Podcasts about The New England Journal of Medicine

Ingrid og Jørgen har vært på vift til nordisk infeksjonskonferanse i København - gled deg til en potpurri av info om endokardittbehandling, staph aureus-bakteriemi, fecal mikrobiotatransplantasjon og veldig mye annet!Ordforklaring: FMT = fekal mikrobiotatransplantasjon. S.aureus = gule stafylokker (bakterie). Bakteriemi = bakterier i blodbanen. Sputum/ekspektorat = slim fra nedre luftveier. Nasofarynx = området mellom svelg og nese (øvre luftveier) der mange luftveisprøver tas fra. PCR = polymerase chain reaction, analysemetode.Referanser: 1. Kibsgaard HL, Mathisen M, Kofstad T, Heggelund L, Muller KE. Microbiological sampling in lower respiratory tract infections: comparing nasopharyngeal and sputum specimens. Infect Dis (Lond). 2026:1-11.2. Bundgaard H, Pries-Heje M, Hjulmand J, Hasselbalch R, Jorgensen PG, Fano S, et al. Response-Tailored or Standard-Duration Antibiotic Treatment for Infective Endocarditis. N Engl J Med. 2026.3. Bier N, Hanson B, Jiang ZD, DuPont HL, Arias CA, Miller WR. A Case of Successful Treatment of Recurrent Urinary Tract Infection by Extended-Spectrum beta-Lactamase Producing Klebsiella pneumoniae Using Oral Lyophilized Fecal Microbiota Transplant. Microb Drug Resist. 2023;29(1):34-8.4. Lemiengre MB, van Driel ML, Merenstein D, Liira H, Makela M, De Sutter AI. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2018;9(9):CD006089.5. Venekamp RP, Sanders SL, Glasziou PP, Rovers MM. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2023;11(11):CD000219.6. Lemaignen A, Bernard L, Tattevin P, Bru JP, Duval X, Hoen B, et al. Oral switch versus standard intravenous antibiotic therapy in left-sided endocarditis due to susceptible staphylococci, streptococci or enterococci (RODEO): a protocol for two open-label randomised controlled trials. BMJ Open. 2020;10(7):e033540.7. Burdet C, Saidani N, Dupieux C, Lemaignen A, Canoui E, Surgers L, et al. Cloxacillin versus cefazolin for meticillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa): a prospective, open-label, multicentre, non-inferiority, randomised clinical trial. Lancet. 2025;406(10517):2349-59.8. Azoulay E, Russell L, Van de Louw A, Metaxa V, Bauer P, Povoa P, et al. Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med. 2020;46(2):298-314. Hosted on Acast. See acast.com/privacy for more information.

This week, we feature new research on statin therapy in older adults, treatments for IgG4-related disease and advanced breast cancer, and a once-weekly oral regimen for HIV. We review Andes virus and follow a challenging case of a disseminated infection. Articles explore scientific independence, opioid-settlement funds, pharmaceutical policy, and the role of community in patient care.

Luister naar de De VVE Podcast. Een initiatief van de Nederlandse Vereniging voor epidemiologie. Hierin voeren Dr. Bart Torensma, Dr. Marissa van Maaren en Dr. Sander van Kuijk tal van gesprekken met aansprekende wetenschappers over boeiende thema's in de wonderlijke wereld van de epidemiologie. Bedoeld als intellectuele verdieping en stapsteen in de VVE-ambitie om de epidemiologische gemeenschap verder met elkaar te verbinden. In deze aflevering #11: Prof. dr. Kit C.B. Roes: Professor of Biostatistics, Radboud University Medical Center: IQ Health Wie bewaakt een klinische trial terwijl die nog loopt? Dat is het werk van de Data Safety Monitoring Board: een onafhankelijke commissie die tussentijds meekijkt naar veiligheid, effect en datakwaliteit, en adviseert of de studie door kan, aangepast moet worden of moet stoppen.Klinkt overzichtelijk, maar de praktijk is dat zelden. Wat als de data iets laten zien waar niemand op rekende? Hoe communiceer je met een sponsor zonder die te ontblinden? En wanneer wint klinisch oordeel het van een statistische stopregel?In deze aflevering duiken we in de wereld van DSMB's: hoe ze werken, waar het misgaat en wat je vooraf moet regelen om ze hun werk goed te laten doen.Boek: Data Monitoring Committees in Clinical Trials: A Practical PerspectiveAuthor(s):Susan S. Ellenberg, Thomas R. Fleming, David L. DeMets. Print ISBN:9781119512653 |Online ISBN:9781119512684 |DOI:10.1002/9781119512684Artikelen:1. DeMets DL, Ellenberg SS. Data Monitoring Committees — Expect the Unexpected. N Engl J Med.2016;375(14):1365-1371. DOI: 10.1056/NEJMra1510066Auteurs: David L. DeMets (Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison) en Susan S. Ellenberg (Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine). Onderdeel van de NEJM-serie "The Changing Face of Clinical Trials". Gepubliceerd 6 oktober 2016.2. Cartwright MJ, Friede T, Lawrence D, May E, Mütze T, Roes K. Stakeholders' Perspectives on Current Issues in Data Monitoring Committees. Biometrical Journal. 2024;66(7):e202300384. DOI: 10.1002/bimj.202300384Auteurs: Michael J. Cartwright (Parexel International, Sheffield, UK), Tim Friede (University Medical Center Göttingen / DZHK), David Lawrence en Tobias Mütze (Novartis Pharma AG, Basel), Emma May (ICON PLC / BioNTech SE), Kit Roes (Radboudumc, Nijmegen). Open access (Creative Commons).3. DAMOCLES Study Group. A proposed charter for clinical trial data monitoring committees: helping them to do their job well. Lancet. 2005;365(9460):711-722. DOI: 10.1016/S0140-6736(05)17965-3Corresponderend auteur: Prof. Marion K. Campbell (Health Services Research Unit, University of Aberdeen). Groepsleden: A.M. Grant, D.G. Altman, A.G. Babiker, M.K. Campbell, F. Clemens, J.H. Darbyshire, D.R. Elbourne, S.K. McLeer, M.K.B. Parmar, S.J. Pocock, D.J. Spiegelhalter, M.R. Sydes, A.E. Walker, S.A. Wallace. Gefinancierd door het UK NHS Health Technology Assessment Programme. Gepubliceerd 19 februari 2005.

*JOIN THE PHYSIONIC INSIDERS [PREMIUM CONTENT]*Join the Physionic Insiders: https://bit.ly/PhysionicInsiders2 *HEALTH AUTONOMY [COURSE]*Learn to Analyze & Apply Studies for Yourself: https://bit.ly/healthautonomy*JOIN THE COMMUNITY*Join my Community [It's Free!]: https://bit.ly/PhysionicCommunity2*EMAIL LIST*1-2 Weekly Email of Value [It's Free!]: http://bit.ly/2AXIzK6*HIRE ME FOR CONSULTING:* Consulting: https://bit.ly/3dmUl2H Created with Biorender0:00 - Introduction2:13 - Blood Cholesterol is not Important13:08 - Something else matters WAY more than Blood Cholesterol16:45 - Main PointsReferences[Funding/Conflicts are provided in the free article (found in the email list and Physionic Community Article Library)][1] Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association's PREVENT equations. Circulation. 2024;149:430–449. doi:10.1161/CIRCULATIONAHA.123.067626.[2] Dugani SB, Moorthy MV, Li C, et al. Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident coronary heart disease in women. JAMA Cardiol. 2021;6(4):437–447. doi:10.1001/jamacardio.2020.7073.[3] Magnussen C, Alegre-Diaz J, Al-Nasser LA, et al. Global effect of cardiovascular risk factors on lifetime estimates. N Engl J Med. 2025;393(2):125–138. doi:10.1056/NEJMoa2415879.[4] Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153:e1154–e1276. doi:10.1161/CIR.0000000000001423.[5] Cannon CP, Blazing MA, Giugliano RP, et al; IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372(25):2387–2397. doi:10.1056/NEJMoa1410489.[6] Nordestgaard BG, Langlois MR, Langsted A, et al. Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM. Atherosclerosis. 2020;294:46–61. doi:10.1016/j.atherosclerosis.2019.12.005.[7] Prospective Studies Collaboration, Lewington S, Whitlock G, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007;370(9602):1829–1839. doi:10.1016/S0140-6736(07)61778-4.[8] Johannesen CDL, Langsted A, Mortensen MB, Nordestgaard BG. Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study. BMJ. 2020;371:m4266. doi:10.1136/bmj.m4266.Please use the following link to submit your critique: https://bit.ly/PhysionicCritiqueDisclaimer: None of the information provided by this brand is a replacement for your physician's advice. This brand is information for the sake of knowledge and the options of choice it provides, not in any way a personalized prescription. Please consult your physician before making any health related changes.

Dr. Justin Abbatemarco and Dr. Irene Cortese discuss recent advances in the treatment of progressive multifocal leukoencephalopathy (PML), focusing on immune-based therapies like virus-specific T cells and immune checkpoint inhibitors.  Show citation:  Gonzalez CE, Fletcher A, Jenkins TL, et al. Resolution of PML after Treatment with Virus-Specific T Cells and HCT. N Engl J Med. 2026;394(20):2061-2064. doi:10.1056/NEJMc2514186 

This week, we feature new research on anticoagulation for atrial fibrillation, treatment for narcolepsy, and gene and cell therapies for multiple myeloma and Wiskott–Aldrich syndrome. We review the clinical use of common genetic variants and follow a case of a young child with fatigue and frequent falls. Perspectives explore access to sickle cell therapies, child health, and biomedical science.

Recorded on-site at ESC Congress 2026 in Munich, Stephen Greene, MD, and Muthiah Vaduganathan, MD, MPH, discuss a late-breaking trial in transthyretin amyloid cardiomyopathy and what has changed in the new European heart failure guidelines. The conversation focuses on how clinicians should interpret the latest evidence in day-to-day practice.Read the full article: https://www.hcplive.com/view/don-t-miss-a-beat-cardio-ttransform-and-new-hf-guidelines-at-esc-2026Stephen Greene, MD, is an advanced heart failure specialist at Duke University School of Medicine. Muthiah Vaduganathan, MD, MPH, is a cardiologist at Brigham and Women's Hospital.References Fontana M, Masri A, Solomon SD, et al; CARDIO-TTRansform Investigators. Eplontersen for transthyretin amyloid cardiomyopathy. N Engl J Med. Published online August 28, 2026. doi:10.1056/NEJMoa2608510 Gillmore JD, Hamatani Y, Fontana M, et al. Gene silencer therapy in transthyretin amyloid cardiomyopathy: a meta-analysis of outcomes trials. JAMA. Published online August 30, 2026. doi:10.1001/jama.2026.17246 Køber L, Adamo M, Ruwald A, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J. 2026;ehag100. doi:10.1093/eurheartj/ehag100

Mi nombre es Dr. Mauricio González, médico internista y especialista en endocrinología en formación. Suscríbete al podcast para decodificar la medicina de vanguardia sin engaños ni dramas

In this episode of the ESVS Podcast, we discuss one of the oldest yet most effective treatments in vascular medicine: compression therapy.Our guest is Professor Melina Vega de Ceniga, Head of the Department of Angiology and Vascular Surgery at Galdakao-Usansolo University Hospital, Spain, and an internationally recognised expert in chronic venous disease. She is an active member of the European Society for Vascular Surgery (ESVS), she has been involved in the creation and development of the ESVS Podcast programme.Together, we explore the physiological basis of compression therapy, its indications across a wide range of vascular conditions, the different compression systems available, and practical aspects of their application. We also discuss pressure selection, contraindications, compression therapy in patients with peripheral arterial disease and heart failure, and the management of venous leg ulcers.Finally, Professor Vega de Ceniga shares practical strategies to improve patient adherence, prevent ulcer recurrence, and optimise long-term outcomes.This episode provides practical guidance for vascular specialists, trainees, wound-care professionals, and all clinicians involved in the management of patients with chronic venous disease and lower-limb oedema.This episode has been supported by Urgo MedicalReferencesDe Maeseneer MGR, Kakkos SK, Aherne T, et al. ESVS 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63:184–267.O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2021;9.Gohel MS, Heatley F, Liu X, et al. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. N Engl J Med. 2018;378:2105–2114.

This week, we feature new research on colorectal cancer surveillance, metabolic acidosis in critical illness, pediatric leukemia, and food-allergy prevention. We also review esophageal cancer and follow a case of severe nutritional deficiency and memory loss. Perspectives address AI and the clinical workforce, physician staffing in the Indian Health Service, human trafficking and child health, and the enduring legacy of the HIV epidemic.

