bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cycling and education intervention for the treatment of hip osteoarthritis: A quality improvement replication programme
Authors: Wainwright Thomas W , Burgess Louise C , Immins Tikki , Cowan Neil , Middleton Robert G 
Published: July 2020

Objectives: The Cycling against Hip Pain programme is a 6-week exercise and education treatment pathway for people with hip osteoarthritis. Preliminary results of the Cycling against Hip Pain programme found significant improvements in clinical and patient-reported outcome measures for patients referred from primary care. This article evaluates the effectiveness of the changes made to the pathway in a quality improvement replication programme. Methods: The replicated Cycling against Hip Pain programme was delivered between February 2018 and September 2019 in a region of England with a high percentage of adults aged over 65 years. All participants were referred from the orthopaedic outpatient department of the funding hospital (secondary care). The programme was delivered at a local leisure centre and combined 30 min of education on osteoarthritis with 30 min of progressive static cycling, once a week for 6 weeks. Results: The participants on the replicated Cycling against Hip Pain programme did not differ from the original cohort in terms of age or pre-programme weight, however, presented with worse hip symptoms at baseline. Consistent with the findings from the original cohort, participants demonstrated significant improvements to their Oxford Hip Score, 30-s chair stand performance, Timed Up and Go score, Hip Osteoarthritis Outcome Score function and pain, EQ5D health rating, EQ5D-5L score and pain at rest and on weight bearing. In addition, participants reported an increase in knowledge, confidence and motivation to exercise. Conclusion: A 6-week cycling and education intervention for the treatment of hip osteoarthritis provided benefits to function, pain and quality of life for patients referred from secondary care. These results are consistent with findings from patients who were referred from primary care and further support the potential of the pathway in the conservative management of hip osteoarthritis.
Updated GMC guidance on decision-making and consent: implications for urologists
Authors: Duffy Siobhan , Barlow Catriona , Underwood Mark , Day Elizabeth 
Published: July 2020

We summarise the updated General Medical Council guidance on consent and decision-making. We explore the emphasis on enabling supported decision-making and the implications this has in day to day urological practice. In particular, we address some of the issues encountered in one-stop clinics, on pooled elective lists and with pre-written consent forms. The new guidance will emphasise the importance of sharing information relevant to your patient in light of the Montgomery ruling. Every decision is unique. We must appreciate the importance of the process of decision-making and understand our role as the clinician. Here we suggest some practical considerations to address the updated General Medical Council guidance. Level of evidence: Not applicable.
Across the Spectrum from Borderline Dysplasia to Global Pincer Femoroacetabular Impingement: Arthroscopic Outcomes from a Large Hip Arthroscopy Study Group
Authors: Kivlan Benjamin , Nho Shane , Wolff Andrew , Salvo John , Christoforetti John , Ellis Thomas , Carreira Dominic , Matsuda Dean 
Published: July 2020

Objectives: Outcomes from hip arthroscopy for dysplasia and global pincer FAI have fallen short of those for patients with normal acetabular coverage, but no study has investigated arthroscopic outcomes across the spectrum of acetabular coverage. Our objective is to report comparative hip arthroscopic outcomes of patients with low (borderline dysplasia), normal, and high (global pincer FAI) lateral acetabular coverage. Methods: A retrospective analysis of prospectively-collected data from a large multi-center registry (seven United States centers) was performed. Primary hip arthroscopy patients were assigned to one of three groups based on preoperative lateral center-edge angle (LCEA): borderline dysplasia (≤25°), normal (26-38°), and pincer FAI (≥39°). Repeated measures ANOVA compared pre-operative to 2-year minimum post-operative iHOT-12 scores. Subsequent ANOVA determined the effect of acetabular coverage on magnitude of change in scores. Results: Of 437 patients, the only statistical difference between groups was lower prevalence of acetabuloplasty in the borderline dysplasia group (p=0.001). A significant improvement in the pre-operative to post-operative iHOT-12 scores for patients with normal acetabular coverage, acetabular undercoverage, and acetabular overcoverage was observed; F(1, 339)=311.06; p<0.001, with no statistical differences in pre-operative (p=0.505) and post-operative (p<0.488) iHOT-12 scores when comparing the groups based on acetabular coverage. Mean iHOT-12 scores increased from 37.3 pre-operatively to 68.7 postoperatively, p<0.001, in the borderline dysplasia group, from 34.4 to 72, p<0.001, in the normal coverage group, and from 35.3 to 69.4, p<0.001, in the pincer group. These pre-operative scores increased by 31.4, 37.8, and 34.1, respectively, with no effect for acetabular coverage on the magnitude of change from pre-operative to post-operative iHOT-12 scores, F(2,339) =1.18; p=0.310. 10 subjects (2.3%) underwent conversion arthroplasty and 19 patients (4.4%) underwent revision arthroscopy with no significant effect of acetabular coverage on the incidence of revision or conversion surgery, X2 (6,433)=11.535, P = 0.073. Conclusion: Lateral acetabular coverage did not influence outcomes from primary hip arthroscopy performed in patients with low (borderline dysplasia), normal, and high (global pincer FAI) LCEA. Borderline dysplasia and moderate global pincer FAI with no or minimal osteoarthritis do not compromise successful 2-year minimum outcomes or survivorship following primary hip arthroscopy when performed by experienced surgeons.
Combined subcritical thresholds of glenoid and humeral sided bone loss are predictive of failure after arthroscopic Bankart repair
Authors: Kane Gillian , Golan Elan , Wilson Kevin , Lesniak Bryson , Lin Ryan Li Albert 
Published: July 2020

