bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patellar Dysplasia and Cell-Based Cartilage Repair Outcomes
Authors: Retzky J , Palahres GM , Tacher R , Gomoll AH , Strickland S 
Published: November 2024

Objectives We aimed to evaluate the relationship between Wiberg patella type and outcomes following cell-based cartilage repair (autologous chondrocyte implantation [ACI] or particulated juvenile allograft cartilage transplantation [PJAC]) for the treatment of patellar chondral lesions at minimum 2-year follow-up. We hypothesized that Wiberg classification of patella shape would have no impact on patient-reported outcome measures (PROMs) or graft survival. Methods Patients undergoing ACI or PJAC for full-thickness patellar chondral defects between 2016-2020 were retrospectively reviewed following Institutional Review Board approval. The change in PROMs, including International Knee Documentation Committee (IKDC), Kujala, Veterans Rand 12 (VR-12) Mental, and VR-12 Physical scores, from pre- to postoperative and the percentage of patients who achieved the MCID for IKDC and Kujala scores were compared for the Wiberg A versus Wiberg B versus Wiberg C groups. Log-rank test was used to evaluate for differences in survival between subgroups. Results Fifty-nine patients (63 knees) were included, with an average age of 33.3±8.6 years, median BMI of 26.0 kg/m2 (interquartile range:21.8–30.2 kg/m2), and median time to follow up of 3.5 years (interquartile range:2.6–4.2 years). Twenty-six patellae (41%) were Wiberg type A, 29 (46%) were Wiberg type B, and 8 (13%) were Wiberg type C. There were no differences between Wiberg A versus B versus C groups with respect to change in PROMs from pre- to postoperative or the percentage of patients who achieved the MCID for IKDC or Kujala scores (p>0.05 for all). There were no differences in survival between groups (p=0.45). Conclusion Wiberg patella type has no impact on patient-reported outcomes or graft survival at midterm follow-up. Patella dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures.
Establishing Minimal Detectable Change Thresholds for the International Knee Documentation Committee and Kujala Scores at One and Two Years After Patellofemoral Joint Arthroplasty
Authors: Kunze K , Palhares GM , Uppstrom TJ , Gomoll AH , Stein BES , Strickland SM 
Published: November 2024

Objectives To define the minimal detectable change (MDC) for the international knee documentation committee (IKDC) and Kujala scores one and two years after patellofemoral joint arthroplasty (PFA). Methods A distribution-based method was applied to establish MDC thresholds among 225 patients undergoing primary PFA at a single high-volume musculoskeletal-care center. Stability of change in MDC achievement was explored by quantifying the proportion of achievement at one- and two-year postoperative timepoints. Multivariable logistic regression analysis was performed to explore the association between sociodemographic and operative features on MDC achievement. Results MDC thresholds for the Kujala score were 10.3 (71.1% achievement) and 10.6 (70.4% achievement) at one- and two years, respectively. The MDC thresholds for the IKDC score were 11.2 (78.1% achievement) and 12.3 (69.0% achievement) at one- and two years, respectively. Predictors of achieving the MDC for the Kujala and IKDC scores at both time points were lower preoperative Kujala and IKDC scores, respectively. Preoperative thresholds of ≤ 24.1 and 7.6 for the Kujala and IKDC scores, respectively, were associated with a 90% MDC achievement probability. When preoperative thresholds approached 64.3 and 48.3 for the Kujala and IKDC, respectively, MDC achievement probability reduced to 50%. Conclusion The MDC thresholds for the Kujala and IKDC scores two years after PFA were 10.6 and 12.3, respectively. Clinically significant health status changes were maintained overall, with a slight decrease in achievement rates between one and two years. MDC achievement was associated with disability at presentation. These findings may assist knee surgeons with patient selection and the decision to proceed with PFA by better understanding the patient-specific propensity for MDC achievement.
The Impact of a Target-Based Approach Conservative Treatment in Patients Waiting for Total Knee Replacement
Authors: Campos GC , Costa AHD , Piovesana LG , Piedade SR , Miranda JB , Zorzi AR 
Published: November 2024