With Gregorio Tersalvi, Mayo Clinic, Rochester, Minnesota - USA, Lars Kober and Jawad Haider Butt, Rigshospitalet - Copenhagen University Hospital, Copenhagen - Denmark, Jolie Bruno, Inselspital, Bern University Hospital, University of Bern, Bern - Switzerland, Jorg Hausleiter, LMU University Hospital, LMU Munich, Munich - Germany, Benedikt Norbert Beer, University Medical Center Hamburg-Eppendorf, Hamburg - Germany, Marianna Adamo, University and Civil Hospital of Brescia, Brescia - Italy and Novi Yanti Sari, Siloam Hospitals Group, Jakarta - Indonesia. In this episode, we discuss the late-breaking clinical science presented at ESC Congress 2026 in Munich, Germany. First, Jolie Bruno interviews Lars Kober and Jawad Haider Butt on hydralazine plus isosorbide dinitrate in HFrEF, covering the results of the H-HeFT trial and of the accompanying H-ISDN meta-analysis. H-HeFT compared H-ISDN with placebo in patients with symptomatic heart failure and an ejection fraction of 40% or less, while the meta-analysis pooled three placebo-controlled trials to assess the effect of H-ISDN on mortality and heart failure events. Next, Benedikt N. Beer interviews Jorg Hausleiter, who highlights the key findings of TRIC-I-HF, a randomised, open-label trial of transcatheter tricuspid valve repair on top of medical therapy versus medical therapy alone in patients with severe tricuspid regurgitation and heart failure. Finally, Novi Yanti Sari interviews Marianna Adamo, who co-chaired the 2026 ESC Guidelines for the management of heart failure and outlines the main novelties of the document. This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsor. Presenter: Gregorio Tersalvi, Mayo Clinic, Rochester, Minnesota - USA Segment 1: Title: H-HeFT: Hydralazine-Isosorbide Dinitrate in HFrEF + H-ISDN Meta-Analysis Results paper: not yet published Design paper: Wiggers H, Køber L, Gislason G, et al. The DANish randomized, double-blind, placebo controlled trial in patients with chronic HEART failure (DANHEART): A 2 × 2 factorial trial of hydralazine-isosorbide dinitrate in patients with chronic heart failure (H-HeFT) and metformin in patients with chronic heart failure and diabetes or prediabetes (Met-HeFT). Am Heart J. 2021;231:137-146. doi:10.1016/j.ahj.2020.09.020 Segment 2: Title: TRIC-I-HF (TRICuspid Intervention in Heart Failure) Results paper: Hausleiter J, Stocker TJ, Geisler T, et al. Tricuspid-Valve Intervention in Heart Failure. N Engl J Med. Published online August 30, 2026. doi:10.1056/NEJMoa2606934 Design paper: Stocker TJ, Geisler T, Rottbauer W, et al. Rationale and design of the TRIC-I-HF-DZHK24 (TRICuspid Intervention in Heart Failure) trial. Eur J Heart Fail. 2025;27(10):1895-1904. doi:10.1002/ejhf.3795 Segment 3: Title: Highlights from the 2026 ESC Guidelines for the management of heart failure Guideline paper: Køber L, Adamo M, Ruwald AC, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J. Published online August 28, 2026. doi:10.1093/eurheartj/ehag100

*JOIN THE PHYSIONIC INSIDERS [PREMIUM CONTENT]*Join the Physionic Insiders: https://bit.ly/PhysionicInsiders2 *HEALTH AUTONOMY [COURSE]*Learn to Analyze & Apply Studies for Yourself: https://bit.ly/healthautonomy*JOIN THE COMMUNITY*Join my Community [It's Free!]: https://bit.ly/PhysionicCommunity2*EMAIL LIST*1-2 Weekly Email of Value [It's Free!]: http://bit.ly/2AXIzK6*HIRE ME FOR CONSULTING:* Consulting: https://bit.ly/3dmUl2H Created with Biorender0:00 - Introduction1:18 - Peptides on Cardiovascular Disease3:09 - Peptides on Reversing Arterial Plaque6:58 - There is hope...References [Funding/Conflicts are provided in the free article (found in the email list and Physionic Community Article Library)][Study 1018] Marso SP, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016. doi:10.1056/NEJMoa1607141.[Study 1019] Gerstein HC, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND). Lancet. 2019. doi:10.1016/S0140-6736(19)31149-3.[Study 1020] Gerstein HC, et al. The effect of dulaglutide on stroke: an exploratory analysis of REWIND. Lancet Diabetes Endocrinol. 2020. doi:10.1016/S2213-8587(19)30423-1.[Study 1021] Hernandez AF, et al. Albiglutide and cardiovascular outcomes in type 2 diabetes and cardiovascular disease. Lancet. 2018. doi:10.1016/S0140-6736(18)32261-X.[Study 1022] Lincoff AM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023. doi:10.1056/NEJMoa2307563.[Study 1023] McGuire DK, et al. Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes. N Engl J Med. 2025. doi:10.1056/NEJMoa2501006.[Study 1024] Gitto M, et al. GLP-1 receptor agonists and coronary plaque regression after acute coronary syndromes. Acta Diabetol. 2026. doi:10.1007/s00592-025-02606-z.[Study 1025] Kataoka Y, et al. GLP-1 analogues and delipidation of coronary atheroma. Atheroscler Plus. 2024. doi:10.1016/j.athplu.2024.03.001.[Study 1026] Heinsen LJ, et al. Liraglutide treatment and progression of coronary artery fibrous plaque. BMC Cardiovasc Disord. 2023. doi:10.1186/s12872-023-03228-5.[Study 1027] Zhang J, et al. Exenatide versus insulin and carotid intima-media thickness in type 2 diabetes. Cardiovasc Diabetol. 2020. doi:10.1186/s12933-020-01014-7.[Study 1028] Rizzo M, et al. Liraglutide decreases carotid intima-media thickness in type 2 diabetes. Cardiovasc Diabetol. 2014. doi:10.1186/1475-2840-13-49.[Study 1029] Rizzo M, et al. Liraglutide improves metabolic parameters and carotid intima-media thickness. Cardiovasc Diabetol. 2016. doi:10.1186/s12933-016-0480-8.[Study 1030] Patti AM, et al. Semaglutide and subclinical atherosclerosis in type 2 diabetes. Biomedicines. 2023. doi:10.3390/biomedicines11051362.[Study 1031] Sun L, et al. Liraglutide and atherosclerosis in impaired glucose tolerance. Exp Ther Med. 2023. doi:10.3892/etm.2023.11948.[Study 997] Lundgren JR, et al. Healthy weight loss maintenance with exercise, liraglutide, or both. N Engl J Med. 2021. doi:10.1056/NEJMoa2028198.Please use the following link to submit your critique: https://bit.ly/PhysionicCritiqueDisclaimer: None of the information provided by this brand is a replacement for your physician's advice. This brand is information for the sake of knowledge and the options of choice it provides, not in any way a personalized prescription. Please consult your physician before making any health related changes.

*JOIN THE PHYSIONIC INSIDERS [PREMIUM CONTENT]*Join the Physionic Insiders: https://bit.ly/PhysionicInsiders2 *HEALTH AUTONOMY [COURSE]*Learn to Analyze & Apply Studies for Yourself: https://bit.ly/healthautonomy*JOIN THE COMMUNITY*Join my Community [It's Free!]: https://bit.ly/PhysionicCommunity2*EMAIL LIST*1-2 Weekly Email of Value [It's Free!]: http://bit.ly/2AXIzK6*HIRE ME FOR CONSULTING:* Consulting: https://bit.ly/3dmUl2H Created with Biorender0:00 - Introduction1:09 - No Good Research on Health Effects of Fiber5:21 - This is what we Need!8:08 - Whoops.. Hypocrisy? 12:50 - Main PointsReferences [1] Park Y, Subar AF, Hollenbeck A, Schatzkin A. Dietary fiber intake and mortality in the NIH-AARP diet and health study. Arch Intern Med. 2011;171(12):1061-1068. doi:10.1001/archinternmed.2011.18[2] Chuang SC, Norat T, Murphy N, et al. Fiber intake and total and cause-specific mortality in the European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr. 2012;96(1):164-174. doi:10.3945/ajcn.111.028415[3] Buil-Cosiales P, Zazpe I, Toledo E, et al. Fiber intake and all-cause mortality in the Prevención con Dieta Mediterránea (PREDIMED) study. Am J Clin Nutr. 2014;100(6):1498-1507. doi:10.3945/ajcn.114.093757[4] Li S, Flint A, Pai JK, et al. Dietary fiber intake and mortality among survivors of myocardial infarction: prospective cohort study. BMJ. 2014;348. doi:10.1136/bmj.g2659[5] Katagiri R, Goto A, Sawada N, et al. Dietary fiber intake and total and cause-specific mortality: the Japan Public Health Center-based prospective study. Am J Clin Nutr. 2020;111(5):1027-1035. doi:10.1093/ajcn/nqaa002[6] Burn J, Bishop DT, Mecklin JP, et al. Effect of aspirin or resistant starch on colorectal neoplasia in the Lynch syndrome. N Engl J Med. 2008;359(24):2567-2578. doi:10.1056/NEJMoa0801297[7] Robertson MD, Bickerton AS, Dennis AL, Vidal H, Frayn KN. Insulin-sensitizing effects of dietary resistant starch and effects on skeletal muscle and adipose tissue metabolism. Am J Clin Nutr. 2005;82(3):559-567. doi:10.1093/ajcn.82.3.559[8] Ziai SA, Larijani B, Akhoondzadeh S, et al. Psyllium decreased serum glucose and glycosylated hemoglobin significantly in diabetic outpatients. J Ethnopharmacol. 2005;102(2):202-207. doi:10.1016/j.jep.2005.06.042[9] Abutair AS, Naser IA, Hamed AT. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutr J. 2016;15(1):86. doi:10.1186/s12937-016-0207-4[10] Solà R, Bruckert E, Valls RM, et al. Soluble fibre (Plantago ovata husk) reduces plasma low-density lipoprotein (LDL) cholesterol, triglycerides, insulin, oxidised LDL and systolic blood pressure in hypercholesterolaemic patients: A randomised trial. Atherosclerosis. 2010;211(2):630-637. doi:10.1016/j.atherosclerosis.2010.03.010[11] Burke V, Hodgson JM, Beilin LJ, Giangiulioi N, Rogers P, Puddey IB. Dietary protein and soluble fiber reduce ambulatory blood pressure in treated hypertensives. Hypertension. 2001;38(4):821-826. doi:10.1161/hy1001.092614[12] Wolever TM, Jenkins DJ, Mueller S, et al. Psyllium reduces blood lipids in men and women with hyperlipidemia. Am J Med Sci. 1994;307(4):269-273. doi:10.1097/00000441-199404000-00005Please use the following link to submit your critique: https://bit.ly/PhysionicCritiqueDisclaimer: None of the information provided by this brand is a replacement for your physician's advice. This brand is information for the sake of knowledge and the options of choice it provides, not in any way a personalized prescription. Please consult your physician before making any health related changes.

Un nouvel épisode du Pharmascope est disponible! Dans ce premier d'une série de deux épisodes sur l'hyperplasie bénigne de la prostate, Nicolas, Olivier et Amélie discutent d'évaluation, de mesures non-pharmacologiques et commencent à jaser de traitements.  Les objectifs pour cet épisode sont les suivants: Discuter de l'évaluation et du diagnostic de l'hyperplasie bénigne de la prostate. Discuter des traitements non-pharmacologiques de l'hyperplasie bénigne de la prostate. Discuter des produits naturels dans le traitement de l'hyperplasie bénigne de la prostate. Ressources pertinentes en lien avec l'épisode  Wei JT, Dauw CA, Brodsky CN. Lower Urinary Tract Symptoms in Men: A Review. JAMA. 2025 Sep 2;334(9):809-821. Elterman D, et coll. UPDATE – Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J. 2022 Aug;16(8):245-256. Goueli R, et coll. Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (2026) Part I: Presentation and Evaluation. J Urol. 2026 Aug;216(2):143-151. McConnell JD, et coll; Medical Therapy of Prostatic Symptoms (MTOPS) Research Group. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003 Dec 18;349(25):2387-98. Platz EA, et coll. Incidence and progression of lower urinary tract symptoms in a large prospective cohort of United States men. J Urol. 2012 Aug;188(2):496-501. Kumar A, et coll. Self-management interventions for men with lower urinary tract symptoms: A systematic review and meta-analysis of randomized controlled trials. Arch Gerontol Geriatr. 2025 Apr;131:105742. Brown CT, et coll. Self management for men with lower urinary tract symptoms: randomised controlled trial. BMJ. 2007 Jan 6;334(7583):25. Franco JV, et coll Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database Syst Rev. 2023 Jun 22;6(6):CD001423.

