bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Cardiovascular Adverse Events in Patients Treated with R-CHOP Regimens by 3D Transthoracic Echocardiography
Authors: Shen Yi-Hui , Zhang Hui , Zhang Bo Yuan , Ni YangYue , Zhao Rui , Zhang Qunling , Hsi David , Cheng Leilei
Published: January 2021

Background: Patients treated for lymphoma are at risk of cardiovascular
adverse events. Global longitudinal strain (GLS) and global
circumferential strain (GCS) were reported for predicting cardiovascular
adverse events in patients treated with doxorubicin. However, the
prognostic value of RV ejection fraction by 3D transthoracic
echocardiography (3D TTE) have not been elucidated yet. We hypothesized
that RV echocardiography parameters increases the sensitivity for
predicting the later CAE. Methods: In this retrospective study,
ninety-six patients with diffuse large B-cell lymphoma with normal
cardiac function treated with R-CHOP regimen were studied between
January 2013 and January 2015 by 3D TTE. Basic demographic data,
oncology and echocardiography parameters were measured. The main
outcomes were the proportion of patients with grade 3–4 cardiovascular
adverse events (CAE). The association of pre-chemotherapy and
post-chemotherapy echocardiography parameters with CAEs was analyzed
using proportional hazard analysis. Results: Over a median follow-up
period of 6.1 years (range, 4.9-7.6 years) after the completion of
chemotherapy, 18 of 96 patients (19%) experienced CAEs. Univariate
predictors of CAE (P < .05) were LVGLS, LVGCS, RVEF, and
RVESV. Multivariate analysis of all significant univariate variables
showed that RVEF (hazard ratio, 0.848; 95% confidence
interval,0.785–0.916; P < .001) were significantly and
independently associated with CAE. Stepwise analysis of the multivariate
associations showed an increase in the global x2 value after adding LVEF
(P < .001) to significant clinical variables. Conclusion:
LVGLS and RVEF were significantly and independently associated with CAE
in patients. Adding RVEF to other clinical variables provided
incremental prognostic information.
Characterization of temporal electrical activity patterns for detection of critical isthmus regions of recurrent atypical atrial flutter
Authors: Vonderlin Nadine , Siebermair Johannes , Pesch Elena , Köhler Miriam , Riesinger Lisa , Kaya Elif , Kochhäuser Simon , Janosi Rolf , Rassaf Tienush , Wakili Reza
Published: January 2021

Introduction Identifying the critical isthmus region (CIR) of complex
atrial tachycardias (AT) is challenging. The Lumipoint® (LP) software,
developed for the Rhythmia® mapping system, aims to facilitate
successful termination of ATs by identifying the CIR. Objective
Objective of this study was to evaluate specificity and sensitivity of
LP regarding arrhythmia-relevant CIR detection in patients with
atypical-atrial-flutter (AAF). Methods In this retrospective analysis we
analyzed 57 AAF-forms. Electrical activity (EA) was mapped over
tachycardia cycle length resulting in 2-dimensional EA pattern. The
hypothesis was that an EA minimum suggests a potential CIR with
slow-conduction-zone. Results A total of n=33 patients were included.
LP-algorithm identified a mean of 2.4 EA minima and 4.4 suggested CIRs
per AAF-form. Overall, we observed a low specificity with 12.3% but a
high sensitivity of 98.2%. Detailed EA analysis revealed that depth
(≤20%) and width (>50ms) of EA minima were the best
predictors of relevant CIRs. Wide minima occurred rarely (17.5%), while
low minima were more frequently present (75.4%). Minima with a depth of
EA≤20% showed the best sensitivity and specificity overall (95% and
60%, respectively). Analysis in recurrent ablations in 5 patients
presenting de-novo AAF revealed that the CIR of de-novo AAF was already
detected by LP during the index procedure. Conclusion The LP algorithm
provides an excellent sensitivity (98.2%), but poor specificity
(12.3%) to detect the CIR in AAF. Specificity improved by preselection
of the lowest and widest EA minima. In addition, there might be role of
initial bystander CIRs becoming relevant for future AAFs
Pine cones powder for the adsorptive removal of copper ions from water
Authors: Ouafi Redouane , Omor Anass , Gaga Younes , Akhazzane Mohamed , Taleb Mustapha , Rais Zakia
Published: January 2021

This research investigates the adsorption potential of pine cone powder (PCP) for the removal of copper ions (Cu(II)) from aqueous solutions. The process of adsorption was reasonably fast, completed within a time of 60 min. The pseudo-second order kinetic model describes properly the Cu(II) adsorption by PCP. The adsorbent was characterised by various instrumental techniques and batch experiments were conducted to investigate the effect of PCP dose, solution pH, particle size and initial Cu(II) concentration on adsorption efficiency. Optimum Cu(II) removal occurred at a slightly acidic pH, with a particle size less than 100 ?m. The effective PCP dose was estimated to be 36 g L-1. The increase in the initial concentration of Cu (II) was accompanied by a reduction in the rate of its reduction by almost half. The Langmuir model was the best fitting isotherm with a maximum adsorption capacity of 9.08 mg g-1. The thermodynamic parameters values showed that the Cu(II) adsorption was a spontaneous and endothermic process. The results of this research suggest that Cu(II) could be removed through an environmentally friendly process using PCP as low-cost natural waste.
Some examples of treason in the 13th-century Serbia
Authors: Komatina Ivana
Published: January 2021