Objectives We are certainly far from a consensus on the best form of knee osteoarthritis treatment or on an effective treatment recommendation. Moreover, indication for total knee arthroplasty still subjective and depends on several aspects such as physician’s experience, patient’s perception and also the treatment carried out so far. There is a non-negligible number of patients who end up undergoing arthroplasty when they could improve with conservative treatment if they had access to adequate treatment. The objective of this study is to evaluate the impact of an individualized conservative treatment in part of OA patients referred for surgical treatment, awaiting total knee replacement. Methods We enrolled 77 patients referred to the knee surgery outpatient clinic of a University Hospital, with indication of total knee arthroplasty. They were divided into two groups: treatment group received target-based approach care and the waiting group received standard treatment. All patients underwent radiographic analysis according to Kellgren & Lawrence, functional evaluation with application of the VAS scale, WOMAC questionnaire, SF-36 questionnaire, 6MWT and muscular strength evaluation. Results The treatment group presented lower perception regarding pain intensity (P = 0.017). As well as improvement in the quality of life compared to the waiting group, an increase in SF-36 scores was observed in the SF-36 AF (P = 0.49) and SF-36 AS (P = 0.013), SF-36 EGS (P = 0.003) and SF-36 V (P = 0.042). In the treatment group there was improvement in the functional capacity of the lower limb, as demonstrated by reduction of knee extensor torque deficit (P <0.001) and increase in distance in the 6MWT (P <0.001). Conclusion Target-besed approach conservative treatment improved symptoms and quality of life in OA patients with an indication for total knee replacement.
Anatomical Study of Medial Patellar Stabilizers
Authors: LHC Araújo , MLC Cavalcante 
Published: November 2024

Objectives To study the anatomy of the medial patellar stabilizers and their relationship with adjacent structures. Methods Anatomical study on 15 knees, six from cadaver donors and nine from suprapatellar amputation. Results The medial ligament complex was identified in the dissected knees. The characteristics of the ligaments, the insertion sites, the morphometry and the relationships with adjacent structures were documented. Conclusion The medial ligament complex was identified in the dissected knees. The characteristics of the ligaments, the insertion sites, the morphometry and the relationships with adjacent structures were documented.
Cross-sectional Effects of Isolated Meniscal Tears on In Vivo Biomechanics of the Knee: A Systematic Review of Motion Analysis Studies
Authors: Mameri ES , Gustafson JA , Gonzalez FF , Leporace G , Metsavaht LF , Chahla J 
Published: November 2024

Objectives: To systematically review the effects of meniscal tears on in vivo knee biomechanics, with a focus on kinematic and kinetic outcome measures. Methods: Databases were queried for level I-IV studies that met the following criteria: in vivo studies of gait or motion analysis, cohorts with isolated meniscal pathology, and kinematics and/or kinetics outcome measures. Demographic data, methods of motion analysis, tasks performed, and kinematics and kinetics outcomes were extracted. Standardized mean differences with a random-effects model were calculated to compare cohorts with meniscal tears and healthy controls when outcomes were homogeneous. Results: Thirteen studies were eligible, with a pooled sample of 176 medial meniscal and 74 lateral meniscal tears. Eleven studies assessed gait biomechanics. There was considerable variability in reported outcomes and motion capture methods. Meta-analysis revealed statistically significant decreases in peak knee flexion angle, range of adduction-abduction, and internal-external rotation (p < 0.05) for the pooled sample of lateral meniscus tears. In terms of kinetics, although qualitative evidence in individual studies suggested alterations (e.g., decreased total support moment of the injured limb), quantitative analysis failed to demonstrate significant differences in peak knee flexion moment and peak knee adduction moment (p ≥ 0.05). Conclusion: Lateral meniscus tears significantly impact in vivo knee kinematics across all three planes of motion. No significant differences were observed in the kinetics of medial meniscus tears, and the evidence for their impact on kinematics remains conflicting. Our findings suggest that analyzing more demanding functional tasks may be necessary to detect the biomechanical changes caused by meniscal tears.
Ochronotic Arthropathy of the Knee: A Case Report
Authors: SANTOS MARZO NUNES , COUTO RICARDO DAVID , BRUSTOLIM DANIELE 
Published: November 2024

