University of Arizona

Although most imaging assessments are made qualitatively, quantitative measurements in orthopedic imaging are becoming more important in detecting subtle findings and assessing degrees of abnormality, which can help direct surgical management. In the knee, patellofemoral maltracking is a common cause of anterior pain, particularly in younger patients. Failure to recognize this pathophysiology may result in accelerated chondral loss and osteoarthritis (OA), and the imaging findings may be subtle. As a result, clinicians and radiologists have developed numerous measurements to detect and quantify patellofemoral alignment. Additional entities, such as femorotibial subluxation or angular abnormalities, may only be detected by using standardized measurements and can help detect ligamentous insufficiency or developmental malalignment, which can lead to instability and OA in the medial and lateral femorotibial compartments. Finally, the proper positioning and hardware selection for knee arthroplasty are critical to preventing early hardware failure and postsurgical pain. This review, which focuses on the knee, is the second in a three-part series discussing the appropriate imaging modalities on which to obtain specific lower extremity measurements as well as proper measurement techniques, grouped by pathology. Furthermore, the normal value or range of values according to current literature is reported, along with the significance of abnormal measurements.

We describe our longitudinal experience with patients who underwent surgical treatment for Tarlov cysts. General and disease-specific validated outcome measures were used to assess health-related quality of life through 2 years postoperatively. Patients who underwent surgical treatment for sacral Tarlov cysts between 2008 and 2023 were included. Demographics and cyst characteristics were documented. End points were the disease-specific Tarlov Quality-of-Life Scale and general health-related quality-of-life measures including the Oswestry Disability Index, visual analog pain Scales, and Short-Form 36. Patients completed survey measures preoperatively and at 3, 6, 12, and 24 months after surgery. Data were obtained from 417 patients with an average age of 52.5 ± 11.2 years, and 91.1% was female. Patients reported significant improvement in the Tarlov Cyst Quality of Life (3.2 ± 0.1 to 2.1 ± 0.1, P < .001), visual analog pain scales at rest (4.5 ± 0.1 to 2.3 ± 0.1, P < .001) and upon activity (5.7 ± 0.2 to 3.1 ± 0.1, P < .001), and the Oswestry Disability Index (45.5 ± 0.8 to 31.6 ± 1.0, P < .001). Patients also reported improvement on 7 of the 8 Short Form 36 scales: Physical Functioning, Physical Limitations, Bodily Pain, Vitality, Social Functioning, Emotional Limitations, and Mental Health ( P < .001 for all models). There was significant improvement from the 1 to 2 years for physical functioning ( P = .040) and social functioning ( P = .016). The median tolerated sitting time increased from 15 min preoperatively to 45 minutes at 2 years postoperatively. This study, to our knowledge, is the first to demonstrate significant improvement in patients surgically treated for Tarlov cysts using general and disease-specific health-related quality-of-life scales for 2 years after surgery. Our results suggest that patients may continue to improve for up to 2 years after surgery in some domains.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additive Manufacturing (AM) has revolutionized industries by enabling the production of complex, customized products with unparalleled efficiency. However, the increasing reliance on AM in critical sectors such as aerospace, healthcare, and defense has exposed it to significant cybersecurity and reliability challenges, including intellectual property theft, process sabotage, and data tampering. These vulnerabilities as well as reliability issues can compromise product integrity, safety, and operational continuity, posing severe risks to both industry and national security. In this work, we propose a novel methodology for modeling the AM process chain as a Cyber-Physical System (CPS) using multi-modal data structured in a graph format. Our methodology leverages Graph Neural Networks (GNNs) to detect and localize anomalies across diverse data modalities, enabling precise identification of both the nature and source of attack/fault. By integrating data fusion, advanced anomaly classification, and localization techniques, our solution provides a robust methodology for enhancing the security and reliability of AM processes, ensuring their safe deployment in critical applications. Furthermore, the proposed technique is adaptable to other industrial systems, underscoring its potential for broader impact in securing critical infrastructure.

Transient pain and ocular inflammation may occur with ophthalmic surgery. Pain is an important determinant of patient satisfaction, and inflammation can increase the risk for suboptimal visual outcomes. Topical anti-inflammatory therapies can reduce the incidence of postoperative pain and inflammation but have many limitations, including nonadherence and significant potential side effects such as cataract formation and intraocular pressure elevation. There is unmet need for a therapy that provides anti-inflammatory and analgesic activity while overcoming the limitations of topical therapy. The intracanalicular dexamethasone insert (DEX) overcomes many of the limitations of topical therapy. DEX is a fluorescent yellow cylindrical-shaped polyethylene glycol-based hydrogel insert incorporating 0.4mg preservative-free dexamethasone. The insert was designed based on human anatomy and measurements of the canalicular system and continuously releases a tapered dose of dexamethasone over approximately 30days onto the surface of the eye. The insert is completely resorbable and does not require removal. DEX was approved by the US Food and Drug Administration for the treatment of pain (in 2018) and inflammation (in 2019) following ocular surgery; in 2021, the treatment of ocular itching associated with allergic conjunctivitis was added as an indication. We present a comprehensive review of the current therapeutic landscape for management of postoperative pain and inflammation following cataract surgery, including the limitations of topical eye drop medications. We review data from the key phase2 and 3 clinical trials that supported the approval and label expansion for DEX. We also summarize the broader literature of smaller studies evaluating the role of DEX in controlling postoperative pain and inflammation for a variety of ophthalmic surgery beyond cataract surgery as well as in management of ocular itching associated with allergic conjunctivitis.