COVID-19 exerts deleterious cardiopulmonary effects, leading to a worse prognosis in the most affected. This retrospective multi-center observational cohort study aimed to analyze the trajectories of key vitals amongst hospitalized COVID-19 patients using a chest-patch wearable providing continuous remote patient monitoring of numerous vital signs. The study was conducted in five COVID-19 isolation units. A total of 492 COVID-19 patients were included in the final analysis. Physiological parameters were measured every 15 min. More than 3 million measurements were collected including heart rate, systolic and diastolic blood pressure, cardiac output, cardiac index, systemic vascular resistance, respiratory rate, blood oxygen saturation, and body temperature. Cardiovascular deterioration appeared early after admission and in parallel with changes in the respiratory parameters, showing a significant difference in trajectories within sub-populations at high risk. Early detection of cardiovascular deterioration of COVID-19 patients is achievable when using frequent remote patient monitoring.

Background/Objectives: Diabetic neuropathy (DN) is a prevalent complication of diabetes mellitus, affecting up to 50% of long-term patients and causing significant pain, reduced quality of life, and healthcare burden. Conventional treatments, including anticonvulsants, antidepressants, and opioids, offer limited efficacy and are associated with adverse effects. Emerging evidence suggests that cannabis, acting via the endocannabinoid system, may provide analgesic and neuroprotective benefits. This study evaluates the long-term effects of inhaled cannabis as adjunctive therapy for refractory painful DN. Inhaled cannabis exhibits rapid onset pharmacokinetics (within minutes, lasting 2–4 h) due to pulmonary absorption, targeting CB1 and CB2 receptors to modulate pain and inflammation. Methods: In this prospective, observational study, 52 patients with confirmed painful DN, unresponsive to at least three prior analgesics plus non-pharmacological interventions, were recruited from a single clinic. Following a 1-month washout, patients initiated inhaled medical-grade cannabis (20% THC, <1% CBD), titrated individually. Assessments occurred at baseline and annually for 5 years, including the Brief Pain Inventory (BPI) for pain severity and interference; the degree of pain relief; Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score; HbA1c; and medication usage. Statistical analyses used repeated-measures ANOVA, Kruskal–Wallis tests, Welch’s t-tests, and Pearson’s correlations via Analyze-it for Excel. Results: Of 52 patients (mean age 45.3 ± 17.8 years; 71.2% male; diabetes duration 23.3 ± 17.8 years), 50 completed follow-up visits. Significant reductions occurred in BPI pain severity (9.0 ± 0.8 to 2.0 ± 0.7, p < 0.001), interference (7.5 ± 1.7 to 2.2 ± 0.9, p < 0.001), LANSS score (19.4 ± 3.8 to 10.2 ± 6.4, p < 0.001), and HbA1c (9.77% ± 1.50 to 7.79% ± 1.51, p < 0.001). Analgesic use decreased markedly (e.g., morphine equivalents: 66.8 ± 49.2 mg to 4.5 ± 9.6 mg). Cannabis dose correlated positively with pain relief (r = 0.74, p < 0.001) and negatively with narcotic use (r = −0.43, p < 0.001) and pain interference (r = −0.43, p < 0.001). No serious adverse events were reported; mild side effects (e.g., dry mouth or euphoria) occurred in 15.4% of patients. Conclusions: Inhaled cannabis showed sustained pain relief, improved glycemic control, and opioid-sparing effects in refractory DN over 5 years, with a favorable safety profile. These findings are associative due to the observational design, and randomized controlled trials (RCTs) are needed to confirm efficacy and determine optimal usage, addressing limitations such as single-center bias and small sample size (n = 52). Future studies incorporating biomarker analysis (e.g., endocannabinoid levels) could elucidate mechanisms and enhance precision in cannabis therapy.

