Podcasts about pmid

In this episode, we dive into the rapidly evolving world of ambient listening AI in healthcare. From outpatient clinics to inpatient wards and operating rooms, this technology is reshaping how care is delivered, documented, and experienced. We explore how ambient listening AI is improving clinic flow by streamlining documentation and reducing interruptions, allowing clinicians to stay more present with their patients. The technology is increasingly adaptive to individual provider styles, learning preferences and workflows to deliver more personalized support. Plus, we share practical tips for new users to get the most out of their ambient listening AI systems from day one. Join us as we hear from experts on the front lines and debate the future of ambient listening AI in medicine—where the walls really do have ears, but for all the right reasons. Host:  - Nicole Petcka, MD – General Surgery Resident, Emory University, @npetcka2022 Guests:  - Samuel R. Torres Landa Fernández, MD – Minimally Invasive Surgery Fellow, Emory University  - Anastasios Nikolaos (Nick​) Panagopoulos, MD – Internal Medicine Resident, Emory University  - Joe Sharma, MD - McGarity Chair in Endocrine Surgery and Professor of Surgery, Vice-chair for Patient Safety, Quality and Innovation, Emory University  Resources:  Enhancing Accuracy of Operative Reports with Automated Artificial Intelligence Analysis of Surgical Video Khanna A, Wolf T, Frank I, Krueger A, Shah P, Sharma V, Gettman MT, Boorjian SA, Asselmann D, Tollefson MK. Enhancing Accuracy of Operative Reports with Automated Artificial Intelligence Analysis of Surgical Video. J Am Coll Surg. 2025 May 1;240(5):739-746. doi: 10.1097/XCS.0000000000001352. Epub 2025 Apr 16. PMID: 39918224. https://pubmed.ncbi.nlm.nih.gov/39918224/ 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://app.behindtheknife.org/listen

Contributor: Aaron Lessen, MD Educational Pearls: How do we take care of kids in severe pain? There are many non-pharmacologic options for pain (i.e. ice, elevation) as well as more conventional medication options (i.e. acetaminophen, NSAIDS) but in severe pain stronger medications might be indicated. These stronger medications include options such as IV morphine, a subdissociative dose of ketamine, as well as intranasal fentanyl. Intranasal fentanyl has many advantages: Studies have shown it might be more effective early on in controlling pain, as in the first 15-20 minutes after administration, and then becomes equivalent to other pain control options Total adverse effects were also lower with IN fentanyl, including low rates of nausea and vomiting To administer, use the IV formulation with an atomizer and spray into the nose; therefore, you do not need an IV line Dose is 1-2 micrograms per kilogram, can be redosed once at 10 minutes.  Don't forget about gabapentinoids for neuropathic pain, muscle relaxants for muscle spasms, and nerve blocks when appropriate. (Disclaimer: muscle relaxers have not been well studied in children) References Alsabri M, Hafez AH, Singer E, Elhady MM, Waqar M, Gill P. Efficacy and Safety of Intranasal Fentanyl in Pediatric Emergencies: A Systematic Review and Meta-analysis. Pediatr Emerg Care. 2024 Oct 1;40(10):748-752. doi: 10.1097/PEC.0000000000003187. Epub 2024 Apr 11. PMID: 38713846. Bailey B, Trottier ED. Managing Pediatric Pain in the Emergency Department. Paediatr Drugs. 2016 Aug;18(4):287-301. doi: 10.1007/s40272-016-0181-5. PMID: 27260499. Hadland SE, Agarwal R, Raman SR, Smith MJ, Bryl A, Michel J, Kelley-Quon LI, Raval MV, Renny MH, Larson-Steckler B, Wexelblatt S, Wilder RT, Flinn SK. Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline. Pediatrics. 2024 Sep 30:e2024068752. doi: 10.1542/peds.2024-068752. Epub ahead of print. PMID: 39344439. Summarized by Jeffrey Olson, MS4 | Edited by Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Send us a textNeonatologists' perceptions of uncertainty: a national survey.Rholl E, Krick JA, Leuthner SR, Pan AY, Challa SA, Kukora S.J Perinatol. 2025 Apr 19. doi: 10.1038/s41372-025-02292-3. Online ahead of print.PMID: 40253559 No abstract available.As 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!

Drs. Amy Crockett (@amyhcrockett), Ben Ereshefsky (@brainofbpharm), and Pamela Bailey (@pamipenem) join Dr. Julie Ann Justo (@julie_justo) to discuss new treatment strategies for management of intraamniotic infections, also known as chorioamnionitis. They discuss whether it is time to move away from the combination of ampicillin, gentamicin, and/or clindamycin, alternative antibiotic regimens to consider, and stewardship strategies to approach this practice change at a local level. References: Basic stats/epi on chorioamnionitis: Romero R, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med. 2015 Jan;43(1):19-36. doi: 10.1515/jpm-2014-0249. PMID: 25720095. ACOG 2017 Guideline for IAI: Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017 Aug;130(2):e95-e101. doi: 10.1097/AOG.0000000000002236. PMID: 28742677. ACOG 2024 Update on clinical criteria for IAI: ACOG Clinical Practice Update: Update on Criteria for Suspected Diagnosis of Intraamniotic Infection. Obstetrics & Gynecology 144(1):p e17-e19, July 2024. doi: 10.1097/AOG.0000000000005593 Helpful review with more recent microorganisms : Jung E, et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol. 2024 Mar;230(3S):S807-S840. doi: 10.1016/j.ajog.2023.02.002. PMID: 38233317. Cochrane Review: Chapman E, et al. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev. 2014 Dec 19;2014(12):CD010976. doi: 10.1002/14651858.CD010976.pub2. PMID: 25526426. Helpful recent review on intrapartum infections: Bailey, P, et al_._ Out with the Old, In with the New: A Review of the Treatment of Intrapartum Infections. Curr Infect Dis Rep. 2024;26:107–113 doi: 10.1007/s11908-024-00838-8. Role of genital mycoplasmas in IAI: Romero R, et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med. 2019 Nov 26;47(9):915-931. doi: 10.1515/jpm-2019-0297. PMID: 31693497. Regimens without enterococcal coverage with similar clinical outcomes: Blanco JD, et al. Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections. Antimicrob Agents Chemother. 1983 Oct;24(4):500-4. doi: 10.1128/AAC.24.4.500. PMID: 6360038. Bookstaver PB, et al. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015 Nov;35(11):1052-62. doi: 10.1002/phar.1649. PMID: 26598097. Updated review in pregnancy, includes data on frequency of antibiotic use in pregnancy: Nguyen J, et al. A review of antibiotic safety in pregnancy-2025 update. Pharmacotherapy. 2025 Apr;45(4):227-237. doi: 10.1002/phar.70010. Epub 2025 Mar 19. PMID: 40105039. Locksmith GJ, et al. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstet Gynecol. 2005 Mar;105(3):473-9. doi: 10.1097/01.AOG.0000151106.87930.1a. PMID: 15738010. Clindamycin CDI Risk: Miller AC, et al. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis. 2023 Aug 5;10(8):ofad413. doi: 10.1093/ofid/ofad413. PMID: 37622034. Impact of penicillin allergy on clindamycin use & cites 47% clindamycin resistance per CDC among GBS: Snider JB, et al. Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes. BMC Pregnancy Childbirth. 2023 May 30;23(1):400. doi: 10.1186/s12884-023-05697-0. PMID: 37254067. Clindamycin anaerobic coverage data: Hastey CJ, et al. Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology. Anaerobe. 2016 Dec;42:27-30. doi: 10.1016/j.anaerobe.2016.07.003. PMID: 27427465. Older PK study of ampicillin & gentamicin for chorioamnionitis: Gilstrap LC 3rd, Bawdon RE, Burris J. Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis. Obstet Gynecol. 1988 Jul;72(1):124-5. PMID: 3380500. Paper putting out the call for modernization of OB/Gyn antibiotic regimens: Pek Z, Heil E, Wilson E. Getting With the Times: A Review of Peripartum Infections and Proposed Modernized Treatment Regimens. Open Forum Infect Dis. 2022 Sep 5;9(9):ofac460. doi: 10.1093/ofid/ofac460. PMID: 36168554. Vanderbilt University Medical Center experience with modernizing OB/Gyn infection regimens: Smiley C, et al. Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center. Open Forum Infect Dis. 2024 Sep 5;11(9):ofae475. doi: 10.1093/ofid/ofae475. PMID: 39252868. Prisma Health/University of South Carolina experience with modernizing OB/Gyn infection regimens: Bailey P, et al. Cefoxitin for Intra-amniotic Infections and Endometritis: A Retrospective Comparison to Traditional Antimicrobial Therapy Regimens Within a Healthcare System. Clin Infect Dis. 2024 Jul 19;79(1):247-254. doi: 10.1093/cid/ciae042. PMID: 38297884.

In this episode of the Epigenetics Podcast, we talked with Ani Deshpande from Sanford Burnham Prebys about his work on epigenetic regulation and developing small molecules through high throughput screens for AML. Throughout our discussion, we delve into Dr. Despande's journey into the field of biology and science, tracing his evolution from a literature enthusiast in Mumbai to a dedicated cancer researcher. He reflects on his formative experiences during his PhD at Ludwig Maximilian University in Munich, where she developed murine models for refractory acute myeloid leukemia (AML). We examine these models' contributions to therapeutic discovery and understanding the intricate mechanisms underscoring AML's complexities. Transitioning to his postdoctoral work at Scott Armstrong's lab in Boston, Dr. Despande shares his insights on the importance of epigenetic regulators, such as DOT1L, in leukemias, and how they can serve as strategic therapeutic targets. His ambitious pursuit of translational research is further highlighted through his efforts in developing a conditional knockout mouse model and his collaborative work utilizing CRISPR technology to refine our understanding of epigenetic regulation in cancer pathogenesis. Moreover, we engage in a conversation about the challenges and opportunities that arise when establishing his lab at Sanford Burnham Prebys. Dr. Despande candidly discusses the delicate balance between pursuing topics of genuine interest versus adhering to grant fundability, underlining the tension researchers face in the current scientific landscape. His emphasis on the critical need for innovation within lab settings serves as a motivational call for emerging scientists to venture beyond the established templates that often inhibit groundbreaking discoveries. We conclude our dialogue with an exploration of his recent projects, which involve targeting specific epigenetic modifiers and how his lab's findings can contribute to greater understanding and potential treatments for not only AML but also other pediatric cancers driven by gene fusions. Dr. Despande's insights into the integration of modern technologies, such as CRISPR libraries, exemplify his commitment to pushing the boundaries of cancer research. In addition to discussing his scientific contributions, we touch upon Dr. Despande's foray into podcasting (The Discovery Dialogues), shedding light on his motivation to bridge the communication gap between scientists and the broader public. He articulates his desire to demystify scientific discoveries and promote awareness about the intricate journey of research that lays the groundwork for medical advancements. This multidimensional discussion not only highlights his scientific achievements but also emphasizes the importance of effective science communication in fostering public understanding and appreciation of research.   References Deshpande AJ, Cusan M, Rawat VP, Reuter H, Krause A, Pott C, Quintanilla-Martinez L, Kakadia P, Kuchenbauer F, Ahmed F, Delabesse E, Hahn M, Lichter P, Kneba M, Hiddemann W, Macintyre E, Mecucci C, Ludwig WD, Humphries RK, Bohlander SK, Feuring-Buske M, Buske C. Acute myeloid leukemia is propagated by a leukemic stem cell with lymphoid characteristics in a mouse model of CALM/AF10-positive leukemia. Cancer Cell. 2006 Nov;10(5):363-74. doi: 10.1016/j.ccr.2006.08.023. PMID: 17097559. Deshpande AJ, Deshpande A, Sinha AU, Chen L, Chang J, Cihan A, Fazio M, Chen CW, Zhu N, Koche R, Dzhekieva L, Ibáñez G, Dias S, Banka D, Krivtsov A, Luo M, Roeder RG, Bradner JE, Bernt KM, Armstrong SA. AF10 regulates progressive H3K79 methylation and HOX gene expression in diverse AML subtypes. Cancer Cell. 2014 Dec 8;26(6):896-908. doi: 10.1016/j.ccell.2014.10.009. Epub 2014 Nov 20. PMID: 25464900; PMCID: PMC4291116. Sinha S, Barbosa K, Cheng K, Leiserson MDM, Jain P, Deshpande A, Wilson DM 3rd, Ryan BM, Luo J, Ronai ZA, Lee JS, Deshpande AJ, Ruppin E. A systematic genome-wide mapping of oncogenic mutation selection during CRISPR-Cas9 genome editing. Nat Commun. 2021 Nov 11;12(1):6512. doi: 10.1038/s41467-021-26788-6. Erratum in: Nat Commun. 2022 May 16;13(1):2828. doi: 10.1038/s41467-022-30475-5. PMID: 34764240; PMCID: PMC8586238.   Related Episodes Targeting COMPASS to Cure Childhood Leukemia (Ali Shilatifard) The Menin-MLL Complex and Small Molecule Inhibitors (Yadira Soto-Feliciano) MLL Proteins in Mixed-Lineage Leukemia (Yali Dou)   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

Contributor: Travis Barlock, MD Educational Pearls: Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation Narrowed bronchioles lead to turbulent airflow → creates the wheezing Crackles (rales) suggest pulmonary edema which is often due to heart failure Approximately 35% of heart failure patients have bronchial edema, which can also produce wheezing COPD and heart failure can coexist in a patient, and both of these diseases can cause wheezing It's vital to differentiate whether the wheezing is due to the patient's COPD or their heart failure because the treatment differs Diagnosing wheezing due to heart failure (cardiac asthma): Symptoms: orthopnea, paroxysmal nocturnal dyspnea Diagnostic tools: bedside ultrasound Treatment: diuresis and BiPAP for respiratory support Not all wheezing is asthma Consider heart failure in the differential and tailor treatment accordingly References 1. Buckner K. Cardiac asthma. Immunol Allergy Clin North Am. 2013 Feb;33(1):35-44. doi: 10.1016/j.iac.2012.10.012. Epub 2012 Dec 23. PMID: 23337063. 2. Hollingsworth HM. Wheezing and stridor. Clin Chest Med. 1987 Jun;8(2):231-40. PMID: 3304813. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

In this episode, I'm diving into one of the most requested topics I've had all year:“Can I take creatine while breastfeeding?”I unpack what creatine actually is, how it supports not just physical recovery but also cognitive function, and why it might be helpful postpartum (but why you need to make your own educated choice). I cover:How creatine helps with muscle energy, recovery, and strengthThe emerging research around creatine and cognition — and why doses above 5g may be necessary for mental clarityWhat we know (and don't know) about creatine during lactationA new 2023 animal study showing creatine's role in reducing neuroinflammation and improving postnatal developmentHow to take it safely, what type to choose, and when it might not be appropriateAnd finally — why some critics think creatine is overrated.This episode isn't about hype or fear — it's about giving you the tools, context, and confidence to make an informed decision that supports your performance, recovery, and brain health.Research:Rae et al., 2003 – Creatine supplementation improves cognitive performance in sleep-deprived individualsMcMorris et al., 2007 – Creatine and cognitive performance: a review of the literatureAvgerinos et al., 2018 – Meta-analysis on the cognitive effects of creatineGouveia et al., 2023 – Creatine supplementation increases postnatal growth and strength and prevents overexpression of IL-6 in the hippocampus in an experimental model of cerebral palsy (PMID: 37141266)ISSN Position Stand, 2021 – Creatine Supplementation and ExerciseDisclaimer:This episode is for educational purposes only and is not medical advice. Please consult your GP, dietitian, or women's health specialist before starting any new supplementation, especially while breastfeeding.