Objectives: Glenoid and humeral sided bone loss are both independent risk factors for failure after arthroscopic Bankart repair. The purpose of this study was to determine the combined effect of subcritical levels of humeral and glenoid sided bone loss on failure after arthroscopic Bankart repair. Methods: 171 individuals with minimum 2 years follow up who underwent primary arthroscopic Bankart repair between 2007-2015 were included in this study. Glenoid and humeral sided bone loss were measured using the glenoid track model. Cases were defined as individuals who sustained a subluxation or dislocation event after the index procedure, while controls were defined as individuals who did not. Subjects were stratified by age (20+ versus < 20 years). Receiver operating curves (ROC) were generated to determine the threshold of glenoid and humeral sided bone loss that could best predict failure. Results: There were 53 cases and 118 controls. Increased glenoid (p < .001) and humeral-sided (p = .013) bone loss independently predicted failure. ROC analysis demonstrated that threshold values of 12% glenoid (AUC = 0.62) and 13 mm humeral (AUC = 0.60) bone loss were predictive of failure. Combined subcritical thresholds of 10% glenoid and 10 mm humeral sided bone loss successfully predicted outcomes of 49/56 (87.5%) individuals over age 20 and 79/117 (67.5%) individuals under age 20. Humeral and glenoid sided bone loss had an additive effect on risk of failure in older individuals while glenoid sided bone loss was primarily responsible for failure in younger individuals. Conclusion: Both glenoid and humeral sided bone loss are predictive of failure after arthroscopic Bankart repair. Combined subcritical thresholds of glenoid and humeral sided bone loss accurately predict failure, particularly in individuals over the age of 20. These results suggest that individuals with subcritical bipolar lesions may be at higher risk of failure after arthroscopic Bankart repair than previously thought. [Table: see text]
Return to Sport Rates and Functional Outcomes Following Bilateral Hip Arthroscopy in High-Level Athletes
Authors: Domb Benjamin , Kyin Cynthia , Shapira Jacob , Maldonado David , Lall Ajay , Rosinsky Philip 
Published: July 2020