The paper observes examples of treason, that is, infidelity in the
13th-century Serbia. The author intends to show how this procedure was
sanctioned by common law, since the punishments for such crimes appeared in
the Serbian medieval written law only from the 14th century, all that with
the aim of getting to know as closely as possible the social context of
medieval Serbia.
Surgical Management of the Axilla in Breast Cancer
Authors: Donovan Cory , Giuliano Armando E
Published: January 2021

The management of the axilla in breast cancer has shifted from axillary dissection in all patients to sentinel lymph node biopsy (SLNB) alone for most patients, including patients with sentinel lymph node metastases. Although important to clinical staging, physical examination alone does not accurately predict axillary metastasis. There are some circumstances where SLNB is contraindicated or should be used with caution. The impact of SLNB after neoadjuvant chemotherapy remains unproven, but its use is reasonable for some patients. Patients with tumor-free sentinel lymph nodes or nodes with micrometastatic disease require no further axillary surgery. Most patients with one to three lymph nodes positive for macrometastatic disease who undergo segmental mastectomy and radiation do not require an axillary lymph node dissection (ALND). There has not been a dramatic increase in axillary recurrence or a decrease in survival with the decreased use of ALND. In the future, with improvements in genomic analysis, ALND and even SLNB may be even less important in local control and prognosis. 

This review contains 9 figures, 7 tables and 52 references. 
Key words: ACOSOG Z0011, axilla, axillary dissection, axillary radiation, breast cancer, macrometastasis, micrometastasis, sentinel lymph node biopsy
Estrogen Receptor–Positive, HER-2 Nonamplified Breast Cancer
Authors: Elmore Leisha C , Margenthaler Julie A.
Published: January 2021

Although histologic type provides critical insight into the behavior and natural history of breast cancer, gene expression profiling plays an important role in determining prognosis and guiding treatment selection. Tumor cells express biologically active molecules on the cell surface and within the cell that serve as receptors and rely on ligands to mediate a response to the cell. Two nuclear receptors, estrogen receptor (ER) and progesterone receptor (PR), and one cell surface receptor, human epidermal growth factor 2 receptor (HER-2), have been established as critical factors in the management of breast cancer. The first hormone receptor, ER, was identified and described in the 1960s. Advances in genomic analysis have allowed for molecular subtyping within the umbrella of hormone receptor status. Here we focus on tumors that express ER but do not express HER-2 and the relevant diagnostic workup and treatment (neoadjuvant and adjuvant) strategies.
This review contains 5 figures, 5 tables, and 41 references.
Key words: adjuvant therapy, breast cancer, endocrine therapy, estrogen receptor positive, HER-2 nonamplified, hormone receptors
Male Breast Cancer
Authors: Stone Kimberly S. , Wapnir Irene L
Published: January 2021

This is a contemporary review of risk factors and genetic predisposition associated with breast cancer in men. The workup and evaluation of breast masses and surgical management of cancer in this population are detailed. In addition, systemic therapies for the treatment of breast cancer in men are reviewed and compared with the therapeutic approaches used for women.   

This reviews contains 5 figures, 2 tables and 50 references. 
Key words: breast-conserving surgery, chemotherapy, endocrine therapy, genetic predisposition testing, genomic profiling, lymphadenectomy, male breast cancer, mastectomy, radiotherapy, sentinel lymph node biopsy
Pregnancy-Associated Breast Cancer
Authors: Ahn Soojin , Port Elisa R.
Published: January 2021

Breast cancer diagnosed during pregnancy or in the first postpartum year is referred to as pregnancy-associated breast cancer (PABC). With more women postponing childbearing until later in life, the incidence of PABC is expected to increase. Often there is a delay in diagnosis as small tumors are difficult to detect on a physical examination, and new findings may be obscured against the background of normal physiologic changes associated with pregnancy. Therefore, PABC tends to be diagnosed at a more advanced stage. Once an abnormality is suspected, diagnostic testing should be pursued. Breast ultrasonography is the imaging study of choice, although mammography can be safely performed with proper shielding. Magnetic resonance imaging with contrast is contraindicated due to possible teratogenic effects of gadolinium. Core-needle biopsy of any suspicious masses should be performed. After the establishment of the diagnosis, multidisciplinary treatment planning should be undertaken to optimize the outcome for both the mother and the baby. As certain systemic therapy agents and radiotherapy cannot be safely given during pregnancy, the sequence and timing of the different components of multimodality treatment must be carefully planned. PABC was previously thought to confer a poorer prognosis, but recent studies have shown no significant difference in survival between pregnant and nonpregnant patients when matched by age and stage. 
Key words: antihormonal therapy, breast cancer, breast surgery, chemotherapy, oncofertility, pregnancy, prognosis, radiation, sentinel lymph node biopsy
Rare Tumors of the Colorectal Region
Authors: Abelson Jonathan S , Yeo Heather L
Published: January 2021

