What's New | Decker

There has been much interest in the development of breast cancer prevention strategies. Pharmacologic approaches are the most developed at this time. The nonsteroidal selective estrogen receptor modulator (SERM) tamoxifen, a mainstay in the management of breast cancer, has also been tested as a chemopreventive agent.
Screening strategies for breast cancer include the triad of breast self-examination (BSE), clinical breast examination by a health care professional, and screening mammography. Although widely touted as an important component of early detection, BSE is of uncertain value.
Increased understanding of growth pathways of breast cancer has led to the identification of crucial nonendocrine pathways that are potential targets for therapy. One such target is the HER-2 protein, a transmembrane protein that is overexpressed in about 20% of breast cancers, generally because of gene amplification.

BTAI is now the gold standard n treating patients with these problems
The grade of injury with these lesions has been defined and there is controversy on which lesion should be treated and how emergently
Recently in the US a device changed its IFU because of complications after TEVAR for BTAI. It was being used outside its IFU.
Recent advancement on sizing and device differences between BTAI and other pathologies treated with TEVAR

Use of HVPG to accurately diagnose portal hypertension
Child-Pugh score and MELD score in risk stratification and decision-making
Fibroelastography, multidetecter row CT scan, and capsule endoscopy as emerging modalities in detection of varices.

Spirometry has few absolute contraindications, although several conditions should merit caution and others may affect the quality of results. Pain, nausea, or other subjective discomforts, as well as altered mental status, will likely lead to poor results and therefore are relative contraindications.
The role of the carbon monoxide (CO) diffusing capacity (DL_CO) test is to provide information on the transfer of gas from alveolar air to the bloodstream. DL_CO reflects the overall efficiency of gas movement at each step from the mouth to the hemoglobin in the pulmonary capillary blood.
Certain substances and behavior should be avoided prior to testing as they can lead to either false positives or false negatives. Recent upper respiratory tract infection and cigarette smoking can elevate bronchial hyperresponsiveness.

Improvements in transdermal drug delivery with use of fractional lasers/radiofrequency ablation combined with ultrasound therapy. Advances in nanotechnology will further improve the ability to deliver targeted therapies
Improved understanding of signaling pathways in wound healing states will allow for future target-specific therapeutics. Some candidate drugs are being tested in animal models
Tissue engineering and use of polysaccharide and protein scaffolds may eventually improve wound healing via delivery of growth factors, favorable cytokines, and improvement in tissue oxygenation

Extracorporeal membrane oxygenation (ECMO) is a modified method of cardiopulmonary bypass that is used as a last resort modality for support of the pediatric patient in cardiac and/or respiratory failure.
VADs are a newer, alternative method of mechanical circulatory support for children in refractory heart failure or cardiogenic shock who are awaiting transplantation. VAD use in adults is well established, and its use in children has been steadily increasing over the last decade.
Lactate is a by-product of anaerobic metabolism and is often used to diagnose and monitor the progression of shock. Although lactate is less frequently elevated in pediatric patients, an initial elevated lactate level has been found to be associated with increased risk of organ dysfunction in pediatric sepsis and can be followed as a marker of resuscitation.

Oppositional defiant disorder (ODD) has a high prevalence and substantial morbidity
Diagnosis of ODD is based on a careful history, interview, mental status examination, and collateral information from school.
Disruptive mood dysregulation disorder is a new DSM-5 diagnosis that should be carefully considered in the differential diagnosis of children and adolescents with ODD
Genetic and neuroimaging studies have examined the possible neurobiological basis of ODD, but to date there is no definitive biomarker or biological findings in ODD.
Parent behavioral management training and psychosocial interventions are the cornerstone of treatment planning for ODD.

Breast, Gynecologic, and Genitourinary Malignancies