Objectives: To determine the rate of return to sport (RTS) in high-level athletes undergoing bilateral hip arthroscopy and report minimum 1-year patient-reported outcomes (PROs) for this cohort. We hypothesized that RTS rates, as well as sport-specific PROs, will be lower than the rates and scores previously reported in the literature for unilateral hip arthroscopy. Methods: Data were prospectively collected on all patients undergoing hip arthroscopy at our institution from November 2011 to July 2018. Patients were included if they underwent bilateral hip arthroscopy and were either a high school, collegiate, or professional athlete prior to their first surgery. RTS was defined as a patient’s return to competitive participation in their respective sport. Additional PROs, including modified Harris Hip Score (mHHS), nonarthritic hip score (NAHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS), as well as complication rates and future surgeries were documented and compared for all patients. Results: A total of 87 patients met inclusion criteria, for which follow-up was available for 82 (94.3%). At latest follow-up, 44 (53.7%) patients returned to sport. Of patients returning, 56% did so at the same level or higher. The most common reasons for not returning to sport were due to graduation/lifestyle change (47.4%) and hip symptoms (44.7%). Patients returning to sport had significantly higher PROs at latest follow-up relative to those who did not return, including for mHHS (93.7 vs. 87.5), NAHS (94.4 vs. 88.2), HOS-SSS (90.9 vs. 78.2) (P < 0.05). Rates of achieving PASS and MCID for mHHS were not significantly different. However, for HOS-SSS, patients who returned had significantly higher rates of achieving the MCID and PASS. Conclusion: Rates of RTS after bilateral hip arthroscopy are lower than those after unilateral hip arthroscopy. When comparing patients that returned to sports and those who did not return, we show that although both groups show a significant improvement in PROs following surgery, those that returned to sport achieved significantly higher scores in all outcome measures. In addition, patients returning to sports showed a significantly higher rate of attaining MCID and PASS scores for the HOS-SSS, possibly attesting to the validity of this score and its thresholds.
Kinematic evaluation of isolated and combined medial patellofemoral and patellotibial ligament reconstruction to address lateral patellar instability
Authors: Aman Zachary , Brady Alex , Rosenberg Sam , Turnbull Travis , Storaci Hunter , Dornan Grant , LaPrade Robert , Grantham William 
Published: July 2020

Objectives: The roles of the medial patellofemoral and patellotibial ligaments in patellofemoral kinematics have been previously reported. However, the effect of isolated and combined surgical reconstruction of these ligaments to restore native patellofemoral kinematics is not well understood. The purpose of this study was to determine the isolated and combined effects of medial patellofemoral and patellotibial ligament deficiency and reconstruction on patellofemoral kinematics. Methods: Sixteen matched-paired female, fresh-frozen, cadaveric knee specimens with a mean age of 53.5 years (range, 26-65) were used. Specimens were tested in five conditions; 1) intact, 2) MPFL or MPTL cut, 3) MPFL and MPTL combined cut, 4) MPFL or MPTL reconstruction, and 5) MPFL and MPTL combined reconstruction. Dynamic testing was performed by taking the knees through range of motion from 0° to 90° of knee flexion at 60 mm/min using a dynamic tensile testing machine by applying a force through the quadricep tendon. Following dynamic testing, knees were tested statically using a lateral load of 45 N applied to the patella at 0°, 30°, 60°, and 90° of flexion. In both dynamic and static loading tests, a motion capture system detected patellar position for each testing state to distinguish changes in patellar kinematics. Linear mixed effects modeling was performed to compare testing states. Results: Isolated MPFL deficiency created the greatest lateral translation of the patella at all knee flexion angles (p<0.001). MPTL deficiency alone did not create significant patella instability (p=0.68 or greater), but further increased instability when the MPFL was deficient (p<0.001). Isolated MPFL and combined MPFL and MPTL reconstruction decreased lateral patella translation (p<0.001). Native patella tracking was best recreated with combined ligament reconstruction while MPFL reconstruction alone over constrained the patella in extension and under constrained in flexion. Conclusions: The MPFL plays the greatest role in medial patellar stability, but the MPTL appears to have a large influence on patella tracking. The MPTL may be most important in preventing patellofemoral osteoarthritis following patella dislocation. Further investigation is needed to evaluate patellofemoral contact pressure following medial patellar ligament reconstruction.
Prognostic Factors Influencing Outcomes of High Tibial Osteotomy in The Varus Knee: The Role of The Deformity
Authors: Pilone Carola , Verdone Federico , Rossi Roberto , Bonasia Davide , Rosso Federica 
Published: July 2020

