Podcasts about pmid

LISTENER DISCRETION IS ADVISED. Kim YG, Choi YY, Han KD, Min K, Choi HY, Shim J, Choi JI, Kim YH. Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias. Sci Rep. 2021 Sep 13;11(1):18111. doi: 10.1038/s41598-021-97335-y. PMID: 34518592 Ren J, Yang Y, Zhu J, Wu S, Wang J, Zhang H, Shao X. The use of intravenous amiodarone in patients with atrial fibrillation and Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol. 2021 Jan;44(1):35-43. doi: 10.1111/pace.14113. Epub 2020 Dec 9. PMID: 33118640.

In this Thoracic Surgery episode of Behind the Knife we enjoy a conversation with world-renowned thoracic surgeon and educator, Dr. Stephen Yang, as he takes us through 30 years of experience divulging his personal tips, tricks, and pitfalls to avoid when tackling the technical nuances of mastering robotic segmentectomies. Hosts:  Dr. Stephen C. Yang, MD -  professor of surgery and medical oncology The Johns Hopkins Hospital Dr. Kyla D. Rakoczy, MD - PGY3 General Surgery Resident at The Johns Hopkins Hospital Learning Objectives: Understand the utility of segmentectomies for peripheral T1N0 non-small-cell-lung cancer  How to prepare for robotic segmentectomy using CT scans and 3D reconstructions  Learn where to place your ports and how to optimize intra-operative techniques to minimize complications after robotic segmentectomy  References: Kang MW. Evolution of Lung Cancer Surgery: Historical Milestones, Current Strategy, and Future Innovations. J Chest Surg. 2025 May 5;58(3):79-84. doi: 10.5090/jcs.25.025. Epub 2025 Apr 15. PMID: 40230346; PMCID: PMC12066400. https://pubmed.ncbi.nlm.nih.gov/40230346/ Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995 Sep;60(3):615-22; discussion 622-3. doi: 10.1016/0003-4975(95)00537-u. PMID: 7677489. https://pubmed.ncbi.nlm.nih.gov/7677489/ Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for Stage I lung cancer. Eur J Surg Oncol. 1991 Feb;17(1):42-6. PMID: 1995356. https://pubmed.ncbi.nlm.nih.gov/1995356/ Liu L, Aokage K, Chen C, Chen C, Chen L, Kim YH, Lee CY, Liu C, Liu CC, Nishio W, Suzuki K, Tan L, Tseng YL, Yotsukura M, Watanabe SI. Asia expert consensus on segmentectomy in non-small cell lung cancer: A modified Delphi study. JTCVS Open. 2023 Apr 7;14:483-501. doi: 10.1016/j.xjon.2023.03.013. PMID: 37425437; PMCID: PMC10328970. https://pubmed.ncbi.nlm.nih.gov/37425437/ Galvez C, Bolufer S, Lirio F, Recuero JL, Córcoles JM, Socci L, Cabañero A, López I, Sánchez D, Figueroa S, Salcedo JG, Campo-Cañaveral JL, Genovés M, Hernando F, Moldes M, Blanco A, Azcarate L, Rivo E, Viti A, Mongil R. "Complex segmentectomies: Comparison with simple and effect of experience on postoperative outcomes". Eur J Surg Oncol. 2025 Jul;51(7):109748. doi: 10.1016/j.ejso.2025.109748. Epub 2025 Mar 5. PMID: 40064065. https://pubmed.ncbi.nlm.nih.gov/40064065/ Perroni G, Veronesi G. Robotic segmentectomy: indication and technique. J Thorac Dis. 2020 Jun;12(6):3404-3410. doi: 10.21037/jtd.2020.02.53. PMID: 32642266; PMCID: PMC7330783. https://pubmed.ncbi.nlm.nih.gov/32642266/ Montagne, F., Dhainaut, C., & Benhamed, L. M. (n.d.). Pre-operative 3D reconstruction—let's first anticipate the surgical procedure. Video-Assisted Thoracic Surgery. Retrieved November 13, 2025, from https://vats.amegroups.org/article/view/7889/html Shimizu K, Nakazawa S, Nagashima T, Kuwano H, Mogi A. 3D-CT anatomy for VATS segmentectomy. J Vis Surg. 2017 Jul 1;3:88. doi: 10.21037/jovs.2017.05.10. PMID: 29078650; PMCID: PMC5637987. https://pubmed.ncbi.nlm.nih.gov/29078650/ Zhang O, Alzul R, Carelli M, Melfi F, Tian D, Cao C. Complications of Robotic Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy for Resectable Non-Small Cell Lung Cancer. J Pers Med. 2022 Aug 12;12(8):1311. doi: 10.3390/jpm12081311. PMID: 36013260; PMCID: PMC9410342. https://pubmed.ncbi.nlm.nih.gov/36013260/ Lee BE, Altorki N. Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer. Cancers (Basel). 2023 May 25;15(11):2914. doi: 10.3390/cancers15112914. PMID: 37296877; PMCID: PMC10251869. https://pubmed.ncbi.nlm.nih.gov/37296877/ Zhang Y, Liu S, Han Y, Xiang J, Cerfolio RJ, Li H. Robotic Anatomical Segmentectomy: An Analysis of the Learning Curve. Ann Thorac Surg. 2019 May;107(5):1515-1522. doi: 10.1016/j.athoracsur.2018.11.041. Epub 2018 Dec 19. PMID: 30578780. https://pubmed.ncbi.nlm.nih.gov/30578780/ Peeters M, Jansen Y, Daemen JHT, van Roozendaal LM, De Leyn P, Hulsewé KWE, Vissers YLJ, de Loos ER. The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review. Transl Lung Cancer Res. 2024 Mar 29;13(3):612-622. doi: 10.21037/tlcr-23-807. Epub 2024 Mar 27. PMID: 38601441; PMCID: PMC11002498. https://pubmed.ncbi.nlm.nih.gov/38601441/ Altorki N, Wang X, Damman B, Mentlick J, Landreneau R, Wigle D, Jones DR, Conti M, Ashrafi AS, Liberman M, de Perrot M, Mitchell JD, Keenan R, Bauer T, Miller D, Stinchcombe TE. Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance). J Thorac Cardiovasc Surg. 2024 Jan;167(1):338-347.e1. doi: 10.1016/j.jtcvs.2023.07.008. Epub 2023 Jul 18. Erratum in: J Thorac Cardiovasc Surg. 2025 Apr;169(4):1181. doi: 10.1016/j.jtcvs.2024.12.011. PMID: 37473998; PMCID: PMC10794519. https://pubmed.ncbi.nlm.nih.gov/37473998/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode of the Epigenetics Podcast, we talked with Fides Zenk from the École polytechnique fédérale de Lausanne about her work on transgenerational inheritance in Drosophila and brain organoids for human development insights. Dr. Zenk begins by sharing her journey into the field of biology, revealing her childhood fascination with nature and the intricate details of plant development. Her transition from an interest in ecology to a deep dive into molecular biology and gene regulation lays the groundwork for understanding her current research focus. We explore how her early experiences continue to shape her scientific curiosity, particularly her passion for studying cellular changes over time during embryonic development. As the conversation progresses, Dr. Zenk paints a vivid picture of her work at EPFL, where she combines functional genomics, chromatin profiling, and molecular biology techniques. She elaborates on her initial research during her PhD with Nicola Iovino, where she investigated the transgenerational inheritance of histone modifications in Drosophila. This discussion includes fascinating insights into how histone modifications can carry information across generations and their implications in gene expression regulation during early embryonic stages. Dr. Zenk also provides a glimpse into her postdoctoral work with Barbara Treutlein, where she shifted focus to human models and quantitative analysis using brain organoids. This segment of the episode reveals her commitment to translating molecular mechanisms to human health, especially in understanding the intricacies of brain development and neurogenesis. She describes how her team mapped dynamic changes in histone modifications during critical developmental stages, integrating various data modalities to build an intricate developmental atlas.   References Zenk F, Loeser E, Schiavo R, et al. Germ line-inherited H3K27me3 restricts enhancer function during maternal-to-zygotic transition. Science (New York, N.Y.). 2017 Jul;357(6347):212-216. DOI: 10.1126/science.aam5339. PMID: 28706074. Zenk F, Zhan Y, Kos P, et al. HP1 drives de novo 3D genome reorganization in early Drosophila embryos. Nature. 2021 May;593(7858):289-293. DOI: 10.1038/s41586-021-03460-z. PMID: 33854237; PMCID: PMC8116211. Zenk F, Fleck JS, Jansen SMJ, et al. Single-cell epigenomic reconstruction of developmental trajectories from pluripotency in human neural organoid systems. Nature Neuroscience. 2024 Jul;27(7):1376-1386. DOI: 10.1038/s41593-024-01652-0. PMID: 38914828; PMCID: PMC11239525. Related Episodes The Role of Small RNAs in Transgenerational Inheritance in C. elegans (Oded Rechavi) Mapping the Epigenome: From Arabidopsis to the Human Brain (Joseph Ecker) Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

In the original Løvset maneuver (described for breech presentations), the fetus is rotated in one direction to facilitate arm delivery. For shoulder dystocia, the reverse Løvset applies rotation in the opposite direction—specifically rotating the posterior shoulder toward a "belly down" position through up to 180 degrees of rotation. These maneuvers were first described by Norwegian obstetrician Jørgen Løvset in the 1940s. Now, in the current November 2025 AJOG, this maneuver is back in the spotlight. In this episode, we will review the reverse Løvset maneuver for shoulder dystocia and review its effectiveness. Which maneuver is more likely to result in fetal brachial plexus injury? Listen in for details. 1. A critical evaluation of the external and internal maneuvers for resolution of shoulder dystocia, March 2024; AJOG. https://www.ajog.org/article/S0002-9378(23)00022-4/fulltext2. Grindheim, Sindre et al.Reverse Løvset maneuver for shoulder dystocia, American Journal of Obstetrics & Gynecology, Volume 233, Issue 5, 505.e1 - 505.e43. Leung TY, Stuart O, Suen SS, Sahota DS, Lau TK, Lao TT. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG. 2011 Jul;118(8):985-90. doi: 10.1111/j.1471-0528.2011.02968.x. Epub 2011 Apr 12. PMID: 21481159.4. Grobman WA, Miller D, Burke C, Hornbogen A, Tam K, Costello R. Outcomes associated with introduction of a shoulder dystocia protocol. Am J Obstet Gynecol. 2011;205(6):513−517.STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Episodio 1236 en colaboración con MerckDentro de la campaña "Impulsando el crecimiento, inspirando confianza" de Merck en este episodio hablamos sobre el déficit de hormona de crecimiento, una enfermedad que genera un gran impacto en la vida de los niños que conviven con ella y la de sus familias.Para conocer mejor en qué consiste, el funcionamiento de la hormona del crecimiento, la importancia de su detección temprana y de su tratamiento, hablamos con la Dra. Rosenova, endocrina pediátrica del IMED Valencia.Estudio referenciado:Backeljauw P, Cappa M, Kiess W, Law L, Cookson C, Sert C, Whalen J, Dattani MT. Impact of short stature on quality of life: A systematic literature review. Growth Horm IGF Res. 2021 Apr-Jun;57-58:101392. doi: 10.1016/j.ghir.2021.101392. Epub 2021 Apr 30. PMID: 33975197.https://pubmed.ncbi.nlm.nih.gov/33975197/ Web: https://madresfera.com/Newsletter: https://www.madresfera.com/newsletter/ Música: #mobygratis https://mobygratis.com/Conviértete en un seguidor de este podcast: https://www.spreaker.com/podcast/buenos-dias-madresfera--2023835/support.

