A Curve Ball

A 70-year-old man presented to the emergency department after an episode of altered mental status. Two days before presentation, he began having increased urinary frequency and decreased urine volume after eating a rice cake made with potato. On the day of presentation, he appeared disoriented and h...

Full description

Saved in:
Bibliographic Details
Published inThe New England journal of medicine Vol. 383; no. 10; pp. 970 - 975
Main Authors Mukaigawara, Mitsuru, Manesh, Reza, Kinjo, Mitsuyo, Sugita, Shuichi, Olson, Andrew P.J
Format Journal Article
LanguageEnglish
Published Boston Massachusetts Medical Society 03.09.2020
Subjects
Abdomen
Anaphylaxis
Beta blockers
Cardiac arrhythmia
Case reports
Consciousness
Creatinine
Edema
Emergency medical care
Fainting
Hydronephrosis
Hyperplasia
Hypotension
Infections
Insect bites
Lungs
Poisoning
Sepsis
Sugarcane
Typhus
Urine
Urogenital system
Japan
Online AccessGet full text

Cover

Abstract A 70-year-old man presented to the emergency department after an episode of altered mental status. Two days before presentation, he began having increased urinary frequency and decreased urine volume after eating a rice cake made with potato. On the day of presentation, he appeared disoriented and he fell.
AbstractList A 70-year-old man presented to the emergency department after an episode of altered mental status. Two days before presentation, he began having increased urinary frequency and decreased urine volume after eating a rice cake made with potato. On the day of presentation, he appeared disoriented and he fell.
Author Olson, Andrew P.J
Mukaigawara, Mitsuru
Kinjo, Mitsuyo
Manesh, Reza
Sugita, Shuichi
Author_xml – sequence: 1
  givenname: Mitsuru
  surname: Mukaigawara
  fullname: Mukaigawara, Mitsuru
  organization: From the Department of Medicine, Okinawa Miyako Hospital (M.M., S.S.), and the Department of Medicine, Okinawa Chubu Hospital (M.K.) — both in Okinawa, Japan; Harvard Kennedy School, Cambridge, MA (M.M.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.M.); and the Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis (A.P.J.O.)
– sequence: 2
  givenname: Reza
  surname: Manesh
  fullname: Manesh, Reza
  organization: From the Department of Medicine, Okinawa Miyako Hospital (M.M., S.S.), and the Department of Medicine, Okinawa Chubu Hospital (M.K.) — both in Okinawa, Japan; Harvard Kennedy School, Cambridge, MA (M.M.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.M.); and the Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis (A.P.J.O.)
– sequence: 3
  givenname: Mitsuyo
  surname: Kinjo
  fullname: Kinjo, Mitsuyo
  organization: From the Department of Medicine, Okinawa Miyako Hospital (M.M., S.S.), and the Department of Medicine, Okinawa Chubu Hospital (M.K.) — both in Okinawa, Japan; Harvard Kennedy School, Cambridge, MA (M.M.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.M.); and the Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis (A.P.J.O.)
– sequence: 4
  givenname: Shuichi
  surname: Sugita
  fullname: Sugita, Shuichi
  organization: From the Department of Medicine, Okinawa Miyako Hospital (M.M., S.S.), and the Department of Medicine, Okinawa Chubu Hospital (M.K.) — both in Okinawa, Japan; Harvard Kennedy School, Cambridge, MA (M.M.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.M.); and the Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis (A.P.J.O.)
– sequence: 5
  givenname: Andrew P.J
  surname: Olson
  fullname: Olson, Andrew P.J
  organization: From the Department of Medicine, Okinawa Miyako Hospital (M.M., S.S.), and the Department of Medicine, Okinawa Chubu Hospital (M.K.) — both in Okinawa, Japan; Harvard Kennedy School, Cambridge, MA (M.M.); the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.M.); and the Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis (A.P.J.O.)
