Dan and Pat react to Week 7's NFL action and recap each Sunday afternoon game! Sponsors: TickPick - TickPick, the original no-fee ticket site, is teaming up with ZIP, the buy now, pay later service provider, to give away five huge season ticket packages for the 2022 season! You can try your luck today and enter to win by going to TICKPICK.COM/PROS. Jock Market - The app where daily fantasy becomes a stock exchange. Buy and sell shares of players in real time, for real money. Download Jock Market in the App or Play Stores, or check out Jockmkt.com and use code "PROS" for a 100% deposit match up to $50 on your first deposit. Pristine Auction - Get the best deals in sports memorabilia including signed helmets and custom jerseys with guaranteed authenticity. Enter registration code "FantasyPros" when you sign up to receive a free $5 credit. Timestamps: Trust or Bust - 0:02:18 I'm Confused By Your Opinion, Sir - 0:07:09 Marquise Brown - 0:09:19 KC vs. TEN - 0:12:21 WAS vs. GB - 0:19:22 CIN vs. BAL - 0:26:48 CAR vs. NYG - 0:36:26 ATL vs. MIA - 0:41:21 NYJ vs. NE - 0:47:52 PHI vs. LV - 0:51:16 DET vs. LAR - 0:55:34 CHI vs. TB - 1:01:18 HOU vs. ARI - 1:04:44
Dan is joined once again by Dr. David Chao (ProFootballDoc.com) to tackle the most pressing injury questions for Week 7. Later, Dan and Yates preview every single game taking place this week! Sponsors: PrizePicks - Turn your picks into real cash with PrizePicks! Use our Promo Code “GRIDIRON” to receive a 100% instant deposit match up to $100. Magic Spoon - Magic Spoon offers tasty, healthy cereal that cuts down on sugar and carbs. Go to magicspoon.com/fantasypros to grab a variety pack and try it today! And be sure to use our promo code FANTASYPROS at checkout to get $5 off. Timestamps: Injury Analysis - 0:00:21 Baker Mayfield - 0:00:54 Alex Collins - 0:01:53 Tyreek Hill - 0:02:58 Antonio Gibson - 0:04:19 Julio Jones - 0:05:47 Dak Prescott - 0:07:04 Dan & Kyle in the Morning - 0:09:08 Over/Under Challenge - 0:11:20 DEN vs. CLE - 0:14:35 D'Ernest Johnson - 0:14:35 Odell Beckham - 0:17:26 Javonte Williams/Melvin Gordon - 0:21:09 Tim Patrick - 0:22:22 KC vs. TEN - 0:24:53 Mecole Hardman - 0:26:08 Julio Jones - 0:27:30 TEN WRs - 0:28:18 Ryan Tannehill - 0:28:44 WAS vs. GB - 0:29:18 A.J. Dillon - 0:29:42 Terry McLaurin - 0:31:18 J.D. McKissic - 0:31:59 Jaret Patterson - 0:32:57 CIN vs. BAL - 0:34:14 Joe Burrow - 0:34:19 Tee Higgins/Tyler Boyd - 0:35:06 Marquise Brown/Rashod Bateman - 0:35:58 Devonta Freeman - 0:37:03 CAR vs. NYG - 0:40:11 Devontae Booker - 0:40:15 Sterling Shepard - 0:41:14 Darius Slayton - 0:41:56 Chuba Hubbard - 0:42:24 Sam Darnold - 0:43:13 Robby Anderson - 0:43:39 ATL vs. MIA - 0:44:20 Myles Gaskin - 0:45:01 Matt Ryan - 0:45:46 NYJ vs. NE - 0:46:57 Jakobi Meyers - 0:47:01 Rhamondre Stevenson - 0:48:05 Corey Davis - 0:49:18 Michael Carter - 0:51:14 PHI vs. LV - 0:52:01 Jalen Hurts - 0:52:19 Kenyan Drake - 0:53:38 Hunter Renfrow/Henry Ruggs - 0:54:07 DET vs. LAR - 0:54:53 Jamaal Williams - 0:55:09 Amon-Ra St. Brown - 0:55:51 Sony Michel - 0:57:05 Tyler Higbee - 0:58:11 CHI vs. TB - 0:58:52 Damien Williams/Khalil Herbert - 0:58:52 Cole Kmet - 1:00:20 TB WRs - 1:00:47 HOU vs. ARI - 1:02:44 Mark Ingram - 1:02:57 James Conner - 1:03:38 ARI WRs - 1:04:18 IND vs. SF - 1:05:27 T.Y Hilton/Michael Pittman - 1:05:27 Elijah Mitchell - 1:06:37 Ross Dwelley - 1:07:38 NO vs. SEA - 1:08:11 Alex Collins - 1:08:11 Rashaad Penny - 1:09:51 Marquez Callaway - 1:10:42 Jameis Winston - 1:11:20
Awesemo's team of NFL daily fantasy football experts have everything you need to prepare you to make the most out of your NFL DFS lineups. Today, Dave "Loughy" Loughran and Matt Savoca will host the Week 7 NFL Daily Fantasy Strategy Show, identifying the best matchups of the week. The guys will break down the daily fantasy slates on DraftKings and FanDuel, analyze pricing and find the best picks for your daily fantasy football lineups.The NBA is Back! Celebrate with 50% off your first week of Awesemo+ Platinum with promo code ‘CURRY' http://awese.moe/CurryGet up to a $100 First Match Deposit Bonus with PrizePicks when you use Promo Code ‘AWESEMO' http://awesome.moe/PrizePicksFollow @AwesemoNFL on Twitter here: http://awese.moe/AwesemoNFL
En este mensaje tratamos el siguiente caso de una mujer que «descargó su conciencia» de manera anónima en nuestro sitio www.conciencia.net, autorizándonos a que la citáramos: «Hace unos meses me mudé a otro país para vivir con mi papá. Tengo veintidós años, y mis padres se divorciaron hace veinte años.... »Mi papá ya hizo su vida con otra mujer, pero aun así sigue odiando a mi mamá. Desde que me mudé a la casa de él... se ha puesto muy violento. No me ha llegado a pegar, porque mi madrastra ha intervenido; pero me ha dicho que, si él quiere, así como me dio la vida me la puede quitar.... »Él me dice que soy una manipuladora y mentirosa como mi mamá, y esto me está afectando mucho porque ya ni siquiera sé quién soy. »Sé que debo honrar a mi padre, pero lo único que quiero es regresar a mi casa... porque le tengo miedo.» Este es el consejo que le dio mi esposa: «Estimada amiga: »Nos conmueve su caso, y sentimos mucho lo que ha sufrido. Sin embargo, ¡le tenemos buenas noticias! Usted debe hacer exactamente lo que dice que quiere hacer, que es regresar a casa. Le instamos a que lo haga de inmediato, alejándose de su padre abusivo lo más pronto posible. »Lo más prudente es que haga los planes para el viaje, pero que luego espere hasta el momento de partir para contárselo a su padre.... Si