Does soot in the airway always mean an immediate intubation? Join our Burn Team as they debunk common myths surrounding inhalation injury and distinguish true airway threats from superficial flash burns. We break down critical management strategies, from the 'HAM' protocol to ventilator management, and explain why these patients require massive fluid resuscitation. Tune in to master these high-stakes clinical decisions and ensure you are ready for your next burn patient. Hosts: - Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento - Laura Johnson – Grady Memorial Hospital - Lauren Nosanov – Grady Memorial Hospital - Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans Learning Objectives: - Recognize the clinical features and diagnostic challenges of inhalation injury in burn patients, including differentiation from thermal airway injury and flash burns. - Apply evidence-based criteria to guide intubation and ventilatory management, including the avoidance of unnecessary intubation. - Implement key principles of supportive care and complication prevention, including fluid resuscitation, pharmacologic therapies, and long-term airway considerations. References: - Hope E Werenski, Anju Saraswat, James H Holmes, John K Bailey, Is Burn Center Admission Necessary After Home Oxygen Ignition Injury?, Journal of Burn Care & Research, 2025;, iraf189, https://doi.org/10.1093/jbcr/iraf189 - Kathleen S. Romanowski, Tina L. Palmieri, Soman Sen, David G. Greenhalgh, More Than One Third of Intubations in Patients Transferred to Burn Centers are Unnecessary: Proposed Guidelines for Appropriate Intubation of the Burn Patient, Journal of Burn Care & Research, Volume 37, Issue 5, September-October 2016, Pages e409–e414, https://doi.org/10.1097/BCR.0000000000000288 https://pubmed.ncbi.nlm.nih.gov/26284640/ - Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, Cancio LC, Chung KK. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015 Oct 28;19:351. doi: 10.1186/s13054-015-1077-4. PMID: 26507130; PMCID: PMC4624587. https://pubmed.ncbi.nlm.nih.gov/26507130/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this uplifting episode, hosts Beth Glassman and Cathy Gildenhorn sit down with Leanna Scaglione, a powerhouse rare disease advocate and marathon runner living with NF2-Related Schwannomatosis (NF2-SWN), formerly known as neurofibromatosis type 2. Diagnosed at just 16 years old, Leanna's life changed dramatically when tumors were discovered in her nervous system, a hallmark of NF2-SWN. Many would have slowed down. Instead, Leanna sped up. Today, she has: Completed multiple marathons, including Berlin and New York City Participated in clinical trials Become an advocate and 2025 Ambassador for the Children's Tumor Foundation Set her sights on becoming the first person with NF2 to complete all 7 Abbott World Marathon Majors Her message is powerful: a diagnosis doesn't define the finish line. In This Episode, We Discuss: What NF2-SWN is and how it impacts the nervous system The emotional toll of receiving a life-altering diagnosis as a teenager Losing a dream — and finding a new one Running marathons through surgeries, treatments, and uncertainty How advocacy and visibility can change the rare disease landscape Building a life rooted in resilience, purpose, and possibility About Our Guest: Leanna Scaglione is 34 years old living with NF2-Related Schwannomatosis (NF2-SWN). Ever since being diagnosed at 16 years old, she has refused to live defined by her diagnosis. From relearning to walk, participating in immunotherapy drug trials, and going through numerous surgeries she has defied the odds against her. Most recently she has undergone surgery to remove her right acoustic neuroma. She continues to live her best life as an endurance runner, sharing her story and experiences living with NF2 in hopes to spread awareness, motivate her community and rally for a cure. Resources:  Children's Tumor Foundation NF2 Accelerator: A Strategic Portfolio Approach to End NF2 Articles Explaining NF2 MedlinePlus GeneReviews National Organization for Rare Disorders (NORD) Research from China that Leanna reference for a gene therapy for NF2 Yuan R, Wang B, Wang Y, Liu P. Gene Therapy for Neurofibromatosis Type 2-Related Schwannomatosis: Recent Progress, Challenges, and Future Directions. Oncol Ther. 2024 Jun;12(2):257-276. doi: 10.1007/s40487-024-00279-2. Epub 2024 May 17. PMID: 38760612; PMCID: PMC11187037. Additional Research Articles Alexandra K. O'Donohue, Samantha L. Ginn, Gaetan Burgio, Yemima Berman, Gabriel Dabscheck, Aaron Schindeler, The evolving landscape of NF gene therapy: Hurdles and opportunities, Molecular Therapy Nucleic Acids, Volume 36, Issue 1, 2025, 102475 ,ISSN 2162-2531, https://doi.org/10.1016/j.omtn.2025.102475. Connect With Us:   Stay tuned for the next new episode of “It Happened To Me”! In the meantime, you can listen to our previous episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “It Happened To Me”.  “It Happened To Me” is created and hosted by Cathy Gildenhorn and Beth Glassman. DNA Today's Kira Dineen is our executive producer and marketing lead. Amanda Andreoli is our associate producer. Ashlyn Enokian is our graphic designer. See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, ItHappenedToMePod.com. Questions/inquiries can be sent to ItHappenedToMePod@gmail.com. 

Enid Martinez, MD is a Senior Associate in Critical Care at Boston Children's Hospital, and an Assistant Professor of Anaesthesia at Harvard Medical School. She is the Director of the Pediatric Critical Care Nutrition Program in the Division of Critical Care Medicine and Principal Investigator for a clinical-translational research program on gastrointestinal function and nutrition in pediatric critical illness. Learning Objectives:By the end of this podcast, listeners should be able to:Recognize the impact of nutritional status on outcomes of critically-ill children.Describe the key aspects of the metabolic stress response in critical illness.Discuss a clinical approach to accurately estimating and prescribing nutrition in critically-ill children.Reflect on an expert's approach to managing aspects of nutrition in critically-ill children where there may not be high-quality evidence. Selected references:Mehta et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):706-742. doi: 10.1177/0148607117711387. Epub 2017 Jun 2. PMID: 28686844. Fivez et al. Early versus Late Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1111-22. doi: 10.1056/NEJMoa1514762. Epub 2016 Mar 15. PMID: 26975590.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

If a supplement offered to make you run faster and lower your risk of injury, you think it's too good to be true. But with carbohydrates during your run, it is true! Fueling with 60-90 grams of carbs per hour on long runs and races will improve your performance and reduce injury risk. We delve deep into the science around gels and sports drinks during your runs. After listening, you'll feel more confident about how to fuel your runs to race your fastest and feel your best.Thank you to our sponsors:✨ Previnex: Previnex creates clinically effective, third-party tested supplements made with high-quality ingredients, including Muscle Health Plus (creatine). Use the code treadlightly for 15% off your first order at previnex.com✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts starting in December, when we'll be releasing special subscriber-only content!In this episode, you will learn:✅ Why you need to fuel long runs - and why you may be fueling less than you think you are✅ The performance benefits of intra-run fueling✅ Recommended carb ranges for long runs and races✅ If one big gel or several smaller gels per hour works better✅ The one piece of the fueling puzzle you can't skip✅ The risks of chronic under-fueling on runs✅ Do you need to fuel if doing long runs in zone 2?✅ Do fueling needs adjust based on body mass?✅ Should you fuel on shorter runs?If You Enjoyed this Episode, You May Also Like:

As promised, our host Dr, Ryan Moenster is back and breaking down the recently published ATS pneumonia guidelines — what's pneu, what's controversial, and what it means for your antimicrobial game! Dr. Whitney Hartlage (@whithartlage11) is back to join the conversation, plus fresh takes from Drs. Sharon Weissman and Sahil Angelo (@angelo_sahil). References: Am J Respir Crit Care Med. 2025 Jul 18. doi: 10.1164/rccm.202507-1692ST. Online ahead of print. IDSA Sepsis Task Force. Infectious Diseases Society of America (IDSA) POSITION STATEMENT: Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines. Clin Infect Dis. 2018 May 2;66(10):1631-1635. doi: 10.1093/cid/cix997. PMID: 29182749; PMCID: PMC6927848.

In dieser Folge sprechen wir über das perioperative Bridging bei Patientinnen und Patienten nach viszeralchirurgischen Eingriffen. Diese Analyse mit einem viszeralchirurgischen Patientenkollektiv bestätigt Ergebnisse der hochrangig publizierten Bridge-Studie (Douketis et al. 2015), in welcher ein therapeutisches Bridgen mit vermehrten Blutungsepisoden assoziiert war und ein Nicht-Bridgen nicht mit erhöhten thrombembolischen Ereignissen einherging.Moderation: Felix RühlmannGast: PD Tobias TichelbäckerBesprochene Publikation:Lock JF, Ungeheuer L, Borst P, Swol J, Löb S, Brede EM, Röder D, Lengenfelder B, Sauer K, Germer CT. Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery. Perioper Med (Lond). 2020 Nov 23;9(1):39. doi: 10.1186/s13741-020-00170-4. PMID: 33292504; PMCID: PMC7682086.

When considering the broad topic of the upper respiratory tract infection, catarrh and coryza is mentioned.  What are they and why do old and outdated medical terms still persist.   Check out the paper mentioned BLOOM H. Catarrh as a family illness. Proc R Soc Med. 1957 Mar;50(3):167-70. doi: 10.1177/003591575705000312. PMID: 13420158; PMCID: PMC1889102.     www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice, always consult your usual doctor 

Recurrent pregnancy loss (RPL) affects approximately 5% of couples and is an emotional burden on those affected. There is some evidence that vaginal progesterone supplementation may be considered in patients with recurrent pregnancy loss who are experiencing vaginal bleeding during the first trimester. But what about prophylactic low dose aspirin in the first trimester, or preconceptionally, for unexplained RPL? Is that evidence-based? A new publication from the SMFM's journal Pregnancy has examined this. Listen in for details. 1. 22 November 2025: Low-dose aspirin in unexplained recurrent pregnancy loss: A systematic review and meta-analysis (Pregnancy): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pmf2.700992. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, T. Flint Porter, Cynthia Gyanff-Bannerman, Tracy Manuck. Low-Dose Aspirin Use During Pregnancy. American College of Obstetricians and Gynecologists (2018)3. Naimi AI, Perkins NJ, Sjaarda LA, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth : Per Protocol Analysis of a Randomized Trial. Annals of Internal Medicine. 2021;174(5):595-601. doi:10.7326/M20-0469.4. Lee EE, Jun JK, Lee EB.Management of Women With Antiphospholipid Antibodies or Antiphospholipid Syndrome During Pregnancy. Journal of Korean Medical Science. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24.5. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

What does a goiter and syphilis have in common with the first descriptions of giant cell arteritis? Join us as we dive into the history of the most common type of vasculitis! Intro 0:13 GCA at ACR 2025 00:30 How Brown has approached framing this episode 1:01 A primer leading us to GCA 3:15 Let's get to the story 4:02 The man who couldn't wear a hat 4:57 Dr. Bayard Horton's 7:40 A tangent on cluster headaches 8:27 Let's get back to GCA 13:16 The first temporal artery biopsy 14:28 Vision loss and other puzzle pieces of GCA 16:27 What about jaw claudication? 21:15 Could GCA be transmissible? Injecting ground temporal arteries into healthy volunteers 24:13 Oxygen? Histamines? Adrenal cortical extract? Looking for GCA treatments 26:55 Steroids and GCA 28:40 A quote from the 1959 Mayo Clinic Board of Governors 32:24 Extracranial involvement in GCA 33:24 When did we recognize aorta involvement? Syphilis enters the picture 35:08 A recap of the history of GCA 41:25 Thanks for listening 42:19 We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Boes CJ, Cephalalgia. 2007;doi:10.1111/j.1468-2982.2007.01238.x Cummer CL, et al. JAMA. 1912;doi:10.1001/jama.1912.04270080101004 Horton BT, Proc Cent SOC Clin Res. 1946 Sproul EE, et al. Am J Pathol. 1937;PMID: 19970328 Disclosures: Brown reports no relevant financial disclosures.

