Long term improvement of knee osteoarthritis after injection of single high/very high volume of very pure PRP: A retrospective analysis of patients optimally managed in dedicated centers.

Introduction: PRP is gaining increasing interest for pain relief and improvement of joint function in patients with knee osteoarthritis (KOA) but practices and results remain heterogeneous limiting its adoption as standard of care. Current international recommendations are to collect real-life evidence of efficacy with a systematic monitoring of PRP quality and patients' outcomes. We aimed to analyze the response of patients presenting KOA and treated with standardized PRP injection in routine care. We also investigated the potential contributing factors including patient's phenotype and PRP characteristics. Methods: Patients with symptomatic KOA and that failed first-line therapy received a single injection of a qualified PRP prepared using medical devices allowing to recover a high/very high volume of very pure PRP. Visual analogue scale (VAS) and Western Ontario and McMaster Osteoarthritis Index (WOMAC) score were recorded at baseline and during 18 months follow-up. Results: 431 patients had available follow-up data at 3 months, 291 at 6 months, 137 at 12 months and 44 at 18 months. PRP induced a significant decrease of WOMAC score at all follow up endpoints (29.2 ± 19.2 at 3 months, p < 0.001 and 25.9 ± 19.7 at 12 months, p < 0.01, compared to 39.7 ± 18.9 at baseline). Similar results were observed for pain VAS (38.9 ± 23.3 at 3 months, p < 0.001 and 35.3 ± 24.1 at 12 months, p < 0.05, compared to 56.0 ± 20.7 at baseline). Changes at 12 months were correlated to baseline scores and to the level of improvement at 3 months. The proportion of OMERACT OARSI responders reached 56.2 % for the total cohort and 60.4 % for severe patients at 6 months. Treatment failure occurred for 8.4 % of patients. Age, BMI or Kellgren-Lawrence grade did not impact on efficacy. Conclusion: This real-life study evidences the clinical benefit of a standardized high or very high-volume injection of very pure PRP in patients with KOA, including those with a severe grade. It opens perspectives in the positioning of such strategy to delay arthroplasty and provide insights on factors able to anticipate long term efficacy.

The impacts of whole-lake acidification and eutrophication on the accumulation of lead in sediments from manipulated lakes in the Experimental Lakes Area (IISD-ELA).

Acidification and eutrophication are common limnological stressors impacting many water bodies across the globe. While the negative impacts of these stressors on limnetic communities are generally known, their influence on the accumulation of specific sediment constituents, such as metals, remains unclear. Benefitting from past research and long-term monitoring, lakes at the International Institute for Sustainable Development - Experimental Lakes Area (IISD-ELA) in northwestern Ontario, Canada are invaluable to understand the extent to which these two common lake stressors can influence the accumulation of metals in lacustrine sediment. To address these issues, sediment cores were retrieved from six lakes: four were subjected to past experimental acidification or eutrophication and two were reference lakes. Focusing on elemental lead (Pb), a metal known to have accumulated in lake sediments worldwide and generally exhibiting a relatively small fraction of terrigenous input, we assessed the hypothesis that greater accumulation of Pb would be observed in lakes subjected to eutrophication, while the reverse was expected for lakes subjected to acidification experiments. Our analyses support this hypothesis, whereby relatively low enrichment was recorded in sediments deposited in the acidified lake during the manipulation era. On the other hand, eutrophied lakes demonstrated a strong enrichment in Pb during experimental manipulation. When investigating the mechanisms behind these divergent responses, we found epilimnetic dissolved organic carbon (DOC) and conductivity were associated with a relative increase in Pb accumulation in sediments. Acidic pH is also expected to mediate these responses by decreasing epilimnetic DOC concentrations leading to reduced Pb accumulation in the sediment.

Comparing Quantitative Methods for Analyzing Sediment DNA Records of Cyanobacteria in Experimental and Reference Lakes.

Sediment DNA (sedDNA) analyses are rapidly emerging as powerful tools for the reconstruction of environmental and evolutionary change. While there are an increasing number of studies using molecular genetic approaches to track changes over time, few studies have compared the coherence between quantitative polymerase chain reaction (PCR) methods and metabarcoding techniques. Primer specificity, bioinformatic analyses, and PCR inhibitors in sediments could affect the quantitative data obtained from these approaches. We compared the performance of droplet digital polymerase chain reaction (ddPCR) and high-throughput sequencing (HTS) for the quantification of target genes of cyanobacteria in lake sediments and tested whether the two techniques similarly reveal expected patterns through time. Absolute concentrations of cyanobacterial 16S rRNA genes were compared between ddPCR and HTS using dated sediment cores collected from two experimental (Lake 227, fertilized since 1969 and Lake 223, acidified from 1976 to 1983) and two reference lakes (Lakes 224 and 442) in the Experimental Lakes Area (ELA), Canada. Relative abundances of Microcystis 16S rRNA (MICR) genes were also compared between the two methods. Moderate to strong positive correlations were found between the molecular approaches among all four cores but results from ddPCR were more consistent with the known history of lake manipulations. A 100-fold increase in ddPCR estimates of cyanobacterial gene abundance beginning in ~1968 occurred in Lake 227, in keeping with experimental addition of nutrients and increase in planktonic cyanobacteria. In contrast, no significant rise in cyanobacterial abundance associated with lake fertilization was observed with HTS. Relative abundances of Microcystis between the two techniques showed moderate to strong levels of coherence in top intervals of the sediment cores. Both ddPCR and HTS approaches are suitable for sedDNA analysis, but studies aiming to quantify absolute abundances from complex environments should consider using ddPCR due to its high tolerance to PCR inhibitors.