⚠️ 面對流感要注意出現疑似流感症狀時，需盡早就醫黃金 48 小時內服用抗流感藥物，可降低併發症風險！參考文獻1. 衛生福利部疾病管制署-核心教材-流感併發重症-(2026版)2. 感染症醫學會-何謂H1N113. 1918 Influenza: the Mother of All Pandemics4. 馬偕紀念醫院-H1N1 H5N1 H7N9 傻傻分不清楚5. 衛生福利部疾病管制署：季節性流感防治工作手冊6. Influenza in children. Paediatr Child Health. 2005 Oct;10(8):485-7. doi: 10.1093/pch/10.8.485. PMID: 19668662; PMCID: PMC2722601.7. 衛生福利部疾病管制署：流感疫苗接種Q&A8. Ikematsu H, et al. N Engl J Med 2020; 383:309-320.9. Dutkowski R. J Antimicrob Chemother. 2010;65 Suppl 2:ii11–ii24.10. 衛生福利部疾病管制署：流感抗病毒藥劑11. 衛生福利部疾病管制署：季節性流感防治＿＿Hiho～大家好，我是志祺，這集來聊聊的來賓是⋯⋯小兒科醫師 柚子醫師！這集你會聽到⋯⋯→ 「流感」指的就是某段時間特別流行的感冒嗎？跟普通感冒差在哪？→ 流感是怎麼一步步引發重症的？→ 「今年得過流感，明年就比較不容易再得」是真的還是迷思？→ 台灣歷年流感重症與死亡人數的起伏，跟什麼有關？→ 為什麼天天面對病人的醫師、護理師，反而不會得流感？→ 一樣得流感，為什麼有人吃藥休息就沒事，有人卻併發重症？→ 小朋友的流感症狀跟大人一樣嗎？「一人生病全家中標」該怎麼隔離？→ 想預防流感、或身邊已經有人中標，可以怎麼自保？追蹤追起來！✨ 來賓柚子醫師的 Facebook：https://www.facebook.com/yourgoodoctor/＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿

In this episode, Dr. Rebecca Dekker and Dr. Sara Ailshire examine the available evidence on planned unassisted birth, also known as freebirth, defined as intentionally giving birth without a qualified midwife or physician present.   They explore why some people choose a planned unassisted birth, including previous trauma, distrust of the medical system, barriers to preferred care, and a desire for greater autonomy. Dr. Dekker and Dr. Ailshire also explain how freebirth differs from midwife-attended home birth, what research shows about planned community birth, and the safeguards a trained birth attendant can provide during pregnancy, labor, birth, and the newborn period. Finally, they discuss investigative reporting concerning the Free Birth Society, including allegations of misinformation and preventable harm associated with its community.   Content Note: This episode includes discussions of stillbirth, maternal death, newborn death, birth trauma, and serious complications related to planned unassisted birth.   (00:03:20) What Is Freebirth? (00:07:41) Prenatal Care, Wild Pregnancy, and Freebirth (00:10:30) How Common Is Freebirth? (00:14:27) The History and Origins of Freebirth (00:22:16) Why Do Some People Choose Freebirth? (00:26:14) What Do We Know About the Risks of Freebirth? (00:34:42) The Role of Skilled Midwives in Home Birth Safety (00:42:28) Free Birth Society Controversy (00:53:49) Lessons from the Free Birth Society (00:55:44) Warning Signs of Controlling Group Dynamics and Influencer Manipulation (01:01:50) Final Takeaways on Freebirth, Safety, and Informed Decision-Making   View the full transcript for this episode at evidencebasedbirth.com.   ResourcesEBB 23 – Home Birth Midwives EBB 110 – Inside an Unplanned, Unassisted Home Birth with Parent Sabrina Tran EBB 122 – Home birth during the pandemic with Vicki Penwell EBB 292 – Confronting the Unknowns in Childbirth with Liesel Teen of the Mommy Labor Nurse EBB 130 – Home Birth in the Black Community with Isis Rose Count the Kicks: https://countthekicks.org/ PUSH Pregnancy: https://www.pushpregnancy.org/ Star Legacy Foundation: https://starlegacyfoundation.org/ Healthy Birth Day: https://healthybirthday.org/ CDC Stillbirth resources: https://www.cdc.gov/stillbirth/communication-resources/index.html Share Pregnancy and Infant Loss Support: https://nationalshare.org/ Stillbirth and infant loss support communities: https://postpartum.net/group/stillbirth-and-infant-loss-support-for-parents/   Works Cited Birthplace in England Collaborative Group (BECG). (2011). "Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study." BMJ 343: d7400. https://pubmed.ncbi.nlm.nih.gov/22117057/ Biesele, M. (1997). "An Ideal of Unassisted Birth: Hunting, Healing, and Transformation among the Kalahari Ju/'hoansi." In Childbirth and Authoritative Knowledge. Cross-Cultural Perspectives. Davis-Floyd, R. & C.F. Sargent (eds), Childbirth and Authoritative Knowledge. Cross-Cultural Perspectives, Berkeley: University of California Press, pp. 474-92. Bjellmo, S. & Iversen, J. K. (2025). "Unassisted home births in Norway: A growing concern." Acta Obstet Gynecol Scand 104(8): 1418-1419. https://pubmed.ncbi.nlm.nih.gov/40536244/ Boodman, S. G. (2007). "Do-it-yourself Delivery." The Washington Post. July 31. https://www.washingtonpost.com/wp-dyn/content/article/2007/07/27/AR2007072702164.html Bovbjerg, M. L., Cheyney, M., Hoehn-Velasco, L., et al. (2024). "Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals." Med Care 62(12): 820-829. https://pubmed.ncbi.nlm.nih.gov/39514513/ Boushra, M., Stone, A., & Rathbun, K. M. (2023). "Umbilical Cord Prolapse." In StatPearls. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542241/ Brandt, J. S. & Ananth, C. V. (2023). "Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management." Am J Obstet Gynecol 228(5S): S1313-S1329. https://pmc.ncbi.nlm.nih.gov/articles/PMC10176440/ Carlson, K. & Vadakekut, E. S. (2026). "Amniotic Fluid Embolism." In StatPearls. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559107/ Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Natality on CDC WONDER Online Database. (2026). Data are from the Natality Records 2016-2024, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/natality-expanded-current.html on Jul 29, 2026. Cheyney, M., Bovbjerg, M., Everson, C., et al. (2014). "Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009." J Midwifery Womens Health 59(1): 17-27. https://pubmed.ncbi.nlm.nih.gov/24479690/ Dahlen, H., Kumar-Hazard, B., & Schmied, V. (2020). Birthing Outside the System: The Canary in the Coal Mine. Edited Volume. London: Routledge. Dahlen, H. G., Jackson, M., & Stevens, J. (2011). "Homebirth, freebirth and doulas: casualty and consequences of a broken maternity system." Women Birth 24(1): 47-50. https://pubmed.ncbi.nlm.nih.gov/21163719/ Davey, M. (2026). "Stacey Warnecke died after choosing a birth free of all medical help. An inquest wants to know why." The Guardian. June 19. https://www.theguardian.com/australia-news/2026/jun/20/stacey-warnecke-melbourne-influencer-died-freebirth-inquest-ntwnfb Davis-Floyd, R. & Cheyney, M. (2019). Birth in Eight Cultures. Edited Volume. Waveland Press. Einerson, B. D., Gilner, J. B., & Zuckerwise, L. C. (2023). "Placenta Accreta Spectrum." Obstet Gynecol 142(1): 31-50.https://pmc.ncbi.nlm.nih.gov/articles/PMC10491415/ Feeley, C. & Thomson, G. (2016). "Tensions and conflicts in 'choice': Womens' experiences of freebirthing in the UK." Midwifery 41: 16-21. https://pubmed.ncbi.nlm.nih.gov/27498184/ Feeley, C. & Thomson, G. (2016). "Why do some women choose to freebirth in the UK? An interpretative phenomenological study." BMC Pregnancy Childbirth 16: 59. https://pubmed.ncbi.nlm.nih.gov/27000100/ Greenfield, M., Payne-Gifford, S., McKenzie, G. (2021). "Between a Rock and a Hard Place: Considering "Freebirth" During Covid-19." Front Glob Womens Health 2: 603744. https://pubmed.ncbi.nlm.nih.gov/34816178/ Hutton, E. K., Cappelletti, A., Reitsma, A. H., et al. (2016). "Outcomes associated with planned place of birth among women with low-risk pregnancies." CMAJ 188(5): E80-E90. https://pubmed.ncbi.nlm.nih.gov/26696622/ Iceland Monitor. (2024). "How do you know this woman had this child." Iceland Monitor. May 9. https://icelandmonitor.mbl.is/news/news/2024/05/09/how_do_you_know_this_woman_had_this_child/ Johansson, M., Jansson, O., Lilja, F., et al. (2023). "Freebirth, the only option for women who do not fit into common practice- A Swedish national interview study." Sex Reprod Healthc 37: 100866. https://pubmed.ncbi.nlm.nih.gov/37295181/ Johnston, K. & MacDougall, C. (2026). "Toward Conceptual Clarity: Out-of-Hospital Birth Practices and Freebirth Entrepreneurialism." Atlantis: Critical Studies in Gender, Culture, & Social Justice. 47(1): 44–57. https://atlantisjournal.ca/atlantis/en/article/view/5920 Kale, S. & Osborne, L. (2025). "Influencers made millions pushing 'wild' births – now the Free Birth Society is linked to baby deaths around the world." The Guardian. November 22. https://www.theguardian.com/world/ng-interactive/2025/nov/22/free-birth-society-linked-to-babies-deaths-investigation Kale, S. & Davey, M. (2026). "A US champion of 'freebirthing' always claimed there had been no maternal deaths linked to the movement. Is Stacey Warnecke the first?" The Guardian. June 29. https://www.theguardian.com/world/2026/jun/30/freebirth-wellness-influencer-stacey-warnecke-death-ntwnfb Lou, S., Dahlen, H. G., Gefke Hansen, S., et al. (2022). "Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women's motivations and preparations for freebirth." Sex Reprod Healthc 34: 100789. https://pubmed.ncbi.nlm.nih.gov/36332498/ Mackeen, D. (2026). "She wanted a `free birth.' It put her and her baby in grave danger." The New York Times. April 22. https://www.nytimes.com/2026/04/22/science/free-birth-wild-pregancy-risks-home-birth.html McKenzie, G., Robert, G., & Montgomery, E. (2020). "Exploring the conceptualisation and study of freebirthing as a historical and social phenomenon: a meta-narrative review of diverse research traditions." Med Humanit 46(4): 512-524. https://pubmed.ncbi.nlm.nih.gov/32361690/ Miller, J. F. (2020). "Solitary and Kin-Assisted Rarámuri Birth: Ideals and realities." In Birthing Models on the Human Rights Frontier. Daviss, B. & Davis-Floyd, R., eds. Routledge: London. Payne, E. (2025). "Officials 'strongly advise' against freebirths after cluster of stillbirths in Ontario." Ottawa Citizen. January 15. https://ottawacitizen.com/news/local-news/officials-advise-against-freebirths-after-stillbirths-ontario Pillai, S., Cheyney, M., Everson, C. L., et al. (2020). "Fetal macrosomia in home and birth center births in the United States: Maternal, fetal, and newborn outcomes." Birth 47(4):409-417. https://pmc.ncbi.nlm.nih.gov/articles/PMC8923081/ Rosenberg, K. & Trevathan, W. (1995). " Bipedalism and human birth: The obstetrical dilemma revisited." Evolutionary Anthropology 4(5): 161-168. https://doi.org/10.1002/evan.1360040506Sargent, C. (1982). "The Implications of Role Expectations for Birth Assistance among Bariba." Soc Sci Med 16(16): 1483-1489. https://pubmed.ncbi.nlm.nih.gov/7135022/ Shorey, S., Jarašiūnaitė-Fedosejeva, G., Akik, B. K., et al. (2023). "Trends and motivations for freebirth: A scoping review." Birth 50(1): 16-31. https://pubmed.ncbi.nlm.nih.gov/36598288/ Shostak, M. (1981). Nisa: The Life and Words of a !Kung Woman. Cambridge: Harvard University Press. Snowden, J. M., Tilden, E. L., Snyder, J., et al. (2015). "Planned Out-of-Hospital Birth and Birth Outcomes." N Engl J Med 373(27): 2642-2653. https://pubmed.ncbi.nlm.nih.gov/26716916/ Sperlich, M. & Gabriel, C. (2022). ""I got to catch my own baby": a qualitative study of out of hospital birth." Reprod Health 19(1): 43. https://pubmed.ncbi.nlm.nih.gov/35164785/ Togioka, B. M. & Tonismae, T. (2023). "Uterine Rupture." In StatPearls. Treasure Island: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559209/ Uda, E. (2026). "Facing rural realities and mistrust in hospitals, these women turned to home births." CBC Radio. April 26. https://www.cbc.ca/radio/thecurrent/freebirthing-rural-maternal-medicine-9.7172199

This week, we feature new research on gene-edited therapies for children with β-thalassemia and sickle cell disease, treatment for membranous nephropathy, coronary revascularization after myocardial infarction, and an outbreak of severe methemoglobinemia. We review treatment decisions in multiple myeloma, follow a case of man with fever and rash, and report on psychedelic drug development. Perspectives address preventive care, AI-assisted translation, barriers to health care access, and the long shadow of Bedlam.