Rare tumors of the colon and rectum account for less than 5% of all colorectal tumors. The most common of these rare tumors include anorectal melanoma, rectal neuroendocrine tumors, rectal gastrointestinal stromal tumors (GISTs), and retrorectal tumors. Their prognosis is varied and depends on underling pathology. Surgery plays an important role in many of these tumors. Molecularly targeted therapy and immunotherapy have expanding roles in GIST and anal melanoma, respectively. Adjuvant chemotherapy or radiation therapy may be employed in specific circumstances of unresectable or metastatic disease or for symptom control. 

This review contains 4 figures, 6 tables and 60 references. 
Key words: anal canal, antineoplastic agents, anus neoplasms, chordoma, gastrointestinal stromal tumors, melanoma, neuroendocrine tumors, operative, radiotherapy, rectal neoplasms, surgical procedures
Myxofibrosarcoma and Undifferentiated Pleomorphic Sarcoma
Authors: Lee Ann Y
Published: January 2021

Both myxofibrosarcoma and undifferentiated pleomorphic sarcoma (UPS) are sarcomas that primarily occur in the extremities of older patients. UPS (previously known as malignant fibrous histiocytoma) is now considered a diagnosis of exclusion, representing a group of high-grade, heterogeneous tumors with no clear line differentiation and characterized by high rates of distant metastases. Myxofibrosarcoma (formerly myxoid variant of malignant fibrous histiocytoma) is a distinct histologic entity that is largely distinguished from UPS by its myxoid stroma and curvilinear vascular pattern. Myxofibrosarcoma tends to have a locally infiltrative behavior that can often be seen as T2 hyperintense “tails” on magnetic resonance imaging. Local recurrence rates can be as high as 61% and are independent of grade. Unlike other sarcomas, it is recommended that tumors be excised with at least a 2 cm margin around both clinically and radiographically evident tumor. Low-grade tumors do not tend to metastasize but can recur as high-grade tumors with increased metastatic potential. Surgery is the mainstay of treatment for localized disease. For high-grade tumors, this may require complex plastics and vascular reconstruction. Selecting cases for multimodality therapy, including radiation and chemotherapy, should be done on a case-by-case basis after review by a multidisciplinary sarcoma team with particular attention to a patient’s risk of local recurrence and distant metastases. Further studies into histology-specific therapeutic targets will help inform future clinical trials.

This review contains 4 figures, 4 tables and 54 references
Key words: chemotherapy, distant metastases, extremity sarcoma, local recurrence, malignant fibrous histiocytoma, myxofibrosarcoma, radiation, sarcoma, surgical margins, T2 hyperintense tails, undifferentiated pleomorphic sarcoma
Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma
Authors: Welch Terrence D. , Klarich Kyle W , Oh Jae K.
Published: January 2021

The pericardium consists of a fibrous sac and a serous membrane. Because of its simple structure, the clinical syndromes involving the pericardium are relatively few but vary substantially in severity. Cardiac tumors may be either primary or secondary and either benign or malignant, with attachment sites throughout the endocardium. Cardiovascular trauma should be suspected in all patients with chest injuries or severe generalized trauma. Cardiovascular injury may be either blunt or penetrating. This review covers pericardial disease, cardiac tumors, and cardiovascular trauma. Figures show an electrocardiogram in acute pericarditis; acute pericarditis with delayed gadolinium enhancement of the pericardium shown with cardiac magnetic resonance imaging; underlying cause of pericardial effusion requiring pericardiocentesis; pericardial pressure-volume curves; large pericardial effusion with swinging motion of the heart resulting in electrical alternans; typical pulsed-wave Doppler pattern of tamponade; underlying causes of constrictive pericarditis in patients undergoing pericardiectomy; pericardial calcification seen on a chest radiograph; thickened pericardium; typical pulsed-wave Doppler pattern of constrictive pericarditis; typical mitral annular tissue velocities in constrictive pericarditis; a diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis; simultaneous right ventricular and left ventricular pressure tracings in restrictive cardiomyopathy; computed tomographic scan showing inflammatory constrictive pericarditis; systolic and diastolic transesophageal echocardiographic images of a large left atrial myxoma attached to the atrial septum; a decision tree of management options for patients with suspected papillary; transesophageal echocardiographic examples of aortic valve, mitral valve, left ventricular outflow tract, and tricuspid valve papillary fibroelastomas; and transesophageal short-axis view of the descending thoracic aorta in a hypotensive patient after a motor vehicle accident. The table lists tamponade versus constriction versus restrictive cardiomyopathy.
This review contains 18 highly rendered figures, 1 table, and 77 references.
Critical Care Implications of Thyroid Disease States
Authors: Sullivan James , Kalin Daniel
Published: January 2021

