Podcasts about pmid

If you've scrolled through your feeds recently, you've probably seen the video that's causing a stir: a prominent infertility doctor sharing her “Hot Take” personal observations on social media, claiming that IUDs are a hidden cause of intrauterine adhesions- or severe uterine scar tissue. Now, Listen. It is completely natural to see a specialist standing in a white coat making a passionate claim and think, "Wow, should I be worried about my birth control?" But here is the reality we need to establish right out of the gate: a handful of individual cases shared online is the very definition of anecdotal evidence. It does not fulfill the criteria of rigorous scientific observation. When we pull back from the algorithm and look at the actual clinical data involving millions of IUD users worldwide, the science shows us something completely different. In fact, large-scale studies demonstrate that IUDs do not cause this scarring—and historically, certain models have actually been used to prevent the uterine walls from sticking together during post-surgical healing. So today, we are separating the scrolling panic from the actual science. We have REA data from the recent FACT (Fertility After Contraceptive Termination) study from 2021 (AJOG). We're breaking down what the data really says, why the internet loves a medical scare, and the true, proven causes of intrauterine adhesions. 1. Abel MK, Wald K, Cedars MI, Noel M. Uterine Synechiae After Intrauterine Device Use: A Case Series. Journal of Assisted Reproduction and Genetics. 2021. 2. Chung E, Wang F, Zhang J, Strug M, Aghajanova L, Lathi R. The impact of prior hormonal intrauterine device (IUD) use on endometrial lining thickness in the fertility clinic setting: a retrospective cohort study. J Assist Reprod Genet. 2026 Jun 25. doi: 10.1007/s10815-026-03950-x. Epub ahead of print. PMID: 42347902.3. Peipert JF, Zhao Q, Schreiber CA, Teal S, Turok DK, Natavio M, Cordon S, Daggy J. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol. 2021 Aug;225(2):157.e1-157.e9. doi: 10.1016/j.ajog.2021.03.011. Epub 2021 Mar 11. PMID: 33716075.

Antenatal corticosteroids are a MAJOR win in the management of preterm labor. An initial course of antenatal corticosteroids has been shown to reduce morbidity and mortality in patients with preterm prelabor rupture of membranes. For patients who remain undelivered after the initial course of antenatal corticosteroids, it is uncertain whether a booster course of antenatal corticosteroids reduces neonatal morbidity or increases the infection risk. The ACOG, in its current guidance, has concluded that the current evidence is insufficient to make a recommendation. Corticosteroids, especially at the doses given, are also powerful immunosuppressants. When you administer that first course, you accept a minor, calculated risk for a massive, proven benefit. But when you introduce a second course of steroids into a uterine environment that has already been ruptured and exposed to vaginal flora for weeks, you are pouring fuel on the fire. PLUS, the environment for the fetus with prolonged preterm prelabor rupture of membranes is unique. PPPROM, the chronic exposure to ruptured membranes and the resultant oligohydramnios is theorized to trigger a kind of stress response in the fetus- so the baby may make their own endogenous corticosteroid flare. So, rescue steroids after an initial course of steroids in PPROM cases has remained controversial but we have updated data that has provided new insights. In this episode, we will highlight an RCT from 2023 and a more recent systematic review and meta-analysis from May 2026 on this very subject. Listen in for details. 1. Garite TJ, Kurtzman J, Maurel K, Clark R; Obstetrix Collaborative Research Network. Impact of a 'rescue course' of antenatal corticosteroids: a multicenter randomized placebo-controlled trial. Am J Obstet Gynecol. 2009 Mar;200(3):248.e1-9. doi: 10.1016/j.ajog.2009.01.021. Erratum in: Am J Obstet Gynecol. 2009 Oct;201(4):428. PMID: 19254583.2. Tenbrink E, Quain A, Rone V, Harris K, Hadley E, Haas D, Shanks A. Risk of Neonatal Sepsis With Rescue Steroids in Preterm Premature Rupture of Membranes. Cureus. 2023 Apr 6;15(4):e37207. doi: 10.7759/cureus.37207. PMID: 37159785; PMCID: PMC10163895.3. Melamed N, Murphy KE, Pylypjuk C, et al. Timingof Antenatal Corticosteroid Administration and Neonatal Outcomes. JAMA Netw Open. 2025;8(5):e2511315. 