Uncontrolled and resistant hypertension is more common than we think. In the second episode of this special three-part series, Dr. Neil Skolnik discusses management strategies, but also explores our new understanding of aldosterone and its stealth role in hypertension. This series is supported with support from AstraZeneca. Please listen to the episodes by clicking on the podcast player below or by freely subscribing to DOC Updates via Apple Podcasts, Amazon Music, Spotify, or your preferred podcast platform. Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Payal Kohli, MD, Harvard-educated preventive cardiologist and the Founder and Medical Director of Cherry Creek Heart​ in Aurora Colorado, Associate Adjunct Professor in Cardiology at Johns Hopkins University, and Associate Adjunct Professor in Cardiology at Duke University Selected references: 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee. Hypertension 2025; 82(10) Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016;387:957 Efficacy and Safety of Baxdrostat in Uncontrolled and Resistant Hypertension. N Engl J Med 2025;393:1363-74. DOI: 10.1056/NEJMoa2507109 Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 2025, 00, 1–43 https://doi.org/10.1210/clinem/dgaf284 A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015;373:2103-2116

MASH is often called a silent disease, but its impact can be significant. Join Dr. Gerry Clancy and University of Iowa liver specialists Dr. Marta Tejedor Bravo and Dr. Alan Gunderson as they explore risk factors, screening, disease progression, and emerging therapies that are reshaping care for patients with metabolic liver disease. Liver Wellness | The University of Iowa Iowa Liver Wellness Symposium: Cirrhosis Care in Motion 2026 5k Race - Run for Your Liver, Run for Your life (and last year's video Run for Your Liver, Run for Your Life) Episode Transcript CE Credit Available Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Alan E. Gunderson, MD Clinical Associate Professor of Internal Medicine-Gastroenterology and Hepatology University of Iowa Carver College of Medicine Marta Tejedor Bravo, MD, MSc, PhD Clinical Associate Professor of Internal Medicine-Gastroenterology and Hepatology University of Iowa Carver College of Medicine Financial Disclosures:   Dr. Clancy, Dr. Tejedor Bravo, and the members of the Rounding@IOWA planning committee have disclosed no relevant financial relationships. Dr. Gunderson has disclosed the following relationships: CymaBay Therapeutics, Inc.; GigaGen, Inc.; LISCure Biosciences, Inc. - Sponsored Research Relevant financial relationships have been mitigated. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.00 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 1.00 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. JA0000310-0000-26-058-H01 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References:  Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, Kleiner DE, Loomba R. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023 May 1;77(5):1797-1835. doi: 10.1097/HEP.0000000000000323. Epub 2023 Mar 17. PMID: 36727674; PMCID: PMC10735173. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024 Sep;81(3):492-542. doi: 10.1016/j.jhep.2024.04.031. Epub 2024 Jun 7. PMID: 38851997. Younossi ZM, Zelber-Sagi S, Lazarus JV, Wong VW, Yilmaz Y, Duseja A, Eguchi Y, Castera L, Pessoa MG, Oliveira CP, El-Kassas M, Tsochatzis E, Fan JG, Spearman CW, Tacke F, Castellanos Fernandez MI, Alkhouri N, Schattenberg JM, Romero-Gómez M, Noureddin M, Allen AM, Ong JP, Roberts SK, Shubrook JH, Burra P, Kohli R, Kautz A, Holleboom AG, Lam B, Isaacs S, Macedo P, Gastaldelli A, Henry L, Ivancovsky-Wajcman D, Nader F, de Avila L, Price JK, Mark HE, Villota-Rivas M, Barberá A, Kalligeros M, Gerber LH, Alqahtani SA. Global Consensus Recommendations for Metabolic Dysfunction-Associated Steatotic Liver Disease and Steatohepatitis. Gastroenterology. 2025 Oct;169(5):1017-1032.e2. doi: 10.1053/j.gastro.2025.02.044. Epub 2025 Apr 11. PMID: 40222485. Mladenić K, Lenartić M, Marinović S, Polić B, Wensveen FM. The "Domino effect" in MASLD: The inflammatory cascade of steatohepatitis. Eur J Immunol. 2024 Apr;54(4):e2149641. doi: 10.1002/eji.202149641. Epub 2024 Feb 5. PMID: 38314819. Harrison SA, Bedossa P, Guy CD, Schattenberg JM, Loomba R, Taub R, Labriola D, Moussa SE, Neff GW, Rinella ME, Anstee QM, Abdelmalek MF, Younossi Z, Baum SJ, Francque S, Charlton MR, Newsome PN, Lanthier N, Schiefke I, Mangia A, Pericàs JM, Patil R, Sanyal AJ, Noureddin M, Bansal MB, Alkhouri N, Castera L, Rudraraju M, Ratziu V; MAESTRO-NASH Investigators. A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis. N Engl J Med. 2024 Feb 8;390(6):497-509. doi: 10.1056/NEJMoa2309000. PMID: 38324483. Sanyal AJ, Newsome PN, Kliers I, Østergaard LH, Long MT, Kjær MS, Cali AMG, Bugianesi E, Rinella ME, Roden M, Ratziu V; ESSENCE Study Group. Phase 3 Trial of Semaglutide in Metabolic Dysfunction-Associated Steatohepatitis. N Engl J Med. 2025 Jun 5;392(21):2089-2099. doi: 10.1056/NEJMoa2413258. Epub 2025 Apr 30. PMID: 40305708.  

Ich habe „Born to Run“ gelesen und bin barfuß bis zum Halbmarathon gelaufen. Es fühlte sich großartig an – bis mein Mittelfußknochen brach. Ausgerechnet bei dem, wofür ich angeblich geboren war.In dieser Folge gehe ich der Frage nach, wofür Dein Körper wirklich gebaut ist. Du erfährst, welche unscheinbare Fähigkeit Dich zum Ausdauer-Champion des Tierreichs macht – und in welcher zweiten Disziplin die Evolution ausdrücklich gegen Dich gearbeitet hat. Genau die ist der Grund, warum Du überhaupt ins Fitnessstudio gehst.Dazu die Geschichte eines Klienten: Radsportler, Trainingsumfänge, bei denen Du schon vom Zuhören müde wirst – und trotzdem ein Bauch, der einfach nicht weichen wollte. Was wir geändert haben, war das Gegenteil von dem, was er erwartet hatte.Und wir nehmen die beliebtesten „Die Evolution sagt“-Argumente auseinander: Paleo, Carnivore, Barfußlaufen. Was davon wissenschaftlich ist – und was schlicht romantischer Quatsch.____________*WERBUNG: Infos zum Werbepartner dieser Folge und allen weiteren Werbepartnern findest Du hier.____________Erwähnte Bücher und DokusChristopher McDougall – „Born to Run“. Auch als Hörbuch.Mark Maslow – „Looking Good Naked. Die Gesamtausgabe“. Auch als Hörbuch.Mark Maslow – „Dranbleiben!“. Auch als Hörbuch.In englischer Sprache:BBC-Doku „The Life of Mammals“ mit David Attenborough – enthält die Hetzjagd-Szene mit dem San-Jäger Karoha Langwane (gefilmt 2001 in der Kalahari, in Zusammenarbeit mit Louis Liebenberg)Richard Wrangham – „Catching Fire“. Das Buch zur Kochhypothese. Auch als Hörbuch.Marlene Zuk – „Paleofantasy“.Weitere RessourcenDas Elektrolytpulver, das ich nutze → [Link]Meine Basis-Empfehlungen → [Link]Folge 563 – Hydration: das WieFolge 573 – Hydration: das WarumWissenschaftliche QuellenBramble, D.M. & Lieberman, D.E. (2004): Endurance running and the evolution of Homo. Nature, 432(7015), 345–352.Lieberman, D.E. et al. (2006): The human gluteus maximus and its role in running. J Exp Biol, 209(11), 2143–2155.Liebenberg, L. (2006): Persistence hunting by modern hunter-gatherers. Curr Anthropol, 47(6), 1017–1026.Morin, E. & Winterhalder, B. (2024): Ethnography and ethnohistory support the efficiency of hunting through endurance running in humans. Nat Hum Behav, 8(6), 1065–1075.Morton, R.W. et al. (2018): A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Br J Sports Med, 52(6), 376–384.Aiello, L.C. & Wheeler, P. (1995): The expensive-tissue hypothesis: The brain and the digestive system in human and primate evolution. Curr Anthropol, 36(2), 199–221.Navarrete, A., van Schaik, C.P. & Isler, K. (2011): Energetics and the evolution of human brain size. Nature, 480(7375), 91–93.Pontzer, H. et al. (2012): Hunter-gatherer energetics and human obesity. PLoS One, 7(7), e40503.Pontzer, H. et al. (2016): Constrained total energy expenditure and metabolic adaptation to physical activity in adult humans. Curr Biol, 26(3), 410–417.Bellicha, A. et al. (2021): Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies. Obes Rev, 22(S4), e13256.Lieberman, D.E. et al. (2010): Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature, 463(7280), 531–535.Daoud, A.I. et al. (2012): Foot strike and injury rates in endurance runners: A retrospective study. Med Sci Sports Exerc, 44(7), 1325–1334.McMurry, M.P. et al. (1991): Changes in lipid and lipoprotein levels and body weight in Tarahumara Indians after consumption of an affluent diet. N Engl J Med, 325(24), 1704–1708.

This week, we feature new research on acute myeloid leukemia, achondroplasia, pediatric septic shock, and RAS-mutant lung cancer. We also review the evaluation and management of pulmonary nodules and follow a diagnostic case of recurrent fractures. Perspectives explore reproductive health care, the human–animal bond in health care access, and on creating space for patients' voices in clinical decision making.

Elizabeth Tobin-Tyler is a professor of health services, policy and practice at the Brown University School of Public Health and of family medicine and medical science at Warren Alpert Medical School of Brown University. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. E. Tobin-Tyler and G. Chalker. Telehealth Access to Mifepristone — Evaluating Reproductive-Coercion Arguments. N Engl J Med 2026;395:833-835.

Central venous access remains foundational to the delivery of critical care, yet the techniques used for central line insertion have evolved minimally since the introduction of the Seldinger method more than 70 years ago. This relative stagnation persists despite increasing patient complexity and heightened expectations for procedural safety, efficiency, and reliability. This episode of the Society of Critical Care Medicine (SCCM) Podcast examines how procedural variability and fragmented workflows continue to contribute to risk during central venous catheter insertion in critically ill patients. It also considers the growing need to reassess long-standing approaches that may no longer align with the demands of contemporary ICU practice. Host Kyle B. Enfield, MD, speaks with Adnan Javed, MD, about emerging insertion techniques and integrated technologies designed to simplify procedural steps, reduce variability, and support more consistent performance at the bedside. Through a focused exploration of innovation in procedural design, this discussion highlights how streamlined, integrated approaches may enhance clinician performance, improve safety, and advance the standard of care in high-acuity environments. This episode provides a critical perspective on the future of central venous access and the role of innovation in transforming a commonly performed, yet high-stakes, procedure. This episode is sponsored by BD. Learning Objectives Describe how procedural complexity and workflow variability contribute to risk during central venous catheter insertion in critically ill patients Understand the potential of emerging insertion techniques and integrated, simplified approaches to improve procedural safety, consistency, and clinician performance   Resource referenced in this episode: Pronovost P, Needham D, Berenholtz S, et al. An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU. N Engl J Med. 2006;355(26):2725-2732. doi:10.1056/NEJMoa061115

Daniela DiMarco, MD, MPH is joined by guest speaker Valeria Cantos, MD for this episode of “Conversations with CEI.” Dr. Valeria Cantos is an Associate Professor at the Division of Infectious Diseases at Emory. She is an investigator at the Emory Ponce Clinical research site, where she leads HIV prevention and HIV vaccine clinical trials from the HPTN and HVTN networks. Herpes simplex virus (HSV) infection is one of the most common STIs worldwide. This episode covers a brief overview of herpes simplex virus (HSV) mucocutaneous infections including current recommendations for testing, diagnosis, treatment, and preventing perinatal HSV transmission. They also discuss managing more challenging scenarios to provide practical guidance and address common clinical questions. Related Content: CEI Line: 1-866-637-2342 www.ceitraining.org www.hivguidelines.org Plunkett M, Neville CT, Chang JG. Genital Herpes: Rapid Evidence Review. Am Fam Physician. 2024 Nov;110(5):487-492. PMID: 39556630. Gnann JW Jr, Whitley RJ. CLINICAL PRACTICE. Genital Herpes. N Engl J Med. 2016 Aug 18;375(7):666-74. doi: 10.1056/NEJMcp1603178. PMID: 27532832. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. Erratum in: MMWR Morb Mortal Wkly Rep. 2023 Jan 27;72(4):107-108. doi: 10.15585/mmwr.mm7204a5. PMID: 34292926; PMCID: PMC8344968.

