Maximizing hemostasis in total knee arthroplasty (TKA) remains a challenge today. Blood loss associated with knee joint reconstruction can lead to pain, joint stiffness, hemarthrosis, wound drainage, risk of infection, and slowed postoperative rehabilitation. This article reviews the current concept of hemostasis in TKA. The following topics are discussed in this article: (1) the types of blood loss in TKA, (2) the hemostatic effects of tranexamic acid (TXA) in TKA, (3) the advantages of the use of a tourniquet in TKA, (4) advantages and disadvantages of wound drainage after TKA, (5) benefits of cryotherapy in TKA and revision TKA, and (6) To compare the results of the use of TXA, platelet-rich plasma, and fibrin sealant in TKA.

Background: There is accumulating evidence that Vitamin D deficiency contributes to the occurrence of stroke, including ischemic and hemorrhagic strokes. However, the relationship between Vitamin D levels and the risk of hemorrhage stroke was less conclusive. Aim: This prospective study is aimed for relationship between Vitamin D status and specific nonlobar hemorrhagic stroke in a Taiwanese cohort. Methods: A prospective study of 44 adult patients (32 males and 12 females; 27 aged <65 years and 17 ≥65 years) with acute nonlobar spontaneous intracerebral hemorrhage (sICH) was undertaken for 24 months (December 2017–November 2019) in a general reference teaching hospital. The serum 25-hydroxyvitamin D (25(OH) D) level was examined within 1 day of the stroke. The associations between Vitamin D status, age, low-density lipoprotein levels, and hemorrhagic stroke were analyzed using the Chi-squared test for comparisons. Statistical significance was set at P < 0.05. Results: The mean serum concentration of (25(OH) D) was 20.30 ng/ml. There were 14 patients with Vitamin D insufficiency (<30 ng/ml), and 23 with Vitamin D deficiency (<20 ng/ml). There was no age dependence to the Vitamin D deficiency and insufficiency in patients with acute nonlobar sICH. We also found no significant correlation between Vitamin D deficiency and low-density lipoprotein concentration. Conclusion: A particularly high prevalence of Vitamin D deficiency was found in Taiwanese patients with specific hemorrhagic stroke, acute nonlobar sICH, and this was independent of age or serum low-density lipoprotein levels.

Background: Current therapeutic strategies have poor effects in triple-negative breast cancer (TNBC) patients due to lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 expression. Identification of novel genes of TNBC prognosis aids in the development of effective treatment strategies. Aim: We aim at explore key genes related to TNBC recurrence. Methods: RNAseq and clinical characteristics data were derived from The Cancer Genome Atlas Breast Invasive Carcinoma project. Ninety-seven TNBC patients were included. We used DESeq2 and Cox regression to identify significant genes to TNBC recurrence. Pathway enrichment analysis and protein–protein interaction plot were conducted to understand the functions of target genes. Results: We discovered top nine important genes for TNBC recurrence. Lower mRNA expression of potassium voltage-gated channel subfamily Q member 5, H3 clustered histone 10, and ADP-ribosylation factor-like protein 17 and higher mRNA expression of synuclein beta, interleukin 6 (IL-6), casein kappa, RHOC, phosphodiesterase 8B, and laminin subunit alpha 3 (LAMA3) were associated with higher risk of recurrence. IL-6, LAMA3, and Ras homolog family member V (RHOV) genes out of nine candidate genes can make the best prediction of TNBC recurrence (area under receiver operating characteristic curve: 0.95, sensitivity: 0.89 and specificity: 0.97). The top three significant Gene Ontology (GO) pathways are nucleosome, ion gated channel activity, and epidermis development. Significant GO pathways can be categorized into four functions: cell–cell adhesion, cell transportation, cell proliferation, ion channel and transporter, and immune. Conclusion: We discovered that the gene set of IL6, LAMA3, and RHOV can accurately predict TNBC recurrence. These genes warrant further study to confirm their causal association with TNBC prognosis and possible treatment targets.