4. Porreco R, Garite TJ, Combs CA, Maurel K, Huls CK, Baker S, Fortner KB, Longo SA, Nageotte M, Lewis D, Tran L; Obstetrix Collaborative Research Network. Booster course of antenatal corticosteroids after preterm prelabor rupture of membranes: a double-blind randomized trial. Am J Obstet Gynecol MFM. 2023 May;5(5):100896. doi: 10.1016/j.ajogmf.2023.100896. Epub 2023 Feb 14. PMID: 36796641.5. Da Costa Y, Ramanathan V, Oliveira JA, Brito J, Yousif A. Repeat versus Single Course of Antenatal Corticosteroid in Management of Preterm Premature Rupture of Membranes: A Systematic Review and Meta-analysis. Am J Perinatol. 2026 May;43(7):925-932. doi: 10.1055/a-2708-5314. Epub 2025 Oct 9. PMID: 41067234

The long run is a staple of training plans from the 5K to ultra - but why? In this episode, we discuss the science of long runs, including the physiological adaptations, progressions, specificity and more. Plus, we answer your questions about why sleep is difficult after a long run, if walk breaks are okay, and if you treadmill long runs at a lower heart rate are better than outdoors.Thank you to our sponsors:✨ Mizuno: Shop Mizuno's newest bouncy supertrainer: https://runtothefinish.com/neovista3/In this episode, you'll learn:✅ Why long runs are beneficial✅ If fueling your long runs compromises adaptations✅ How to progress your long runs✅ How often you should do long runs at goal race pace✅ Cardiac drift, cadence, and other things to pay attention to on long runs✅ Terrain specificity during long runsIf you enjoyed this episode, you may like:

Send us Fan MailVitamin K refusal has crossed 5%. That's one in twenty babies, and the curve is bending the wrong way. Ben and Eli work through a new Pediatrics case review that opens with a warning shot, that hemorrhagic presentation in an infant should no longer be a diagnostic mystery, alongside a JAMA letter tracking refusal from 2.9% in 2017 to 5.2% in 2024. Eighty-one times the risk. Intracranial hemorrhage in most late-onset cases. Twenty percent mortality. They talk about the halo effect on other refusals, the ICD code you should be using, and why this conversation belongs in the obstetrics office, not the nursery.----Vitamin K Deficiency Bleeding After Refusal: A Sentinel Event in a Misinformation Era. Jacobs JW, Booth GS, Wheeler AP, Adkins BD.Pediatrics. 2026 May 1;157(5):e2026075994. doi: 10.1542/peds.2026-075994.PMID: 41916583 No abstract available.Trends in Vitamin K Administration Among Infants. Scott K, Miller E, Culhane JF, Greenspan J, Handley SC, Lo JY, Knake LA, McKenney KM, Burris HH, Dysart K.JAMA. 2026 Jan 20;335(3):272-274. doi: 10.1001/jama.2025.21460.PMID: 41359326 Free PMC article.Babies Are Bleeding to Death as Parents Reject a Vitamin Shot Given at Birth https://www.propublica.org/article/more-parents-decline-vitamin-k-shot-newbornsSupport 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!

Ehlers-Danlos Syndrome is a genetic connective tissue disorder that can affect many body systems.  It is important to understand how it might intersect with urgent care both as a cause of certain presentations and a factor impacting treatment and management of some UC presentations.     Check out the paper mentioned Sobey G. Ehlers-Danlos syndrome - a commonly misunderstood group of conditions. Clin Med (Lond). 2014 Aug;14(4):432-6. doi: 10.7861/clinmedicine.14-4-432. PMID: 25099849; PMCID: PMC4952841.   www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice, always consult your usual doctor

Hormone optimization goes beyond testosterone and estrogen. In this episode of the Optimization Academy Podcast, Dr. Greg Jones talks with Ashley Madsen, PA-C, about why symptoms like fatigue, brain fog, low libido, weight changes, poor recovery, and perimenopause concerns often need a deeper, more personalized approach.They discuss why testosterone levels are dropping in younger men, why many women's hormone symptoms are dismissed or misunderstood, and how stress, sleep, toxins, lifestyle, body composition, and metabolic health can affect hormone balance. Ashley also breaks down common misconceptions around testosterone therapy, estrogen, progesterone, peptide therapy, genomics, and longevity medicine.If you've been searching for answers around low testosterone, perimenopause, fatigue, brain fog, weight resistance, hormone therapy, or recovery, this episode offers a practical look at what may actually be driving those changes, and why symptoms, labs, lifestyle, and personalized care all matter.