In this World Shared Practice Forum Podcast, Dr. Vinay Nadkarni discusses emergent tracheal intubation in pediatric critical care. Drawing from the NEAR4KIDS registry and comparing with recent adult-focused evidence, Dr. Nadkarni discusses the challenges of airway management in children, emphasizing the importance of patient-specific physiology. He highlights how patient positioning and equipment choices can improve intubation outcomes. Additionally, the episode explores the benefits of video laryngoscopy and apneic oxygenation. This content is pertinent for healthcare professionals seeking to enhance their understanding of pediatric airway management, offering practical insights supported by recent research. LEARNING OBJECTIVES - Compare pediatric and adult emergency tracheal intubation evidence and practices - Explore the role of the NEAR4KIDS registry in improving pediatric intubation practices - Identify effective strategies to enhance first-attempt success in tracheal intubations - Assess the impact of patient positioning and equipment choices on intubation outcomes - Evaluate the benefits of video laryngoscopy and apneic oxygenation in pediatric settings AUTHORS Vinay Nadkarni, MD, MS Professor, Anesthesiology Critical Care and Pediatrics University of Pennsylvania Perelman School of Medicine Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: November 25, 2025. ARTICLES REFERENCED - DeMasi SC, Casey JD, Semler MW. Evidence-based Emergency Tracheal Intubation. Am J Respir Crit Care Med. 2025;211(7):1156-1164. doi:10.1164/rccm.202411-2165CI - Garcia-Marcinkiewicz AG, Kovatsis PG, Hunyady AI, et al. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial. Lancet. 2020;396(10266):1905-1913. doi:10.1016/S0140-6736(20)32532-0 - Hagberg CA, Artime CA, Aziz MF, eds. Hagberg and Benumof's Airway Management. 5th ed. Philadelphia, PA: Elsevier; 2023. - Khanam D, Schoenfeld E, Ginsberg-Peltz J, et al. First-Pass Success of Intubations Using Video Versus Direct Laryngoscopy in Children With Limited Neck Mobility. Pediatr Emerg Care. 2024;40(6):454-458. doi:10.1097/PEC.0000000000003058 - Waheed S, Kapadia NN, Jawed DR, Raheem A, Khan MF. Randomized controlled trial to assess the effectiveness of apnoeic oxygenation in adults using a low-flow or high-flow nasal cannula with head side elevation during endotracheal intubation in the emergency department. BMC Res Notes. 2025 Jul 1;18(1):264. doi: 10.1186/s13104-025-07328-7. Erratum in: BMC Res Notes. 2025 Sep 8;18(1):384. doi: 10.1186/s13104-025-07412-y. PMID: 40598378; PMCID: PMC12219693. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/mr2657n4ckgpz7g3tw37gbx/202511_WSP_Nadkarni_transcript Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Nadkarni V, Burns JP. Pediatric Intubation Practices: Insights from NEAR4KIDS. 11/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/pediatric-intubation-practices-insights-from-near4kids-by-v-nadkarni-openpediatrics.

Having data is sometimes different than having clinically applicable data. This is exactly the issue with the proposed plan to reduce surgical site infection (SSI) by changing surgical gloves after placental delivery at C-Section. Just 24 hours ago, we received the question from a PGY4 OBGYN resident asking whether the practice of changing surgical gloves at C-Section after placental delivery to reduce SSI was evidence-based. So, in this episode, we will review the data - which is timely since this was recently published on November 13, 2025 in the J Hospital Infection. This study follows a statement on this practice released by FIGO in September 2025. It's an interesting proposal, and there is clearly data in support of this, yet the ACOG and CDC do not recommend this practice as of Nov 2025. Is there a disconnect? Listen in for details. 1. FIGO: https://www.figo.org/news/new-ijgo-review-provides-comprehensive-framework-preventing-post-caesarean-sepsis (International Journal of Gynecology & Obstetrics)2. Stanberry B, Jordan L, Pullyblank A, Hargreaves J. Glove change during caesarean birth: impact on maternity service budgets and capacity. J Hosp Infect. 2025 Nov 13:S0195-6701(25)00354-8. doi: 10.1016/j.jhin.2025.10.033. Epub ahead of print. PMID: 41241232.3. Narice BF, Almeida JR, Farrell T, Madhuvrata P. Impact of Changing Gloves During Cesarean Section on Postoperative Infective Complications: A Systematic Review and Meta-Analysis. Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(9):1581-1594. doi:10.1111/aogs.14161.4. Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection (ChEETAh): A Pragmatic, Cluster-Randomised Trial in Seven Low-Income and Middle-Income Countries.NIHR Global Research Health Unit on Global Surgery. Lancet (London, England). 2022;400(10365):1767-1776. doi:10.1016/S0140-6736(22)01884-0.5. Gialdini C, Chamillard M, Diaz V, Pasquale J, Thangaratinam S, Abalos E, Torloni MR, Betran AP. Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews. EClinicalMedicine. 2024 May 19;72:102632. doi: 10.1016/j.eclinm.2024.102632. PMID: 38812964; PMCID: PMC11134562.

Contributor: Megan Hurley, MD Educational Pearls: Assess first: confirm the hook isn't near vital structures. Automatic subspecialty consult for eye involvement or proximity to carotid artery, radial artery, peritoneum, testicle, or urethra Barbed hook: cannot be pulled back through the entry without disengaging the barb Removal Techniques String-Pull: best for superficial, single-barbed hooks Depress shank and eye of hook to disengage barb and then pull string taut and jerk suddenly along the long axis Can only be used when the hook is in a body part that can be firmly secured so it won't move during the procedure Little or no anesthesia needed Push-Through & Snip: best choice when barb is near the skin surface Anesthetize first and advance the hook forward until the barb emerges. Cut off the barb and then back hook out Small exit wound, no sutures needed Needle Cover: for larger hooks that are superficial Anesthetize first and then slide an 18 or 20-gauge needle along the hook until the bevel covers the barb. Then back out the needle and hook together Cut-it-out: last resort Make an incision along the body of hook to barb and then remove hook Adjuncts: Hydrodissection with lidocaine along the tract can ease removal Post-Procedure Irrigate thoroughly and apply antibiotic ointment Routine prophylaxis not needed because complications are rare Consider prophylactic antibiotics if hook is deeply embedded in high-risk area or contaminated by fresh water or salt water References Aiello LP, Iwamoto M, Guyer DR. Penetrating ocular fish-hook injuries. Surgical management and long-term visual outcome. Ophthalmology. 1992 Jun;99(6):862-6. doi: 10.1016/s0161-6420(92)31881-0. PMID: 1630774. Malitz DI. Fish-hook injuries. Ophthalmology. 1993 Jan;100(1):3-4. doi: 10.1016/s0161-6420(93)31700-8. PMID: 8433823. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4

This month we are joined by Dr. Karen Meagher, Assistant Professor of Health Justice and Bioethics at the Lewis Katz School of Medicine at Temple University. Recently, Dr. Meagher was the Associate Director of public engagement in the Biomedical Ethics Research Program at the Mayo Clinic. Her research focuses on public health ethics and social implications of advances in microbial and human genetics. She has a PhD in philosophy from Michigan State University. From 2012-2016 she worked as a senior policy and research analyst on the staff of president Barak Obama's Presidential Commission for the study of bioethical issues.Listen in as Dr. Meagher shares her career journey starting with her undergraduate interest in the philosophy of science and social influences of how science gets done. She describes how she was drawn to the growing field of public health ethics, which blossomed in the early 2000s with increasing publications and dedicated journals. Dr. Meagher describes her Virtue Ethics orientation to public health ethics and shares the inside scoop on what it is like to serve on a Presidential Commission.Later in her career, embedded with Mayo clinic biobank, Dr. Meagher describes her experiences with public engagement with community and how bioethicists can be a bridge between basic scientists and the community when grappling with difficult ethical dilemmas like those dealing with broad consent for future research with banked specimens.Finally, we delve into a discussion of how Dr. Meagher's work on antimicrobial resistance led her to engage in concepts of One Health Policy, which recognizes the interdependence of people, animals and the environment. She highlights the importance of breaking down silos between researchers in different sectors and how bioethics can bridge disciplines and create shared moral language, while also centering engagement of communities to help define these problems from different perspectives. Selected publications of Dr. Meagher's which were referenced in the podcast can be found here:Meagher KM. Can One Health Policy Help Us Expand an Ethics of Interconnection and Interdependence? AMA J Ethics. 2024 Feb 1;26(2):E162-170. doi: 10.1001/amajethics.2024.162. PMID: 38306206.https://pubmed.ncbi.nlm.nih.gov/38306206/Meagher KM, Curtis SH, Gamm KO, Sutton EJ, McCormick JB, Sharp RR. At a Moment's Notice: Community Advisory Board Perspectives on Biobank Communication to Supplement Broad Consent. Public Health Genomics. 2020;23(3-4):77-89. doi: 10.1159/000507057. Epub 2020 May 12. PMID: 32396907.https://pubmed.ncbi.nlm.nih.gov/32396907/Meagher KM. Considering virtue: public health and clinical ethics. J Eval Clin Pract. 2011 Oct;17(5):888-93. doi: 10.1111/j.1365-2753.2011.01721.x. Epub 2011 Aug 11. PMID: 21834841.https://pubmed.ncbi.nlm.nih.gov/21834841/Meagher KM, Lee LM. Integrating Public Health and Deliberative Public Bioethics: Lessons from the Human Genome Project Ethical, Legal, and Social Implications Program. Public Health Rep. 2016 Jan-Feb;131(1):44-51. doi: 10.1177/003335491613100110. PMID: 26843669; PMCID: PMC4716471.https://pubmed.ncbi.nlm.nih.gov/26843669/

In this episode of Making Shift Happen, Coach Jen breaks down the REAL off-season training formula that helps mountain bikers and gravel cyclists get fitter without burnout. Learn how to reduce training volume, maintain motivation, build strength, and avoid trainer fatigue, all while setting yourself up for a stronger spring season. What You'll Learn: Why training less in winter can actually make you fitter How to reduce volume without losing performance The mental shift that keeps motivation alive How to keep indoor trainer sessions fun and doable The essential role of strength training in the off-season A simple, effective weekly winter training structure Why consistency beats intensity in the off-season How to avoid burnout and still improve fitness This is perfect for mountain bikers, gravel cyclists, busy professionals, and anyone who wants to maintain fitness without suffering through the winter. Plus, learn more about the #ShredStrong program’s winter phase that starts on January 5th – the ultimate off-season strength and conditioning plan for cyclists. Or, work with Jen 1:1 by applying to work with her here: https://wvy4j2tn9vy.typeform.com/to/efp8oWSk Check out these other relevant episodes: 230. Strength Training for Pain-Free Knees 226. Off-Season Strength Training for Cyclists: Build Your Best Season Yet 221. How to Develop Durability on the Bike Research referenced in this episode: PMID 40632222 #ShredStrong: Our Winter Cycle Starts on Monday, January 5, 2026! #ShredStrong is my year-round strength training program for mountain bikers and gravel cyclists. You can join any time you want, but we’re starting the main Winter cycle in January! Learn more about the program and sign-up HERE!  Do You Want a Coach to Help Make Training & Nutrition Easier and Simpler for You? Hi, it’s me.