usted cree que su madrastra es digna de confianza, puede pedirle a ella que la ayude a hacer los arreglos en secreto. »Usted está confundida en cuanto al verdadero sentido de honrar. Es cierto que los Diez Mandamientos dicen que debemos honrar a nuestros padres,1 pero honrar nunca quiere decir que debemos tranquilamente ser el objeto de abuso físico y emocional. Debido al deseo que tiene de hacer lo correcto, usted se ha expuesto a un grave peligro. »Jesucristo afirmó que el mandamiento más importante es que amemos a Dios con todo nuestro corazón, todo nuestro ser y toda nuestra mente. Pero Cristo luego dijo que el segundo mandamiento en importancia es que amemos al prójimo como a nosotros mismos....2 ¿Quiere eso decir que debemos permitir que nos robe toda la comida de la mesa en que cenamos como familia cada noche? ¡Claro que no! Nuestro prójimo tiene la responsabilidad de proveer para su propia familia y de abstenerse de robar la comida nuestra. El amor no requiere que permitamos que se nos maltrate. »Así mismo, el honrar a su padre no requiere que usted permita que él la maltrate. Le recomendamos que lea el Caso 518 en www.conciencia.net a fin de considerar más a fondo el significado de honrar durante las diversas etapas de la vida. »Ni el amor ni la honra requieren que dejemos que la maldad forme parte de nuestra vida. Su padre no tiene derecho alguno de quitarle a usted la vida, y en definitiva no debe usted quedarse en ningún lugar donde corra peligro de que eso suceda.» Con eso termina lo que Linda, mi esposa, recomienda en este caso. El caso completo, que por falta de espacio no pudimos incluir en esta edición, puede leerse con sólo pulsar la pestaña en www.conciencia.net que dice: «Casos», y luego buscar el Caso 665. Carlos ReyUn Mensaje a la Concienciawww.conciencia.net 1 Éx 20:12; Dt 5:16; Mt 15:4; 19:19; Lc 18:20; Ef 6:2 2 Lv 19:18; Mt 22:35-39
Thank you for 24k streams! For this episode we got our girls Aileen and Melissa and it is a horny one! We talk about Aileen's time as a dancer, her premium snapchat days (which was *chef kiss*) and Melissa tells us about her two boys story. Catch the full video action on my OnlyFans and follow me on social media @ AaronScene! Onlyfans.com/aaronscene
Dan and Pat react to Week 6's NFL action and recap each Sunday morning and afternoon game! Sponsors: PrizePicks - Turn your picks into real cash with PrizePicks! Use our Promo Code “GRIDIRON” to receive a 100% instant deposit match up to $100. Kraken - If you're interested in investing in cryptocurrencies but aren't sure where to get started, check out the Kraken app. Visit kraken.com/fantasypros now to learn more or search for "Kraken" in the app store. Timestamps: Trust or Bust - 0:02:07 I Am Confused By Your Opinion, Sir - 0:05:55 MIA vs. JAC - 0:10:48 GB vs. CHI - 0:16:08 CIN vs. DET - 0:25:17 HOU vs. IND - 0:31:52 LAR vs. NYG - 0:34:31 KC vs. WAS - 0:39:54 MIN vs. CAR - 0:45:34 LAC vs. BAL - 0:49:13 ARI vs. CLE - 0:52:49 LV vs. DEN - 0:58:24 DAL vs. NE - 1:02:56
Mike and LV back together again, we have not left you! We talk why we have been too busy to pod ( work work work), why Mike is an annoying boss,partying with Ballers, and GRUDEN. *Also please utilize the leave a message function down below we would really love to do an episode of listener questions / comments and our responses. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/stircrazypod/message Support this podcast: https://anchor.fm/stircrazypod/support
Lecturas: Isaías 53, 10-11 Salmo 33:4-5,18-20,22 Hebreos 4, 14-16 Marcos 10, 35-45 En el Evangelio que se nos presenta hoy, los hijos de Zebedeo no saben lo que están pidiendo. Su forma de pensar evoca el modo en que los gentiles gobiernan, con privilegios reales y honores. Pero el camino al reino de Cristo es por la vía de su cruz. Para compartir su gloria, hemos de estar dispuestos a tomar de la copa de la que El bebe. La copa (o “cáliz”) es una imagen que, en el Antiguo Testamento, se refiere al juicio de Dios. Los malvados tendrían que tomar de ella en castigo por sus pecados (cfr. Sal 75, 9; Jer 25, 15.28; Is 51.17). Pero Jesús ha venido a tomar esta copa en favor de toda la humanidad. Ha venido a ser bautizado—es decir, decir meterse o sumergirse—en los sufrimientos que hemos merecido por nuestros pecados (cfr. Lc 12, 50). De este modo cumplirá la misión prefigurada por el Siervo Sufriente de Isaías, de quien leemos en la primera lectura de este domingo. Como el Siervo de Isaías, el Hijo de Hombre dará su vida en ofrenda por el pecado, así como los sacerdotes de Israel ofrecieron sacrificios por los pecados del pueblo (Lv 5, 17-19). Jesus es el Sumo Sacerdote celestial de toda la humanidad, como dice en la epístola de este domingo. Los Sumos Sacerdotes de Israel ofrecieron la sangre de cabritos y terneros en el santuario del Templo. Pero Jesús entró en el santuario del cielo con su propia Sangre (cfr. Hb 9, 12). Y al cargar con nuestra culpa y ofrecer su vida para cumplir la voluntad de Dios, Jesús rescato “a muchos”, pagando el precio de la redención de la humanidad, liberándola de la esclavitud espiritual del pecado y a la muerte. El nos ha librado de la muerte, como decimos con gozo en el salmo de hoy. Debemos permanecer firmes en la profesión de nuestra fe, como nos exhorta la epístola de esta misa. Hemos de ver nuestras pruebas y sufrimientos como la parte que nos toca de la copa que Cristo prometió a los que creen en Él (cfr. Col 1, 24). Tenemos que recordar que hemos sido bautizados en su Pasión y Muerte (cfr. Ro 6, 3).