Chronic pain management increasingly seeks objective biomarkers to complement subjective assessments. Ultra-weak photon emission (UPE), measurable via gas discharge visualization (GDV), has been proposed as a potential biomarker for various health conditions. However, the specificity of UPE measurements for pain versus comorbid conditions remains unexplored. This prospective cohort study followed 200 adults with electrodiagnostically confirmed neuropathic pain receiving cannabis therapy for 48 months. Assessments included the Numerical Rating Scale (NRS) for pain, Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and Biowell UPE measurements. Cannabis therapy yielded 91.5% clinical response rate. However, UPE measurements showed striking differential validity: Biowell stress correlated strongly with GAD-7 (r = 0.579, p < 0.001) but negligibly with NRS (r = 0.093, p = 0.001), representing a 6.2-fold difference. Variance explained was 33.5% for anxiety versus 0.9% for pain. ROC analysis revealed good discrimination for clinical anxiety (AUC = 0.744) but poor discrimination for pain (AUC = 0.550). Mixed-effects modeling confirmed UPE stress predicted GAD-7 (b = 1.82, p < 0.001) but not NRS (b = −0.03, p = 0.84). These findings demonstrate that Biowell UPE measurements specifically capture psychological stress rather than nociceptive processes, with important implications for biomarker development in pain medicine. This study emphasizes the critical importance of validating proposed biomarkers against multiple related outcomes to establish specificity and appropriate clinical applications.

Background/Objectives: Reverse total shoulder arthroplasty (RTSA) is increasingly common, but large-scale studies on age-related differences in outcomes are limited. This study aims to evaluate epidemiological trends, clinical indications, and postoperative outcomes in patients under 65 undergoing RTSA. Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) from 2016–2021, including 48,460 patients aged 35–64 undergoing shoulder arthroplasty. Patients were stratified into three age groups: 35–45, 46–55, and 56–65 years. We assessed trends, clinical indications, comorbidities, hospital stay metrics, and postoperative complications using chi-square tests, ANOVA, and multivariate logistic regression. Results: Procedure volumes increased from 2016 to 2019, peaking at 2007 cases, but declined in 2020 and 2021 (924 cases). The 56–65 age group consistently comprised the majority of procedures (81.7% in 2016 to 88.3% in 2021). Comorbidities like type 2 diabetes (5.9% to 22.8%), hypertension (27.9% to 55.3%), and dyslipidemia (10.3% to 40.5%) increased with age (p < 0.001). Rotator cuff tears were more prevalent in older patients (25% to 48.5%, p < 0.001), while instability was higher in the youngest group (8.8%, p < 0.001). Osteoarthritis was the most common indication, increasing with age (56.6% to 62.5%, p < 0.001). Cardiac complications increased with age (2.2% to 5.1%, p = 0.04). Female gender (OR = 1.548, p < 0.001), private insurance (OR = 1.570, p < 0.001), and small hospital size were associated with higher odds of cardiac complications. Native American race showed lower odds (OR = 0.308, p = 0.009) compared to White patients. Conclusions: Significant age-related differences exist in comorbidities, clinical indications, and postoperative complications following RTSA. Older patients had higher rates of comorbidities and cardiac complications, while younger patients presented with instability. These findings highlight the importance of age-specific perioperative management to optimize outcomes.

Background: Shoulder arthroplasty is performed for various etiologies, including osteoarthritis, proximal humerus fractures (PHFs), and rotator cuff tears. While previous studies have focused on outcomes based on implant choice, less is known about the independent effects of surgery type, comorbidities, and fracture status on postoperative outcomes. This study evaluates their influence on length of stay (LOS), in-hospital mortality, and postoperative complications. Methods: A retrospective cohort analysis of 664,545 patients undergoing anatomic total shoulder arthroplasty (ATSA), reverse total shoulder arthroplasty (RTSA), or hemiarthroplasty (HA) was conducted. Multivariable Poisson and logistic regression models assessed predictors of LOS, mortality, and complications. Results: Among 132,909 patients, 63.3% underwent RTSA, 31.3% underwent ATSA, and 5.4% underwent HA. Mean hospitalization was longest for HA (2.56 days) and RTSA (1.82 days) compared to ATSA (1.39 days; p < 0.001). Poisson regression confirmed that RTSA increased LOS by 24.1% versus ATSA (IRR = 1.24, p < 0.001), while HA had the highest LOS (IRR = 1.58, p < 0.001). Postoperative complications were observed in 8.37% of ATSA, 13.81% of RTSA, and 17.81% of HA cases (overall ~12.3%). Compared with ATSA, RTSA increased the odds of complications (OR = 1.48, p < 0.001), while HA presented the greatest complication risk (OR = 1.51, p < 0.001). Among proximal humerus fracture (PHF) patients (9.9% of the cohort), 84.7% underwent RTSA. PHF independently increased LOS (IRR = 1.61, p < 0.001), mortality (OR = 1.62, p = 0.051), and complications (OR = 2.33, p < 0.001). Conclusions: RTSA is associated with longer hospitalization and higher complication rates, while PHF worsens LOS, mortality, and complication risk.

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.