Endotracheal intubation (ETI) with direct view laryngoscopy (DL) is the gold standard for airway management. Videolaryngoscopy (VL) can improve glottis visualization, thus facilitating ETI. The aim of this monocentric, randomized, prospective study on a physician staffed German air ambulance is to compare DL and VL for ETI in terms of number of attempts and time as well as visualization of the glottis in a prehospital setting in a physician-based rescue system in adult patients. A power analysis was performed à priori. We used consecutive on-scene randomization with a sealed envelope system for the DL and VL-group. Successful ETI with first pass success was significantly more frequent with VL than DL and three seconds faster. The percentage of glottis opening and the Cormack & Lehane classification were significantly better with VL than DL. Regarding improved first pass success in ETI with the VL, we would recommend the use of VL for prehospital airway management in physician-based rescue systems.

Recent studies revealed that the bromodomain and extra-terminal (BET) epigenetic reader proteins resemble key regulators in the underlying pathophysiology of cancer, diabetes, or cardiovascular disease. However, whether they also regulate vascular remodelling processes by direct effects on vascular cells is unknown. In this study, we investigated the effects of the BET proteins on human smooth muscle cell (SMC) function in vitro and neointima formation in response to vascular injury in vivo. Selective inhibition of BETs by the small molecule (+)-JQ1 dose-dependently reduced proliferation and migration of SMCs without apoptotic or toxic effects. Flow cytometric analysis revealed a cell cycle arrest in the G0/G1 phase in the presence of (+)-JQ1. Microarray- and pathway analyses revealed a substantial transcriptional regulation of gene sets controlled by the Forkhead box O (FOXO1)1-transcription factor. Silencing of the most significantly regulated FOXO1-dependent gene, CDKN1A, abolished the antiproliferative effects. Immunohistochemical colocalization, co-immunoprecipitation, and promoter-binding ELISA assay data confirmed that the BET protein BRD4 directly binds to FOXO1 and regulates FOXO1 transactivational capacity. In vivo, local application of (+)-JQ1 significantly attenuated SMC proliferation and neointimal lesion formation following wire-induced injury of the femoral artery in C57BL/6 mice. Inhibition of the BET-containing protein BRD4 after vascular injury by (+)-JQ1 restores FOXO1 transactivational activity, subsequent CDKN1A expression, cell cycle arrest and thus prevents SMC proliferation in vitro and neointima formation in vivo. Inhibition of BET epigenetic reader proteins might thus represent a promising therapeutic strategy to prevent adverse vascular remodelling.

Purpose: The relationship between sagittal lumbopelvic alignment and the bony pathomorphology of hip dysplasia is currently at the forefront of clinical and scientific interest. The aim of this study was to determine whether there is a compensatory lumbopelvic aspect associated with the two major acetabular phenotypes in dysplastic hips.Methods: From September 2022 to March 2024, a total of 145 patients with symptomatic bilateral hip dysplasia were included in the study. Hips were categorized into either anterolateral or posterolateral morphologies based on anteroposterior pelvic x‐rays. Additionally, the lumbopelvic sagittal alignment was determined radiographically. Furthermore, a multivariable linear regression analysis was conducted to assess the association of lumbopelvic sagittal alignment with additional independent factors.Results: Pelvic tilt (PT) significantly differed between the anterolateral and posterolateral phenotypes of hip dysplasia (16.84° ± 8.75° vs. 11.51° ± 6.63°, respectively; p < 0.001). Similar significant findings were observed for pelvic incidence (57.19° ± 12.96° vs. 50.75° ± 13.1°, respectively; p < 0.001). A PT of >14.5° was identified as the most likely factor associated with anterolateral dysplasia.Conclusions: The results of this study reveal a paradox in the hip–spine association in hip dysplasia. Contrary to previous theories, it seems that PT constitutes a component of the corresponding phenotype of dysplastic pathology, rather than functioning as a compensatory tilt.Level Evidence: Level III.

The diagnosis of periprosthetic infections (PJI) can be challenging in clinical practice because the clinical presentations of aseptic loosening and low-grade infections are similar. Semiquantitative evaluation of leukocyte esterase (LE) in synovial fluid using a urine strip test has already established itself as a diagnostic method over the past decade. The analysis of LE in synovial fluid leads to a high number of false-positive test results. In the present study, the value of a combined semiquantitative determination of glucose and LE in synovial fluid to improve the diagnosis of PJI was investigated. Over a 4-year period, 145 synovial samples were collected from patients who developed joint effusion after arthroplasty. LE and glucose test strips were considered as an index test for the diagnosis of PJI. A ++ or +++ LE and a negative glucose test strip reading were considered as positive test results. Modified diagnostic criteria for PJI as recommended by the Musculoskeletal Infection Society (MSIS) served as the reference test, except that intraoperative findings were excluded. Forty-six out of 145 samples were classified as septic complication according to the reference test. In regard to PJI, our data showed that combined use of LE and glucose strip test reading displayed a 98.0% specificity (95% confidence interval (CI): 95.2% to 100%), a 50% sensitivity (95% CI: 35.6% to 64.4%), a 92% positive predictive value (95% CI: 81.4% to 100.0%), and an 80.3% negative predictive value (95% CI: 73.2% to 87.4%). In contrast, the exclusive analysis of LE on the urine strip to diagnose PJI demonstrated a 90.9% specificity (95% CI: 85.2% to 96.6%), a 67.4% sensitivity (95% CI: 53.8% to 80.9%), a 77.5% positive predictive value (95% CI: 64.6% to 90.4%), and an 85.7% negative predictive value (5% CI: 79.0% to 92.4%). A combination of LE and glucose test pad reading is considered superior as a potential “rule-in” method for the diagnosis of PJI compared with LE test pad analysis alone. However, combined LE and glucose synovial fluid testing also demonstrated lower test sensitivity and thus diagnostic accuracy compared with LE analysis alone. Therefore, combined glucose and LE test pad analysis does not represent a sufficient diagnostic standard to exclude PJI with certainty.

Purpose: The objective of this case series was to investigate the effect of ultrasound‐guided cement removal devices on operating time and patient safety in the revision of cemented knee and hip arthroplasties.Methods: A total of 11 cases were examined in which ultrasound‐guided cement extraction was utilised for implant removal. The primary endpoint of the study was the duration of the surgery. Additionally, the cohort was analysed for the occurrence of intraoperative fractures or postoperative ossification. Postoperative laboratory dynamics of haemoglobin and C‐reactive protein levels were also investigated. A matched group of 11 patients who underwent revision arthroplasty using conventional techniques to remove bone cement served as the reference group.Results: Ultrasound‐guided removal of cement from the medullary canal was associated with a significantly longer operation time (187.19 min ± 54.4 vs. 121.91 min ± 43.5, (p = 0.0026). Furthermore, there was a significant decrease in haemoglobin drop relative to baseline haemoglobin levels when ultrasound‐guided tools were employed for cement removal (2.36 g/dL ± 1.9 vs. 4.54 g/dL ± 1.9, p = 0.0015). Moreover, an intraoperative fracture complication of the femoral shaft was observed when the cement was removed using an ultrasonic cement stripper.Conclusion: A comparison between the two groups reveals a significant increase in surgical duration when cement removal was performed using ultrasound‐guided technique. Simultaneously, the use of an ultrasound‐assisted system for cement removal did not mitigate the risk of intraoperative bone perforation. Based on the data presented in this study, the authors cannot conclude that the use of ultrasound‐guided devices for the removal of cement residues from the medullary canal during revision surgery is superior to conventional techniques.Level of Evidence: Level IV.