- The use of microvascular free tissue transfer to reconstruct surgical defects in the head has allowed surgeons to resect large tumors with large margins while simultaneously achieving improved functional results.
- Imaging studies (e.g., computed tomography [CT] and magnetic resonance imaging) may be helpful in locating the source of a cervical metastasis. Positron emission tomography (PET) detects lesions with increased metabolic activity but has the limitation of being unable to detect lesions smaller than 1 cm in diameter.
Latest Updates
- The use of microvascular free tissue transfer to reconstruct surgical defects in the head has allowed surgeons to resect large tumors with large margins while simultaneously achieving improved functional results.
- Imaging studies (e.g., computed tomography [CT] and magnetic resonance imaging) may be helpful in locating the source of a cervical metastasis. Positron emission tomography (PET) detects lesions with increased metabolic activity but has the limitation of being unable to detect lesions smaller than 1 cm in diameter.
Clinical Trial Design and Statistics
- Because of the complex nature of clinical trial design, significant resources and infrastructure are invested in drug development. Many drugs fail to progress beyond the phase I/II stage, and many phase III trials take years to accrue and publish results, leading to a delay in Food and Drug Administration (FDA) approval for diseases that desperately need better therapeutic options. The relatively recent FDA Safety and Innovation Act has allowed for the creation of priority and expedited review for drugs and biologics in serious conditions and where there is an unmet medical need. The designation of fast-track or breakthrough therapy may be granted when there is preclinical or clinical evidence to suggest that the intervention may result in a substantial improvement over currently available therapies.
- Prior to embarking on a clinical trial, data entry, editing (“cleaning”), and analysis should be anticipated. Planning for data management begins with developing rules for coding the variables for computer entry. The appropriate hardware and software programs should be selected and standardized across study sites.
- A type I error (false positive) occurs if an investigator rejects a null hypothesis that is true in the population. A type II error (false negative) occurs if the investigator fails to reject a null hypothesis that is false in the population. Neither of these errors can be avoided entirely.
Complications Following Bariatric Surgery
- Bariatric surgery is the most effective therapy for obesity and associated metabolic diseases
- 200,000 bariatric procedures are performed annually in the US with an overall low complication rate
- Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass are the most commonly performed procedures and each have unique complication profiles
Pathophysiology of Alzheimer Disease
- Amyloid positron emission tomography (PET) has greatly expanded our knowledge of Alzheimer disease (AD), from its preclinical to its clinical manifestations.
- Tau PET has become available as a research tool and is providing new insights into the evolution of AD.
- A conceptual scheme that classifies the imaging and cerebrospinal fluid biomarkers of AD into amyloid, tau, and neurodegeneration has been adopted.
Initial Management of Life-Threatening Trauma
- Initial volume resuscitation should commence with 1 L isotonic crystalloid solution followed by blood products at 1:1:1 ratio (1 unit packed red blood cells to 1 unit fresh frozen plasma to 1 unit platelets) if the patient is not responsive to the initial fluid bolus.
- In patients with massive hemorrhage or evidence of fibrinolysis, tranexamic acid has demonstrated improved survival if administered within 3 hours of injury.
- Use of resuscitative endovascular balloon occlusion of the aorta may be an important adjunct in the control of life-threatening abdominal or pelvic hemorrhage.
- In cases of external hemorrhage of an extremity, a tourniquet should be used to control bleeding.
- Review of emerging genetics and etiologic theories of bipolar disorders
- Correlation between recent neurobiologic findings and clinical manifestations of bipolar disorders
- Discussion of the role of endocrine and immune alterations in metabolic derangements associated with bipolar disorders
- Zika virus: Delayconception if potential exposure: 8 weeks: females or 3 months: males
- Subclinical hypothyroid: Treatment is associated with improved pregnancy outcomes when TSH levels are above 4 mIU/L.
- Tubal patency: Hysterosalpingo-contrast sonography was recently introduced as an additional screening method to assess tubal patency.
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