BookMark eNp1kEtLw0AUhQepYNq6dV0QxE3qncwrWdZQX1TddD9MJjOQkJczieC_b2rcWOjZ3M33XQ5njmZN2xiEbjCsMTD-8LF9e9edxwkGAvwCBZgRElIKfIYCgCgOqUjIFZp7X8IYTJMALTerdHDfZvWoqmqJLq2qvLn-uwu0f9ru05dw9_n8mm52oSYE9yFWBhJt4yyzRICFKLOUxTYXXAFlTNE4FzpnOOM6ExoMxDTnGjKmLBM8Jwt0P73tXPs1GN_LuvDaVJVqTDt4GVGSJEJEQozo7QlatoNrxnK_FBcM2JGiE6Vd670zVuqiV33RNr1TRSUxyONC8v9Co7Y-0TpX1Mr9nBfuJqGuvWxMWZ8DD4FycyU
CitedBy_id crossref_primary_10_1007_s40278_020_84396_7
Cites_doi 10.1097/MEJ.0b013e32832d8516
10.1001/jama.2016.0289
10.1016/S0022-3476(62)80144-9
10.1001/archderm.1957.01550170088015
10.1001/jama.1963.63710130013022
10.1080/15563650902948859
10.1016/S0190-9622(82)70149-5
10.1248/bpb1978.15.287
10.1111/cup.12205
10.1089/jwh.2010.2708
10.1016/0735-6757(88)90001-0
10.1179/2295333714Y.0000000033
10.1016/S1473-3099(09)70066-0
ContentType Journal Article
Copyright Copyright © 2020 Massachusetts Medical Society. All rights reserved.
Copyright_xml – notice: Copyright © 2020 Massachusetts Medical Society. All rights reserved.
DBID AAYXX
CITATION
7RV
7X7
7XB
8AO
8C1
8FE
8FH
8FI
ABUWG
AFKRA
AN0
AZQEC
BBNVY
BEC
BENPR
BHPHI
CCPQU
DWQXO
FYUFA
GHDGH
GNUQQ
GUQSH
HCIFZ
K0Y
LK8
M0R
M0T
M1P
M2M
M2O
M2P
M7P
MBDVC
NAPCQ
PHGZM
PHGZT
PJZUB
PKEHL
PPXIY
PQEST
PQGLB
PQQKQ
PQUKI
PRINS
PSYQQ
Q9U
7X8
DOI 10.1056/NEJMcps1910306
DatabaseName CrossRef
Nursing & Allied Health Database
Health & Medical Collection
ProQuest Central (purchase pre-March 2016)
ProQuest Pharma Collection
Public Health Database
ProQuest SciTech Collection
ProQuest Natural Science Collection
Hospital Premium Collection
ProQuest Central (Alumni)
ProQuest Central UK/Ireland
British Nursing Database
ProQuest Central Essentials
Biological Science Collection
eLibrary
ProQuest Central
Natural Science Collection
ProQuest One Community College
ProQuest Central Korea
Proquest Health Research Premium Collection
Health Research Premium Collection (Alumni)
ProQuest Central Student
ProQuest Research Library
SciTech Premium Collection
New England Journal of Medicine
Biological Sciences
Consumer Database (Proquest)
Healthcare Administration Database
Medical Database
Psychology Database
Research Library
Science Database
Biological Science Database
Research Library (Corporate)
Nursing & Allied Health Premium
ProQuest Central Premium
ProQuest One Academic (New)
ProQuest Health & Medical Research Collection
ProQuest One Academic Middle East (New)
ProQuest One Health & Nursing
ProQuest One Academic Eastern Edition (DO NOT USE)
ProQuest One Applied & Life Sciences
ProQuest One Academic
ProQuest One Academic UKI Edition
ProQuest Central China
ProQuest One Psychology
ProQuest Central Basic
MEDLINE - Academic
DatabaseTitle CrossRef
ProQuest One Psychology
Research Library Prep
ProQuest Central Student
ProQuest One Academic Middle East (New)
ProQuest Central Essentials
elibrary
ProQuest Central (Alumni Edition)
SciTech Premium Collection
ProQuest One Community College
ProQuest One Health & Nursing
New England Journal of Medicine
ProQuest Natural Science Collection
ProQuest Pharma Collection
ProQuest Central China
