Search Results (377)

This study investigates the potential, limitations, and pedagogical implications of applying a parallel multi-model AI evaluation workflow, using ChatGPT, DeepSeek, and Uizard, to assess student design projects in higher education. Because design assessment involves both formal criteria and subjective creative interpretation, the study first established a human expert baseline based on three independent university professors. The human inter-rater reliability was low to moderate, with a mean pairwise Spearman’s ρ of 0.36 and Cronbach’s α of 0.60 for packaging design, and ρ of 0.43 and α of 0.69 for web design. This finding is central to the study, as it shows that the human benchmark in creative design assessment is itself variable and interpretive. Against this baseline, AI–human alignment remained limited and task-dependent. For packaging design, the AI ensemble showed only a weak positive association with the human expert baseline (Spearman’s ρ = 0.30, p = 0.031), which should be interpreted cautiously given the Bonferroni-adjusted significance threshold used in the study. For web design, no significant AI–human association was observed. Qualitative analysis of AI-generated rationales identified recurring limitations, including hallucination, aesthetic shield effects, and missed context, where visually polished work was rewarded despite deeper conceptual or structural weaknesses. The findings suggest that current AI systems can provide useful formative feedback on visible formal features, but they are not reliable as autonomous grading tools for complex creative work. AI-assisted assessment is therefore best understood as a supervised formative support mechanism, while final evaluation should remain grounded in human pedagogical judgment. Full article

Sodium alginate was extracted from beach-cast Sargassum spp. collected along the coast of Puerto Progreso, Yucatán, Mexico, using two established pretreatment routes based on formaldehyde and ethanol. This study evaluates how extraction methodology controls alginate recovery, molecular structure, hydrogel rheology, macroscopic integrity, swelling behavior, and preliminary inorganic contaminant profiles. The ethanol-based route provided the highest extraction yield, reaching 19.87 ± 0.79% w/w for AE-5, whereas the formaldehyde route reached a maximum of 15.60 ± 0.62% w/w for AF-12; statistical analysis confirmed significant differences among extraction conditions (ANOVA, p < 0.05). Despite its lower yield, the formaldehyde route produced alginate with higher intrinsic viscosity (2.13 dL/g) and viscosity-average molecular weight (1.00 × 105 g/mol) than the ethanol-derived sample (1.33 dL/g and 0.62 × 105 g/mol), indicating better preservation of polymer chain length. ¹H NMR analysis showed that AE-5 had higher guluronic acid content (F_G = 0.60), lower M/G ratio (0.67), and higher G-block fraction (F_GG = 0.54), favoring Ca²⁺-mediated junction zone formation. Consequently, AE-5-derived hydrogels exhibited the highest storage modulus at 1 Hz (G′ = 23,650 Pa), compared with AF-12-derived hydrogels (13,160 Pa) and the commercial reference (14,480 Pa). However, visual inspection and swelling analysis showed that the higher small-amplitude stiffness of AE-5 did not translate into superior macroscopic integrity; these hydrogels showed greater fragmentation during handling and higher long-term swelling. In contrast, AF-12-derived hydrogels showed lower stiffness but better apparent cohesion and a more restricted swelling profile, consistent with enhanced long-range network connectivity derived from higher molecular weight. FTIR confirmed preservation of the characteristic functional groups of sodium alginate, whereas XRD provided qualitative evidence of residual crystalline inorganic phases. Selected-metal analysis by MP-AES detected Cu in both extracted alginates, while As was detected but not quantified only in AF-12; Cd and Pb were not detected under the analytical conditions employed. Overall, the results establish a route-dependent structure-property relationship in which extraction conditions govern yield, chain preservation, block architecture, viscoelastic response, swelling behavior, and preliminary contaminant profile. These findings support beach-cast Sargassum as a promising source of research-grade sodium alginate, while emphasizing that further purification, expanded contaminant profiling, arsenic speciation, biological evaluation, and direct mechanical testing are required before any food, biomedical, pharmaceutical, or environmental application can be proposed. Full article

