Background Septic arthritis is associated with substantial morbidity and mortality. While surgical irrigation and debridement are commonly recommended, non-surgical management remains frequently utilized, particularly in medically complex patients. However, large-scale national comparisons between these strategies are limited. This study aimed to compare in-hospital outcomes of surgical versus non-surgical management using a nationwide database. Methods A retrospective cohort study was conducted using the National Inpatient Sample (2016-2021). Adult hospitalizations with septic arthritis and known anatomic sites were identified using ICD-10 codes and stratified by treatment strategy. Primary outcomes included in-hospital mortality, length of stay, and total hospital charges. Secondary outcomes included in-hospital complications. Multivariable logistic regression was used to assess independent associations between treatment and outcomes, adjusting for demographics and comorbidities. Results A total of 46,282 hospitalizations were identified, including 27,961 (60.4%) treated surgically and 18,321 (39.6%) non-surgically. In-hospital mortality was significantly lower in the surgical group (1.4% vs. 3.1%, p < 0.001). Length of stay was similar, though more variable in the non-surgical cohort. Surgical management was associated with higher hospital charges ($71,725 vs. $63,434, p < 0.001). Non-surgical treatment demonstrated higher rates of complications, including sepsis, acute kidney injury, respiratory failure, and thromboembolic events (all p < 0.001). After adjustment, surgical management remained independently associated with reduced complications, including respiratory failure (OR 0.552), stroke (OR 0.505), cardiac arrest (OR 0.353), and sepsis (OR 0.871) (all p < 0.001). Conclusions Surgical management of septic arthritis was associated with lower in-hospital mortality and fewer complications despite higher costs. However, these findings should be interpreted in the context of potential residual confounding and differences in baseline illness severity between treatment groups.

Background: Cemented and cementless fixation techniques in total hip arthroplasty (THA) each present distinct biomechanical properties and perioperative risk profiles. While cementless fixation has gained increasing popularity, large-scale nationally representative comparisons of perioperative outcomes between cemented and cementless elective THA remain limited. This study aimed to compare complication rates, healthcare utilization, and temporal trends between cemented and cementless elective THA using the National Inpatient Sample. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2016 to 2021. Adult patients undergoing elective primary total hip arthroplasty were identified using ICD-10-PCS codes and categorized into cemented and cementless fixation groups. Patient demographics, comorbidities, indications, postoperative complications, length of stay, hospital charges, and in-hospital mortality were compared. Multivariate logistic regression analysis was performed to evaluate the independent association between fixation type and postoperative complications while adjusting for demographic, clinical, and hospital-level variables. Results: A total of 81,668 elective THAs were identified, including 40,290 cemented (49.33%) and 41,378 cementless (50.67%) procedures. Cemented THA was associated with a shorter length of stay (2.09 ± 1.88 vs. 2.26 ± 2.47 days, p < 0.001) and lower total hospital charges ($65,584.53 ± 48,797.21 vs. $72,186.84 ± 49,860.20, p < 0.001). Unadjusted analyses demonstrated higher rates of acute kidney injury and sepsis in the cementless group. After multivariate adjustment, cemented fixation was associated with lower odds of acute kidney injury (OR 0.87, 95% CI 0.79-0.96, p = 0.004). However, cemented THA was associated with higher odds of postoperative delirium (OR 1.20, 95% CI 1.02-1.42, p = 0.030), blood transfusion (OR 1.27, 95% CI 1.17-1.37, p < 0.001), and periprosthetic fracture (OR 1.32, 95% CI 1.02-1.71, p = 0.035). Rates of myocardial infarction, pneumonia, venous thromboembolism, urinary tract infection, and in-hospital mortality were similar between groups. Temporal analysis demonstrated comparable utilization trends, with a decline in elective procedures during 2020-2021. Conclusions: In this nationwide analysis, cemented total hip arthroplasty was associated with lower risk of acute kidney injury, shorter length of stay, and lower hospital charges, but higher odds of postoperative delirium, blood transfusion, and periprosthetic fracture compared with cementless fixation. These findings highlight distinct perioperative risk profiles between fixation strategies and may assist surgeons in individualized decision-making for elective total hip arthroplasty.