Dan is joined once again by Dr. David Chao (ProFootballDoc.com) to tackle the most pressing injury questions for Week 6. Later, Dan and Yates preview every single game taking place this week! Sponsors: Underdog Fantasy - Underdog Fantasy is the best and easiest place to play fantasy football for big cash prizes. Go to underdogfantasy.com, the app store, or the Google Play store, sign up with the code FANTASYPROS, and get a free $25 in bonus cash. Manscaped - Manscaped is #1 in men's below the belt grooming. They offer precision engineered tools for your family jewels. Get 20% off and free shipping with the code YATES at Manscaped.com. AirMedCare - If a medical emergency arises, AirMedCare Network provides members with world class emergency air transport services to the nearest hospital with NO out of pocket expenses. Visit airmedcarenetwork.com/fantasypros and use offer code FANTASYPROS to get up to a $50 Visa or Amazon gift card with a new membership. Timestamps: Injury Analysis - 0:00:22 Dalvin Cook - 0:01:29 Christian McCaffrey - 0:02:24 Nick Chubb - 0:04:54 Saquon Barkley - 0:06:31 Ezekiel Elliott - 0:07:49 Tyreek Hill - 0:09:12 Damien Harris - 0:10:32 Terry McLaurin - 0:11:50 Dan & Kyle in the Morning - 0:14:34 Over/Under Challenge - 0:16:13 Justin Herbert - 0:16:33 Nick Chubb - 0:17:44 Kadarius Toney - 0:18:24 Marquise Brown - 0:19:29 TB vs. PHI - 0:21:00 Leonard Fournette - 0:21:00 TB WRs - 0:23:06 O.J. Howard/Cameron Brate - 0:24:59 Jalen Hurts - 0:25:44 Miles Sanders - 0:28:01 DeVonta Smith - 0:28:46 MIA vs. JAC - 0:30:22 Marvin Jones/Laviska Shenault - 0:30:32 Dan Arnold - 0:32:59 Jaylen Waddle - 0:34:27 Mike Gesicki - 0:35:52 GB vs. CHI - 0:36:25 Aaron Rodgers - 0:36:25 A.J. Dillon - 0:37:02 Khalil Herbert - 0:37:46 Allen Robinson/Darnell Mooney - 0:38:34 CIN vs. DET - 0:41:10 Joe Mixon - 0:41:20 CIN WRs - 0:41:59 Jamaal Williams - 0:42:50 Amon-Ra St. Brown - 0:43:47 HOU vs. IND - 0:44:26 Michael Pittman - 0:44:28 Carson Wentz - 0:45:10 Brandin Cooks - 0:46:03 LAR vs. NYG - 0:46:49 Devontae Booker - 0:47:17 Kadarius Toney - 0:47:56 Sony Michel - 0:49:35 KC vs. WAS - 0:50:32 Ricky Seals-Jones - 0:50:58 Mecole Hardman - 0:51:41 MIN vs. CAR - 0:53:49 Adam Thielen - 0:54:34 Chuba Hubbard - 0:55:53 LAC vs. BAL - 0:56:41 Latavius Murray/Ty'Son Williams - 0:57:48 ARI vs. CLE - 0:58:22 Demetric Felton - 0:58:22 Odell Beckham - 0:59:14 David Njoku - 0:59:49 Chase Edmonds/James Conner - 1:00:37 ARI WRs - 1:01:13 LV vs. DEN - 1:02:17 Melvin Gordon/Javonte Williams - 1:02:17 Courtland Sutton - 1:03:03 Henry Ruggs - 1:03:56 DAL vs. NE - 1:04:56 Tony Pollard - 1:05:00 Dalton Schultz - 1:05:38 Rhamondre Stevenson - 1:06:33 Hunter Henry - 1:07:20 SEA vs. PIT - 1:07:53 SEA RBs - 1:08:41 Tyler Lockett - 1:09:37 Gerald Everett - 1:10:20 BUF vs. TEN - 1:11:00 A.J. Brown/Julio Jones - 1:11:00 Ryan Tannehill - 1:11:34 Stefon Diggs - 1:13:43 Emmanuel Sanders - 1:14:28 Dawson Knox - 1:14:47 Zack Moss/Devin Singletary - 1:15:17 Cole Beasley - 1:15:42
Welcome in thank you for making that call, on this episode I Recap the Bucs and Eagles game. Finish up my Starters for week 2 KC vs WAS, ARI vs CLE, LV vs DEN, DAL vs NE, SEA vs PIT and BUF vs TEN --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
LAUDES JUEVES DE LA XXVIII SEMANA DE ORDINARIO (Oración de la mañana) - lV semana del Salterio INVOCACIÓN INICIAL V. Señor abre mis labios R. Y mi boca proclamará tu alabanza INVITATORIO Ant. Entrad en la presencia del Señor con aclamaciones. SALMODIA Salmo 142 - Ant. En la mañana, Señor, hazme escuchar tu gracia. Cántico - Ant. El Señor hara derivar hacia Jerusalén como un rio la paz. Salmo 146 - Ant. Nuestro Dios merece una alabanza armoniosa. CÁNTICO EVANGÉLICO Ant. Anuncia, Señor, la salvación a tu pueblo y perdonanosnuestros pecados. Cántico de Zacarías. EL MESÍAS Y SU PRECURSOR Lc 1, 68-79 Bendito sea el Señor, Dios de Israel, porque ha visitado y redimido a su pueblo. suscitándonos una fuerza de salvación en la casa de David, su siervo, según lo había predicho desde antiguo por boca de sus santos profetas: Es la salvación que nos libra de nuestros enemigos y de la mano de todos los que nos odian; ha realizado así la misericordia que tuvo con nuestros padres, recordando su santa alianza y el juramento que juró a nuestro padre Abraham. Para concedernos que, libres de temor, arrancados de la mano de los enemigos, le sirvamos con santidad y justicia, en su presencia, todos nuestros días. Y a ti, niño, te llamarán Profeta del Altísimo, porque irás delante del Señor a preparar sus caminos, anunciando a su pueblo la salvación, el perdón de sus pecados. Por la entrañable misericordia de nuestro Dios, nos visitará el sol que nace de lo alto, para iluminar a los que viven en tiniebla y en sombra de muerte, para guiar nuestros pasos por el camino de la paz. Gloria al Padre, y al Hijo, y al Espíritu Santo. Como era en el principio, ahora y siempre, por los siglos de los siglos. Amén. PRECES “Tú, que eres nuestra vida, escuchanos, Señor.” Conclusion V. El Señor nos bendiga, nos guarde de todo mal y nos lleve a la vida eterna. R. Amén. (812)
Andy and Drew go through the slate game by game and give you their thoughts, analysis for each game and which bets they're making for the NFL slate. Welcome :34 TB at PHI 4:30 MIA vs JAX 10:41 HOU at IND 17:44 GB at CHI 23:09 KC at WFT 30:43 MIN at CAR 41:53 LAC at BAL 49:48 CIN at DET 59:12 LAR at NYG 1:05:40 ARI at CLE 1:09:48 LV at DEN 1:13:31 DAL at NE 1:20:25 SEA at PIT 1:22:50
Welcome to episode 63! For this After Party we got our guy Dom the Cincinnati DJ Whore himself and we talk about his life and time in El Paso and on Cinci Street, his little love triangle and he tells about his most embarrassing sex story. Plus Sabring joins us and takes off some clothes for the vibes. Catch the full video on my OnlyFans and follow me on social media @ AaronScene! Onlyfans.com/aaronscene
LAUDES MIERCOLES DE LA XXVIII SEMANA DE ORDINARIO (Oración de la mañana) - lV semana del Salterio INVOCACIÓN INICIAL V. Señor abre mis labios R. Y mi boca proclamará tu alabanza INVITATORIO Ant. Aclama al Señor, tierra entera, servid al Señor con alegría. SALMODIA Salmo 107 - Ant. Mi corazón está firme, Dios mío, mi corazón está firme. Cántico - Ant. El Señor me ha revestido de justicia y santidad. Salmo 145 - Ant. Alabare al Señor mientras viva. CÁNTICO EVANGÉLICO Ant. Sirvamos al Señor con santidad todos nuestros días. Cántico de Zacarías. EL MESÍAS Y SU PRECURSOR Lc 1, 68-79 Bendito sea el Señor, Dios de Israel, porque ha visitado y redimido a su pueblo. suscitándonos una fuerza de salvación en la casa de David, su siervo, según lo había predicho desde antiguo por boca de sus santos profetas: Es la salvación que nos libra de nuestros enemigos y de la mano de todos los que nos odian; ha realizado así la misericordia que tuvo con nuestros padres, recordando su santa alianza y el juramento que juró a nuestro padre Abraham. Para concedernos que, libres de temor, arrancados de la mano de los enemigos, le sirvamos con santidad y justicia, en su presencia, todos nuestros días. Y a ti, niño, te llamarán Profeta del Altísimo, porque irás delante del Señor a preparar sus caminos, anunciando a su pueblo la salvación, el perdón de sus pecados. Por la entrañable misericordia de nuestro Dios, nos visitará el sol que nace de lo alto, para iluminar a los que viven en tiniebla y en sombra de muerte, para guiar nuestros pasos por el camino de la paz. Gloria al Padre, y al Hijo, y al Espíritu Santo. Como era en el principio, ahora y siempre, por los siglos de los siglos. Amén. PRECES “Rey de la gloria, escuchanos.” Conclusion V. El Señor nos bendiga, nos guarde de todo mal y nos lleve a la vida eterna. R. Amén. (810)