Even if you don't have hot flashes, stay with me on this because this episode is on exercise and hot flashes. We're going to dissect the science and eradicate “science says” as a cry for validity by influencers.  Hot flashes are one of the most common symptoms of menopause. I'll talk about the relationship between exercise and hot flashes along with other menopause symptoms like muscle loss or fat increase.   In previous podcast episodes and books, I've shared researcher comments about whether exercise could mitigate menopause symptoms. The answer, “Yes, provided it's intense enough.”    The Science A 2024 study on 72 pre, peri and postmenopausal women, published in the Menopause Journal of The Menopause Society, looked at the impact of minutes spent in 3 exercise intensities and body composition on total menopause symptoms (TMS).  More symptoms were associated with higher body fat. Intense physical exercise improves % body composition and may reduce TMS, beneficial for perimenopausal women.  An article published by the American College of Sports Medicine, looked at protein turnover changes, muscle size, quality and strength during menopause. All seemed to decline.    What we don't know [Dr Stuart Phillips' response to Mary Claire Haver's Instagram post regarding estrogen's impact on muscle] is the cause for these changes.   Is there evidence for causation between decline of estrogen and decrease in muscle mass, which some women experience:  Insomnia  Poor mood, depression or anxiety Lack of motivation (serotonin receptors) A time crunch in midlife  Comfort or emotional eating  Repeatedly, women will say, “I haven't changed a thing, but my results have changed.” That would be true if you didn't change what it was you were doing. If your hormones have changed, we have to change the exercise.   Another 2024 study in Menopause Journal showed both moderate intensity and resistance training exercise will decrease hot flash occurrence in some women, especially in women with depression.  High Intensity - more impact on body composition and positive impact on hot flashes Moderate Intensity - decreased hot flash occurrence   Exercise and Hot Flashes, Estrogen and Muscle Whether we're talking about exercise and hot flashes or estrogen and muscle loss, so many variables could be at play, even if the science is a randomized double-blind study with a large enough subject pool. If hormones have changed, we have to change the exercise (including nutrition and sleep habits) or it's not going to work.  If medications become important, then we have to look at micronutrients because they're depleted by each prescription or OTC med. If you don't absorb micronutrients you don't have optimal muscle or strength building blocks.    Social Media The type of studies that influencers share matters. Whether they've shared a review of literature, a double-blind randomized control study, or a narrative or know what that means What is the interpretation that helps you make decisions on changes you may want to consider or that reinforces what you are doing? The only real thing an influencer is sharing unless they share the science with you is, “what works for me” and you're left to guess… is that really what happens behind the scenes?    But before I share that, I think we know this:  Both are on a worthy mission… To improve the knowledge we have about muscle, bone and aging and the impact on them of daily and weekly habits  To acknowledge menopause has historically impacted women's health.   What can you do with the information? Make the best choices on exercise prescription, dietary choices, lifestyle habits to offset what is impacted by hormonal changes Make the best choices with their time and energy for women with hormonal changes to get the optimal health habits. Provide clarity about the exercise prescription that is most advantageous and then customize it for women based on their fitness status, health history, and stage of menopause  Train an army of Menopause Fitness Specialist® in every fitness club, health center, university and behind every online program.    Become a Coach on Exercise and Hot Flashes for Women in Midlife If you are interested in becoming a Flipping 50 Menopause Fitness Specialist® and tired of guessing for yourself, your clients and watching a lot of bro science applied to women without ever considering…  We've never asked questions about pelvic floor health in intake forms in the fitness industry. We've never considered from ovulation to luteal phase, a change in nutrition and exercise might serve a woman in reducing injury and getting better results. We've never suggested a woman test her muscle mass at 25 and bone at 30 when she's peaking to compare later.   Do you want to know how to create a comprehensive exercise prescription that supports, not worsens:  Insomnia Pre-diabetes and insulin resistance Low libido  Low bone mass  Body and (specifically) belly fat Exercise  Hot flashes/night sweats   More than 7 other key changes in exercise prescription that help a woman arrive at menopause, thrive through menopause, and enhance her longevity – reach out to me right now. We're opening the enrollment for the Flipping50 Menopause Specialist®. This is an amazing opportunity to join the program. Not only get the knowledge you need, but the business growth coaching so you aren't a wise broke trainer or coach like so many of your peers.  The number of trainers increased from 250,000 to 750,000 in the last decade. The number of health coaches has grown from zero to thousands in a few short years.  Yet, few of those are making a profit, let alone a living.  They're building websites, apps, social media…  they are failing. But you don't have to.  If you start from the beginning, skip the guessing with the copycat Chatgpt copy. You don't have to have a MBA in marketing or sales but you need to have a formula and blueprint to follow to build a business that starts successfully and is sustainable.    References on Exercise and Hot Flashes:  Moore SR, Cabre HE, Smith-Ryan AE. Body composition, physical activity, and menopause symptoms: how do they relate? Menopause. 2024 Apr 1;31(4):336-341. doi: 10.1097/GME.0000000000002334. Epub 2024 Mar 5. PMID: 38442308. Witkowski S, Evard R, Rickson JJ, White Q, Sievert LL. Physical activity and exercise for hot flashes: trigger or treatment? Menopause. 2023 Feb 1;30(2):218-224. doi: 10.1097/GME.0000000000002107. Epub 2022 Nov 7. PMID: 36696647; PMCID: PMC9886316.   Other Episodes You Might Like: Previous Episode - How and Why to Consider Meditation in Menopause Next Episode - How to Bounce Back Boldly After You Blew Your Diet More Like This - Caffeine, Hot Flashes, and Fat Burning During Menopause   Resources:  Join Flipping 50 Menopause Fitness Specialist® to become a coach! Book a Discovery Call with Debra to talk about your own menopause or becoming a coach.