The World Health Organization's 2019 recognition in ICD-11 that chronic primary pain constitutes a disease in its own right demands novel conceptual frameworks. Current models focusing on peripheral and central sensitization, while valuable, may describe downstream manifestations rather than primary etiology. We hypothesize that chronic pain may arise from disruption of bioelectromagnetic coherence at the interface where consciousness and neural tissue interact—upstream of the cytokine cascades, neuroinflammation, central sensitization, and epigenetic modifications typically studied as pain mechanisms. Convergent lines of evidence support this hypothesis: (1) thalamocortical dysrhythmia documented in chronic pain patients via magnetoencephalography, with therapeutic correction producing pain relief; (2) heart rate variability abnormalities and reduced cardiac coherence consistently found in chronic pain populations; (3) photobiomodulation efficacy in randomized controlled trials suggesting electromagnetic etiology; (4) mitochondrial bioenergetic dysfunction preceding inflammatory cascades; (5) ultra-weak photon emission alterations correlating with disease states; and (6) circadian rhythm disruption patterns in chronic pain conditions. This framework positions inflammatory cascades, glial activation, and central sensitization as potential downstream consequences of bioelectromagnetic disruption rather than primary causes. The hypothesis generates falsifiable predictions and suggests novel therapeutic approaches targeting electromagnetic coherence restoration.

Purpose To evaluate 10-year outcomes of medical cannabis therapy on opioid use, pain intensity, functional disability, concomitant medication use, and adverse events in cannabis-naïve chronic low back pain (CLBP) patients, with particular attention to clinically meaningful outcomes defined by established minimal clinically important difference (MCID) thresholds. Methods Single-center longitudinal observational study of 1,000 consecutive cannabis-naïve CLBP patients from a registry database (2015–2024), reported following STROBE guidelines. Primary outcome: morphine milligram equivalents (MMEQ). Secondary outcomes: Numeric Rating Scale (NRS) for pain intensity, Oswestry Disability Index (ODI) for functional disability, cannabis dosing patterns, adverse events, and concomitant medication use. Pre-specified MCID thresholds: ≥50% MMEQ reduction, ≥ 30% NRS reduction, ≥ 10-point ODI improvement. Statistical analyses included paired t-tests for completers and linear mixed-effects models for sensitivity analyses. Results Of 1,000 enrolled patients, 638 (63.8%) completed 10-year follow-up. Among completers, MMEQ decreased from 62.8 ± 35.7 to 6.4 ± 7.1 mg/day (− 89.8%, p < 0.001); NRS from 8.71 ± 1.23 to 1.37 ± 1.71 (− 84.2%, p < 0.001); ODI from 52.9 ± 11.9% to 36.8 ± 14.9% (16.1-point reduction, − 30.4%, p < 0.001). MCID responders: 91.2% for MMEQ, 96.6% for NRS, 62.1% for ODI. Substantial polypharmacy reductions occurred: tramadol/tapentadol − 84.0 percentage points (pp), benzodiazepines − 73.5 pp, SSRIs − 71.9 pp, gabapentinoids − 30.7 pp. True tolerability adverse events occurred in 11.4% of visits; serious psychiatric events in 0.02%. Conclusions In this uncontrolled observational study, medical cannabis therapy was associated with reductions in opioid use, pain intensity, and functional disability over 10 years, accompanied by polypharmacy reduction and acceptable tolerability. Effect sizes substantially exceeded RCT benchmarks (e.g., − 0.6 NRS difference vs. placebo in a recent phase 3 trial), suggesting observational biases contribute to these findings. These hypothesis-generating data warrant validation in randomized controlled trials.