ProQuest Central
ProQuest One Applied & Life Sciences
ProQuest Health & Medical Research Collection
Health Research Premium Collection
Natural Science Collection
ProQuest Central Korea
Health & Medical Research Collection
Biological Science Collection
ProQuest Research Library
ProQuest Central (New)
ProQuest Public Health
ProQuest Biological Science Collection
ProQuest Central Basic
ProQuest Science Journals
ProQuest Family Health
ProQuest One Academic Eastern Edition
British Nursing Index with Full Text
ProQuest Health Management
ProQuest Nursing & Allied Health Source
ProQuest Hospital Collection
Health Research Premium Collection (Alumni)
Biological Science Database
ProQuest SciTech Collection
Nursing & Allied Health Premium
ProQuest Health & Medical Complete
ProQuest Medical Library
ProQuest Psychology Journals
ProQuest One Academic UKI Edition
ProQuest One Academic
ProQuest One Academic (New)
MEDLINE - Academic
DatabaseTitleList
ProQuest One Psychology
Database_xml – sequence: 1
  dbid: BENPR
  name: ProQuest Central
  url: https://www.proquest.com/central
  sourceTypes: Aggregation Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 1533-4406
Editor Solomon, Caren G
Editor_xml – sequence: 1
  givenname: Caren G
  surname: Solomon
  fullname: Solomon, Caren G
EndPage 975
ExternalDocumentID 10_1056_NEJMcps1910306
NJ202009033831015
Genre Clinical Problem-Solving
GeographicLocations Japan
GeographicLocations_xml – name: Japan
GroupedDBID -
0R
0WA
123
186
1VV
29N
2KS
2WC
34G
39C
4
4.4
53G
55
5RE
7FN
7RV
7X7
85S
8AO
8C1
8FE
8FH
8FI
AACLI
AAEJM
AAIKC
AALRV
AAPBV
AAQQT
AARDX
AAWTL
ABACO
ABEHJ
ABFLS
ABIVO
ABOCM
ABPPZ
ABPTK
ABQIJ
ABUWG
ABWJO
ACGFS
ACGOD
ACJLH
ACNCT
ACPRK
ACRZS
ADBBV
ADBIT
ADCBC
AENEX
AETEA
AFFNX
AFHKK
AFKRA
AGFXO
AGNAY
AHMBA
AJJEV
AJVPN
ALMA_UNASSIGNED_HOLDINGS
AN0
AQUVI
AZQEC
BBAFP
BBNVY
BCU
BENPR
BES
BHPHI
BKEYQ
BKNYI
BLC
BNQBC
BPHCQ
BVXVI
C45
CJ0
CO
CS3
DCD
DU5
DWQXO
DZ
EBS
ET
EX3
F5P
FD8
FM.
FYUFA
GJ
GNUQQ
GUQSH
HCIFZ
HZ
I4R
IH2
K-O
KM
KOO
L7B
LK8
M0R
M0T
M1P
M2M
M2O
M2P
M7P
MVM
N9A
NAPCQ
NEJ
O9-
OK1
OMK
OVD
P-O
P-S
P2P
PADUT
PCD
PQEST
PQQKQ
PQUKI
PRINS
PROAC
PSQYO
QJJ
RHI
RWL
RXW
S10
S6N
SJFOW
SJN
TAE
TAF
TEORI
TN5
TUQ
TWZ
UCV
UKR
UMD
VQA
W2G
WH7
WOQ
WOW
X
X7M
XJT
XYN
XZL
YCJ
YNT
YRY
YZZ
ZA5
ZHY
ZR0
---
-DZ
-ET
-~X
.-4
.55
.CO
.GJ
0R~
36B
AAMNW
AAYXX
ABBLC
ABCQX
ABDQB
ABJNI
ACKOT
ACPFK
ADRHT
ADUKH
AERZD
AFOSN
AGHSJ
ALIPV
BYPQX
CCPQU
CITATION
H13
HF~
HMCUK
HZ~
N4W
PHGZM
PHGZT
PSYQQ
UKHRP
YFH
YR2
YR5
YYP
ZCA
ZVN
~KM
7XB
BEC
K0Y
MBDVC
PJZUB
PKEHL
PPXIY
PQGLB
Q9U
7X8
ID FETCH-LOGICAL-c331t-1ae09cf8bbf370f02bf458fd76a0455a48d7cd51b6cb7c0e084d6c0b5af576d3
IEDL.DBID 7X7
ISSN 0028-4793
1533-4406
IngestDate Fri Jul 11 09:36:52 EDT 2025
Sat Aug 23 13:35:15 EDT 2025
Tue Jul 01 01:43:31 EDT 2025
Thu Apr 24 23:10:24 EDT 2025
Tue Dec 21 14:38:51 EST 2021
IsPeerReviewed true
IsScholarly true
Issue 10
Language English
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c331t-1ae09cf8bbf370f02bf458fd76a0455a48d7cd51b6cb7c0e084d6c0b5af576d3
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
ObjectType-Report-3