Comparing the outcomes of the induced membrane technique between the tibia and femur: Retrospective single-center study of 33 patients.

INTRODUCTION: Bone defects are challenging to treat surgically. The primary objective of our study was to compare the union rate and time to union between the tibia and femur when using the induced membrane technique. The secondary objective was to document how failures were managed. MATERIAL AND METHODS: This retrospective, single-center study involved 33 patients (23 men, 10 women) who were older than 18 years of age. They were treated surgically for a leg fracture or long bone nonunion (22 tibia, 11 femur) using the induced membrane technique between January 2011 and December 2016 and had a complete follow-up. The minimum follow-up was 1 year for fractures and 2 years for non-union cases. Bone union was defined as the presence of at least two cortices with bridging on two radiographic views and return to full weight bearing. RESULTS: The mean patient age was 38.3±15.5 years (18-72). The mean bone defect size was 7.9±5.0cm (2.3-18.0). The mean follow-up was 3.3±1.8 years (1-7.2). The union rate was 61% (20 patients). The mean time to union was 10±6.4 months (3-23). The time to union was significantly longer in the tibia (11.6±6.9 months [3-23]) than in the femur (6.3±2.9 months [3.4-10.3]) (p=0.025). The failure rate did not differ between the tibia and femur. Nine of the 13 patients (69%) in which the treatment failed were reoperated; 7 of them underwent nonunion treatment (78%) and 2 underwent amputation (22%). The other 4 patients were waiting for an infection to resolve before being reoperated. CONCLUSION: The induced membrane technique is an effective surgical procedure for large bone defects in both the tibia and femur. However, the time to union was shorter in the femur than the tibia in our cohort. LEVEL OF EVIDENCE: IV, retrospective study.

Human and climate global-scale imprint on sediment transfer during the Holocene.

Accelerated soil erosion has become a pervasive feature on landscapes around the world and is recognized to have substantial implications for land productivity, downstream water quality, and biogeochemical cycles. However, the scarcity of global syntheses that consider long-term processes has limited our understanding of the timing, the amplitude, and the extent of soil erosion over millennial time scales. As such, we lack the ability to make predictions about the responses of soil erosion to long-term climate and land cover changes. Here, we reconstruct sedimentation rates for 632 lakes based on chronologies constrained by 3,980 calibrated 14C ages to assess the relative changes in lake-watershed erosion rates over the last 12,000 y. Estimated soil erosion dynamics were then complemented with land cover reconstructions inferred from 43,669 pollen samples and with climate time series from the Max Planck Institute Earth System Model. Our results show that a significant portion of the Earth surface shifted to human-driven soil erosion rate already 4,000 y ago. In particular, inferred soil erosion rates increased in 35% of the watersheds, and most of these sites showed a decrease in the proportion of arboreal pollen, which would be expected with land clearance. Further analysis revealed that land cover change was the main driver of inferred soil erosion in 70% of all studied watersheds. This study suggests that soil erosion has been altering terrestrial and aquatic ecosystems for millennia, leading to carbon (C) losses that could have ultimately induced feedbacks on the climate system.

Medial patellofemoral ligament reconstruction in children: do osseous abnormalities matter?

PURPOSE: Management of post-traumatic patellar instability in children with osseous abnormalities is challenging because of the presence of an open physis. The aim of our study was to compare the rate of recurrence after isolated reconstruction of the medial patellofemoral ligament (MPFL) in children with or without osseous abnormalities. METHODS: The medical records of 25 children (27 knees) with recurrent patellar dislocation were reviewed. Each child underwent an isolated reconstruction of the MPFL using a hamstring graft. At the last follow-up, a clinical and radiographic evaluation was performed, including assessment of functional outcomes based on the Kujala score. Patients were compared in terms of the occurrence of a pre-existing osseous abnormality. RESULTS: The mean age at the time of the surgery was 13.8 years. Eleven patients had trochlear dysplasia (40%), three had a patella alta (11%) and seven had an increased TT-TG (26%). The recurrence rate was 3.7% (one patient), after a mean follow-up of 41.1 months. Recurrence was not more frequent in patients with preoperative anatomical predisposing factors. The mean Kujala score was 95. The mean time to return to practicing sports was 7.1 months. CONCLUSIONS: Isolated MPFL reconstruction is an effective option for the management of post-traumatic patellofemoral instability in skeletally immature patients. The results of this technique seem to be independent on either proximal or distal misalignments such as trochlear dysplasia, patella alta, or increased TT-TG.