BACKGROUND:Elbow valgus stability relies on both static and dynamic stabilizers. The medial collateral ligament, particularly the anterior bundle (AB), provides primary resistance to valgus stress, whereas the flexor-pronator mass (FPM) offers secondary, dynamic support. Combined disruption of these structures-especially following trauma-can result in significant elbow instability. This cadaveric study aimed to quantify radiographic changes in the medial ulnohumeral joint (UHJ) space and valgus alignment following sequential transection of the AB, posterior bundle (PB), and FPM. METHODS:Twelve cadaveric elbows were sequentially tested after sequential transection of the AB, PB, and FPM. Radiographs were obtained at 60° of flexion under standardized valgus stress. Changes in mean medial UHJ space and α-angle were compared across stages using the Friedman test with Wilcoxon post-hoc analysis (P < .05). RESULTS:The mean specimen age was 63 years (70% male). Mean medial UHJ space increased progressively from 5.4 ± 1.1 mm in the intact state to 12.4 ± 3.0 mm after AB transection, 16.1 ± 3.9 mm after combined AB + PB transection, and 26.4 ± 7.8 mm after additional FPM release. Correspondingly, mean α-angle rose from 2.8° ± 1.7° to 3.4° ± 3.0°, 5.0° ± 4.2°, and 13.6° ± 8.6°, respectively. All comparisons were statistically significant (P < .001). CONCLUSION:In this cadaveric model, UHJ opening ≈15 mm suggested full medial collateral ligament disruption, and >20 mm or α-angle ≈13° indicated additional FPM compromise; these values are experimental reference ranges for medial soft-tissue injuries.

BACKGROUND:Chondral/osteochondral knee lesions are commonly encountered and often associated with progression of osteoarthritis (OA). Nevertheless, knee repair trials have traditionally excluded patients with concurrent mild to moderate OA. PURPOSE:To compare the clinical and safety outcomes of knee repair with an aragonite-based osteochondral implant with outcomes of surgical standard of care (SSOC) in patients with chondral/osteochondral knee lesions, including those with mild to moderate OA. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:Investigators at 26 centers across 8 countries enrolled adult patients (21-75 years of age) with ≤3 cartilage defects of International Cartilage Regeneration & Joint Preservation Society grade ≥3a located on the femoral condyles and/or trochlea, total treatable area 1 to 7 cm2, bony defect depth ≤8 mm, and Kellgren-Lawrence knee OA score of 0 to 3. Patients were randomized 2:1 to receive an aragonite-based implant or SSOC (arthroscopic debridement or microfracture) and followed for 5 years. The primary endpoint was improvement in overall Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary endpoints included percentage of responders (minimum overall KOOS improvement ≥ 30 points), patient-reported outcomes (KOOS subscale values and International Knee Documentation Committee subjective score), treatment failure (ie, need for any secondary treatment), and treatment-emergent adverse events. A covariate analysis compared primary/secondary outcomes between patients with no to minimal and mild to moderate OA. RESULTS:In total, 167 patients underwent knee repair with the study implant and 84 with SSOC, with follow-up compliance rates of 88.4% and 83.1%, respectively, at 5 years. The mean baseline overall KOOS values were comparable between the implant (41.2 ± 13.1) and SSOC (41.7 ± 12.4) groups. By the final follow-up, improvement was significantly greater for the implant group (81.0 ± 23.0 vs 59.1 ± 25.2; 22.6-point difference; 95% CI, 16.6-28.7). The overall KOOS responder rate was 74.7% in the implant group and 29.6% in the SSOC group. The implant group experienced significantly superior outcomes between baseline and the final follow-up for all secondary patient-reported outcome measures. Treatment failure rate was significantly higher with SSOC than the implant (35.7% vs 15.0%; P < .001). Among patients with mild to moderate OA, the implant group exhibited a higher overall KOOS responder rate (74.6% vs 36.2%) and lower failure rate (13.2% vs 40.7%; P < .001) than the SSOC group. CONCLUSION:The results confirmed that the aragonite-based scaffold is both safe and superior to SSOC in improving clinical outcomes at up to 5 years' evaluation, as well as in patients with mild to moderate OA.