Objectives: High Tibial Osteotomy (HTO) is widely performed to treat early arthiritis in the varus knee. The aim of this prospective study is to evaluate different prognostic factors affecting the outcomes of HTO and, with special attention to the role of the site of deformity. Methods: 231 Opening Wedge HTO (OWHTO) were performed in 202 patients and included in the study. Inclusion criteria were: 1) age > 18 years, 2) no major associated procedures (i.e. ACL reconstruction, major cartilage procedure, 3) only OWHTO, 4) pre-operative complete clinical and radiological evaluation available. Patients were evaluated with (1) the Knee Society score (KSS), (2) the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, (3) another self-evaluation scale, (4) long-leg radiographs, and (5) plain radiographs. On the x-ray different angles were evaluated, including Join Line Congruence Angle. Furthermore, the location of deformity was established. Three main outcomes were identified: Indication to Total Knee Arthroplasty (TKA), KSS poor or fair and WOMAC < 76 points), and different prognostic factors were identified (Fig. 1). All the variables were firstly tested in a single regression model to evaluate the association with each outcome. All the variables with p<0.1 were re-tested in a multiple regression model. Results: 32 patients were lost to follow-up and 31 patients did not meet the inclusion criteria, leaving 139 patients (156 OWHTOs) for the study. The average age was 52.9 ± 9.6 years, and the average follow-up was 97.7 ± 42.8 months. Post-operatively there was a significant improvement in both the KSS and WOMAC score compared to the pre-operative period (p<0.0001). The only variable related to TKA indication was a pre-operative JLCA ≥5° (OR=24.3, p=0.0483). Conversely, different variables were related to a worse KSS, including pre-operative BMI >30 Kg/m2 (OR=78.9, p=0.0028), pre-operative ROM <120° of flexion (OR=40.8, p=0.0421), pre-operative mLDFA ≥91° (OR=36,6,p=0.0401) and femoral pre-operative CORA ≥3° of varus (OR=39,9 p=0.0269). Furthermore, a pre-operative BMI >30 Kg/m2 (OR=29,5, p=0.0314) was associated to a worse WOMAC score. Conversely, patients with a pre-operative mMPTA ≤84° had lower risk to obtain a worse KSS oe WOMAC score (respectively OR= 0,2 p=0.0364 and OR=0,3 p=0.0071). The cumulative survivorship was calculated with the Kaplan-Meier method, and it resulted equal to 98.6% at 5 years and decreased to 85.5% at 10 years. Conclusion: OWHTO is a good treatment for early arthritis in the varus knee if the correct indications are applied. The outcomes can be considered good, with 85% of 10-year survivorship. It is mandatory to correctly address the location of the deformity, because the presence of a femoral varus deformity is related to worse outcomes. Similarly, presence of a pre-operative JLCA ≥5° is the only factor associated to TKA indication. [Table: see text]
Role of pre-operative PROMIS scores in predicting post-operative outcomes and likelihood of achieving MCID following arthroscopic meniscus surgery
Authors: Kuhlmann Noah , Franovic Sreten , Moutzouros Vasilios , Makhni Eric 
Published: July 2020

Objectives: The minimum clinically important difference (MCID) for Patient Reported Outcomes Measurement and Information System computer-adaptive test (PROMIS-CAT) forms in patients undergoing meniscus surgery remains unknown. Therefore, the purpose of this study was to examine changes of PROMIS t-scores in meniscus surgery patients, as well as to determine the MCID in PROMIS scores for these patients. Secondarily, we sought to determine factors that predicted achievement of this MCID. Methods: Patients undergoing meniscal surgery (medial and/or lateral meniscectomy or meniscus repair) by one of two orthopaedic surgeons were asked to complete three PROMIS-CAT forms preoperatively, and at various postoperative visits. The three administered forms were as follows: PROMIS Physical Function (PROMIS-PF), PROMIS Pain Interference (PROMIS-PI), and PROMIS Depression (PROMIS-D). Average t-scores were analyzed across the time points within each domain. Additionally, the MCID for each PROMIS domain was calculated. Finally, predictive preoperative score cutoffs were determined for each domain with respect to MCID. Results: Average PROMIS t-score improved significantly in each domain from the preoperative to 6 weeks postoperative timepoint (38.6 ± 6.9 v 44.0 ± 3.5, 63.3 ± 6.1 v 55.3 ± 3.0, and 48.2 ± 9.6 v 44.2 ± 4.8) for PROMIS PF, PI, and D, respectively (Figure I). MCID values were calculated following a distribution-based methodology. These values were 3.48, 3.09, and 4.82, respectively. Of patients undergoing meniscus surgeries, 71.0%, 80.2% and 58.8% of patients achieved MCID respectively. After construction of prognostic preoperative score cutoffs in each PROMIS domain, 96.3%, 94.7% and 91.7% of patients meeting the prognostic cutoff scores achieved MCID, respectively (Table I). Conclusion: With respect to PROMIS CAT forms, significant improvement was detected at 6 weeks postoperatively in each of three domains, suggesting these surgeries are effective. Additionally, our results suggest that preoperative PROMIS scores can predict operative success in the form of achieving MCID. [Figure: see text][Table: see text]
Trib1 promotes acute myeloid leukemia progression by modulating the transcriptional programs of Hoxa9
Authors: Yoshino Seiko , Yokoyama Takashi , Sunami Yoshitaka , Takahara Tomoko , Nakamura Aya , Yamazaki Yukari , Tsutsumi Shuichi , Aburatani Hiroyuki , Nakamura Takuro 
Published: July 2020