The Bakri Postpartum Balloon was described and first used clinically in 1999 by Dr. Younes N. Bakri (Georgia, USA). It is intended to treat postpartum hemorrhage (PPH). In the United States, it received its first major FDA clearance (via 510(k) for commercial marketing) on April 17, 2002. Manufacturer guidelines for the Bakri (Cook Medical) state that the balloon may be left indwelling for a maximum of 24 hours, but the determination of removal time is left to the clinician once “bleeding is controlled and the patient is stable.” However, the optimal duration of intrauterine balloon tamponade placement remains unclear. One retrospective cohort study from AJOG (Einerson et al) of 274 women found no significant difference in PPH outcomes when intrauterine balloon tamponade was left in place for 2–12 hours, compared with more than 12 hours. However, only 30 women had the intrauterine balloon tamponade placement for 10 hours or less. And remember, this was not a prospective trial looking at a minimum of 2 hours, 2 hours was just the lower margin of the “short duration” group. Now, a new RCT (with authors from Denver and Vermont) published in the July 2026 Green Journal provides new data. In this first of its kind pragmatic, randomized trial of noninferiority, a 6-hour duration of intrauterine balloon tamponade usage for postpartum hemorrhage (PPH) control was compared with an 18-hour duration. Listen in for details. 1. Durfee, J., Adkins, K., Heyborne, K., Larrea, N., & Schultz, C. (2026). Intrauterine Balloon Tamponade Duration for Postpartum Hemorrhage: A Randomized Controlled Trial. Obstetrics & Gynecology, 148(1), 113–120. https://doi.org/10.1097/AOG.00000000000062952. Garabedian C, Prats C, Seco A, Deneux-Tharaux C, Rozenberg P, Berveiller P. Duration of Intrauterine Balloon Tamponade in Post-Partum Haemorrhage Management After Vaginal Delivery: A Secondary Cohort Analysis From the French TUB Trial. BJOG. 2026 Jan;133(1):123-131. doi: 10.1111/1471-0528.18345. Epub 2025 Sep 1. PMID: 40888007; PMCID: PMC12676195.3. Einerson BD, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol 2017;216:300.e1–5.

Your patient brushes well, avoids sweets — and still keeps getting decay. What if the answer isn't in their mouth at all? What if two inexpensive finger-prick tests told you more about a patient's gum disease and implant prognosis than anything on the radiograph? And here's the uncomfortable one: if the science is this clear, is not checking starting to look like a medico-legal risk? Especially for imlpant surgery! This is a conversation with Dr Tif Qureshi — the dentist who changed how the profession thinks about the lifelong patient, the envelope of function, and Align, Bleach, Bond. He's gone down a new rabbit hole: metabolic health. In general practice he's now doing blood tests — HbA1c and vitamin D — and making the case that the mouth isn't connected to the body, it is the body. This isn't about becoming a “biological dentist” (as you'll hear, Tif is refreshingly blunt about the wilder end of that world). It's about respecting the biology, screening sensibly, and helping patients where we're genuinely placed to help. https://youtu.be/mt1MXLFCTp0 Watch PDP275 on YouTube Protrusive Dental Pearl: Test Yourself First Before you even think about introducing blood tests for your patients, ask whether you're checking your own biomarkers at a sensible interval. The deepest way to understand this topic is to learn it on yourself and your family first — run your own HbA1c, vitamin D, iron, and liver and kidney markers, and see what the data tells you. Start quarterly, like hygienist visits, then stretch to six-monthly or annual once things look good. Getting invested in your own numbers is what makes better food and lifestyle choices actually stick — and it's the honest starting point for ever offering this to a patient. What You'll Take From This Episode The metabolic lens — why one