Background: Chronic corticosteroids are commonly prescribed for autoimmune and inflammatory disorders, yet their impact on perioperative outcomes following elective total hip arthroplasty (THA) remains incompletely defined. This study evaluated the association between chronic corticosteroid use and postoperative complications and hospital outcomes after elective primary THA. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016-2021). Adult patients undergoing elective primary THA were identified using ICD-10-PCS codes. Chronic corticosteroid use was defined by ICD-10-CM code Z79.52. The primary outcome was any postoperative complication, including venous thromboembolism (VTE), major bleeding, acute kidney injury, myocardial infarction, stroke, or sepsis. Secondary outcomes included prolonged length of stay, high hospital charges, discharge to rehabilitation, and in-hospital mortality. Multivariable weighted logistic regression and 1:1 propensity score matching (PSM) was applied. Results: The weighted cohort represented approximately 600,000 hospitalizations, of which 0.91% involved chronic steroid use. Steroid users had a higher burden of comorbidities. After adjustment, chronic corticosteroid use was independently associated with increased odds of any postoperative complication (OR 1.32), major bleeding (OR 1.46), prolonged hospitalization (OR 1.26), discharge to rehabilitation (OR 1.06), and in-hospital mortality (OR 2.53). In the matched cohort (1079 pairs), steroid use remained significantly associated with overall complications (OR 1.84) and acute kidney injury (OR 2.10). Conclusions: Although uncommon, chronic corticosteroid use is associated with a clinically meaningful increase in perioperative morbidity after elective THA. These findings highlight chronic corticosteroid use as a marker of increased perioperative risk that warrants greater clinical recognition, and they provide hypothesis-generating evidence to inform future studies of perioperative management in this population.

Background: Limb-salvage surgery using extendable distal femoral endoprostheses has become the standard reconstruction following tumor resection in skeletally immature patients, allowing continued growth and improved function. However, mechanical complications, particularly tibial pain, remain challenging and poorly understood. This study aimed to identify radiographic predictors of tibial pain and evaluate their potential utility in early risk detection. Methods: A retrospective cohort study was conducted of 29 skeletally immature patients (mean age 10.4 years) who underwent expandable distal femoral endoprosthetic replacement between 2008 and 2018 at a tertiary orthopedic oncology center. Standardized radiographs were analyzed at 6 months and final follow-up (mean 75 months) to assess cortical thickness, stem-to-cortex distances, stem migration, stress shielding, pedestal formation, and periosteal reaction. Associations between radiographic parameters and tibial pain were assessed using multivariable logistic regression, t-tests, and chi-square analyses. Results: Seventeen patients (58.6%) developed activity-limiting tibial pain requiring analgesics, as documented during follow-up. Mean medial and lateral cortical thickness increased from 3.0 mm and 3.4 mm to 4.1 mm and 5.1 mm, respectively. The logistic regression model demonstrated strong explanatory power (Pseudo R2 = 0.57, p = 0.004). Medial cortical thickness at last follow-up was the only significant independent predictor of tibial pain (p = 0.042), and was significantly associated with tibial pain. Patients with tibial pain exhibited greater medial cortical thickening (p < 0.001). Stem migration (φ = 0.421, p = 0.065), stress shielding (φ = 0.476, p = 0.044), pedestal formation (φ = 0.608, p = 0.004), and periosteal reaction (φ = 0.569, p = 0.008) were also associated with pain. Conclusions: Medial cortical hypertrophy emerged as a potential radiographic biomarker for tibial pain. after expandable distal femoral endoprosthesis in growing patients. The findings suggest that cortical remodeling, stress shielding, and pedestal formation collectively reflect stem micromotion and bone adaptation. Early radiographic surveillance of these parameters warrants further investigation in prospective studies to determine their clinical utility. Larger multicenter studies are warranted to validate these predictors and refine postoperative monitoring protocols.