LAUDES MARTES DE LA Xll SEMANA DE ORDINARIO (Oración de la mañana) - lV semana del Salterio INVOCACIÓN INICIAL V. Señor abre mis labios R. Y mi boca proclamará tu alabanza INVITATORIO Ant. Al Señor, al Dios grandre, venid, adoremosle . SALMODIA Salmo 100 - Ant. Para ti es mi musica, Seño; voy a explicar el camino perfecto. Cántico - Ant. No nos desampares, Señor, para siempre. Salmo 143 - Ant. Te cantaré, Dios mío, un cantico nuevo. CÁNTICO EVANGÉLICO Ant. Bendito sea el Señor, Dios deIsrael, porqueha visitado y redimido a su pueblo. Cántico de Zacarías. EL MESÍAS Y SU PRECURSOR Lc 1, 68-79 Bendito sea el Señor, Dios de Israel, porque ha visitado y redimido a su pueblo. suscitándonos una fuerza de salvación en la casa de David, su siervo, según lo había predicho desde antiguo por boca de sus santos profetas: Es la salvación que nos libra de nuestros enemigos y de la mano de todos los que nos odian; ha realizado así la misericordia que tuvo con nuestros padres, recordando su santa alianza y el juramento que juró a nuestro padre Abraham. Para concedernos que, libres de temor, arrancados de la mano de los enemigos, le sirvamos con santidad y justicia, en su presencia, todos nuestros días. Y a ti, niño, te llamarán Profeta del Altísimo, porque irás delante del Señor a preparar sus caminos, anunciando a su pueblo la salvación, el perdón de sus pecados. Por la entrañable misericordia de nuestro Dios, nos visitará el sol que nace de lo alto, para iluminar a los que viven en tiniebla y en sombra de muerte, para guiar nuestros pasos por el camino de la paz. Gloria al Padre, y al Hijo, y al Espíritu Santo. Como era en el principio, ahora y siempre, por los siglos de los siglos. Amén. PRECES “Por el honor de tu nombre, Escuchanos, Señor.” Conclusion V. El Señor nos bendiga, nos guarde de todo mal y nos lleve a la vida eterna. R. Amén. (808)
Please join author Milton Packer and Associate Editor Justin Ezekowitz as they discuss the Perspective "Heart Failure and a Preserved Ejection Fraction: A Side-by-Side Examination of the PARAGON-HF and EMPEROR-Preserved Trials." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the Journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, it really is so great to be back with you chatting about the papers here in the Journal. Thank you for going solo and for just being the greatest partner on earth. Thank you for that. For everyone listening in, we are back with some gusto and especially with this feature discussion today. You are not going to want to miss it. We are talking to Dr. Milton Packer as well as Dr. Justin Ezekowitz. We are going to compare PARAGON and EMPEROR-Preserved trials in heart failure with preserved ejection fraction. A really interesting discussion you're not going to want to miss, but now let's start with some papers in today's issue. I'd like to start, please. Dr. Greg Hundley: You bet. Dr. Carolyn Lam: Greg, you know the optimal duration of antiplatelet therapy in patients with high bleeding risk with or without oral anticoagulation after coronary stenting? Well, that still remains a question. Today's paper is a pre-specified subgroup analysis of the MASTER DAPT trial and reports on the outcomes of patients with or without an oral anticoagulation indication in this study. Dr. Greg Hundley: Right, Carolyn. Remind us. What was the MASTER DAPT trial? What did it test? Dr. Carolyn Lam: Ah. MASTER DAPT investigated an abbreviated or one-month versus a non-abbreviated or three to 12-month dual antiplatelet therapy and a stopping of antiplatelet therapy at six months strategy after coronary stenting in an all-comer population at high bleeding risk. Dr. Greg Hundley: Carolyn, what did this subgroup analysis of outcomes in patients with and without oral anticoagulation show? Dr. Carolyn Lam: At 12 months of follow-up, ischemic and net risk did not differ with abbreviated versus non-abbreviated anti-platelet regimens in both subgroups, although significantly fewer clinically relevant bleeding events occurred in the group without an oral anticoagulation indication. Whereas only numerically fewer bleeding events occurred in the group with an oral anticoagulation indication that did not reach statistical significance. This subgroup analysis from the MASTER DAPT trial really adds additional evidence that dual antiplatelet therapy beyond one month in patients with or without an indication for oral anticoagulation really has no benefit and only increases bleeding risk. Dr. Greg Hundley: Oh, very important finding, Carolyn. Great research. Well, Carolyn, how the extracellular matrix microenvironment modulates the contractile phenotype of vascular smooth muscle cells and confers vascular homeostasis really remains elusive. Thus, these investigators led by Professor Wei Kong at Peking University applied protein-protein interaction network analysis to explore novel extracellular matrix proteins associated with the vascular smooth muscle cell phenotype. Dr. Carolyn Lam: Huh. Interesting. What did they find, Greg? Dr. Greg Hundley: Right, Carolyn. By combining an in-vitro and an in-vivo genetic mice vascular injury model, they identified nidogen-2, a basement membrane glycoprotein, as a key extracellular matrix protein for maintenance of vascular smooth muscle cell identity. Nidogen-2 exerted its protective function via direct interaction and modulation of Jagged1-Notch3 signaling. Dr. Carolyn Lam: Wow! Nidogen-2 and Jagged1-Notch3. I always learn so much. What are the clinical implications, Greg? Dr. Greg Hundley: Right, Carolyn. Perhaps targeting nidogen-2 to precisely modulate Jagged1-Notch3 signaling, well, that may provide novel therapeutic strategy for atherosclerosis and post-injury restenosis. Dr. Carolyn Lam: Very nice. Well, in the next paper, we discuss inflammation in heart failure. We know that inflammation contributes to the pathogenesis of heart failure, but there is limited understanding of inflammation's potential benefits. Interesting, huh? Well, these authors, Dr. Wollert and colleagues from Hannover Medical School in Germany, identified an adaptive crosstalk between inflammatory cells and cardiomyocytes that protects against persistent afterload stress-induced heart failure in mice. Monocytes and macrophages produced myeloid-derived growth factor in the pressure overloaded myocardium to augment SERCA2a expression in cardiomyocyte's calcium cycling and contractility. Myeloid-derived growth factor plasma concentrations were also found to be elevated in patients with aortic stenosis and to decline after aortic valve implantation indicating that pressure overload also triggers myeloid-derived growth factor release in humans. Dr. Greg Hundley: Carolyn, really informative preclinical science, but what are the clinical implications? Dr. Carolyn Lam: Ah. These observations molecularly defined a feature of the inflammatory response to hemodynamic overload that protects against heart failure development. Inflammation's beneficial trade therefore need to be considered when developing inflammation as a therapeutic target in heart failure. All of this is really discussed in a lovely editorial entitled Inflammation and Heart Failure: Friend or Foe? That's by Drs. Hajjar and Leopold. Dr. Greg Hundley: Great job, Carolyn. Well, my next paper focuses on resistant hypertension. Carolyn, although lifestyle modifications generally are effective in lowering blood pressure among patients with unmedicated hypertension or those treated with one to two antihypertensive agents, the value of exercise and diet for lowering blood pressure in patients with resistant hypertension is unknown. To address this, Professor James Blumenthal and co-authors at Duke University Medical Center enrolled 140 patients with resistant hypertension with an average age of 63 years, 48% women, 59% black, 31% diabetes, and 21% with chronic kidney disease and randomly assigned them to A, a four-month cardiac rehab center-based program of lifestyle modification. We're going to call that C-LIFE, consisting of dietary counseling, behavior and weight management, and exercise. Or number 2 or the B, a single counseling session providing standardized education and physician advice. We'll call that