Producer Madi educates the masses on teeth disease. Audio Intro: “Pantyhose” by TV GirlFrom the Free Music ArchiveCC BY NC 4.0Audio Outro: “Pantyhose” by TV GirlFrom the Free Music ArchiveCC BY NC 4.0“Necrotizing Periodontitis.” Center for Advanced Periodontics & Implant Dentistry, advancedperio.org/p/BLOG-106627-2023.8.7-Necrotizing-Periodontitis-p.asp.Ogunleye, Rachel, Obioma Ukoha, Weronika Nasterska, Ewen McColl, Fatima Dantata, and Ifeoluwa Adetula. “Necrotising Periodontal Diseases: An Update on Classification and Management.” BDJ Team, vol. 10, 2023, pp. 22–25. doi:10.1038/s41407-023-1749-x.Balaji, Thodur Madapusi, et al. “Necrotizing Periodontal Diseases in Human Immunodeficiency Virus-Infected Patients Receiving Highly Active Antiretroviral Therapy: A Review.” Disease-a-Month, vol. 67, no. 9, Sept. 2021, Art. 101168, doi:10.1016/j.disamonth.2021.101168.Novak, M. J. “Necrotizing Ulcerative Periodontitis.” Annals of Periodontology, vol. 4, no. 1, Dec. 1999, pp. 74-78. doi:10.1902/annals.1999.4.1.74Herrera, David, et al. “Acute Periodontal Lesions (Periodontal Abscesses and Necrotizing Periodontal Diseases) and Endo-Periodontal Lesions.” Journal of Clinical Periodontology, vol. 45, Suppl. 20, June 2018, pp. S78–S94. doi: 10.1111/jcpe.12941.Gasner NS, Brizuela M, Schure RS. Necrotizing Periodontal Diseases. 2025 Jul 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32491349.

Regional anesthesia, typically with a spinal or epidural, haslong been favored for cesarean births due in part to concerns about the effects that general anesthesia (GA) may have on newborns at delivery. However, data has shown that up to 1 in 6 women may experience pain with a “topped-off”labor epidural, during the cesarean. A new publication in the journal Anesthesia is now being interpreted as implying that general anesthesia may be a valid alternative electively. Is that what this new study found? Has GA been linked to postpartum depression? What about later child neurodevelopmental delays? This is a fascinating topic…Listen in for details. 1.     Langer, Sarah M.D.1; Lim, Grace M.D., M.Sc.2;Qiu, Yue M.D.3; Biaesch, Jingyuan D.O.4; Neuman, Mark D. M.D., M.Sc.5. NeonatalOutcomes with Regional versus General Anesthesia for Cesarean Delivery: AMeta-analysis of Randomized Controlled Trials. Anesthesiology():10.1097/ALN.0000000000005785, November 12, 2025. | DOI:10.1097/ALN.00000000000057852.     Guglielminotti J, Monk C, Russell MT, Li G.Association of General Anesthesia for Cesarean Delivery with PostpartumDepression and Suicidality. Anesth Analg. 2025 Sep 1;141(3):618-628. doi:10.1213/ANE.0000000000007314. Epub 2024 Dec 4. PMID: 39630595; PMCID:PMC12134152.3.     Chen, YC., Liang, FW., Tan, PH. et al.Association between general anesthesia for cesarean delivery and subsequentdevelopmental disorders in children: a nationwide retrospective cohort study.BMC Med 23, 119 (2025). https://doi.org/10.1186/s12916-025-03886-64.     https://www.pennmedicine.org/news/new-study-challenges-fears-about-general-anesthesia-during-c-section

Stop powering through the pain! Surgery is a high-performance sport, yet surgeons often operate with minimal support, leading to chronic pain and potential career-ending injuries. This episode dives into the crucial topic of surgical ergonomics, explaining why your posture, instrument size, and even hydration impact your performance and longevity. Learn essential OR hacks—from adjusting monitor height and using micro-break stretches to strategic pre-case fueling—to mitigate the physical toll. We also share candid stories from surgeons who faced debilitating injuries, providing critical advice on acknowledging pain, seeking help, and treating recovery like a full-time job. It's time to invest in your physical health, because your hands and posture are your most vital instruments. Hosts:  Agnes Premkumar, MD (General Surgery Resident at Creighton University) @agnespremkumar  Steven Thornton, MD (General Surgery Resident at Duke University) @swthorntonjr Guests: Kathryn Coan, MD (Dignity Health, Phoenix) Anathea Powell, MD (Renown Health, Reno) Danielle Tanner, MD (Creighton University, Phoenix) Dr. Kathryn Coan is an endocrine surgeon, and associate professor at the Creighton University School of Medicine in Phoenix. Outside of the OR, she enjoys being active such as playing golf, hockey, and hiking. Dr. Anathea Powell is a colorectal surgeon working at Renown Health in Reno, Nevada and the University of Nevada, Reno. Outside of the OR, she has certifications in personal training as well as coaching for nutrition, sleep and recovery, mobility, and menopause. She is also a former All American in triathlon and aquabike (swim-bike). Dr. Danielle Tanner is a PGY-5 at Creighton University School of Medicine in Phoenix and aspires to be a rural general surgeon. Publications and Applications Discussed: Black Belt Academic Surgical Skills: https://bbass.org/ Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018 Feb 21;153(2):e174947. doi: 10.1001/jamasurg.2017.4947. Epub 2018 Feb 21. PMID: 29282463; PMCID: PMC5838584. https://pubmed.ncbi.nlm.nih.gov/29282463/ Sutton E, Irvin M, Zeigler C, Lee G, Park A. The ergonomics of women in surgery. Surg Endosc. 2014 Apr;28(4):1051-5. doi: 10.1007/s00464-013-3281-0. PMID: 24232047. https://pubmed.ncbi.nlm.nih.gov/24232047/ Patel VR, Stearns SA, Liu M, Tsai TC, Jena AB. Mortality Among Surgeons in the United States. JAMA Surg. 2025 Sep 1;160(9):1032-1034. doi: 10.1001/jamasurg.2025.2482. PMID: 40737024; PMCID: PMC12311820. https://pubmed.ncbi.nlm.nih.gov/40737024/ Lee MR, Lee GI. Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery. J Gynecol Oncol. 2017 Sep;28(5):e70. doi: 10.3802/jgo.2017.28.e70. Epub 2017 Jun 23. PMID: 28657231; PMCID: PMC5540729. https://pubmed.ncbi.nlm.nih.gov/28657231/ Berguer R. The application of ergonomics in the work environment of general surgeons. Rev Environ Health. 1997 Apr-Jun;12(2):99-106. doi: 10.1515/reveh.1997.12.2.99. PMID: 9273926. https://pubmed.ncbi.nlm.nih.gov/9273926/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Thank you to our sponsors:✨ Previnex: Previnex creates clinically effective, third-party tested supplements made with high-quality ingredients, including Muscle Health Plus (creatine). Use the code treadlightly for 15% off your first order at previnex.com✨ Amazfit: User-friendly simple running watches with advanced features, at an affordable price point. Use link http://bit.ly/4nai73H for 10% off your purchase.✨ FlipBelt: Sleek storage options, including no-bounce running belts and shorts. Use code TLF20 at flipbelt.com for 20% off your purchase.In this episode, you will learn:✅ Is there such thing as too much running?✅ On the colon cancer and running study✅ Is too much running bad for your heart?✅ Does running help with mood disorders and mental health?✅ Age-related declines✅ Creating a training plan for running for healthField Tests for our Listener Question:Cooper test: After a 10-20 min warm-up, run as far as you can in 12 minutes. Record distance and enter into this calculator.1.5-mile run test: After a 10-20 min warm-up, run as fast as you can for 1.5 miles. Record distance and enter into this calculator.Lactate threshold test. After a 10-20 min warm-up, run 30 minutes as fast as you can (self-paced, even effort). Your average pace over the final 20 minutes is your velocity at second LT (60-min race pace) and your average HR over the final 20 min is your LTHR.If you enjoyed this episode, you may also like:

Dr. Julie Ann Justo is joined by experts Drs. Krista Gens and Javier A. Villafuerte Gálvez as they dive deep into the gut microbiome and explore the latest therapeutic frontier for C. difficile infections.  From bacteria battles to breakthrough treatments, this one's a must-listen! You can also review the helpful infographic on our website (https://breakpoints-sidp.org/infographics/). This podcast was supported by an unrestricted grant from Nestlé Health Science. References: Helpful review from one of our guest experts: Gens KD, et al. Fecal microbiota transplantation and emerging treatments for Clostridium difficile infection. J Pharm Pract. 2013 Oct;26(5):498-505. doi: 10.1177/0897190013499527. PMID: 23966282. More modern review: Herbin SR, et al. Breaking the Cycle of Recurrent Clostridioides difficile Infections: A Narrative Review Exploring Current and Novel Therapeutic Strategies. J Pharm Pract. 2024 Dec;37(6):1361-1373. doi: 10.1177/08971900241248883. Epub 2024 May 13. PMID: 38739837. Review on designing microbiota based therapies (pre-print only): Ke S, et al. Rational Design of Live Biotherapeutic Products for the Prevention of Clostridioides difficile Infection. 2024 May 02. doi: 10.1101/2024.04.30.591969. [FDA Guidance regarding IND requirements for fecal microbiota transplant](https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-regarding-investigational-new-drug-requirements-use-fecal-microbiota). 2022 Nov. OpenBiome webpage with resources for hospitals: How to Start an FMT Program. 2025. Peery AF, et al. AGA Clinical Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases. Gastroenterology. 2024 Mar;166(3):409-434. doi: 10.1053/j.gastro.2024.01.008. PMID: 38395525. Johnson S, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin Infect Dis. 2021 Sep 7;73(5):755-757. doi: 10.1093/cid/ciab718. PMID: 34492699. Henry Ford's experience getting fecal microbiota products for patients: Abene S. Fecal Microbiota Capsules Improve CDI Access Through Specialty Pharmacy Integration. Contagion Live. 2025 Jul 11. An international view on CDI management: Mendo-Lopez R, et al. Best Practices in the Management of Clostridioides difficile Infection in Developing Nations. Trop Med Infect Dis. 2024 Aug 19;9(8):185. doi: 10.3390/tropicalmed9080185. PMID: 39195623. Review on investigational LBP agents: Monday L, et al. Microbiota-Based Live Biotherapeutic Products for Clostridioides Difficile Infection- The Devil is in the Details. Infect Drug Resist. 2024 Feb 15;17:623-639. doi: 10.2147/IDR.S419243. PMID: 38375101. More on quorum sensing: Falà AK, et al. Quorum sensing in human gut and food microbiomes: Significance and potential for therapeutic targeting. Front Microbiol. 2022 Nov 25;13:1002185. doi: 10.3389/fmicb.2022.1002185. PMID: 36504831. Economic impacts of CDI pts: Reilly J, et al. Economic impact of multiple recurrent Clostridioides difficile infection in a community teaching hospital. Infect Control Hosp Epidemiol. 2025 Sep 29:1-3. doi: 10.1017/ice.2025.10295. Epub ahead of print. PMID: 41020576.