Hallux valgus (HV) is a prevalent three-dimensional foot deformity, yet it is primarily assessed in the anteroposterior plane radiographs. The role of the sagittal plane and specifically the plantar fat pad remains poorly understood. This study aimed to quantitatively explore the relationship between plantar fat-pad geometry and HV progression. In this retrospective study, we analysed 274 feet from 144 patients who underwent HV corrective surgery at Hasharon Hospital, Israel (2014–2024). Using custom Python-based software, we annotated 22 anatomical landmarks on preoperative, weight-bearing lateral radiographs (3 plantar fat pads and 19 plantar bony points). For each fat pad, 19 Distance features were generated (total 57), comprising 19 pairwise standardised distances. Associations between these distances and standard HV angles (HVA, IMA, DMAA, HIA) were assessed using Pearson and Spearman correlations, A subgroup analysis was carried out to compare patients aged below and above 40 years, as well as between male and female patients. In the full cohort, no distance feature correlated with standard HV angles at the prespecified threshold ( |r| or |ρ |≥ 0.25 , two-sided p<0.05 ). Stratified analyses revealed subgroup-specific patterns: females showed three significant relationships (mainly involving the calcaneal fat pad), whereas males showed 29 predominantly negative forefoot–hindfoot correlations (e.g., base of 5th metatarsal fat pad → calcaneal fat pad vs. HIA: r=-0.44 , ρ =-0.39 , both p<0.01 ). The <40 y group exhibited six significant features (including sesamoid-based positives), while the ≥ 40 y group showed two first-ray–focused associations. Several effects were stronger on Spearman than Pearson, consistent with nonlinearity, and many between-group differences were significant by Fisher’s r -to- z ( p<0.05 ). Progressive Distance Mapping (PDM) summarized these effects into composite, radiograph-overlaid maps. Progressive Distance Mapping (PDM) may suggest subgroup-dependent, progressive associations between plantar fat–pad–anchored distance geometry and hallux valgus (HV) severity. Despite no universal cohort-level correlations, PDM identifies four distinct morphologic subtypes within each subgroup (stratified by age and sex), this may suggest differing pathogenesis and patterns of plantar fat-pad involvement. These subtype-specific signatures are often nonlinear;

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population. While cannabis-based therapies have shown short-term analgesic potential, long-term evidence remains scarce. This study assessed the four-year efficacy of inhaled cannabis therapy on pain and disability outcomes, while exploring BioWell gas discharge visualization (GDV) parameters as non-invasive biomarkers. Methods: In this prospective observational study (IRB 0634-25-RMC and 807-21-RMC), 241 adults with CLBP (mean age 49.3 ± 14.9 years; 62.2% male) who had failed ≥1 year of conventional therapy initiated inhaled cannabis (predominantly smoking, 91%). Cannabis contained THC (4–22%) and CBD (2–22%), with dosing titrated from 21.5 g/month (Year 1) to 56.7 g/month (Year 4). Primary outcomes—NRS, ODI, BPI severity and interference—and secondary BioWell stress and vitality were assessed annually. Analyses included repeated-measures ANOVA, mixed-effects models, ROC analysis, network analysis, K-means clustering, and survival analysis. Results: Of 241 enrolled patients, 229 (95.0%) completed Year 4 follow-up. NRS decreased from 8.08 ± 1.61 to 2.71 ± 1.46 (p < 0.001), ODI from 55.05 ± 15.90 to 36.82 ± 8.47 (p < 0.001), BPI severity from 7.94 ± 1.71 to 1.11 ± 0.53 (p < 0.001), and BPI interference from 5.84 ± 2.02 to 2.20 ± 1.69 (p < 0.001). BioWell stress discriminated moderate-to-severe pain (NRS > 4) with AUC 0.71 (95% CI 0.65–0.77). Fibromyalgia at baseline predicted discontinuation (HR 1.59, 95% CI 1.18–2.14, p = 0.003). Conclusions: Inhaled cannabis therapy was associated with sustained reductions in pain and disability over four years. BioWell stress showed modest discriminative ability as a biomarker. These findings are associative and require confirmation in controlled trials.

