Podcasts about pmid

In resuscitative trauma surgery every second counts. Can time and lives be saved by moving interventions closer to the point of injury? In this episode, we discuss a recent journal article on prehospital resuscitative thoracotomy as a treatment for traumatic cardiac arrest. Opening the chest on the street, who should do it, why should we do it, and for whom?• Hosts:  Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.  Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83 Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon, Royal London Hospital and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin Mr Zane Perkins. Consultant Trauma & UGI Surgeon, Royal London Hospital and Prehospital Surgeon at London's Air Ambulance. @ZBPerkins  • Learning objectives: A)    To be aware of the steps of a resuscitative thoracotomy (RT)B)     To understand the rational for prehospital (PH) trauma interventions.C)     To understand the timelines required to optimise success in PH RT.D)    To be familiar with the training governance for clinicians undertaking PH RT.E)     To recognise that PH RT is predominantly an intervention for cardiac tamponade.F)     To understand the contexts in which PH RT might be successful as a standardised intervention.• References: Perkins ZB, Greenhalgh R, Ter Avest E, Aziz S, Whitehouse A, Read S, Foster L, Chege F, Henry C, Carden R, Kocierz L, Davies G, Hurst T, Lendrum R, Thomas SH, Lockey DJ, Christian MD. Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. JAMA Surg. 2025 Feb 26;160(4):432–40. doi: 10.1001/jamasurg.2024.7245. PMID: 40009367; PMCID: PMC11866073. https://pubmed.ncbi.nlm.nih.gov/40009367/ ter Avest, E., Kocierz, L., Alvarez, C. et al. Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest: a data-driven approach. Crit Care 29, 485 (2025). https://doi.org/10.1186/s13054-025-05705-z. https://pubmed.ncbi.nlm.nih.gov/41233917/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Ursodiol (ursodeoxycholic acid) is a prescription bile acid medication used to dissolve cholesterol gallstones, prevent gallstones during rapid weight loss, and treat liver diseases like primary biliary cholangitis (PBC) by reducing toxic bile acids and cholesterol production. It works by changing bile composition, making it less saturated with cholesterol, and is available as oral medication. Of course, it is also the foundational medication for treatment of diagnosed Intrahepatic Cholestasis of Pregnancy (ICP). Does this medication reduce adverse perinatal outcomes? In this episode, we will review a new study from the Green Journal, which will be out in February 2026, examining the recurrence risk for ICP using data from NY. In a patient with prior history of ICP, is there any guidance on monitoring of serum bile acids in the subsequent pregnancy before symptoms develop? We will explain. PLUS we will review the data on whether Ursodiol may hold promise in recurrence prevention or in reduction of adverse outcomes once the condition is diagnosed. Listen in for details. 1. 2019: Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, Hunter R, Dorling J, Williamson C, Thornton JG; PITCHES study group. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019 Sep 7;394(10201):849-860. doi: 10.1016/S0140-6736(19)31270-X. Epub 2019 Aug 1. PMID: 31378395; PMCID: PMC6739598. https://pubmed.ncbi.nlm.nih.gov/31378395/2. February 08, 2025: Rahim, Mussarat N et al. Pregnancy and the liver. The Lancet. 2021; Volume 405, Issue 10477, 498 – 513 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02351-1/fulltext3. SMFM CS 53; 20214. Rosenberg, Henri M. MD; Sarker, Minhazur R. MD; Ramos, Gladys A. MD; Bianco, Angela MD; Ferrara, Lauren MD; DeBolt, Chelsea A. MD. Intrahepatic Cholestasis of Pregnancy Recurrence in a Subsequent Pregnancy. Obstetrics & Gynecology 147(2):p 239-241, February 2026. | DOI: 10.1097/AOG.0000000000006033 https://journals.lww.com/greenjournal/fulltext/2026/02000/intrahepatic_cholestasis_of_pregnancy_recurrence.13.aspx5. Ovadia C, Sajous J, Seed PT et al. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2021 Jul;6(7):547-558. doi: 10.1016/S2468-1253(21)00074-1. Epub 2021 Apr 27. PMID: 33915090; PMCID: PMC8192305.6. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. European Association for the Study of the Liver; 2023

Contributor: Aaron Lessen, MD Educational Pearls BRASH Syndrome: Bradycardia Renal Failure AV Nodal Blockade Shock Hyperkalemia  Clinical Features: Profound bradycardia and shock in patients on AV nodal blockers: Commonly, Beta Blockers or Calcium Channel Blockers Etiology:  Caused by an inciting kidney injury: Common triggers include precipitating illness, dehydration, or medications  Results in hyperkalemia The enhanced effect of the combination of AV nodal blockade and hyperkalemia leads to a more profound presentation of shock. Treatment:  IV Fluids, unless volume overloaded Epinephrine for bradycardia Lasix for volume overload, only if the patient is still making urine Low threshold to dialyze for hyperkalemia Focus on treating early and more aggressively.  References: Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. 2020 Aug;59(2):216-223. doi: 10.1016/j.jemermed.2020.05.001. Epub 2020 Jun 18. PMID: 32565167.   Summarized by Ashley Lyons OMS3 Editting by Ashley Lyons OMS3 and Jeffrey Olson MS4   Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-468 Overview: We first discussed aspirin use for primary prevention of cardiovascular disease in 2022 when the USPSTF recommended against it. In this follow-up episode, we review new trial data reinforcing that guidance and help you translate the evidence into safer prevention strategies. Build confidence in supporting patients with evidence-based approaches to reduce cardiovascular risk. Episode resource links: Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial. Eur Heart J. 2025 Aug 12:ehaf514. doi: 10.1093/eurheartj/ehaf514. Epub ahead of print. PMID: 40796244. Guest: Robert A. Baldor MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Picture this: a patient with early-stage breast cancer is sitting in front of you in the clinic. You are about to offer your expert management plan. The age-old question arises—should you really perform a sentinel lymph node biopsy, or could omission actually help this patient more? Today, we're tackling one of the hottest debates in modern breast cancer care.Should we rethink sentinel lymph node biopsy for select patients, and can skipping it actually improve quality of life without sacrificing cancer control? The stakes couldn't be higher—balancing accurate cancer staging and minimizing harm is the name of the game. Together, we're breaking down the latest evidence from the SOUND and INSEMA trials. What do these landmark studies mean for your patients, your practice, and the future of axillary management? Ready for a journal review that might just change your next consult? Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency ProgramTwitter/X: @RashmiJKumar- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine Twitter/X: @MPilewskie- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program Twitter/X: @SDownsCannerLearning Objectives:- Understand when and for whom it is safe and beneficial to omit sentinel lymph node biopsy (SLNB) in early-stage breast cancer patients.- Identify the risks associated with foregoing SLNB, including loss of nodal staging, and analyze how this impacts treatment selection and prognosis.- Review key findings from the SOUND and INSEMA trials and their influence on axillary management.- Discuss implications for adjuvant therapy, genomic profiling, and multidisciplinary clinical practice.- Recognize which patient populations should still receive SLNB, and the importance of individualized, multidisciplinary decision-making.References:- Gentilini OD, Botteri E, Sangalli C, et al. Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial. JAMA Oncol. 2023;9(11):1557–1564. doi:10.1001/jamaoncol.2023.3759 https://pubmed.ncbi.nlm.nih.gov/37733364/- Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer – primary results of the INSEMA trial. N Eng J Med. 2024. doi:10.1056/NEJMoa2412063.https://pubmed.ncbi.nlm.nih.gov/39665649/- Sparano JA, Gray RJ, Makower DF, Albain KS, Saphner TJ, Badve SS, Wagner LI, Kaklamani VG, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Toppmeyer DL, Brufsky AM, Goetz MP, Berenberg JL, Mahalcioiu C, Desbiens C, Hayes DF, Dees EC, Geyer CE Jr, Olson JA Jr, Wood WC, Lively T, Paik S, Ellis MJ, Abrams J, Sledge GW Jr. Clinical Outcomes in Early Breast Cancer With a High 21-Gene Recurrence Score of 26 to 100 Assigned to Adjuvant Chemotherapy Plus Endocrine Therapy: A Secondary Analysis of the TAILORx Randomized Clinical Trial. JAMA Oncol. 2020 Mar 1;6(3):367-374. doi: 10.1001/jamaoncol.2019.4794. PMID: 31566680; PMCID: PMC6777230. https://pubmed.ncbi.nlm.nih.gov/31566680/- Slamon DJ, Fasching PA, Hurvitz S, Chia S, Crown J, Martín M, Barrios CH, Bardia A, Im SA, Yardley DA, Untch M, Huang CS, Stroyakovskiy D, Xu B, Moroose RL, Loi S, Visco F, Bee-Munteanu V, Afenjar K, Fresco R, Taran T, Chakravartty A, Zarate JP, Lteif A, Hortobagyi GN. Rationale and trial design of NATALEE: a Phase III trial of adjuvant ribociclib + endocrine therapy versus endocrine therapy alone in patients with HR+/HER2- early breast cancer. Ther Adv Med Oncol. 2023 May 29;15:17588359231178125. doi: 10.1177/17588359231178125. Erratum in: Ther Adv Med Oncol. 2023 Sep 29;15:17588359231201818. doi: 10.1177/17588359231201818. PMID: 37275963; PMCID: PMC10233570. https://pubmed.ncbi.nlm.nih.gov/37275963/Sponsor Disclosure: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Send us a textIn this episode of Journal Club, Ben and Daphna review a retrospective cohort study from the Journal of Perinatology examining the association between NICU capacity strain and neonatal outcomes. We discuss how high census and acuity on admission day correlate with increased mortality and morbidity when adjusted for hospital and patient factors. Join us as we explore why being "slammed with admissions" is more than just a badge of honor—it's a critical safety metric for our patients.----The association of NICU capacity strain with neonatal mortality and morbidity. Salazar EG, Passarella M, Formanowski B, Rogowski J, Edwards EM, Halpern SD, Phibbs C, Lorch SA.J Perinatol. 2025 Dec;45(12):1801-1808. doi: 10.1038/s41372-025-02449-0. Epub 2025 Oct 20.PMID: 41116036 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Deep Dive in DDH is a three-part limited series where experts in the field of DDH have been invited to discuss the controversies in the management of hip dysplasia. Episode 1 was published in August and discussed management of DDH in infants under 6 months of age. In Episode 2, we are joined by Eduardo Novais at Nemour Children's Health in Jacksonville and Salil Upasani of Rady Children's Hospital and discuss the controversies in the management of developmental hip dislocations in the operating room including the process to decide between closed and open reduction, the use of concomitant osteotomies, adjunctive imaging, and casting protocols. Hosted by Will Morris (Scottish Rite for Children). Music by A. A. Aalto. Referenced Publications: Novais EN, Hill MK, Carry PM, Heyn PC. Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis. Clin Orthop Relat Res. 2016 May;474(5):1166-77. doi: 10.1007/s11999-015-4590-5. PMID: 26472583; PMCID: PMC4814411. Schmaranzer F, Justo P, Kallini JR, Ferrer MG, Miller P, Bixby SD, Novais EN. Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction. J Bone Joint Surg Am. 2024 Jan 17;106(2):110-119. doi: 10.2106/JBJS.23.00333. Epub 2023 Nov 22. PMID: 37992184; PMCID: PMC12205695. Morris WZ, Chilakapati S, Hinds SA, Herring JA, Kim HKW. The Clinical Significance of Infolded Limbus on Postreduction Arthrogram in Developmental Dysplasia of the Hip. J Pediatr Orthop. 2022 Apr 1;42(4):e309-e314. doi: 10.1097/BPO.0000000000002070. PMID: 35132011. Morris WZ, Hinds S, Worrall H, Jo CH, Kim HKW. Secondary Surgery and Residual Dysplasia Following Late Closed or Open Reduction of Developmental Dysplasia of the Hip. J Bone Joint Surg Am. 2021 Feb 3;103(3):235-242. doi: 10.2106/JBJS.20.00562. PMID: 33252590. Gans I, Sankar WN. The medial dye pool revisited: correlation between arthrography and MRI In closed reductions for DDH. J Pediatr Orthop. 2014 Dec;34(8):787-90. doi: 10.1097/BPO.0000000000000187. PMID: 24787303. Novais EN, Hollnagel KF, Bixby SD, Ferrer MG, Williams DN, Kim YJ, Schmaranzer F. Predictive value of post-reduction gadolinium-enhanced magnetic resonance imaging in detecting avascular necrosis after closed and open reduction for developmental dysplasia: A minimum 5-year follow-up study. J Child Orthop. 2025 Jul 6;19(4):329-338. doi: 10.1177/18632521251350524. PMID: 40630930; PMCID: PMC12230044. Paez C, Badrinath R, Holt J, Bomar JD, Mubarak SJ, Upasani VV, Wenger DR. Ligamentum Teres Transfer During Medial Open Reduction in Patients with Developmental Dysplasia of the Hip. Iowa Orthop J. 2021;41(1):47-53. PMID: 34552403; PMCID: PMC8259203.