SEPA. Dr. Greg Hundley: The primary endpoint was clinic measured systolic blood pressure. Secondary endpoints included 24-hour ambulatory blood pressure and selective cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of baroreflex on heart rate; high-frequency heart rate variability to assess vagally-mediated modulation of heart rate; flow-mediated dilation to evaluate endothelial function; and pulse wave velocity to assess arterial stiffness; and then finally left ventricular mass to characterize left ventricular structure and remodeling. Dr. Carolyn Lam: Wow! That is a very, first of all, important clinical question. Then also, just very intricate methodology in assessing this. What did they find? Dr. Greg Hundley: Right, Carolyn. Between-group comparisons revealed that the reduction in clinic systolic blood pressure was greater in C-LIFE compared with SEPA. Next, 24-hour ambulatory systolic blood pressure also was reduced in C-LIFE with no change in SEPA. Then next, compared with SEPA, C-LIFE resulted in greater improvements in baroreflex sensitivity, high-frequency heart rate variability, and flow-mediated dilation. There was no between-group differences in pulse wave velocity or LV mass. Dr. Greg Hundley: Carolyn, diet and exercise can lower blood pressure in patients with resistant hypertension. When delivered in a cardiac rehabilitation setting, a four-month program of diet and exercise as adjunctive therapy, results in a significant reduction in clinic and ambulatory blood pressure, and improvement in selected cardiovascular disease biomarkers. Dr. Carolyn Lam: Wow! Really nice, Greg. Okay. Well, looks like we're all going to round up already with what else there is in today's issue. Let me start. There's an exchange of letters between Drs. Fang and Vinceti regarding the article Blood Pressure Effects on Sodium Reduction: Dose-Response Meta-analysis of Experimental Studies. Dr. Greg Hundley: Right, Carolyn. I've got a few things in the mail bag. First, Professor Anker has a Research Letter regarding the Kidney Function After Initiation and Discontinuation of Empagliflozin in Heart Failure Patients With and Without Type 2 Diabetes: Insights From the EMPERIAL Trials. Dr. Gerstenfeld has an ECG challenge entitled Atrioventricular Block with Narrow and Wide QRS: The Pause That Refreshes. Then lastly, Dr. Donald Lloyd-Jones has an AHA update regarding the American Heart Association's focus on primordial prevention. Well, Carolyn, I can't wait to hear this fantastic feature discussion with you and Dr. Packer. How about we jump to that? Dr. Carolyn Lam: Great. Let's go, Greg. Dr. Carolyn Lam: Because side-by-side exam of PARAGON and EMPEROR is like side-by-side of... Dr. Justin Ezekowitz: You can compare our new and our old prime minister much like your paper did. Dr. Milton Packer: Yeah, yeah. Dr. Justin Ezekowitz: There are [crosstalk] and it could be viewed until they perform in the broader world how it goes. You don't quite know. Dr. Milton Packer: The only problem is you can't do a head-to-head comparison of the old prime minister and the new prime minister. Dr. Justin Ezekowitz: That is true except that the head-to-head comparison includes excellent care by both the new and the old. I think that comparison's going to be pretty equal. I think we can case-control that one. Dr. Carolyn Lam: I really liked that that was politically correct because we are recording. Everybody, welcome to the feature discussion. I am here with Dr. Milton Packer from Baylor and he really needs no introduction. We're discussing heart failure with preserved ejection fraction. As well as our associate editor, Dr. Justin Ezekowitz from University of Alberta. Hence, in case anybody's wondering, we were talking about the Canadian elections. Let's just launch straight into it, a side-by-side comparison of PARAGON and EMPEROR-Preserved. Dr. Packer... Milton, if I may, what in the world drove you to do this? Dr. Milton Packer: My God. Oh, my God. Yes. Dr. Carolyn Lam: Tell us about what drove you to do this and please, if you could just summarize the results. Dr. Milton Packer: Well, let me just say from the outset that this was a commentary, not an original research article. Dr. Carolyn Lam: Yes. Dr. Milton Packer: The commentary was motivated by two very straightforward observations. We had two large scale outcome trials of two different drugs in heart failure with a preserved ejection fraction. I was privileged to serve as you were, Carolyn, on the leadership committees of both trials. It's not as if we have involvement in only one trial. We have involvement in both trials and we are very proud of that involvement. Dr. Milton Packer: One trial came in with a effect size of about 13% on its primary endpoint with a borderline P-value. A second trial, EMPEROR-Preserved, came in with a 21% reduction and its primary endpoint with a really small and persuasive P-value. The two patient populations in the two trials were really amazingly similar. We wanted to understand why it was 21% in one trial and persuasively so and why it appeared to be smaller in the PARAGON trial with sacubitril/valsartan. We thought, well, maybe that difference was related to how endpoints were defined or maybe that difference was related to the influence of ejection fraction. The reason we got excited about that was that as almost everyone knows, PARAGON found an influence of ejection fraction on the effect of sacubitril/valsartan in patients with HFpEF. We found an influence of ejection fraction on the effect of empagliflozin in HFpEF in EMPEROR-Preserved. We wanted to understand whether that influence was similar in the two trials. Dr. Milton Packer: Just to make life simple, PARAGON had created certain cut points for ejection fraction. They had presented and previously published in Circulation endpoints based on those cut points of ejection fraction. All we did was we used their endpoints and their cut points, and we put the two trials side by side. We did not do a statistical comparison of the effect size. There're actually no P-values in the whole commentary. But what we wanted to see was: Was the shape of the ejection fraction influence relationship similar or different in the two trials? Well, very simple. In PARAGON, as has been reported, there was a linear relationship: as ejection fraction increased, the effect of sacubitril/valsartan got smaller. In EMPEROR-Preserved, there was also an attenuation at a highest ejection fraction, but the relationship wasn't linear. It was like a hockey stick. It was flat and then went up at an ejection fraction over 62.5, which was the cut point that PARAGON used. Dr. Milton Packer: When we compared patients between the low 40s and the low 60s, the effect size in empagliflozin appeared to be larger than the effect size of sacubitril/valsartan in that ejection fraction group using the same endpoints. In fact, for hospitalizations for heart failure, which is really what SGLT2 inhibitors do, it was twice as great with empagliflozin in EMPEROR-Preserved than with sacubitril/valsartan in PARAGON-HF. We thought this was really interesting. We put the pictures up side by side. We wrote a commentary and Circulation was so kind to accept it. Dr. Carolyn Lam: Oh, but Milton, you were very, honestly as always, very clever to have done this analysis. But if I could reiterate a few things for the audience, which is very important. First of all, as you rightly first pointed out, it's a perspective piece. It is not a head-on comparison with P-values. It could not be. Let's just also give the audience a bit of background in that PARAGON included patients with an ejection fraction of 45% and above. EMPEROR-Preserved was above 40. PARAGON looked at total heart failure hospitalizations and cardiovascular death as a primary outcome. EMPEROR looked at first cardiovascular death or heart failure hospitalization. Dr. Carolyn Lam: Let's just remember the designs were