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Introduction During the COVID-19 pandemic, the AO Foundation, an orthopedic education organization, had to transition its live education programs to an online format. Skills that were previously evaluated and corrected in person by educators were now assessed through online lectures and discussion groups. Our goal was to evaluate an online course designed to teach the skill of "leg length and coronal deformity measurement" and to assess participants' ability to demonstrate this skill using online software. Methods An IRB-approved study was conducted during an online osteotomy course. A total of 176 participants were instructed on how to measure length and angulation through the course lectures and planning tutorials. The Bonesetter App (Detroit Bonesetter, Detroit, Michigan, USA) was used as the digital planning tool. Participants analyzed four cases of coronal deformity using long-leg standing radiographs. They were required to identify any deformities present, specify the type of deformity, and determine whether it affected the femur, tibia, or joint. Additionally, participants needed to calculate the deformity as part of the osteotomy planning process. Their measurements and drawings were saved and subsequently evaluated by two independent observers. Results Out of 176 online participants, 76% (315 out of 417) correctly completed the four exercises. The most frequent errors occurred in measuring total deformity and joint deformity. The average standard deviation of length measurements was ±0.29 cm (based on 244 measurements), while for angular measurements, it was ±0.71 degrees (based on 688 measurements). The intraclass correlation coefficient was greater than 0.96. Conclusions The online course effectively taught coronal deformity measurement, although participants struggled most with measuring joint angles and total deformity. Future courses should provide more detailed explanations for these measurements., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Wayne State University Institutional Review Board issued approval 21-10-4123. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Vaidya et al.)

The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method., (© 2024 Deutsche Dermatologische Gesellschaft (DDG).)

Background and objectives: Alignment of the lower extremity is important when treating congenital deformities, fractures, and joint replacement. During the COVID-19 pandemic, AO North America offered an online course on deformity measurement and planning. The Bonesetter app is a deformity planning tool that is freely available online. The purpose of this study was to see how effective an online course was in teaching axial alignment measurement and to assess that skill using an online digital planning tool, the Bonesetter app. Materials and Methods: An online module on axial alignment was provided during the AONA osteotomy course as well as a tutorial on how to use an online digital planning tool (Bonesetter app). The tools within the Bonesetter app allow users to draw digital lines directly on the CT images and measure the exact angle between two planes. Participants in this study were directed to perform these measurements in four different cases that tested different variations of deformity. Results: The measurements were completed correctly in case 1 = 56%, case 2 = 61%, case 3 = 84%, and case 4 = 76%. The standard deviation of angular digital measurements between individuals was ±4.26 degrees. Measuring the angle directly vs. drawing angles to a horizontal line had smaller standard deviations per case (p < 0.005) and less incidents outside 1 standard deviation for each measurement. Errors in adding and subtracting were the most common errors, particularly in relation to femoral anteversion or retroversion. Conclusions: The online course successfully instructed a group of orthopedic surgeons to measure alignment and malalignment of lower limb axial deformities. The Bonesetter app helped participants to learn this skill and identify errors in measurement. The inability to differentiate between anteversion and retroversion of the femur is a common source of error when it occurs and should be a focus of instruction.

Background: Group O erythrocytes and/or whole blood are used for urgent transfusions in patients of unknown blood type. This study investigated the impact of transfusing increasing numbers of uncrossmatched type O products on the recipient's first in-hospital ABO type., Methods: This was a retrospective cohort study. Results of the first ABO type obtained in adult, non-type O recipients (i.e., types A, B, AB) after receiving at least one unit of uncrossmatched type O erythrocyte-containing product(s) for any bleeding etiology were analyzed along with the number of uncrossmatched type O erythrocyte-containing products administered in the prehospital and/or in hospital setting before the first type and screen sample was drawn., Results: There were 10 institutions that contributed a total of 695 patient records. Among patients who received up to 10 uncrossmatched type O erythrocyte-containing products, the median A antigen agglutination strength in A and AB individuals on forward typing (i.e., testing the recipient's erythrocytes for A and/or B antigens) was the maximum (4+), whereas the median B antigen agglutination strength among B and AB recipients of up to 10 units was 3 to 4+. The median agglutination strength on the reverse type (i.e., testing the recipient's plasma for corresponding anti-A and -B antibodies) was very strong, between 3 and 4+, for recipients of up to 10 units of uncrossmatched erythrocyte-containing products. Overall, the ABO type of 665 of 695 (95.7%; 95% CI, 93.9 to 97.0%) of these patients could be accurately determined on the first type and screen sample obtained after transfusion of uncrossmatched type O erythrocyte-containing products., Conclusions: The transfusion of smaller quantities of uncrossmatched type O erythrocyte-containing products, in particular up to 10 units, does not usually interfere with determining the recipient's ABO type. The early collection of a type and screen sample is important.