ObjectType-Case Study-4
ObjectType-Case Study-2
content type line 23
ObjectType-Conference Proceeding-3
ObjectType-Feature-5
ObjectType-Article-4
ObjectType-Report-1
ORCID 0000-0001-6530-2083
0000-0002-8342-230X
PQID 2439675057
PQPubID 40644
PageCount 6
ParticipantIDs proquest_miscellaneous_2439977277
proquest_journals_2439675057
crossref_citationtrail_10_1056_NEJMcps1910306
crossref_primary_10_1056_NEJMcps1910306
mms_nejm_10_1056_NEJMcps1910306
ProviderPackageCode CITATION
AAYXX
PublicationCentury 2000
PublicationDate 20200903
2020-09-03
PublicationDateYYYYMMDD 2020-09-03
PublicationDate_xml – month: 09
  year: 2020
  text: 20200903
  day: 03
PublicationDecade 2020
PublicationPlace Boston
PublicationPlace_xml – name: Boston
PublicationTitle The New England journal of medicine
PublicationYear 2020
Publisher Massachusetts Medical Society
Publisher_xml – name: Massachusetts Medical Society
References Teshima, D, Morishita, K, Ueda, Y (r014) 1992; 15
Baker, DH, Wilson, RE (r010) 1963; 186
Jordan, JW, Crissey, JT (r008) 1957; 75
Shankar-Hari, M, Phillips, GS, Levy, ML (r001) 2016; 315
Lung, D, Clancy, C (r012) 2009; 47
Iavazzo, C, Gkegkes, ID, Zarkada, IM, Falagas, ME (r004) 2011; 20
Valdes-Dapena, MA, Arey, JB (r005) 1962; 61
Lappin, E, Ferguson, AJ (r002) 2009; 9
Webb, DV, Stowman, AM, Patterson, JW (r007) 2013; 40
Wong, LC, Heimbach, MD, Truscott, DR, Duncan, BD (r009) 1964; 90
Litovitz, TL, Klein-Schwartz, W, Oderda, GM, Schmitz, BF (r006) 1988; 6
Higny, J, Vanpee, D, Boulouffe, C (r011) 2014; 69
Corradi, F, Brusasco, C, Palermo, S, Belvederi, G (r003) 2010; 17
Schillinger, BM, Berstein, M, Goldberg, LA, Shalita, AR (r013) 1982; 7
e_1_3_4_3_2
e_1_3_4_2_2
e_1_3_4_9_2
e_1_3_4_8_2
e_1_3_4_7_2
e_1_3_4_6_2
e_1_3_4_5_2
e_1_3_4_4_2
e_1_3_4_11_2
e_1_3_4_12_2
e_1_3_4_15_2
Wong LC (e_1_3_4_10_2) 1964; 90
e_1_3_4_13_2
e_1_3_4_14_2
References_xml – volume: 69
  start-page: 299
  year: 2014
  end-page: 301
  ident: r011
  article-title: Bluish vomiting: a rare clinical presentation of poisoning.
  publication-title: Acta Clin Belg
– volume: 9
  start-page: 281
  year: 2009
  end-page: 290
  ident: r002
  article-title: Gram-positive toxic shock syndromes.
  publication-title: Lancet Infect Dis
– volume: 186
  start-page: 1169
  year: 1963
  end-page: 1170
  ident: r010
  article-title: The lethality of boric acid in the treatment of burns.
  publication-title: JAMA
– volume: 17
  start-page: 48
  year: 2010
  end-page: 51
  ident: r003
  article-title: A case report of massive acute boric acid poisoning.
  publication-title: Eur J Emerg Med
– volume: 40
  start-page: 962
  year: 2013
  end-page: 965
  ident: r007
  article-title: Boric acid ingestion clinically mimicking toxic epidermal necrolysis.
  publication-title: J Cutan Pathol
– volume: 47
  start-page: 432
  year: 2009
  end-page: 432
  ident: r012
  article-title: “Boiled lobster” rash of acute boric acid toxicity.
  publication-title: Clin Toxicol (Phila)
– volume: 7
  start-page: 667
  year: 1982
  end-page: 673
  ident: r013
  article-title: Boric acid poisoning.