Around the start of 2026, a study sparked viral headlines claiming that cheese could reduce dementia risk. But... nutrition science almost never works like this. One study can't "prove" a food is protective or harmful, and viral health claims often miss the most important details of research: how the data was gathered, what was actually measured, what variables were controlled for, and what it means in real life. In this episode, we unpack what the 'viral cheese study' (PMID: 41406402) actually found, what it DOESN'T mean, and why critical thinking around nutrition headlines matters more than ever. We discuss: • Why viral food headlines are so persuasive (and so often misleading) • What the cheese study REALLY reported • The difference between correlation and causation in nutrition research • Why long-term dietary recall data can be unreliable • How bias (including our personal food preferences) shapes interpretation of research • What "show me the data" really means in a world of clickbait science • How to interpret food and brain health studies without falling into extremes We also speak to Emily Sonestedt, research group leader and associate professor at Lund University, and one of the authors of the viral study. "Your Brain On..." is hosted by neurologists, scientists, and public health advocates Drs. Ayesha and Dean Sherzai. SUPPORTED BY: the 2026 NEURO World Retreat. A 5-day journey through science, nature, and community, on the California coastline: https://www.neuroworldretreat.com/  'Your Brain On... Cheese' • SEASON 6 • EPISODE 6 ——— LINKS The study, 'High- and Low-Fat Dairy Consumption and Long-Term Risk of Dementia: Evidence From a 25-Year Prospective Cohort Study': https://pubmed.ncbi.nlm.nih.gov/41406402/  ——— FOLLOW US Join NEURO World: https://neuro.world/ Instagram: https://www.instagram.com/thebraindocs YouTube: https://www.youtube.com/thebraindocs More info and episodes: TheBrainDocs.com/Podcast

It's a controversial topic: the impact of uterine incision (hysterectomy) on the neonate delivery interval (also called the U-D interval). Does it matter? Just to be clear, we're talking about time from uterine entry to fetal extraction, not skin incision to fetal extraction. Past publications have produced conflicting results, often limited by small sample sizes, heterogeneous indications for delivery, and reliance on surrogate markers (like apgar scores) rather than clinical morbidity. But a new study published in the Gray journal at the end of 2025 (December 30, 2025) gives some new insights. In this episode, we will review this retrospective study and play the “Devil's advocate” as we summarize the rebuttal data. As the reports are conflicting, we will end the podcast with a real-world interpretation and application of this data. Listen in for details. 1. Bart, Yossi et al. Uterine Incision-to-Delivery Interval and Neonatal Outcomes among Non-urgent, Term, Cesarean Deliveries. American Journal of Obstetrics & Gynecology, Volume 0, Issue 0. https://www.ajog.org/article/S0002-9378(25)00980-9/fulltext?rss=yes2. Maayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, Kuint J. The effect of time intervals on neonatal outcome in elective cesarean delivery at term under regional anesthesia. Int J Gynaecol Obstet. 2010 Dec;111(3):224-8. doi: 10.1016/j.ijgo.2010.07.022. Epub 2010 Sep 19. PMID: 20855070. https://pubmed.ncbi.nlm.nih.gov/20855070/3. Spain JE, Tuuli M, Stout MJ, Roehl KA, Odibo AO, Macones GA, Cahill AG. Time from uterine incision to delivery and hypoxic neonatal outcomes. Am J Perinatol. 2015 Apr;32(5):497-502. doi: 10.1055/s-0034-1396696. Epub 2014 Dec 24. PMID: 25539409.4. Bader AM, Datta S, Arthur GR, Benvenuti E, Courtney M, Hauch M. Maternal and fetal catecholamines and uterine incision-to-delivery interval during elective cesarean. Obstet Gynecol. 1990 Apr;75(4):600-3. PMID: 2107478.5. Tekin, E., Inal, H.A. & Isenlik, B.S. A Comparison of the Effect of Time from Uterine Incision to Delivery on Neonatal Outcomes in Women with One Previous and Repeat (Two or More) Cesarean Sections. SN Compr. Clin. Med. 5, 80 (2023). https://doi.org/10.1007/s42399-023-01427-x

Luke Hedrick, Dave Furfaro, and recurrent RFJC guest Robert Wharton are joined again today by Nicole Ng to discuss the FIBRONEER-IPF trial investigating Nerandomilast in patients with IPF. This trial was published in NEJM in 2025 and looked at Neradomilast vs placebo for treating patients with IPF, on or off background anti-fibrotic therapy. This agents is now FDA approved for pulmonary fibrosis, and understanding the trial results is essential for any pulmonary physician treating patients with IPF or progressive pulmonary fibrosis. Article and Reference Today’s episode discusses the FIBRONEER-IPF trial published in NEJM in 2025. Richeldi L, Azuma A, Cottin V, Kreuter M, Maher TM, Martinez FJ, Oldham JM, Valenzuela C, Clerisme-Beaty E, Gordat M, Wachtlin D, Liu Y, Schlecker C, Stowasser S, Zoz DF, Wijsenbeek MS; FIBRONEER-IPF Trial Investigators. Nerandomilast in Patients with Idiopathic Pulmonary Fibrosis. N Engl J Med. 2025 Jun 12;392(22):2193-2202. doi: 10.1056/NEJMoa2414108. Epub 2025 May 18. PMID: 40387033. https://www.nejm.org/doi/abs/10.1056/NEJMoa2414108 Meet Our Guests Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a pulmonary and critical care fellow at Johns Hopkins. Dr. Nicole Ng is an Assistant Profess of Medicine at Mount Sinai Hospital, and is the Associate Director of the Interstitial Lung Disease Program for the Mount Sinai National Jewish Health Respiratory Institute. Infographic Key Learning Points Why this trial mattered IPF therapies remain limited: nintedanib and pirfenidone slow (but do not stop) decline and often cause GI side effects. Nerandomilast is a newer agent (a preferential PDE4B inhibitor) with antifibrotic + immunomodulatory effects. Phase 2 data (NEJM 2022) looked very promising (suggesting near-“halt” of FVC decline), so this phase 3 trial was a big test of that signal. Trial design essentials Industry-sponsored, randomized, double-blind, placebo-controlled, large multinational study (332 sites, 36 countries). Population: IPF diagnosed via guideline-aligned criteria with central imaging review and multidisciplinary diagnostic confirmation. Intervention: nerandomilast 18 mg BID, 9 mg BID, or placebo; stratified by background antifibrotic use. Primary endpoint: change in FVC at 52 weeks, analyzed with a mixed model for repeated measures. Key secondary endpoint: time to first acute exacerbation, respiratory hospitalization, or death (composite). Who was enrolled Typical IPF trial demographics: ~80% male, mean age ~70, many former smokers. Many were already on background therapy (~45% nintedanib, ~30–33% pirfenidone). Notable exclusions included significant liver disease, advanced CKD, recent major cardiovascular events, and psychiatric risk (suicidality/severe depression), reflecting class concerns seen with other PDE4 inhibitors. Efficacy: what the primary endpoint showed Nerandomilast produced a statistically significant but modest reduction in annual FVC decline vs placebo (roughly 60–70 mL difference). Importantly, it did not halt FVC decline the way the phase 2 data suggested; patients still progressed. Important nuance: interaction with pirfenidone Patients on pirfenidone had ~50% lower nerandomilast trough levels. Clinically: 9 mg BID looked ineffective with pirfenidone, so 18 mg BID is needed if used together. In those not on background therapy or on nintedanib, 9 mg and 18 mg looked similar—suggesting the apparent “dose-response” might be partly driven by the pirfenidone drug interaction Secondary and patient-centered outcomes were neutral No demonstrated benefit in the composite outcome (exacerbation/resp hospitalization/death) or its components. Quality of life measures were neutral and declined in all groups, emphasizing that slowing FVC alone may not translate into felt improvement without a disease-reversing therapy. The discussants noted this may reflect limited power/duration for these outcomes and mentioned signals from other datasets/pooling that might suggest mortality benefit—but in this specific trial, the key secondary endpoint was not positive. Safety and tolerability Diarrhea was the main adverse event: Higher overall with the 18 mg dose, and highest when combined with nintedanib (up to ~62%). Mostly mild/manageable; discontinuation due to diarrhea was relatively uncommon (but higher in those on nintedanib). Reassuringly, there was no signal for increased depression/suicidality/vasculitis despite psychiatric exclusions and theoretical class risk. How to interpret “modest FVC benefit” clinically The group framed nerandomilast as another tool that adds incremental slowing of progression. They emphasized that comparing absolute FVC differences across trials (ASCEND/INPULSIS vs this trial) is tricky because populations and “natural history” in placebo arms have changed over time (earlier diagnosis, improved supportive care, etc.). They highlighted channeling bias: patients already on antifibrotics may be sicker (longer disease duration, lower PFTs, more oxygen), complicating subgroup comparisons. Practical takeaways for real-world use All three antifibrotics are “fair game”; choice should be shared decision-making based on goals, tolerability, dosing preferences, and logistics. Reasons they favored nerandomilast in practice: No routine lab monitoring (major convenience advantage vs traditional antifibrotics). Generally better GI tolerability than nintedanib. BID dosing (vs pirfenidone TID). Approach to combination therapy: They generally favor add-on rather than immediate combination to reduce confusion about side effects—while acknowledging it may slow reaching “maximal therapy.” Dosing guidance emphasized: Start 18 mg BID for IPF, especially if combined with pirfenidone (since dose reduction may make it ineffective). 9 mg BID may be considered if dose reduction is needed and the patient is not on pirfenidone (e.g., monotherapy or with nintedanib).

In this Complex Care Journal Club podcast episode, Drs. Reshma Amin and Christopher Baker discuss a clinical practice guideline from the American Thoracic Society on the care of infants and children with tracheostomies. They describe the role of interprofessional and family-centered decision-making, safety- and ethics-driven recommendations, and next steps for implementation across diverse healthcare settings. SPEAKERS Reshma Amin, MD, MSc Staff Respirologist, Director of Sleep Medicine and Long-term Ventilation The Hospital for Sick Children Senior Associate Scientist, SickKids Research Institute Professor, The University of Toronto Christopher D. Baker, MD Director, Ventilation Care Program, Children's Hospital Colorado Professor of Pediatrics - Pulmonary Medicine University of Colorado School of Medicine HOST Kilby Mann, MD Associate ‌Professor Pediatric Rehabilitation Medicine Children's Hospital Colorado DATE Initial publication date: January 13, 2026. JOURNAL CLUB ARTICLE Amin R, Agarwal A, Chiang J, Collaco JM, Cristea AI, Propst EJ, Sobotka SA, Balakrishnan K, Benscoter D, Brenner MJ, Castro-Codesal ML, Cuevas Guaman M, Daines CL, Dawson JA, Edwards JD, Graham RJ, Henningfeld JK, Hoekstra NE, Jackson AJ, Johnson RF, Kam K, Kun SS, Napolitano N, Pacheco A, Panitch HB, Prager JD, Shi JY, Soma M, St-Laurent A, Syed F, Watters KF, Zielinski D, Ho ATN, Velagapudi RK, Zeba F, Knight SL, Iyer N, Baker CD. Care of Infants and Children with Tracheostomies: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2025 Nov;211(11):2001-2020. doi: 10.1164/rccm.202508-2055ST. PMID: 41123183; PMCID: PMC12618984. OTHER ARTICLES REFERENCED Sherman JM, Davis S, Albamonte-Petrick S, Chatburn RL, Fitton C, Green C, Johnston J, Lyrene RK, Myer C 3rd, Othersen HB, Wood R, Zach M, Zander J, Zinman R. Care of the child with a chronic tracheostomy. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 2000 Jan;161(1):297-308. doi: 10.1164/ajrccm.161.1.ats1-00. PMID: 10619835. ‌ Sterni LM, Collaco JM, Baker CD, Carroll JL, Sharma GD, Brozek JL, Finder JD, Ackerman VL, Arens R, Boroughs DS, Carter J, Daigle KL, Dougherty J, Gozal D, Kevill K, Kravitz RM, Kriseman T, MacLusky I, Rivera-Spoljaric K, Tori AJ, Ferkol T, Halbower AC; ATS Pediatric Chronic Home Ventilation Workgroup. An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation. Am J Respir Crit Care Med. 2016 Apr 15;193(8):e16-35. doi: 10.1164/rccm.201602-0276ST. PMID: 27082538; PMCID: PMC5439679. ‌ TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/wkhzg7pznk5cgb23sk9xg7w7/Amin_and_Baker_Final_transcript_1-9-26_kh_ra_Baker Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Amin R, Baker CD, Mann K. Balancing Safety, Practicality, and Equity in Pediatric Tracheostomy Guidelines. 1/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/balancing-safety-practicality-and-equity-in-pediatric-tracheostomy-guidelines.