Background: Temporary ventricular-assisted device (VAD) provides timely organ perfusion in patients with cardiogenic shock and serves as a bridge to heart transplant. Intravenous levosimendan could provide pharmacologic inotropic support. Aim: We aimed to investigate the adjuvant efficacy of levosimendan in patients with temporary VAD, especially for VAD weaning. Methods: We retrospectively reviewed the medical records of patients receiving temporary VAD for cardiogenic shock between January 2017 and May 2019 in a medical center in Taiwan. Patients were divided into the levosimendan (n = 9, administered levosimendan immediately after VAD), and control groups (n = 20, no levosimendan administered). The biochemistry of systemic perfusion was compared at 1 and 3 days after VAD. After 2 months, the cardiac function of the patients with successful VAD weaning was evaluated by echocardiography. At 6 months follow-up, survival outcome and Kaplan–Meier survival curves were presented. Results: In total, 29 patients receiving temporary VAD for cardiogenic shock were enrolled, including 9 patients treated with levosimendan infusion. In the levosimendan group, both mean arterial pressure and lactate level decreased significantly (P = 0.037 and 0.023, respectively), and the ratio of arterial oxygen partial pressure to fractional inspired oxygen improved significantly (P = 0.048). No difference in inotropes tapering, consciousness, systemic perfusion biochemistry, and cardiac enzymes. Echocardiography showed significantly improved systolic function and pulmonary artery pressure 2 months later (P = 0.043 and 0.046, respectively) in patients with successful weaning. The levosimendan group had a better weaning rate (P = 0.013) and lower mortality rate (P = 0.571) at 6-month follow-up. Conclusion: The levosimendan group showed a better weaning rate and lower mortality rate.

Background: Betahistine is used as an H3 antagonist. It has been used to treat balance disorders. During the administration of the drug, the trachea may be affected through oral intake. Aim: This study aimed to determine the effects of betahistine on the tracheal smooth muscle of rats in vitro. Methods: On a rat trachea that had been isolated and immersed in Krebs solution in a muscle bath, we evaluated the efficacy of betahistine. We examined how the application of parasympathetic mimetic agents altered tracheal contractility. The betahistine was evaluated using the following criteria: the drug's effects on tracheal smooth muscle contractions triggered by parasympathetic mimetic 10^{− 6} M methacholine, electrically induced tracheal smooth muscle contractions, and resting tracheal smooth muscle tension were listed below. Results: At preparation concentrations as high as 10^{− 4} M, betahistine produced a substantial relaxing response. The medication also prevented spike contraction brought by electrical field stimulation. However, betahistine alone had a negligible effect on the basal tension of the trachea at increasing concentrations. Conclusion: According to this study, excessive levels of betahistine might actually oppose cholinergic receptors and prevented the tracheal smooth muscles parasympathetic activity.

Spinal spondylosis is an extremely common problem among the middle-aged and elderly population. However, it is an extremely rare cause of syringomyelia in clinical practice. The differentiation between syringomyelia and hydromyelia is not always straightforward and rather exhaustive. Spinal cord compression and instability are the proposed mechanisms of injury-causing syringomyelia. Symptomatic presentation depends primarily on the location of the syrinx within the neuraxis, be it motor, sensory or autonomic disturbance. There were abundant of successful cases in the past, whereby surgical interventions can regress the appearance of syringomyelia in magnetic resonance imaging. However, there was a mixed result in terms of patients' symptom. There were only 6 reported articles of syringomyelia secondary to cervical spondylosis found worldwide. We describe a case of T11/T12 thoracic intervertebral disc protrusion causing long segment syringomyelia till conus medullaris.

Solitary fibrous tumors (SFTs) are uncommon fibroblastic mesenchymal neoplasms that rarely metastasize. They were primarily considered intrathoracic tumors; however, recent studies have reported SFTs in extrathoracic locations. This report describes a rare case of an SFT in the preperitoneal space that mimicked an intra-abdominal tumor radiographically. A 67-year-old woman was diagnosed with an extrahepatic tumor through ultrasonography. Computed tomography revealed a nodule near the liver's left lobe at the upper abdominal midline. Laparoscopic tumor resection was performed to minimize undersampling and tumor seeding. Laparoscopy revealed a well-circumscribed tumor located in the preperitoneal space. The tumor was resected en bloc with a macroscopically negative margin. Histopathological examinations confirmed an SFT using immunohistochemistry. Adjuvant treatment was not administered. No residual lesions were reported at the 6-month and 1-year follow-ups. Although SFT rarely metastasizes, early diagnosis and treatment of SFTs should be emphasized to ensure optimal patient outcomes.

Gastrointestinal (GI) polyps are uncommon connective tissue or epithelial tumors that typically affect the colon but can affect any part of the digestive system, from the esophagus to the ano-rectum. They may be solitary or multiple, sporadic or inherited, benign or malignant. The risk of malignancy is strongly associated with the type and size of the polyp. GI lipomas and GI stromal tumors are both rare causes of GI polyps which may present with GI hemorrhage or obstruction. Most polyps are asymptomatic and are detected incidentally when patients are being worked up for unrelated symptoms. When present, the symptoms might vary, but the most frequent ones are abdominal pain, GI bleeding, intussusceptions, and intestinal obstruction. A surgeon with keen clinical suspicion can make an early diagnosis to help avoid serious inherent complications.