The term "hypnosis" was first described in 1843 byScottish surgeon James Braid, who published the book Neurypnology. He coined the term "hypnosis" from the Greek word for sleep to describe the trance-like state induced by focusing on a bright object. Self-hypnosis has nowbeen shown to aid in menopausal hot flash reduction! In this episode, we will review this brand new publication from JAMA Network which confirmed via a multicenter RCT that a simple daily hypnosis audio session was effective forsymptom relief. The study is the first to compare self-guided hypnosis with an active control condition (i.e. sham white noise control group). Listen in for details. 1.     Elkins G, Arring N, Morgan G, Lorenz T, Muniz V,Lafferty C, Scheffrahn K, Alldredge C, Barton D. Self-Administered Hypnosis vsSham Hypnosis for Hot Flashes: A Randomized Clinical Trial. JAMA Netw Open.2025 Nov 3;8(11):e2542537. doi: 10.1001/jamanetworkopen.2025.42537. PMID:41217756.2.     https://interestingengineering.com/health/hypnosis-lowers-menopause-hot-flashes 

A new prospective multicenter cohort of 250 patients with shock examines the safety and outcomes of peripheral vasopressor administration. Extravasation events were rare and clustered only after several days of infusion, while norepinephrine use and simple physiologic markers correlated with survival. In this episode, I translate the findings into bedside guardrails—which sites and gauges to use, how to monitor, and when to pivot to a central line.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation:Petros A, Melkie A, Kotiso KS, Kebede D, Oljira CF, Assefa Gemechu F, Yusuf H, Abebe S, Ashagre A, Bekele A, Yohannes A, Etesa EK, Bedru M, Gebremariam TH. Peripheral line for vasopressor administration: Prospective multicenter observational cohort study for survival and safety. PLoS One. 2025 Oct 13;20(10):e0333275. doi: 10.1371/journal.pone.0333275. PMID: 41082535; PMCID: PMC12517475.

The Research Round-Up returns! Hosts Silvia Radenkovic and Rodrigo Starosta are joined by Dr Hilary Vernon and Dr Austin Larson for a deep dive into the latest discoveries in mitochondrial disease. Together they explore how new biomarkers like FGF21 and GDF15 are reshaping diagnosis, how multi-omics approaches are accelerating precision care, and what large-scale data from gnomAD to stem-cell models is revealing about disease mechanisms and therapeutic opportunities. A lively, expert-led discussion connecting science, diagnostics, and patient impact across the mitochondrial field. Laricchia KM, et al Mitochondrial DNA variation across 56,434 individuals in gnomAD. Genome Res. 2022 Mar;32(3):569-582. doi: 10.1101/gr.276013.121. Epub 2022 Jan 24. PMID: 35074858; PMCID: PMC8896463. Liu O, et al FGF21 and GDF15 are elevated in Barth Syndrome and are correlated to important clinical measures. Mol Genet Metab. 2023 Nov;140(3):107676. doi: 10.1016/j.ymgme.2023.107676. Epub 2023 Aug 2. PMID: 37549445. Van Hove JLK, et al Protein biomarkers GDF15 and FGF21 to differentiate mitochondrial hepatopathies from other pediatric liver diseases. Hepatol Commun. 2024 Jan 5;8(1):e0361. doi: 10.1097/HC9.0000000000000361. Erratum in: Hepatol Commun. 2024 Jan 29;8(2):e0390. doi: 10.1097/HC9.0000000000000390. PMID: 38180987; PMCID: PMC10781130. Starosta RT, et al An integrated multi-omics approach allowed ultra-rapid diagnosis of a deep intronic pathogenic variant in PDHX and precision treatment in a neonate critically ill with lactic acidosis. Mitochondrion. 2024 Nov;79:101973. doi: 10.1016/j.mito.2024.101973. Epub 2024 Oct 15. PMID: 39413893; PMCID: PMC11578067. Jain IH, et al Hypoxia as a therapy for mitochondrial disease. Science. 2016 Apr 1;352(6281):54-61. doi: 10.1126/science.aad9642. Epub 2016 Feb 25. PMID: 26917594; PMCID: PMC4860742 Sandlers Y, et al Metabolomics Reveals New Mechanisms for Pathogenesis in Barth Syndrome and Introduces Novel Roles for Cardiolipin in Cellular Function. PLoS One. 2016 Mar 25;11(3):e0151802. doi: 10.1371/journal.pone.0151802. PMID: 27015085; PMCID: PMC4807847. Sniezek Carney O, et al. Stem cell models of TAFAZZIN deficiency reveal novel tissue-specific pathologies in Barth syndrome. Hum Mol Genet. 2025 Jan 23;34(1):101-115. doi: 10.1093/hmg/ddae152. PMID: 39535077; PMCID: PMC11756277.

Intravenous dihydropyridine calcium channel blockers can quietly worsen oxygenation by blunting hypoxic pulmonary vasoconstriction. In this episode, we break down the bedside mechanism, which agents are implicated, who's at highest risk (post-op atelectasis, obesity, pneumonia, focal ARDS, COPD), how soon it happens, and exactly what to do.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citations:Weir EK, López-Barneo J, Buckler KJ, Archer SL. Acute oxygen-sensing mechanisms. N Engl J Med. 2005 Nov 10;353(19):2042-55. doi: 10.1056/NEJMra050002. PMID: 16282179; PMCID: PMC2803102.Weir EK, Olschewski A. Role of ion channels in acute and chronic responses of the pulmonary vasculature to hypoxia. Cardiovasc Res. 2006 Sep 1;71(4):630-41. doi: 10.1016/j.cardiores.2006.04.014. Epub 2006 Apr 27. PMID: 16828723.Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology. 2015 Apr;122(4):932-46. doi: 10.1097/ALN.0000000000000569. PMID: 25587641.Timour G, Fréderic V, Olivier S, Shango DN. Nicardipine-induced acute respiratory failure: Case report and literature review. Clin Case Rep. 2023 May 1;11(5):e7186. doi: 10.1002/ccr3.7186. PMID: 37143457; PMCID: PMC10151601.McMurtry IF, Davidson AB, Reeves JT, Grover RF. Inhibition of hypoxic pulmonary vasoconstriction by calcium antagonists in isolated rat lungs. Circ Res. 1976 Feb;38(2):99-104. doi: 10.1161/01.RES.38.2.99. PMID: 1245025.Simonneau G, Escourrou P, Duroux P, Lockhart A. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine. N Engl J Med. 1981 Jun 25;304(26):1582-5. doi: 10.1056/NEJM198106253042606. PMID: 7231503.Kennedy T, Summer W. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine. Am J Cardiol. 1982 Oct;50(4):864-8. doi: 10.1016/0002-9149(82)91246-2. PMID: 7124646.Chrétien B, Decros JB, Suard F, Dolladille C, Fischer MO, Alexandre J, Descamps R. Hypoxia Associated With Dihydropyridine Calcium Channel Inhibitors: A Pharmacovigilance Study in VigiBase. Clin Pharmacol Ther. 2023 Sep;114(3):686-692. doi: 10.1002/cpt.2970. Epub 2023 Jun 29. PMID: 37309986.Burghuber OC. Nifedipine attenuates acute hypoxic pulmonary vasoconstriction in patients with chronic obstructive pulmonary disease. Respiration. 1987;52(2):86-93. doi: 10.1159/000195309. PMID: 3671896.Suard F, Mombrun M, Fischer MO, Hanouz JL, Decros JB, Derville S, Gakuba C, Al Issa G, Menard C, Chretien B, Descamps R. Oxygenation Effects of Antihypertensive Agents in Intensive Care: A Prospective Comparative Study of Nicardipine and Urapidil. Clin Pharmacol Ther. 2025 Mar;117(3):742-748. doi: 10.1002/cpt.3509. Epub 2024 Nov 27. PMID: 39604146.

Winter is coming... and with it, the temptation to trade your saddle for a couch. In this episode, Coach Jen Kates shares how mountain bikers and gravel cyclists can maintain (and even build) bike fitness through the colder months - without burning-out or losing motivation. Learn how to balance smart strength training, targeted rides, and mindset shifts that help you stay consistent all season long. Plus, get the scoop on our #ShredStrong program, kicking off the winter phase on January 5th - the ultimate off-season strength and conditioning plan for cyclists. Or, work with Jen 1:1 by applying to work with here here: https://wvy4j2tn9vy.typeform.com/to/efp8oWSk What You'll Learn: How much cycling volume you really need to maintain fitness this winter The best strength training strategies for cyclists in the off-season Why less riding doesn't mean losing progress Simple ways to boost motivation and avoid burnout How #ShredStrong and 1:1 coaching helps you train smarter, not harder Check out these other relevant episodes: 230. Strength Training for Pain-Free Knees 226. Off-Season Strength Training for Cyclists: Build Your Best Season Yet 219. MTB Gains: Strength Training Secrets with a PT Who Rides  Research referenced in this episode: PMID 2314932: https://pubmed.ncbi.nlm.nih.gov/23914932/ (Note: Research shows that adding strength/resistance training to endurance training can improve endurance outcomes for cyclists, not necessarily that you need to reduce endurance training miles/volume by 30%.) #ShredStrong: Our Winter Cycle Starts on Monday, January 5, 2026! #ShredStrong is my year-round strength training program for mountain bikers and gravel cyclists. You can join any time you want, but we're starting the main Winter cycle in January! Learn more about the program and sign-up HERE!  Do You Want a Coach to Help Make Training & Nutrition Easier and Simpler for You? Hi, it's me.