Alkaptonuria (AKU) is a low-prevalence genetic inherited disease expressed in an autosomal recessive and monogenic manner, characterized by a tissue accumulation of homogentisic acid (HGA). It is more severe in male patients, with arthritic symptoms as the earliest clinical picture in most cases. This enzyme deficiency metabolic disorder causes an increase in HGA, an intermediary in the metabolism of amino acids normally excreted in the urine. Homogentisic aciduria can be observed in patients with alkaptonuria, manifested by darkening of the first-morning urine. Ochronosis, a tissue homogentisic acid accumulation, progresses with connective tissue pigmentation and severe ochronotic joints osteoarthropathy. Ochronosis can also occur in the eyes, ears, skin, and heart valves. Also, are seen blackened kidneys and prostate stones, injuries to muscles and tendons, as well as fractures. We present a case report of a 60-year-old male patient who previously underwent two arthroscopies of the left knee due to pain with no predefined etiology. After a year, he sought a referral orthopedic hospital complaining of diffuse pain and persistent edema due to severe lateral femolotibial and patellofemoral osteoarthritis and valgus deformity. Total arthroplasty of the left knee was indicated and performed, with a suspected diagnosis of ochronosis intraoperatively and confirmed with additional tests. The patient has been followed up for 2 years after left knee arthroplasty, with a favorable outcome.
Treatment patterns and outcomes in follicular lymphoma with POD24: an analysis from the LEO Consortium
Authors: Day Jonathan R. , Larson Melissa C. , Durani Urshila , Koff Jean L. , Wang Yucai , Habermann Thomas M. , Lossos Izidore S. , Nastoupil Loretta J. , Strouse Christopher , Chihara Dai , Martin Peter , Leonard John P. , Cohen Jonathon B. , Kahl Brad S. , Ruan Jia , Burack W. Richard , Friedberg Jonathan W. , Cerhan James R. , Flowers Christopher R. , Link Brian K. , Maurer Matthew J. , Casulo Carla 
Published: November 2024

Abstract
Progression of disease within 24 months of initial immunochemotherapy (POD24) is a negative prognostic factor for patients with follicular lymphoma (FL). There is no standard treatment after POD24. Assembling an academic-based cohort from the Lymphoma Epidemiology of Outcomes Consortium for Real World Evidence, we evaluated patterns of care and outcomes for 220 patients with FL with POD24 and retained FL histology. Therapy after POD24 was heterogeneous, with no treatment category accounting for &gt;25% of the total. Among patients initially treated with bendamustine-rituximab, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was the predominant second-line choice (48%). Among patients initially treated with R-CHOP, aggressive salvage therapy was the predominant second-line choice (38%). Overall response rate to therapy after POD24 was 64% (95% confidence interval [CI], 56-70); complete response rate was 39% (95% CI, 32-46). The median event-free survival for therapy after POD24 was 9.8 months (95% CI, 7.3-12.1); 5-year overall survival (OS) was 71% (95% CI, 65-78). OS was inferior for patients aged &gt;70 years (hazard ratio [HR], 2.31; 95% CI, 1.27-4.20) and those with high-risk FL International Prognostic Index scores at diagnosis (HR, 2.10; 95% CI, 1.23-3.60). No treatment category stood out with more favorable results. Cause of death was predominantly lymphoma related. Patients with follicular histology at their POD24 event had a low cumulative incidence of transformation (1.1% at 5 years). Our study is among the largest cohorts describing contemporary patterns of care for patients with POD24, providing a focused data set useful for interpreting and designing prospective clinical trials in this population.
Comparable outcomes after busulfan- or treosulfan-based conditioning for allo-HSCT in children with ALL: results of FORUM
Authors: Kalwak Krzysztof , Moser Laura M. , Pötschger Ulrike , Bader Peter , Kleinschmidt Katharina , Meisel Roland , Dalle Jean-Hugues , Yesilipek Akif , Balduzzi Adriana , Krivan Gergely , Goussetis Evgenios , Staciuk Raquel , Sedlacek Petr , Pichler Herbert , Svec Peter , Gabriel Melissa , Güngör Tayfun , Bilic Ernest , Buechner Jochen , Renard Marleen , Vettenranta Kim , Ifversen Marianne , Diaz-de-Heredia Cristina , Stein Jerry , Toporski Jacek , Bierings Marc , Peters Christina , Ansari Marc , Locatelli Franco 
Published: November 2024

