Τρίτη 6 Απριλίου 2021

Cytoplasmic ADP-ribosylation levels correlate with markers of patient outcome in distinct human cancers

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Modern Pathology, Published online: 19 March 2021; doi:10.1038/s41379-021-00788-9

Cytoplasmic ADP-ribosylation levels correlate with markers of patient outcome in distinct human cancers
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Recurrent novel HMGA2-NCOR2 fusions characterize a subset of keratin-positive giant cell-rich soft tissue tumors

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Modern Pathology, Published online: 19 March 2021; doi:10.1038/s41379-021-00789-8

Recurrent novel HMGA2-NCOR2 fusions characterize a subset of keratin-positive giant cell-rich soft tissue tumors
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PulmCrit Rant – Intermediate DVT prophylaxis in COVID: We need for better pants

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COVID will eventually lead to many improvements in our approach to critical illness.  I've been hoping that one of these would be an improved understanding of venous thromboembolism (VTE) prophylaxis, but perhaps that was overly optimistic. We provide VTE prophylaxis to nearly every patient in the ICU.  Consequently, even tiny changes in our VTE prophylaxis […]

EMCrit Project by Josh Farkas.

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Triple-negative breast lobular carcinoma: a luminal androgen receptor carcinoma with specific ESRRA mutations

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Modern Pathology, Published online: 22 March 2021; doi:10.1038/s41379-021-00742-9

Triple-negative breast lobular carcinoma: a luminal androgen receptor carcinoma with specific ESRRA mutations
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IBCC – Stupor & Coma

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Stupor and coma can be a challenging presentation, because it has a broad differential filled with very severe diseases.  An organized approach is essential.  One core feature of that approach is the coma neurologic examination, which remains central to the evaluation even in the era of abundant CT and MRI scanning. The IBCC chapter is […]

EMCrit Project by Josh Farkas.

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Diagnostics for Gonorrhea and Chlamydia in the Emergency Department: Fight Smarter Not Harder

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In 2018 alone, 583,405 cases of Neisseria gonorrhoeae and 1,758,688 cases of Chlamydia trachomatis were reported to the Centers for Diseases Control and Prevention, representing an increase of 63% and 19%, respectively, since 2014.1 Approximately 7% to 16% of sexually transmitted infections are diagnosed and treated in emergency departments (EDs), and this trend is likely to continue.2,3 Because of their high sensitivity (>95%) and specificity (>99%), nucleic acid amplification tests (NAATs) are the mainstay of laboratory diagnosis for N gonorrhoeae and C trachomatis and can be performed on first-void urine or specimens obtained from the vagina, endocervix, oropharynx, or rectum.
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Boy with Abdominal Pain

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An 11-year-old boy presented to the emergency department with sudden-onset, severe, sharp, right upper quadrant abdominal pain and vomiting. On examination, the patient was afebrile, with a pulse rate of 92 beats/min and right upper quadrant tenderness. Laboratory test results were unremarkable, including a WBC count of 9,670/mm3 without left shift. Radiography of the abdomen revealed no evidence of obstruction. Abdominal point-of-care ultrasonography was performed (Figures 1 and 2, left panel, and Video E1, available online at http://www.annemergmed.com) and the diagnosis was confirmed by contrast-enhanced computed tomography (CT) (Figures 1 and 2, right panel).
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Woman with ST Changes Following Days of Vomiting

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A 76-year-old woman with a history of recently diagnosed gastritis, osteoarthritis, depression, and hypertension presented to the emergency department (ED) for generalized weakness after an unwitnessed fall. She was found by her son, who stated that she had been feeling weak during the past few weeks and had had daily episodes of nausea with nonbilious and nonbloody vomiting that had increased in frequency during the past week. On the patient's arrival, her pulse rate was 100 beats/min, temperature 97.2°F, respiratory rate 24 breaths/min, oxygen saturation 100% on room air, and blood pressure 128/60 mm Hg.
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ECG of the month: A “de Winter”-like ECG pattern in a patient presenting with progressive lethargy

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An 87-year-old man with hypertension, diabetic nephropathy, and heart failure with preserved ejection fraction was brought to the emergency department (ED) for progressive weakness with lethargy for the past 3 days. His medication included atenolol, perindopril, torsemide, amlodipine, atorvastatin, sitagliptin, and basal insulin. Spironolactone was added to this regimen 2 weeks ago in the setting of clinical congestion. On arrival at the ED, he was bradycardic, at 53 beats/min. Capillary blood glucose level was elevated, at 14 mmol/L.
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Symptomatic Emergency Department Patients Should Undergo Empirical Therapy for Gonorrhea/Chlamydia Regardless of Testing

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Neisseria gonorrhoeae and Chlamydia trachomatis are the 2 most commonly diagnosed and reported sexually transmitted infections in the United States.1 Among men, these infections cause urethritis and epididymitis. Among women, they cause cervicitis and urethritis, although most infected patients are asymptomatic.2 Antibiotics readily cure urethritis, cervicitis, and pelvic inflammatory disease, and early treatment of these infections prevents transmission and complications. All emergency department (ED) patients with presentations consistent with N gonorrhoeae or C trachomatis should undergo empirical therapy rather than test-based treatment.
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Bridging Oceans and Thrombolysis

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Zi W, Qiu Z, Li F, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA. 2021;325:234-243.
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Young Man with Odynophagia

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A 30-year-old man presented to the emergency department with throat pain and oral intolerance of fluids for several hours. Earlier that day, an outpatient operation was aborted after multiple unsuccessful intubation attempts in the operating room. The patient had unremarkable vital signs, noting only odynophagia. Computed tomography (CT) of the neck and an esophagram with water-soluble contrast were acquired.
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Highlighting the Concepts of Local Exhaust Ventilation in Negative-Pressure Rooms

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We think the letter by Braude and Femling1 pointed out that negative-pressure rooms are not absolutely safe for health care professionals. The authors briefly mention that negative pressure and air exchanges will not make the room much safer owing to aerosolized particles that are generated continuously.
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