Latest Updates

Management of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma

    • New International Association of Pancreatology definition of BRPC in 3 domains: anatomic, biological, and conditional.
    • Neoadjuvant chemotherapy is preferred in BRPC and may become a standard approach for resectable tumors.
    • FOLFIRINOX or gemcitabine/nab-paclitaxel are the two preferred regimens in BPRC and LAPC.
    • Due to neoadjuvant chemotherapy, increased number of patients is eligible for resection +/- vein reconstruction.
    • PV resection is a safe method for achieving R0 resection in BRPC and highly-selected LAPC.

External and Implantable Pacemakers and Defibrillators

    • Battery life has been a limiting factor; however, recent advances have increased battery life to up to 12 years.
    • Multisite pacing addresses the issue of nonresponse to resynchronization by stimulating multiple sites within one target structure.
    • Leadless pacemakers obviate the need for generator placement by placing the device directly into the ventricular wall.

Temperature Measurement and Thermal Management

    • Commonly used medications, such as propofol and inhalational agents, lead to vasodilation and decrease the threshold of vasoconstriction, leading to heat loss. It is important to decrease the incidence of hypothermia by using forced air convection in patients undergoing surgical procedures.
    • The MRI environment  poses a unique stress on the thermoregulatory system due to the introduction of radiofrequency electromagnetic radiation, causing iatrogenic hyperthermia if dissipation of heat is not allowed.
    • Certain sites provide more accurate temperature readings of core body temperature. However, the selection of the most appropriate site depends additionally on the procedure being performed and the sites available.

Nutrition Management in Mechanical Circulatory Support

    • Mechanical circulatory support devices are a major advancement in extending the life of patients with heart failure and can serve as a bridge to transplantation or long-term support for patients who are not transplantation candidates.
    • Patients requiring mechanical circulatory support are at high risk for malnutrition.
    • Mechanical circulatory support patients may require enteral or parenteral nutrition support depending on the degree of malnutrition, severity of disease, and gastrointestinal function.

Nutrition Management in Mechanical Circulatory Support

    • Mechanical circulatory support devices are a major advancement in extending the life of patients with heart failure and can serve as a bridge to transplantation or long-term support for patients who are not transplantation candidates.
    • Patients requiring mechanical circulatory support are at high risk for malnutrition.
    • Mechanical circulatory support patients may require enteral or parenteral nutrition support depending on the degree of malnutrition, severity of disease, and gastrointestinal function.

Triple-Negative Breast Cancer

    • Recognition that TNBC is heterogeneous, improving understanding of TNBC biology, potentially enabling more precise therapies.
    • Adding platinum salts and PARP inhibitors to neoadjuvant chemotherapy (NAC) significantly improves pathologic complete response.
    • Axillary pathologic complete response (nodal downstaging) following NAC can result in more conservative axillary surgery.
    • For residual disease post NAC, additional adjuvant therapy with capecitabine improves overall and disease-free survival.

Tuberculosis

    • 2017 ATC/IDSA/CDC Guidelines for the Diagnosis of Tuberculosis
    • MDG goal to halt and reverse TB epidemic by 2015 has already been achieved

The Anesthesia Machine: Managing Exhaled and Waste Gases

    • CO2 absorbent material composition changes, including lithium-based absorbent, with lower risk of carbon monoxide and compound A production
    • New guidelines from the Malignant Hyperthermia Association of the United States on anesthesia machine preparation for MH-susceptible patients
    • Development of the Vapor-Clean filter, a charcoal-based filter that can remove traces of volatile anesthetic gases and prepare a machine for an MH-susceptible patient in less than two minutes
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