Abstract
The superiority of total body irradiation (TBI)–based vs chemotherapy conditioning for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with acute lymphoblastic leukemia (ALL) has been established in the international, prospective phase-3 FORUM study, randomizing 417 patients aged 4-18 years in complete remission (CR), who received allo-HSCT from HLA-matched sibling or unrelated donors. Because of the unavailability of TBI in some regions and to accommodate individual contraindications, this study reports the prespecified comparison of outcomes of patients receiving busulfan (BU)– or treosulfan (TREO)–based regimens from 2013 to 2018. Overall, 180 and 128 patients received BU/thiotepa (THIO)/fludarabine (FLU) or TREO/THIO/FLU, respectively. Data were analyzed as of February 2023, with a median follow-up of 4.2 years (range, 0.3-9.1). 3-year overall survival was 0.71 (BU, 95% confidence interval [0.64-0.77]) and 0.72 (TREO, [0.63-0.79]) and 3-year event-free survival was 0.60 (BU, [0.53-0.67]) and 0.55 (TREO, [0.46-0.63]). The 3-year cumulative incidence of relapse (BU, 0.31 [0.25-0.38]; TREO, 0.36 [0.27-0.44]); and nonrelapse mortality (BU, 0.08 [0.05-0.13]; TREO, 0.09 [0.05-0.15]) were comparable. One case of fatal veno-occlusive disease occurred in each group. No significant differences in acute and chronic graft-versus-host disease (GVHD) or 3-year GVHD-free and relapse-free survival (BU, 0.48 [0.41-0.55]; TREO, 0.45 [0.37-0.54]) were recorded. Outcomes for patients in first and second CR were similar irrespective of the regimen. In conclusion, BU/THIO/FLU or TREO/THIO/FLU regimens can be an alternative to TBI for patients with ALL aged &gt;4 years with contraindications or lack of access to TBI. This trial was registered at www.ClinicalTrials.gov as #NCT01949129.
Prognostic relevance of exercise pulmonary hypertension: results of the multicentre PEX-NET Clinical Research Collaboration
Authors: Kovacs Gabor , Humbert Marc , Avian Alexander , Lewis Gregory D. , Ulrich Silvia , Vonk Noordegraaf Anton , Souza Rogerio , Galiè Nazzareno , Malhotra Rajeev , Saxer Stephanie , Grünig Ekkehard , Egenlauf Benjamin , Ewert Ralf , Heine Alexander , Tedford Ryan J. , Houston Brian A. , Kasperowicz Krzysztof , Kurzyna Marcin , Rosenkranz Stephan , Herkenrath Simon , Barbera Joan Albert , Blanco Isabel , Oliveira Rudolf K.F. , Andersen Mads , Savale Laurent , Systrom David , Maron Bradley A. , Tello Khodr , Condliffe Robin , Mak Susanna , Baratto Claudia , Hsu Steven , D'Alto Michele , McCabe Colm , Herve Philippe , Olschewski Horst 
Published: November 2024

BackgroundExercise pulmonary hypertension (PH) was defined by a mean pulmonary arterial pressure (mPAP)/cardiac output (CO) slope >3 mmHg·min·L−1between rest and exercise in the 2022 European Society of Cardiology/European Respiratory Society PH guidelines. However, large, multicentre studies on the prognostic relevance of exercise haemodynamics and its added value to resting haemodynamics are missing.Patients and methodsThe PEX-NET (Pulmonary Haemodynamics during Exercise Network) registry enrolled patients who underwent clinically indicated right heart catheterisations both at rest and ergometer exercise from 23 PH centres worldwide. In this retrospective analysis we included subjects with resting mPAP <25 mmHg and complete haemodynamic data at rest and exercise in the same body position. Mixed effects Cox proportional hazard models with random effect centre were applied to identify independent markers of prognosis among the haemodynamic parameters.ResultsWe included 764 patients (64% females; median (interquartile range) age 59 (46–69) years and mPAP 17 (14–20) mmHg). Median (range) observation time was 6.8 (0.1–15.9) years and 87 patients (11%) died during follow-up. After adjustment for age, sex, haemoglobin level and resting haemodynamics, CO (hazard ratio (HR) 0.85, 95% CI 0.77–0.93; p=0.001) and transpulmonary gradient (HR 1.04, 95% CI 1.00–1.08; p=0.044) at peak exercise and the mPAP/CO slope (HR 1.12, 95% CI 1.06–1.18; p<0.001) were the only independent predictors of prognosis. Patients with a mPAP/CO slope >3 mmHg·min·L−1had significantly worse survival compared to those with a mPAP/CO slope ≤3 mmHg·min·L−1(HR 2.04, 95% CI 1.16–3.58; p=0.013).ConclusionThe mPAP/CO slope is a robust and independent predictor of prognosis in patients with normal or mildly elevated resting PAP that provides prognostic information beyond resting haemodynamics and appears suitable to define exercise PH.
Development of an open-source tool for risk assessment in pulmonary endarterectomy
Authors: Liley James , Bunclark Katherine , Newnham Michael , Cannon John , Sheares Karen , Taboada Dolores , Ng Choo , Screaton Nicholas , Jenkins David , Pepke-Zaba Joanna , Toshner Mark 
Published: November 2024

