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To determine bone morphogenetic protein (BMP)-2 protein and Aggrecan in osteoarthritic and healthy cartilage with special regard to localization and degree of cartilage damage 95 samples representing osteoarthritic cartilage and 17 samples out of normal cartilage were graded histological by Mankin Score and were studied by immunohistochemistry for the expression of BMP-2 and Aggrecan. BMP-2 protein was detected intracellular in normal and in osteoarthritic cartilage. Extracellular was detected exclusively in osteoarthritic cartilage and exhibits characteristic extracellular patterns: samples with BMP-2 in the extracellular matrix show BMP-2 negative coronae around BMP-2 positive cells. There is a statistically significant increase in the prevalence of extracellular BMP-2 with increasing ICRS grade/Mankin grade. Aggrecan was detected in the extracellular matrix und exhibited coronas throughout all layers. A decline of extracellular Aggrecan with increasing ICRS grade could be observed. Normal cartilage shows no intracellular Aggrecan whereas an increase in the prevalence of intracellular Aggrecan could be detected in osteoarthritic cartilage. The appearance of intracellular Aggrecan is often associated with extracellular BMP-2. The detection of BMP-2 protein in normal as well as in osteoarthritic cartilage highlights the importance of BMP-2 in tissue homeostasis and point to a putative role for maintaining tissue integrity during the development of osteoarthritis. The co-appearance of extracellular BMP-2 and intracellular Aggrecan indicates a functional relationship. The most interesting result is the characteristic distribution of extracellular BMP-2. These coronas seem to have an impact during progression of osteoarthritis and need to be further investigated.

Polytrauma is a term describing the condition of a person who has been simultaneously subjected to multiple traumatic injuries to at least two different areas of the body. The injuries are life threatening individually or in combination, e.g. a serious head injury in addition to a tension pneumothorax. It is defined via an Injury Severity Score (ISS) of at least 16 points.Adequate initial treatment of severely injured patients is significantly affected by the prediction or the knowledge of the post-traumatic course. Under pathophysiological aspects we distinguish between four different phases in polytrauma management:The surgical strategy should respect the phase-like post-traumatic course. We distinguish 4 phases: lifesaving immediate surgery, urgent primary interventions, secondary and tertiary interventions.After the acute care (“day 1-surgery”) there are 2 time windows where plastic surgery for reconstruction of extensive soft tissue defects can be performed. First, this is the period between the 5 and 10 posttraumatic day (“window of opportunity”). Here, after definitive fracture stabilization, a remaining soft tissue defect can be covered with split thickness skin graft or a local rotation flap. Another possibility for soft tissue reconstruction opens up after the period of immunosuppression (about 11 to 21 days after injury).In many multiply injured patients, primary closure of soft tissue injuries is critical. The relative hypoxia of tissues may lead to impairment and delayed wound healing. In addition, there is an increased risk of infection.For small soft-tissue injuries, we recommend a secondary wound closure after temporary covering the wound with artificial skin or skin substitutes until the swelling goes down.For medium soft tissue defects, a secondary closure is often achieved by mobilizing the surrounding soft tissues.In extensive soft tissue defects which are associated with considerable periosteal damage, soft tissue covering requires excellent perfusion. The defect coverage should be performed within 72 hours after the trauma. Otherwise there is a risk of further damage to this extremity.Large post-traumatic soft tissue defects are a challenge for the surgeon and require a well-defined therapeutic strategy. The overall concept of soft tissue coverage depends on the extent of exposed bone, tendons and nerves. An absolute prerequisite for wound closure is to completely cover the implants with vital and well-vascularized soft tissue. To obtain satisfactory results, early communication and cooperation between orthopaedic surgeons and plastic surgeons is recommend.In highly open fractures with extensive soft tissue defects (Group IIIb and IIIc) one must consider the possibility of early amputation, although the primary goal is to save the limbs. Long-term hospitalization has significant social and economic implications for the patient. The “mangled extremity severity score” (MESS) is an established decision-making aid.