disordered glucose-and-insulin system sits under so much chronic and dental disease, and why dentistry is well placed to act on it. Sugar, redefined — why patients who avoid sweets still get decay, and how frequency of starchy carbs drives the problem. The two biomarkers that matter most — what HbA1c and vitamin D each tell you about caries, perio and healing. How to run it in practice — finger-prick logistics, what to test, and how to raise it on the medical history form. The medico-legal case — why documenting these markers can protect you before implant, graft and perio work. Highlights of This Episode 00:00  Why Dentists Should Care About Blood Tests 06:00  Metabolic Disease: The Root Cause Dentists Miss 13:00  Why Starchy Carbs Cause Decay, Not Just Sugar 15:50  HbA1c and Caries: What the SHIP Study Shows 21:00  Insulin Resistance: The Hidden Driver of Gum Disease 26:00  How to Talk to Patients About Diet Without Scaring Them 31:00  Why Vitamin D Deserves a Place in Dentistry 34:00  Vitamin D, Implant Failure and Perio Risk 37:00  Blood Tests as Medico-Legal Defence 42:00  What Dentists Should Test: HbA1c and Vitamin D 44:00  How In-Practice Blood Testing Actually Works 50:00  The Mouth Is the Body: Screening, Not Diagnosing 51:00  Is This Biological Dentistry? An Honest Answer 57:00  How to Learn Blood Testing for Your Practice From the Guest Dr Tif Qureshi qualified from King's College London in 1992 and is a Past President of the British Academy of Cosmetic Dentistry. He is Founder and Clinical Director of IAS Academy, best known for pioneering Align, Bleach, Bond and Progressive Smile Design, and as a teacher of the Dahl concept. His current focus is metabolic health in general practice.

Join us as we discuss research on mental health and wellbeing in the surgical workforce with Drs. Yang and Collins. The episode explores key findings from recent national surveys showing that nearly one in seven surgeons report suicidal ideation in the past year, with depression, anxiety, and PTSD affecting 15–20% of the surgical population. The conversation highlights protective factors—professional fulfillment, resilience, self-valuation, and connection—while distinguishing between healthy resilience and normalized suffering. Dr. Yang and Dr. Collins discuss systemic barriers including time constraints, out-of-pocket mental health costs, and persistent stigma, alongside actionable institutional interventions: protecting dedicated wellbeing time, establishing peer support and psychological first aid programs, ensuring free mental health access, and expanding research to understand what helps surgeons thrive. The episode emphasizes that self-care is essential to patient safety and invites listeners to become advocates, engage with the literature, and help drive culture change within their institutions. For more information about the AAS wellbeing survey, please email Dr. Yang at CJYANG@MGH.HARVARD.EDU.Host:   Steven Thornton, MD (General Surgery Resident at Duke University) Agnes Premkumar (General Surgery Resident at Creighton) Guests: Jeff Yang, MD (Massachusetts General Hospital) Reagan Collins, MD (University of Pennsylvania) Publications Discussed: Hughes TM, Collins RA, Cunningham CE. Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce. JAMA Surg. 2024 Jan 1;159(1):7-8. doi: 10.1001/jamasurg.2023.4658. PMID: 37792380. [https://pubmed.ncbi.nlm.nih.gov/37792380/] Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg. 2024 Mar 1;279(3):429-436. doi: 10.1097/SLA.0000000000006159. Epub 2023 Nov 23. PMID: 37991182. [https://pubmed.ncbi.nlm.nih.gov/37991182/]  Yaghmour NA, Bynum WE 4th, Hafferty FW, Könings KD, Richter T, Brigham TP, Nasca TJ. Causes of Death Among US Medical Residents. JAMA Netw Open. 2025 May 1;8(5):e259238. doi: 10.1001/jamanetworkopen.2025.9238. Erratum in: JAMA Netw Open. 2025 Jul 1;8(7):e2523489. doi: 10.1001/jamanetworkopen.2025.23489. PMID: 40366660; PMCID: PMC12079293. [https://pubmed.ncbi.nlm.nih.gov/40366660/] Nasca BJ, Hunt ML, Ramirez RT, Eng JS, Li RD, Agarwal G, Bilimoria KY, Hu YY. One is too many: suicidality among general surgery residents. Acad Med. 2025 Dec 24:wvaf105. doi: 10.1093/acamed/wvaf105. Epub ahead of print. PMID: 41819820. [https://pubmed.ncbi.nlm.nih.gov/41819820/] 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: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral 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-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-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 Fan MailIn this Journal Club, Ben and Daphna dig into two new papers on PDA management in our smallest patients. First, the SMART-PDA pilot RCT from Souvik Mitra and colleagues, which uses comprehensive hemodynamic screening to selectively treat high-volume shunts in infants born before 26 weeks, and whose striking Bayesian signal for reduced pulmonary hemorrhage and NEC stopped the trial early. Then a companion JAMA Network Open comparative effectiveness study across four pharmacotherapy regimens. Along the way, Ben shares hemodynamics pearls from his Montreal training: why left ventricular output, LA:Ao ratio, and transductal velocity matter more than PDA diameter alone.----Selective early medical treatment of the patent ductus arteriosus in extremely low gestational age infants: a pilot randomised controlled trial (SMART-PDA). Mitra S, Hebert A, Castaldo MP, Disher T, El-Naggar W, Dhillon S, Alhassen Z, Koo J, Katheria AC, Hyderi A, Kumaran K, Ting J, Surak A, Larocque J, Pepper D, Hornberger L, Makoni M, Weisz DE, Jain A, Bacchini F, Cameron-Nola AJJ, Hatfield T, Dorling J, McNamara PJ, Thabane L.Arch Dis Child Fetal Neonatal Ed. 2026 May 18:fetalneonatal-2026-330462. doi: 10.1136/archdischild-2026-330462. Online ahead of print.PMID: 42150872Pharmacologic Therapies for Patent Ductus Arteriosus in Extremely Preterm Infants. Mitra S, Jain A, Ting JY, Ben Fadel N, Drolet C, Abou Mehrem A, Soraisham AS, Jasani B, Louis D, Lapointe A, Dorling J, Khurshid F, Hyderi A, Kumaran K, Toye J, Harabor A, Weisz DE, Stavel M, Morin A, Bhattacharya S, Lalitha R, Afifi J, Augustine S, Castaldo MP, Hatfield T, Su YC, Shah PS; Canadian Neonatal Network Investigators.JAMA Netw Open. 2026 Jun 1;9(6):e2617477. doi: 10.1001/jamanetworkopen.2026.17477.PMID: 42262753 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!

Gonadal hormones have a complicated influence on appetite. Estradiol generally suppresses appetite, whereas progesterone opposes estradiol's action such that their combined presence represents a high-risk hormonal milieu for Binge Eating (BE). Testosterone is thought to be associated with increased BE in females but appears protective in males. In some reports, combination oral contraceptive (COC) use has been linked to greater BE-related appetitive processes (e.g., food intake). Now, we have 2 recent, back-to-back publications (June 2026 in JAMA Network Open, and July 2026 in Appetite) that have examined the relationship of hormonal contraception on binge eating behavior. These found seemingly opposing conclusions. Listen in for details. 1. Klump KL, Di Dio AM, Anaya C, et al. Combined Oral Contraceptive Use and Binge Eating. JAMA Netw Open. 2026;9(6):e2619047. doi:10.1001/jamanetworkopen.2026.190472. Katz JM, Yan R, Beltz AM, Gearhardt AN. Associations between reproductive hormonal milieus and binge eating: The roles of sex and hormonal contraceptive use. Appetite. 2026 Jul 1;222:108547. doi: 10.1016/j.appet.2026.108547. Epub 2026 Mar 20. PMID: 41866083.3. Bass L, Prostináková T, Silang KG, Griffiths-Gray A, McQuilliam S, Mahon E, Whitehead A, Johnson KO. Does it hold weight? The perceived effects of contraceptive use on weight status in females: A mixed-methods study. PLoS One. 2025 Dec 29;20(12):e0339323. doi: 10.1371/journal.pone.0339323. PMID: 41460817; PMCID: PMC12747328.