different. Of course in the comparison, PARAGON compared sacubitril/valsartan versus valsartan. I like the way you very carefully wrote in your study that it was more a study of neprilysin inhibition since it's sacubitril/valsartan against valsartan and it was empagliflozin versus placebo. We know that it's important to state that as a basis. Then really important to say to everybody out there, pick up our journal. You must look at this bigger. I myself have already cited it at least twice already, Milton, because people will just naturally ask that. "Are the results different because of ejection fraction or different endpoints?" What you did there in that beautiful figure is that you tried as best as you can to match it up in terms of ejection fraction bins and match it up in terms of hospitalizations. There. I just wanted to state those few things, but I'm really- Dr. Milton Packer: Oh, no. No. Carolyn, you're 100% right. That's why there are couple of things. I just want to underscore what you said because I think your points were spot on. First of all, we really lined up the endpoints and the ejection fraction. We tried our best to compare apples and apples. It would not have been a useful exercise for us to compare different endpoints and different ejection fraction subgroups. But I just want to make sure that everyone understands: I'm a big fan of sacubitril/valsartan and I'm a big fan of neprilysin inhibition. As you know, both PARADIGM-HF and PARAGON-HF weren't really tests of sacubitril/valsartan; they were tests of neprilysin inhibition. They were great tests at that. PARAGON in particular was a great test of that. We're comparing neprilysin inhibition and SGLT2 inhibition. Dr. Milton Packer: But here's my most important point: we do not want people to choose one over the other. That was not the intent. We think that there are data in patients with certain ejection fractions, let's say between 40 and 60, I'm just creating a range, where both interventions are appropriate. Now I understand there are cost considerations and I don't want to minimize that, but we are not suggesting that anyone prefer one drug over the other. All we wanted to do was we wanted to ask the question: Since the effect size in one trial seemed to be different than the effect size in the other trial, what were the ejection fraction subgroups that represented that difference? We found that the patients with ejection fractions greater than 60, 65% did not contribute to that difference. It was the patients with lower ejection fractions that contributed to the difference. I hope that's helpful. Dr. Carolyn Lam: Ah. That's wonderful. Justin, have you recovered from the talk about the Canadian elections? Dr. Justin Ezekowitz: Oh. I have indeed. Dr. Carolyn Lam: I'm on swinging. Dr. Justin Ezekowitz: I have indeed. Thanks for recognizing that Canada just had a major election we carried out in six weeks. But, Milton, I really enjoyed reading this. Maybe I can just ask you about two elements within this perspective piece, which is number 1, what's incredibly concordant is a lack of difference across cardiovascular death for both agents in both trials regardless of the trial differences and the potential differences in patient populations recruited; that's number 1. It's incredibly flat for cardiovascular death. Dr. Justin Ezekowitz: But number 2 is there is a danger in comparing trials even non-statistically. That's often a pitfall we get into, but we have to put some frame of reference on that. What is the one or two key things you think differ between PARAGON and EMPEROR-Preserved that you say, "You really need to look at these trials differently"? Those two questions came to mind when looking at this great figure that you produced. Dr. Milton Packer: Okay. The first question is so much easier and that is that these drugs don't reduce cardiovascular deaths. Full stop. It's really interesting because sacubitril/valsartan reduces cardiovascular death in people with ejection fractions of 40% or less, but not in patients with ejection fraction greater than that. The primary effect is heart failure hospitalizations. Empagliflozin didn't reduce cardiovascular death even in patients with the ejection fraction less than 40% or greater than 40%. What we're really, really talking about two drugs where the major effect is a reduction in heart failure hospitalizations. That comes out whether you do the analysis as time-to-first-event or total heart failure hospitalizations. Dr. Milton Packer: Of course, we're looking forward to the DELIVER trial with dapagliflozin. My own personal expectation is they're going to come out with a very striking effect on heart failure hospitalizations and not on cardiovascular deaths. Cardiovascular deaths in patients with HFpEF is really... It's a hard goal because only half of the deaths are cardiovascular. These patients have so many comorbidities that influence prognosis. The other thing, which is really important, is that heart failure hospitalizations only represented 18% of all hospitalizations in these patients; it's really small. I think of empagliflozin as being a treatment of the heart failure of HFpEF, not a treatment for HFpEF. I hope that makes sense. Justin, what was your second question? Dr. Justin Ezekowitz: Absolutely. Dr. Milton Packer: Oh, the differences between- Dr. Justin Ezekowitz: Yeah. Thank you, Milton. Dr. Milton Packer: Okay. There's always differences between two trials. As I said before, Carol and I were involved in both trials. They were done slightly at different times. They didn't overlap. Remember that the cut points in the two trials, one was 40%, one was 45%, really didn't matter to our analysis because we corrected for that in our ejection fraction subgroups. I was actually really much more impressed by the similarities than by the differences, but here's the catch. HFpEF is an incredibly heterogeneous disease. When we look at baseline characteristics, we're looking at means, medians, percentages. We're not picking up on any heterogeneity and there's a lot of heterogeneity. I actually think that HFrEF is a reasonably homogeneous disease. I think HFpEF is an incredibly diverse disease with a whole host of different disorders. What I'm amazed by is that we actually got an effect size that was greater than 20% in an all-comers HFpEF analysis. Dr. Milton Packer: But in all honesty, Justin, it wasn't really all-comers. We excluded people with BMIs over 45. There are a lot of patients who are obese and had BMIs greater than 45 who have HFpEF. By the way, especially in Texas. I didn't say that. We didn't enroll those patients. In all honesty, if I had to do it all over again, I would have. By the way, PARAGON didn't enroll them either. Dr. Carolyn Lam: Well, this is an incredible conversation. I know that we could just do a whole hour of chatting about what this implies for the higher ejection fraction, what this implies for how we should be treating heart failure. I don't even dare to ask for some last words maybe from both Justin and Milton, but recognizing that the time is short, anything else to add? Dr. Milton Packer: I think Justin should do last words. Dr. Justin Ezekowitz: Well, let me summarize by saying there is a hockey stick. We love hockey sticks in Canada. A simple and an excellent comparison. I think people should really look at that figure to understand it, but do not undertreat your patients with HFpEF and look at these with a grain of salt. Thanks for joining us, Milton. Thanks, Carolyn. Dr. Milton Packer: Thank you so much. Dr. Carolyn Lam: On behalf of Greg and I, you've been listening to Circulation on the Run. Thank you so much for joining us today and don't forget to tune in again next week. Dr. Greg Hundley: This program is copyright of the American Heart Association 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors, or of the American Heart Association. For more, visit ahajournals.org.