Episode 191: Diagnosis of ADHDFuture Dr. Granat explains how to diagnose Attention Deficit Hyperactivity Disorder. She explained the influence of social media in increasing awareness of ADHD. Dr. Arreaza added input about the validated tools for ADHD diagnosis and highlighted the importance of expert evaluation for the diagnosis of this disorder.  Written by Yen Stephanie Granat, MSIV. Ross University School of Medicine. Comments and editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Steph: I love podcasts—many of us do—and if you, like me, spend any amount of your leisure time listening to podcasts, perusing the news, or scrolling social media; you've likely noticed an alarming trend in the number of discussions we seem to be having about ADHD. It has grown into a very hot topic over the past couple of years, and for some of us, it seems to have even begun sneaking into our “recommended videos” and across our news feeds! Naturally, for the average person this can spur questions like:“Do I have ADHD? Do we all have it? How can I be certain either way, and what do I do if I find myself relating to most of the symptoms that I'm seeing discussed?”Granted that there is a whirlpool of information circulating around this hot topic, I was hoping to spend a bit of time clearly outlining the disorder for anyone finding themselves curious. I believe that can best be achieved through outlining a clear, concise, and easy-to-understand definition of what ADHD is; outlining what it is not; and helping people sift through the fact and the fiction. As with many important things we see discussed on the internet, we're seeing is that there is much more fiction than fact. Arreaza: I'm so glad you chose this topic! I think it is challenging to find reliable information about complex topics like ADHD. Tik Tok, Instagram and Facebook are great social media platforms, but we have to admit that fake news have spread like a fire in recent years. So, if you, listener, are looking for reliable information about ADHD, you are in the right place. With ADHD, there aren't any obvious indicators, or rapid tests someone can take at home to give themselves a reliable “yes” or “no” test result. People's concerns with ADHD are valid, and important to address, so we will discuss the steps to identify some of signs and symptoms they are seeing on TikTok or their favorite podcaster. Steph: Healthcare anxiety is a vital factor to consider when it comes to large cultural conversations around our minds and bodies; so, I hope to sweep away some of the misconceptions and misinformation floating around about ADHD. In doing so, I want to help alleviate any stress or confusion for anyone finding themselves wondering if ADHD is impacting their lives! We might even be able to more accurately navigate these kinds of “viral topics” (for lack of a better term) next time we see them popping up on our news feeds.Arreaza: The first thing I want to say about ADHD is “the crumpled paper sign.”Steph: What is that?Arreaza: It is an undescribed sign of ADHD, I have noticed it, and it is anecdotal, not evidence based. When I walk into a room to see a pediatric patient, I have noticed that when the paper that covers the examination table is crumpled, most of the times it is because the pediatric patient is very active. Then I proceed to ask questions about ADHD and I have been right many times about the diagnosis. So, just an anecdote, remember the crumpled paper sign.  Steph: When you have patients coming to you asking for stimulants because they think they have ADHD, hopefully, after today, you can be better prepared to help those patients. So, for the average person—anyone wanting to be sure if this diagnosis applies to them—how can we really know?”Arreaza: So, let's talk about diagnosis.Steph: Yes, the clearest information we have is the DSM-5, which defines these disorders, as well as outlines the specific criteria (or “checkpoints”) one needs to meet to be able to have a formal diagnosis. However, this manual is best utilized by a trained professional—in this case, a physician—who can properly assess your signs and symptoms and give you a clear answer. Steph: ADHD stands for Attention Deficit Hyperactivity Disorder. It is among the most common neurodevelopmental disorders of childhood. That is not to say it does not affect adult—it does—and because it can be easy to miss, it's very possible for someone to have ADHD without knowing. Arreaza: I recently learned that ADD is an outdated term. Some people with ADHD do not have hyperactivity but the term still applies to them. Steph: Yes, there are multiple types that I will explain in just a bit. But overall the disorder is most simply characterized by a significant degree of difficulty in paying attention, controlling impulsive behaviors, or in being overly active in a way that the individual finds very difficult to control. (CDC)Arreaza: How common is ADHD?Steph: The most recently published data from The CDC estimates that 7 million (11.4%) of U.S. children between the ages of 3 and 17 have been diagnosed with ADHD. For adults, it is estimated that there are 15.5 million (6%) individuals in the U.S. who currently have ADHD. Arreaza: I suspected it would be more than that. [Anecdote about Boy Scout camp]. Steph: I totally agree. With short videos on TikTok, or paying high subscription fees to skip ads, it feels like as a society we all have a shorter attention span. Arreaza: Even churches are adapting to the new generation of believers: Shorter sermons and shorter lessons.Steph: When it comes to better understanding these numbers, it's also important to know that there are three distinct presentations of ADHD recognized by The CDC and The World Health Organization. Arreaza: The DSM-5 TR no longer uses the word “subtypes” for ADHD. Instead, it uses the word "presentation" to describe the different ways that ADHD may manifest in a person. That reminded me to update my old DSM-5 manual and I ordered it while reading today about ADHD. This means people with ADHD are no longer diagnosed as having a “subtype”. Instead, they are diagnosed with ADHD and a certain “presentation” of symptoms.Steph: These presentations are:Inattentive TypePeople often have difficulty planning or completing tasksThey find themselves easily distracted (especially when it comes to longer, focus-oriented tasks)They can often forget details and specifics, even with things that are part of their daily routineThis used to be referred to as “ADD” (you'll notice the absence of an “H”, segue).Hyperactive-Impulsive TypePeople often have a sense of intense “restlessness”, noticeable even in calm environments.They tend to be noticeably more talkative, and might often be seen interrupting others, or finishing their sentences.They find significant difficulty in being still for extended periods. Because of this, they are often unable to sit through a movie or class time, without fidgeting or getting up and moving around.With this category of ADHD, we often see an impulsiveness that unwittingly leads to risky behavior. Because of this, accidents and bodily injury are more common in individuals with this type of ADHD.Combined TypeThese are individuals who exhibit symptoms from both “Inattentive” and “Hyperactive-Impulsive” ADHD equally.Some listeners might have noticed that the categories are quite different, meaning that ADHD presents in different ways depending on the person! Two people who have ADHD can be in the same room and have vastly different presentations, whilst still having many of the same types of challenges. You also might have noticed what makes the discussion so interesting to the general public, which is also the thing that makes speaking to a professional to get formally tested so important:The diagnostic criteria rely heavily on patterns of behavior, or external variables; rather than on how a person might feel, or certain measurements taken from lab tests.Arreaza: Diagnosing ADHD requires evaluation by a professional who is properly trained for this. Fortunately, we have tools to assist with the diagnosis. The attention deficit must be noted in more than one major setting (e.g., social, academic, or occupational), that's why the information should be gathered from multiple sources, including parents, teachers, and other caregivers, using validated tools, such as:The Neuropsychiatric EEG-Based ADHD Assessment Aid (NEBA), recommended by the American Academy of NeurologyThe Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) and the Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS), recommended by the Society for Developmental and Behavioral Pediatrics.For adults: The validated rating scales include the Adult ADHD Self-Report Scale (ASRS) and the Conners Adult ADHD Rating Scales (CAARS).Steph: This is important because nearly everyone alive has experienced several, if not most, of these behavioral patterns at least once. Whether or not an individual has ADHD, I'm certain we could all think of moments we've had great difficulty focusing or sitting still. Perhaps some of us are incredibly forgetful, or act more impulsively than the average person might find typical. Getting a professional diagnosis is important because it is in skillfully assessing “the bigger picture” of a person's life, or their patterns of behavior, that a skilled physician, who understands the nuances and complexities in these disorders, can properly tell each of us whether we have ADHD, or not.Essentially, most of us could stand to use a bit more focus these days, but far fewer of us would meaningfully benefit from the kinds of treatments and therapies needed by individuals with ADHD to live healthier, more happy and regulated lives.Arreaza: I had a mother who came to discuss the results of the Vanderbilt Questionnaire. I think she left a little disappointed when she heard that, based on the responses from her and the teacher, her son did not have ADHD. Some kids may have behaviors such as being distracted during a meeting, forgetting about homework or having a lot of energy, but that does NOT mean necessarily that they have ADHD, right?Steph: Absolutely! The important thing to remember here is that these patterns of behavior outlined in the DSM-5 are merely an external gauge for a neurological reality. What the science is showing us is that the brains of people with ADHD are wired differently than that of the more “neurotypical” brain. Much like a check engine light would serve as a signal to a driver that something under the hood needs attention; these patterns of behavior, when they begin impeding our day to day lives, might tell us that it's time to see a professional (whether it be an auto mechanic or a trained physician). I think we all know someone who drives with their check engine light and not a care in the world. Arreaza: How serious/urgent is ADHD? Why should we care to make the diagnosis?Steph: Although we've yet to see anyone incur harm solely from having ADHD, it does lead to quite a range of more serious issues, some of which might prove more urgent. In the cases of ADHD, specifically, what we know is that there is a notable degree of dysregulation in some key neurotransmitters, like dopamine and norepinephrine. More plainly, what we are seeing in the brains of people with ADHD is a disruption, or alteration, of some of the brain's key chemicals.These neurotransmitters are largely responsible for much-needed processes like Motivation, Satisfaction, Focus, Impulse control, even things like energy and feelings of happiness. Many of these things serve as “fuel” for our day-to-day lives; things we'd call our “executive function”.  These are also what prove dysfunctional in those struggling with ADHD. It is in this sense that we might be able to bridge a meaningful gap between ADHD as being seen through patterns of behaviorthat signal a real, neurological reality.Steph: We often hear of the brain referenced as a kind of supercomputer. A more accurate assessment might be that the brain is more of a network of interconnected computers that run different processes and require continual communication with one another for our brain to function properly and seamlessly. What we're seeing in members of the population with this diagnosis, is a significant disruption in these lines of communication. Although this is a very broad oversimplification, for the purposes of our metaphor is to think of it like our brain chemicals getting caught in a traffic jam, or parts of our brain attempting to communicate to one another with poor cell signal. Arreaza: Making the diagnosis is critical to start treatment because having that level of dysfunction sounds like having a very difficult life.Steph: Yeah! I think that's why this conversation matters so much. There's a sense of urgency there, because much of life is, in fact, boring. Things like paying bills, exercising and eating well, work and school—these are all things that are vital to health and wellbeing in day-to-day life; and for the more neurotypical brain, these things might prove occasionally challenging. Yet, they are still doable. For those with ADHD however, this goes far beyond mere boredom or “laziness” (which proves to be a trigger term for many—more on that in just a bit).For folks listening, I wanted to offer some statistics that show why this is such a big concern for the public, whether one has a formal ADHD diagnosis or not. The facts are figures are:Children with ADHD are more than five times as likely as the child without ADHD to have major depression.A significant increase in the prevalence of anxiety is seen in ADHD patients, ranging from 15% to 35%, when accounting for overlap in symptoms.There are significant correlations in youth diagnosed with ADHD, and those diagnosed with what are known as “externalizing disorders”. These are things like Conduct Disorder, Disruptive Mood Dysregulation Disorder, and Oppositional Defiant Disorder.We are seeing a much higher rate of academic problems in kids who have ADHD, like reading disorder, impaired verbal skills, and visual motor integration.We're finding that many, if not most, of these connections are being made after diagnosis. In the case of the “internalized disorders”, like depression and anxiety, we're often seeing years between ADHD diagnoses and the diagnoses of major depressive disorder or anxiety disorders. Given this framework, much of the data is theorized to point towards what we call “negative environmental circumstances”, otherwise known as “ADHD-related demoralization”.For children, this often looks like struggling with sitting still during class, failing to get homework done (because they forgot, or couldn't focus on the tasks at hand), and struggling to focus their attention on what their teacher is saying during lecture. These things often lead to bad grades, discipline or forced time sitting still in detention. This can be seen in more problems at home, with children being disciplined often for behavior that they struggle immensely to control.For adults, this can mean forgetting to pay your bills, missing work meetings, having trouble making appointments, or having difficulty with day-to-day tasks, really anything that requires sustained attention. We often see adults with ADHD who are chasing normalcy with caffeine addictions or even struggling with substance use. Arreaza: Substance use disorder actually can be a way for some people living with ADHD to self-treat their symptoms. Steph: These differences between the individual's experience and the world around them can lead to really powerful feelings of failure or inadequacy. They can affect your social life, your sense of community, and even further limit your capacity to seek help.Literacy in these things is so important—not just for the individual who feels that they may have ADHD, but also for those who are likely to encounter people with ADHD in their own lives. Understanding why some of these patterns pop up, even those who might not have a formal diagnosis, can go a long way to properly approaching these behaviors with success and with empathy.Arreaza: Learning about ADHD is fundamental for primary care doctors. We talked about the high prevalence and the influence of the media in increasing awareness and sometimes increasing public panic. So, we have to be prepared to diagnose or undiagnosed ADHD. Steph: Whether we're the physicians in the room, or the patient in the chair, I think it's important to have a clear understanding of what ADHD is and how it can affect lives. Thanks for listening, I hope we were able to teach you a little more about ADHD. ______________Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _______________References:NICHQ-Vanderbilt-Assessment-Scales PDF: https://nichq.org/wp-content/uploads/2024/09/NICHQ-Vanderbilt-Assessment-Scales.pdfADHD: The facts. ADDA - Attention Deficit Disorder Association. (2023, January 11). https://add.org/adhd-facts/American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases. 2019 Sep 6;7(17):2420-2426. doi: 10.12998/wjcc.v7.i17.2420. PMID: 31559278; PMCID: PMC6745333.Staley BS, Robinson LR, Claussen AH, et al. Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment and Telehealth Use in Adults — National Center for Health Statistics Rapid Surveys System, United States, October – November 2023. CDC.Gov, MMWR Morb Mortal Wkly Rep 2024;73:890-895.Danielson ML, Claussen AH, Arifkhanova A, Gonzalez MG, Surman C. Who Provides Outpatient Clinical Care for Adults With ADHD? Analysis of Healthcare Claims by Types of Providers Among Private Insurance and Medicaid Enrollees, 2021. J Atten Disord. 2024 Jun;28(8):1225-1235. doi: 10.1177/10870547241238899. Epub 2024 Mar 18. PMID: 38500256; PMCID: PMC11108736. https://pubmed.ncbi.nlm.nih.gov/38500256/Mattingly G, Childress A. Clinical implications of attention-deficit/hyperactivity disorder in adults: what new data on diagnostic trends, treatment barriers, and telehealth utilization tell us. J Clin Psychiatry. 2024;85(4):24com15592. https://www.psychiatrist.com/jcp/implications-adult-adhd-diagnostic-trends-treatment-barriers-telehealth/Didier J. My four kids and I all have ADHD. We need telehealth options. STAT News. Published October 10, 2024. Accessed October 10, 2024. https://www.statnews.com/2024/10/10/adhd-medication-shortage-telehealth-dea-congress/.Hong J, Mattingly GW, Carbray JA, Cooper TV, Findling RL, Gignac M, Glaser PE, Lopez FA, Maletic V, McIntyre RS, Robb AS, Singh MK, Stein MA, Stahl SM. Expert consensus statement for telepsychiatry and attention-deficit hyperactivity disorder. CNS Spectr. 2024 May 20:1-12. doi: 10.1017/S1092852924000208. Epub ahead of print. PMID: 38764385. https://pubmed.ncbi.nlm.nih.gov/38764385/Gabor Maté: The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. (2022). Youtube. Retrieved April 27, 2025, from https://www.youtube.com/watch?v=ttu21ViNiC0. Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode of The Moss Report, Ben Moss speaks with Dr. Ralph Moss about a little-known natural compound that may have big implications: Modified Citrus Pectin (MCP). A recent clinical trial in Israel found that MCP helped slow PSA doubling time in men with recurrent prostate cancer—suggesting it may offer real, measurable support for patients after treatment. Ben and Ralph trace the story from its origins in the 1990s through modern-day research, digging into how MCP works by targeting Galectin-3, a molecule tied to inflammation and cancer spread. Along the way, they highlight the researchers who kept this idea alive, including Dr. Kenneth Pienta and Dr. Isaac Eliaz, and ask why this research isn't more widely known. It's an honest, science-based conversation about where evidence and action meet—and how natural approaches might still be flying under the radar. Link to the full article with transcript, slide presentation, links and cited studies. https://www.themossreport.com/mcp-podcast/ Products mentioned in this podcast: Pectasol-C – https://econugenics.com/?a_aid=TMR Mycolife – The Moss Method Mushroom Formula – https://mycolife.us/product/the-moss-method-mushroom-formula/ Links and Resources:

Welcome to the podcast with Dr. Brendan McCarthy!   Today's episode is all about testosterone therapy in women—a topic that's often misunderstood, highly debated, and rarely taught in depth. I'm sharing what I've learned over my years of clinical experience, how I approach testosterone use in women safely, and why the conversation around it needs to evolve.   Dr. Brendan McCarthy founded Protea Medical Center in 2002. While he's been the chief medical officer, Protea has grown and evolved into a dynamic medical center serving the Valley and Central Arizona. A nationally recognized as an expert in hormone replacement therapy, Dr McCarthy s the only instructor in the nation who teaches BioHRT on live patients. Physicians travel to Arizona to take his course and integrate it into their own practices. Besides hormone replacement therapy, Dr. McCarthy has spoken nationally and locally before physicians on topics such as weight loss, infertility, nutritional therapy and more.   Hurst BS, Jones AI, Elliot M, Marshburn PB, Matthews ML. Absorption of vaginal estrogen cream during sexual intercourse: a prospective, randomized, controlled trial. J Reprod Med. 2008;53(1):29–32. PMID: 18251358   Thank you for tuning in and don't forget to hit that SUBSCRIBE button! Let us know in the COMMENTS if you have any questions or what you may want Dr. McCarthy to talk about next!   Check out Dr. Brendan McCarthy's Book! https://www.amazon.com/Jump-Off-Mood-...   -More Links- Instagram: www.instagram.com/drbrendanmccarthy TikTok: www.tiktok.com/drbrendanmccarthy Clinic Website: www.protealife.com

In this episode, Dr. Tyler Betteridge discusses his recent review of an artile about adductor injuries and the develoipment of a functional test to identify the likelihood of injury based on its results.The article discusses the BAPT adductor test, which did show correlation of lower scores and increased injury risk.  Scores below 33 reps resulted in a 20% higher likelihood of adductor injury.Listen to hear more about this study!Article:de Queiroz JHM, Frota JP, Dos Reis FA, de Oliveira RR. Development and Predictive Validation of the Brazilian Adductor Performance Test for Estimating the Chance of Hip Adductor Injuries in Elite Soccer Athletes. Int J Sports Physiol Perform. 2023 Apr 20;18(6):653-659. doi: 10.1123/ijspp.2022-0306. PMID: 37080542.