Textile materials made from staple fibers typically have protruding fibers on their surface, commonly referred to as surface hairiness. During fraying, the surface of the textile material is susceptible to damage, which affects its appearance and leads to fuzzing by roughening or the emergence of new fibers. The propensity for fuzzing is assessed using the standard visual method (EN ISO 12945-4:2020), which is intuitive and cost-effective but better suited for evaluating more pronounced surface phenomena, such as pilling. This is mainly because fuzzing is usually accompanied by pilling, and their simultaneous occurrence makes separate analysis difficult. As a result, instrumental methods for assessing fuzzing that provide a more objective evaluation are rarely reported. In this research, an advanced digital imaging assessment method was introduced, using an innovative apparatus that, with simultaneous assessment of pilling, enabled separate digital imaging of the same textile fabric specimen’s surface fuzzing through a refined viewing angle. Additionally, newly developed software enabled digital analysis and acquisition of quantitative numerical values related to surface fuzzing. The research was conducted on six single-component woven fabrics made from cotton, wool, viscose, polyamide 6.6, polyester, and acrylic. Fuzzing was induced using an ICI tester (EN ISO 12945-1:2020) and a Martindale tester (EN ISO 12945-2:2020) through predefined box revolutions and fuzzing rubs ranging from 125 to 30,000. Fuzzing was assessed using both the standard visual method and the advanced digital imaging assessment method, with grading according to established classes based on the percentage change in fuzzing layer height. The results highlight the applicability of the advanced digital assessment method, as it separately captures the occurrence of fuzzing and distinguishes it from pilling. Full article

Background: Three-level anterior cervical discectomy and fusion (ACDF) is widely used for multilevel cervical degenerative disc disease; however, the relationship between postoperative alignment trajectories, adjacent segment degeneration (ASD), and late patient-reported outcomes remains incompletely defined. This study evaluated plane-specific radiological alignment changes, MRI-based ASD, and late functional outcomes in a homogeneous three-level ACDF cohort. Methods: This single-center observational cohort included 29 patients who underwent three-level ACDF between January 2018 and December 2023 and had complete radiographic follow-up. Radiological data were collected retrospectively from institutional records and imaging archives. Cervical sagittal and coronal alignment were assessed using Cobb angles on radiographs obtained preoperatively and at 6 months, 1 year, and 2 years postoperatively. ASD was evaluated at the superior adjacent segment on 2-year MRI. Late patient-reported clinical outcomes were assessed at a mean follow-up of 42.6 ± 6.8 months using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Nottingham Health Profile (NHP). Results: Sagittal Cobb angle changed significantly over time (χ²(3) = 12.60, p = 0.006; Kendall’s W = 0.145), whereas coronal Cobb angle showed a statistically significant reduction over time, although the absolute magnitude of change was small (χ²(3) = 28.74, p < 0.001; Kendall’s W = 0.330). Lower sagittal Cobb angle correlated with worse NDI (r = −0.46, p = 0.004), and greater coronal Cobb angle correlated with worse physical activity scores (r = 0.52, p = 0.006). Higher Pfirrmann grade correlated with worse NDI (r = 0.49, p = 0.004) and pain scores (r = 0.44, p = 0.021). In exploratory regression analysis, sagittal Cobb angle and Pfirrmann grade were retained in the model for NDI, but these findings should be interpreted as hypothesis-generating. Conclusions: After three-level ACDF, sagittal and coronal alignment followed different postoperative trajectories. Lower sagittal alignment and greater adjacent disc degeneration were associated with worse late neck-related disability. However, given the modest sample size and exploratory nature of the regression analysis, these findings should be interpreted as hypothesis-generating. Larger prospective studies are needed to confirm whether sagittal alignment and MRI-based adjacent segment degeneration independently contribute to late functional outcomes. Full article