LAUDES LUNES DE LA XXVIII SEMANA DE ORDINARIO (Oración de la mañana) - lV semana del Salterio INVOCACIÓN INICIAL V. Señor abre mis labios R. Y mi boca proclamará tu alabanza INVITATORIO Ant. Demos Vitores al Señor, aclamandolo con cantos. SALMODIA Salmo 89 - Ant. Por la mañana, sacianos de tu misericordia. Cántico - Ant. Llegue la alabanza del Señor hasta eñ confin de la tierra. Salmo 134 - Ant. Alabad el nombre del Señor, los que estais en casa del Señor. CÁNTICO EVANGÉLICO Ant. Bendito sea el Señor, Dios deIsrael, porqueha visitado y redimido a su pueblo. Cántico de Zacarías. EL MESÍAS Y SU PRECURSOR Lc 1, 68-79 Bendito sea el Señor, Dios de Israel, porque ha visitado y redimido a su pueblo. suscitándonos una fuerza de salvación en la casa de David, su siervo, según lo había predicho desde antiguo por boca de sus santos profetas: Es la salvación que nos libra de nuestros enemigos y de la mano de todos los que nos odian; ha realizado así la misericordia que tuvo con nuestros padres, recordando su santa alianza y el juramento que juró a nuestro padre Abraham. Para concedernos que, libres de temor, arrancados de la mano de los enemigos, le sirvamos con santidad y justicia, en su presencia, todos nuestros días. Y a ti, niño, te llamarán Profeta del Altísimo, porque irás delante del Señor a preparar sus caminos, anunciando a su pueblo la salvación, el perdón de sus pecados. Por la entrañable misericordia de nuestro Dios, nos visitará el sol que nace de lo alto, para iluminar a los que viven en tiniebla y en sombra de muerte, para guiar nuestros pasos por el camino de la paz. Gloria al Padre, y al Hijo, y al Espíritu Santo. Como era en el principio, ahora y siempre, por los siglos de los siglos. Amén. PRECES “Escuchanos, Señor.” Conclusion V. El Señor nos bendiga, nos guarde de todo mal y nos lleve a la vida eterna. R. Amén. (806)
Joe and Pat react to Week 5's NFL action and recap each Sunday afternoon game! Sponsors: Jock Market - The app where daily fantasy becomes a stock exchange. Buy and sell shares of players in real time, for real money. Download Jock Market in the App or Play Stores, or check out Jockmkt.com and use code "PROS" for a 100% deposit match up to $50 on your first deposit. Pristine Auction - Get the best deals in sports memorabilia including signed helmets and custom jerseys with guaranteed authenticity. Enter registration code "FantasyPros" when you sign up to receive a free $5 credit. Timestamps: Trust or Bust - 0:03:47 Matchup Recaps - 0:09:30 NYJ vs. ATL - 0:09:30 GB vs. CIN - 0:13:59 DET vs. MIN - 0:19:17 DEN vs. PIT - 0:23:31 MIA vs. TB - 0:28:43 NO vs. WAS - 0:36:13 PHI vs. CAR - 0:40:18 TEN vs. JAC - 0:45:45 NE vs. HOU - 0:51:39 CHI vs. LV - 0:56:27 CLE vs. LAC - 1:00:16 NYG vs. DAL - 1:06:53 SF vs. ARI - 1:13:42 Biggest Takeaway - 1:18:47
Dan is joined once again by Dr. David Chao (ProFootballDoc.com) to tackle the most pressing injury questions for Week 5. Later, Dan and Yates preview every single game taking place this week! Sponsors: Bachan's - It's still grilling season and the ideal time to check out Bachan's. Bring your family and friends together with delicious, rich flavor. Go to bachans.com/fantasypros and use the code “FantasyPros” at checkout for 20% off. Magic Spoon - Magic Spoon offers tasty, healthy cereal that cuts down on sugar and carbs. Go to magicspoon.com/fantasypros to grab a variety pack and try it today! And be sure to use our promo code FANTASYPROS at checkout to get $5 off. PrizePicks - Turn your picks into real cash with PrizePicks! Use our Promo Code “GRIDIRON” to receive a 100% instant deposit match up to $100. Timestamps: Injury Analysis - 0:00:21 Russell Wilson - 0:01:09 Christian McCaffrey - 0:03:46 Joe Mixon - 0:06:52 Baker Mayfield - 0:07:48 Dalvin Cook - 0:09:51 A.J. Brown - 0:10:41 Jimmy Garoppolo - 0:12:14 Dan & Kyle in the Morning - 0:14:37 Over/Under Challenge - 0:16:44 Jalen Hurts - 0:17:05 Chuba Hubbard - 0:18:19 Allen Robinson - 0:18:58 TNF Recap - 0:20:30 LAR vs. SEA - 0:20:30 Robert Woods - 0:21:05 Darrell Henderson - 0:22:26 Sony Michel - 0:23:33 Tyler Higbee - 0:23:59 Russell Wilson - 0:25:16 D.K. Metcalf/Tyler Lockett - 0:25:52 Alex Collins - 0:26:55 NYJ vs. ATL - 0:29:59 Kyle Pitts - 0:29:59 Corey Davis - 0:32:24 Jamison Crowder - 0:33:09 Michael Carter - 0:33:41 NE vs. HOU - 0:33:59 Jakobi Meyers - 0:34:12 Hunter Henry - 0:35:00 D'Andre Swift/Jamaal Williams - 0:35:56 Kirk Cousins - 0:37:17 PHI vs. CAR - 0:39:51 Chuba Hubbard - 0:39:51 Sam Darnold - 0:40:26 Robby Anderson - 0:41:04 DeVonta Smith - 0:42:05 Dallas Goedert/Zach Ertz - 0:42:34 NO vs. WAS - 0:43:16 Antonio Gibson - 0:43:16 NO WRs - 0:44:36 TEN vs. JAC - 0:44:56 Ryan Tannehill - 0:45:15 Marvin Jones/Laviska Shenault - 0:46:32 MIA vs. TB - 0:47:29 MIA RBs - 0:47:29 Jaylen Waddle/DeVante Parker - 0:47:57 TB WRs - 0:48:53 Tom Brady - 0:50:12 Leonard Fournette - 0:51:13 GB vs. CIN - 0:53:18 Aaron Rodgers - 0:53:18 Robert Tonyan - 0:54:15 Samaje Perine - 0:54:47 CIN WRs - 0:56:00 Melvin Gordon/Javonte Williams - 0:56:27 Courtland Sutton/Tim Patrick - 0:57:48 Najee Harris - 1:00:00 CHI vs. LV - 1:02:44 Darnell Mooney/Allen Robinson - 1:03:15 Henry Ruggs - 1:04:00 Hunter Renfrow - 1:04:38 CLE vs. LAC - 1:05:57 Odell Beckham - 1:06:45 Nick Chubb - 1:07:40 Mike Williams - 1:08:21 Jared Cook - 1:09:28 NYG vs. DAL - 1:10:06 CeeDee Lamb - 1:10:08 Dalton Schultz - 1:11:04 Kenny Golladay - 1:12:04 Kadarius Toney - 1:12:42 Daniel Jones - 1:13:29 SF vs. ARI - 1:13:58 DeAndre Hopkins - 1:14:01 A.J. Green - 1:14:46 James Conner/Chase Edmonds - 1:15:35 Elijah Mitchell/Trey Sermon - 1:16:47 BUF vs. KC - 1:18:00 Emmanuel Sanders - 1:18:07 Dawson Knox - 1:18:45 Cole Beasley - 1:19:39 Josh Gordon - 1:20:30 IND vs. BAL - 1:20:49 Michael Pittman - 1:20:54 Marquise Brown - 1:21:48 Ty'Son Williams/Latavius Murray - 1:22:40
Thanks for making that call! I have Week 5 starters part 2 for you starting with the Saints and Washington, CHI vs LV, CLE vs LAC, SF vs ARI, NYG vs DAL, BUF vs KC and IND vs BAL. Be sure to follow me on Twitter @thedynasty411 Hit me up with any questions you might have I'm happy to help.