How do we make artificial intelligence more intelligent? This week, Technology Now dives deep into the world of AI agents and how they interact with large language models. We ask what are some of the current problems with AI, and examine how applying agents can help artificial intelligence to provide better answers to our questions. Jimmy Whitaker, Chief Scientist in the AI Private Cloud Group at HPE, tells us more.This is Technology Now, a weekly show from Hewlett Packard Enterprise. Every week, hosts Michael Bird and Aubrey Lovell look at a story that's been making headlines, take a look at the technology behind it, and explain why it matters to organizations and what can be learnt from it.Jimmy Whitaker: https://www.linkedin.com/in/jimmymwhitaker/Sources cited in this week's episode:Today I learned: https://www.simonsfoundation.org/2025/04/29/flares-from-magnetized-stars-can-forge-planets-worth-of-gold-other-heavy-elements/Anirudh Patel et al., 2025, Direct Evidence for r-process Nucleosynthesis in Delayed MeV Emission from the SGR 1806–20 Magnetar Giant Flare, ApJL 984 L29, DOI 10.3847/2041-8213/adc9b0This week in history:Strassburg MA. The global eradication of smallpox. Am J Infect Control. 1982 May;10(2):53-9. doi: 10.1016/0196-6553(82)90003-7. PMID: 7044193.Muyembe JJ, et al, 2024, Ebola Outbreak Response in the DRC with r-VSV-ZEBOV-GP Ring Vaccination, The New England Journal of Medicine, 2024;391:2327-2336, VOL. 391 NO.24, https://www.nejm.org/doi/10.1056/NEJMoa1904387https://www.who.int/health-topics/poliomyelitis#tab=tab_1

We all know about the medical school curriculum. But what about the hidden curriculum, or how students learn about the unspoken culture of medicine through everyday, informal interactions? In this episode, Dr. Sandra Quezada and Dr. Sarah Dubbs explore the hidden curriculum with some examples, chat about whether the hidden curriculum can be positive or negative, and offer guidance on how students can best navigate the hidden curriculum and thrive within it.   References: Lawrence C, Mhlaba T, Stewart KA, et al. The Hidden Curricula of Medical Education: A Scoping Review. Acad Med. 2018 Apr;93(4):648-656. PMID: 29116981. Bandini J, Mitchell C, Epstein-Peterson ZD, et al. Student and Faculty Reflections of the Hidden Curriculum. Am J Hosp Palliat Care. 2017 Feb;34(1):57-63. Epub 2016 Jul 11. PMID: 26566929. Martimianakis MA, Michalec B, Lam J, et al. Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis. Acad Med. 2015 Nov;90(11 Suppl):S5-S13. PMID: 26505101. Hopkins L, Saciragic L, Kim J, Posner G. The Hidden Curriculum: Exposing the Unintended Lessons of Medical Education. Cureus. 2016 Oct 25;8(10):e845. PMID: 27909633 Kalter L. Navigating the Hidden Curriculum in Medical School. AAMC News. Published July 13, 2019. Accessed December 10, 2024. Link.  Freedman D. The Hidden Curriculum. NYU Langone Health Hub. Accessed December 10, 2024. Link.   

What do alcohol, sleep, diet and “purpose in life” have in common?According to a powerful new study, they're all modifiable risk factors that may determine your future risk of stroke, dementia and late-life depression — three of the most pressing health challenges of our time.In this episode of The Mind-Gut Conversation, Dr. Mayer breaks down this comprehensive review, which analyzed data from over 180 meta-analyses and ranked risk factors based on their impact on healthy aging and brain health. The findings go far beyond just cholesterol or glucose — and include often overlooked lifestyle and psychological factors like social engagement and chronic stress.In this episode, you'll learn:1) Which modifiable factors have the greatest impact on dementia, stroke and depression2) Why physical and psychological health are deeply intertwined3) How “purpose in life” scored higher than some traditional clinical markers4) What these findings mean for real-world prevention — and your everyday choicesWhether you're supporting a loved one or simply planning for your own long-term health, this episode offers evidence-backed clarity on what actually matters most.Want to read the study yourself? Here's the link & PMID reference:https://pubmed.ncbi.nlm.nih.gov/40180437/ PMID: 40180437If you'd like to go deeper into these topics, you can learn more on emeranmayer.com!

I'm discussing the truth about "Lifting Heavy" in group fitness.Sources (Research Show Notes)Schoenfeld BJ et al. (2016). Longer Interset Rest Periods Enhance Muscle Strength and Hypertrophy in Resistance-Trained Men. J Strength Cond Res, 30(7):1805-12. PMID: 26605807pubmed.ncbi.nlm.nih.govGrgic J et al. (2017). The effects of short versus long inter-set rest intervals on measures of muscle hypertrophy: A systematic review. Eur J Sport Sci, 17(8): 983-993. PMID: 28641044pubmed.ncbi.nlm.nih.govMcKendry J et al. (2016). Short inter-set rest blunts resistance exercise-induced increases in myofibrillar protein synthesis in young males. Exp Physiol, 101(7): 866-82. PMID: 27126459pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.govSchoenfeld BJ. (2010). The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res, 24(10): 2857-2875.journals.lww.com“Give it a rest” Meta-analysis (Singer et al. 2024). Inter-set Rest Interval Duration and Muscle Hypertrophy: A Bayesian Meta-Analysis. Frontiers in Sports and Active Living. DOI: 10.3389/fspor.2024.1429789frontiersin.orgTopics:(00:08) - Are strength training classes worth doing? (06:14) - This is the problem with "lift heavy" (13:01) - Why does rest period matter? (36:32) - It's not just about aesthetics (41:17) - Hearing this in the spirit I intended

About our Guest: Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. Learning Objectives: By the end of this podcast series, listeners should be able to: Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.Understand the experience of introducing a novel form of respiratory support in a PICU.Describe the stepwise escalation of NPV settings often used in acute respiratory failure.References:Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.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.

Send us a textIntermittent sigh breaths during high-frequency oscillatory ventilation in preterm infants: a randomised crossover study.Hough JL, Jardine L, Hough MJ, Steele M, Greisen G, Heiring C.Arch Dis Child Fetal Neonatal Ed. 2025 Apr 17;110(3):297-302. doi: 10.1136/archdischild-2024-327445.PMID: 39406472 Clinical Trial.As 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 textEffect of kangaroo mother care in low birth weight infants on human milk intake: a randomized controlled trial.Sinha B, Mazumder S, Thakur A, Devi S, More D, Ashorn P, Sommerfelt H, Kurpad A, Bhandari N.Am J Clin Nutr. 2025 May;121(5):1109-1116. doi: 10.1016/j.ajcnut.2025.02.006. Epub 2025 Feb 11.PMID: 39947481 Free article. Clinical Trial.As 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!

Let's unpack something most midlife women are totally missing – protein for Menopause Hormone Support. Are you feeling moody, low-energy, or constantly craving carbs in midlife? It might not just be your hormones—it could be your protein intake… and its effect on your hormones.  In today's episode, know how protein connects hormones and why your daily meals might be the hormonal tune-up you didn't know you needed. Cortisol & Protein: The Stress-Balance Dance Cortisol levels increase in response to low blood sugar or stress, which are common when meals are high-carb and low-protein. A high-protein diet blunts cortisol spikes post-meal and improves the body's stress response.   Insulin: Protein's Role in Glucose Control Protein stimulates insulin—but in a modulated way that helps with blood sugar stability, not spikes. In midlife and beyond, protein helps preserve insulin sensitivity, especially when combined with resistance training.   Ghrelin & Leptin: Protein vs. Cravings Ghrelin = your hunger hormone. Protein is the most effective macronutrient at suppressing ghrelin. Leptin = satiety hormone. Protein helps regulate leptin sensitivity over time. The Protein theory goes that if the body doesn't get enough protein it will message you it wants more. The problem is the message is not clear. It's just a hunger signal. You're left to figure it out or deal with the tempting cookies, cakes, and chocolate hidden in the icebox.    Estrogen: From Muscle Protector to MIA Estrogen is an anabolic hormone—it supports muscle maintenance, insulin sensitivity, and metabolic efficiency. As estrogen declines in perimenopause and menopause, its natural support of muscle protein synthesis (MPS) disappears. With estrogen no longer stimulating MPS, women must now rely on two primary tools to stimulate it: Resistance training Adequate high-quality protein (especially leucine-rich) “Estrogen enhances the anabolic response of skeletal muscle to both feeding and resistance exercise, and its loss results in anabolic resistance.”   More Truths About Protein for Menopause Hormone Support Muscle Protein Synthesis declines with age—and even more so without estrogen.  This is why RDA-level protein (0.8g/kg) is not sufficient in midlife - a statement agreed on by Registered Dietitians, longevity and geriatric experts alike.  Experts (ISSN) recommend ≥1.6–2.2g/kg of body weight for active women in midlife to maintain muscle, metabolism, and hormonal resilience.   The Anabolic vs. Catabolic Hormone Framework Anabolic Hormones = Build & Repair These are hormones that stimulate tissue growth and regeneration: Testosterone – promotes muscle growth, strength, libido Growth Hormone (GH) – supports repair, recovery, and fat metabolism Estrogen – helps preserve lean mass, regulates insulin sensitivity Insulin – can be anabolic by shuttling nutrients into cells, especially post-exercise Protein intake supports all of these by providing the amino acid building blocks needed for anabolic activity. Catabolic Hormones = Break DownThese are hormones that promote the breakdown of muscle, tissue, and energy stores: Cortisol – breaks down muscle for glucose during stress Epinephrine/Norepinephrine – mobilize energy in fight-or-flight Chronically elevated catabolic hormones + low protein = muscle loss, cravings, fatigue. Fat Storage Insulin isn't actually a catabolic hormone but it does increase fat storage. You can't be burning fat if insulin is high, as is true for many women. Focusing on boosting the anabolic hormones is the game-changer.    Other Episodes You Might Like: Previous Episode - Can We Just Stop the Self Sabotage to Feel Your Best Ever  Next Episode - How and Why to Consider Meditation in Menopause More Like This - Where Protein Recommendations for Women Come From?   Resources:  This episode is brought to you by Flipping 50 Longevity Pro Protein & Fiber, the simplest ingredient, cleanest, third-party-tested protein powder formulated specifically for midlife metabolism. No bloat, no fillers, just functional fuel. Use code PODCAST10 for 10% off at checkout.   References:  Lemmens SG, Born JM, Martens EA, Martens MJ, Westerterp-Plantenga MS. PLoS One. 2011 Feb 3;6(2):e16826. doi: 10.1371/journal.pone.0016826. PMID: 21304815; PMCID: PMC3033415. Layman et al., 2008 reported that diets with higher protein and lower carbs improved insulin sensitivity in adults. DOI: 10.1093/jn/138.3.514 Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Am J Clin Nutr. 2013 Apr;97(4):677-88. doi: 10.3945/ajcn.112.053116. Epub 2013 Feb 27. PMID: 23446906; PMCID: PMC3718776. Tang JE, Moore DR, Kujbida GW, Tarnopolsky MA, Phillips SM. J Appl Physiol (1985). 2009 Sep;107(3):987-92. doi: 10.1152/japplphysiol.00076.2009. Epub 2009 Jul 9. PMID: 19589961.  

Welcome to the podcast with Dr. Brendan McCarthy!   Explore how progesterone travels through the body depending on the method of delivery—oral, transdermal, or injection. Dr. McCarthy explains why certain forms may not be effective for all patients and discusses how the body metabolizes progesterone, influencing its therapeutic impact. This episode is essential for anyone considering or currently on hormone replacement therapy.   Dr. Brendan McCarthy founded Protea Medical Center in 2002. While he's been the chief medical officer, Protea has grown and evolved into a dynamic medical center serving the Valley and Central Arizona. A nationally recognized as an expert in hormone replacement therapy, Dr McCarthy s the only instructor in the nation who teaches BioHRT on live patients. Physicians travel to Arizona to take his course and integrate it into their own practices. Besides hormone replacement therapy, Dr. McCarthy has spoken nationally and locally before physicians on topics such as weight loss, infertility, nutritional therapy and more.   Hurst BS, Jones AI, Elliot M, Marshburn PB, Matthews ML. Absorption of vaginal estrogen cream during sexual intercourse: a prospective, randomized, controlled trial. J Reprod Med. 2008;53(1):29–32. PMID: 18251358   Thank you for tuning in and don't forget to hit that SUBSCRIBE button! Let us know in the COMMENTS if you have any questions or what you may want Dr. McCarthy to talk about next!   Check out Dr. Brendan McCarthy's Book! https://www.amazon.com/Jump-Off-Mood-...   -More Links- Instagram: www.instagram.com/drbrendanmccarthy TikTok: www.tiktok.com/drbrendanmccarthy Clinic Website: www.protealife.com