This study examines the spatial organization of the Iksan Ssangneung neungwon, a late Baekje royal tomb precinct located in Iksan, southwestern Korea, and associated with the Sabi period. It analyzes visual differentiation, defined here as the graded variation in visual relationships between the Daewangneung and the Sowangneung along a movement sequence. The study uses an integrated GIS-based analysis of terrain, hydrology, and movement-based visual differentiation. A ridge-based approach sequence is defined using topographic and hydrological criteria, and observation points are generated at fixed intervals. Construct Sight Lines analysis measures vertical prominence, angular separation, and visual intensity, which are integrated into a composite index. The results show that, within this modeled ridge-based approach scenario, visual differentiation is unevenly distributed along the approach sequence. Composite values increase toward a restricted central segment of the modeled route and decrease toward the transitional and outer segments. The highest values coincide with the burial mounds and the Seogwangdong architectural locus. Movement along the ridge is associated with intensified visual differentiation centered on the Daewangneung, whereas the architectural locus appears to create a local viewing condition in which the visual contrast between the two mounds is moderated. The results suggest that, within this route-dependent reconstruction, spatial organization can be examined as a measurable pattern of graded visual differentiation shaped by topography, hydrology, movement, and locally differentiated viewing conditions. Full article

Background: Neovascular age-related macular degeneration (nAMD) remains a leading cause of irreversible central vision loss. Although anti-vascular endothelial growth factor (anti-VEGF) therapy has transformed management, pivotal trials enrolled exclusively treatment-naïve patients, leaving clinicians without pooled evidence to guide switching decisions in previously treated eyes. This systematic review and meta-analysis assessed real-world visual, anatomical, durability, and safety outcomes following switching to aflibercept 8 mg in previously treated nAMD. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Embase, Web of Science, CENTRAL, Scopus, and Google Scholar through April 2026. Studies reporting switching to aflibercept 8 mg with change in best-corrected visual acuity (BCVA), central subfield thickness (CST), or treatment interval were included. Continuous outcomes were pooled using random-effects models with Hartung–Knapp–Sidik–Jonkman adjustment; proportions were estimated using generalized linear mixed models. Methodological quality was evaluated using the JBI Critical Appraisal Checklist for Case Series. Certainty of evidence was assessed using GRADE. The protocol was registered with PROSPERO (CRD420261371334). Results: Twenty-one studies met inclusion criteria. BCVA remained stable (WMD: −0.017 logMAR; 95% CI: −0.027 to −0.007; +0.83 ETDRS letters; I² = 0%). CST decreased significantly (WMD: −21.5 µm; 95% CI: −29.3 to −13.7; I² = 56.0%), and treatment intervals extended by +1.79 weeks (95% CI: +1.32 to +2.27; I² = 74.3%). Intraretinal and subretinal fluid each resolved in 37.5% of eyes. Intraocular inflammation was rare across 9959 treated eyes, though this pool was not restricted to switched eyes, with no confirmed retinal vasculitis. Sensitivity analyses confirmed robustness across all co-primary estimates. GRADE certainty was low for BCVA and very low for CST and treatment interval. Conclusions: Low-certainty evidence suggests that switching to aflibercept 8 mg preserves visual acuity, while very-low-certainty evidence suggests reductions in central subfield thickness and modest extension of treatment intervals. Intraocular inflammation was rare, though safety denominators included non-switch eyes. These findings provide preliminary pooled estimates to inform switch decisions in previously treated eyes. Full article

Background/Objectives: Accurate evaluation of knee osteoarthritis (KOA) severity is critical for optimal patient care, yet manual radiographic grading remains subject to observer variability. This study aims to evaluate the performance of a fine-tuned contrastive language–image pre-training (CLIP) framework designed to assist clinicians in grading KOA severity in plain radiographs using the Kellgren–Lawrence (KL) classification system (Grades 0–4). Methods: The model operates by projecting visual features from radiographs and standard textual clinical descriptions into a shared embedding space. Training was conducted using 8260 posterior–anterior (PA) fixed-flexion X-ray images from the Osteoarthritis Initiative (OAI) dataset. For robust external evaluation across distinct data distributions, the model was tested on an independent dataset consisting of 1650 plain radiographs. Results: When evaluated on the external validation dataset, the fine-tuned CLIP model achieved an accuracy of 76.94% and an F1-score of 76.66%. Comparative analysis demonstrates that these aligned vision-language representations provide competitive, stable diagnostic capabilities even when applied to an entirely independent data distribution. Conclusions: Fine-tuned CLIP architectures offer a viable and valuable foundation for semantically transparent, computer-aided evaluation of KOA. Full article