CardioNerds (Amit Goyal and Daniel Ambinder), join Dr. Anjali Wagle (Internal medicine resident, Johns Hopkins Hospital) and Dr. Nick Smith (Cardiology fellow, Johns Hopkins Hospital) for an important discussion involving a patient with non-ischemic dilated cardiomyopathy and biventricular heart failure who had developed diuretic resistance. They discuss the role for invasive hemodynamic assessment of volume overload, initial strategies in managing a patient with volume overload, the role of guideline directed therapy in the management of patients with recurrent volume overload, and advanced strategies for diuretic resistance. Dr. Nisha Gilotra (Director of the Cardiac Sarcoidosis Program and assistant professor of medicine, Johns Hopkins Hospital) provides the E-CPR for this episode. Audio editing and Approach to Diuretic Resistance infographic by Dr. Gurleen Kaur (Director of the CardioNerds Internship). This episode is made possible with support from Panacea Financial. Panacea Financial is a national digital bank built for doctors by doctors. Visit panaceafinancial.com today to open your free account and join the growing community of physicians nationwide who expect more from their bank. Panacea Financial is a division of Primis, member FDIC. Claim free CME just for enjoying this episode! Disclosures: NoneJump to: Patient summary - Case teaching - References CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Patient Summary - Diuretic Resistance A young woman in her 20s with non-ischemic dilated cardiomyopathy and NYHA class IV ACC stage D biventricular heart failure with an LV ejection fraction of 30-35% on palliative inotropic therapy complicated by cardiogenic cirrhosis and stage IIIb chronic kidney disease presented with acute decompensated heart failure with volume overload. During her hospitalization she exhibited profound signs of diuretic resistance with minimal improvement after increasing inotropes, increasing IV loop diuretics, adding IV thiazides, and trialing continuous IV furosemide. She was given high dose mineralocorticoids, IV acetazolamide, and hypertonic saline paired with IV furosemide and had a durable treatment response. Episode Teaching - Diuretic Resistance Pearls - Diuretic Resistance Diuretic resistance is a complex clinical problem defined as inadequate natriuresis despite an adequate diuretic regimen. However, the practitioner cannot overlook low output heart failure and/or insufficient renal perfusion as the causes for inadequate diuretic response. In cases of inadequate urine output due to low cardiac output, increased inotropic or mechanical support would be the first objective.Confirming adequate cardiac output to support renal perfusion and/or confirming high filling pressures may require invasive hemodynamic assessment.Sodium avidity is most effectively blunted by treating the patient with maximally tolerated guideline directed therapy. This includes but is not limited to a backbone of ARNI (or ACE or ARB), mineralocorticoid receptor antagonists, beta-blockers, and SGLT-2 inhibitors.In cases of advanced diuretic resistance, hypertonic saline paired with high dose IV furosemide can be an effective strategy.In cases of diuretic resistance combined with cirrhosis and heart failure there is a synergistic hyperaldosteronism that can be targeted with higher doses of mineralocorticoid receptors as is seen in the treatment of cirrhosis with ascites. Notes - Diuretic Resistance 1. What is the role for invasive hemodynamic assessment in acute decompensated heart failure? Cases where intracardiac filling pressures are in question: right heart catheterization (RHC) can give insight into the presence and degree of right versus left sided filling pressures.
After a very successful week 4 we are back for another week of NFL action. This week there is some exciting news about a new podcast name. With a new name you still get the same great content as we dive into every game with another heated debated, our favorite bets, and longshots. Of course, all this after a brief recap of week 4 and our heroes and zeros of the week. Come join the action for another winning week in the NFL season!Show NotesNEW NAME 0:00Week 4 Recap 2:00LAR vs SEA 13:25NYJ vs ATL 19:50GB vs CIN 24:00TEN vs JAX 28:00MIA vs TB 33:00NE vs HOU 37:30PHI vs CAR 41:10DET vs MIN 46:30DEN vs PIT 49:30NO vs WAS 53:20CHI vs LV 57:45Debate of the week - CLE vs LAC 1:01:00NYG vs DAL 1:08:30SF vs ARZ 1:14:00BUF vs KC 1:17:30IND vs BAL 1:20:45Long Shots 1:23:45Favorite Bets of the Week 1:25:00Parlays 1:26:20YouTube Link ⬇️ https://youtu.be/ff3sbuN6_50
Dan is joined once again by Dr. David Chao (ProFootballDoc.com) to tackle the most pressing injury questions for Week 4. Later, Dan and Yates preview every single game taking place this week! Sponsors: TickPick - TickPick, the original no-fee ticket site, is teaming up with ZIP, the buy now, pay later service provider, to give away five huge season ticket packages for the 2022 season! You can try your luck today and enter to win by going to TICKPICK.COM/PROS. Pristine Auction - Get the best deals in sports memorabilia including signed helmets and custom jerseys with guaranteed authenticity. Enter registration code "FantasyPros" when you sign up to receive a free $5 credit. AirMedCare - If a medical emergency arises, AirMedCare Network provides members with world class emergency air transport services to the nearest hospital with NO out of pocket expenses. Visit airmedcarenetwork.com/fantasypros and use offer code FANTASYPROS to get up to a $50 Visa or Amazon gift card with a new membership. Timestamps: Injury Analysis - 0:00:18 Dalvin Cook - 0:00:46 Chase Claypool - 0:01:35 Tyler Lockett - 0:03:42 Darrell Henderson - 0:04:45 A.J. Brown/Julio Jones - 0:05:48 Joe Mixon - 0:06:45 Christian McCaffrey - 0:08:05 Dan & Kyle in the Morning - 0:10:23 Over/Under Challenge - 0:11:49 JAC vs. CIN - 0:14:49 Joe Mixon - 0:14:56 CIN WRs - 0:17:19 Laviska Shenault - 0:17:49 James Robinson - 0:19:02 WAS vs. ATL - 0:21:20 Antonio Gibson - 0:21:20 Cordarelle Patterson - 0:22:28 Calvin Ridley - 0:23:23 Mike Davis - 0:23:50 HOU vs. BUF - 0:24:17 Zack Moss - 0:24:30 Emmanuel Sanders/Cole Beasley/Gabriel Davis - 0:25:07 Dawson Knox - 0:26:11 Brandin Cooks - 0:26:52 DET vs. CHI - 0:27:37 Justin Fields - 0:27:37 Allen Robinson/Darnell Mooney - 0:28:22 Jamaal Williams/T.J. Hockenson/D'Andre Swift - 0:29:37 CAR vs. DAL - 0:30:55 Tony Pollard - 0:31:07 Dalton Schultz/Blake Jarwin - 0:31:56 Chuba Hubbard - 0:33:11 Robby Anderson - 0:33:56 Sam Darnold - 0:35:01 IND vs. MIA - 0:37:29 Jonathan Taylor - 0:37:29 Nyheim Hines - 0:38:39 Jaylen Waddle - 0:39:49 Robert Tonyan - 0:40:48 CLE vs. MIN - 0:41:14 Odell Beckham, Jr. - 0:41:30 Tyler Conklin - 0:43:12 NYG vs. NO - 0:45:09 Alvin Kamara/Marquez Callaway - 0:45:15 Kenny Golladay - 0:46:08 TEN vs. NYJ - 0:48:01 Ryan Tannehill - 0:48:04 Corey Davis - 0:49:14 KC vs. PHI - 0:49:51 Mecole Hardman - 0:50:10 Jalen Hurts - 0:50:55 DeVonta Smith - 0:51:57 ARI vs. LAR - 0:52:39 Chase Edmonds/James Conner - 0:52:46 DeAndre Hopkins - 0:53:24 Christian Kirk/Rondale Moore - 0:53:52 Cooper Kupp - 0:54:59 Robert Woods - 0:55:50 Darrell Henderson - 0:56:52 SEA vs. SF - 0:58:05 Tyler Lockett - 0:58:09 D'Wayne Eskridge - 0:58:49 BAL vs. DEN - 1:00:31 Marquise Brown - 1:00:40 Ty'Son Williams - 1:02:08 Courtland Sutton/Tim Patrick - 1:03:53 PIT vs. GB - 1:04:49 Chase Claypool/JuJu Smith-Schuster - 1:05:08 Najee Harris - 1:05:42 TB vs. NE - 1:06:53 Damien Harris - 1:06:56 Ronald Jones/Leonard Fournette - 1:08:28 LV vs. LAC - 1:09:28 Jared Cook - 1:10:03 Derek Carr - 1:10:29 Henry Ruggs - 1:11:15