Thyroid dysfunction in the critically ill has many causes. In this review, primary and acquired thyroid disease states are discussed. The anatomy, physiology, and pathophysiology of thyroid disorders are addressed, as well as surgical and medical treatment options. Nonthyroidal illness syndrome (sick euthyroid) is also considered.
This review contains 3 figures, 7 tables, and 31 references.
Key words: agranulocytosis, brain death, hyperthyroidism, hypothyroidism, sick euthyroid
High-Risk Breast Lesions
Authors: Bleicher Richard J
Published: January 2021

Clinicians who treat breast disease deal with a variety of pathologic findings. Although there is often a focus on paradigms and data regarding malignant breast disease, benign breast disease ranges from that which requires no imaging, evaluation, or treatment to that which requires further testing to rule out concomitant cancer and ameliorate subsequent risk. This review discusses the most frequent types of high-risk lesions facing the breast practitioner, including atypical ductal hyperplasia, lobular neoplasia, radial scar, and papillary lesions. It is critical that the clinician understand the implications of each finding to advise about the risks associated with each of these entities, fully assess the need for further therapy, and mitigate the patient’s future risk. 
This review contains 2 tables, and 69 references.
Key words: atypical ductal hyperplasia, atypical lobular hyperplasia, lobular neoplasia, lobular carcinoma in situ, papillary lesions, pleomorphic, pseudoangiomatous stromal hyperplasia, radial scar, usual ductal hyperplasia
Lobular Breast Cancer
Authors: Mamtani Anita , King Tari A
Published: January 2021

Invasive lobular carcinoma (ILC) is the second most common type of breast cancer, with a unique pathogenesis and distinct clinical biology. These cancers display a characteristic loss of E-cadherin, and the vast majority are estrogen receptor positive (ER+), with a low-to-intermediate grade. These features generally portend a favorable prognosis, but there is a propensity for late recurrences and metastasis to atypical locations. These infiltrative tumors can be more clinically challenging than the more common ductal cancers. Their insidious nature can make them more difficult to diagnose, and they may show a differing response to standard therapies, keeping with the predominantly ER+ phenotype. Although ILC patients comprise a small minority in large breast cancer trials, most fundamentals of locoregional and systemic therapy presently remain shared between all cancer types. Recognizing the nuances of treating ILC remains important, and the recent discovery of novel mutations that are more frequently expressed in ILC holds promise for further investigations into lobular-specific targeted therapies.

This review 3 figures, 8 tables and 50 references
Key words: aromatase inhibitors, breast cancer, breast conservation, chemotherapy, E-cadherin, invasive lobular carcinoma, mastectomy, The Cancer Genome Analysis
Benign Breast Disease
Authors: Valente Stephanie A , Grobmyer Stephen R
Published: January 2021

Benign breast disease constitutes any abnormality that upon further workup is found to be noncancerous and does not establish premalignant potential. Benign breast diseases can present in various ways, such as breast pain, a palpable breast lump, nipple discharge, or an imaging abnormality. Appropriate workup is essential to ensure that the new change is benign. This may entail additional imaging, biopsy, or surgery if necessary. Surgeons need to be able to recognize the presentation, appropriate workup, and treatment recommendations for the various benign breast diseases. This review addresses the broad range of benign breast lesions and their management recommendations. 
This review contains 7 figures, 5 tables and 54 references
Key words: benign breast disease, breast cyst, breast mass, breast pain, idiopathic granulomatous mastitis, nipple discharge, papilloma, periductal mastitis, sclerosing adenosis
Basics of Imaging Techniques in Evaluation of Soft Tissue Tumors
Authors: Aherne Emily Alanna , Hwang Sinchun
Published: January 2021

Medical imaging plays a pivotal role in the detection, diagnosis, and clinical management of primary soft tissue tumors. Various imaging modalities have been used, and each modality offers unique advantages in the workup of soft tissue tumors by localizing the lesions in different compartments of the body and characterizing macroscopic tissue composition of the lesions in a noninvasive and safe manner. We review the clinical role and technical aspects of the frequently used imaging modalities, including magnetic resonance imaging (MRI), computed tomography, ultrasonography, positron emission tomography, and plain radiography with an emphasis on MRI as a mainstay imaging modality and a brief discussion of advanced techniques. We also review imaging features of common soft tissue tumors that can be detected and characterized using current imaging techniques.
 
Key words: computed tomography, diffusion-weighted imaging, imaging, magnetic resonance imaging, positron emission tomography, soft tissue, technique, tumor, ultrasonography
Surgical Management of Extremity and Truncal Sarcoma
Authors: Roland Christina L , Cormier Janice N
Published: January 2021

Soft tissue sarcomas are a heterogeneous group of neoplasms that arise throughout the body, but most commonly in the extremity and trunk. A multidisciplinary treatment approach has resulted in local control rates exceeding 90% and 5-year survival rates exceeding 70%. For patients with localized soft tissue sarcoma, limb-sparing surgical resection is the mainstay of therapy, with radiation therapy and chemotherapy used as adjuncts to reduce local and distant recurrences. Amputation is reserved for patients with primary or recurrent tumors that cannot be grossly resected with a limb-sparing procedure and preservation of function, which should occur in less than 5% of patients. Most patients who die of soft tissue sarcoma die of metastatic disease, which becomes evident within 2 to 3 years of initial diagnosis in 80% of cases, highlighting the need for improved systemic therapy options and optimal treatment at the time of diagnosis.

