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Introduction: Regional anesthesia has long been used in a perioperative setting for the treatment of both pre- and postoperative pain. Recently, this skill has been brought into the emergency department (ED) as a modality for treating acute pain as the pendulum shifts away from an opiate-based armamentarium and toward a multimodal future. In this case series, we describe a way to use the pectoralis nerve block I and II in the treatment of pain with regard to breast abscesses and/or breast cellulitis managed in the ED.Case Series: This paper describes three cases, all of which consist of a painful complaint in the thoracic region. The first was a patient diagnosed with a breast abscess. The second patient was diagnosed with breast cellulitis. Finally, the third patient was diagnosed with a large breast abscess that extended into the axilla. All three sustained immense relief with the pectoralis block.Conclusion: While further research is needed on a larger scale, preliminary data suggests that the ultrasound-guided pectoralis nerve block is an effective and safe modality of acute pain control in regard to breast and axillary abscesses along with breast cellulitis.

Learning Objectives: Demonstrate a curriculum designed to teach medical students how to successfully write the medical decision making portion of the emergency medicine note.Introduction: Documentation is an essential component of patient care in the emergency department (ED). Although students are taught the general rules of note-writing prior to clerkships, the emergency medicine (EM) note differs from most rotations. There is a need to teach the specifics of documentation of the EM note to medical students. The Emergency Medicine Residents’ Association (EMRA) Education Committee created a curriculum to teach formal documentation to medical students.Educational Objective: Create a curriculum designed to teach medical students how to successfully write the medical decision making (MDM) portion of the EM note.Curricular Design: Our curriculum design assumes that all senior medical students were taught the basics of writing a history and physical. Therefore, we primarily focused on teaching the MDM portion of the EM note. Following IRB approval and consent from the 55 students in our study, each student filled out a survey about their previous experience with documentation in the ED (Image 1). Next, students watched a video of a complete simulated patient encounter in order to assess their baseline ability to document a formal MDM that included the ED course and disposition. These notes were then graded on a rubric (Image 2) by a resident physician at each site who was a member of the curriculum development team to ensure standardization. Students were then given access to the EMRA documentation template and video. After the educational intervention, students documented a new MDM based on a different video encounter and were graded again.Impact/Effectiveness: We found that a documentation curriculum significantly improved students’ MDM documentation. Repeated measures ANOVA revealed a strong effect on MDM Documentation scores [F(1, 38) = 72.547, p < .001, ηp2 = .656], demonstrating that MDM documentation statistically improved after the training curriculum and that implementation improves student documentation in the ED.

Intrinsic and acquired resistance to mitogen-activated protein kinase inhibitors (MAPKi) in melanoma remains a major therapeutic challenge. Here, we show that the clinical development of resistance to MAPKi is associated with reduced tumor expression of the melanoma suppressor Autophagy and Beclin 1 Regulator 1 (AMBRA1) and that lower expression levels of AMBRA1 predict a poor response to MAPKi treatment. Functional analyses show that loss of AMBRA1 induces phenotype switching and orchestrates an extracellular signal-regulated kinase (ERK)-independent resistance mechanism by activating focal adhesion kinase 1 (FAK1). In both in vitro and in vivo settings, melanomas with low AMBRA1 expression exhibit intrinsic resistance to MAPKi therapy but higher sensitivity to FAK1 inhibition. Finally, we show that the rapid development of resistance in initially MAPKi-sensitive melanomas can be attributed to preexisting subclones characterized by low AMBRA1 expression and that cotreatment with MAPKi and FAK1 inhibitors (FAKi) effectively prevents the development of resistance in these tumors. In summary, our findings underscore the value of AMBRA1 expression for predicting melanoma response to MAPKi and supporting the therapeutic efficacy of FAKi to overcome MAPKi-induced resistance. [ABSTRACT FROM AUTHOR]

Cellular engulfment and uptake of macromolecular assemblies or nanoparticles via endocytosis can be associated to both healthy and disease-related biological processes as well as delivery of drug nanoparticles and potential nanotoxicity of pollutants. Depending on the physical and chemical properties of the system, the adsorbed particles may remain at the membrane surface, become wrapped by the membrane, or translocate across the membrane through an endocytosis-like process. In this paper, we address the question of how the wrapping of colloidal particles by lipid membranes can be controlled by the shape of the particles, the particle–membrane adhesion energy, the membrane phase behavior, and the membrane-bending rigidity. We use a model system composed of soft core–shell microgel particles with spherical and ellipsoidal shapes, together with phospholipid membranes with varying composition. Confocal microscopy data clearly demonstrate how tuning of these basic properties of particles and membranes can be used to direct wrapping and membrane deformation and the organization of the particles at the membrane. The deep-wrapped states are more favorable for ellipsoidal than for spherical microgel particles of similar volume. Theoretical calculations for fixed adhesion strength predict the opposite behavior— wrapping becomes more difficult with increasing aspect ratio. The comparison with the experiments implies that the microgel adhesion strength must increase with increasing particle stretching. Considering the versatility offered by microgels systems to be synthesized with different shapes, functionalizations, and mechanical properties, the present findings further inspire future studies involving nanoparticle–membrane interactions relevant for the design of novel biomaterials and therapeutic applications. [ABSTRACT FROM AUTHOR]