In this episode Dr. Raffaele Teperino shares insights from his ongoing research focused on developmental programming, particularly how paternal health before conception influences not only offspring health but also maternal health outcomes. As we trace his academic journey from studying biotechnology and pharmacology to leading his own lab, Dr. Teperino reflects on his early fascination with medicine, the pivotal experiences that shaped his career, and the integration of epigenetics into understanding metabolic diseases. We discuss the nuances of epigenetics—going beyond simple chromatin biology to examine its wider implications on phenotypic variation. Dr. Teperino emphasizes his approach of modeling relevant physiological phenomena in the lab to better understand the underlying mechanisms driving conditions like obesity and metabolic disruption. A particular focus is placed on his experiences during his postdoctoral years, where he investigated the developmental pathways of hedgehog signaling and its metabolic implications in adipogenesis. Our talk shifts towards the practical implications of his research, highlighting recent investigations into how circadian rhythms and paternal lifestyles influence offspring health. Dr. Teperino reveals his findings on how disturbances in circadian rhythms can lead to intergenerational health issues, showcasing the surprising effects observed in offspring of fathers experiencing circadian misalignment. We delve into the significance of seminal fluid as a potential medium for intergenerational transfer of stress responses, examining the role of stress hormones and their impacts on fetal development. As we explore a fascinating recent study highlighting the impact of paternal diets on future generations, Dr. Teperino underscores the importance of understanding the shorter exposure periods sufficient to trigger these health changes. He presents data that links paternal obesity and preconception health to an increased risk of obesity and insulin resistance in children, challenging traditional narratives around maternal responsibility for offspring health.   References Darr J, Tomar A, Lassi M, Gerlini R, Berti L, Hering A, Scheid F, Hrabě de Angelis M, Witting M, Teperino R. iTAG-RNA Isolates Cell-Specific Transcriptional Responses to Environmental Stimuli and Identifies an RNA-Based Endocrine Axis. Cell Rep. 2020 Mar 3;30(9):3183-3194.e4. doi: 10.1016/j.celrep.2020.02.020. PMID: 32130917. Lassi M, Tomar A, Comas-Armangué G, Vogtmann R, Dijkstra DJ, Corujo D, Gerlini R, Darr J, Scheid F, Rozman J, Aguilar-Pimentel A, Koren O, Buschbeck M, Fuchs H, Marschall S, Gailus-Durner V, Hrabe de Angelis M, Plösch T, Gellhaus A, Teperino R. Disruption of paternal circadian rhythm affects metabolic health in male offspring via nongerm cell factors. Sci Adv. 2021 May 26;7(22):eabg6424. doi: 10.1126/sciadv.abg6424. PMID: 34039610; PMCID: PMC8153725. Tomar A, Gomez-Velazquez M, Gerlini R, Comas-Armangué G, Makharadze L, Kolbe T, Boersma A, Dahlhoff M, Burgstaller JP, Lassi M, Darr J, Toppari J, Virtanen H, Kühnapfel A, Scholz M, Landgraf K, Kiess W, Vogel M, Gailus-Durner V, Fuchs H, Marschall S, Hrabě de Angelis M, Kotaja N, Körner A, Teperino R. Epigenetic inheritance of diet-induced and sperm-borne mitochondrial RNAs. Nature. 2024 Jun;630(8017):720-727. doi: 10.1038/s41586-024-07472-3. Epub 2024 Jun 5. PMID: 38839949; PMCID: PMC11186758.   Related Episodes The Impact of Paternal Diet on Offspring Metabolism (Upasna Sharma) Transgenerational Inheritance and Evolution of Epimutations (Peter Sarkies) The Role of Small RNAs in Transgenerational Inheritance in C. elegans (Oded Rechavi)   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

This episode explores the treatment of patients with intermediate-risk non-muscle-invasive bladder cancer (IR NMIBC), an important topic in urology today. Expert in the field, Marco Moschini, delves into the topic of risk-adapted treatment, where patients are assigned to a particular risk group based on patient- and tumour-related factors, also taking into account the prior treatment history and the timing of recurrences. Topics discussed include: Current confusion about the clinical heterogeneity within the intermediate-risk patient group The best way to select adequate intravesical therapy for this group The lack of consensus regarding an optimal schedule for adjuvant intravesical chemotherapy *References Scilipoti P, et al. Urol Oncol. 2024;42(12):451.e1-451.e10. PMID: 39060208. European Association of Urology. EAU NMIBC Risk Calculator, https://nmibc.net/ Sylvester RJ, et al. Eur Urol. 2021;79(4):480-488. PMID: 33419683. Tan WS, et al. Eur Urol Oncol. 2022;5(5):505-516. PMID: 35718695. Gontero P, et al. EAU Guidelines on Non-muscle invasive Bladder Cancer (TaT1 and CIS), Limited Update March 2025. European Association of Urology Guidelines Office, Arnhem, The Netherlands, 2025. Full Guideline Friedrich MG et al. Eur Urol. 2007;DOI:10.1016/j.eururo.2007.02.063.

A Rebelião Saudável nasceu da união de diversos profissionais de saúde que pensam diferente e cujo foco é promover saúde e bem estar, com comida de verdade e sem medicamentos.Semanalmente a Rebelião se reune no app Telegram para discussão de tópicos importantes relacionados a Nutrição Humana e Qualidade de vida. Nessa semana, conversamos conversamos sobre Existe Vício em Comida?O artigo analisado no podcast foi: Gearhardt AN, Schulte EM. Is Food Addictive? A Review of the Science. Annu Rev Nutr. 2021 Oct 11;41:387-410. doi: 10.1146/annurev-nutr-110420-111710. Epub 2021 Jun 21. PMID: 34152831.

In this Mini Series episode, I dive into a nuanced conversation around gratitude practices for perinatal trauma survivors. While gratitude can be a powerful tool for healing, it often becomes complicated when paired with the experiences of trauma, grief, and loss.Whether you've felt pressure to “just be grateful” or are searching for ways to reconnect with yourself and your story, this episode offers validation and actionable insight.

Send us a textDescription: An immersive reading of A Hymn to God the Father by John Donne with reflection on medical errors and confession. Website:https://anauscultation.wordpress.comWork:A Hymn to God the Father by John DonneWilt thou forgive that sin where I begun,         Which was my sin, though it were done before?Wilt thou forgive that sin, through which I run,         And do run still, though still I do deplore?                When thou hast done, thou hast not done,                        For I have more.Wilt thou forgive that sin which I have won         Others to sin, and made my sin their door?Wilt thou forgive that sin which I did shun         A year or two, but wallow'd in, a score?                When thou hast done, thou hast not done,                        For I have more.I have a sin of fear, that when I have spun         My last thread, I shall perish on the shore;But swear by thyself, that at my death thy Son         Shall shine as he shines now, and heretofore;                And, having done that, thou hast done;                        I fear no more.References:Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000 Mar 18;320(7237):726-7. doi: 10.1136/bmj.320.7237.726. Finkelstein A, Brezis M, Taub A, Arad D. Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives. Isr J Health Policy Res. 2024 Mar 11;13(1):13.Rodziewicz TL, Houseman B, Vaqar S, et al. Medical Error Reduction and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000. PMID: 25077248.

In our recent episode on global burn surgery with Dr. Barclay Stewart and Dr. Manish Yadav, we discussed several cases at Kirtipur Hospital in Nepal to illustrate the global burden of burns and similarities and differences in treating burns at Harborview Medical Center, a level 1 trauma and ABA verified burn center in Seattle, WA and Kirtipur Hospital (Nepal Cleft and Burn Center) in Kathmandu, Nepal. In this episode Dr. Stewart and Dr. Yadav return for an interview by UW Surgery Resident, Paul Herman, sharing insights on how to get involved in global surgery with an emphasis on sustainable participation. Hosts:  Manish Yadav, Kirtipur Hospital, Nepal Barclay Stewart, UW/Harborview Medical Center Paul Herman, UW/Harborview General Surgery Resident, @paul_herm  Tam Pham, UW/Harborview Medical Center (Editor) Learning Objectives 1.     Approaches to global surgery  a.     Describe historical perspectives on global health and global surgery reviewing biases global surgery inherits from global health due to the history of colonialism, neo-colonialism and systemic inequalities b.     Review a recently published framework and evaluation metrics for sustainable global surgery partnerships (GSPs) as described by Binda et al., in Annals of Surgery in March 2024. c.      Provide examples of this framework from a successful global surgery partnership d.     Define vertical, horizontal and diagonal global surgery approaches e.     Share tips for initial engagement for individuals interested in getting involved in global surgery References 1.     Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank. 2.     Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health. 2024 Jan 4;9(1):e014173. doi: 10.1136/bmjgh-2023-014173. PMID: 38176746; PMCID: PMC10773343. https://pubmed.ncbi.nlm.nih.gov/38176746/ 3.     Binda CJ, Adams J, Livergant R, Lam S, Panchendrabose K, Joharifard S, Haji F, Joos E. Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study. Ann Surg. 2024 Mar 1;279(3):549-553. doi: 10.1097/SLA.0000000000006058. Epub 2023 Aug 4. PMID: 37539584; PMCID: PMC10829902.  https://pubmed.ncbi.nlm.nih.gov/37539584/ 4.     Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986. https://pubmed.ncbi.nlm.nih.gov/33908733/ 5.     Frenk J, Gómez-Dantés O, Knaul FM: The health systems agenda: prospects for the diagonal approach. The handbook of global health policy. 2014 Apr 24; pp. 425–439 6.     Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744. https://pubmed.ncbi.nlm.nih.gov/29475744/ 7.     Strain, S., Adjei, E., Edelman, D. et al. The current landscape of global international surgical rotations for general surgery residents in the United States: a survey by the Association for Program Directors in Surgery's (APDS) global surgery taskforce. Global Surg Educ 3, 77 (2024). https://doi.org/10.1007/s44186-024-00273-2 8.     Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns. 2024 Jun;50(5):1160-1173. doi: 10.1016/j.burns.2024.02.008. Epub 2024 Feb 15. PMID: 38472005; PMCID: PMC11116054. https://pubmed.ncbi.nlm.nih.gov/38472005/ 9.     Shrestha R, Mehta K, Mesic A, Dahanayake D, Yadav M, Rai S, Nakarmi K, Bista P, Pham T, Stewart BT. Barriers and facilitators to implementing enteral resuscitation for major burn injuries: Reflections from Nepalese care providers. Burns. 2024 Oct 28;51(1):107302. doi: 10.1016/j.burns.2024.107302. Epub ahead of print. PMID: 39577105. https://pubmed.ncbi.nlm.nih.gov/39577105/ 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://app.behindtheknife.org/listen

About our Guest: Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. Learning Objectives: By the end of this podcast series, listeners should be able to: Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.Understand the experience of introducing a novel form of respiratory support in a PICU.Describe the stepwise escalation of NPV settings often used in acute respiratory failure.References:Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.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.

Hundreds of years ago, people were treating stomach troubles with poo. Centuries later, in our modern era, doctors began to treat people with poo again. Why did people do this... and why did we not stop? -- Connect: www.privy-cast.com Social and Contact Links: linktr.ee/privycast Follow Hunter -- Give Thanks, Give Back: Wounded Warrior Project Living Water International -- Music:  Intro and Outro Derived from: "Barroom Ballet" Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 4.0 License http://creativecommons.org/licenses/by/4.0/ - Transition Music: "Big Blue" by Podington Bear www.soundofpicture.com www.podingtonbear.com -- Privy is proud to be hosted by Podbean. Looking to start a podcast? Learn more at: https://www.podbean.com/Privycast -- Sources: https://en.wikipedia.org/wiki/Fecal_microbiota_transplant#History https://en.wikipedia.org/wiki/Ge_Hong https://en.wikipedia.org/wiki/Traditional_Chinese_medicines_derived_from_the_human_body Shi YC, Yang YS. Fecal microbiota transplantation: Current status and challenges in China. JGH Open. 2018 Jul 30;2(4):114-116. doi: 10.1002/jgh3.12071. PMID: 30483574; PMCID: PMC6152466. https://pmc.ncbi.nlm.nih.gov/articles/PMC6152466/#jgh312071-bib-0002 https://web.archive.org/web/20170314080738/http://medcom.uiowa.edu/health/fecal-transplantation/ https://cmjournal.biomedcentral.com/articles/10.1186/s13020-019-0253-x https://en.wikipedia.org/wiki/Li_Shizhen https://www.bbc.com/news/magazine-27503660 https://asm.org/articles/2024/february/fecal-microbiota-transplants-past-present-future https://en.wikipedia.org/wiki/Fecal_microbiota_spores,_live

Did you know that congenital cytomegalovirus (cCMV) is the most common congenital viral infection in newborns and a leading cause of non-genetic hearing loss? Despite its prevalence, awareness and screening for cCMV remain inconsistent across healthcare systems. In this episode, we dive into the critical importance of cCMV screening, early diagnosis, and intervention. Join our expert guests Dr. Ingrid Camelo and Dr. John Noel as they discuss: The impact of cCMV on neonatal and long-term health outcomes Best practices for screening and diagnostic methods The role of early intervention, including antiviral therapy How advocacy efforts are shaping the future of universal screening policies Tune in to stay informed on how pediatricians and healthcare providers can play a vital role in improving outcomes for infants affected by cCMV. Special thanks to Dr. James Grubbs for peer reviewing this episode. CME Credit (requires free sign up): Link Coming Soon! References:  American Academy of Pediatrics. A targeted approach for congenital cytomegalovirus. Available at: https://publications.aap.org/pediatrics/article/139/2/e20162128/60211/A-Targeted-Approach-for-Congenital-Cytomegalovirus. Accessed August 13, 2024. Chiopris G, Veronese P, Cusenza F, Procaccianti M, Perrone S, Daccò V, Colombo C, Esposito S. Congenital cytomegalovirus infection: update on diagnosis and treatment. Microorganisms. 2020 Oct 1;8(10):1516. doi: 10.3390/microorganisms8101516. PMID: 33019752; PMCID: PMC7599523. Gantt S. Newborn cytomegalovirus screening: is this the new standard? Curr Opin Otolaryngol Head Neck Surg. 2023 Dec 1;31(6):382-387. doi: 10.1097/MOO.0000000000000925. Epub 2023 Oct 11. PMID: 37820202. Minnesota Department of Health. Minnesota implements universal newborn screening for cytomegalovirus. Available at: https://www.health.state.mn.us/news/pressrel/2023/ccmv020823.html. Accessed August 13, 2024. National CMV Foundation. Advocacy: universal newborn CMV screening. Available at: https://www.nationalcmv.org/about-us/advocacy#:~:text=Minnesota%20was%20the%20first%20state%20to%20enact%20universal%20newborn%20CMV%20screening. Accessed August 13, 2024. New York State Department of Health. Newborn screening for cytomegalovirus. Available at: https://www.health.ny.gov/press/releases/2023/2023-09-29_newborn_screening.htm#:~:text=ALBANY%2C%20N.Y.,all%20babies%20for%20the%20virus. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: clinical features and diagnosis. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-clinical-features-and-diagnosis?search=cmv%20screening&source=search_result&selectedTitle=1%7E28&usage_type=default&display_rank=1#H92269684. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: management and outcome. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-management-and-outcome?search=congenital%20cmv&source=search_result&selectedTitle=2%7E66&usage_type=default&display_rank=2. Accessed August 13, 2024. UpToDate. Ganciclovir and valganciclovir: an overview. Available at: https://www.uptodate.com/contents/ganciclovir-and-valganciclovir-an-overview?search=ganciclovir&source=search_result&selectedTitle=2%7E80&usage_type=default&display_rank=1#H6. Accessed August 13, 2024. University of Texas Medical Branch. Neonatology manual: infectious diseases. Available at: https://www.utmb.edu/pedi_ed/NeonatologyManual/InfectiousDiseases/InfectiousDiseases3.html#:~:text=may%20be%20required.-,Cytomegalovirus,Clinical%20findings. Accessed August 13, 2024. National Center for Biotechnology Information. Cytomegalovirus (CMV) infection. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541003/. Accessed August 13, 2024.                                                                                                             