This review contains 13 figures, 4 tables and 53 references
Key words: amputation, multimodality, radiation therapy, soft tissue sarcoma, staging, surgery, treatment, wide resection
Management of Recurrent Retroperitoneal Sarcoma
Authors: Parsyan Armen , Gupta Abha , Catton Charles , Gladdy Rebecca
Published: January 2021

Retroperitoneal sarcomas (RPSs) are a heterogeneous group of mesenchymal tumors. The mainstay of treatment of RPS is curative surgical resection, which often involves a multivisceral resection. The predominant pattern of failure in RPS is local recurrence, which poses significant management challenges and limits survival. There is a paucity of high-level evidence to guide the management of primary and recurrent RPS, mainly due to the rarity of the disease. This review highlights the challenges and decision making in the diagnosis and management of recurrent RPS. 

Key words: chemotherapy, distant recurrence, leiomyosarcoma, liposarcoma, local recurrence, radiation therapy, retroperitoneal sarcoma, surgical resection
Atrial Fibrillation
Authors: Al-Salamah Tareq , Bontempo Laura J.
Published: January 2021

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by chaotic atrial electrical activity.  It is associated with heart failure, stroke, and reduced quality of life. AF is frequently recurrent and refractory to treatment. These facts underscore the importance of recognizing this arrhythmia even in its asymptomatic form. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of AF. Figures show AF, atrial flutter, and AF with preexcitation on a 12-lead electrocardiogram, rate control agent selection recommendations, and a decision-making algorithm for oral anticoagulation therapy. Tables list etiologies and risk factors for AF, American Heart Association/American College of Cardiology/Heart Rhythm Society classification of AF, some of the clinical consequences of AF, diagnostic evaluation for AF, antiarrhythmic drugs for conversion of AF, drugs used for acute rate control of AF, CHA2DS2-VASc score calculation, CHA2DS2-VASc  adjusted stroke rate and treatment guidelines, scoring system to assess the risk of bleeding with oral anticoagulation: HAS-BLED (hypertension, abnormal renal/liver function, history of stroke, bleeding history or predisposition, labile international normalized ratio, elderly [65 years], drugs/alcohol concomitant), and HAS-BLED scores with proportion of patients from the Euro Heart Survey in each category and associated major bleeding risk.
 
This review contains 5 highly rendered figures, 10 tables, and 69 references
Key words: Atrial fibrillation; Supraventricular tachycardia; Irregular heart beat; Cardioversion; Nonvalvular atrial fibrillation; Paroxysmal atrial fibrillation; Rate control; CHA2DS2-VASc scoring system; Rhythm control
Supraventricular Tachycardia
Authors: Baker Annalee M
Published: January 2021

Supraventricular tachycardia (SVT) is a category of arrhythmias that originate at or above the atrioventricular node. These are typically narrow complex QRS arrhythmias, without discernible P waves, with a regular rhythm and rapid rate. SVT is relatively common, occurring in 2.25 cases per 1,000 persons. Therefore, understanding the pathophysiology and method of treatment of SVT is an important skill for the emergency medicine physician to master. Therapeutic interventions include vagal maneuvers or pharmacologic agents, such as adenosine or calcium channel blockers, for the stable patient and synchronized cardioversion for the unstable patient. Stable patients with minimal comorbidities whose sinus rhythm is converted back in the emergency department can be safely discharged with a close follow-up by a cardiologist. However, admission is often required for the patient who presents with unstable SVT or has multiple comorbidities and requires further work-up.
 
This review contains 10 figures, 3 tables, and 48 references.
Keywords: ablation, adenosine, cardioversion, supraventricular tachycardia, valsalva maneuver, Wolff-Parkinson-White syndrome
Emergencies in Hematology and Oncology
Authors: Curley David P
Published: January 2021

Clinicians must be able to recognize and treat emergencies associated with malignancies and cancer treatment. Such emergencies include metabolic, neurologic, cardiovascular, hematologic, and infectious emergencies. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment and disposition and outcomes for these emergencies in hematology and oncology. Figures show mechanisms of spinal cord compression, a magnetic resonance image showing a metastasis to the thoracic spine compressing the spinal cord, a contrast-enhanced magnetic resonance image of a 54-year-old female with metastatic ovarian cancer, an electrocardiogram and a cardiac echocardiogram of a 50-year-old female with malignant pericardial effusion with cardiac tamponade, a computed tomography scan of a mass compressing the superior vena cava, a blood smear from a patient with acute myeloid leukemia, and an algorithm showing the initial management of fever and neutropenia. Tables list the management of hypercalcemia of malignancy; Cairo-Bishop definition of laboratory and clinical tumor lysis; grading, risk stratification, and management of tumor lysis syndrome; management of intracranial hypertension and seizures in adults; factors favoring low risk of severe infection in patients with neutropenic fever; Multinational Association for Supportive Care in Cancer (MASCC) risk index score; and indications for the addition of a gram-positive antibiotic to the initial empirical regimen.
This review contains 8 highly rendered figures, 9 tables, and 136 references.
Approach to the Patient Presenting with Chest Pain
Authors: Temin Elizabeth
Published: January 2021