Helllllo Geoffs! This week your fave gruesome twosome are back to discuss the wild story of Karolina Olssen, including a side-quest into the world of tooth worms! We're also talking about New Orleans ‘Casket Girls,' so you're in for a treat! We've got an obituary with a twist, one for a gal with a familiar name and so much more, including, duh, some dumb.ass.criminalllllls! Watch us on YouTube: Youtube.com/@obitchuarypodcast Buy our book: prh.com/obitchuary Come see us live on tour: obitchuarypodcast.com Join our Patreon: Patreon.com/cultliter Follow us on Twitch: https://www.twitch.tv/otwitchuary Follow along online: @obitchuarypod on Twitter & Instagram @obitchuarypodcast on TikTok Check out Spencer's other podcast Cult Liter wherever you're listening! Sources:https://www.fox13news.com/news/florida-man-sets-own-home-fire-after-shooting-toward-neighbors-house-tampa-police-sayGerabek WE. The tooth-worm: historical aspects of a popular medical belief. Clin Oral Investig. 1999 Mar;3(1):1-6. doi: 10.1007/s007840050070. PMID: 10522185.https://en.wikipedia.org/wiki/Karolina_Olssonhttps://www.sindecusemuseum.org/tooth-wormshttps://en.wikipedia.org/wiki/Karolina_Olssonhttps://abc7news.com/post/exclusive-funeral-director-gives-san-jose-man-alexander-pinons-brain-parents-requested-clothing/18277944/https://www.neworleans.com/things-to-do/history/the-casket-girls-of-new-orleans/https://en.wikipedia.org/wiki/Casquette_girlhttps://www.verylocal.com/ursuline-convent-casket-girls/20209/https://www.neworleans.com/things-to-do/history/the-casket-girls-of-new-orleans/https://en.wikipedia.org/wiki/Casquette_girlhttps://www.newspapers.com/search/results/?keyword=casket+girls+https://www.newspapers.com/image/822672357/?match=1&terms=casket%20girls%20https://www.newspapers.com/image/435976310/?article=40c78fc4-853d-4dd3-a414-15313498c6f2&terms=%22new%20years%20eve%22https://www.newspapers.com/image/87342546/?match=1&terms=%22home%20wrecker%20dies%22https://www.cbsnews.com/news/naked-man-arrested-at-planet-fitness-said-he-thought-it-was-a-judgement-free-zone-police-say/ Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Uterine rupture or dehiscence associated with TOLAC results in the most significant increase in the likelihood of additional maternal and neonatal morbidity. It should be noted that the terms “uterine rupture” and “uterine dehiscence” are not consistently distinguished from each other in the literature and often are used interchangeably. Furthermore, the reported incidence of uterine rupture varies in part because some studies have grouped true, catastrophic uterine rupture together with asymptomatic scar dehiscence. In January 2026, a new meta-analysis examines the relationship between oxytocin use with TOLAC and uterine rupture. In this episode, we will summarize the key findings in that study and review the data on the use of internal monitors during TOLAC. Do internal monitors (FSE, IUPC) offer a safer TOLAC compared with external monitors? Listen in for details.1. Nicolì, Pierpaolo et al.Oxytocin dosing during trial of labor after cesarean to minimize the risk of uterine rupture: a systematic review and meta-analysisAmerican Journal of Obstetrics & Gynecology MFM, Volume 8, Issue 1, 1018462. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology 130(5):p e217-e233, November 2017. | DOI: 10.1097/AOG.00000000000023983. ACOG Clinical Practice Guideline No. 10:Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management. Obstetrics & Gynecology 146(4):p 583-599, October 2025. | DOI: 10.1097/AOG.00000000000060494. Bruno AM, Allshouse AA, Metz TD. Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean. Obstet Gynecol. 2025 Dec 1;146(6):843-850. doi: 10.1097/AOG.0000000000006106. Epub 2025 Oct 30. PMID: 41325062.

Send us a textIn this Journal Club episode, Ben and Daphna review a salient study from JAMA Network Open examining outcomes of infants born at 21 weeks' gestation at the University of Iowa. They walk through resuscitation practices, early physiologic challenges, survival trends, and short-term developmental outcomes, while placing the data in the broader context of shifting limits of viability. The discussion highlights both cautious optimism and the many unanswered questions that remain as neonatology continues to push the boundaries of what is possible.----Outcomes of Infants Born at 21 Weeks' Gestational Age. Hyland RM, Mat HD, Boly TJ, Thomas BJ, Stanford AH, Harmon HM, Bermick JR, Davila RC, Colaizy TT, Dagle JM, Klein JM, Greiner AL, Bell EF, McNamara PJ; University of Iowa Neonatology Program.JAMA Netw Open. 2025 Dec 1;8(12):e2548211. doi:10.1001/jamanetworkopen.2025.48211.PMID: 41385227 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

This week’s Pulm PEEPs Pearls episode is a focused discussion between Furf and Monty about non-pharmacologic techniques for airway clearance in the non-Cystic Fibrosis bronchiectasis population. This is a focused, high-yield discussion of the key points about airway clearance, including practical tips and a discussion of the evidence. This episode was prepared in conjunction with George Doumat MD. Goerge is an internal medicine resident at UT Southwestern and joined us for a Pulm PEEPs – BMJ Thorax journal club episode. He is now acting as a Pulm PEEPs Editor for the Pulm PEEPs Pearls series. Key Learning Points 1) Why airway clearance matters in non-CF bronchiectasis Non-CF bronchiectasis is defined by irreversible bronchial dilation with impaired mucociliary clearance, leading to mucus retention. Retained sputum drives the classic vicious cycle: mucus → infection → neutrophilic inflammation → airway damage → worse clearance. Airway clearance techniques (ACTs) are meant to interrupt this cycle, primarily by improving mucus mobilization and symptom control. 2) What ACTs are trying to achieve clinically Main benefits are: More effective sputum clearance Reduced cough/dyspnea burden Improved activity tolerance and quality of life Effects on spirometry are usually small. Exacerbation reduction is possible, but evidence is mixed—some longer-term data suggest benefit for specific techniques. 3) The main ACT “families” and when to use them Breathing-based techniques (device-free, flexible) ACBT (Active Cycle of Breathing Technique): breath control → deep breaths with holds → huffing. Pros: portable, adaptable, good first-line option. Key requirement: teaching/coaching to get technique right. Autogenic drainage: controlled breathing at different lung volumes to move mucus from peripheral → central airways. Pros: no device, can work well once learned. Cons: more technically demanding, needs training and practice. PEP / Oscillatory PEP (stents airways + “vibrates” mucus loose) PEP: back-pressure helps prevent small airway collapse during exhalation; often paired with huff/cough. Oscillatory PEP (Flutter/Acapella/Aerobika): adds oscillation that many patients find easy and satisfying to use. Good fit for: people who benefit from airway stenting, want something portable, and prefer a device. Mechanical/manual techniques (help when patient can't self-clear well) HFCWO (“the vest”): external chest wall oscillation; helpful for high sputum volumes, dexterity limits, or difficulty coordinating breathing maneuvers. Postural drainage/percussion/vibration: caregiver/therapist-assisted options; still useful but consider: GERD/reflux risk with certain positions Hemoptysis risk with vigorous techniques 4) How to choose the “right” technique (the practical framework) There is no one-size-fits-all. Match the tool to the patient: Sputum burden (volume/viscosity) Strength, coordination, cognition, dexterity Comorbidities (GERD, hemoptysis history, severe obstruction/airway collapse) Lifestyle + portability (what they'll actually do) Cost/access and availability of respiratory therapy/physio support A key mindset from the script: this is not a lifetime contract—reassess and adjust over time with shared decision-making. 5) Evidence takeaways (what improves, what doesn't) ACTs reliably improve sputum expectoration and often symptoms/QoL. QoL/cough scores (e.g., SGRQ, LCQ) tend to improve modestly, particularly with oscillatory PEP and some vest studies. Lung function: typically minimal change; occasional short-term FEV₁ benefit is reported in some vest trials. Exacerbations: mixed overall; the script highlights a longer-term RCT of ELTGOL showing fewer exacerbations at 12 months vs placebo exercises. Safety: generally excellent; main cautions are hemoptysis and reflux (depending on technique/positioning). 6) Special population pearls Hemoptysis / fragile airways: start with gentle breathing-based ACTs (ACBT, controlled huffing); avoid overly vigorous oscillatory/manual methods if concerned. Severe obstruction or early airway collapse: PEP/oscillatory PEP can help by keeping small airways open on exhalation. Mobility/coordination barriers: consider HFCWO vest or simple oscillatory PEP devices to enable daily adherence. During exacerbations: keep it simple—1–2 reliable techniques, prioritize daily consistency, and re-check technique. 7) The “real” bottom line Start with simple, self-manageable options (often ACBT ± PEP). The “best” ACT is the one the patient will do consistently. Reassess technique and fit over time; education and demonstration are part of the therapy. References and Further Reading  Lee AL et al., “Airway clearance techniques for bronchiectasis,” Cochrane Database Syst Rev. 2015; PMC7175838. PMID: 26591003. Athanazio RA et al., “Airway Clearance Techniques in Bronchiectasis,” Front Med (Lausanne). 2020; PMC7674976. PMID: 33251032. Iacono R et al., “Mucociliary clearance techniques for treating non-cystic fibrosis bronchiectasis,” Eur Rev Med Pharmacol Sci. 2015; PMID: 26078380. Polverino E et al., “European Respiratory Society statement on airway clearance techniques in bronchiectasis,” Eur Respir J. 2023; PMID: 37142337. Doumat G, Aksamit TR, Kanj AN. Bronchiectasis: A clinical review of inflammation. Respir Med. 2025 Aug;244:108179. doi: 10.1016/j.rmed.2025.108179. Epub 2025 May 25. PMID: 40425105.