In this episode, Dr. Mark Ettensohn responds to a common question: How can someone with a perfectly normal and mostly happy childhood develop narcissistic personality disorder? The discussion challenges the widespread misconception that narcissism is simply a personality type, a collection of traits, or the result of genetics alone. Dr. Ettensohn explains that pathological narcissism is a disorder of self-esteem regulation and identity formation, not just a pattern of behavior. Drawing on clinical research and developmental theory, he explores how early experiences that appear loving and stable can still leave important parts of the self unseen, unrecognized, or conditionally valued. These subtle, chronic relational injuries, repeated over years rather than occurring as a single traumatic event, can distort the developing self's capacity to maintain a stable and realistic sense of worth. The episode distinguishes between “popular narcissism,” which focuses on abusive behavior, and clinical narcissism, which reflects an internal system of dysregulated self-esteem. Through metaphor and clinical reflection, Dr. Ettensohn illustrates how a child can grow up in an environment that looks healthy on the surface yet still learn to equate love with performance, value with achievement, and safety with control. Additional Resources Website: https://healnpd.org Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH SUBSCRIBE HERE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 BECOME A MEMBER: https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join Article Citations: Vater, A., Ritter, K., Schröder-Abé, M., Schütz, A., Lammers, C.-H., & Roepke, S. (2013). When grandiosity and vulnerability collide: Implicit and explicit self-esteem in narcissistic personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44(1), 37–47. https://doi.org/10.1016/j.jbtep.2012.07.004 Weinberg I, Ronningstam E. Narcissistic Personality Disorder: Progress in Understanding and Treatment. Focus (Am Psychiatr Publ). 2022 Oct;20(4):368-377. doi: 10.1176/appi.focus.20220052. Epub 2022 Oct 25. PMID: 37200887; PMCID: PMC10187400.

Do you routinely order prophylactic antibiotics at time ofsecond-degree laceration repair? Is there data for that? While the use of prophylacticantibiotics “is reasonable” (per ACOG PB 198) for OASIS lacerations, what doesthe data look like for second degree lacs? Well, the answer is both supportiveAND non-supportive of that practice! In this episode, we will cover a brand newpublication (RCT) from BMJ on this very issue, and also highlight a meta-analysisfrom Plos One (May 2025) that also examined this question. Listen in fordetails!1.     ACOG PB 1982.     Armstrong H, Whitehurst J, Morris RK, HodgettsMorton V, Man R; CHAPTER group. Antibiotic prophylaxis for childbirth-relatedperineal trauma: A systematic review and meta-analysis. PLoS One. 2025 May9;20(5):e0323267. doi: 10.1371/journal.pone.0323267. PMID: 40344566; PMCID:PMC12064200.3.     Risk of infection and wound dehiscence after useof prophylactic antibiotics in episiotomy or second degree tear (REPAIR study):single centre, double blind, placebo controlled randomised trial. BMJ 2025; 391doi: https://doi.org/10.1136/bmj-2025-084312 (Published 29 October 2025): BMJ2025;391:e084312

This episode continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn and his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Narcissistic Personality Disorder: Progress in Understanding and Treatment by Igor Weinberg, Ph.D., and Elsa Ronningstam, Ph.D. The conversation examines recent advances in how clinicians conceptualize and treat narcissistic personality disorder, moving beyond fixed trait models toward a dynamic, relational understanding of the self and its development. Themes include the interplay between grandiose and vulnerable self-states, the interdependence of self-esteem regulation, affect, cognition, empathy, and interpersonal functioning, and the recognition that narcissistic pathology evolves through cumulative disruptions in early attunement and relational safety. The discussion also explores how developmental misattunements - whether through neglect, overindulgence, or inconsistency - shape defensive adaptations and contribute to the oscillation between self-inflation and shame. Throughout the seminar, the team reflects on the therapeutic process of working with narcissistic patients, emphasizing empathy, reflective capacity, and the slow, relational work of rupture and repair that makes genuine transformation possible. This series is designed for clinicians, students, and anyone interested in a nuanced, compassionate understanding of narcissism, personality, and psychological change. To learn more about our work, visit www.HealNPD.org Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH SUBSCRIBE HERE: https://rb.gy/kbhusf LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 BECOME A MEMBER: https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join Citation for the article discussed: Weinberg I, Ronningstam E. Narcissistic Personality Disorder: Progress in Understanding and Treatment. Focus (Am Psychiatr Publ). 2022 Oct;20(4):368-377. doi: 10.1176/appi.focus.20220052. Epub 2022 Oct 25. PMID: 37200887; PMCID: PMC10187400. Full text of the article: https://pmc.ncbi.nlm.nih.gov/articles/PMC10187400/

In this episode of Saving Lives: Critical Care Conversations, we discuss new evidence from the University of Pennsylvania that challenges how we time inotropic therapy in acute decompensated heart failure–related cardiogenic shock.This retrospective cohort study found that patients who received inotropes within eight hours of meeting SCAI stage C criteria had a 28-day mortality of 17%, compared to 33% in those who received them later. Early inotrope use was also associated with less vasopressor dependence and quicker access to echocardiography and hemodynamic monitoring.We'll explore what this means for emergency and critical care practice—how recognizing hypoperfusion early, even in normotensive patients, may improve survival. We'll also touch on the role of SCAI and SHARC criteria in timely shock identification and management.Because in cardiogenic shock, the difference between early and delayed therapy might be the difference between life and death.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Greenwood JC, Ratnayake C, Shabbir M, Opitz S, Jang DH, Choi WJ, Panebianco NL, Shofer FS, Augoustides JGT, Bakker J, Wald JW, Abella BS. Timing of inotropic support is associated with mortality in patients with acute decompensated heart failure-associated cardiogenic shock. Intensive Care Med Exp. 2025 Oct 31;13(1):111. doi: 10.1186/s40635-025-00806-z. PMID: 41174190; PMCID: PMC12579036.

In this deep-dive, Mankanwal Sachdev explores how cholangioscopy moves us from fluoroscopic silhouettes to direct mucosal visualization—and why that changes diagnosis and therapy across indeterminate strictures, PSC dominant lesions, and difficult stones. We walk through the current platform landscape (SpyGlass™ DS2, eyeMAX™, and Dragonfly™), practical biopsy technique to improve yield, and real-world lithotripsy choices (EHL vs Holmium laser) with a focus on workflow, cost, and verification of clearance. We also look ahead to AI-assisted interpretation, robotic/telerobotic control, and how training is evolving with ESGE 2025 standards and ASGE/ACG guidance. If you're building or refining a pancreatobiliary program, this episode offers an evidence-based framework you can put to work tomorrow.   Key takeaways: Use cholangioscopy when results will change management; pair with EUS for maximal diagnostic yield. Standardize biopsy protocols and specimen handling with pathology. Choose energy based on stone density, access, and resources; confirm clearance by direct inspection. Build a training pathway (simulation + supervised volume) and consider tiered credentialing. Selected references: ESGE 2025 (PMID: 40588224); ACG 2023 biliary strictures; ASGE 2023 malignancy in biliary strictures; Amaral 2023 laser vs EHL (PMID: 37203215); Mauro 2023 review (PMID: 37761300).

Jody discusses insomnia and how to treat it from a primary care perspective.Links & References:1) FDA Info on Flu Vaccines2) ACOG Position on Tylenol3) AAP Position on Tylenol4) Texas vs Tylenol Lawsuit5) History of Government Shutdowns (USA Today)6) CBT-I Coach App7) Zammit GK. Ramelteon: a novel hypnotic indicated for the treatment of insomnia. Psychiatry (Edgmont). 2007 Sep;4(9):36-42. PMID: 20532119; PMCID: PMC2880941.8) Bennett T, Bray D, Neville MW. Suvorexant, a dual orexin receptor antagonist for the management of insomnia. P T. 2014 Apr;39(4):264-6. PMID: 24757363; PMCID: PMC3989084.9) Episode-Specific Reference Material (OpenEvidence)

Taking folic acid prior to conception and during pregnancy can help protect the unborn baby from developing abnormalities. Supplements are particularly important for women who have epilepsy, as anti-seizure medication (previously known as anti-convulsants or anti-epileptic drugs) can lead to a deficiency in folic acid. Until 2023, high doses of 4-5 mg per day were recommended. However, this has changed as the data has changed. Did you know the SMFM no longer recommends “high dose” folic acid preconceptionally for patients on seizure medications? This is also highlighted in a recently released epub from Obstetrics and Gynecology (Green Journal) on October 31, 2025. Listen in for details. 1. Mokashi, Mugdha MD, MPH; Cozzi-Glaser, Gabriella MD; Kominiarek, Michelle A. MD, MS. Dietary Supplements in the Perinatal Period. Obstetrics & Gynecology ():10.1097/AOG.0000000000006098, October 31, 2025. | DOI: 10.1097/AOG.00000000000060982. Asadi-Pooya AA. High dose folic acid supplementation in women with epilepsy: are we sure it is safe? Seizure. 2015 Apr;27:51-3. doi: 10.1016/j.seizure.2015.02.030. Epub 2015 Mar 7. PMID: 25891927.3. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant4. Turner C, McIntosh T, Gaffney D, Germaine M, Hogan J, O'Higgins A. A 10-year review of periconceptual folic acid supplementation in women with epilepsy taking antiseizure medications. J Matern Fetal Neonatal Med. 2025 Dec;38(1):2524094. doi: 10.1080/14767058.2025.2524094. Epub 2025 Jun 30. PMID: 40588438.5. https://www.aan.com/PressRoom/Home/PressRelease/5170#:~:text=The%20guideline%20recommends%20that%20people,and%20possibly%20improve%20neurodevelopmental%20outcomes.6. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant

Drs. Maria Mojica, Robert Bonomo, and Ryan Shields join Dr. Erin McCreary (@erinmccreary) for a Halloween special reviewing the scariest resistance mechanisms and baddest bugs – Burkholderia spp., Achromobacter spp., and Elizabethkingia spp. Never have beta lactamase enzymes and other complexities been explained so hauntingly well. We don't want to spook you, but these environmental, opportunistic pathogens are found around the globe. While we hope you don't encounter them, take a listen to prepare in case one jumps out in your practice! This episode was sponsored by an unrestricted grant from Shionogi Inc. References: Spencer HK, Spitznogle SL, Borjan J, Aitken SL. An Overview of the Treatment of Less Common Non-Lactose-Fermenting Gram-Negative Bacteria. Pharmacotherapy. 2020 Sep;40(9):936-951. doi: 10.1002/phar.2447. Epub 2020 Aug 14. PMID: 32687670. Defining antimicrobial susceptibility testing methods and breakpoints among Achromobacter species SIDP 2025 Webinar | Mind the Gap: CLSI M100 Updates to Optimize Stewardship and Patient Care Outcomes Yasmin M, Rojas LJ, Marshall SH, Hujer AM, Cmolik A, Marshall E, Boucher HW, Vila AJ, Soldevila M, Diene SM, Rolain JM, Bonomo RA. Characterization of a Novel Pathogen in Immunocompromised Patients: Elizabethkingia anophelis-Exploring the Scope of Resistance to Contemporary Antimicrobial Agents and β-lactamase Inhibitors. Open Forum Infect Dis. 2023 Jan 31;10(2):ofad014. doi: 10.1093/ofid/ofad014. PMID: 36820316; PMCID: PMC9938519. Warner NC, Bartelt LA, Lachiewicz AM, Tompkins KM, Miller MB, Alby K, Jones MB, Carr AL, Alexander J, Gainey AB, Daniels R, Burch AK, Brown DE, Brownstein MJ, Cheema F, Linder KE, Shields RK, Longworth S, van Duin D. Cefiderocol for the Treatment of Adult and Pediatric Patients With Cystic Fibrosis and Achromobacter xylosoxidans Infections. Clin Infect Dis. 2021 Oct 5;73(7):e1754-e1757. doi: 10.1093/cid/ciaa1847. PMID: 33313656; PMCID: PMC8678443. El Chakhtoura NG, Saade E, Wilson BM, Perez F, Papp-Wallace KM, Bonomo RA. A 17-Year Nationwide Study of Burkholderia cepacia Complex Bloodstream Infections Among Patients in the United States Veterans Health Administration. Clin Infect Dis. 2017 Oct 15;65(8):1253-1259. doi: 10.1093/cid/cix559. PMID: 29017247; PMCID: PMC5848224.