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain. 
This review contains 1 figure, 25 tables, and 36 references.
Key words: acute coronary syndrome, acute myocardial infarction,  angina pectoris, chest pain, coronary artery disease,  pulmonary embolism, high sensitivity troponin, HEART Score, EDAC score, cardiac CT Angiogram
Acute Pancreatitis
Authors: Ahn Jason , Huang Calvin K.
Published: January 2021

Pancreatitis is a leading differential diagnosis in patients presenting with abdominal pain.  Although there are multiple initial inciting factors, the end result is the inappropriate activation of pancreatic enzymes leading to localized, and sometimes systemic, inflammation.  The severity of pancreatitis as a disease can range from mild pain to shock and hypotension.  This review covers the initial treatment and stabilization of patients with this disease as well as the mainstay of diagnosis including lab testing and imaging.  Disease severity scoring systems including the revised Atlanta Criteria, APACHE II score, SIRS criteria, BISAP score, and Ranson criteria, followed by treatment and disposition stratified by disease severity, are discussed.  Figures display pertinent findings of the imaging modalities including fluoroscopy, ultrasound, and computed tomography.  Tables list the major causes of pancreatitis, differential diagnosis, and non-pancreatic causes of amylase and lipase elevation.
This review contains 6 figures, 5 tables, and 53 references.
Key words: pancreatitis, abdominal pain, shock, gallstones, ultrasound, lipase, amylase
Hypersensitivity Reactions and Anaphylaxis
Authors: Ford Kristopher K. , Loftus Timothy M. , Moellman Joseph J.
Published: January 2021

Allergic reactions vary in intensity from mild rash or allergic rhinitis to devastating anaphylactic shock. Anaphylaxis, often underrecognized and undertreated, can be a life-threatening syndrome leading to multiorgan dysfunction. This review covers the etiology, pathophysiology, and treatment of severe allergic reactions and anaphylaxis. It is precipitated by exposure to particular allergens—commonly food, medications, insect stings, and environmental exposures—in a previously sensitized individual. Symptoms develop from an IgE-mediated immune response leading to degranulation of mast cells and basophils and the release of preformed mediators, lipid-derived metabolites, and inflammatory cytokines. First-line treatment for anaphylaxis involves epinephrine. Secondary treatments are antihistamines and corticosteroids. Further treatments for patients refractory to standard therapies involve vasopressor agents, nebulized albuterol, and glucagon. Frequency and duration of biphasic reactions are variable, limiting the development of consensus guidelines for monitoring of anaphylactic reactions.
Figures show the immune activity and inflammatory pathways in allergic responses, mast cell degranulation, and a depiction of common organs involved and corresponding clinical manifestations. Tables list the criteria for diagnosis of anaphylaxis, classification of hypersensitivity reactions, common clinical manifestations, and etiology and mediators of anaphylaxis. 
This review contains 4 highly rendered figures, 11 tables, and 43 references.
Key words: allergy, anaphylaxis, antihistamine, corticosteroid, epinephrine, mast cells
Nonopioid Analgesics
Authors: Rhyee Sean , Boyle Katherine
Published: January 2021

Acetaminophen is the most common toxic ingestion in the United States, causing 400 deaths per year. Poisoning occurs both intentionally and unintentionally, with suicidal intent, overuse for treatment of pain, and ingestion of multiple medications containing acetaminophen all contributing. Aspirin poisoning remains a concern even though its popularity as an analgesic and antipyretic has decreased over time. Among nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), ibuprofen and naproxen are the most commonly encountered in overdose, likely due to their easy availability as over-the-counter medications. This review covers the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes related to acetaminophen, aspirin, and ibuprofen and other NSAIDs. Tables describe N-acetylcysteine dosing, King’s College criteria for acetaminophen-induced liver failure, and indications for hemodialysis in aspirin poisoning. Figures include a pie chart showing acetaminophen metabolization, the Rumack-Matthew nomogram, and a graph showing frequency of hepatotoxicity in patients receiving N-acetylcysteine.
This review contains 3 highly rendered figures, 3 tables, and 97 references.
Cardiovascular Medications
Authors: Carreiro Stephanie , Ward Jeanine
Published: January 2021