In children with septic shock, does the choice between balanced crystalloids and 0.9% saline actually matter? This episode reviews the composition and physiologic differences between commonly used crystalloids, summarizes the 2026 PRoMPT BOLUS trial, and discusses how its findings fit with the updated Surviving Sepsis Campaign pediatric guidelines. We also consider the trial's limitations and what the results mean for fluid selection at the bedside. Learning Objectives By the end of this episode, listeners should be able to: Compare the composition and physiologic effects of 0.9% saline and balanced crystalloids used for pediatric fluid resuscitation. Summarize the design and major findings of the PRoMPT BOLUS trial. Describe important limitations of PRoMPT BOLUS when applying its results to children with septic shock. Apply current evidence and 2026 Surviving Sepsis Campaign recommendations when selecting crystalloid fluids for pediatric septic shock. References Weiss SL, Peters MJ, Oczkowski SJW, et al. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Pediatr Crit Care Med. 2026. Published April 1, 2026. Jointly issued by the Society of Critical Care Medicine and Infectious Diseases Society of America. Recommendation 24 suggests balanced/buffered crystalloids over 0.9% saline for children with septic shock requiring fluid boluses (conditional recommendation, very low certainty), while recognizing 0.9% saline as a suitable alternative and preferred in selected situations such as hyponatremia or concern for increased intracranial pressure. Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. N Engl J Med. 2026. Published April 24, 2026. PRoMPT BOLUS was a large pragmatic randomized trial comparing balanced crystalloids with 0.9% saline in children treated for suspected septic shock and found no reduction in major adverse kidney events within 30 days with balanced fluids. Transcript This transcript was generated using Descript and subsequently reviewed and lightly edited for spelling, grammar, and clarity. Minor inaccuracies may remain, and the audio recording should be considered the definitive version of this content. Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I'm your host, Brad Sobolewski, and today we're gonna talk about which fluid we should use when managing a septic pediatric patient. So when we resuscitate a child with septic shock, the major decision is usually not whether to give crystalloid, but which crystalloid to give. And for a long time, there's been a gradual shift towards balanced fluids such as Lactated Ringer's or Plasma-Lyte, largely because they are more physiologic and produce less hyperchloremia than normal saline. The question's always been whether those biochemical differences actually translate into better clinical outcomes. That is the question that a study called PRoMPT BOLUS was designed to answer. So before getting into the trial, it's worth briefly reviewing what these fluids actually contain. So normal saline is 0.9% sodium chloride. It contains one hundred and fifty-four milliequivalents per liter of sodium and a hundred and fifty-four milliequivalents per liter of chloride. The chloride concentration is substantially higher than plasma. Balanced crystalloids contain less chloride and have some other electrolytes and a buffer. Lactated Ringer's contains approximately a hundred and thirty milliequivalents per liter of sodium, one hundred and nine of chloride, four of potassium, a small amount of calcium, and lactate as a buffer. Plasma-Lyte contains approximately one hundred and forty of sodium, ninety-eight of chloride, five of potassium, magnesium, and acetate and gluconate as buffers. The concern with normal saline is that the large chloride loads can produce hyperchloremic metabolic acidosis. There's also been concern about adverse effects on renal blood flow and kidney function. Balanced fluids are designed to more closely approximate plasma composition, so the hypothesis has been that they might reduce kidney injury. That hypothesis has been supported by physiologic data and by some adult studies, although pediatric evidence before PRoMPT BOLUS was limited and inconsistent. The 2026 Surviving Sepsis Campaign Pediatric Guidelines recommend crystalloids over albumin for initial resuscitation and conditionally suggest balanced or buffered crystalloids over 0.9% saline in children with septic shock who require fluid boluses. Importantly, that recommendation is based on very low-certainty evidence. Balanced options again include Lactated Ringer's, Hartmann's solution, or Plasma-Lyte. If balanced fluids are not readily available, saline remains an acceptable alternative. Saline may also be preferable in some specific situations like significant hyponatremia or concern for increased intracranial pressure. For children in resource-abundant settings, the general approach is still ten to twenty mLs per kilo per bolus with reassessment after each bolus, potentially up to forty to sixty mLs per kilo in the first hour if perfusion remains abnormal and there are no signs of fluid overload. Now, PRoMPT BOLUS, the full name of which is the Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis, was an international randomized pragmatic trial designed to specifically compare the two fluid strategies in children with suspected septic shock. The final trial enrolled nine thousand and forty-one children from two months to younger than eighteen years across forty-seven emergency departments in five countries. Children were randomized to predominantly balanced crystalloid or predominantly 0.9% saline, and the assigned fluid strategy was used for bolus and maintenance crystalloid during the initial treatment period. The balanced fluid arm was not a single product. Depending on the site, children could get Lactated Ringer's, Hartmann's solution, or Plasma-Lyte. That's important when interpreting the study. PRoMPT BOLUS was really testing a strategy of predominantly balanced crystalloid versus a strategy of predominantly saline use rather than comparing LR versus saline alone, though LR was the most commonly used one. The primary outcome was something called MAKE30, M-A-K-E thirty, or major adverse kidney events within thirty days. This was a composite outcome that included death, new renal replacement therapy, or persistent kidney dysfunction. That choice of outcome is useful because the biologic rationale for balanced fluids has always centered largely on kidney protection. The investigators were therefore asking whether the lower chloride exposure associated with balanced fluids translated into clinically meaningful renal benefit. So what was the result? Well, the spoiler is that the answer was no. So MAKE30 occurred in three point four percent of children receiving balanced fluids and three percent receiving saline. The relative risk was one point one with a ninety-five percent confidence interval from point eight eight to one point four. There were also no significant differences in death, new renal replacement therapy, persistent kidney dysfunction, or hospital-free days. In practical terms, balanced crystalloids did not improve the major patient-centered outcomes the trial was designed to measure. There were clear biochemical differences between the groups. Hyperchloremia occurred in thirty-one point four percent of children receiving balanced fluids compared with forty-nine percent with saline. Hypernatremia was also less common with balanced fluids, one point eight versus three point one percent. Hyperlactatemia was slightly more common in the balanced fluid group, nineteen point eight compared with sixteen point seven percent. So the fluids behaved differently in the ways that you would expect physiologically. Balanced crystalloids clearly reduced hyperchloremia, but that difference did not translate into fewer major kidney events, less dialysis, shorter hospitalization, or lower mortality. There are several limitations to this study worth keeping in mind. The first is that this was a broad emergency department population with suspected septic shock, not a study limited to children with the most severe forms of shock. Only a minority of patients required vasoactive medications, and overall mortality was low. The results are therefore most applicable to the typical child with suspected septic shock receiving early ED resuscitation. They do not completely answer whether fluid composition might matter more in a smaller subgroup of children receiving very large fluid volumes or prolonged resuscitation. The second limitation is that the event rate for MAKE30 was lower than expected. When the trial was designed, investigators anticipated an event rate of about six percent in the saline group. The observed rate was closer to three percent. That means there were fewer outcome events than anticipated, which reduced the ability to detect a very small treatment effect. So the trial makes a large benefit from balanced fluids unlikely, but it can't exclude a small or subtle difference. A third limitation is that the balanced fluid group included several different solutions. Lactated Ringer's, Plasma-Lyte, and Hartmann's are all considered under the umbrella of balanced crystalloids, but they're not chemically identical. The study therefore supports the broader conclusion that a balanced fluid strategy is not superior to saline for most children in this setting, rather than providing equivalence between any single specific balanced solution and saline, even though Lactated Ringer's is used far and away most often. The trial was also intentionally pragmatic, which means that there was some crossover between fluid types. Adherence was defined as receiving at least seventy-five percent of crystalloid as the assigned fluid rather than requiring exclusive use of one fluid. That could reduce the ability to detect a small treatment effect, but it also makes the study more reflective of real clinical practice. The investigators themselves described the trial as a comparison of predominant rather than exclusive use of balanced crystalloids versus saline. Finally, the trial was open label, so clinicians knew which fluid the child was receiving. That introduces the possibility of treatment bias, though the primary outcome relied on relatively objective measures. A substantial proportion of children also did not have a measured baseline creatinine, so baseline kidney function sometimes had to be imputed using age- and sex-based values. That's worth remembering because persistent kidney dysfunction was part of the primary composite outcome. Taken together, I think PRoMPT BOLUS makes the bedside decision simpler. Balanced fluids remain a completely reasonable and defensible choice. They cause less hyperchloremia, and there's no reason to abandon them if they're already part of your usual resuscitation fluid strategy or your order sets. At the same time, the largest pediatric randomized trial now shows no improvement in major kidney or mortality outcomes compared with normal saline. So if you use saline at your local hospital, that's okay too. The 2026 Surviving Sepsis Campaign still conditionally favors balanced crystalloids, but that recommendation is based on very low-certainty evidence. So PRoMPT BOLUS adds important randomized data suggesting that for most children with septic shock, either crystalloid strategy is reasonable. The practical takeaway is that the choice of crystalloid is probably less important than getting the resuscitation itself right. Give 10 to 20 mLs per kilo when a fluid bolus is indicated, reassess frequently, watch for improvement in perfusion and for signs of fluid overload, and move to vasoactive support when fluid alone is not correcting the shock. Balanced crystalloids will produce less hyperchloremia. Normal saline will produce more. In PRoMPT BOLUS, that biochemical difference did not translate into a difference in kidney injury, dialysis, or mortality. For most children with septic shock, balanced fluids are fine, normal saline is fine, and timely, thoughtful resuscitation matters much more than which bag is hanging. I hope you found this episode on fluids for sepsis in children helpful and that you'll be able to take this knowledge back to the bedside the next time you work in the emergency department. If you've got other topics you want me to cover, especially as they relate to practice-changing research in pediatrics, like the PRoMPT BOLUS trial from the Pediatric Emergency Care Applied Research Network, PECARN as we call it, let me know. Send it my way. If you have time to leave a review on your favorite podcast site, please do so. It helps other people find the show, and definitely share this with your colleagues. I think this study and perhaps this podcast episode could be a great combo for an upcoming journal club. For PEM Currents, the Pediatric Emergency Medicine Podcast, this has been Brad Sobolewski. See you next time.  

This week, we feature new research on acute respiratory failure, wheezing in childhood, lung cancer, and obesity. We review myeloproliferative neoplasms and follow a diagnostic case of a patient with myasthenia gravis who developed dyspnea and weakness. Perspectives explore medical marijuana research, AI in clinical care, sexual and gender minority health research, and the Perspectives Editor saying goodbye.

Rebecca Haffajee is a professor in the Department of Health Policy and Management at the Yale School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. R.L. Haffajee, R.A. Mikos, and Z.D. Cooper. Marijuana Rescheduling — A Game Changer for Research? N Engl J Med 2026;395:729-731.