Pelvic floor physical therapy (PFPT) is a crucial yet often overlooked component of gut health that can dramatically improve quality of life for people suffering from bowel issues, bladder problems, or pelvic pain. Dr. Alicia Jeffrey-Thomas joins us to demystify and normalize this specialized therapy and explain how proper pelvic floor function impacts everything from constipation to sexual health.• Understand that daily bowel movements don't necessarily mean you're not constipated• What happens during a PFPT session and how therapists create a safe + comfortable environment• The importance of proper pooping position• Why breathing techniques and sounds (like mooing!) can help relax your pelvic floor during bowel movements• Demystifying tools like pelvic wands and dilators for at-home maintenance • How dyssynergic defecation affects approximately 50% of people with constipation and how pelvic floor PT can help• Why all women can benefit from pelvic floor PT after childbirth (and even during pregnancy)•  Men face pelvic health issues too, like post-prostate surgery incontinence • The downside of "peeing just in case" and how it trains your bladder to signal fullness prematurelyIf you've experienced pelvic floor issues, don't accept them as normal - seek help from a pelvic floor physical therapist who can address these problems and improve your overall quality of life.References and Resources:Rao SS, Patcharatrakul T. Diagnosis and Treatment of Dyssynergic Defecation. J Neurogastroenterol Motil. 2016 Jul 30;22(3):423-35. doi: 10.5056/jnm16060. PMID: 27270989; PMCID: PMC4930297.Ye AL, Johnston E, Hwang S. Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies. Curr Oncol Rep. 2024;26(3):212-220. doi:10.1007/s11912-024-01498-6Where to find a pelvic floor PT:https://pelvicrehab.com/https://pelvicglobal.com/directory/Alicia Jeffrey-Thomas' book, Power to the Pelvis.Got constipation? Check out Kate's constipation guide. Learn more about Kate and Dr. Riehl:Website: www.katescarlata.com and www.drriehl.comInstagram: @katescarlata @drriehl and @theguthealthpodcastOrder Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS. The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

In this episode, I make a brave confession and explore how Terrifier (2016) reflects the psychological phenomenon of imposter syndrome.Mental Health is Horrifying is hosted by Candis Green, Registered Psychotherapist and owner of Many Moons Therapy...............................................................Show Notes:Join Out Of The Broom Closet if you would like to move from shame to pride in claiming your identity as a witch, and confidently step out of the broom closet. This course includes psychoeducation about shame, trauma, and exile within our cultural context, and witch-positive exercises to connect with your authentic self including tarot, journaling, spellwork, and creative visualization. Want to work together? I offer 1:1 psychotherapy (Ontario), along with tarot, horror, and dreamwork services, both individually and through my group program, the Final Girls Club. Podcast artwork by Chloe Hurst at Contempo MintTerrifier 2025 ConferenceHuecker MR, Shreffler J, McKeny PT, Davis D. Imposter Phenomenon. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 36251839.

In this episode of The Moss Report, Ben Moss sits down with Dr. Ralph Moss to explore the science of resveratrol, a powerful plant compound found in these two everyday foods. Discover why low doses may be more effective than you think, how synergy between natural compounds supports health, and what the latest research says about cancer stem cells. Listen now and pour yourself a glass of insight. “Fill up that self-help space with scientifically documented ways to reduce your cancer risk.” – Dr. Ralph W. Moss

Diarrhea is one of the more common concerns in emergency medicine worldwide and in the United States, yet we often do not spend enough time understanding the breadth of causes and considerations for this syndrome. Do you know which patients benefit from Zinc? Would you like to review HUS? Can you mixup Oral Rehydration Solution if you needed to? We cover all of this and more in this “code brown” of a chapter! So come, get dirty with Alex and Venk in this truly crappy chapter of Always on EM!   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. doi: 10.1093/cid/cix669. PMID: 29053792; PMCID: PMC5850553. Gore JI, Surawicz C. Severe acute diarrhea. Gastroenterol Clin North Am. 2003 Dec;32(4):1249-67. doi: 10.1016/s0889-8553(03)00100-6. PMID: 14696306; PMCID: PMC7127018. Freedman SB, van de Kar NCAJ, Tarr PI. Shiga Toxin–Producing Escherichia coli and the Hemolytic–Uremic Syndrome. The New England Journal of Medicine. 2023;389(15):1402-1414. doi:10.1056/NEJMra2108739. Logan C, Beadsworth MB, Beeching NJ. HIV and diarrhoea: what is new? Curr Opin Infect Dis. 2016 Oct;29(5):486-94. doi: 10.1097/QCO.0000000000000305. PMID: 27472290. Chassany O, Michaux A, Bergmann JF. Drug-induced diarrhoea. Drug Saf. 2000 Jan;22(1):53-72. doi: 10.2165/00002018-200022010-00005. PMID: 10647976. Schiller LR. Secretory diarrhea. Curr Gastroenterol Rep. 1999 Oct;1(5):389-97. doi: 10.1007/s11894-999-0020-8. PMID: 10980977. Gong Z, Wang Y. Immune Checkpoint Inhibitor-Mediated Diarrhea and Colitis: A Clinical Review. JCO Oncol Pract. 2020 Aug;16(8):453-461. doi: 10.1200/OP.20.00002. Epub 2020 Jun 25. PMID: 32584703. Do C, Evans GJ, DeAguero J, Escobar GP, Lin HC, Wagner B. Dysnatremia in Gastrointestinal Disorders. Front Med (Lausanne). 2022 May 13;9:892265. doi: 10.3389/fmed.2022.892265. PMID: 35646996; PMCID: PMC9136014. Expert Panel on Gastrointestinal Imaging; Chang KJ, Marin D, Kim DH, Fowler KJ, Camacho MA, Cash BD, Garcia EM, Hatten BW, Kambadakone AR, Levy AD, Liu PS, Moreno C, Peterson CM, Pietryga JA, Siegel A, Weinstein S, Carucci LR. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol. 2020 May;17(5S):S305-S314. doi: 10.1016/j.jacr.2020.01.025. PMID: 32370974. Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017 Jun;19(6):28. doi: 10.1007/s11894-017-0566-9. PMID: 28439845. Modahl L, Digumarthy SR, Rhea JT, Conn AK, Saini S, Lee SI. Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol. 2006 Nov;3(11):860-6. doi: 10.1016/j.jacr.2006.05.011. PMID: 17412185. Scheirey CD, Fowler KJ, Therrien JA, et al. ACR Appropriateness Criteria Acute Nonlocalized Abdominal Pain. Journal of the American College of Radiology : JACR. 2018;15(11S):S217-S231. doi:10.1016/j.jacr.2018.09.010. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol. 2009 Oct;104(10):2596-604; quiz 2605. doi: 10.1038/ajg.2009.329. Epub 2009 Jun 23. PMID: 19550407. Musekiwa A, Volmink J. Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions. Cochrane Database Syst Rev. 2011 Dec 7;2011(12):CD003754. doi: 10.1002/14651858.CD003754.pub3. PMID: 22161381; PMCID: PMC6532622. Centers for Disease Control and Prevention (CDC). Scombroid fish poisoning associated with tuna steaks--Louisiana and Tennessee, 2006. MMWR Morb Mortal Wkly Rep. 2007 Aug 17;56(32):817-9. PMID: 17703171. Résière D, Florentin J, Mehdaoui H, Mahi Z, Gueye P, Hommel D, Pujo J, NKontcho F, Portecop P, Nevière R, Kallel H, Mégarbane B. Clinical Characteristics of Ciguatera Poisoning in Martinique, French West Indies-A Case Series. Toxins (Basel). 2022 Aug 3;14(8):535. doi: 10.3390/toxins14080535. PMID: 36006197; PMCID: PMC9415704. Centers for Disease Control and Prevention (CDC). Ciguatera fish poisoning--Texas, 1998, and South Carolina, 2004. MMWR Morb Mortal Wkly Rep. 2006 Sep 1;55(34):935-7. PMID: 16943762. Thyroid Inferno EM Blog: https://emblog.mayo.edu/2014/11/01/thyroid-inferno/  Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016 Dec 20;12(12):CD005436. doi: 10.1002/14651858.CD005436.pub5. PMID: 27996088; PMCID: PMC5450879. Dhingra U, Kisenge R, Sudfeld CR, Dhingra P, Somji S, Dutta A, Bakari M, Deb S, Devi P, Liu E, Chauhan A, Kumar J, Semwal OP, Aboud S, Bahl R, Ashorn P, Simon J, Duggan CP, Sazawal S, Manji K. Lower-Dose Zinc for Childhood Diarrhea - A Randomized, Multicenter Trial. N Engl J Med. 2020 Sep 24;383(13):1231-1241. doi: 10.1056/NEJMoa1915905. PMID: 32966722; PMCID: PMC7466932. Dalfa RA, El Aish KIA, El Raai M, El Gazaly N, Shatat A. Oral zinc supplementation for children with acute diarrhoea: a quasi-experimental study. Lancet. 2018 Feb 21;391 Suppl 2:S36. doi: 10.1016/S0140-6736(18)30402-1. Epub 2018 Feb 21. PMID: 29553435.   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Seasonal allergies seem to be getting worse. A lot of people are feeling it now.It's common to reach for antihistamines without really thinking about it. They definitely have their place and can be really helpful when symptoms are bad. But taking them every day is something we still don't fully understand, especially when it comes to long-term effects.If you deal with allergies for months each year, it's worth pausing and exploring strategies that might be more sustainable.Many healthy habits that support overall health can also help manage inflammation, immune function and allergy symptoms. They're not always as quick as taking a capsule, but they can make a real difference over time.In this episode, I'm sharing:Why seasonal allergies seem to be getting worseThe role and potential risks of antihistamines5 daily habits that could ease allergy/hay fever symptomsQuick note about nettle: I didn't find much strong research, but that doesn't mean it couldn't help some people. It just shows how much more there is to learn.SourcesAntihistamines: Sue et al. J Allergy Clin Immunol Pract. 2024. PMID: 38935035.Vitamin D: Malik et al. European Respiratory Journal. 2015 Dietary diversity: Nakamoto et al. Asia Pacific Journal of Clinical Nutrition. 2019Fibre: Sdona et al. Clinical and translational allergy. 2022Polyphenols, chlorophyll, quercetin, vitamins C, D and E: Pellow et al. Complement Ther Med. 2020Fruits & vegetables: Kusunoki et al. Pediatr Allergy Immunol. 2017 | Oh et al. Pediatr Allergy Immunol. 2020Probiotics: Ried et al. Frontiers in Nutrition. 2022Ginger & curcumin: Yamprasert et al. BMC Complement Med Ther. 2020 | Wu et al. Ann Allergy Asthma Immunol. 2016Saline rinse: Wang et al. Allergologia et Immunopathologia. 2020Steam inhalation: Vathanophas et al. Asian Pac J Allergy Immunol. 2021

Contributor: Aaron Lessen, MD Educational Pearls: What is a Rescue Inhaler? A rescue inhaler is a medication for people with asthma to quickly reverse the symptoms of an asthma attack. Historically albuterol (Short Acting Beta Agonist (SABA)) monotherapy has been the mainstay rescue inhaler. This is because albuterol works fast and is relatively cheap. What are Combination Rescue Inhalers? Combination rescue inhalers contain a fast-acting bronchodilator as well as an inhaled corticosteroid (ICS) The steroid helps to reduce some of the chronic airway inflammation that is worsening the asthma attack and can help to prevent future attacks Examples include budesonide-formoterol and albuterol-budesonide Global Initiative for Asthma (GINA), states that combination therapy is now the preferred reliever for adults and adolescents with mild asthma What are the drawbacks of Combination Rescue Inhalers? These inhalers are generally more expensive than just using a SABA inhaler which can be a barrier for some people Improper use can also lead to conditions like thrush due to the addition of the steroid References Krings JG, Beasley R. The Role of ICS-Containing Rescue Therapy Versus SABA Alone in Asthma Management Today. J Allergy Clin Immunol Pract. 2024 Apr;12(4):870-879. doi: 10.1016/j.jaip.2024.01.011. Epub 2024 Jan 17. PMID: 38237858; PMCID: PMC10999356. Papi A, Chipps BE, Beasley R, Panettieri RA Jr, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Johnsson E, Rees R, Cappelletti C, Albers FC. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma. N Engl J Med. 2022 Jun 2;386(22):2071-2083. doi: 10.1056/NEJMoa2203163. Epub 2022 May 15. PMID: 35569035. Summarized by Jeffrey Olson, MS3 | Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