Listener discretion is advised! (explicit) References: McGovern B, Garan H, Ruskin JN. Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson-White syndrome. Ann Intern Med. 1986 Jun;104(6):791-4. doi: 10.7326/0003-4819-104-6-791. PMID: 3706931. Strasberg B, Sagie A, Rechavia E, Katz A, Ovsyscher IA, Sclarovsky S, Agmon J. Deleterious effects of intravenous verapamil in Wolff-Parkinson-White patients and atrial fibrillation. Cardiovasc Drugs Ther. 1989 Jan;2(6):801-6. doi: 10.1007/BF00133211. PMID: 2488095. UK Paramedic Assaults: https://collegeofparamedics.co.uk/COP/COP/News/2025/AACE_Calls_For_Further_Interventions.aspx#:~:text=New%20data%20shows%20UK%20ambulance,15%25%20on%20the%20previous%20year.

In our first summer series episode, we review a topic that keeps coming back. Hormone therapy for menopause. It was a thing, then it stopped being a thing, now it's a thing again.   Become a supporter of our show today either on Patreon or through PayPal! Thank you! http://www.patreon.com/thebodyofevidence/ https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE   Email us your questions at thebodyofevidence@gmail.com.   Editor:    Robyn Flynn Theme music: “Fall of the Ocean Queen“ by Joseph Hackl Rod of Asclepius designed by Kamil J. Przybos Chris' book, Does Coffee Cause Cancer?: https://ecwpress.com/products/does-coffee-cause-cancer   Obviously, Chris is not your doctor (probably). This podcast is not medical advice for you; it is what we call information. References:  Geographic variability of menopausal symptoms   1) Nappi RE et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause. 2021 May 24;28(8):875-882. doi: 10.1097/GME.0000000000001793.    2) Nappi RE, et al.  Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey. Maturitas. 2023 Jan;167:66-74. doi: 10.1016/j.maturitas.2022.09.006.    What's the normal duration of symptoms   3) Avis NE, et al. Study of Women's Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015 Apr;175(4):531-9. doi: 10.1001/jamainternmed.2014.8063.  The Women's Health Initiative (WHI) studies   Rossouw JE et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33. doi: 10.1001/jama.288.3.321.    Anderson GL et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004 Apr 14;291(14):1701-12. doi: 10.1001/jama.291.14.1701.   Decline in HRT after WHI studies   Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012 Sep;120(3):595-603. doi: 10.1097/AOG.0b013e318265df42.   Danish Osteoporosis Prevention Study Schierbeck LL metal. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409.   Kronos Early Estrogen Prevention Study (KEEPS) Harman SM, et al. Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 2014 Aug 19;161(4):249-60. doi: 10.7326/M14-0353.   Kronos Early Estrogen Prevention Study (KEEPS) Hodis HN et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 2016 Mar 31;374(13):1221-31. doi: 10.1056/NEJMoa1505241.    Stopping hormonal therapy   Berman RS et al. Risk factors associated with women's compliance with estrogen replacement therapy. J Womens Health. 1997 Apr;6(2):219-26. doi: 10.1089/jwh.1997.6.219.   Grady D, Sawaya GF. Discontinuation of postmenopausal hormone therapy. Am J Med. 2005 Dec 19;118 Suppl 12B:163-5. doi: 10.1016/j.amjmed.2005.09.051.   Tapering vs. abrupt stop or hormonal therapy   Haimov-Kochman R et al. Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study. Menopause. 2006 May-Jun;13(3):370-6. doi: 10.1097/01.gme.0000186663.36211.c0. PMID: 16735933.