CardioNerds (Drs. Dr. Natalie Marrero, Dr. Ritika Tuli, and Dr. Rafael Toro Manotas) discuss multimodality imaging for risk stratification, evaluation, and management of chronic coronary artery disease with Dr. Panithaya Chareonthaitawee. Audio editing by CardioNerds intern Iman Razeghian. This episode was produced as part of the CardioNerds Academy curriculum by House Taussig under the guidance of House Chief, Dr. Natalie Marrero and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. This discussion was planned in collaboration with the Mayo Clinic Cardiovascular Board Review Course. In this episode, we discuss the pathophysiology and risk stratification of chronic coronary artery disease (CAD), as well as the current landscape of non-invasive evaluation of this condition. CAD remains a leading cause of morbidity and mortality despite advances in pharmacological and non-pharmacological strategies for the prevention and treatment of atherosclerotic disease. The concept of chronic CAD has shifted from the traditional model of stable, obstructive, flow-limiting disease, toward the current understanding of a dynamic process that extends beyond obstructive epicardial lesions to include non-obstructive plaque, diffuse atherosclerosis, and microvascular disease. Similarly, the imaging modalities used to evaluate CAD have evolved, and clinicians now have an extensive menu of options, each with distinct advantages and limitations, that must be selected carefully to maximize diagnostic accuracy and optimize treatment guidance, while also considering resource availability, local expertise, and high-value care. By the end of the episode, listeners will understand the pathophysiology of chronic CAD, risk-stratify patients with suspected CAD, recognize the advantages and pitfalls of each non-invasive diagnostic modality, and select the most appropriate diagnostic tool for a given clinical scenario. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls: Chronic CAD is a complex process that extends beyond obstructive epicardial stenosis to include non-obstructive disease, dynamic plaque burden and ischemia, diffuse atherosclerosis, microvascular dysfunction, vasospasm, among others. When evaluating patients with suspected CAD, the diagnostic process should be guided by a specific and appropriate clinical question before ordering any tests. The current diagnostic tool arsenal is broadly divided into anatomic and functional imaging modalities. These are complementary, each with distinct properties and limitations, addressing different clinical questions and assessing different aspects of disease. Local availability and expertise, along with patient-specific considerations and contraindications, determine the choice of diagnostic modality. No single test is best for every patient. INOCA and coronary microvascular dysfunction represent a common and increasingly recognized entity that is diagnosable and treatable; initial evaluation includes non-invasive testing such as stress PET and stress CMR. References Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454. doi:10.1161/CIR.0000000000001029 https://pubmed.ncbi.nlm.nih.gov/34709879/ Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-3537. doi:10.1093/eurheartj/ehae177 https://pubmed.ncbi.nlm.nih.gov/39210710/ Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119. doi:10.1161/CIR.0000000000001168 https://pubmed.ncbi.nlm.nih.gov/37471501/ Edvardsen T, Asch FM, Davidson B, et al. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2022;35(4):329-354. doi:10.1016/j.echo.2021.12.012 https://pubmed.ncbi.nlm.nih.gov/35379446/ Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015;372(14):1291-1300. doi:10.1056/NEJMoa1415516 https://pubmed.ncbi.nlm.nih.gov/39210710/ Sharma A, Coles A, Sekaran NK, et al. Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease. J Am Coll Cardiol. 2019;73(8):893-902. doi:10.1016/j.jacc.2018.11.056 https://pubmed.ncbi.nlm.nih.gov/30819356/ SCOT-HEART Investigators, Newby DE, Adamson PD, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018;379(10):924-933. doi:10.1056/NEJMoa1805971 https://pubmed.ncbi.nlm.nih.gov/30145934/ Li Z, Xu T, Wang Z, et al. Prognostic Significance of Computed Tomography-Derived Fractional Flow Reserve for Long-Term Outcomes in Individuals With Coronary Artery Disease. J Am Heart Assoc. 2025;14(2):e037988. doi:10.1161/JAHA.124.037988 https://pubmed.ncbi.nlm.nih.gov/39791423/ Bateman TM, Al-Mallah MH, et al. Clinical indications for positron emission tomography myocardial perfusion imaging and myocardial blood flow quantification: An American Society of Nuclear Cardiology position statement. J Nucl Cardiol. 2026;57:102619. doi:10.1016/j.nuclcard.2025.102619 https://pubmed.ncbi.nlm.nih.gov/41482140/ Taqueti VR, Di Carli MF. Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018;72(21):2625-2641. doi:10.1016/j.jacc.2018.09.042 https://pubmed.ncbi.nlm.nih.gov/30466521/ Taqueti VR, Hachamovitch R, Murthy VL, et al. Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization. Circulation. 2015;131(1):19-27. doi:10.1161/CIRCULATIONAHA.114.011939 https://pubmed.ncbi.nlm.nih.gov/25400060/ Mehta PK, Huang J, Levit RD, Malas W, Waheed N, Bairey Merz CN. Ischemia and no obstructive coronary arteries (INOCA): A narrative review. Atherosclerosis. 2022;363:8-21. doi:10.1016/j.atherosclerosis.2022.11.009 https://pubmed.ncbi.nlm.nih.gov/36423427/ Kunadian V, Chieffo A, Camici PG, et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. EuroIntervention. 2021;16(13):1049-1069. doi:10.4244/EIJY20M07_01 https://pubmed.ncbi.nlm.nih.gov/32624456/

To achieve optimal outcomes for patients, it is not only the individual efforts of clinicians that matter in achieving optimal outcomes for our patients. Having a system that supports and facilitates those efforts is essential. In this special episode, Neil Skolnik speaks with Nihar Desai about the challenges of managing chronic kidney disease and diabetes. This special episode is sponsored with support from Bayer. Please listen to the episodes by clicking on the podcast player below or by freely subscribing to DOC Updates via Apple Podcasts, Amazon Music, Spotify, or your preferred podcast platform. Presented by: Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Nihar Desai, MD, MPH, Associate Professor of Medicine and Associate Chief of the Section of Cardiovascular Medicine at Yale University School of Medicine, Investigator at the Center for Outcomes Research and Evaluation, and Medical Director for Value Innovation at the Yale New Haven Health System. Selected references: Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026. The American Diabetes Association's Standards of Care 2026, Diabetes Care 2026;49 (Supplement_1) :S246–S260 Finerenone in Type 1 Diabetes and Chronic Kidney Disease. N Engl J Med 2026;394:947-957 Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020;383:2219-2229 Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2020;383:1436-1446 Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med 2024;391:109-121

O sarampo voltou a preocupar: os casos estão em alta no Brasil, especialmente em São Paulo. Neste episódio, Frederico Amorim e Lucca Cirilo discutem o cenário atual dessa doença altamente contagiosa e o que o profissional de saúde precisa saber para reconhecer e conduzir os casos, abordando:O que está acontecendo: o cenário atual, por que os casos voltaram e as recomendações de vacinaçãoQuando suspeitar: padrão de lesões, sintomas associados e como o quadro muda no paciente já vacinado, complicaçõesComo diagnosticar e manejar o quadro: exames diagnósticos, uso de EPIs, notificação Tratamento de suporteIsolamento e profilaxia para contactantes: tempo de isolamento, vacinação de bloqueio, indicação de imunoglobulina. Referências:1. Ministério da Saúde. Ministério da Saúde reforça vacinação de crianças e adolescentes em São Paulo [Internet]. Brasília: Ministério da Saúde; 2026 [citado 2026 ago 13]. 2. Ministério da Saúde. Nota Técnica nº 85/2026-CGICI/DPNI/SVSA/MS [Internet]. Brasília: Ministério da Saúde; 2026.3. Prefeitura de São Paulo, Secretaria Municipal da Saúde. Uso de imunoglobulina humana na profilaxia pós-exposição ao sarampo [Internet]. São Paulo; 2026. Versão 2.4. Do LAH, Mulholland K. Measles 2025. N Engl J Med. 2025 Dec 18;393(24):2447-2458. PMID: 40561553.5. Leung J et al. Clin Infect Dis. 2025 Mar 17;80(3):663-672. PMID: 39271123

CardioNerds (Dr. Apoorva Gangavelli, Dr. Cory Sejo, and Dr. Joseph Kassab), discuss tricuspid regurgitation evaluation and management with Dr. Sunil Mankad. This episode was produced as part of the CardioNerds Academy curriculum by House Einthoven under the guidance of House Chief, Dr. Apoorva Gangavelli and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. This discussion was planned in collaboration with the Mayo Clinic Cardiovascular Board Review Course.  Audio editing by CardioNerds intern Emma Winakur. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Key Points: Tricuspid regurgitation is common and associated with increased mortality at every stage, regardless of etiology. Outcomes are worse with worsening severity, so accurate grading is critical. Etiology is critical to guide treatment decisions. Etiology includes primary vs secondary (atrial or ventricular) vs CIED-related TR. 3D echocardiography can be very helpful in determining TR etiology, especially in CIED-related TR. Diuresis with the goal of euvolemia is step one. Additionally, underlying contributory conditions (eg. pulmonary HTN, HFrEF, atrial fibrillation) should be addressed, if appropriate, and then TR severity reassessed. The choice between T-TEER and TTVR hinges on anatomy, RV function, pulmonary hypertension, and the ability to tolerate anticoagulation. T-TEER is generally first line in atrial functional TR with appropriate anatomy, in patients with poor RV function who cannot tolerate a sudden increase in RV afterload, or in patients who cannot tolerate the necessary anticoagulation with TTVR. TTVR is preferred with wide coaptation gaps and CIED-related TR. This is a team sport. Multidisciplinary discussions utilizing imaging (TTE/TEE, CT), risk scores (TRI-SCORE or TRIO), patient preference, and prior institutional experience are essential for the effective treatment of severe TR. Notes: What is the clinical importance of tricuspid regurgitation? TR is very common with approximately 4% of people over 75 having moderate or greater severity. TR (even mild) is associated with increased mortality. Those outcomes worsen as the TR severity worsens, and this phenomenon is independent of the mechanism of regurgitation. What is unique about the tricuspid valve compared to the other cardiac valves? It is at an anterior location which allows it to be imaged well with transthoracic echocardiography It is the largest valve and composed generally of 3 leaflets (but very often can have 4+ leaflets). Importantly, the RV is compliant and changes size and shape readily based on loading conditions. The TV annulus similarly changes size and shape based on hemodynamic conditions such as preload. What is a good framework for approaching the causes of tricuspid regurgitation? Determine the presence and define the severity of TR. Using TTE, we want to measure the right atrial size, the RV size, and any other concomitant valvular lesions.  Use TTE (2D and 3D) to characterize leaflet anatomy and characteristics. Subtypes of TR mechanisms (many times etiology is mixed). Primary: primary leaflet abnormality, occurs in ~10% of cases. Look for prolapse, flail, endocarditis, etc. Secondary/functional: leaflets normal but surrounding structures are abnormal. Atrial: RA and tricuspid annular dilation but normal RV size/shape, and can be related to arrhythmias like atrial fibrillation. Ventricular: RV dilated and/or dysfunctional with leaflet tethering. Can be related to pulmonary hypertension or primary RV disease. Cardiac implantable electronic device (CIED): Related to device (usually pacemakers or ICD) interaction with TV leaflets. Includes perforation, entanglement in subvalvular apparatus, impingement, etc. 3D TTE particularly helpful to evaluate How do we grade TR severity? It is very important to grade the severity of TR, and this is generally done with echocardiography. There are both quantitative and qualitative methods which use Doppler and various equations to estimate TR severity. Current recommendations have expanded TR severity beyond mild/moderate/severe to include “massive” and “torrential” categories. The most important parameters measured/calculated are vena contracta width, regurgitant volume, regurgitant fraction, and effective regurgitant orifice area. Helpful qualitative metrics include hepatic venous flow reversal. When should additional studies beyond transthoracic echocardiography, such as transesophageal echocardiography (TEE), cardiac computed tomography (CT), and cardiac magnetic resonance imaging (MRI) be pursued? TEE is particularly helpful if TTE views are poor. Since TEE is used during transcatheter intervention, a pre-procedure TEE to define anatomy, determine procedure candidacy, and plan for the procedure is critical.  CT is also helpful for procedure planning and has particular strengths in defining annulus size and geometry. A CT is required prior to transcatheter tricuspid valve replacement (TTVR). MRI is helpful for measuring RV volumes and function, but is not generally used to assess TR severity.  What is the approach to the treatment for severe tricuspid regurgitation? The first step is to try to determine the etiology. For secondary TR, treating the underlying condition is indicated. For example, pulmonary vasodilators for pulmonary HTN or guideline therapy for heart failure with reduced ejection fraction. Diuretics are the mainstay for treatment, with the goal to obtain euvolemia. This may require inpatient admission to optimize volume status and medication regimen. Once reversible etiologies are addressed, if the patient is still symptomatic from TR, additional therapies can be considered. What is the role of right heart catheterizations (RHC) in patients with severe TR? RHC is very helpful for many reasons. We use it in TR to help determine volume status, cardiac output, and RV function. Additionally, identifying and characterizing pulmonary hypertension (with pulmonary artery pressures and calculating pulmonary vascular resistance) is an important factor when choosing future therapies.  With severe tricuspid regurgitation, when should we refer for intervention (either with surgery or transcatheter repair or replacement)? Once reversible etiologies are addressed and euvolemia has been achieved, if the patient is still symptomatic from TR despite aggressive medical optimization, additional therapies can be considered. Once euvolemic, a repeat TTE should be ordered to reassess the severity of the TR. Use calculators (for example, either the TRI-SCORE or TRIO score) to predict operative mortality for isolated TR surgery. What are our transcatheter treatment options in severe tricuspid regurgitation, and how do we choose between them? The primary approved transcatheter treatment options for severe TR include transcatheter tricuspid edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR), of which the Edwards EVOQUE valve is the only one currently approved by the FDA. There are other TTVR device under investigation. These decisions should be made with a multi-disciplinary team including representation from cardiac imaging, interventional cardiology, and cardiothoracic surgery. Factors that go into the decision between T-TEER and TTVR include anatomy (annulus width, coaptation gap, leaflet length), RV reserve, pulmonary hypertension presence, ability to tolerate anticoagulation, patient preference, and institutional experience.  T-TEER is generally the first line with atrial functional and suitable anatomy. It is successful at reducing TR but does not generally eliminate it.  TTVR with EVOQUE is preferred in certain anatomic considerations like a large coaptation gap or when there is CIED-related TR (as this was excluded in T-TEER trials). Patients must be suitable for anticoagulation to receive TTVR as there is risk of leaflet thrombosis without it. If moderate/severe pulmonary hypertension is present, or there is poor RV function, TTVR may be avoided as the sudden elimination of TR causes a sudden increase in RV afterload which may not be tolerated. What is the role in advanced metrics for evaluating RV function? Advanced metrics like RV/PA coupling are under investigation but have not made it into the guidelines. The clinical utility is not yet known.  Assessing the RV function is important as stated above. Dr. Mankad prefers using 3D TTE to calculate an RVEF, or tracking RV longitudinal free wall strain. If you do encounter CIED-related TR, how do you treat it? Evaluate with TTE or TEE. 3D is very helpful to identify relative anatomy and leaflet-device interactions. There is no clear consensus about treatment if CIED-related TR is the primary mechanism of severe TR. If recently implanted, repositioning may be a valid option, but requires discussions with multiple teams including electrophysiology, advanced cardiac imaging, CT surgery, and interventional cardiology. References O’Gara PT, Lindenfeld J, Hahn RT, et al. 10 Issues for the Clinician in Tricuspid Regurgitation Evaluation and Management: 2025 ACC Expert Consensus Decision Pathway. J Am Coll Cardiol. 2025;S0735-1097(25)07047-0. O’Gara PT, Little SH, Badhwar V, et al. Operator and Institutional Recommendations and Requirements for Tricuspid Interventions: 2026 ACC/AHA/ASE/HRS/STS Expert Consensus Systems of Care Document. J Am Coll Cardiol. 2026;S0735-1097(26)05481-1. Hahn RT. Tricuspid Regurgitation. N Engl J Med. 2023;388(20):1876-1891. Davidson LJ, Tang GHL, Ho EC, et al. The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. Circulation. 2024;149(22):e1223-e1238.