Send us a textDescription: An immersive reading of With Child by Genevieve Taggard with reflection on pregnancy, maternal mortality, pace, and isolation. Website:https://anauscultation.wordpress.comWork:With Childby Genevieve Taggard Now I am slow and placid, fond of sun,Like a sleek beast, or a worn one:No slim and languid girl—not gladWith the windy trip I once had,But velvet-footed, musing of my own,Torpid, mellow, stupid as a stone.You cleft me with your beauty's pulse, and nowYour pulse has taken body. Care not howThe old grace goes, how heavy I am grown,Big with this loneliness, how you alonePonder our love. Touch my feet and feelHow earth tingles, teeming at my heel!Earth's urge, not mine,—my little death, not hers;And the pure beauty yearns and stirs.It does not heed our ecstacies, it turnsWith secrets of its own, its own concerns,Toward a windy world of its own, toward starkAnd solitary places. In the dark,Defiant even now, it tugs and moansTo be untangled from these mother's bones.References:Goldenberg RL, McClure EM. Maternal mortality. Am J Obstet Gynecol. 2011 Oct;205(4):293-5. doi: 10.1016/j.ajog.2011.07.045. Epub 2011 Aug 4. PMID: 22083050; PMCID: PMC3893928.https://www.who.int/news-room/fact-sheets/detail/maternal-mortality Hoyert DL. Maternal mortality rates in the United States, 2023. NCHS Health E-Stats. 2025. DOI: https://dx.doi.org/10.15620/cdc/174577.Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians; Denberg TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris RP, Humphrey LL, Vijan S. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14. PMID: 28192789.Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004 Jan;130(1):3-18. doi: 10.1037/0033-2909.130.1.3. PMID: 14717648.

Hey guys! Happy 2026! I know Dry January is super popular, so I wanted to take today's episode to dive into alcohol and fat loss. We're diving into how and why it affects fat loss, and specifically how it's harder as we age. Research published on PubMed shows that women tend to reach higher blood alcohol levels than men drinking the same amount, partly because they generally have less body water and a smaller volume for alcohol to distribute into (PMID 10890798, PMID 11329488). Research also shows that as we age, total body water and lean body mass decline, so the same amount of alcohol results in higher blood alcohol concentrations in older adults (PMID 837653, PMID 18090653).Join the Shred (starts Jan 12th)Apply for coaching CURED Serenity gummies (code Emma saves 20% through jan)HAPI supplements The EmPowered Community free Facebook group Follow Emma on InstagramFollow Emma on Facebook

Currently, as of today's date, neither the ACOG nor SMFM currently support routine early induction of labor for suspected fetal macrosomia, instead recommending individualized counseling and reserving elective cesarean for extreme estimated fetal weights. However, a 2025 multicenter, open-label, randomized controlled trial was published in the Lancet comparing induction of labor versus standard care in pregnant women with fetuses suspected to be large for gestational age. The study used a parallel-group design with 1:1 randomization, enrolling women from 106 NHS hospitals across England, Scotland, and Wales. The per-protocol analysis demonstrated a significant reduction (40%) in shoulder dystocia with induction of labor at 38- 38 weeks and 4 days. Is this in conflict with the ACOG current guidance? In this episode, we will review the “Big Baby study” from the Lancet and provide 3 main limitations of this very large study, review the importance of PP vs ITT results, and explain why more data is still needed. Listen in for details. 1. ACOG PB 178; 2017 (reaffirmed 2024)2. Gardosi J, Ewington LJ, Booth K, Bick D, Bouliotis G, Butler E, Deshpande S, Ellson H, Fisher J, Gornall A, Lall R, Mistry H, Naghdi S, Petrou S, Slowther AM, Wood S, Underwood M, Quenby S. Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial. Lancet. 2025 May 17;405(10491):1743-1756. doi: 10.1016/S0140-6736(25)00162-X. Epub 2025 May 1. PMID: 40319899.3. Blaauwgeers, Anne N et al. Rethinking induction of labour for LGA fetuses: the Big Baby trial. The Lancet, Volume 406, Issue 10512, 1562

AABP Executive Director Dr. Fred Gingrich is joined by Dr. Bob Van Saun, professor and extension veterinarian at Penn State University. He is also a member of the AABP Nutrition Committee. If you are interested in beef or dairy nutrition, consider joining the committee by visiting this page.  Van Saun starts by reviewing why mineral and vitamin transfer are important beyond their biological role in fetal development and reminds us that milk does not have a significant quantity of trace elements and some vitamins. It is important to provide a diet that is adequate in vitamins and minerals to the dam to ensure the developing fetus is not deficient and that the newborn calf is very dependent on what we feed the dam. Van Saun reviews how minerals and vitamins are regulated in the body and what we know about the placental transfer of minerals and vitamins to the fetus during gestation. He offers suggestions for practicing veterinarians for evaluating the nutritional status of dams. He suggests starting by evaluating the ration that has been formulated to ensure it is consistent with recommendations from NASEUM 2021 (dairy) and NASEM 2016 (beef). The veterinarians can then submit biologic samples for vitamin and mineral analysis which can be done via liver biopsy or blood testing as well as when each test is applicable. In addition, liver samples from stillborn fetuses can be submitted to develop a database for clients mineral and vitamin programs and to determine if stillbirths are due to deficiencies.  Links:Hostetler CE, Kincaid RL, Mirando MA. The role of essential trace elements in embryonic and fetal development in livestock. Vet J. 2003;166(2):125-39. https://doi.org/10.1016/s1090-0233(02)00310-6. PMID: 12902178  National Academies of Sciences, Engineering, and Medicine (NASEM) 2021. Nutrient Requirements of Dairy Cattle: Eighth Revised Edition. Washington, DC: The National Academies Press. https://doi.org/10.17226/25806 National Academies of Sciences, Engineering, and Medicine. 2016. Nutrient Requirements of Beef Cattle: Eighth Revised Edition. Washington, DC: The National Academies Press. https://doi.org/10.17226/19014

In mid-December 2025, the FDA approved an at home devicethat aims to treat depression by sending electric current into a part of the brain (the prefrontal cortex) known to regulate mood. This has been available in the UK since 2019 but it is new to the US. The manufacturer has stated that over 55,000 patients have used the device across Europe, the UK, Switzerland, and Hong Kong. How does this work? Is there data to support this new therapy? In this episode, we will summarize three consecutive years of data (2023, 2024,2025) to answer that question. Listen in for details. 1.     Sci Amer: https://www.scientificamerican.com/article/u-s-approves-first-device-to-treat-depression-with-brain-stimulation-at-home/2.     August 12, 2023: Burkhardt, Gerrit et al.Transcranial direct current stimulation as an additional treatment to selectiveserotonin reuptake inhibitors in adults with major depressive disorder inGermany (DepressionDC): a triple-blind, randomised, sham-controlled,multicentre trial The Lancet, Volume 402, Issue 10401, 545 – 5543.     October 21, 2024: Woodham, R.D., Selvaraj, S.,Lajmi, N. et al. Home-based transcranial direct current stimulation treatmentfor major depressive disorder: a fully remote phase 2 randomizedsham-controlled trial. Nat Med 31, 87–95 (2025). https://doi.org/10.1038/s41591-024-4.     December 15, 2025: Moshfeghinia R, Bordbar S,Roointanpour Y, Arab Bafrani M, Shalbafan M. Efficacy and safety of home-basedtranscranial direct current stimulation (tDCS) on patients with depressivedisorders: a systematic review and meta-analysis of randomized clinical trials.Sci Rep. 2025 Dec 15;15(1):43850. doi: 10.1038/s41598-025-28648-5. PMID:41398008; PMCID: PMC12705823.