Feeling knee pain on the bike (or in life)? You're not alone, and it doesn't have to be your norm. In this episode of Making Shift Happen, Jen breaks down why knees hurt (even when your bike fit is fine), why isometric strength training (like wall-sits) is a powerful tool, and how supporting hips and ankles will give your knees the backup they deserve. You'll learn: Why knee pain shows up for cyclists and what real causes are (it's not just your saddle height) How isometric wall-sits and other iso exercises reduce knee/tendon pain and build resilience (evidence included) How to structure your off-season strength and mobility plan for pain-free knees next season Why the upcoming #ShredStrong program (starts Nov 3rd - details below!) is the best way to build the strength system your knees demand Check out these other relevant episodes: This episode also includes the link for the free PDF on bike fit: 219. MTB Gains: Strength Training Secrets with a PT Who Rides  155. Combining Bike Fit and Physical Therapy with Natalie Colins, DPT Research referenced in this episode: PMID 31033611  DOI: 10.2147/OAJSM.S136653 #ShredStrong: Our Fall Cycle Starts on Monday, November 3, 2025! #ShredStrong is my year-round strength training program for mountain bikers and gravel cyclists. You can join any time you want, but we're starting the main Fall cycle in November! Learn more about the program and sign-up HERE!  Do You Want a Coach to Help Make Training & Nutrition Easier and Simpler for You? Hi, it's me.

In this episode of the Epigenetics Podcast, we talked with Vincent Pasque from KU Leuven about his work on the reprogramming of cell identity through epigenetic mechanisms, particularly during early development and cellular reprogramming. We begin by tracing Vincent's journey into biology, sparked by early childhood experiences in nature and meaningful encounters with inspiring teachers. His fascination with the complexities of biology crystallized during a pivotal moment while listening to a radio segment on epigenetics in the late '90s, which led him to pursue studies in genetics and biochemistry. This formative path brought him to leading institutions, including the prestigious lab of John Gurdon, where he explored the phenomenon of nuclear reprogramming. Vincent recounts his early experiments that led to the discovery of macro H2A as a barrier to reprogramming, emphasizing the core challenge of erasing somatic cell identity. As the conversation unfolds, Vincent introduces us to critical findings from his research. He shares how the inactive X chromosome serves as a compelling model to investigate epigenetic regulation, revealing that the dynamics of reprogramming and differentiation are far from simple reversals of development. He highlights the significant differences between male and female iPSCs and how X-linked genes influence DNA methylation and differentiation rates in these cells. The implications of these findings extend beyond developmental biology to inform our understanding of diseases, particularly cancer. Transitioning to his current work, Vincent describes pioneering advances in characterizing the chromatin-associated proteome during the differentiation of human pluripotent stem cells. The surprising discovery of elevated histone modifications in naïve cells leads to intriguing questions about the barriers to cellular plasticity and the mechanisms by which cells resist alternative fate conversions. The potential applications of this research could reshape our approach to regenerative medicine and therapeutic interventions. References Pasque V, Gillich A, Garrett N, Gurdon JB. Histone variant macroH2A confers resistance to nuclear reprogramming. The EMBO Journal. 2011 May;30(12):2373-2387. DOI: 10.1038/emboj.2011.144. PMID: 21552206; PMCID: PMC3116279. Jullien, J., Miyamoto, K., Pasque, V., Allen, G. E., Bradshaw, C. R., Garrett, N. J., Halley-Stott, R. P., Kimura, H., Ohsumi, K., & Gurdon, J. B. (2014). Hierarchical Molecular Events Driven by Oocyte-Specific Factors Lead to Rapid and Extensive Reprogramming. Molecular Cell, 55(4), 524–536. https://doi.org/10.1016/j.molcel.2014.06.024 Pasque V, Tchieu J, Karnik R, et al. X chromosome reactivation dynamics reveal stages of reprogramming to pluripotency. Cell. 2014 Dec;159(7):1681-1697. DOI: 10.1016/j.cell.2014.11.040. PMID: 25525883; PMCID: PMC4282187. Zijlmans DW, Talon I, Verhelst S, et al. Integrated multi-omics reveal polycomb repressive complex 2 restricts human trophoblast induction. Nature Cell Biology. 2022 Jun;24(6):858-871. DOI: 10.1038/s41556-022-00932-w. PMID: 35697783; PMCID: PMC9203278. Related Episodes The Discovery of Genomic Imprinting (Azim Surani) Gene Expression Control and Intricacies of X-chromosome Inactivation (Claire Rougeulle) Epigenetics and X-Inactivation (Edith Heard) Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

Elinzanetant, sold under the brand name Lynkuet, receivedapproval from the U.S. Food and Drug Administration (FDA) on October 24, 2025, for the treatment of moderate to severe hot flashes due to menopause.  How is this different than Fezolinetant, which was approved in 2023? Listen in for details. 1.   Menegaz de Almeida, Artur MS; Oliveira, Paloma MS; Lopes, Lucca MD; Leite, Marianna MS; Morbach, Victória MS; Alves Kelly, Francinny MD; Barros, Ítalo MS; Aquino de Moraes, Francisco Cezar MS; Prevedello, Alexandra MD. Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis. Obstetrics & Gynecology 145(3):p 253-261, March 2025. | DOI: 10.1097/AOG.00000000000058122.     Pinkerton JV, Simon JA, Joffe H, Maki PM, NappiRE, Panay N, Soares CN, Thurston RC, Caetano C, Haberland C, Haseli Mashhadi N, Krahn U, Mellinger U, Parke S, Seitz C, Zuurman L. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA. 2024 Aug 22;332(16):1343–54. doi: 10.1001/jama.2024.14618. Epub ahead of print. PMID: 39172446; PMCID: PMC11342219.3.     Cardoso F, Parke S, Brennan DJ, Briggs P,Donders G, Panay N, Haseli-Mashhadi N, Block M, Caetano C, Francuski M, Haberland C, Laapas K, Seitz C, Zuurman L. Elinzanetant for Vasomotor Symptomsfrom Endocrine Therapy for Breast Cancer. N Engl J Med. 2025 Aug 21;393(8):753-763. doi: 10.1056/NEJMoa2415566. Epub 2025 Jun 2. PMID: 40454634.STRONG COFFEE PROMO: 20% Off Strong CoffeeCompany https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Contributors: Preeya Prakash MD, Adam Greenhaw PharmD, Travis Barlock MD, and Jeffrey Olson MS4 In this episode, cardiologist Preeya Prakash and medical student Jeffrey Olson listen in as two cases are presented from EMM's recent event, Tox Talk 2025. Talk 1- Digoxin Overdose Dr. Adam Greenhaw presents a case of a Digoxin overdose along with many pearls. During the studio listen in, Dr. Prakash helps to answer the questions of: How does digoxin work? Why might a patient still be on digoxin in 2025? What are the EKG findings of digoxin toxicity? Is there any utility in atropine for bradycardia caused by digoxin? Should you use calcium to treat hyperkalemia in the setting of a digoxin overdose? If/when might a cardiologist get involved in a patient with a digoxin overdose? Talk 2- Propranolol Overdose Dr. Travis Barlock presents a case of a beta blocker overdose as well as many associated pearls. During our studio listen in, Dr. Prakash helps to answer the questions of: What are the different beta blockers and how do they work? If you are worried about a propranolol overdose, what medications do you want on hand? What POCUS cardiac view can give you the most information for different scenarios? Why or why not might transcutaneous or intravenous pacing be a good idea for a beta blocker overdose? If/when might you want a cardiologist to get involved in a patient with a beta blocker overdose? References Alahmed AA, Lauffenburger JC, Vaduganathan M, Aldemerdash A, Ting C, Fatani N, Fanikos J, Buckley LF. Contemporary Trends in the Use of and Expenditures on Digoxin in the United States. Am J Cardiovasc Drugs. 2022 Sep;22(5):567-575. doi: 10.1007/s40256-022-00540-x. Epub 2022 Jun 24. PMID: 35739347; PMCID: PMC10263277. Chan BS, Buckley NA. Digoxin-specific antibody fragments in the treatment of digoxin toxicity. Clin Toxicol (Phila). 2014 Sep-Oct;52(8):824-36. doi: 10.3109/15563650.2014.943907. Epub 2014 Aug 4. PMID: 25089630. Hack JB, Wingate S, Zolty R, Rich MW, Hauptman PJ. Expert Consensus on the Diagnosis and Management of Digoxin Toxicity. Am J Med. 2025 Jan;138(1):25-33.e14. doi: 10.1016/j.amjmed.2024.08.018. Epub 2024 Sep 11. PMID: 39265879. Krenz JR, Kaakeh Y. An Overview of Hyperinsulinemic-Euglycemic Therapy in Calcium Channel Blocker and β-blocker Overdose. Pharmacotherapy. 2018 Nov;38(11):1130-1142. doi: 10.1002/phar.2177. Epub 2018 Oct 4. PMID: 30141827. Patocka J, Nepovimova E, Wu W, Kuca K. Digoxin: Pharmacology and toxicology-A review. Environ Toxicol Pharmacol. 2020 Oct;79:103400. doi: 10.1016/j.etap.2020.103400. Epub 2020 May 7. PMID: 32464466. Rotella JA, Greene SL, Koutsogiannis Z, Graudins A, Hung Leang Y, Kuan K, Baxter H, Bourke E, Wong A. Treatment for beta-blocker poisoning: a systematic review. Clin Toxicol (Phila). 2020 Oct;58(10):943-983. doi: 10.1080/15563650.2020.1752918. Epub 2020 Apr 20. PMID: 32310006. Produced by Jeffrey Olson, MS4 Donate: https://emergencymedicalminute.org/donate/