Dr Swapnil Pawar is joined by Dr Jose Chacko to discuss the LOGICAL trial, published in the New England Journal of Medicine in June 2026. Does limiting oxygen after cardiac arrest protect the brain from reperfusion injury? LOGICAL (the largest randomised trial of oxygen therapy after cardiac arrest to date) randomised 1,840 patients across 53 ICUs in Australia, New Zealand and Ireland to conservative versus liberal oxygen therapy. In this episode: – The pathophysiological rationale: hypoxic-ischaemic encephalopathy, reperfusion injury and free radical damage – Where LOGICAL sits alongside EXACT, ICU-ROX, HOT-ICU and the Danish BOX trial – The Mega-ROX master protocol design, and why the sepsis and non-HIE brain injury arms are still to come – Trial design: SpO₂ upper limit of 95% and FiO₂ down to 0.21 in the conservative arm versus no upper limit and a floor of FiO₂ 0.3 in the liberal arm – The results: no difference in favourable neurological outcome at 180 days (38.2% vs 39.7%), survival, length of stay, quality of life or cognitive function – Strengths, limitations, and what it means at the bedside, including why the hosts have landed in different places on titrating down to room air Reference: The LOGICAL Investigators and the ANZICS Clinical Trials Group. Conservative Oxygen for Unresponsive Patients after Cardiac Arrest. N Engl J Med. 2026 Jun 10. Full summary, outcome tables and references at critcareedu.com.au

This week, we feature new research on polymyalgia rheumatica, hypercholesterolemia, prostate cancer, and multiple myeloma. We review evidence-based strategies for tobacco cessation, and follow a case of a woman with nausea, dizziness, and metabolic acidosis. We discuss recent advances in gene editing for rare metabolic diseases. Perspectives address HIV care, health care quality, medical ethics, and finding resilience in the face of serious illness.

Eric Schneider is an adjunct professor of health policy and management at the Harvard T.H. Chan School of Public Health and a member of the Journal's Perspective Advisory Board. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. M. Chernew and E.C. Schneider. Rethinking the Role of Pay for Performance in Federal Health Care Quality Programs. N Engl J Med 2026;395:625-628.

HEADLINES: One Nation senators turned their backs during the Acknowledgement of Country in Parliament. The life-saving devices on every NSW ambulance have just been pulled from sale, and paramedics are demanding answers. A reality TV contestant accused of beheading her partner has pleaded not guilty to murder, flagging a mental health defence. Meta, Google, Tiktok and Snapchat to face 3000 lawsuits over how addictive their platforms are for young users. Andrew and Tristan Tate are pushing to be released from federal custody. A young girl’s quick thinking has helped save a stranded humpback whale, and good news for the Great Barrier Reef. GET IN TOUCHGot a story, news tip-off, feedback or dilemma?Send us a voice note or email us at thequicky@mamamia.com.au CREDITSHost: Charlotte Mortlock Audio Producer: Scott Stronach Group Executive Producer: Georgie Page Check out The Quicky Instagram here and our TikTok here Discover more Mamamia podcasts here Did you know some of our shows are now in video on the Apple Podcast app? Make sure your phone is up to date and check it out here! Mamamia acknowledges the traditional owners of the land on which we have recorded this podcast.Become a Mamamia subscriber: https://www.mamamia.com.au/subscribeSee omnystudio.com/listener for privacy information.

This week, we feature new research on chronic kidney disease, high-risk prostate cancer, peripheral artery disease, and oxygen therapy after cardiac arrest. We review the evaluation and management of syncope, follow a challenging case of immune-related inflammatory illness, and report on Perspectives exploring pandemic preparedness, the Bundibugyo Ebola outbreak, and physician mental health.

Jean Nachega is a professor of infectious diseases and the director of the Biomedical Research Institute at Stellenbosch University and an associate professor at the University of Pittsburgh School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A. Zumla and Others. Ebola at 50 — Lessons for Outbreak Response and Preparedness. N Engl J Med 2026;395:527-529. S. Tonen-Wolyec and L. Bélec. The Social Contract of Bundibugyo Ebola Isolation. N Engl J Med. DOI: 10.1056/NEJMp2607429.

Featuring perspectives from Dr Joshua K Sabari, including the following topics: Heymach JV et al. Zongertinib in previously treated HER2-mutant non-small cell lung cancer. N Engl J Med 2025;392(23):2321-33. (0:00) Popat S et al. Zongertinib as first-line treatment in patients with advanced HER2-mutant NSCLC: Beamion LUNG-1. ESMO 2025;Abstract LBA74. (5:25) Le X et al. Sevabertinib in advanced HER2-mutant non-small cell lung cancer. N Engl J Med 2025;393(18):1819-32. (12:37) CME information and select publications

This week, we feature advances that may change care for prostate cancer, multiple myeloma, acute pain, and IgA nephropathy. We review platelet factor 4 disorders and follow a case of persistent nasal ulceration. Perspectives explore medical aid in dying, federal authority in health care, public health and litigation, and the challenge of delivering life-changing news with honesty and compassion.

Jerry Avorn is a professor of medicine at Harvard Medical School and the codirector of the Program on Regulation, Therapeutics, and Law at Harvard Medical School and Brigham and Women's Hospital. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. J. Avorn. Products That Pose Health Risks — Can Litigation Protect Us When Government Fails? N Engl J Med 2026;395:421-423.

CardioNerds (Drs. Apoorva Gangavelli, Jenna Skowronski, and Hannah Every) discuss the continuum of prevention and heart failure with Drs. Anu Lala and Martha Gulati. Grounded in a clinical case of a 55-year-old woman with uncontrolled hypertension, type 2 diabetes, and obesity who is on the trajectory toward heart failure, this episode unpacks a paradigm-shifting framework from a joint HFSA/ASPC Scientific Statement. The discussion explores how prevention should not be siloed from heart failure management but rather integrated across a patient’s lifespan—from primary prevention in at-risk individuals, to secondary prevention in those with established heart failure, to tertiary prevention in patients with advanced therapies such as LVADs and heart transplantation. The experts highlight the importance of aggressive risk factor management, biomarker-guided screening, the AHA’s Life’s Essential 8, and the need for multidisciplinary collaboration and systems-level change to shift heart failure care from reactive to proactive. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Systemic inflammatory diseases are associated with an elevated CVD risk that has significant implications for early detection, risk Heart failure prevention is a continuum, not a checkpoint. Prevention applies at every stage—from at-risk (Stage A) through advanced/post-transplant care—and every clinical encounter is an opportunity to intervene. The AHA’s Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep, BMI, blood lipids, blood glucose, blood pressure) forms the foundation at every stage. Hypertension carries the highest population-attributable risk for heart failure of any modifiable risk factor. In the Framingham Heart Study, 91% of patients with newly diagnosed HF had pre-existing hypertension. The SPRINT trial demonstrated a 38% reduction in HF incidence with intensive blood pressure targets (30 ng/L or NT-proBNP >125 ng/L) identify individuals at heightened risk for progression to symptomatic HF. The ACC/AHA/HFSA guidelines give a Class IIa recommendation for natriuretic peptide screening in at-risk patients. Urine albumin-to-creatinine ratio (UACR) is an underutilized screening tool that provides additional insight into CKM risk. The heart failure label does not close the prevention window—it accentuates it. Secondary prevention through GDMT optimization (quadruple therapy in HFrEF) and continued risk factor management remains critical. Tertiary prevention extends to post-LVAD and post-transplant patients, where hypertension, diabetes, obesity, and CKD management remain essential to long-term outcomes. Show notes For a comprehensive review, please review the full HFSA/ASPC Joint Scientific Statement: Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine. J Card Fail. 2026;32:75-105. doi:10.1016/j.cardfail.2025.06.013 1. What is the “continuum of prevention” framework, and how does it differ from traditional approaches to heart failure prevention? Historically, prevention and heart failure management have been treated as separate disciplines—primary prevention handled by preventive cardiologists and treatment managed by heart failure specialists. This joint HFSA/ASPC Scientific Statement reframes prevention as a dynamic, continuous process that spans a patient’s entire lifespan, regardless of HF stage or ejection fraction. The framework maps onto the ACC/AHA HF staging system: Primary prevention targets Stage A (“at risk”) and Stage B (“pre-HF”) patients to reduce the burden of incident HF. Secondary prevention targets Stage C (symptomatic) and Stage D (advanced) patients to reduce the impact of established HF through GDMT optimization and ongoing risk factor management. Tertiary prevention encompasses risk factor management in patients with LVADs or heart transplants—populations where hypertension, diabetes, and obesity still drive outcomes. The Central Figure of the statement illustrates that Life’s Essential 8 (blood pressure and lipid control, diabetes management, exercise, sleep, smoking cessation, weight management, and diet/nutrition counseling) forms the foundation at every stage, with pharmacologic and device-based therapies layered on top as disease progresses (Figure) 2. How do traditional risk factors drive heart failure, and what should clinicians prioritize? Hypertension carries the greatest population-attributable risk for HF. In the Framingham Heart Study (N=5,143), HTN was associated with a 2- to 3-fold increased risk of HF, with a population-attributable risk of 39% in men and 59% in women. The SPRINT trial showed a 38% reduction in HF incidence and 25% reduction in the primary composite outcome with intensive BP targets (30 ng/L or NT-proBNP >125 ng/L) are associated with heightened risk for progression to symptomatic HF. In the ARIC study, incorporating NT-proBNP reclassified 20% of older adults without HF into Stage B. Factors that affect interpretation include age, sex, obesity (lower values), and CKD (higher values). High-sensitivity cardiac troponin (hs-cTn): Concentrations above the 99th percentile are now included in the definition of Stage B HF. Troponin testing may complement natriuretic peptides, particularly when BNP/NT-proBNP values are ambiguous. Risk scores: The PCP-HF equation predicts 10-year HF risk using traditional risk factors plus QRS duration. The AHA PREVENT score incorporates HF risk calculation and includes markers of kidney function (albuminuria, eGFR), though it may underestimate risk in men and Black adults. The CKM syndrome staging framework (Stages 0–4) provides a holistic approach to assessing systemic cardiovascular-kidney-metabolic risk. 4. What are the key nontraditional risk factors and cross-cutting themes in heart failure prevention? Genetics: Pathogenic cardiomyopathy variants exist in ~1 in 200 individuals in the general population. The HFSA and ACMG recommend cascade testing to identify at-risk family members. Polygenic risk scores for dilated cardiomyopathy show a 3.8-fold risk for DCM in the top 10th percentile compared with the median. Sex-specific considerations: Women have 2.8 times the odds of developing HFpEF, while men have similarly increased odds of HFrEF. A complete obstetric/gynecologic history is essential—preeclampsia is associated with a 4-fold increased risk of HF. Peripartum cardiomyopathy requires intentional screening in high-risk populations. Cardiotoxic exposures: Clinicians should be aware of medications that cause direct myocardial toxicity (e.g., anthracyclines, trastuzumab, tyrosine kinase inhibitors). A team-based approach with pharmacists can help optimize medication selection and risk factor modification. Social determinants of health: Environmental exposures (air pollution, arsenic, lead, cadmium), food insecurity, financial instability, and limited healthcare access contribute to HF risk and progression. Equity-focused, risk-based prevention strategies are needed. Psychological health: Depression is common in HF and independently associated with worse outcomes. Screening with brief questionnaires (e.g., PHQ-2) is recommended. Meditation, spirituality, and holistic wellness approaches remain underutilized. 5. What systems-level and policy changes are needed to move the needle on heart failure prevention? Multidisciplinary HF prevention clinics that bring together preventive cardiologists, HF specialists, endocrinologists, nephrologists, dietitians, pharmacists, exercise physiologists, and genetic counselors are advocated by the statement. EHR-embedded risk stratification could proactively flag patients on a trajectory toward HF—analogous to sepsis alerts or fall risk flags—enabling earlier intervention, particularly for patients who may not reach a cardiologist. Cardiac rehabilitation remains underutilized, particularly in HFrEF (Class 2b recommendation) and HFpEF (not yet covered by Medicare). The HF-ACTION trial showed quality-of-life benefits, and the REHAB-HF trial showed particular benefit in older patients with HFpEF. Policy priorities include expanding insurance coverage for preventive screening and novel therapies (SGLT2i, GLP-1 RAs, nsMRAs), reducing clinical inertia through team-based care models with closer follow-up intervals, and ensuring equitable access to evidence-based therapies across diverse populations. Digital health and AI hold promise for personalized risk prediction, remote monitoring (e.g., wearable devices, implantable PA pressure monitors), and virtual cardiac rehabilitation to overcome access barriers. Figure  Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013) References Key references are bolded. Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. 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JAMA. 1996;275(20):1557-1562. doi:10.1001/jama.1996.03530440037034 Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997. doi:10.1001/jama.288.23.2981 Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145-153. doi:10.1056/NEJM200001203420301 Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa1504720 Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa2107038 Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286 Filippatos G, Anker SD, Agarwal R, et al. Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes: analyses from the FIGARO-DKD trial. Circulation. 2022;145(6):437-447. doi:10.1161/CIRCULATIONAHA.121.057983 Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475-1485. doi:10.1056/NEJMoa2407107 Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563 Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. Lancet. 2024;404(10454):773-786. doi:10.1016/S0140-6736(24)01498-3  Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963 Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636-1664. doi:10.1161/CIR.0000000000001175 Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):430-449. doi:10.1161/CIRCULATIONAHA.123.067626 Khan SS, Ning H, Shah SJ, et al. 10-year risk equations for incident heart failure in the general population. J Am Coll Cardiol. 2019;73(19):2388-2397. doi:10.1016/j.jacc.2019.02.057 Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC expert panel. J Am Coll Cardiol. 2021;77(11):1454-1469. doi:10.1016/j.jacc.2021.01.030 Packer M. Leptin-aldosterone-neprilysin axis: identification of its distinctive role in the pathogenesis of the three phenotypes of heart failure in people with obesity. Circulation. 2018;137(15):1614-1631. doi:10.1161/CIRCULATIONAHA.117.032474 Lala A, Tayal U, Hamo CE, et al. Sex differences in heart failure. J Card Fail. 2022;28(3):477-498. doi:10.1016/j.cardfail.2021.10.006 Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure. Eur J Heart Fail. 2021;23(3):352-380. doi:10.1002/ejhf.2115 Hershberger RE, Givertz MM, Ho CY, et al. Genetic evaluation of cardiomyopathy—a Heart Failure Society of America practice guideline. J Card Fail. 2018;24(5):281-302. doi:10.1016/j.cardfail.2018.03.004 Levine GN, Cohen BE, Commodore-Mensah Y, et al. 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¿Has escuchado maravillas sobre medicamentos como Ozempic, Wegovy o Mounjaro, pero nadie te habla de las constantes náuseas y el malestar estomacal? La realidad clínica es que una gran parte de los pacientes abandonan estos tratamientos para la obesidad simplemente porque los efectos secundarios arruinan su calidad de vida. Pero la ciencia médica está a punto de dar un salto monumental. En este episodio, descubriremos a la AMILINA, una hormona producida por tu páncreas que está demostrando resultados asombrosos en ensayos clínicos: pérdida de peso significativa sin los severos vómitos ni malestares intestinales de los fármacos actuales. En este episodio aprenderás: → Cómo tu páncreas libera dos hormonas cada vez que comes. → Cómo la amilina bloquea el freno metabólico que hace que recuperes el peso perdido. → Cómo dos equipos de investigadores resolvieron el mismo problema químico de formas distintas. → Cómo la combinación CagriSema alcanza una reducción significativa del peso corporal. → Por qué la amilina resensibiliza tu cerebro a la leptina, algo que la semaglutida no logra.   Mi nombre es Dr. Mauricio González, médico internista y especialista en endocrinología en formación. Aquí comparto información basada en evidencia para que tomes decisiones de salud sin mitos ni marketing engañoso. Suscríbete a mi boletín informativo en: www.drmauriciogonzalez.com/   ⚠️ Este podcast tiene fines exclusivamente educativos e informativos y no constituye asesoramiento médico, diagnóstico ni tratamiento personalizado. Los medicamentos que se discuten en este episodio se encuentran en fase de investigación y no cuentan con aprobación de la FDA. Consulta siempre a tu médico o a un profesional de la salud calificado antes de cambiar tu régimen de tratamiento.   ¡Sigamos la conversación en redes sociales! Instagram