Background: Chronic low back pain (CLBP) is a leading cause of disability, often managed with opioids despite risks. Cannabis, containing tetrahydrocannabinol (THC) and cannabidiol, offers a potential alternative, but long-term data are limited. Objective: To evaluate the efficacy, safety, and opioid-sparing effects of cannabis therapy over 10 years in CLBP patients. Methods: In a prospective study (2013-2023), 168 adults (135 males, mean age 47 +/- 19 years) with CLBP (>= 1 year) and anatomical abnormalities (e.g., disc herniation, 83%) received cannabis (20% THC, 50 +/- 10 g/month) at a specialized orthopedic clinic. Baseline treatments included opioids (91%) and surgery (47%). Outcomes-pain (Visual Analogue Scale, VAS), disability (Oswestry Disability Index, ODI), quality of life (SF-12), and opioid use-were assessed at baseline, 1, 3, 12, 24, 60, and 120 months. Statistical analysis used ANOVA, t-tests, and Kruskal-Wallis; missing data were imputed via Last Observation Carried Forward.Results: At 10 years (n = 159), VAS decreased from 84.6 +/- 14.8 to 7.0 +/- 11.0 (p < 0.0001), ODI from 61.7 +/- 13.7 to 4.0 +/- 6.0 (p < 0.0001), and SF-12 Physical and Mental Component Summaries improved by 21.1 points each (p < 0.0001). Opioid use dropped from 91% to 8.2% (morphine equivalent dose: 30 +/- 12 to 1 +/- 3 mg, p < 0.001). Six patients (3.6%) discontinued due to adverse effects; nine die. Conclusions: Long-term cannabis therapy significantly reduced pain, disability, and opioid dependence in CLBP, with sustained quality-of-life gains, supporting its role in chronic pain management.

Articular surface lesions, which include chondral and osteochondral defects, are debilitating and favor the development of osteoarthritis. The long-term follow-up of the world's first case of implantation of an aragonite-based scaffold (Agili-C™, from CartiHeal) in a chronic post-traumatic osteochondral knee joint lesion (International Cartilage Repair Society (ICRS) grade IV, size 2 ​cm2) was presented. Over a decade after implantation, the treatment results remained stable, the patient was fully satisfied, and was able to resume his preinjury activities. Despite the partial meniscectomy of the medial meniscus, the degenerative process was successfully contained, with only subtle osteophytes and mild narrowing of the medial compartment. In addition, radiologic monitoring of the restored bone and cartilage tissue showed successful and durable results. STUDY DESIGN: Case-report (level of evidence: V).

Background/Objectives: Hallux valgus (HV), a common foot deformity, is difficult to quantify beyond traditional angular measurements. This study introduces a novel dynamic distance mapping technique to visualize HV progression and identify spatial features linked to severity. Methods: A retrospective analysis of 335 feet from 178 patients undergoing HV surgery at Hasharon Hospital, Israel (2014–2024), utilized custom Python software to annotate 24 landmarks on preoperative standing anteroposterior radiographs. This generated 276 normalized Euclidean distances, analyzed via Pearson correlation against HV angles (HVA, IMA, DMAA, HIA). Results: Seven distances correlated negatively (r > 0.4, p < 0.05) and seven positively with HVA, involving the distal phalanx, sesamoids, and second metatarsal. Eleven distances showed strong positive correlation (r > 0.4, p < 0.05) with IMA, reflecting displacement patterns. Moderate correlations were observed with DMAA (six negative, r −0.3 to −0.4; two positive, r 0.3 to 0.4, p < 0.05) and HIA (two negative, r −0.3 to −0.4, p < 0.05). Visualizations highlighted progressive spatial changes. Conclusions: Dynamic distance mapping provides valuable insights into hallux valgus (HV) progression, as evidenced by significant correlations with HVA and IMA, supporting its potential role in surgical planning. However, its ability to capture 3D deformities requires validation against weightbearing computed tomography (WBCT). Future research should explore correlations with specific indications for corrective osteotomies to enhance clinical applicability.

Continuous measurement of pressure is vital in many fields of industry, medicine, and science. Of particular interest is the ability to measure pressure in a noninvasive and contact-free manner. This work presents the potential of oblique incident reflectometry (OIR) to monitor variation in pressure via the reduced scattering parameter (μs′). Pressure deforms the geometry of the medium and causes distortion of its internal structure and the spatial distribution of optical properties. Light scattering is related to the morphology (size, density, distribution, etc.) and refractive index distributions of the medium, and applied pressure will influence directly these parameters. Therefore, we assume that pressure can be quantitatively assessed through monitoring the reduced scattering coefficient. For this purpose, the technique of OIR to evaluate the scattering parameter during pressure variations was utilized. OIR is a simple noninvasive and contact-free imaging technique able to quantify both absorption and scattering properties of a sample. In our setup, the medium is illuminated obliquely by a narrow laser beam, and the diffuse reflectance light is captured by a CCD camera. In offline processing, the shift (δ) of the diffuse light center from the incident point is mathematically analyzed and μs′ coefficient (μs′∼δ−1) is extracted. We present here confirmation of the validity of this assumption through results of a series of experiments performed on turbid liquid and artery occlusion of a human subject under different pressure levels. Thus, μs′ has the potential to serve as a good indicator for the monitoring of pressure.