Background/Objectives: Unanticipated difficult airway remains a critical patient safety concern in perioperative care. Despite routine preoperative assessment, difficult intubation may still occur in patients without obvious high-risk findings. This study aimed to evaluate perioperative factors associated with unanticipated difficult intubation and to examine the relationship between preoperative assessment and intraoperative intubation difficulty in routine clinical practice. Methods: This retrospective case–control study included adult patients undergoing general anesthesia with tracheal intubation between 2015 and 2020 at a tertiary care hospital. Unanticipated difficult intubation was defined as requiring ≥3 intubation attempts without documented preoperative suspicion of difficult airway. Patients with anticipated difficult airway or preoperative mechanical ventilation were excluded. A total of 95 cases and 429 controls were analyzed. Associations were explored using multivariable logistic regression. Results: Among 524 patients, cases more frequently had ASA physical status III and airway/neck/oral deformity. Notably, intubation difficulty became evident only at laryngoscopy, characterized by poorer visualization, increased intubation attempts (median 4 vs. 1), and frequent escalation to video laryngoscopy. Severe laryngoscopic views (Cormack–Lehane grade III–IV: 74.8% vs. 3.0%) were markedly overrepresented among cases. In multivariable analysis, ASA III and airway deformity remained independently associated with unanticipated difficult intubation. The model demonstrated modest discrimination (AUC 0.685). Conclusions: Unanticipated difficult intubation was uncommon but clinically important and frequently became apparent only during airway management. Although several associated factors were identified, routine bedside airway assessment alone may not reliably predict all cases of intraoperative difficult intubation. These findings highlight the limitations of routine bedside airway assessment in identifying all patients who subsequently experience difficult intubation and support the need for improved strategies to identify patients at risk. Full article

Background/Objectives: Systematic assessment of orthodontic treatment needs is essential for prioritizing care in public health programs. The Dental Aesthetic Index (DAI) provides a composite severity score; however, understanding which individual occlusal traits drive severe treatment needs has a practical screening value. This study aimed to determine which occlusal features, categorized using established clinical thresholds, independently associated with severe orthodontic treatment need. Methods: Pretreatment records of 292 patients (141 men, 151 women; aged 13–42 years) were analyzed. The outcome was severe treatment need (DAI ≥ 31). Ten DAI components were categorized using IOTN-DHC severity cutpoints; Angle and skeletal classifications were also assessed. Candidate predictors (p < 0.20) were entered into multivariate logistic regression with backward elimination. Discrimination was assessed by ROC analysis; internal validation used bootstrap resampling and cross-validation. Results: Of the 292 patients, 141 (48.3%) had severe treatment needs. Six occlusal features were independently associated with severe treatment need (all p < 0.001): overjet severity (adjusted odds ratio [OR] = 412.4; 95% confidence interval [CI]: 82.1–2072.1), missing anterior teeth (OR = 29.3; 95% CI: 8.6–99.5), open bite severity (OR = 13.4; 95% CI: 4.6–39.5), diastema (OR = 7.4; 95% CI: 2.4–22.5), molar cusp relationship (OR = 4.7; 95% CI: 2.3–9.5), and anterior spacing (OR = 2.9; 95% CI: 1.5–5.4). The area under the ROC curve was 0.971 (optimism-corrected: 0.968), and 90.8% of the patients were correctly classified by the final model (sensitivity, 89.4%; specificity, 92.1%). Angle classification, skeletal classification, sex, age, and crowding were not included in the final model. Conclusions: Six clinically categorized occlusal features assessed by visual inspection were independently associated with severe orthodontic treatment need in this explanatory analysis, with overjet severity as the dominant determinant. Categorical severity grades based on established clinical thresholds retained strong discriminative information (optimism-corrected AUC = 0.968), suggesting that simplified assessments may be sufficient for the initial screening. Dental and skeletal classifications did not provide an independent predictive value beyond that of occlusal features. External validation is needed before clinical implementation. Full article