REBEL Rundown Key Points Mastery Learning: A unique educational framework focusing on achieving high competence with minimal variability among learners. Deliberate Practice: Involves learner-driven improvement, guided by expert feedback and breaking skills down into micro steps. Psychological Safety: Essential in mastery learning, allowing open feedback without fear or shame, enhancing growth. Embrace the productive struggle!  Practice to Prevent Skill Decay and Improve Clinically: Application of mastery learning principles helps maintain high proficiency levels in both common and rare procedures. Click here for Direct Download of the Podcast. Previously Covered and Related Content: REBEL MIND: The Dunning-Kruger EffectREBEL MIND: Growth vs Fixed Mindset Introduction Welcome back to Rebel MIND, the podcast where we sharpen the person behind the practitioner. MIND stands for Mastering Internal Negativity during Difficulty. This series emphasizes productivity, provider performance, and team optimization to ensure we are at our best during high-pressure situations. In this episode, host Dr. Kim Bambach chats with master educator Dr. Jennifer Yee about the science of performance through mastery learning and deliberate practice. Jennifer Yee, DO is an associate residency program director for OSU Emergency Medicine, the OSU EM director for assessment and evaluation, and an associate professor of emergency medicine.  She is from Akron, Ohio and earned her bachelor degree from Ohio University and her medical degree through the Ohio University College of Medicine. Her residency training was completed through Summa Akron City Hospital. After serving as chief resident, she completed a simulation medicine fellowship at Summa.She completed Northwestern's Designing and Implementing Simulation-Based Mastery-Learning Curricula, as well as Ohio State's Master of Art's program in Biomedical Education. She established a mastery-based procedural curriculum for OSU’s EM residency program before creation of an institution-wide mastery-based central venous catheter (CVC) curriculum for all housestaff expected to place CVCs during their clinical training. Cognitive Question How can use the principles of mastery learning as better benchmark for learning, performance, and patient safety? How can we practice deliberately? What is Mastery Learning? Unlike traditional clinical training, which is time-bound (e.g., “you are competent after a 3-year residency” or “after 10 chest tubes”), Mastery Learning is outcome-bound. The goal is to get every single learner from their unique baseline to an identical, objectively high level of performance with minimal variation. In this framework, learners start with a pre-brief, followed by baseline assessment, targeted debrief, deliberate practice, and a final evaluation using a checklist with a strict minimum passing standard (often set via methods like the Mastery Angoff). The mastery learning framework has been shown to improve patient safety.The Northwestern Central Line Study: Research demonstrated that requiring residents to achieve a set benchmark on a simulator prior to clinical performance led to fewer needle passes, a decrease in mechanical complications (such as accidental arterial punctures), and a subsequent reduction in catheter-associated infection rates in the intensive care unit.High-Acuity, Low-Occurrence (HALO) Procedures: Studies have demonstrated that for rare, critical procedures like emergency cricothyrotomies or transvenous pacing, baseline testing shows that very few trainees can meet a standard passing score initially. However, following targeted simulation training and deliberate practice, 100% of participants successfully achieved the minimum standard required to perform the procedure competently. The Anatomy of Deliberate Practice We often assume experience or confidence equals competence, but humans are notoriously poor self-assessors (plug for our Dunning-Kruger episode!). True deliberate practice isn’t just repeating a task for 10,000 hours; it is purposeful, learner-driven micro-skill improvement guided by an expert coach.High-Quality Feedback: Avoid vague phrases like “good job” or “read more.” Effective coaching relies on strictly objective, real-time observations (e.g., “I am watching your needle angle. If you enter the skin more steeply, you will hit the vessel faster”).Embrace a Growth Mindset: Stripping away your ego to be silently watched and critiqued  is inherently awkward. Normalize deliberate practice to create psychological safety. Overcoming this requires building an environment centered on patient safety, where baselines are treated as data points rather than judgments. True growth happens with the “productive struggle”.Adaptive Expertise: True mastery means moving past a rigid checklist. It requires learners to understand the reasoning behind their actions and anticipate next steps, complications, and plot twists in real time. Immediate Action Steps for Your Next Shift **Reflect on Personal Goals**: Identify specific clinical skills you wish to improve and set objectives.  **Seek Expert Feedback**: Find a mentor or coach for guided practice and objective feedback on your skills.  **Cultivate Psychological Safety**: Foster an environment where discussing mistakes and receiving feedback is viewed as growth rather than criticism.  **Practice Adaptively**: Introduce scenarios with atypical anatomy,  complications, plot twists to better prepare for real-world complexity.  Conclusion By focusing on specific skill improvement and welcoming constructive feedback, clinicians can build competence and confidence, ultimately improving performance and patient safety. Effective mastery learning hinges on creating psychologically safe learning environments, engaging in focused deliberate practice, and leveraging expert feedback. This approach can be applied to clinical procedural excellence as well as many other skills, including communication and team dynamics. Clinical Bottom Line Mastery learning is an outcome-bound framework to reach a high standard of performance and deliberate practice is the tool that can help you achieve that high performance through expert feedback. Further Reading Barsuk JH, et al.Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Quality & Safety. Sep 2014.PMID: 24632995Klein MR, et al.Developing simulation-based mastery learning curricula for emergency medicine skills training. AEM Education and Training. Jun 2025.PMID: 40521339 Meet the Authors Kim Bambach, MD Assistant Professor of Emergency Medicine The Ohio State University Wexner Medical Center, Columbus, OH Jennifer Yee, DO Associate Professor of Emergency Medicine, Associate Program Director The Ohio State University Wexner Medical Center, Columbus, OH Showing Slide 1 of 2 The post REBEL MIND – Mastery Learning and Deliberate Practice appeared first on REBEL EM - Emergency Medicine Blog.

