The p53 pathway in breast cancer

p53 mutation remains the most common genetic change identified in human neoplasia. In breast cancer, p53 mutation is associated with more aggressive disease and worse overall survival. The frequency of mutation in p53 is, however, lower in breast cancer than in other solid tumours. Changes, both genetic and epigenetic, have been identified in regulators of p53 activity and in some downstream transcriptional targets of p53 in breast cancers that express wild-type p53. Molecular pathological analysis of the structure and expression of constituents of the p53 pathway is likely to have value in diagnosis, in prognostic assessment and, ultimately, in treatment of breast cancer

Images in clinical medicine. Medical mystery - an unusual complication of colonoscopy

A 69-year-old man presented to the emergency department with a 3-day history of left-sided lower abdominal and groin pain. The pain had begun 36 hours after the patient had undergone colonoscopy, at which time he was found to have extensive diverticular disease. He had undergone polypectomy of a moderately dysplastic tubular adenoma of the sigmoid colon. On measurement of vital signs, he had tachycardia (pulse rate, 110) and hypotension (blood pressure, 95/70 mm Hg) and was febrile (temperature, 100.7°F [38.2°C]). Physical examination revealed erythema and swelling of the left inguinoscrotal region with associated tenderness on palpation. The remainder of his abdomen was generally soft and nontender on palpation. The results of routine laboratory testing were unremarkable except for a creatine kinase level of 387 U per liter (normal range, 0 to 170), an international normalized ratio of 1.4, and a derived fibrinogen level of 6.4 g per liter (normal range, 1.5 to 4.5). A computed tomographic scan of the patient's pelvis is shown here. What is the diagnosis

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous