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Major histocompatibility complex class II (MHC-II Kaposi's sarcoma-associated herpesvirus (KSHV) is an oncogenic gammaherpesvirus that causes several malignancies, such as Kaposi's sarcoma (KS), primary effusion lymphomas (PELs), and multicentric Castleman's disease (MCD), in immunocompromised individuals (1, 2). The life cycle of KSHV consists of a predominant latent phase marked by restricted gene expression and a transient lytic replication phase characterized by the production of functional virions. KSHV maintains a lifelong persistent infection in susceptible hosts after primary infection (3, 4). One of the main factors contributing to the successful lifelong persistence of KSHV is its astounding ability to hide from host immune surveillance. During the course of evolution, KSHV has evolved multiple mechanisms to evade and modulate nearly all aspects of both the innate and adaptive immunities of infected hosts (5-7).Latency-associated nuclear antigen (LANA or LANA-1) is the most abundantly expressed protein in all KSHV-infected cells (8-10). LANA is a large multifunctional protein that plays diverse Citation Thakker S, Purushothaman P, Gupta N, Challa S, Cai Q, Verma SC. 2015. Kaposi's sarcoma-associated herpesvirus latency-associated nuclear antigen inhibits major histocompatibility complex class II expression by disrupting enhanceosome assembly through binding with the regulatory factor X complex.

Background: Ankle fractures are one of the most common orthopedic injuries, and although most patients have a satisfactory outcome following operative fixation, there are patients that have persistent pain despite anatomic reduction. Intra-articular injuries have been suggested as one potential cause of these suboptimal outcomes. Our study assesses the clinical impact of performing an ankle arthroscopy during ankle fracture open reduction and internal fixation (ORIF). Methods: This was a retrospective chart review of all patients who underwent operative fixation of a bimalleolar or trimalleolar ankle fracture at our institution from 2014 through 2018. We extracted all demographic data, fracture pattern, operative procedures performed, tourniquet times, arthroscopic findings and any arthroscopic interventions. We then conducted a phone and e-mail survey. Our study included 213 total patients (142 traditional ORIF, 71 ORIF plus arthroscopy) with an average age of 40 years. The average follow-up was 32.4 months with a survey follow-up rate of 50.7% (110/213). Results: The average tourniquet time for the arthroscopy cohort was 10 minutes longer (89 minutes vs 79 minutes). During the arthroscopy, there was a 28% (20/71) rate of full-thickness osteochondral lesions, 33% (24/71) rate of loose bodies, and a 49% (35/71) rate of partial-thickness cartilage injury. The mean Patient Reported Outcome Information System (PROMIS) physical function score among Weber B fibula fractures was 45.8 and 42.3 in the arthroscopy and nonarthroscopy groups, respectively (P ¼ .012). In addition, the patient satisfaction rate in Weber B fibula fractures was higher in those patients who underwent arthroscopy compared with ORIF alone (93% vs 75%, P ¼ .05). Patients who had a tibiotalar joint dislocation at the time of the ankle fracture had a significantly higher PROMIS physical function score (46.6 vs 40.2, P ¼ .005) when their surgery included arthroscopy. Conclusion: Ankle arthroscopy at the time of ORIF led to statistically significant improvements in patient-reported outcomes for Weber B fibula fractures and ankle dislocations. There was no increase in complication rates and the arthroscopy took 10 minutes longer on average. Level of Evidence: Level III, retrospective cohort study.

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Category: Sports, Outcomes Introduction/Purpose: Injuries are a major part of elite sports and patient-reported outcomes tools (PROs) are becoming commonplace for the assessment of injury and treatment outcomes. The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated set of assessment tools with increasing popularity. The PROMIS metrics utilize computerized adaptive testing (CAT) to capture health status measurements through individualized assessments, with minimal user burden, and without the loss of precision or content validity. The purpose of this study was to evaluate elite athletes using PROMIS scores and assess the impact of injury on those scores in order to gain insight into how participation and injury can impact the health of NCAA Division 1 athletes participating in a variety of sports. Methods: Over a six-month period, athletes from 11 sports at a single Division 1 Athletics program were recruited to participate in longitudinal prospective data collection using four PROMIS CAT scales/domains: Pain Interference (PI), Physical Function (PF), Depression, and Ability to Participate in Social Roles and Activities (PSRA). Using REDCap (Research Electronic Data Capture), athletes completed an assesment that included the PROMIS tools prior to participation in their respective sport’s season for the 2018-2019 academic year and following the completion of their season. Athletes suffering a season-ending injury were asked to complete the PROMIS survey within a week following the injury. De-identified data was analyzed using Student’s T-test. PROMIS outcome measures were analyzed using linear mixed model regression. A p-value of < 0.05 was considered statistically significant. Results: A total of 315 pre-season surveys were collected and of those 139 post-season surveys have been completed at this point in the academic year. PF, Depression and PSRA scores were significantly different in athletes than in the general age-matched population. PI scores were similar to the normal population. The distribution of PI and PF scores were significantly different pre and post-season with a difference in means of 2.2 and -3.2 respectively (p<.01). No significant difference was observed in the Depression and PSRA scores at the end of the season. A total of 23 significant injuries were reported up to this point in the season, resulting in a significant change from both pre-season scores and post-season in uninjured controls (Figure 1). Conclusion: We found significantly worse PI and PF scores after a full season compared to preseason, suggesting that athletic participation alone impacts the athlete’s overall function and condition. Season-altering injuries resulted in clinically significant differences in all four domains, suggesting that injuries greatly affect athletes not only physically, but mentally and socially. These data indicate that consideration should be given to pre-season PROMIS surveys for individual athletes to ensure that subsequent scores are properly interpreted. Additional study will elucidate the impact of specific sports and injuries, providing data to physicians, trainers, and coaches to inform treatment and return to sport protocols.