Episode 210: Heat Stroke BasicsWritten by Jacob Dunn, MS4, American University of the Caribbean. Edits and comments 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. Definition:Heat stroke represents the most severe form of heat-related illness, characterized by a core body temperature exceeding 40°C (104°F) accompanied by central nervous system (CNS) dysfunction. Arreaza: Key element is the body temperature and altered mental status. Jacob: This life-threatening condition arises from the body's failure to dissipate heat effectively, often in the context of excessive environmental heat load or strenuous physical activity. Arreaza: You mentioned, it is a spectrum. What is the difference between heat exhaustion and heat stroke? Jacob: Unlike milder heat illnesses such as heat exhaustion, heat stroke involves multisystem organ dysfunction driven by direct thermal injury, systemic inflammation, and cytokine release. You can think of it as the body's thermostat breaking under extreme stress — leading to rapid, cascading failures if not addressed immediately. Arreaza: Tell us what you found out about the pathophysiology of heat stroke?Jacob: Pathophysiology: Under normal conditions, the body keeps its core temperature tightly controlled through sweating, vasodilation of skin blood vessels, and behavioral responses like seeking shade or drinking water. But in extreme heat or prolonged exertion, those mechanisms get overwhelmed.Once core temperature rises above about 40°C (104°F), the hypothalamus—the brain's thermostat—can't keep up. The body shifts from controlled thermoregulation to uncontrolled, passive heating. Heat stroke isn't just someone getting too hot—it's a full-blown failure of the body's heat-regulating system. Arreaza: So, it's interesting. the cell functions get affected at this point, several dangerous processes start happening at the same time.Jacob: Yes: Cellular Heat InjuryHigh temperatures disrupt proteins, enzymes, and cell membranes. Mitochondria start to fail, ATP production drops, and cells become leaky. This leads to direct tissue injury in vital organs like the brain, liver, kidneys, and heart.Arreaza: Yikes. Cytokines play a big role in the pathophysiology of heat stroke too. Jacob: Systemic Inflammatory ResponseHeat damages the gut barrier, allowing endotoxins to enter the bloodstream. This triggers a massive cytokine release—similar to sepsis. The result is widespread inflammation, endothelial injury, and microvascular collapse.Arreaza: What other systems are affected?Coagulation AbnormalitiesEndothelial damage activates the clotting cascade. Patients may develop a DIC-like picture: microthrombi forming in some areas while clotting factors get consumed in others. This contributes to organ dysfunction and bleeding.Circulatory CollapseAs the body shunts blood to the skin for cooling, perfusion to vital organs drops. Combine that with dehydration from sweating and fluid loss, and you get hypotension, decreased cardiac output, and worsening ischemia.Arreaza: And one of the key features is neurologic dysfunction.Jacob: Neurologic DysfunctionThe brain is extremely sensitive to heat. Encephalopathy, confusion, seizures, and coma occur because neurons malfunction at high temperatures. This is why altered mental status is the hallmark of true heat stroke.Arreaza: Cell injury, inflammation, coagulopathy, circulatory collapse and neurologic dysfunction. Jacob: Ultimately, heat stroke is a multisystem catastrophic event—a combination of thermal injury, inflammatory storm, coagulopathy, and circulatory collapse. Without rapid cooling and aggressive supportive care, these processes spiral into irreversible organ failure.Background and Types:Arreaza: Heat stroke is part of a spectrum of heat-related disorders—it is a true medical emergency. Mortality rate reaches 30%, even with optimal treatment. This mortality correlates directly with the duration of core hyperthermia. I'm reminded of the first time I heard about heat stroke in a baby who was left inside a car in the summer 2005. Jacob: There are two primary types: -nonexertional (classic) heat stroke, which develops insidiously over days and predominantly affects vulnerable populations like children, the elderly, and those with chronic illnesses during heat waves; -exertional heat stroke, which strikes rapidly in young, otherwise healthy individuals, often during intense exercise in hot, humid conditions. Arreaza: In our community, farm workers are especially at risk of heat stroke, but any person living in the Central Valley is basically at risk.Jacob: Risk factors amplify vulnerability across both types, including dehydration, cardiovascular disease, medications that impair sweating (e.g., anticholinergics), and acclimatization deficits. Notably, anhidrosis (lack of sweating) is common but not required for diagnosis. Hot, dry skin can signal the shift from heat exhaustion to stroke. Arreaza: What other conditions look like heat stroke?Differential Diagnosis:Jacob: Presenting with altered mental status and hyperthermia, heat stroke demands a broad differential to avoid missing mimics. -Environmental: heat exhaustion, syncope, or cramps. -Infectious etiologies like sepsis or meningitis must be ruled out. -Endocrine emergencies such as thyroid storm, pheochromocytoma, or diabetic ketoacidosis (DKA) can overlap. -Neurologic insults include cerebrovascular accident (CVA), hypothalamic lesions (bleeding or infarct), or status epilepticus. -Toxicologic culprits are plentiful—sympathomimetic or anticholinergic toxidromes, salicylate poisoning, serotonin syndrome, malignant hyperthermia, neuroleptic malignant syndrome (NMS), or even alcohol/benzodiazepine withdrawal. When it comes to differentials, it is always best to cast a wide net and think about what we could be missing if this is not heat stroke. Arreaza: Let's say we have a patient with hyperthermia and we have to assess him in the ER. What should we do to diagnose it?Jacob: Workup:Diagnosis is primarily clinical, hinging on documented hyperthermia (>40°C) plus CNS changes (e.g., confusion, delirium, seizures, coma) in a hot environment. Arreaza: No single lab confirms it, but targeted testing allows us to detect complications and rule out alternative diagnosis. Jacob: -Start with ECG to assess for dysrhythmias or ischemic changes (sinus tachycardia is classic; ST depressions or T-wave inversions may hint at myocardial strain). -Labs include complete blood count (CBC), comprehensive metabolic panel (electrolytes, renal function, liver enzymes), glucose, arterial blood gas, lactate (elevated in shock), coagulation studies (for disseminated intravascular coagulation, or DIC), creatine kinase (CK) and myoglobin (for rhabdomyolysis), and urinalysis. Toxicology screen if history suggests. Arreaza: I can imagine doing all this while trying to cool down the patient. What about imaging?-Imaging: chest X-ray for pulmonary issues, non-contrast head CT if neurologic concerns suggest edema or bleed (consider lumbar puncture if infection suspected). It is important to note that continuous core temperature monitoring—via rectal, esophageal, or bladder probe—is essential, not just peripheral skin checks. Arreaza: TreatmentManagement:Time is tissue here—initiate cooling en route, if possible, as delays skyrocket morbidity. ABCs first: secure airway (intubate if needed, favoring rocuronium over succinylcholine to avoid hyperkalemia risk), support breathing, and stabilize circulation. -Remove the patient from the heat source, strip clothing, and launch aggressive cooling to target 38-39°C (102-102°F) before halting to prevent rebound hypothermia. -For exertional cases, ice-water immersion reigns supreme—it's the fastest method, with immersion in cold water resulting in near-100% survival if started within 30 minutes. -Nonexertional benefits from evaporative cooling: mist with tepid water (15-25°C) plus fans for convective airflow. -Adjuncts include ice packs to neck, axillae, and groin; -room-temperature IV fluids (avoid cold initially to prevent shivering); -refractory cases, invasive options like peritoneal lavage, endovascular cooling catheters, or even ECMO. -Fluid resuscitation with lactated Ringer's or normal saline (250-500 mL boluses) protects kidneys and counters rhabdomyolysis—aim for urine output of 2-3 mL/kg/hour. Arreaza: What about medications?Jacob: Benzodiazepines (e.g., lorazepam) control agitation, seizures, or shivering; propofol or fentanyl if intubated. Avoid antipyretics like acetaminophen. For intubation, etomidate or ketamine as induction agents. Hypotension often resolves with cooling and fluids; if not, use dopamine or dobutamine over norepinephrine to avoid vasoconstriction. Jacob: What IV fluid is recommended/best for patients with heat stroke?Both lactated Ringer's solution and normal saline are recommended as initial IV fluids for rehydration, but balanced crystalloids such as LR are increasingly favored due to their lower risk of hyperchloremic metabolic acidosis and AKI. However, direct evidence comparing the two specifically in the setting of heat stroke is limited. Arreaza: Are cold IV fluids better/preferred over room temperature fluids?Cold IV fluids are recommended as an adjunctive therapy to help lower core temperature in heat stroke, but they should not delay or replace primary cooling methods such as cold-water immersion. Cold IV fluids can decrease core temperature more rapidly than room temperature fluids. For example, 30mL/kg bolus of chilled isotonic fluids at 4 degrees Celsius over 30 minutes can decrease core temperature by about 1 degree Celsius, compared to 0.5 degree Celsius with room temperature fluids. Arreaza: Getting cold IV sounds uncomfortable but necessary for those patients. Our favorite topic.Screening and Prevention:-Heat stroke prevention focuses on public health and individual awareness rather than routine testing. -High-risk groups—elderly, children, athletes, laborers, or those on impairing meds—should acclimatize gradually (7-14 days), hydrate preemptively (electrolyte solutions over plain water), and monitor temperature in exertional settings. -Communities during heat waves need cooling centers and alerts. -For clinicians, educate patients with CVD or obesity about early signs like dizziness or nausea. -No formal "screening" exists, but vigilance in EDs during summer surges saves lives. -Arreaza: I think awareness is a key element in prevention, so education of the public through traditional media like TV, and even social media can contribute to the prevention of this catastrophic condition.Jacob: Ya so heat stroke is something that should be on every physician's radar in the central valley especially in the summer time given the hot temperatures. Rapid recognition is key. Arreaza: Thanks, Jacob for this topic, and until next time, this is Dr. Arreaza, signing off.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:Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016 Apr;50(4):607-16. doi: 10.1016/j.jemermed.2015.09.014. Epub 2015 Oct 31. PMID: 26525947. https://pubmed.ncbi.nlm.nih.gov/26525947/.Platt, M. A., & LoVecchio, F. (n.d.). Nonexertional classic heat stroke in adults. In UpToDate. Retrieved September 7, 2025, from https://www.uptodate.com/contents/nonexertional-classic-heat-stroke-in-adults. (Key addition: Emphasizes insidious onset in at-risk populations and the role of urban heat islands in exacerbating classic cases.) Heat Stroke. WikEM. Retrieved December 3, 2025, from https://wikem.org/wiki/Heat_stroke. (Key additions: Details on cooling rates for immersion therapy, confirmation that anhidrosis is not diagnostic, and fluid titration to urine output for rhabdomyolysis prevention.)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

While endometriosis is highly associated with Chronic Pelvic Pian (CPP), some women may suffer from a different primary or coexistent secondary etiology: pelvic vascular congestion, called vascular origin (VO)- CPP. Although controversial as an entity, there have been diagnostic algorithms published (via pelvic ultrasound. MRI, or venography) for this condition. Approximately 10-40% of chronic pelvic pain cases may be attributed to pelvic vascular congestion (now termed pelvic venous disorder), though estimates vary considerably depending on the population studied and diagnostic criteria used. In premenopausal women specifically, the prevalence appears higher. One study found that 8% of all premenopausal women had documented chronic pelvic pain of unclear etiology along with dilated ovarian and pelvic veins on cross-sectional imaging. Therapies for this have been limited. Flavonoids are abundant in a colorful diet of fruits, vegetables, tea, and wine, with common sources including citrus fruits (flavanones), berries, apples, grapes (flavan-3-ols/anthocyanins), onions, kale, broccoli (flavonols), and tea, cocoa, red wine (flavan-3-ols), plus soybeans (isoflavones), all providing antioxidants and potential health benefits like better heart and brain health. On Dec. 23, 2025, in the journal Phlebology, researchers published a systematic review on the potential benefits of specific flavonoid mixtures which may provide relief to VO-CPP. Listen in for insights and details.1. Gloviczki ML, Demetres MR, Salazar G, Khilnani NM. Venoactive drugs for venous origin chronic pelvic pain in women: A systematic review. Phlebology. 2025 Dec 23:2683555251411027. doi: 10.1177/02683555251411027. Epub ahead of print. PMID: 41432346.2. Knuttinen MG, Machan L, Khilnani NM, Louie M, Caridi TM, Gupta R, Winokur RS. Diagnosis and Management of Pelvic Venous Disorders: AJR Expert Panel Narrative Review. AJR Am J Roentgenol. 2023 Nov;221(5):565-574. doi: 10.2214/AJR.22.28796. Epub 2023 Apr 5. PMID: 37095667.

我們都知道運動對身體健康有益，但你是否知道，運動更是對抗大腦老化與認知退化的強大武器？ 2025年發表於 The Lancet 的權威綜論研究指出，規律身體活動可以從大腦結構、功能到分子層面，多方位守護我們的腦部健康，延緩認知能力下降，甚至降低阿茲海默症等神經退化性疾病的風險。 運動對於大腦的神經保護作用主要體現在以下幾個層面：

Cardio verbrennt Fett, Gewichte bauen Muskeln auf – oder ist das zu simpel gedacht?In dieser Folge erfährst Du, was die neueste Wissenschaft über Kraft- vs. Kardiotraining sagt und wie Du BEIDES strategisch nutzt, um maximalen Fettabbau zu erreichen. Ohne Muskeln zu verlieren oder dabei auszubrennen.Am Ende hast Du einen klaren Fahrplan: Wie viel Kraft, wie viel Kardio benötigst DU wirklich – basierend auf Deinem Zeitbudget? Plus: Warum 5x Laufen pro Woche Dich ausbremsen kann, während die richtige Kombi aus beidem in 12 Wochen 8 kg Fett schmelzen lässt.____________*WERBUNG: Infos zum Werbepartner dieser Folge und allen weiteren Werbepartnern findest Du hier.____________Mehr zum Thema:Buch: Looking Good Naked: Die GesamtausgabeBuch: Dranbleiben!Artikel: Kraft- und Ausdauertraining – Freund oder Feind?Literatur:Lafontant, K., et al. (2025). Concurrent, resistance, or aerobic training on body fat loss: systematic review and meta-analysis. J Int Soc Sports Nutr, 22(1):2507949. PMID: 40405489Schuenke, M.D., et al. (2002). EPOC after resistance exercise. Eur J Appl Physiol, 86(5):411-7. PMID: 11882927Ding, D., et al. (2025). Daily steps and health outcomes: meta-analysis. Lancet Public Health, 10(8):e668-e681. PMID: 40713949Gaesser, G.A. & Brooks, G.A. (1984). Metabolic bases of EPOC: a review. Med Sci Sports Exerc, 16(1):29-43. PMID: 6369064____________Shownotes und Übersicht aller Folgen.Trag Dich in Marks Dranbleiber Newsletter ein.Entdecke Marks Bücher.Folge Mark auf Instagram, Facebook, Strava, LinkedIn. Hosted on Acast. See acast.com/privacy for more information.

In this episode of "PICU Doc on Call," Dr. Pradip Kamat and Dr. Rahul Damania dive into a fascinating case of a 9-month-old infant who comes in with hypoglycemia and seizures. Together, they break down the basics of glucose metabolism, walk through the causes of hypoglycemia, and discuss the best diagnostic strategies and acute management steps. They put a special spotlight on using diazoxide for hyperinsulinemic hypoglycemia, discussing not only how it works but also its potential side effects. The conversation also discusses dietary interventions for metabolic disorders and highlights the importance of rapid diagnosis and personalized treatment.Show Highlights:Pediatric hypoglycemia and its implications in infantsCase study of a 9-month-old infant with hypoglycemia and seizuresPhysiology of glucose metabolism and its regulationCauses of hypoglycemia, categorized into primary and secondary etiologiesDiagnostic approaches for identifying the cause of hypoglycemiaInitial management strategies for acute hypoglycemiaLong-term treatment options based on underlying causesImportance of timely diagnosis and intervention in the PICU settingPharmacologic management of hyperinsulinemic hypoglycemia, including the use of diazoxideMultidisciplinary care and follow-up for pediatric patients with hypoglycemiaReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 84 Alder M et al. Pediatric Sepsis. Pages 1293-1309Honarmand K, Sirimaturos M, Hirshberg EL, Bircher NG, Agus MSD, Carpenter DL, Downs CR, Farrington EA, Freire AX, Grow A, Irving SY, Krinsley JS, Lanspa MJ, Long MT, Nagpal D, Preiser JC, Srinivasan V, Umpierrez GE, Jacobi J. Society of Critical Care Medicine Guidelines on Glycemic Control for Critically Ill Children and Adults 2024. Crit Care Med. 2024 Apr 1;52(4):e161-e181. doi: 10.1097/CCM.0000000000006174. Epub 2024 Jan 19. PMID: 38240484.Rosenfeld E, Thornton PS. Hypoglycemia in Neonates, Infants, and Children. 2023 Aug 22. In: Feingold KR, Ahmed SF, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Muzumdar R, Purnell J, Rey R, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 37665756.Rayas MS, Salehi M. Non-Diabetic Hypoglycemia. 2024 Jan 27. In: Feingold KR, Ahmed SF, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N,...

