Tranexamic Acid for Shoulder Arthroplasty: A Systematic Review and Meta-Analysis.

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= -0.15; 95%CI: -0.23 to -0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= -0.51; 95%CI: -0.57 to -0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= -1.43; 95%CI: -2.27 to -0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.

Can fluorescence and autofluorescence imaging be useful in diagnosis of basal cell cancer? Proposition of algorithms.

BACKGROUND: The most common non-melanoma skin carcinomas (NMSC) are basal cell carcinomas (BCC). Autofluorescence study may allow a non-invasive distinction of neoplastic lesions from benign lesions, whereas fluorescence spectroscopy enables qualification of the patient for possible photodynamic or surgical treatment. The aim of the study is to assess the suitability of autofluorescence and fluorescence imaging in the diagnosis of the stage of advancement, and the morphological type of changes in basal cell carcinoma of the skin. METHODS: A group of 382 patients with 430 skin lesions of basal cell carcinoma were subjected to an autofluorescence study and a spectral imaging using a spectral camera. The acquired spectra and fluorescence images were analyzed using the Image Pro-Plus 5.0.2 software. An analysis of fluorescence intensity profiles in the long and short axis of the studied changes was carried out. RESULTS: The fluorescence emission observed in BCC lesions with an area of ​​up to 3 cm2 showed a statistically significantly higher level of intensity in comparison to changes in lesions exceeding 3 cm2 (#p < 0.05, ## p < 0.01). In the autofluorescence evaluation, we observed significant differences in the mean values of the Numerical Colour Value (NCV) depending on the size of the area of skin occupied by skin lesions. Based on the spatial and profile assessment of the types of BCC lesions a proposed algorithm for identifying changes was developed. Analysis of green fluorescence intensity profiles, analogous to fluorescence profiles analysis, allowed to propose an algorithm of autofluorescence evaluation in the diagnosis of BCC. CONCLUSIONS: Autofluorescence and fluorescence imaging allow assessment of the extent of neoplastic infiltration and distinguish types of skin lesions with BCC. The determined diagnostic algorithms may be an effective diagnostic solution in the diagnosis of skin lesions of this nature.