Purpose: The purpose of this study was to evaluate the perspective of orthopaedic surgeons on the impact of artificial intelligence (AI) and to evaluate the influence of experience, workplace setting and familiarity with digital solutions on views on AI. Methods: Orthopaedic surgeons of the AGA Society for Arthroscopy and Joint Surgery were invited to participate in an online, cross‐sectional survey designed to gather information on professional background, subjective AI knowledge, opinion on the future impact of AI, openness towards different applications of AI, and perceived advantages and disadvantages of AI. Subgroup analyses were performed to examine the influence of experience, workplace setting and openness towards digital solutions on perspectives towards AI. Results: Overall, 360 orthopaedic surgeons participated. The majority indicated average (43.6%) or rudimentary (38.1%) AI knowledge. Most (54.5%) expected AI to substantially influence orthopaedics within 5–10 years, predominantly as a complementary tool (91.1%). Preoperative planning (83.8%) was identified as the most likely clinical use case. A lack of consensus was observed regarding acceptable error levels. Time savings in preoperative planning (62.5%) and improved documentation (81%) were identified as notable advantages while declining skills of the next generation (64.5%) were rated as the most substantial drawback. There were significant differences in subjective AI knowledge depending on participants' experience (p = 0.021) and familiarity with digital solutions (p < 0.001), acceptable error levels depending on workplace setting (p = 0.004), and prediction of AI impact depending on familiarity with digital solutions (p < 0.001). Conclusion: The majority of orthopaedic surgeons in this survey anticipated a notable positive impact of AI on their field, primarily as an assistive technology. A lack of consensus on acceptable error levels of AI and concerns about declining skills among future surgeons were observed. Level of Evidence: Level IV, cross‐sectional study. [ABSTRACT FROM AUTHOR]

Background: High‐altitude pulmonary hypertension (HAPH) has a prevalence of approximately 10%. Changes in cardiac morphology and function at high altitude, compared to a population that does not develop HAPH are scarce. Methods: Four hundred twenty‐one subjects were screened in a hypoxic chamber inspiring a FiO2 = 12% for 2 h. In 33 subjects an exaggerated increase in systolic pulmonary artery pressure (sPAP) could be confirmed in two independent measurements. Twenty nine of these, and further 24 matched subjects without sPAP increase were examined at 4559 m by Doppler echocardiography including global longitudinal strain (GLS). Results: SPAP increase was higher in HAPH subjects (∆ = 10.2 vs. ∆ = 32.0 mm Hg, p <.001). LV eccentricity index (∆ =.15 vs. ∆ =.31, p =.009) increased more in HAPH. D‐shaped LV (0 [0%] vs. 30 [93.8%], p =.00001) could be observed only in the HAPH group, and only in those with a sPAP ≥50 mm Hg. LV‐EF (∆ = 4.5 vs. ∆ = 6.7%, p =.24) increased in both groups. LV‐GLS (∆ = 1.2 vs. ∆ = 1.1 –%, p =.60) increased slightly. RV end‐diastolic (∆ = 2.20 vs. ∆ = 2.7 cm2, p =.36) and end‐systolic area (∆ = 2.1 vs. ∆ = 2.7 cm2, p =.39), as well as RA end‐systolic area index (∆ = −.9 vs. ∆ =.3 cm2/m2, p =.01) increased, RV‐FAC (∆ = −2.9 vs. ∆ = −4.7%, p =.43) decreased, this was more pronounced in HAPH, RV‐GLS (∆ = 1.6 vs. ∆ = −.7 –%, p =.17) showed marginal changes. Conclusions: LV and LA dimensions decrease and left ventricular function increases at high‐altitude in subjects with and without HAPH. RV and RA dimensions increase, and RV longitudinal strain increases or remains unchanged in subjects with HAPH. Changes are negligible in those without HAPH. [ABSTRACT FROM AUTHOR]

As the number of coronary computed tomography angiography (CTA) examinations is expected to increase, technologies to optimize the imaging workflow are of great interest. The aim of this study was to investigate the potential of artificial intelligence (AI) to improve clinical workflow and diagnostic accuracy in high-volume cardiac imaging centers. A total of 120 patients (79 men; 62.4 (55.0–72.7) years; 26.7 (24.9–30.3) kg/m2) undergoing coronary CTA were randomly assigned to a standard or an AI-based (human AI) coronary analysis group. Severity of coronary artery disease was graded according to CAD-RADS. Initial reports were reviewed and changes were classified. Both groups were similar with regard to age, sex, body mass index, heart rate, Agatston score, and CAD-RADS. The time for coronary CTA assessment (142.5 (106.5–215.0) s vs. 195.0 (146.0–265.5) s; p < 0.002) and the total reporting time (274.0 (208.0–377.0) s vs. 350 (264.0–445.5) s; p < 0.02) were lower in the human AI than in the standard group. The number of cases with no, minor, or CAD-RADS relevant changes did not differ significantly between groups (52, 7, 1 vs. 50, 8, 2; p = 0.80). AI-based analysis significantly improves clinical workflow, even in a specialized high-volume setting, by reducing CTA analysis and overall reporting time without compromising diagnostic accuracy. [ABSTRACT FROM AUTHOR]