Man-made vitreous fibers (MMVF) have been used widely in commercial and residential buildings for over 50 years. Concerns have been expressed since the late 1960s that MMVF products may erode and contribute to fiber levels in the indoor environment. This cooperative investigation was undertaken to quantify indoor respirable fiber levels by phase contrast optical microscopy (PCOM) and to differentiate between fiber types using scanning electron microscopy with energy-dispersive X-ray microanalysis (SEM-EDX). A total of 205 stationary samples were collected using standard industrial hygiene methods in 51 residential and commercial buildings. Twenty-one simultaneous outdoor samples were collected at 19 buildings. All samples were analyzed by PCOM following the NIOSH 7400 Fiber method, "B" counting rules, and 50 randomly selected samples were analyzed by SEM-EDX. The PCOM mean value for all respirable fiber levels was 0.008 f/cc with a median value of 0.007 f/cc and a maximum value of 0.029 f/cc. Ninety-seven percent of the respirable fibers identified by SEM-EDX were determined to be organic. MMVF were detected on only two samples. Airborne fiber levels were very low and the respirable fibers present were primarily organic. The inorganic fiber levels determined by SEM-EDX which included MMVF were less than 0.0001 f/cc.

A Mr 92,000 metalloprotease, originally observed in neutrophils, has been found to be secreted by various normal and malignant cells of fibroblastic, hematopoietic, and epithelial origin. The responsiveness of the various cell types to the tumor promoter phorbol ester (phorbol myristate acetate) to secrete this enzyme and a corresponding Mr 72,000 gelatinase has been determined using gelatin zymograms. The latent zymogen form of the Mr 92,000 enzyme has been purified from phorbol myristate acetate-stimulated HT1080 human fibrosarcoma cells using sequential gelatin-Sepharose affinity chromatography and gel filtration. Selective elution from gelatin-Sepharose allows for a distinct separation of the Mr 92,000 gelatinase from the Mr 72,000 gelatinase. A fraction of the tumor cell derived latent Mr 92,000 enzyme is isolated as an apparent complex with human tissue inhibitor of metalloproteases, which is partially dissociated in sodium dodecyl sulfate and completely dissociated upon reduction of disulfide bonds and upon p-aminophenylmercuric acetate treatment. Organomercurial treatment rapidly allows for autoactivation of the proenzyme to active Mr 83,000 and Mr 75,000 species. At physiological pH, the enzyme rapidly degrades gelatin into small fragments and slowly cleaves native type V collagen at an apparent single site. Native type IV collagen is degraded to a much lesser extent. The NH2-terminal amino acid sequence of the Mr 92,000 proenzyme has been determined and is distinct from the Mr 72,000 gelatinase/type IV collagenase which is constitutively produced by fibroblasts. The Mr 92,000 enzyme is also immunologically distinct from the Mr 72,000 enzyme but immunologically cross-reactive with the neutrophil, high molecular weight gelatinase. The Mr 92,000 enzyme constitutes a distinct member of the matrix metalloprotease family. Its substrate specificity implies a broad physiological role, acting on basement membrane type V collagen as well as on denatured (gelatinized) collagens and thus may be involved in the invasive and migratory phenotype of human cells.