This week, we bring you advances in pancreatic and bladder cancer, preventing gonorrhea, a promising new therapy for adolescent hypertrophic cardiomyopathy, and a review of antiretroviral treatment for HIV. We also follow a striking case of vision loss that led to an unexpected diagnosis and discuss Perspectives on vaccine evidence, hepatitis C elimination, the endorsements of prescription drugs on social media, and the enduring intersection of love and loss in medicine.

Arnold Monto is a professor emeritus of epidemiology and of public health and codirector of the Center for Respiratory Virus Research and Response at the University of Michigan School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. A.S. Monto and H.Y. Chu. The Best of Both Worlds — Using Clinical Trial and Observational Data to Evaluate Vaccine Protection. N Engl J Med 2026;395:313-316.

This week, we present advances in the treatment of multiple myeloma, systemic lupus erythematosus, and coronary artery disease, alongside new national data on health care–associated infections. We also review fibromyalgia and the emerging Bundibugyo virus outbreak, follow a surprising diagnostic case of alpha-gal syndrome, and explore Perspectives on caring for vulnerable patients, trustworthy health information, pharmacotherapeutic decisions in autism care, and the experience of caring for a parent with dementia.

Did you know that the average age of puberty onset in girls has been declining for decades, and that early puberty can have lasting psychological, social, and physical consequences? Roshni Patel, a fourth-year medical student at the Medical College of Georgia, and Bianca Forte, WHNP, a Women's Health Nurse Practitioner with a specialty in Pediatric and Adolescent Gynecology at Wellstar MCG Health, to discuss the recognition, evaluation, and management of precocious puberty in girls. Specifically, they will: Review the normal pubertal timeline and define precocious puberty in females Distinguish between premature thelarche, premature adrenarche, and precocious puberty through history and physical exam findings Discuss the initial diagnostic workup, including bone age studies, hormone levels, and the GnRH stimulation test Differentiate central precocious puberty from peripheral precocious puberty and outline appropriate management for each Address the mental health impact of early puberty and how to support young patients during the clinical encounter Identify when to refer patients to Pediatric Endocrinology or Pediatric and Adolescent Gynecology Special thanks to Dr. Rebecca Yang and Dr. Sarah Straka for peer reviewing this episode Free CME Available: Link Coming Soon! References: Aghaee S, Deardorff J, Quesenberry CP, Greenspan LC, Kushi LH, Kubo A. Associations Between Childhood Obesity and Pubertal Timing Stratified by Sex and Race/Ethnicity. Am J Epidemiol. 2022;191(12):2026-2036. doi:10.1093/aje/kwac148 Berberoğlu M. Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. J Clin Res Pediatr Endocrinol. 2009;1(4):164-174. doi:10.4274/jcrpe.v1i4.3 Carel JC, Léger J. Clinical practice. Precocious puberty. N Engl J Med. 2008;358(22):2366-2377. doi:10.1056/NEJMcp0800459 Dinkelbach L, Grasemann C, Kiewert C, Leikeim L, Schmidt B, Hirtz R. Central Precocious Puberty and Psychiatric Disorders. JAMA Netw Open. 2025;8(6):e2516679. Published 2025 Jun 2. doi:10.1001/jamanetworkopen.2025.16679 Eckert-Lind C, Busch AS, Petersen JH, et al. Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020;174(4):e195881. doi:10.1001/jamapediatrics.2019.5881 Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640 Joinson C, Heron J, Lewis G, Croudace T, Araya R. Timing of menarche and depressive symptoms in adolescent girls from a UK cohort. Br J Psychiatry. 2011;198(1):17-2. doi:10.1192/bp.110.080861 Kaplowitz PB. For Premature Thelarche and Premature Adrenarche, the Case for Waiting before Testing. Horm Res Paediatr. 2020;93(9-10):573-576. doi:10.1159/000512764 Klein DA, Emerick JE, Sylvester JE, Vogt KS. Disorders of Puberty: An Approach to Diagnosis and Management. Am Fam Physician. 2017;96(9):590-599. Kota AS, Sharma L, Ejaz S. Precocious Puberty. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544313/

CardioNerds co-chairs Dr. Dinu Balanescu and Dr. Billy Joe Mullinax, along with FIT lead Dr. Shiavax Rao, discuss the evolving landscape of randomized controlled trials in pulmonary embolism with Dr. Jay Giri, interventional cardiologist, Associate Professor of Medicine, and Director of the Cardiovascular Catheterization Laboratories at the Hospital of the University of Pennsylvania. This episode examines the historical evidence behind systemic thrombolysis, the emergence of catheter-directed therapies and mechanical thrombectomy, and the landmark RCTs – STORM-PE, PEERLESS, HI-PEITHO, and PEERLESS II – that are reshaping intermediate-risk PE management. The discussion highlights challenges in PE trial design, the critical importance of clinical deterioration as an endpoint, and why this era represents an unprecedented wave of evidence generation in PE. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls: Systemic thrombolysis in intermediate-risk PE reduces hemodynamic decompensation but at the cost of ~1.5–2% intracranial hemorrhage risk – a near-zero net benefit that has driven the search for safer catheter-based alternatives. “Focus on clinical deterioration, not mortality” – Due to crossover design in contemporary PE RCTs, control-arm patients who decompensate are rescued with advanced therapies, biasing mortality toward the null. Clinical deterioration is the most informative endpoint to watch in HI-PEITHO, PRAGUE-26, and PEERLESS II. HI-PEITHO is the first large RCT to demonstrate that catheter-directed fibrinolysis plus anticoagulation significantly reduces the composite of PE-related death, cardiorespiratory decompensation, or PE recurrence versus anticoagulation alone (RR 0.39; 95% CI 0.20–0.77; P=0.005), with no intracranial hemorrhage in either arm. The four major upcoming/recently reported PE RCTs (HI-PEITHO, PRAGUE-26, PEERLESS II, PE-TRACT) enroll progressively different risk populations – from the most enriched (HI-PEITHO) to the most permissive (PE-TRACT, which includes intermediate-low risk patients) – enabling a nuanced understanding of which patients benefit most from intervention. PE device clearance follows a fundamentally different FDA pathway than structural heart devices (single-arm safety/efficacy studies vs. mandated RCTs), yet market forces and clinical need have ultimately driven industry and government to sponsor large-scale RCTs – a lesson in how evidence development can evolve organically alongside regulatory frameworks. Notes: Notes drafted by Dr. Shiavax Rao. Question #1: What is the current evidence behind advanced PE therapies? Systemic thrombolysis: Sixteen RCTs over 40 years (1972–2014) enrolling nearly 2,000 patients have studied systemic thrombolysis in intermediate-risk PE. The landmark PEITHO trial (n=1,006) showed that tenecteplase reduced the composite of death or hemodynamic collapse (2.6% vs. 5.6%; P=0.015), driven primarily by reduced hemodynamic decompensation (1.6% vs. 5.0%; P=0.002). However, this came at the cost of increased major bleeding (6.3% vs. 1.5%; P

This week, we present advances in the treatment of idiopathic pulmonary fibrosis, hypothalamic obesity, and lung cancer. We review nutrition in critical illness and follow a diagnostic case involving a patient who had a lung transplant. The Editors warn about the politicization of science. We discuss the dead donor rule in an era of voluntary euthanasia. Perspectives explore the forthcoming crisis in long-term care, reproductive medicine, and the realities of caring for loved ones at the end of life.