In this episode, we explore practical tips for caring for older adults in the clinical setting through a case-based discussion highlighting common perioperative challenges and strategies for success. We also take a deeper dive into the American College of Surgeons Geriatric Surgery Verification Program, including its goals, impact, and how clinicians can get involved in advancing surgical care for the aging patient population. Take Home Points:  The older adult population is the fastest growing patient population and it is important we focus on patient-centered care for this population, as this is a population that almost all of us will engage with.  If you or your hospital isn't prepared to get verified yet, there are still small processes that can be implemented that can make an impactful difference on your patients. Geriatric Surgery Verification is at the cutting edge of quality improvement. Like other verification programs (trauma, bariatric) patients will soon seek out these centers that can best address their personal needs. Hosts:  Agnes Premkumar, MD - General Surgery Resident at Creighton University, @agnespremkumar Nicole L. Petcka, MD – General Surgery Resident at Emory University, @npetcka2022 Guests:  Marcia M. Russell, MD - Professor of Surgery and Vice Chair for Quality and Safety at the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Healthcare System Caroline Smolkin, MD - General Surgery Resident at Northwell and American College of Surgeons Clinical Scholar Resources:  American College of Surgeons Geriatric Surgery Verification Program: https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/  Katlic MR, Wolf J, Demos SJ, Rosenthal RA. Making a Financial Case for the Geriatric Surgery Verification Program. Ann Surg Open. 2024 May 13;5(2):e439. doi: 10.1097/AS9.0000000000000439. PMID: 38911623; PMCID: PMC11191881. https://pubmed.ncbi.nlm.nih.gov/38911623/ Remer SL, Zhou L, Cohen ME, Russell MM, Rosenthal R, Ko CY. Discharge to Post-Acute Care as a Benchmarking Metric for Elderly Surgical Patients. J Am Coll Surg. 2025 Aug 14. doi: 10.1097/XCS.0000000000001495. Epub ahead of print. PMID: 40810404. https://pubmed.ncbi.nlm.nih.gov/40810404/ Jones TS, Jones EL, Richardson V, Finley JB, Franklin JL, Gore DL, Horney CP, Kovar A, Morin TL, Robinson TN. Preliminary data demonstrate the Geriatric Surgery Verification program reduces postoperative length of stay. J Am Geriatr Soc. 2021 Jul;69(7):1993-1999. doi: 10.1111/jgs.17154. Epub 2021 Apr 7. PMID: 33826150. https://pubmed.ncbi.nlm.nih.gov/33826150/ *** UNC Surgery is inviting you to participate in a national survey designed to understand general surgery residents' perspectives on core curriculum content, structure, & delivery. The results of this survey will inform the development of a standardized general surgery education curriculum.    SURVEY LINK: https://docs.google.com/forms/d/e/1FAIpQLSeJztQwgB1rJXpCtvboHprGB_gmHGG4UzY1HITAHRmMx9FcRQ/viewform Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Contributor: Aaron Lessen, MD Educational Pearls: Traumatic Brain Injuries are a frequent complaint in the Emergency Department and have increased in recent years. The American Association for Surgery of Trauma (AAST) has created Brain Injury Guidelines (BIG), in an attempt to categorize brain injuries and the level of treatment they require. They are… BIG 1 Normal neuro exam Not intoxicated Not on anticoagulation or antiplatelet medications Minimal findings on head CT No fracture 8 mm bleed (subdural, epidural, intraparenchymal (or more than 2 locations)) “Scattered” subarachnoid hemorrhage Intraventricular hemorrhage     Full treatment, admission to trauma center, neurosurgery evaluation References Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, Wynne J, Tang A, O'Keeffe T, Rhee P. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014 Apr;76(4):965-9. doi: 10.1097/TA.0000000000000161. PMID: 24662858. Joseph B, Obaid O, Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D; AAST BIG Multi-institutional Study Group. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28. PMID: 35343931. Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Send us a textAzithromycin for Prevention of Bronchopulmonary Dysplasia and Other Neonatal Adverse Outcomes in Preterm Infants: An Updated Systematic Review and Meta-Analysis.Joseph M, Murali Krishna M, Karlinksi Vizentin V, Provinciatto H, Ezenna C.Neonatology. 2025 Aug 12:1-10. doi: 10.1159/000547537. Online ahead of print.PMID: 40795809 Free article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textInfant Renal Replacement Therapy Using Carpediem™: A Multicenter Observational Cohort Study from the ICONIIC Learning Network.Slagle CL, Vuong KT, Krallman KA, Casey L, Gist KM, Jetton JG, Joseph C, Luckritz K, Martin SD, Morgan J, Merrill KA, Plomaritas K, Ramirez D, Tran CL, Shin HS, Snyder AN, Van Wyk B, Yalon L, Goldstein SL, Menon S.J Pediatr. 2025 Sep 26:114838. doi: 10.1016/j.jpeds.2025.114838. Online ahead of print.PMID: 41016463 Free article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textNebulized nitroglycerin as an adjuvant drug in management of persistent pulmonary hypertension of newborns: a randomized controlled trial.Farag MM, Ghazal HAE, Abdel-Mohsen AM, Rezk MA.Eur J Pediatr. 2025 Sep 1;184(9):586. doi: 10.1007/s00431-025-06381-5.PMID: 40888971 Free PMC article. Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Here is a real-world clinical case with a tricky differential: Our team recently readmitted a patient 6 days postpartum/post C-section (which was done for ICP and fetal macrosomia at close to 4500 grams, with A2GDM). She had elevated blood pressures, a frontal headache, some midepigastric pain/RUQ discomfort. Pretty clear picture right: sounds like preeclampsia (PreE) with severe features based on BP elevation and symptoms. So, we started her on mag-sulfate per protocol. Well, her transaminases were in the 400-600s, which was significantly higher than they were at delivery. They then peaked the next day at 900! OK, it still meets criteria for PreE with severe features. But could this also be postpartum Acute fatty Liver of Pregnancy (AFLP)? The clinical picture of these 2 conditions may overlap but there are distinct differences here. AFLP is potentially fatal, so we have to get that diagnosis correct. How can we distinguish AFLP from PreE with severe features or HELLP? Listen in for details.1. https://www.preeclampsia.org/the-news/health-information/acute-fatty-liver-of-pregnancy-can-be-confused-with-preeclampsia-and-hellp-syndrome2. Yemde A Jr, Kawathalkar A, Bhalerao A. Acute Fatty Liver of Pregnancy: A Diagnostic Challenge. Cureus. 2023 Mar 26;15(3):e36708. doi: 10.7759/cureus.36708. PMID: 37113350; PMCID: PMC10129069.3. Maalbi O, Elachhab N, Elkabbaj A, Arfaoui M, Hindi S, Lahbabi S, Oudghiri N, Tachinante R. Management of Acute Fatty Liver of Pregnancy: A Retrospective Study of 12 Cases Compared With Data in the Literature. Cureus. 2025 Jun 11;17(6):e85753. doi: 10.7759/cureus.85753. PMID: 40656400; PMCID: PMC12247011.4. Siwatch S, De A, Kaur B, et al. Safety and Efficacy of Plasmapheresis in Treatment of Acute Fatty Liver of Pregnancy-a Systematic Review and Meta-Analysis.Frontiers in Medicine. 2024;11:1433324. doi:10.3389/fmed.2024.1433324.5. Sarkar M, Brady CW, Fleckenstein J, et al.6. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases.Hepatology (Baltimore, Md.). 2021;73(1):318-365. doi:10.1002/hep.31559.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Sleeve, bypass, or something new – which surgery really dominates the day?  This Bariatric Surgery Journal Club dives into the debate over which bariatric operation is best. We compare the outcomes of the gastric bypass, sleeve gastrectomy, and the newer Sadie procedure, exploring how bypass may have an edge in long-term diabetes remission and weight loss.  We also discuss revisional options for failed sleeves and the importance of matching the patient to the right operation for their specific needs. Hosts: - Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)  - Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) - Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) - Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) Learning objectives: - Contrast the outcomes of Roux-en-Y gastric bypass, sleeve gastrectomy, and revisional options such as the single-anastomosis duodeno-ileal bypass (SADI) - Article #1: Hauge 2025, Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple blind, randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/40185112/ - Describe the design and unique triple-blind methodology of a single-center randomized trial comparing bypass and sleeve in patients with obesity and type 2 diabetes.  - Interpret the clinical relevance of the 5-year outcomes, including 63% diabetes remission with bypass vs 30% with sleeve.  - Examine secondary outcomes such as weight loss and cholesterol reduction, which favored bypass over the sleeve - Formulate patient-centered strategies for selecting bypass versus sleeve in populations with advanced metabolic disease, balancing efficacy with patient preference  - Article #2: The By-Band-Sleeve Collaborative Group 2025, Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicenter, open-label, three-group, randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/40179925/ - Summarize the findings of this multi-center, open-label randomized controlled trial of over 1,300 patients comparing bypass, sleeve, and gastric banding at 5 years - Discuss the relative weight loss outcomes: 67% excess weight loss for bypass, 63% for sleeve, and 28% for adjustable gastric band - Evaluate the improvements in diabetes remission, hypertension control, and lipid management with bypass and sleeve compared to banding. - Analyze the declining role of gastric banding in modern bariatric surgery, while acknowledging its benefits compared to no weight loss treatment - Article #3: Thomopoulos 2024, Long-term results of Roux-en-Y gastric bypass (RYGB) versus single anastomosis duodeno-ileal bypass (SADI) as revisional procedures after failed sleeve gastrectomy: a systematic literature review and pooled analysis https://pubmed.ncbi.nlm.nih.gov/39579238/ - Compare long-term outcomes of bypass versus SADI after failed sleeve gastrectomy, based on pooled analysis of over 1,000 patients  - Interpret the trade-offs: SADI provides greater weight loss and metabolic improvements, but carries a higher risk for malnutrition and fat-soluble vitamin deficiencies  -  Develop strategies for preoperative counseling, nutritional supplementation, and close long-term monitoring, particularly for patients undergoing SADI - Individualize decision-making for revisional surgery, considering factors such as patient goals, comorbidity burden, prior anatomy, BMI, and reliability with follow-up - Evolving revisional strategies will influence the next decade of bariatric surgical innovation   - Overall, bariatric surgery consistently improves weight, diabetes control, and cardiovascular risk. - The procedure of choice should be tailored to the patient through detailed discussion between surgeon and patient, aligning clinical evidence with patient goals and risks.   References 1.     Wågen Hauge J, Borgeraas H, Birkeland KI, Johnson LK, Hertel JK, Hagen M, Gulseth HL, Lindberg M, Lorentzen J, Seip B, Kolotkin RL, Svanevik M, Valderhaug TG, Sandbu R, Hjelmesæth J, Hofsø D. Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2025 May;13(5):397-409. doi: 10.1016/S2213-8587(24)00396-6. Epub 2025 Apr 1. PMID: 40185112. https://pubmed.ncbi.nlm.nih.gov/40185112/ 2.     By-Band-Sleeve Collaborative Group. Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicentre, open label, three-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2025 May;13(5):410-426. doi: 10.1016/S2213-8587(25)00025-7. Epub 2025 Mar 31. PMID: 40179925. https://pubmed.ncbi.nlm.nih.gov/40179925/ 3.     Thomopoulos T, Mantziari S, Joliat GR. Long-term results of Roux-en-Y gastric bypass (RYGB) versus single anastomosis duodeno-ileal bypass (SADI) as revisional procedures after failed sleeve gastrectomy: a systematic literature review and pooled analysis. Langenbecks Arch Surg. 2024 Nov 23;409(1):354. doi: 10.1007/s00423-024-03557-9. PMID: 39579238; PMCID: PMC11585492. https://pubmed.ncbi.nlm.nih.gov/39579238/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US