blood substitute (Volplex / Volplex)

Electric Man: The seduction, and misuse, of surface EMG in TMD - how a muscle signal became a diagnosis, a treatment target, and sometimes a substitute for clinical reasoning.

Castroflorio Tommaso T, Manfredini Daniele D

[Blood Loss in Open Spine Surgeries - Preoperative Estimate vs Reality].

Skála-Rosenbaum Jiří J, Ježek Jakub J, Kafka Petr P

Intraoperative blood loss represents a critical challenge in spinal surgery, with the potential to increase morbidity, mortality, and healthcare costs. Significant blood loss is associated with postoperative complications such as respiratory failure, infections, and hematomas. This paper evaluates current methods of estimating blood loss and highlights the discrepancy between intraoperative clinical estimates and the actual total blood loss, with a specific focus on the phenomenon of hidden blood loss (HBL). The concept of Total Blood Loss (TBL) is analyzed as the sum of Visible Blood Loss (VBL), consisting of blood in suction canisters, sponges, and drains, and HBL, which results from hemolysis and sequestration of blood into tissues. Mathematical formulas, specifically the Gross equation and Nadler's formula for patient blood volume, are discussed as tools for calculating TBL based on hematocrit changes. Visual estimation is consistently shown to be inaccurate, often leading to significant underestimation, especially in losses exceeding 1,000 ml. Research indicates that in major spinal procedures, approximately 21% of the total intraoperative blood loss is captured in surgical sponges. For practical intraoperative monitoring, a "28% coefficient" should be added to the volume in the suction canister to provide a realistic estimate of the blood trapped in textiles. Furthermore, HBL accounts for at least 30% of the total perioperative loss. In extensive posterior thoracolumbar fusions, the visible blood in the suction canister may represent about half of the actual TBL only. Younger patients are paradoxically more susceptible to higher HBL due to more dynamic transcapillary refill and greater vascular compliance.

Arthroscopy for the Painful Shoulder Arthroplasty: Indications, Outcomes, and Technical Considerations.

Jackson Garrett R GR, Koetting Sean S, Childers Justin T JT, Kenter Keith K et al.

Persistent pain, stiffness, or suspected infection following shoulder arthroplasty remains a challenging clinical problem. Arthroscopy has emerged as a minimally invasive diagnostic and therapeutic tool in selected patients with painful anatomic total shoulder arthroplasty, reverse shoulder arthroplasty, or hemiarthroplasty. This review summarizes the current evidence regarding indications, outcomes, complications, and technical considerations for arthroscopy in the setting of pain following prior shoulder arthroplasty. Shoulder arthroscopy after arthroplasty has been described for glenoid component loosening, polyethylene wear, rotator cuff pathology, biceps tendon disease, postoperative stiffness, impingement, and suspected periprosthetic joint infection. Reported outcomes suggest that arthroscopy may improve pain and function in selected patients, particularly after glenoid component removal, biceps procedures, capsular release, and lysis of adhesions. Arthroscopic tissue biopsy also demonstrates greater diagnostic utility than aspiration or serum inflammatory markers for suspected periprosthetic shoulder infection. Technical strategies, including initial subacromial evaluation and controlled glenohumeral entry through the rotator interval, may reduce iatrogenic implant damage during arthroscopic evaluation. Arthroscopy can be both diagnostic and therapeutic in well-selected patients with painful or stiff shoulder arthroplasty. Although it is not a substitute for revision surgery in cases of clear implant failure, instability, or massive cuff insufficiency, it may help clarify the diagnosis, treat focal pathology, and delay or avoid open revision in selected patients.

A Weighted Neural Network Model Based on Laboratory Tests for Identifying Lymph Node Metastases in Esophageal Squamous Cell Carcinomas.

Ouyang Qiangqiang Q, Gao Ziming Z, Yang Jingbo J, Wang Shaoyi S et al.

Lymph node metastasis (LNM) is a key prognostic factor in esophageal squamous cell carcinoma (ESCC), and accurate preoperative prediction remains challenging. Blood biomarkers provide a conventional, preoperative diagnostic technique that is cost-effective and free from radiation risks. So far, previous studies have been published on the precise diagnosis of lymph node metastases using conventional ultrasound or CT techniques. While there is a lack of research studies that address the diagnosis of LNM from blood biomarkers. In this work, we acquired a cohort of blood biomarkers of 1933 patients and designed a weighted neural network (WNN) model for the accurate prediction of LNM from blood biomarkers. The WNN model is designed with a neural network classifier trained on blood biomarkers labeled with pathological nodal (pN) stages of LNM. The experimental findings demonstrate that the WNN model achieved 83.1% accuracy and an AUC of 0.88 on the original, non-augmented test set for diagnosing LNM, while CT only achieved 50.4% accuracy (AUC 0.60) and ultrasound achieved 60.5% accuracy (AUC 0.67). Additionally, SHAP analysis reveals that three blood biomarkers-white blood cells (WBC#), monocytes (Mono#), and neutrophils (Neut#)-significantly impact the WNN model's output. This WNN model shows promise as a research tool to diagnose LNM.