In 2002, the National Institute of Child Health and Human Development (NICHD) proposed the 3-Tier fetal heart rate (FHR) classification system that was subsequently adopted by many organizations, categorizing tracings into three groups: Category I (normal), Category II (indeterminate), and Category III (abnormal). Recently, our podcast team received an interesting question form one of our podcast family members: “If there is a change in the fetal heart rate tracing intrapartum, but it is still in the normal range (like 120 going to 150)- and variability is normal, is that an abnormality? And what is meant by a ‘ZigZag' FHT pattern (different than marked variability)?”. That is a fantastically complex question…and we will explain the answer in this episode.1. Zullo F, Di Mascio D, Raghuraman N, Wagner S, Brunelli R, Giancotti A, Mendez-Figueroa H, Cahill AG, Gupta M, Berghella V, Blackwell SC, Chauhan SP. Three-tiered fetal heart rate interpretation system and adverse neonatal and maternal outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol. 2023 Oct;229(4):377-387. doi: 10.1016/j.ajog.2023.04.008. Epub 2023 Apr 11. PMID: 37044237.2. Ghi T, Di Pasquo E, Dall'Asta A, et al. Intrapartum Fetal Heart Rate Between 150 and 160 BPM at or After 40 Weeks and Labor Outcome.Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(3):548-554. doi:10.1111/aogs.14024.3. The 3 Tier System: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://ncc-efm.org/filz/NICHD_Reference_from_CCPR.pdf4. Jia YJ, Ghi T, Pereira S, Gracia Perez-Bonfils A, Chandraharan E. Pathophysiological Interpretation of Fetal Heart Rate Tracings in Clinical Practice. American Journal of Obstetrics and Gynecology. 2023;228(6):622-644. doi:10.1016/j.ajog.2022.05.0235. Ghi T, Di Pasquo E, Dall'Asta A, et al. Intrapartum Fetal Heart Rate Between 150 and 160 BPM at or After 40 Weeks and Labor Outcome. Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(3):548-554. doi:10.1111/aogs.14024.6. Yang M, Stout MJ, López JD, Colvin R, Macones GA, Cahill AG. Association of Fetal Heart Rate Baseline Change and Neonatal Outcomes. Am J Perinatol. 2017 Jul;34(9):879-886. doi: 10.1055/s-0037-1600911. Epub 2017 Mar 16. PMID: 28301895.

Will running in the “grey zone” cause you to flounder - or appropriately dosed amounts let your fitness flourish? This remastered episode, originally from January 2024, provides a nuanced discussion on how moderate intensity running can be beneficial in the correct doses - but why you don't want to train every day in this zone.✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts starting in December, when we'll be releasing special subscriber-only content!In this episode, you'll learn:✅ What is the grey zone in running?✅ The benefits and detriments of running in the grey zone✅ How to use the talk test✅ When to use zone 3 training✅ Should you do all of your long runs at marathon pace?✅ What is polarized training (hard days hard, easy days easy)✅ Marathon pace/zone 3 workouts✅ Zone 2 vs zone running when you are a beginner runnerIf you enjoyed this episode, you may also like

Endocrine Surgery emergencies are rare. However, they can be clinically significant and understanding how to navigate them as a surgeon in timely fashion is critical. Hosts:  Dr. Rebecca Sippel is an endowed professor of surgery and Division Chief of Endocrine Surgery at University of Wisconsin (UW) - Madison, and she is the most recent past president of the American Association of Endocrine Surgeons (AAES).  She is an internationally recognized leader in the field of endocrine surgery with over 250 publications. She was the principal investigator for a hallmark randomized controlled trial which studied the need for prophylactic central neck dissections in thyroid cancer.   Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI. Her clinical interests are in robotic adrenalectomy, benign and malignant thyroid cancer and hyperparathyroidism. Dr. Simon Holoubek is a fellowship trained endocrine surgeon affiliated with UW Health. His primary practice is with UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1) Learn about thyroid storm in hyperthyroidism and treatment options. 2) Understand how to treat hypercalcemic crisis due to uncontrolled primary hyperparathyroidism. 3) Describe the modified surgical techniques required for thyroidectomy in patients with Graves' disease to prevent recurrent laryngeal nerve traction injury. 4) Identify clinical and intraoperative indicators of parathyroid carcinoma and explain the necessity of en bloc resection to prevent parathyromatosis. References: 1 Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res. 2000 May 15;90(2):161-5. doi: 10.1006/jsre.2000.5875. PMID: 10792958. https://pubmed.ncbi.nlm.nih.gov/10792958/ 2 Yoshimura Noh J, Inoue K, Suzuki N, Yoshihara A, Fukushita M, Matsumoto M, Imai H, Hiruma S, Ichikawa M, Koshibu M, Sankoda A, Hirose R, Watanabe N, Sugino K, Ito K. Dose-dependent incidence of agranulocytosis in patients treated with methimazole and propylthiouracil. Endocr J. 2024 Jul 12;71(7):695-703. doi: 10.1507/endocrj.EJ24-0135. Epub 2024 May 3. PMID: 38710619. https://pubmed.ncbi.nlm.nih.gov/38710619/ 3 Christopher L, Mellman M, Buicko JL. Management of Hypercalcemic Crisis due to Primary Hyperparathyroidism During Pregnancy. Am Surg. 2023 Aug;89(8):3638-3640. doi: 10.1177/00031348231162704. Epub 2023 Apr 27. PMID: 37102502. https://pubmed.ncbi.nlm.nih.gov/37102502/ Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Today, Dave Furfaro, Luke Hedrick, and Robert Wharton discuss the PREDMETH trial published in The New England Journal of Medicine in 2025. This was a non-inferiority trial comparing prednisone to methotrexate for upfront therapy in treatment-naive sarcoidosis patients. Listen in for a break down of the trial, analysis, and clinically applicable pearls. Article and Reference Todays’ episode discusses the PREDMETH trial published in NEJM in 2025. Kahlmann V, Janssen Bonás M, Moor CC, Grutters JC, Mostard RLM, van Rijswijk HNAJ, van der Maten J, Marges ER, Moonen LAA, Overbeek MJ, Koopman B, Loth DW, Nossent EJ, Wagenaar M, Kramer H, Wielders PLML, Bonta PI, Walen S, Bogaarts BAHA, Kerstens R, Overgaauw M, Veltkamp M, Wijsenbeek MS; PREDMETH Collaborators. First-Line Treatment of Pulmonary Sarcoidosis with Prednisone or Methotrexate. N Engl J Med. 2025 Jul 17;393(3):231-242. doi: 10.1056/NEJMoa2501443. Epub 2025 May 18. PMID: 40387020. https://www.nejm.org/doi/full/10.1056/NEJMoa2501443 Meet Our Hosts Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a first year pulmonary and critical care fellow at Johns Hopkins. Key Learning Points Clinical context Prednisone remains the traditional first-line treatment for pulmonary sarcoidosis when treatment is indicated, with evidence for short-term improvements in symptoms, radiographic findings, and pulmonary function—but with substantial, familiar steroid toxicities (weight gain, insomnia, HTN/DM, infection risk, etc.). Despite widespread use, glucocorticoids haven't been robustly tested head-to-head against many alternatives as initial therapy, and evidence for preventing long-term decline (especially in severe disease) is limited. Immunosuppressants (like methotrexate) are often used as steroid-sparing agents, but guideline recommendations are generally conditional/low-quality evidence, and practice varies. Why PREDMETH matters It addresses a real-world question: Can methotrexate be an initial alternative to prednisone in pulmonary sarcoidosis, rather than being reserved only for steroid-sparing later? It also probes a common clinical belief: MTX has slower onset than prednisone (often assumed, not well-proven). Trial design (what to know) Open-label, randomized, noninferiority trial across 17 hospitals in the Netherlands. Included patients with pulmonary sarcoidosis who had a clear pulmonary indication to start systemic therapy (moderate/severe symptoms plus objective risk features like reduced FVC/DLCO or documented decline, plus parenchymal abnormalities). Excluded: non–treatment-naïve patients and those whose primary indication was extrapulmonary disease. Treat-to-tolerability with escalation: both drugs started low and were slowly increased; switch/add-on allowed for inadequate efficacy or unacceptable side effects. Primary endpoint: change in FVC (with the usual caveat that FVC is “objective-ish,” but effort-dependent and not always patient-centered). Noninferiority margin: 5% FVC, justified as within biologic/measurement variation and “not clinically relevant.” Outcomes assessed at weeks 4, 16, 24; powered for ~110 patients to detect the NI margin. Patient population (who this applies to) Mostly middle-aged (~40s) with mild-to-moderate physiologic impairment on average (FVC ~77% predicted; DLCO ~70% predicted). Netherlands-based cohort with limited Black representation (~7%), which matters for generalizability. Would have been helpful to know more about comorbidities (e.g., diabetes), which can strongly influence prednisone risk. Main findings (what happened) Methotrexate was noninferior to prednisone at week 24 for FVC: Between-group difference in least-squares mean change at week 24: −1.17 percentage points (favoring prednisone) with CI −4.27 to +1.93, staying within the 5% NI margin. Timing mattered: Prednisone showed earlier benefit (notably by week 4) in FVC and across quality-of-life measures. By week 24, those early differences largely washed out—possibly because MTX “catches up,” and/or because crossover increased over time. In their reporting, MTX didn't meet noninferiority for FVC until week 24, supporting the practical message that prednisone works faster. Crossover and analysis nuance (important for interpretation) Crossover was fairly high, which complicates noninferiority interpretation: MTX arm: some switched to prednisone for adverse events and others had prednisone added for disease progression/persistent symptoms. Prednisone arm: some had MTX added. In noninferiority trials, heavy crossover can bias intention-to-treat analyses toward finding “no difference” (making noninferiority easier to claim). Per-protocol analyses avoid some of that but introduce other biases. They reported both. Safety signals (what to remember clinically) Adverse events were very common in both arms (almost everyone), mostly mild. Side-effect patterns fit expectations: Prednisone: more insomnia (and classic steroid issues). MTX: more headache/cough/rash, and notably liver enzyme elevations (about 1 in 4), with a small number discontinuing. Serious adverse events were rare; numbers were too small to confidently separate “signal vs noise,” but overall known risk profiles apply. Limitations (why you shouldn't over-read it) Open-label design, and FVC—while objective-ish—is still effort-dependent and can be influenced by expectation/behavior. Small trial, limiting subgroup conclusions (e.g., severity strata, different phenotypes). Generalizability issues (Netherlands demographics; US populations have higher rates of obesity/metabolic syndrome, which may tilt the steroid risk-benefit equation). Crossover reduces precision and interpretability of between-group differences over time. Practice implications (the “so what”) For many patients with pulmonary sarcoidosis needing systemic therapy, MTX is a reasonable initial alternative to prednisone when thinking long-term tolerability and steroid avoidance. Prednisone likely provides faster symptom/QoL relief in the first weeks—so it may be preferable when rapid improvement is important. The trial strengthens the case for a patient-centered discussion: short-term relief vs side-effect tradeoffs, and the possibility of early combination therapy in more severe cases (suggested, not proven).