Multiple classes of xenobiotics have the potential to influence the function of the cardiovascular system. When evaluating the hemodynamic consequences of any toxic exposure and initiating treatment of such abnormalities, the clinician must consider the mechanism by which the toxin exerts its effect. This review focuses on diagnosis and management of toxicity related to common classes of antiarrhythmic drugs and the centrally acting hypertensives. Beta blockers, calcium channel blockers, cardiac glycosides, sodium channel and potassium channel blockers, and clonidine and centrally acting alpha2 agonists are described in relation to principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcome. Tables include classes of antiarrhythmics, various beta-blocker properties, standard dosing regimen for hyperinsulinemia/euglycemia, calcium channel blockers, botanical and animal sources of cardiac glycosides, P-glycoprotein inhibitors, and various alpha agonists. Figures show the mechanisms for beta-receptor activation, hyperinsulinemia/euglycemia, and cardiac glycosides. An electrocardiogram demonstrating digitalis effect is also provided.
This review contains 4 highly rendered figures, 7 tables, and 126 references.
Wound Management
Authors: Starling Jennifer , Lemery Jay
Published: January 2021

The primary purpose of wound management is to create an optimal environment for the body to form an aesthetically pleasing and functional scar. The majority of wounds are treated with primary closure (ie, closure at the time of presentation). This review discusses the essential steps of laceration management, including patient and wound assessment, tissue preparation, decontamination and débridement, techniques of skin closure, and wound aftercare. This is presented as assessment and stabilization, treatment and disposition, and outcomes of wound management. Figures include illustrations of the anatomy of the skin and an ear field block; illustrations of multiple techniques (simple suture, running suture, horizontal and vertical mattress, deep dermal suture, and tissue adhesive); and photographs showing examples of the stapling technique and the tissue adhesive combined with surgical tape technique. Tables list tetanus prophylaxis recommendations, summaries of the commonly used local anesthetics, suture characteristics, wounds recommended for specialist consultation, and suture removal times based on the anatomic site.
This review contains 9 highly rendered figures, 5 tables, and 149 references.
Radiation Injury
Authors: Mazer-Amirshahi Maryann
Published: January 2021

Since the development of x-rays in the late 19th century, radiation has increasingly been used for diagnostic imaging and various industrial purposes. The human health consequences of radiation exposure can range from minor asymptomatic exposures to the development of potentially fatal acute radiation sickness depending on the characteristics of the exposure. This review provides an overview of radiation injury, including historical perspective and principles of toxicity; assessment and stabilization (bedside evaluation, supportive care, and empirical therapy); diagnosis (estimation of radiation dose, laboratory assessment, biodosimetry and bioassays, smoke inhalation, and psychiatric sequelae); treatment and disposition (hematologic acute radiation illness, countermeasures and antidotes, gastrointestinal symptoms, fluid and electrolyte management, surgical intervention, local radiation injury, psychiatric treatment, radiation exposure during pregnancy, palliative care, and disposition); and outcomes (carcinogenesis, noncancer effects). Tables include the characteristic of common radioactive isotopes, common radiation dose equations and conversions, prescribing information for colony-stimulating factors, recommended antimicrobial prophylaxis and treatment regimens, and radioisotope decorporation or blocking agents. Figures show types of ionizing radiation, comparison of radiation contamination and exposure, patterns of early lymphocyte response based on radiation dose, the relationship between time to onset of vomiting and radiation dose, and a sample body chart for documentation of radiation contamination.
This review contains 5 figures, 5 tables, and 82 references.
Key Words: radiation, radiation exposure, radiation sickness, diagnostic imaging, pregnancy, carcinogenesis, toxicity, acute radiation syndrome (ARS)
Lightning and Electrical Injury
Authors: Davis Christopher , Cushing Tracey A.
Published: January 2021

There are multiple types of electrical injuries, which vary according to the type of electricity (alternating current or direct current) and the mechanism of contact. Electrical injuries caused by contact with alternating current are more commonly encountered in the household setting, while direct current is found in industrial accidents. Lightning injuries are rare in the United States but are much more common in developing countries due to a lack of access to infrastructure and more agrarian economies. This review includes an overview, assessment and stabilization, diagnosis, treatment and disposition, and outcomes for each of these types of injury. 
This review contains 2 figures, 18 tables, and 68 references.
Keywords: Lightning, electrical injury, burn, voltage, alternating current, direct current, conducted electrical weapon, TASER, arrhythmia, cardiac arrest, myonecrosis, rhabdomyolysis
Sexual Assault: Acute Care and Beyond
Authors: Gorman Emily I , Linden Judith
Published: January 2021

Sexual assault, which encompasses any nonconsensual sexual contact, is, unfortunately, common. It results in considerable costs to society, including intangible costs such as loss of quality of life among victims. This review covers the approach to the patient and definitive treatment, disposition, and outcomes for adult and adolescent victims of sexual assault. Figures show female anatomy and common areas for genital injury after rape, a Centers for Disease Control and Prevention algorithm for evaluation of possible nonoccupational HIV exposures and nonoccupational post-exposure prophylaxis, a questionnaire for determining additional key aspects of the history of the assault to be completed and explored in detail by the sexual assault examiner, and the components and steps of the Massachusetts Sexual Assault Evidence Collection Kit. Tables list characteristics that define rape, key aspects of the history, recommended treatment to prevent sexually transmitted infections and pregnancy, calculated risks of acquiring HIV from an isolated sexual contact with a known HIV-positive person, and trauma-informed care.
This review contains 5 highly rendered figures, 5 tables, 95 references, and a list of helpful Web sites.
Management of Acute Heart Failure
Authors: Ullman Edward
Published: January 2021