Corrosion-driven section loss in steel tower structures erodes load-carrying capacity, yet field assessment still relies on subjective visual grading. This paper presents a closed-loop framework coupling quantitative image-based corrosion measurement with stochastic degradation modeling, Monte Carlo reliability simulation, and Sobol’ variance-based global sensitivity decomposition. Two complementary segmentation paths—hue–saturation–value (HSV) color-space thresholding for fleet-scale screening and DeepLabV3+ deep learning for detailed evaluation—convert imagery into calibrated section-loss estimates via nonlinear regression. Three analysis modes (single-image, multi-angle weighted-median fusion, and Oriented FAST and Rotated BRIEF (ORB) feature-matched temporal differencing) feed a Bayesian-updated power-law corrosion growth model whose outputs propagate through a time-dependent limit-state function via 10⁶-sample Monte Carlo simulation. Sobol’ indices rank each uncertain input’s contribution to the reliability-index variance. A field demonstration on a 40-year-old galvanized lattice tower in an ISO 9223 C4 coastal environment shows that the corrosion rate constant and zinc coating thickness together govern 65% of the total reliability variance and that a risk-ranked selective maintenance strategy reduces expected life-cycle cost by 71% relative to blanket intervention. Full article

Automated data exploration is very useful for evaluating key aspects of populations such as young adults (which here refers to the youth population in the United States represented by students in grades 9 through 12). This article shows how Principal Component Analysis (PCA) can be used for this exploration. PCA is applicable to data analysis situations with data from $n$ individuals of $m$ attributes (generally $n >> m$). For analytical purposes, the data can be visualized as $n$ points in a Euclidean space with Cartesian coordinates, with $m$ perpendicular coordinate axes, where each axis corresponds to an attribute. When $m$ is large, the points become difficult to visualize, so PCA is useful, as it is a dimensionality reduction method that facilitates the visualization of the points. The objective of this article is to identify relationships between attributes, where there is a primary attribute of interest. The present work describes some of the main theoretical aspects of PCA and then uses PCA to analyze data, as a practical example. The data comes from the publicly available results of a 2023 survey administered to a nationally representative sample of students in the United States, to assess health risk behaviors among young adults (students in grades 9 through 12), which was conducted by the Youth Risk Behavior Surveillance System (YRBSS), managed by the Centers for Disease Control and Prevention—CDC. The results of this work graphically discover relationships between specific data attributes. The reliability of the results is then discussed, considering: (1) recommendations taken from PCA literature, and (2) the use of a graphical tool called a Zoning Biplot, an improved form of displaying PCA results. This work is relevant because it uses the Zoning Biplot, proposed by the authors, which shows more detail in the results compared to a conventional Biplot; the authors argue that this detail allows for valid results across a larger number of datasets, such as the dataset in the example presented. The authors present a graphical development to support the concept and advantage of a Zoning Biplot. Full article

This study is based on an interdisciplinary teaching experience in two 2nd-grade classes, integrating Visual Arts and Mathematics through the use of Pop-Up cards. It aimed to identify how these activities foster disciplinary and interdisciplinary learning, the aspects of the teacher’s role most relevant to enhancing students’ learning, and the types of professional knowledge required. The research methodology follows the four phases of the didactic engineering approach, with data collected comprising photographs, audio/video recordings, and classroom observations. The analysis of students’ learning employs a framework that emerged from the data and was articulated with the literature. Regarding the teachers’ role and knowledge, these dimensions were identified through teachers’ actions in selected classroom episodes. The results show that Pop-Up cards promote rich learning experiences in Visual Arts and Mathematics, enabling students to understand a new artistic composition combined with construction techniques. The experience promoted spatial reasoning by relating three-dimensional shapes to two-dimensional elements of the composition and the identification of geometric figures and metric relationships. Regarding the teachers’ role and knowledge, interdisciplinary pedagogical content knowledge proved essential for guiding the process, which should include the fundamental practices of Creation, Analysis, and Enjoyment, and supporting both artistic and mathematical learning. Full article