Send us a textMaternal Psychological Distress Before and After Childbirth and Neurodevelopmental Delay in Toddlers.Matsumura K, Tanaka T, Kuroda M, Tsuchida A, Hatakeyama T, Kasamatsu H, Inadera H; Japan Environment and Children's Study Group.JAMA Netw Open. 2025 Oct 1;8(10):e2540907. doi: 10.1001/jamanetworkopen.2025.40907.PMID: 41171271 Free PMC article.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textEarly body composition outcomes of infants born very preterm and receiving high volume, human milk feedings (≥170 ml/kg/day) before postnatal day 14.Gunawan E, Molleti M, Salas AA.J Perinatol. 2025 Oct 31. doi: 10.1038/s41372-025-02469-w. Online ahead of print.PMID: 41174086 No abstract available.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textApplied forces during neonatal intubation with direct and video laryngoscopy at different bed elevations: a randomized crossover manikin study.Cavallin F, Pasquali G, Maglio S, Villani PE, Menciassi A, Tognarelli S, Trevisanuto D.Eur J Pediatr. 2025 Nov 5;184(12):732. doi: 10.1007/s00431-025-06524-8.PMID: 41191125 Free PMC article. Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textTreatment of Hypotension of Prematurity: a randomised trial.Alderliesten T, Arasteh E, van Alphen A, Groenendaal F, Dudink J, Benders MJ, van Bel F, Lemmers P. Arch Dis Child Fetal Neonatal Ed. 2025 Dec 15;111(1):F60-F66. doi: 10.1136/archdischild-2024-328253.PMID: 40413017 Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textFull exclusively enteral fluids from day 1 versus gradual feeding in preterm infants (FEED1): a open-label, parallel-group, multicentre, randomised, superiority trial.Ojha S, Mitchell EJ, Johnson MJ, Gale C, McGuire W, Oddie S, Hall SS, Meakin G, Anderson J, Partlet C, Su Y, Johnson S, Walker KF, Ogollah R, Mistry H, Naghdi S, Montgomery A, Dorling J; FEED1 collaborative.Lancet Child Adolesc Health. 2025 Dec;9(12):827-836. doi: 10.1016/S2352-4642(25)00271-8. Epub 2025 Oct 17.PMID: 41115446 Free article. Clinical Trial.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Are you tired all the time, both during runs and during the rest of the day? This remastered episode from 2024 examines training fatigue, abnormal fatigue, vitamin deficiencies, low energy availability, training load management, and more!Thank you to our sponsors:✨ FlipBelt: Sleek storage options, including no-bounce running belts and shorts. Use code TLF20 at flipbelt.com for 20% off your purchase.✨Join us on Patreon.com/treadlightlyrunning or subscribe on Apple Podcasts starting in December, when we'll be releasing special subscriber-only content!In this episode, you'll learn: ✅ Normal vs abnormal fatigue✅ Vitamin D deficiency and low iron levels✅ Low energy and low carbohydrate availability✅ Is caffeine or pre-workout overriding your body's signals?✅ Eating disorders and disordered eating✅ Is it your training plan that is making you tired?✅ Other factors that may cause fatigueIf you enjoyed this episode, you may also like:

Listener discretion is advised. References: Ehrman-Dupre R, Kaigh C, Salzman M, Haroz R, Peterson LK, Schmidt R. Management of Xylazine Withdrawal in a Hospitalized Patient: A Case Report. J Addict Med. 2022 Sep-Oct 01;16(5):595-598. doi: 10.1097/ADM.0000000000000955. Epub 2022 Jan 11. PMID: 35020700. London KS, Huo S, Murphy L, Warrick-Stone T, Goodstein D, Montesi M, Carter M, Butt S, Alexander K, Satz W, Tasillo A, Xu L, Arora M, Casey E, McKeever R, Lowenstein M, Durney P, Hart B, Perrone J. Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA. J Addict Med. 2025 Aug 1. doi: 10.1097/ADM.0000000000001560. Epub ahead of print. PMID: 40747932. Reel B, Maani CV. Dexmedetomidine. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513303/

This video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article's review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait. Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential. This video continues the Heal NPD Seminar Series, featuring Dr. Mark Ettensohn with his associates, Deanna Young, Psy.D., and Danté Spencer, M.A. In this session, the group discusses Empathy and Narcissistic Personality Disorder: From Clinical and Empirical Perspectives (2014), examining the long-standing assumption that narcissistic personality disorder is defined by a lack of empathy. Drawing on the article's review of empirical findings and clinical case material, the conversation explores empathy as a multidimensional and context-dependent capacity rather than a fixed trait. Key themes include the distinction between emotional and cognitive empathy, the variability of empathic functioning across grandiose and vulnerable narcissistic states, and the ways shame, threat, and affective overload can disrupt empathic engagement in intimate relationships. The discussion highlights how empathy may appear intact or even robust in some contexts, while collapsing in situations that feel most emotionally consequential. The seminar also addresses common misunderstandings of neuroimaging findings related to empathy, emphasizing the limits of biological reductionism and the importance of viewing brain-based data as correlates of experience rather than determinants of destiny. Throughout, the group reflects on clinical implications for treatment, including the differentiation between motivation-based and deficit-based empathic disengagement, the role of affect tolerance and reflective capacity, and the relational conditions that support the gradual restoration of empathic availability. This series is intended for clinicians, trainees, and others interested in a nuanced, non-moralizing understanding of narcissistic personality disorder, empathy, and psychological development. To learn more about our work, visit www.HealNPD.org Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 Citation for the article discussed: Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personal Disord. 2014 Jul;5(3):323-33. doi: 10.1037/per0000061. Epub 2014 Feb 10. PMID: 24512457; PMCID: PMC4415495. Full text link: https://pmc.ncbi.nlm.nih.gov/articles/PMC4415495/

The second stage of labor, characterized by active pushing and the descent of the fetal head, can be a challenging and prolonged phase for both mother and baby. Various interventions have been explored to optimize this stage, and one such technique involves the application of vaginal lubricants. The rationale behind this approach is to reduce friction between the fetal head and the birth canal, potentially leading to smoother and faster delivery. Does this seemingly simple technique work? Does the ACOG mention this in the CPG 8 from January 2024? What does the latest research tell us about its effectiveness in assisting or speeding up the birthing process? Listen in for details.1. Yang Q, Cao X, Hu S, Sun M, Lai H, Hou L, Wang Q, Wu C, Wu Y, Xiao L, Luo X, Tian J, Ge L, Shi L. Lubricant for reducing perineal trauma: A systematic review and meta-analysis of randomized controlled trials. J Obstet Gynaecol Res. 2022 Nov;48(11):2807-2820. doi: 10.1111/jog.15399. Epub 2022 Aug 16. PMID: 36319196.2. ACOG: First and Second Stage Labor Management Clinical Practice Guideline Number 8: January 20243. Aquino CI, Saccone G, Troisi J, Zullo F, Guida M, Berghella V. Use of lubricant gel to shorten the second stage of labor during vaginal delivery. J Matern Fetal Neonatal Med. 2019 Dec;32(24):4166-4173. doi: 10.1080/14767058.2018.1482271. Epub 2018 Jun 27. PMID: 29804505.4. Beckmann MM, Stock OM. Antenatal Perineal Massage for Reducing Perineal Trauma. The Cochrane Database of Systematic Reviews. 2013;(4):CD005123. doi:10.1002/14651858.CD005123.pub3.

This is the last episode in the How of Happiness Series that follows the 12 exercises outlined in The How of Happiness by Dr. Sonja LyubomirskyThis episodes explores how meditation and physical activity can boost happiness and well-being. You'll learn how meditation trains the mind for calm and awareness, how exercise can be as effective as medication for improving mood, and why both practices strengthen emotional resilience. Discover simple, practical ways to integrate mindfulness and movement into your daily routine to feel more centered, focused, and fulfilled. Resources Mentioned:The How of Happiness by Sonja LyubomirskyMeditation apps: Headspace, Calm, Insight Timer, Ten Percent HappierMeditation centers: InsightLA, Spirit Rock, The Mindfulness CenterStudies specifically mentioned:Kjaer TW, Bertelsen C, Piccini P, Brooks D, Alving J, Lou HC. Increased dopamine tone during meditation-induced change of consciousness. Brain Res Cogn Brain Res. 2002 Apr;13(2):255-9. doi: 10.1016/s0926-6410(01)00106-9. PMID: 11958969.Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, W.E., Herman, S., Khatri, P., … Krishnan, K.R.R. (1999). Effects of Exercise Training on Older Patients With Major Depression: A Randomized Controlled Trial. Archives of Internal Medicine, 159(19), 2349–2356.https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485159Please subscribe and leave a review on your favorite Podcasting platform. Get 12 Financial Mistakes that Keep Physicians from Building Wealth at https://www.growyourwealthymindset.com/12financialmistakes If you want to start your path to financial freedom, start with the Financial Freedom Workbook. Download your free copy today at https://www.GrowYourWealthyMindset.com/fiworkbook Dr. Elisa Chiang is a physician and money coach who helps other doctors reach their financial goals by mastering their money mindset through personalized 1:1 coaching . You can learn more about Elisa at her website or follow her on social media. Website: https://ww.GrowYourWealthyMindset.com Instagram https://www.instagram.com/GrowYourWealthyMindset Facebook https://www.facebook.com/ElisaChiang https://www.facebook.com/GrowYourWealthyMindset YouTube: https://www.youtube.com/c/WealthyMindsetMD Linked In: www.linkedin.com/in/ElisaChiang Disclaimer: The content provided in the Grow Your Wealthy Mind...

