A seasonal trend analysis of Dobson total ozone data that have been critically reevaluated and revised is performed for 29 northern hemisphere stations located between 19°N and 64°N latitude using data through 1986. The trend model considered for these data allows for a different linear trend for each month of the year, so that the seasonal as well as the latitudinal and regional nature of the total ozone trend behavior can be examined. The trend model also incorporates the 10.7‐cm solar flux series and the 50‐hPa equatorial zonal wind series as additional explanatory factors for solar and quasi‐biennial oscillation induced ozone variations. Regression random effects models are then used for the individual station seasonal trend estimates to obtain trend estimates as a function of latitude for different seasons of the year. The results of this seasonal trend analysis indicate significantly more negative trends during the winter months (December‐March) than during the summer months (May–August), notably at higher latitudes, with the trends in winter becoming more negative with increasing latitude. The trends in the winter are estimated to be of the order of −1.2%, −2.1%, and −3.0% per decade for latitudes 35°N, 45°N, and 55°N, respectively, while trends during the summer are of the order of −0.6% per decade with no distinct pattern as a function of latitude. The year‐round or annual trend over all latitudes is estimated to be about −0.84±0.82% per decade. The trends are found to display some regional variation, with trends in Japan being considerably less negative than those in North America and Europe. Sensitivity studies are also performed to investigate the effects on ozone trend estimates due to certain factors such as abnormal ozone behavior in 1983 and 1985, the use of ozone data prior to 1965, and nuclear weapons testing in the early 1960s. The seasonal trend analysis is also performed using published (unrevised) Dobson data. Trend results based on published data are on average less negative than trends from revised Dobson data for European stations, by about 1.0% per decade across all seasons, with only small average differences for stations in North America and Japan.
Background: Knee injection using either bone marrow aspirate concentrate (BMAC) or stromal vascular fraction (SVF) from adipose tissue has been shown to result in symptomatic improvement in patients with knee osteoarthritis (OA). It is still unclear whether one of these therapies is superior over the other. Purpose: To systematically report the clinical studies evaluating BMAC and SVF in the treatment of knee OA and to compare the clinical efficacy of these 2 injection therapies. Study Design: Meta-analysis; Level of evidence, 4. Methods: This meta-analysis was performed per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Studies were included if they reported the clinical outcomes after a single BMAC or SVF injection in the knee joint of patients with OA. Studies evaluating preparations of culture-expanded stem cells were excluded. A random effects model was used; the clinical efficacy of BMAC or SVF injection was assessed using the standardized mean difference (SMD) and compared. Visual analog scale (VAS) scores for pain and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) knee index were the primary outcomes. The level of statistical significance was set at P < .05. Results: Ten studies and 472 patients with knee OA who received either BMAC (233 patients) or SVF (239 patients) were included. Patients who received an injection had improved VAS outcomes (mean ± SD): from 5.8 ± 1.3 to 2.6 ± 17 for BMAC and from 6.4 ± 1.4 to 3.4 ± 0.5 for SVF. They also experienced significantly reduced pain (SMD [VAS], 2.6 for BMAC and 3.4 for SVF) and improved function (SMD [WOMAC], 1.4 for BMAC and 1.2 for SVF). However, the SVF injection had a significantly greater effect on pain reduction than did the BMAC injection ( P < .0001). Based on WOMAC, the clinical effect of BMAC versus SVF knee injection in patients with knee OA was equivalent ( P = .626). Results were limited by the presence of publication bias as well as variability in the preparation methods utilized in the BMAC and SVF injection protocols. Complications were reported in 50% of the BMAC studies (knee stiffness, persistent knee swelling) and 67% of the SVF studies (knee swelling, knee pain, positive SVF cultures without symptoms of infection, and bleeding at the abdominal harvest site). Conclusion: A single BMAC or SVF injection into the knee joint of patients with OA resulted in symptomatic improvement at short-term follow-up. However, SVF seemed to be more effective than did BMAC in the reduction of knee pain. There was significant variation in the BMAC and SVF injection preparation techniques used across the studies and a lack of stratification of outcomes based on the radiologic classification of OA. Therefore, these results should be taken with caution.
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