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4–22%, CBD 2–22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1–5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin’s rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T² provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan–Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS −5.36 (95% CI −5.65, −5.07), ODI −17.68 (95% CI −19.73, −15.63), BPI-S −6.73 (95% CI −6.99, −6.47), and BPI-I −3.41 (95% CI −3.65, −3.16); all four contrasts had |z| ≥ 16.9 and p < 10⁻²⁰. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T² was F(4, 232) = 872.8, p < 10⁻²⁰. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10⁻⁶⁹), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient’s own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = −0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05–1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022–2024, with patients returning to in-person follow-up by Year 4–5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54–0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile—ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden—supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials. Full article

Background/Objectives: Accurate tibial tunnel placement is critical for successful posterior cruciate ligament reconstruction (PCLR), yet remains technically demanding due to limited visualization and anatomic variability. This study aimed to demonstrate the feasibility of an arthroscopic technique for remnant-preserving PCLR using the champagne-glass drop-off and lateral cartilage point as consistently identifiable arthroscopic anatomic bony landmarks, and to evaluate the success rate of tibial tunnel placement in targeted position using postoperative magnetic resonance imaging (MRI). Methods: A retrospective review was performed of patients who underwent arthroscopic remnant-preserving PCLR using a trans-septal approach with the described dual-landmark technique between March 2020 and October 2022. Of 31 eligible patients, 20 with complete clinical follow-up and postoperative 1-year MRI were included for analysis. Tibial tunnel position was assessed on MRI to determine success rate of placement in the targeted inferior–lateral tibial footprint based on anatomic reference. Clinical outcomes, including knee range of motion and posterior laxity, were also evaluated. Results: MRI evaluation demonstrated tibial tunnel consistent placement with the predefined targeted zone in all patients (20/20). At a median follow-up of 745 days, the mean knee range of motion was 140.0 ± 12.7 degrees. Posterior stability assessment showed grade 0 laxity in 75% of patients and grade 1 laxity in 25%. No graft failures, neurovascular complications, infections, or revision PCLR procedures were observed. Conclusions: This retrospective case series suggests that the dual-landmark technique (champagne-glass drop-off and lateral cartilage point) may facilitate consistent tibial tunnel placement in remnant-preserving PCLR. Level of Evidence: IV (Retrospective case series). Full article

Background: Autologous adipose-derived stromal vascular fraction (SVF) is increasingly used for symptomatic knee osteoarthritis (OA), but it remains uncertain whether patient age should influence candidacy. We examined whether age was related to 12-month pain response after intra-articular SVF administration. Methods: This retrospective knee-level analysis included 357 knees from 266 patients with Kellgren-Lawrence grade II-IV OA treated with adipose-derived SVF and followed for at least 12 months. Pain was assessed with the visual analog scale (VAS). Group comparisons and Spearman correlation analyses were used to explore relationships between age, baseline variables, injected cell number, and pain outcomes. Results: VAS scores improved from 6.5 ± 1.2 before treatment to 3.1 ± 1.6 at final assessment (p < 0.01). Age did not show a significant association with baseline pain (p = 0.128), final pain (p = 0.088), or measured baseline factors. Higher body mass index, more severe radiographic OA, and lower SVF cell number were associated with less favorable final pain scores. No serious treatment-related adverse event was identified. Conclusions: SVF injection was followed by significant pain reduction at 12 months. In this cohort, chronological age was not a meaningful determinant of response, whereas metabolic burden, structural OA severity, and delivered cell dose were more relevant clinical factors. These results argue against excluding patients from SVF treatment solely because of age. Full article