In this episode, you'll hear about the latest developments in tailoring cancer treatments to individual patients using Precision Oncology.  Two thought leaders, Simone Ndujiuba, a Clinical Oncology Pharmacist at Prime Therapeutics, and Karan Cushman, Head of Brand Experience and host of The Precision Medicine Podcast for Trapelo Health, discuss real-world research that is paving the way for Prime and our partners to help providers reduce turnaround times so patients can start treatment as soon as possible.  Join your host Maryam Tabatabai as they dig into this evolving topic of precision oncology. www.primetherapeuitics.com ⁠Chapters⁠Defining precision medicine (08:50)Evaluating real-world operational process of biomarker testing (14:36)Turnaround times are crucial (17:40)A patients view into the importance of time (24:39)Technology and process aid in time and process (29:30)Helping bridge knowledge gaps for providers and payers (33:55) The focus is on Precision Oncology right now (37:00)Precision medicine in other disease categories (40:09)Future of precision oncology is bright (42:07) References Singh, B.P., et al. (2019). Molecular profiling (MP) for malignancies: Knowledge gaps and variable practice patterns among United States oncologists (Onc). American Society of Clinical Oncology. https://meetings. asco.org/abstracts-presentations/173392 Evangelist, M.C., et al. (2023). Contemporary biomarker testing rates in both early and advanced NSCLC: Results from the MYLUNG pragmatic study. Journal of Clinical Oncology, 41(Supplement 16). https://doi.org/10.1200/JCO.2023.41.16_suppl.9109. Ossowski, S., et al. (2022). Improving time to molecular testing results in patients with newly diagnosed, metastatic non-small cell lung cancer. Journal of Clinical Oncology, 18(11). https://doi.org/10.1200/OP.22.00260 Naithani N, Atal AT, Tilak TVSVGK, et al. Precision medicine: Uses and challenges. Med J Armed Forces India. 2021 Jul;77(3):258-265. doi: 10.1016/j.mjafi.2021.06.020.  Jørgensen JT. Twenty Years with Personalized Medicine: Past, Present, and Future of Individualized Pharmacotherapy. Oncologist. 2019 Jul;24(7):e432-e440. doi: 10.1634/theoncologist.2019-0054.  MedlinePlus. What is genetic testing? Retrieved on April 21, 2025 from https://medlineplus.gov/genetics/understanding/testing/genetictesting/. MedlinePlus. What is pharmacogenetic testing? Retrieved on April 21, 2025 from https://medlineplus.gov/lab-tests/pharmacogenetic-tests/#:~:text=Pharmacogenetics%20(also%20called%20pharmacogenomics)%20is,your%20height%20and%20eye%20color.  Riely GJ, Wood DE, Aisner DL, et al. National Cancer Comprehensive Network (NCCN) clinical practice guidelines: non-small cell lung cancer, V3.2005. Retrieved April 21, 2025 from https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.  Benson AB, Venook AP, Adam M, et al. National Cancer Comprehensive Network (NCCN) clinical practice guidelines: colon cancer, V3.2025. Retrieved April 21, 2025 from https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Rosenberg PS, Miranda-Filho A. Cancer Incidence Trends in Successive Social Generations in the US. JAMA Netw Open. 2024 Jun 3;7(6):e2415731. doi: 10.1001/jamanetworkopen.2024.15731. PMID: 38857048; PMCID: PMC11165384. Smeltzer MP, Wynes MW, Lantuejoul S, et al. The International Association for the Study of Lung Cancer Global Survey on Molecular Testing in Lung Cancer. J Thorac Oncol. 2020 Sep;15(9):1434-1448. doi: 10.1016/j.jtho.2020.05.002.The views and opinions expressed by the guest featured on this podcast are their own and do not necessarily reflect the official policy or position of Prime Therapeutics LLC, its hosts, or its affiliates. The guest's appearance on this podcast does not imply an endorsement of their views, products, or services by Prime Therapeutics LLC. All content provided is for informational purposes only and should not be construed as professional advice.

Humans are a collection of their daily habits, which ultimately affect their health and long-term risk for disease. Sandra and Rob discuss the power of celebrating your small wins and how important it is to just keep improving with small, consistent, incremental changes.Resources:Stages of Change for Behaviour Changehttps://pubmed.ncbi.nlm.nih.gov/10170434/ Prochaska, James O.; Velicer, Wayne F. (September 1997). "The transtheoretical model of health behavior change" (PDF). American Journal of Health Promotion. 12 (1): 38–48. doi:10.4278/0890-1171-12.1.38. PMID 10170434. S2CID 46879746. Archived from the original (PDF) on 2010-06-02.Ep 53 SMART Goals - https://youtu.be/TQGTg8HsKwYEp 93 Toni Toledo, RD - PathPod, Positive Approaches to Health - https://youtu.be/TQGTg8HsKwYEp 74. Craving Change with Wendy Shah, RD https://youtu.be/NOlCc7eqsj0Ep 107. Food is Medicine with Dr. Wesley McWhorter https://youtu.be/doju3guWHyc RD Books mentioned:The Obstacle is the Way - Ryan HolidayPower of Habits - Charles DuhiggAtomic Habits - James ClearGetting Things Done - David AllenEnjoying the show? Consider leaving a 5 star review, and/or sharing this episode with your friends and family :)Sign up for our newsletter on our website for weekly updates and other fun info. You can also visit our social media pages. We're on⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠,⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, and⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ YouTube⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.Your support helps fuel the stoke and keeps the show going strong every week. Thanks!Website: www.mywifethedietitian.comEmail: mywifetherd@gmail.com

In this episode, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray dive into a critical case involving a five-week-old baby facing acute respiratory failure due to pertussis. They chat about how this condition shows up, how it's diagnosed, and the best ways to manage it, especially considering the serious complications it can cause in infants, like pulmonary hypertension and the potential need for ECMO. The conversation underscores the importance of catching it early and providing supportive care, while also highlighting how crucial vaccination is in preventing pertussis. Tune in to learn how severe this disease can be and why staying alert in pediatric care is so important.Show Highlights:Clinical case of a five-week-old infant with acute respiratory failure and pertussis diagnosisEpidemiology and public health impact of pertussis, including vaccination rates and outbreak patternsPathophysiology of pertussis and its effects on respiratory health, particularly in infantsClinical presentation of pertussis, including stages of the disease and atypical symptoms in infantsDiagnostic approaches for pertussis, including laboratory findings and PCR testingManagement strategies for severe pertussis, including supportive care and antibiotic therapyPotential complications associated with pertussis, especially in young infantsDifferential diagnosis considerations for pertussis and distinguishing features from other infectionsImportance of vaccination in preventing pertussis and reducing morbidity and mortalityECMO as a treatment option for severe cases and its associated challenges, and outcomesWe welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.References:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter and Rogers texbook of Pediatric intensive care -both do not have any Pertussis mentioned in their index.Rowlands HE, Goldman AP, Harrington K, Karimova A, Brierley J, Cross N, Skellett S, Peters MJ. Impact of rapid leukodepletion on the outcome of severe clinical pertussis in young infants. Pediatrics. 2010 Oct;126(4):e816-27. doi: 10.1542/peds.2009-2860. Epub 2010 Sep 6. PMID: 20819895.Lauria AM, Zabbo CP. Pertussis. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519008/Berger JT, Carcillo JA, Shanley TP, Wessel DL, Clark A, Holubkov R, Meert KL, Newth CJ, Berg RA, Heidemann S, Harrison R, Pollack M, Dalton H, Harvill E, Karanikas A, Liu T, Burr JS, Doctor A, Dean JM, Jenkins TL, Nicholson CE; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Critical pertussis illness in children: a multicenter prospective cohort study. Pediatr Crit Care Med. 2013 May;14(4):356-65. doi: 10.1097/PCC.0b013e31828a70fe. PMID: 23548960; PMCID: PMC3885763.Cousin, V.L., Caula, C., Vignot, J. et al. Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score. Crit Care 29, 71 (2025). https://doi.org/10.1186/s13054-025-05300-2Domico M, Ridout D, MacLaren G, Barbaro R, Annich G, Schlapbach LJ, Brown KL. Extracorporeal Membrane Oxygenation for Pertussis: Predictors of Outcome Including Pulmonary Hypertension and Leukodepletion. Pediatr Crit Care Med. 2018 Mar;19(3):254-261. doi:...

In this episode of the Epigenetics Podcast, we talked with Dr. Frank Johannes from the Technical University of Munich in Freising about his work on evolutionary clocks and epigenetic inheritance in plants. In this episode we discuss Dr. Johannes pursuits in understanding how heritable epigenetic variations, particularly through DNA methylation, affect phenotypic diversity in plants. He shared insights about groundbreaking research initiatives he has led, including one of the first population epigenetic studies in plants that effectively linked heritable DNA methylation changes to critical traits like flowering time and root length. This work underscored the importance of epigenetic factors that extend beyond traditional genetic sequences, illustrating a significant shift in how we comprehend inheritance and trait variation in organisms. As we dug deeper into the science, we examined Dr. Johannes's innovative approaches to studying chromatin-based mechanisms of genome regulation, allowing for a nuanced understanding of epigenetic inheritance. His lab's extensive phenotyping of Arabidopsis plants highlighted how inducing heritable variations in DNA methylation could lead to significant trait outcomes – results that have substantial implications for agriculture and understanding complex characteristics across generations. The dialogue continued to unravel the dynamics between forward and backward epimutations, delving into their heritable nature and their rapid accumulation compared to traditional genetic mutations. Dr. Johannes overturned conventional understanding by presenting epigenetic processes that are not as static as once thought, providing compelling evidence that these spontaneous changes could inform evolutionary clocks; a concept that offers new avenues for studying the relationships between species over relatively short timeframes. Moreover, we discussed the exciting concept of epigenetic clocks, which play a role in assessing the age of various species, including trees. The potential applications for such clocks in environmental management and the assessment of tree vitality further illuminated the practical impacts of Dr. Johannes's research. These insights also pave the way for sophisticated non-invasive methods of understanding plant biology, which can revolutionize forest management practices in the face of climate change and other ecological pressures.   References Colomé-Tatché M, Cortijo S, Wardenaar R, Morgado L, Lahouze B, Sarazin A, Etcheverry M, Martin A, Feng S, Duvernois-Berthet E, Labadie K, Wincker P, Jacobsen SE, Jansen RC, Colot V, Johannes F. Features of the Arabidopsis recombination landscape resulting from the combined loss of sequence variation and DNA methylation. Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):16240-5. doi: 10.1073/pnas.1212955109. Epub 2012 Sep 17. PMID: 22988127; PMCID: PMC3479620. Cortijo S, Wardenaar R, Colomé-Tatché M, Gilly A, Etcheverry M, Labadie K, Caillieux E, Hospital F, Aury JM, Wincker P, Roudier F, Jansen RC, Colot V, Johannes F. Mapping the epigenetic basis of complex traits. Science. 2014 Mar 7;343(6175):1145-8. doi: 10.1126/science.1248127. Epub 2014 Feb 6. PMID: 24505129. van der Graaf A, Wardenaar R, Neumann DA, Taudt A, Shaw RG, Jansen RC, Schmitz RJ, Colomé-Tatché M, Johannes F. Rate, spectrum, and evolutionary dynamics of spontaneous epimutations. Proc Natl Acad Sci U S A. 2015 May 26;112(21):6676-81. doi: 10.1073/pnas.1424254112. Epub 2015 May 11. PMID: 25964364; PMCID: PMC4450394. Yao N, Zhang Z, Yu L, Hazarika R, Yu C, Jang H, Smith LM, Ton J, Liu L, Stachowicz JJ, Reusch TBH, Schmitz RJ, Johannes F. An evolutionary epigenetic clock in plants. Science. 2023 Sep 29;381(6665):1440-1445. doi: 10.1126/science.adh9443. Epub 2023 Sep 28. PMID: 37769069.   Related Episodes Transgenerational Inheritance and Epigenetic Imprinting in Plants (Mary Gehring) Epigenetic Clocks and Biomarkers of Ageing (Morgan Levine)   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

A Rebelião Saudável nasceu da união de diversos profissionais de saúde que pensam diferente e cujo foco é promover saúde e bem estar, com comida de verdade e sem medicamentos.Semanalmente a Rebelião se reune no app Telegram para discussão de tópicos importantes relacionados a Nutrição Humana e Qualidade de vida. Nessa semana, conversamos conversamos sobre Transcitose: O Elo Perdido entre LDL e Aterosclerose!Estudos comentados no Podcast:BOLANLE, I. O.; DE LIEDEKERKE BEAUFORT, G. C.; WEINBERG, P. D. Transcytosis of LDL Across Arterial Endothelium: Mechanisms and Therapeutic Targets. Arteriosclerosis, Thrombosis, and Vascular Biology, v. 45, p. 468–480, abr. 2025. DOI: 10.1161/ATVBAHA.124.321549.Subbotin VM. Excessive intimal hyperplasia in human coronary arteries before intimal lipid depositions is the initiation of coronary atherosclerosis and constitutes a therapeutic target. Drug Discov Today. 2016 Oct;21(10):1578-1595. doi: 10.1016/j.drudis.2016.05.017. Epub 2016 Jun 2. PMID: 27265770.Vídeo sobre transcitose no YouTube: https://youtu.be/j3p85NFtoa8

