SUCRA) probabilities., Results: Included in the analysis were 6 randomized controlled trials (evidence level 1) and 3 prospective comparative studies (evidence level 2) with a total of 1055 patients. Injection of LP-PRP resulted in significantly better WOMAC scores than did injection of hyaluronic acid (mean difference, -21.14; 95% CI, -39.63 to -2.65) or placebo (mean difference, -17.84; 95% CI, -34.95 to -0.73). No such difference was observed with LR-PRP (mean difference, -14.28; 95% CI, -44.80 to 16.25). All treatment groups resulted in equivalent IKDC subjective scores. The SUCRA analysis showed that LP-PRP was the highest ranked treatment for both measures of clinical efficacy (WOMAC and IKDC). Finally, PRP injections resulted in a higher incidence of adverse reactions than hyaluronic acid (odds ratio, 5.63; 95% CI, 1.38-22.90), but there was no difference between LR-PRP and LP-PRP (odds ratio, 0.78; 95% CI, 0.05-11.93). These reactions were nearly always local swelling and pain, with a single study reporting medical side effects including syncope, dizziness, headache, gastritis, and tachycardia (17/1055 total patients)., Conclusion: LP-PRP results in improved functional outcome scores compared with hyaluronic acid and placebo when used for treatment of knee osteoarthritis. LP-PRP and LR-PRP have similar safety profiles, although both induce more transient reactions than does hyaluronic acid. Adverse reactions to PRP may not be directly related to leukocyte concentration., (© 2015 The Author(s).)

A 13-month time series of Arctic Ocean noise from the marginal ice zone of the Eastern Beaufort Sea is analyzed to detect under-ice acoustic transients isolated from ambient noise with a dedicated algorithm. Noise transients due to ice cracking, fracturing, shearing, and ridging are sorted out into three categories: broadband impulses, frequency modulated (FM) tones, and high-frequency broadband noise. Their temporal and acoustic characteristics over the 8-month ice covered period, from November 2005 to mid-June 2006, are presented and their generation mechanisms are discussed. Correlations analyses showed that the occurrence of these ice transients responded to large-scale ice motion and deformation rates forced by meteorological events, often leading to opening of large-scale leads at main discontinuities in the ice cover. Such a sequence, resulting in the opening of a large lead, hundreds by tens of kilometers in size, along the margin of landfast ice and multiyear ice plume in the Beaufort-Chukchi seas is detailed. These ice transients largely contribute to the soundscape properties of the Arctic Ocean, for both its ambient and total noise components. Some FM tonal transients can be confounded with marine mammal songs, especially when they are repeated, with periods similar to wind generated waves.