  publication-title: J Am Acad Dermatol
– volume: 315
  start-page: 775
  year: 2016
  end-page: 787
  ident: r001
  article-title: Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
  publication-title: JAMA
– volume: 90
  start-page: 1018
  year: 1964
  end-page: 1023
  ident: r009
  article-title: Boric acid poisoning: report of 11 cases.
  publication-title: Can Med Assoc J
– volume: 20
  start-page: 1245
  year: 2011
  end-page: 1255
  ident: r004
  article-title: Boric acid for recurrent vulvovaginal candidiasis: the clinical evidence.
  publication-title: J Womens Health (Larchmt)
– volume: 61
  start-page: 531
  year: 1962
  end-page: 546
  ident: r005
  article-title: Boric acid poisoning: three fatal cases with pancreatic inclusions and a review of the literature.
  publication-title: J Pediatr
– volume: 15
  start-page: 287
  year: 1992
  end-page: 294
  ident: r014
  article-title: Clinical management of boric acid ingestion: pharmacokinetic assessment of efficacy of hemodialysis for treatment of acute boric acid poisoning.
  publication-title: J Pharmacobiodyn
– volume: 6
  start-page: 209
  year: 1988
  end-page: 213
  ident: r006
  article-title: Clinical manifestations of toxicity in a series of 784 boric acid ingestions.
  publication-title: Am J Emerg Med
– volume: 75
  start-page: 720
  year: 1957
  end-page: 728
  ident: r008
  article-title: Boric acid poisoning: a report of fatal adult case from cutaneous use: a critical evaluation of the use of this drug in dermatologic practice.
  publication-title: AMA Arch Derm
– ident: e_1_3_4_4_2
  doi: 10.1097/MEJ.0b013e32832d8516
– ident: e_1_3_4_2_2
  doi: 10.1001/jama.2016.0289
– ident: e_1_3_4_6_2
  doi: 10.1016/S0022-3476(62)80144-9
– ident: e_1_3_4_9_2
  doi: 10.1001/archderm.1957.01550170088015
– ident: e_1_3_4_11_2
  doi: 10.1001/jama.1963.63710130013022
– ident: e_1_3_4_13_2
  doi: 10.1080/15563650902948859
– ident: e_1_3_4_14_2
  doi: 10.1016/S0190-9622(82)70149-5
– ident: e_1_3_4_15_2
  doi: 10.1248/bpb1978.15.287
– ident: e_1_3_4_8_2
  doi: 10.1111/cup.12205
– volume: 90
  start-page: 1018
  year: 1964
  ident: e_1_3_4_10_2
  article-title: Boric acid poisoning: report of 11 cases.
  publication-title: Can Med Assoc J
– ident: e_1_3_4_5_2
  doi: 10.1089/jwh.2010.2708
– ident: e_1_3_4_7_2
  doi: 10.1016/0735-6757(88)90001-0
– ident: e_1_3_4_12_2
  doi: 10.1179/2295333714Y.0000000033
– ident: e_1_3_4_3_2
  doi: 10.1016/S1473-3099(09)70066-0
SSID ssj0000149
Score 2.3360252
Snippet A 70-year-old man presented to the emergency department after an episode of altered mental status. Two days before presentation, he began having increased...