Acute heart failure (AHF) is a heterogeneous syndrome characterized by patients who present with signs and symptoms of heart failure (HF) in need of urgent or emergent therapy. Although dyspnea is the most common presentation, AHF is accompanied by a variety of signs and symptoms. AHF primarily afflicts the elderly; these patients typically have numerous comorbid conditions, both cardiovascular and noncardiovascular. Although signs and symptoms are similar in nearly all patients with AHF, the precipitant of acute decompensation, cardiac structure and function, and etiology of HF, as well as other comorbid conditions, vary considerably. This review covers the epidemiology, pathophysiology, diagnosis, treatment, and disposition of patients who present to the emergency department with nonacute coronary syndrome AHF.
This review contains 6 highly rendered figures, 2 videos, 4 tables, and 82 references.
Septic Arthritis and Osteomyelitis
Authors: Leber Melissa
Published: January 2021

Septic arthritis is an inflammatory condition within the joint in reaction to bacterial infection in the joint space. Emergent diagnosis and initiation of therapy are necessary to prevent joint destruction and, in some cases, serious systemic illness. This review covers the epidemiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of septic arthritis. Figures show the pathophysiology of bone infection; an algorithm for the initial evaluation and management of a suspected septic joint; a magnetic resonance image of vertebral body osteomyelitis; a cutaneous sinus in a patient with underlying chronic posttraumatic osteomyelitis at the site of a previous tibial fracture; the probe-to-bone test for diagnosing osteomyelitis in the diabetic foot; an algorithm for the initial evaluation and management of suspected vertebral body osteomyelitis; nonsurgical treatment of osteomyelitis of the foot in a patient with diabetes; and algorithms for the evaluation and management of osteomyelitis in diabetic patients with neuropathic ulcers and no or mild foot infection, osteomyelitis in diabetic patients with neuropathic ulcers and moderate or severe foot infection, and chronic posttraumatic osteomyelitis. Tables list supportive findings for diagnosis of chronic osteomyelitis, risk factors for the development of septic arthritis in patients with underlying joint disease, microbiology in septic arthritis, empirical antibiotic therapy for septic arthritis, microbiology in vertebral osteomyelitis, antibiotic therapy for vertebral osteomyelitis awaiting culture results, representative studies with likelihood ratios for diagnostic tests used in the evaluation of native joint septic arthritis, antibiotic therapy for vertebral osteomyelitis with unknown or established microbiology, and antibiotic therapy for diabetic pedal osteomyelitis with unknown or established microbiology.
 
Key words: osteomyelitis, probe-to-bone test, septic arthritis, septic joint, vertebral osteomyelitis
This review contains 10 highly rendered figures, 9 tables, and 110 references.
Human Trafficking 1: Epidemiology
Authors: Macias-Konstantopoulos Wendy
Published: January 2021

Trafficking in persons, or human trafficking, is the obtaining of persons by force, fraud, coercion, or other improper means, with the intention of exploiting them for financial gain. According to the US Department of State, the more prominent global forms of human trafficking include forced labor, bonded labor (or debt bondage), forced commercial sexual exploitation (or sex trafficking), involuntary domestic servitude, forced child labor, child sex trafficking, child soldiering, and organ trafficking. In the United States, the forced exploitation of persons in the labor industry (i.e., labor trafficking) and in the commercial sex industry (i.e., sex trafficking) account for the majority of human trafficking cases recognized, reported, investigated, and prosecuted. Women and girls account for 55% (11.4 million) of the global trafficked population, whereas men and boys comprise the difference. Three quarters of trafficked persons are adults, whereas children younger than 18 years represent 26% (5.5 million) of victims. Risk factors that have been associated with increased risk of human trafficking include but are not limited to a childhood history of abuse and neglect; financial insecurity; housing instability associated with homelessness, running away, or being thrown out of the home; kinship placements with distant family members, foster care, and other residential placements; intellectual and learning disabilities; identification as lesbian, gay, bisexual, transgender, and questioning (LGBTQ); racial and ethnic minority status; status as an immigrant, migrant worker, and refugee; and involvement in gangs or illicit substance use. Due to the inherently abusive and violent nature of this crime, human trafficking has profound negative implications for the health and well-being of affected persons.

This review contains 2 figures, 4 tables and 53 references
Key words: commercial sexual exploitation, debt bondage, domestic servitude, forced labor, forced substance use, HIV, modern-day slavery, posttraumatic stress disorder, trafficking in persons
Medical Evaluation of the Surgical Patient (SAGHE)
Authors: Gerhard-Herman Marie , Gates Jonathan
Published: January 2021

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium.
This review contains 3 highly rendered figures, 12 tables, and 68 references.