Abstract
The pseudokinase Trib1 functions as a myeloid oncogene that recruits the E3 ubiquitin ligase COP1 to C/EBPα and interacts with MEK1 to enhance extracellular signal-regulated kinase (ERK) phosphorylation. A close genetic effect of Trib1 on Hoxa9 has been observed in myeloid leukemogenesis, where Trib1 overexpression significantly accelerates Hoxa9-induced leukemia onset. However, the mechanism underlying how Trib1 functionally modulates Hoxa9 transcription activity is unclear. Herein, we provide evidence that Trib1 modulates Hoxa9-associated super-enhancers. Chromatin immunoprecipitation sequencing analysis identified increased histone H3K27Ac signals at super-enhancers of the Erg, Spns2, Rgl1, and Pik3cd loci, as well as increased messenger RNA expression of these genes. Modification of super-enhancer activity was mostly achieved via the degradation of C/EBPα p42 by Trib1, with a slight contribution from the MEK/ERK pathway. Silencing of Erg abrogated the growth advantage acquired by Trib1 overexpression, indicating that Erg is a critical downstream target of the Trib1/Hoxa9 axis. Moreover, treatment of acute myeloid leukemia (AML) cells with the BRD4 inhibitor JQ1 showed growth inhibition in a Trib1/Erg-dependent manner both in vitro and in vivo. Upregulation of ERG by TRIB1 was also observed in human AML cell lines, suggesting that Trib1 is a potential therapeutic target of Hoxa9-associated AML. Taken together, our study demonstrates a novel mechanism by which Trib1 modulates chromatin and Hoxa9-driven transcription in myeloid leukemogenesis.
Clinical characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma in the rituximab era
Authors: Bobillo Sabela , Joffe Erel , Lavery Jessica A. , Sermer David , Ghione Paola , Noy Ariela , Caron Philip C. , Hamilton Audrey , Hamlin Paul A. , Horwitz Steven M. , Kumar Anita , Matasar Matthew J. , Moskowitz Alison , Owens Collette N. , Palomba M. Lia , Batlevi Connie L. , Straus David , von Keudell Gottfried , Zelenetz Andrew D. , Yahalom Joachim , Dogan Ahmet , Seshan Venkatraman E. , Younes Anas 
Published: July 2020

Abstract
This retrospective study aimed to better define the characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma (DLBCL) in the rituximab era. Patients diagnosed with stage I DLBCL from 2001 to 2015 treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or R-CHOP–like regimens with or without radiation (RT) were included. We identified 1955 patients with newly diagnosed DLBCL, of whom 341 had stage I and were eligible for this analysis. Extranodal presentation was observed in 224 (66%) patients, whereas 117 (34%) had nodal involvement. The most common extranodal sites were as follows: bone, 21%; stomach, 19%; testis, 9%; intestine, 8%; breast, 8%. Overall, 69% extranodal patients and 68% nodal patients received RT. Median follow-up was 5.5 years (interquartile range, 4.3-8.2). Ten-year overall survival (OS) and disease-free survival were 77% (95% confidence interval [CI], 67%-83%) and 77% (95% CI, 68%-85%). In the multivariable analyses, extranodal involvement was associated with worse OS (hazard ratio [HR], 3.44; 95% CI, 1.05-11.30) and progression-free survival (PFS; HR, 3.25; 95% CI, 1.08-9.72) compared with nodal involvement. Consolidation RT was associated with better OS (HR, 0.26; 95% CI, 0.12-0.49) and PFS (HR, 0.35; 95% CI, 0.18-0.69) in the extranodal population; however, the benefit was no longer observed in patients that were positron emission tomography (PET) negative at the end of immunochemotherapy. Relapses occurred usually late (median, 37 months), and the most common sites were the lymph nodes (31%) and the central nervous system (27%). Extranodal stage I DLBCL had a worse outcome than nodal stage 1 DLBCL. End of immunochemotherapy PET results may help select extranodal patients for consolidation RT.