Stages of HPV-Mediated Carcinogenesis
This depicts the necessary, sequential stages of HPV-mediated carcinogenesis: HPV infection, intraepithelial precancer, and cancer. The images illustrate what a clinician might see on physical examination at each stage of carcinogensis. HPV genotype is a major influence on risks of progression to precancer and cancer compared with immune control and regression to negative results on HPV testing. Familiar and overlapping microscopic (cytologic and histologic) morphologic grading as well as visual classifications have been used to indicate the increasing severity of HPV-induced changes. However, morphologic and visual grading classifications have imperfect reproducibility and accuracy, and many diagnoses are equivocal. Molecular tests (eg, p16/Ki67 dual stain) are increasingly used to identify the likelihood of prevalent and incipient precancer.
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Syphilis is an infection caused by the bacterium Treponema pallidum.
Syphilis is a sexually transmitted infection that is acquired through genital, oral, or anal sex. Syphilis can also be passed to a fetus during pregnancy, causing congenital syphilis. Early diagnosis and treatment of syphilis is important to prevent progression of the disease and avoid transmission to others. Syphilis infections can be decreased by use of condoms during sex.
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Suggested Clinical Approach to Treating the Genitourinary Syndrome of Menopause in Postmenopausal Women
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Fentanyl is a synthetic opioid that is used to treat severe pain. It is 50 to 100 times stronger than morphine. Pharmaceutical fentanyl refers to fentanyl that is prescribed by doctors and can be given as a pill, lozenge, spray (in the nose or under the tongue), skin patch, or injection. Nonpharmaceutical fentanyl is manufactured illegally and is often combined as a powder or liquid with illicit drugs (such as cocaine, methamphetamine, and heroin) or made into counterfeit prescription pills.
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Mechanisms of Action of RNA Interference Therapeutics, CAMs, and NAPs.
RNAi therapeutics (small interfering RNA [siRNA] and antisense oligonucleotides [ASOs]) suppress HBsAg from both integrated HBV DNA and cccDNA, without a direct effect on cccDNA or integrated viral DNA (Panel A). These agents target S and X and thus target transcripts of the HBV genome and subgenomic integrants, which leads to simultaneous inhibition of multiple viral genes due to overlapping mRNA transcripts and knockdown of all viral proteins and pgRNA expressed from cccDNA. Dose-dependent declines in HBsAg are observed, proving that RNAi agents target a hitherto inaccessible source of HBsAg. Liver levels and delivery have been established with newer conjugates (GalNAc). The siRNA has a longer duration of action than ASOs and requires less frequent dosing. Current compounds have minimal off-target effects.
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High-Resolution Computed Tomographic Scan of Patients With Sarcoidosis. A-D, innumerable sarcoid nodules studding the interlobar fissures and bronchovascular bundles and coalescing with the architectural distortion of the lobar airways. E-G, extensive focal consolidation and innumerable nodules tracking along the bronchovascular bundles, septal lines, and interlobar fissures predominantly in the upper lobe. These patterns are characteristic of sarcoidosis.
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Evolution of Point-of-Care Ultrasonography (POCUS) during the Past Decade.
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Natural History of Chronic Hepatitis D. Chronic hepatitis D is associated with a more rapid progression to cirrhosis and a higher risk of hepatocellular carcinoma than HBV monoinfection. Identifying patients in whom fibrosis progresses rapidly would be crucial for determining the prognosis, but mechanisms of fibrotic progression are poorly understood. Histologic findings (hematoxylin and eosin stain) are shown. Liver fibrosis is assessed with the use of Metavir staging, which ranges from F0 (no fibrosis) to F4 (cirrhosis). Some HDV genotypes may influence disease activity. Persistent HDV viremia is a factor in disease progression and a predictor of death. In liver disease in general, factors associated with fibrosis are male sex, older age at infection, excessive alcohol consumption, obesity, diabetes, and immunodeficiency.
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Heart Failure With Preserved Ejection Fraction (HFpEF) Differential Diagnosis
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Suggested Clinical Approach to Prescribing Menopausal Hormone Therapy
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Pathobiologic Mechanisms of Plaque Progression and Disruption
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Principle of the RT-QuIC Technique.
Misfolding of the recombinant prion protein (rec PrP) after contact with PrPSc seeds (conversion) is followed by aggregation into larger structures, which then are fragmented by high-frequency shaking. New seeds provide the basis for further conversion of rec PrP in repeated cycles of incubation and shaking. The results are visualized by measuring the thioflavin T fluorescence that is emitted when the dye binds to aggregates of misfolded protein.
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Open Repair of an Infrarenal Abdominal Aortic Aneurysm.
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