Chegou o episódio escolhido por vocês! Marcela Belleza e Joanne Alves convidam Carol Millon para conversar sobe 6 clinicagens de inibidores de SGLT2, as gliflozinas:Indicações além do DMRisco de CAD euglicêmicaQuando não usar?⁠Cuidados com doença aguda (sick day) e hipovolemia⁠Cuidados pré-operatórioRisco de fratura e amputaçãoReferências:1. Bailey CJ, et al. Dapagliflozin add-on to metformin in type 2 diabetes inadequately controlled with metformin: a randomized, double-blind, placebo-controlled 102-week trial. BMC Med. 2013;11:43. Published 2013 Feb 20. doi:10.1186/1741-7015-11-432. Bersoff-Matcha SJ, et al. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019;170(11):764-769. doi:10.7326/M19-00853. Chang HY, et al. Association Between Sodium-Glucose Cotransporter 2 Inhibitors and Lower Extremity Amputation Among Patients With Type 2 Diabetes. JAMA Intern Med. 2018;178(9):1190-1198. doi:10.1001/jamainternmed.2018.3034 4. Clar C, et al. Systematic review of SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes. BMJ Open. 2012 Oct 18;2(5):e001007. doi: 10.1136/bmjopen-2012-001007. PMID: 23087012; PMCID: PMC3488745.5. Das SR, et al. 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020 Sep 1;76(9):1117-1145. doi: 10.1016/j.jacc.2020.05.037. Epub 2020 Aug 5. PMID: 32771263; PMCID: PMC7545583. 6. Fralick M, et al. Risk of amputation with canagliflozin across categories of age and cardiovascular risk in three US nationwide databases: cohort study. BMJ. 2020;370:m2812. Published 2020 Aug 25. doi:10.1136/bmj.m28127. Li D, et al. Urinary tract and genital infections in patients with type 2 diabetes treated with sodium-glucose co-transporter 2 inhibitors: A meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2017;19(3):348-355. doi:10.1111/dom.128258. Neal B, et al. Rationale, design, and baseline characteristics of the Canagliflozin Cardiovascular Assessment Study (CANVAS)--a randomized placebo-controlled trial. Am Heart J. 2013;166(2):217-223.e11. doi:10.1016/j.ahj.2013.05.0079. Nyirjesy P, et al. Evaluation of vulvovaginal symptoms and Candida colonization in women with type 2 diabetes mellitus treated with canagliflozin, a sodium glucose co-transporter 2 inhibitor. Curr Med Res Opin. 2012;28(7):1173-1178. doi:10.1185/03007995.2012.69705310. Perkovic V, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295-2306. doi:10.1056/NEJMoa181174411. Rosenwasser RF, et al. SGLT-2 inhibitors and their potential in the treatment of diabetes. Diabetes Metab Syndr Obes. 2013 Nov 27;6:453-67. doi: 10.2147/DMSO.S34416. PMID: 24348059; PMCID: PMC3848644.12. Sridharan K, Sivaramakrishnan G. Risk of limb amputation and bone fractures with sodium glucose cotransporter-2 inhibitors: a network meta-analysis and meta-regression. Expert Opin Drug Saf. 2025;24(7):797-804. doi:10.1080/14740338.2024.237775513. Ueda P,  et al. Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events: nationwide register based cohort study. BMJ. 2018;363:k4365. Published 2018 Nov 14. doi:10.1136/bmj.k436514. Watts NB, et al. Effects of Canagliflozin on Fracture Risk in Patients With Type 2 Diabetes Mellitus. J Clin Endocrinol Metab. 2016 Jan;101(1):157-66. doi: 10.1210/jc.2015-3167. Epub 2015 Nov 18. PMID: 26580237; PMCID: PMC4701850.15. Zhuo M, et al. Association of Sodium-Glucose Cotransporter-2 Inhibitors With Fracture Risk in Older Adults With Type 2 Diabetes. JAMA Netw Open. 2021;4(10):e2130762. Published 2021 Oct 1. doi:10.1001/jamanetworkopen.2021.3076216. Emerson Cestari Marino, Leandra Anália Freitas Negretto, Rogério Silicani Ribeiro, Denise Momesso, Alina Coutinho Rodrigues Feitosa, Marcos Tadashi Kakitani Toyoshima, Joaquim Custódio da Silva Junior, Sérgio Vencio, Marcio Weissheimer Lauria, João Roberto de Sá, Domingos A. Malerbi, Fernando Valente, Silmara A. O. Leite, Danillo Ewerton Oliveira Amaral, Gabriel Magalhães Nunes Guimarães, Plínio da Cunha Leal, Maristela Bueno Lopes, Luiz Carlos Bastos Salles, Liana Maria Torres de Araújo Azi, Amanda Gomes Fonseca, Lorena Ibiapina M. Carvalho, Francília Faloni Coelho, Bruno Halpern, Cynthia M. Valerio, Fabio R. Trujilho,  Antonio Carlos Aguiar Brandão, Ruy Lyra e Marcello Bertoluci. Rastreamento e Controle da Hiperglicemia no Perioperatório – Posicionamento Conjunto da Sociedade Brasileira de Diabetes (SBD), Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira para o Estudo da Obesidade e Síndrome Metabólica (ABESO). Diretriz Oficial da Sociedade Brasileira de Diabetes (2025). DOI: 10.29327/5660187.2025-10 , ISBN: 978-65-5941-367-6.17. Singh LG, Ntelis S, Siddiqui T, Seliger SL, Sorkin JD, Spanakis EK. Association of Continued Use of SGLT2 Inhibitors From the Ambulatory to Inpatient Setting With Hospital Outcomes in Patients With Diabetes: A Nationwide Cohort Study. Diabetes Care. 2024;47(6):933-940. doi:10.2337/dc23-112918. Mehta PB, Robinson A, Burkhardt D, Rushakoff RJ. Inpatient Perioperative Euglycemic Diabetic Ketoacidosis Due to Sodium-Glucose Cotransporter-2 Inhibitors - Lessons From a Case Series and Strategies to Decrease Incidence. Endocr Pract. 2022;28(9):884-888. doi:10.1016/j.eprac.2022.06.00619. Umapathysivam MM, Morgan B, Inglis JM, et al. SGLT2 Inhibitor-Associated Ketoacidosis vs Type 1 Diabetes-Associated Ketoacidosis. JAMA Netw Open. 2024;7(3):e242744. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.274420. Fleming N, Hamblin PS, Story D, Ekinci EI. Evolving Evidence of Diabetic Ketoacidosis in Patients Taking Sodium-Glucose Cotransporter 2 Inhibitors. J Clin Endocrinol Metab. 2020;105(8):dgaa200. doi:10.1210/clinem/dgaa20021. Neuen BL, Young T, Heerspink HJL, et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2019;7(11):845-854. doi:10.1016/S2213-8587(19)30256-622. Braunwald E. Gliflozins in the Management of Cardiovascular Disease. N Engl J Med. 2022;386(21):2024-2034. doi:10.1056/NEJMra211501123. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa150472024. Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi:10.1056/NEJMoa161192525. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-357. doi:10.1056/NEJMoa181238926. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008. doi:10.1056/NEJMoa191130327. Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-1424. doi:10.1056/NEJMoa202219028. Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa210703829. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi:10.1056/NEJMoa202481630. The EMPA-KIDNEY Collaborative Group, Herrington WG, Staplin N, et al. Empagliflozin in...

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-463 Overview: Listen in as we discuss how integrating behavioral therapies into the management of chronic back pain can improve function, reduce opioid use, and empower patients. Boost your clinical toolkit with evidence-based strategies that enhance outcomes while aligning with evolving guidelines for safer, multimodal approaches to chronic pain care. Episode resource links: Zgierska AE, Edwards RR, Barrett B, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e253204. doi:10.1001/jamanetworkopen.2025.3204 Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95. doi: 10.15585/mmwr.rr7103a1. PMID: 36327391; PMCID: PMC9639433. Guest: Jillian Joseph, MPAS, PA-C Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-463 Overview: Listen in as we discuss how integrating behavioral therapies into the management of chronic back pain can improve function, reduce opioid use, and empower patients. Boost your clinical toolkit with evidence-based strategies that enhance outcomes while aligning with evolving guidelines for safer, multimodal approaches to chronic pain care. Episode resource links: Zgierska AE, Edwards RR, Barrett B, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e253204. doi:10.1001/jamanetworkopen.2025.3204 Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95. doi: 10.15585/mmwr.rr7103a1. PMID: 36327391; PMCID: PMC9639433. Guest: Jillian Joseph, MPAS, PA-C Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

AABP Executive Director Dr. Fred Gingrich is joined by Dr. Angel Abuelo, AABP member on faculty at Michigan State University College of Veterinary Medicine. Abuelo presented at the 2025 AABP Recent Graduate Conference in Norman, Okla. on managing Salmonella Dublin. AABP members can listen to this presentation for free by accessing the online CE portal on this page or download the BCI Mobile Conference app from your device's store.  Salmonella Dublin is a host-adapted pathogen that results in high morbidity and mortality due to the systemic nature of the disease in calves and in most cases, the pathogen exhibits multi-drug resistance. This pathogen also has implications for human health as a zoonotic disease. Abuelo discusses the clinical presentation in calves is primarily respiratory disease and the carrier state that can be seen in adult cows that serve as a continuous reservoir to maintain the disease on a farm. Diagnostics should include multiple tissues from deceased calves that are necropsied. The best sample to submit in live calves is not feces, but aseptically collected blood cultures.  Abuelo discusses the nuances of treatment in affected calves and due to multi-drug resistance, response to therapy can be poor or lead to a carrier state in recovered animals. Although enrofloxacin is labeled for treatment of bovine respiratory disease, it is not specifically labeled for treatment of Salmonella Dublin and extralabel use of fluoroquinolones in food animals is prohibited by the FDA.  Prevention of the disease is multifactorial and includes all aspects of proper neonatal calf management including adequate and timely pasteurized colostrum, maternity pen management, ventilation, sanitation and nutrition. Abuelo also discusses the use of vaccines in cows and calves to manage the disease on endemically infected farms to prevent outbreaks. Continued research on managing this disease, including the use of vaccines and improved diagnostics, will be important topics for veterinarians and producers who are managing this pathogen. REFERENCES: Frye E, Jennings C, Kremer K. Aseptic technique for blood culture collection in the field to diagnose Salmonella Dublin in calves. J Am Vet Med Assoc. 2025;263(7):1. https://doi.org/10.2460/javma.25.02.0116. PMID: 40267971. https://avmajournals.avma.org/view/journals/javma/263/7/javma.25.02.0116.xml Castro-Vargas RE, Cullens-Nobis FM, Mani R, Roberts JN, Abuelo A. Effect of dry period immunization of Salmonella Dublin latent carriers with a commercial live culture vaccine on intrauterine transmission based on the presence of precolostral antibodies in offspring. J Dairy Sci. 2024;107(12):11436-11445. https://doi.org/10.3168/jds.2024-24945The effect of Salmonella vaccination on Salmonella Dublin blood enzyme-linked immunosorbent assay results. Bov Pract. 2025;59(2), 53-60. https://doi.org/10.21423/bpj20259266 Abuelo A, Renaud D.  Salmonella Dublin Infection in Cattle. Merck Veterinary Manual. 2024. Winter A, Abuelo A, Allen DG, et al. (Eds). Merck, Rahway, NJ, USA. https://www.merckvetmanual.com/digestive-system/salmonellosis/salmonella-dublin-infection-in-cattle Salmonella Dublin Risk Management HERD SD app: https://apps.apple.com/us/app/herd-sd/id6748356498   

Podcast Family, we have covered PCOS on this show many times in the past; and yet- again, there is new information! A new publication from AJOG (Gray journal) describes a new meta-analysis on preconception/continued metformin use in the first trimester. Is this helpful? How does this contrast with the 2023 international guidance update on PCOS? Listen in for details. 1. ASRM: Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (2023)2. Cheshire J, Garg A, Smith P, Devall AJ, Coomarasamy A, Dhillon-Smith RK. Preconception and first-trimester metformin on pregnancy outcomes in women with polycystic ovary syndrome: a systematic review and meta-analysis. Am J Obstet Gynecol. 2025 Dec;233(6):530-547.e8. doi: 10.1016/j.ajog.2025.05.038. Epub 2025 Jun 3. PMID: 40473092.3. Løvvik TS, Carlsen SM, Salvesen Ø, et al. Use of Metformin to Treat Pregnant Women With Polycystic Ovary Syndrome (PregMet2): A Randomised, Double-Blind, Placebo-Controlled Trial. The Lancet. Diabetes & Endocrinology. 2019;7(4):256-266. doi:10.1016/S2213-8587(19)30002-6.4. Teede HJ, Tay CT, Laven J, et al. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility. 2023;120(4):767-793. doi:10.1016/j.fertnstert.2023.07.025.

Contributor: Aaron Lessen, MD Educational Pearls: How do amiodarone and lidocaine work on the heart? Amiodarone Blocks potassium channels (Class III effect). Also blocks sodium and calcium channels. Additional noncompetitive beta-blocker effects. Stabilizes cardiac tissue, slows heart rate, and suppresses both atrial and ventricular arrhythmias. Lidocaine Blocks fast sodium channels in ventricular tissue (Class Ib). Shortens the action potential in ventricular myocardium, especially in ischemic tissue. Suppresses abnormal automaticity in damaged/irritable myocardium. Which one should you pick for a patient in vtach/vfib cardiac arrest? The current guidelines recommend amiodarone for shock-refractory cases but this is based on randomized trials showing better arrhythmia termination and short-term outcomes, but not long-term survival benefits. Two recent studies suggest that lidocaine might actually be preferable. A 2023 paper published in Chest Performed a large retrospective cohort study for treating in-hospital VT/VF cardiac arrest. Among more than 14,000 patients, lidocaine was associated with higher rates of ROSC, 24-hour survival, survival to discharge, and favorable neurologic outcomes. These results held after adjusting for covariates and using propensity score methods. Overall, lidocaine outperformed amiodarone across all major clinical outcomes in this population. A 2025 paper published in Resuscitation Performed a target trial emulation in adults with out-of-hospital shockable cardiac arrest. After propensity score matching in more than 23,000 eligible cases, lidocaine was associated with higher odds of prehospital ROSC, fewer post-drug defibrillations, and greater survival to hospital discharge. These advantages were consistent across matched patient pairs. Dose for lidocaine is an initial 1-1.5 mg/kg IV bolus, followed by additional boluses of 0.5-0.75 mg/kg every 5-10 minutes up to a total of 3 mg/kg if needed. Dose for amiodarone is a 300 mg bolus followed by an additional 150 mg bolus if needed. References Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018 Oct;15(10):e190-e252. doi: 10.1016/j.hrthm.2017.10.035. Epub 2017 Oct 30. Erratum in: Heart Rhythm. 2018 Nov;15(11):e278-e281. doi: 10.1016/j.hrthm.2018.09.026. PMID: 29097320. Smida T, Crowe R, Price BS, Scheidler J, Martin PS, Shukis M, Bardes J. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. Resuscitation. 2025 Mar;208:110515. doi: 10.1016/j.resuscitation.2025.110515. Epub 2025 Jan 23. PMID: 39863130; PMCID: PMC11908894. Wagner D, Kronick SL, Nawer H, Cranford JA, Bradley SM, Neumar RW. Comparative Effectiveness of Amiodarone and Lidocaine for the Treatment of In-Hospital Cardiac Arrest. Chest. 2023 May;163(5):1109-1119. doi: 10.1016/j.chest.2022.10.024. Epub 2022 Nov 2. PMID: 36332663. Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

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

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

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

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