SourceID proquest
crossref
mms
SourceType Aggregation Database
Enrichment Source
Index Database
Publisher
StartPage 970
SubjectTerms Abdomen
Anaphylaxis
Beta blockers
Cardiac arrhythmia
Case reports
Consciousness
Creatinine
Edema
Emergency medical care
Fainting
Hydronephrosis
Hyperplasia
Hypotension
Infections
Insect bites
Lungs
Poisoning
Sepsis
Sugarcane
Typhus
Urine
Urogenital system
Title A Curve Ball
URI https://nejm.org/doi/full/10.1056/NEJMcps1910306
https://www.proquest.com/docview/2439675057
https://www.proquest.com/docview/2439977277
Volume 383
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV1La8JAEF6qQimF0ie1tTaFQk_BPPaVU1FRpKCUYsFb2OehaLRG-_u7Gze2UuwllwyBzG5mvpnZfB8Aj0msTbEjmE8oS3xINfK5psKqpkpIDUIWof1ReDjCg3f4MkET13DL3bHKMiYWgVrOhe2RtyKTOQ24NfDiefHpW9UoO111EhoVULPUZfZIF5mQX_RRDv66DlJJ2ohwyyrNi0VuqhULmneSUmU2y_9E5iLd9E_BicOJXnuzsGfgQGXn4HDoJuEX4LjtddfLL-V12HR6Ccb93rg78J2ygS_iOFz5IVNBIjTlXMckMN7iGiKqJcHMQCzEIJVESBRyLDgRgQoolFgEHDFt6gMZX4FqNs_UNfCgcTEKJccBI1CGlCeKYkwkRBEkOlR14JdvlgrH-m3FJ6ZpMX1GON31RB08be0XG76LvZb3xlFppj5mey0apRNT92Xk6c861sHD9rbZ03ZQwTI1X29sDC6NCLn5_xG34Ciy9a8d8MQNUF0t1-rOgIQVbxY7wVxpN2yCWqc3en37BoZEt7Q
linkProvider ProQuest
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1LSyNBEC5ihFWEZXdVjI_NCIqnwXn0KwdZ1FXimgSRCN6Gfh4kmUSTKP4o_6PVyYxrWNyb5y6a7urqrq-6uusD2GukDoMdLUMuZCMkwtFQOaE9a6ohAhGyjv1H4XaHNW_In1t6W4GX8i-Mf1ZZnonTg9oMtL8jP0zQcyK4RXjxa3gfetYon10tKTRmZnFpn58wZBsdXfzG9d1PkvOz7mkzLFgFQp2m8TiMpY0a2gmlXMojHKlyhApnOJMIb6gkwnBtaKyYVlxHNhLEMB0pKh1ic5NitwuwSFKMZKqweHLWubp-V6-qwNvFlVVZJZKyQ09tr4cjDI88Sp_zggv9_ugfVzD1b-ff4GsBTIPjmSV9h4rNf8CXdpF6X4WV4-B08vBogxPZ661B9zMmvQ7VfJDbDQgIrimNjWKR5MTEQjWsYIwbQhPCXWxrEJYzy3RRZtyzXfSyabqbsmxeEzU4eJMfzgpsfChZR0Vlub3rfyixXSoxK7biKPtrODXYfWvGTeQzIzK3g8lMBoFwwvnm_7uow1Kz225lrYvO5RYsJz749tmldBuq44eJ3UGEMlY_C7sIIPtkS3wFZqT0UA
linkToPdf http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3JSgNBEC1cQEQQV4xGHUHxNGSW3nIQiUtwx4NCbkOvB0km0SSKn-bfWZ3MuCB68zxFM139qutVV3cVwG49dRjsaBlyIeshEY6Gygntu6YaIpAh69g_FL6-YWf35KJFWxPwVr6F8dcqyz1xtFGbrvZn5LUEPSeSW6QXNVdci7g9aR72HkPfQcpnWst2GmOIXNrXFwzf-gfnJ7jWe0nSPL07PguLDgOhTtN4EMbSRnXthFIu5RH-tXKECmc4k0h1qCTCcG1orJhWXEc2EsQwHSkqHfJ0k-KwkzDNUxp7E-Mt_qVyVcG8i8Orsl4kZTXf5F73-hgoeb7-zR9Odjr9H05h5OmaCzBfUNSgMcbUIkzYfAlmrosk_DLMNYLj4dOzDY5ku70Cd_8x5VWYyru5XYOA4OrS2CgWSU5MLFTdCsa4ITQh3MW2AmE5s0wXBcd934t2Nkp8U5Z910QF9j_ke-NSG79KbqOistw-dH6VqJZKzAqj7GefEKrAzsdnNCefI5G57Q7HMkiJE87X_x5iG2YQf9nV-c3lBswmPgr3aaa0ClODp6HdRKoyUFsjUASQ_TMI3wFo8_cg
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=A+Curve+Ball&rft.jtitle=The+New+England+journal+of+medicine&rft.au=Mukaigawara%2C+Mitsuru&rft.au=Manesh%2C+Reza&rft.au=Kinjo%2C+Mitsuyo&rft.au=Sugita%2C+Shuichi&rft.date=2020-09-03&rft.issn=1533-4406&rft.eissn=1533-4406&rft.volume=383&rft.issue=10&rft.spage=970&rft_id=info:doi/10.1056%2FNEJMcps1910306&rft.externalDBID=NO_FULL_TEXT
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0028-4793&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0028-4793&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0028-4793&client=summon