BackgroundRisk prediction tools are routinely utilised in cardiothoracic surgery but have not been developed for pulmonary endarterectomy (PEA). There is no data on whether patients undergoing PEA may benefit from a tailored risk modelling approach. We develop and validate a clinically-usable tool to predict PEA 90-day mortality (90 DM) with the secondary aim of informing factors that may influence five-year mortality (5 YM) and improvement in patient-reported outcomes (PROchange) using common clinical assessment parameters. Derived model predictions were compared to those of the currently most widely implemented cardiothoracic surgery risk tool, EuroSCORE II.MethodsConsecutive patients undergoing PEA for chronic thromboembolic pulmonary hypertension (CTEPH) between 2007 and 2018 (n=1334) were included in a discovery dataset. Outcome predictors included an intentionally broad array of variables, incorporating demographic, functional and physiological measures. Three statistical models (linear regression, penalised linear regression and random forest) were considered per outcome, each calibrated, fitted and assessed using cross-validation, ensuring internal consistency. The best predictive models were incorporated into an open-source PEA risk tool and validated using a separate prospective PEA cohort from 2019 to 2021 (n=443) at the same institution.ResultsRandom forest models had the greatest predictive accuracy for all three outcomes. Novel risk models had acceptable discriminatory ability for outcome 90 DM (AUROC 0.82) outperforming that of EuroSCORE II (AUROC 0.65). CTEPH related factors were important for outcome 90 DM but 5 YM was driven by non-CTEPH factors, dominated by generic cardiovascular risk. We were unable to accurately predict a positive improvement in PRO status (AUROC 0.47).ConclusionsOperative mortality from PEA can be predicted pre-operatively to a potentially clinically useful degree. Our validated models enable individualised risk stratification at clinician point-of-care to better inform shared decision making.
Outpatient Management of Cancer-Associated Pulmonary Embolism: A Systematic Review and Meta-Analysis
Authors: Delluc Aurélien , Pradier Michelle , Siegal Deborah M. , Le Gal Grégoire , Carrier Marc , Wang Tzu-Fei 
Published: November 2024

IntroductionOutpatient management of pulmonary embolism (PE) remains controversial in patients with cancer due to their higher risks of mortality, recurrent venous thromboembolism (VTE) and bleeding complications. This systematic review and meta-analysis aimed to evaluate the safety and feasibility of outpatient management of cancer-associated PE.MethodsWe searched MEDLINE, Embase, Cochrane Central, and Scopus databases from inception to May 30, 2024, for studies on outpatient management of cancer-associated PE. Eligible studies included randomized controlled trials, cohort studies, and case-control studies with ≥10 patients. The primary outcome was 30-day-all-cause mortality; secondary outcomes included VTE-related mortality, major bleeding and recurrent VTE at 30 days. Meta-analysis was performed using random effects models, and heterogeneity was assessed with the I2statistic.ResultsNineteen studies (13 full-article, 6 abstract-only) with a total of 1589 patients managed as outpatients were identified. Criteria for outpatient management of cancer-associated PE were reported in 14 studies. The pooled 30-day all-cause mortality rate was 1.74% (95% CI: 0.99–3.03; I2=0%, 691 patients, 6 full-article). The 30-day major bleeding pooled rate was 2.71% (95% CI: 1.51–4.83; I2=0%; 406 patients, 6 full-article), and the 30-day recurrent VTE pooled rate was 1.26% (95% CI: 0.53–3.00; I2=0%; 396 patients, 5 full-article).ConclusionSelected patients with cancer-associated PE managed as outpatients appear to have low short-term rates of mortality, major bleeding and recurrent VTE suggesting this may be a safe strategy. Further research with larger, prospective studies is needed to confirm these findings and refine risk stratification protocols.