Thinking about doing an away rotation? In this episode of Behind the Knife, we break down everything you need to know about away rotations and sub-internships. From how to apply and what to expect to making a great impression and building connections, we've got you covered. Plus, we discuss whether you should even do an away rotation at all and how to decide if it's the right move for your application. We're joined by a fantastic and diverse group of general surgery residents who share their insights, tips, and experiences. Episode Hosts: –Dr. Josh Roshal, University of Texas Medical Branch, @Joshua_Roshal, jaroshal@utmb.edu –Dr. Colleen McDermott, University of Utah, @ColleenMcDMD, Colleen.McDermott@hsc.utah.edu –Dr. Sophia Williams-Perez, Baylor College of Medicine, @SophWPerez, Sophia.Williams-Perez@bcm.edu –CoSEF: @surgedfellows, cosef.org Guests:  Dr. Steven Thornton, Duke University Medical Center, @swthorntonjr swt12@duke.edu Dr. Nicole Santucci, Washing University in St. Louis, @nicolemsantucci  snicole@wustl.edu Abbas Karim, MS3, University of Texas Medical Branch, @_AbbasKarim aakarim@utmb.edu Reagan Collins, MS4, Texas Tech University Health Sciences Center, @ReaganACollins, reagan.collins@ttuhsc.edu Dr. Annie Hierl, Indiana University, @annie_hierl ahierl@iu.edu  Dr. Jorge Zarate Rodriguez, Washington University in St Louis, @jzaraterod, j.zarate@wustl.edu  References: McDermott CE, Anand A, Brian R, Gan C, L'Huillier JC, Lund S, Sathe T, Silvestri C, Woodward JM. Should I Do a General Surgery Away Rotation?: Perspectives From the Collaboration of Surgical Education Research Fellows (CoSEF). Ann Surg Open. 2024 Dec 3;5(4):e509. doi: 10.1097/AS9.0000000000000509. PMID: 39711667; PMCID: PMC11661735. https://pubmed.ncbi.nlm.nih.gov/39711667/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Send us a textMother's Own Milk Provision During the First 12 Weeks of Life by Gestational Age.Patel AL, Wilson J, Holmes M, Johnson TJ.JAMA Netw Open. 2025 Mar 3;8(3):e250024. doi: 10.1001/jamanetworkopen.2025.0024.PMID: 40042846 Free PMC article.As 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 textLung Recruitment Before Surfactant Administration in Extremely Preterm Neonates: 2-Year Follow-Up of a Randomized Clinical Trial.Gallini F, De Rose DU, Iuliano R, Romeo DM, Tana M, Paladini A, Fusco FP, Nobile S, Cota F, Tirone C, Aurilia C, Lio A, Esposito A, Costa S, D'Andrea V, Ventura ML, Carnielli V, Dani C, Mosca F, Fumagalli M, Scarpelli G, Giordano L, Fasolato V, Petrillo F, Betta P, Solinas A, Gitto E, Gargano G, Mescoli G, Martinelli S, Di Fabio S, Bernardo I, Tina LG, Staffler A, Stasi I, Mondello I, Scapillati E, Vedovato S, Maffei G, Bove A, Vitaliti M, Terrin G, Lago P, Gizzi C, Strozzi C, Villani PE, Berardi A, Cacace C, Bracaglia G, Pascucci E, Cools F, Pillow JJ, Polglase G, Pastorino R, van Kaam AH, Mercuri E, Orfeo L, Vento G; IN-REC-SUR-E Study Group; Malguzzi S, Rigotti C, Cecchi A, Nigro G, Costabile CD, Roma E, Sindico P, Venafra R, Mattia C, Conversano M, Ballardini E, Manganaro A, Balestri E, Gallo C, Catenazzi P, Astori MG, Maranella E, Grassia C, Maiolo K, Castellano D, Massenzi L, Chiodin E, Gallina MR, Consigli C, Sorrentino E, Bonato S, Mancini M, Perniola R, Giannuzzo S, Tranchina E, Cardilli V, Dito L, Regoli D, Tormena F, Battajon N, Arena R, Allais B, Guidotti I, Roversi F, Meli V, Tulino V, Casati A.JAMA Netw Open. 2024 Sep 3;7(9):e2435347. doi: 10.1001/jamanetworkopen.2024.35347.PMID: 39320892 Free PMC article. Clinical Trial.As 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 textAzithromycin therapy for prevention of chronic lung disease of prematurity (AZTEC): a multicentre, double-blind, randomised, placebo-controlled trial.Lowe J, Gillespie D, Aboklaish A, Lau TMM, Consoli C, Babu M, Goddard M, Hood K, Klein N, Thomas-Jones E, Turner M, Hubbard M, Marchesi J, Berrington J, Kotecha S.Lancet Respir Med. 2024 Aug;12(8):608-618. doi: 10.1016/S2213-2600(24)00079-1. Epub 2024 Apr 25.PMID: 38679042 Free article. Clinical Trial. As 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!

In this episode Dr's J and Santhosh examine the medical conditions and contributions of some famous historical figures. Along the way they discuss Dr J's upcoming nuptials, Dr Santhosh first foray into episode production, Alexander of Macedon, the mysterious circumstances surrounding his death, ancient differential diagnoses, pseudothanatos, guillan barre, timeless treatments, catherine the great and public health initiatives, russian roller coasters, smallpox, escape yachts, vaccination ballets, Peter the Great and bladder dysfunction and more! So sit back and relax as we show you a GREAT time in medicine!Further Reading-       https://www.ncbi.nlm.nih.gov/books/NBK470418/-       JOHN T. ALEXANDER, Catherine the Great and Public Health, Journal of the History of Medicine and Allied Sciences, Volume XXXVI, Issue 2, April 1981, Pages 185–204, https://doi.org/10.1093/jhmas/XXXVI.2.185-       https://collections.libraries.indiana.edu/iulibraries/s/smallpox-vaccine-exhibit/page/russian-empire-       https://arstechnica.com/science/2021/12/that-time-catherine-the-great-championed-smallpox-vaccinations/-       https://www.passporthealthusa.com/2023/09/catherine-the-greats-advocacy-for-inoculation/-       Griffiths J. Doctor Thomas Dimsdale, and smallpox in Russia. The variolation of the Empress Catherine the Great. Bristol Med Chir J. 1984 Jan;99(369):14-6. PMID: 6367898; PMCID: PMC5077001. https://pmc.ncbi.nlm.nih.gov/articles/PMC5077001/ Supporting us monthly has all sorts of perks! You get ad free episodes, bonus musical parody, behind the scenes conversations not available to regular folks and more!! Your support helps us to pay for more guest interviews, better equipment, and behind the scenes people who know what they are doing! https://plus.acast.com/s/travelmedicinepodcast. Hosted on Acast. See acast.com/privacy for more information.

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we'll dig into some of the questions we all have about medications we commonly see and use in the ED. In this epsidoe, we unpack the complexities of anticoagulation reversal in the emergency department - It's not just about vitamin K anymore! Tune in as we explore the key reversal agents, when and why to use them, how fast they work, and the risks that come with turning off anticoagulation. From bleeding emergencies to stroke prevention, this quick dive offers practical pearls for navigating the coagulation cascade in real time. Have you had a bad GI bleed or intracranial hemorrhage in a patient on thinners?. Share your story with us on social media or at ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and former Assistant Professor at UC Davis Resources: Baugh CW, Levine M, Cornutt D, et al. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. 2020 Oct;76(4):470-485. doi: 10.1016/j.annemergmed.2019.09.001. Epub 2019 Nov 13. PMID: 31732375; PMCID: PMC7393606. ACEP Point of Care Tools: Anticoagulation Reversal. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Creatine is one of the most researched supplements in the world, and it is found to be safe and effective. However, creatine use among women is vastly under-researched (what else is new?). Recent research is including more women (which we desperately need!), and the current research is showing that women store and synthesize less creatine than males. In this episode, I explain the differences between women and men when to comes to creatine supplementation, and how dosage can be adjusted, if at all. Here's the study I referenced in this episode if you'd like to nerd-out on it with me: PMID 33800439: https://pubmed.ncbi.nlm.nih.gov/33800439/ Here are other episodes worth checking out: 161. All About Creatine and Q+A 208. The Downsides and Dangers of Supplements Working out and trying a new variety of movements is a great way to improve your health. If you want a copy of my FREE workout guide to help you manage your workouts, feel less stressed and feel more focused, then get it here. It can help you put together some workouts on-the-fly if you're traveling - enjoy! #ShredStrong Starts a New Cycle Every Month - Our Next Cycle Starts on Monday, May 5, 2025! #ShredStrong is my signature year-round strength and conditioning training program for mountain bikers and gravel cyclists, but you can join any time you want! Every week, it includes: 3 strength workouts (1 is optional), including some cardio finishers for some fun! A bike intervals session + advice on what other rides or cardio sessions to fit in. A comprehensive mobility plan to help you relax and stabilize your biking muscles. You get personalized coaching feedback and guidance from me on your exercises that you record and send me via video - it's like having a personal trainer in your pocket so you can feel confident in your movement! Every 3 months, you also get a new yoga flow from our in-house yogi, the MTB Yogi! A community video chat where we meet every 4-6 weeks to go over nutrition, training, and other tips that help you in your fitness and wellness journey. All of this is only $49 a month! Or, pay $39 a month if you pay for six months in-full (totaling $234). You can join us every month - each cycle starts around the beginning of every month, depending on the cycle! Learn more of the details of the program and sign-up HERE!  You can also join my email list here to get the latest news on future cycles of the program that start every month (I only email an average of 1-2 times a month and will never spam you). Do You Want a Coach to Help Make Training or Nutrition Easier and Simpler for You? Hi, it's me.

Listen as we discuss the highly-awaited ESOPEC trial, which examines treatment regimens for esophageal and EGJ adenocarcinoma. Wildly impress your thoracic attendings or peers with your nuanced knowledge! FLOT who? You'll know. Pull out the paper and listen along! Learning Objectives: -Discuss the patient population in the ESOPEC trial -Discuss the main differences between the ESOPEC trial and the CROSS trial -Describe the main drawbacks between FLOT and the CROSS regimen. Hosts: Chloe Hanson MD, Brian Louie MD, and Peter White MD   Referenced Material https://www.nejm.org/doi/full/10.1056/NEJMoa2409408 Hoeppner J, Brunner T, Schmoor C, Bronsert P, Kulemann B, Claus R, Utzolino S, Izbicki JR, Gockel I, Gerdes B, Ghadimi M, Reichert B, Lock JF, Bruns C, Reitsamer E, Schmeding M, Benedix F, Keck T, Folprecht G, Thuss-Patience P, Neumann UP, Pascher A, Imhof D, Daum S, Strieder T, Krautz C, Zimmermann S, Werner J, Mahlberg R, Illerhaus G, Grimminger P, Lordick F. Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer. N Engl J Med. 2025 Jan 23;392(4):323-335. doi: 10.1056/NEJMoa2409408. PMID: 39842010. https://www.nejm.org/doi/full/10.1056/NEJMoa1112088 van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A; CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84. doi: 10.1056/NEJMoa1112088. PMID: 22646630. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32557-1/abstract Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, Kopp HG, Mayer F, Haag GM, Luley K, Lindig U, Schmiegel W, Pohl M, Stoehlmacher J, Folprecht G, Probst S, Prasnikar N, Fischbach W, Mahlberg R, Trojan J, Koenigsmann M, Martens UM, Thuss-Patience P, Egger M, Block A, Heinemann V, Illerhaus G, Moehler M, Schenk M, Kullmann F, Behringer DM, Heike M, Pink D, Teschendorf C, Löhr C, Bernhard H, Schuch G, Rethwisch V, von Weikersthal LF, Hartmann JT, Kneba M, Daum S, Schulmann K, Weniger J, Belle S, Gaiser T, Oduncu FS, Güntner M, Hozaeel W, Reichart A, Jäger E, Kraus T, Mönig S, Bechstein WO, Schuler M, Schmalenberg H, Hofheinz RD; FLOT4-AIO Investigators. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019 May 11;393(10184):1948-1957. doi: 10.1016/S0140-6736(18)32557-1. Epub 2019 Apr 11. PMID: 30982686. ***Fellowship Application Link: https://forms.gle/PQgAvGjHrYUqAqTJ9 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://app.behindtheknife.org/listen

Contributor: Travis Barlock, MD Educational Pearls: Key clinical considerations when managing heart transplant patients due to their unique pathophysiology 1. Arrhythmias A transplanted heart is denervated, meaning it lacks autonomic nervous system innervation The lack of vagal tone results in an increased resting heart rate Adenosine can be used since it primarily slows conduction through the AV node  Atropine is ineffective in treating transplant bradyarrhythmia because its mechanism is to inhibit the vagus nerve - but the heart lacks vagal tone Allograft rejection can also cause tachycardia Consult transplant surgery - treatment is usually 500 mg methylprednisolone 2. Rejection Transplant patients are administered immunosuppressants Clinical presentation of acute rejection looks similar to heart failure with increased BNP, increased troponin, and pulmonary edema  Cardiac allograft vasculopathy is a form of chronic rejection Patients will not report chest pain due to denervated heart Symptoms are usually weakness and fatigue 3. High risk of infection due to immunosuppression Increased risk of infections which includes CMV, legionella, tuberculosis, etc Immunosuppressants have side effects such as acute kidney injury or pancytopenia 4. Radiographic Cardiomegaly A study found that radiographic cardiomegaly does not connote heart failure They hypothesized it is instead the result of a mismatch between the size of the transplanted heart and the space in the thoracic cavity  References Murphy JD, Mergo PJ, Taylor HM, Fields R, Mills RM Jr. Significance of radiographic cardiomegaly in orthotopic heart transplant recipients. AJR Am J Roentgenol. 1998 Aug;171(2):371-4. doi: 10.2214/ajr.171.2.9694454. PMID: 9694454. Park MH, Starling RC, Ratliff NB, McCarthy PM, Smedira NS, Pelegrin D, Young JB. Oral steroid pulse without taper for the treatment of asymptomatic moderate cardiac allograft rejection. J Heart Lung Transplant. 1999 Dec;18(12):1224-7. doi: 10.1016/s1053-2498(99)00098-4. PMID: 10612382. Pethig K, Heublein B, Wahlers T, Dannenberg O, Oppelt P, Haverich A. Mycophenolate mofetil for secondary prevention of cardiac allograft vasculopathy: influence on inflammation and progression of intimal hyperplasia. J Heart Lung Transplant. 2004 Jan;23(1):61-6. doi: 10.1016/s1053-2498(03)00097-4. PMID: 14734128. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/