Introduction:The use of medicinal cannabis for managing pain expands, although its efficacy and safety have not been fully established through randomized controlled trials.Objectives:This structured, prospective questionnaire-based cohort was aimed to assess long-term effectiveness and safety of cannabis oil extracts in patients with chronic pain.Methods:Adult Israeli patients licensed to use cannabis oil extracts for chronic pain were followed prospectively for 6 months. The primary outcome measure was change from baseline in average weekly pain intensity, and secondary outcomes were changes in related symptoms and quality of life, recorded before treatment initiation and 1, 3, and 6 months thereafter. Generalized linear mixed model was used to analyze changes over time. In addition, "responders" (≥30% reduction in weekly pain at any time point) were identified.Results:The study included 218 patients at baseline, and 188, 154, and 131 at 1, 3, and 6 months, respectively. At 6 months, the mean daily doses of cannabidiol and Δ9-tetrahydrocannabinol were 22.4 ± 24.0 mg and 20.8 ± 30.1 mg, respectively. Pain decreased from 7.9 ± 1.7 at baseline to 6.6 ± 2.2 at 6 months (F(3,450) = 26.22, P < 0.0001). Most secondary parameters also significantly improved. Of the 218 participants, 24% were "responders" but could not be identified by baseline parameters. "Responders" exhibited higher improvement in secondary outcomes. Adverse events were common but mostly nonserious.Conclusion:This prospective cohort demonstrated a modest overall long-term improvement in chronic pain and related symptoms and a reasonable safety profile with the use of relatively low doses of individually titrated Δ9-tetrahydrocannabinol and cannabidiol.

The features of chondral lesions have been purported to influence clinical outcomes after cartilage repair procedures in the knee. The objective of this study was to find out if specific lesion features correlate with clinical outcome in a RCT comparing an aragonite-based scaffold to debridement/microfracture.

The use of bioabsorbable magnesium (Mg) screws is new in foot surgery. Their relative merit over conventional titanium screws has not yet been proven. This prospective case series study was conducted to compare the clinical and radiological outcomes of bioabsorbable Mg screws and titanium screws. A consecutive series of patients (n = 60; 11 men and 49 women) underwent corrective hallux valgus surgery. The minimum follow-up period was 1 year. The assessment was based on a patient questionnaire, including the American Orthopedic Foot and Ankle Society (AOFAS) hallux valgus score, visual analog scale, patient's global impression of change (PGIC), and fifth metatarsus circumference (IF5C). The radiographic assessment included the intermetatarsal and hallux valgus angles, as well as time to osteotomy union and hardware failure. At 1 year, similar results were obtained radiographically. The healing of the osteotomies was significantly faster in the Mg group. Hardware failure was common in the Mg group (5/26) than in the TI group (0/34) but hardware removal was more common in the TI group (6/34) versus the MG group (0/26). IF5C increased by 8 ± 2 mm in the Mg group. The AOFAS and PGIC scores at 6 months were similar. Validated foot scores and radiographic analysis indicated that there was no detectable difference between the groups. The fast achievement of osteotomy union compensates for a high rate of hardware failure, resulting in patient satisfaction and avoiding reoperation for hardware removal.

Polyp segmentation is an important task in early identification of colon polyps for prevention of colorectal cancer. Numerous methods of machine learning have been utilized in an attempt to solve this task with varying levels of success. A successful polyp segmentation method which is both accurate and fast could make a huge impact on colonoscopy exams, aiding in real-time detection, as well as enabling faster and cheaper offline analysis. Thus, recent studies have worked to produce networks that are more accurate and faster than the previous generation of networks (e.g., NanoNet). Here, we propose ResPVT architecture for polyp segmentation. This platform uses transformers as a backbone and far surpasses all previous networks not only in accuracy but also with a much higher frame rate which may drastically reduce costs in both real time and offline analysis and enable the widespread application of this technology.