About our Guests: Fran Balamuth, MD, PhD, MSCE, is division chief of Pediatric Emergency Medicine at the Children's Hospital of Philadelphia. Dr. Balamuth's research interests focus on pediatric sepsis recognition using epidemiologic and translational approaches, for which she has received NIH and foundation funding. She is the co-PI of the PROMPT BOLUS trial, a multinational pragmatic trial comparing saline vs balanced fluids in pediatric sepsis, which will be the largest acute care pediatric trial in history. In addition, she co-leads the CHOP Pediatric Sepsis Program, which supports and promotes local clinical, research, educational, and quality-improvement initiatives related to sepsis. She is an internationally recognized sepsis leader, and has been invited to serve on the national steering committee for the Improving Pediatric Sepsis Outcomes quality collaborative through the US Children's Hospital Association, and 2 international task forces focused on defining pediatric sepsis through the US Centers for Disease Control and Prevention and the Society of Critical Care Medicine.Scott L. Weiss, MD, MSCE, FCCM, is a Professor of Pediatrics & Pathology and Genomic Medicine at Thomas Jefferson University and division chief of Critical Care Medicine at Nemours Children's Hospital, Delaware. Previously, Dr. Weiss was on the faculty at the Children's Hospital of Philadelphia, where he earned recognition as an international expert in pediatric sepsis. Dr. Weiss' NIH-funded research focuses on epidemiology, fluid resuscitation, and mitochondrial dysfunction in pediatric sepsis. Dr. Weiss is an international expert in pediatric sepsis and served as the co-PI of the PRoMPT BOLUS trial.Nathan Kuppermann, MD, MPH, is Executive Vice President and Chief Academic Officer of Children's National Hospital and Director of the Children's National Research Institute. He also serves as chair of the Department of Pediatrics and associate dean of Pediatric Academic Affairs at the George Washington University School of Medicine and Health Sciences. He is an internationally recognized clinical trialist in pediatric trauma, pediatric DKA, and acute pediatric infections. As the original chair of the Pediatric Emergency Medicine Applied Research Network (PECARN); his research is focused on clinical trials and clinical prediction rules using large cohorts of acutely ill and injured children. Dr. Kuppermann served as the senior investigator of the PRoMPT BOLUS trial.Selected References:Weiss SL, Balamuth F, Long E, Thompson GC, Hayes KL, Katcoff H, Cook M, Tsemberis E, Hickey CP, Williams A, Williamson-Urquhart S, Borland ML, Dalziel SR, Gelbart B, Freedman SB, Babl FE, Huang J, Kuppermann N; Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis (PRoMPT BOLUS) Investigators of the PECARN, PERC, and PREDICT Networks. PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial. Trials. 2021 Nov 6;22(1):776. doi: 10.1186/s13063-021-05717-4. Erratum in: Trials. 2025 Oct 7;26(1):390. doi: 10.1186/s13063-025-09164-3. PMID: 34742327; PMCID: PMC8572061.Weiss SL, Balamuth F, Thurm CW, Downes KJ, Fitzgerald JC, Laskin BL. Major Adverse Kidney Events in Pediatric Sepsis. Clin J Am Soc Nephrol. 2019 May 7;14(5):664-672. doi: 10.2215/CJN.12201018. Epub 2019 Apr 18. PMID: 31000518; PMCID: PMC6500940.Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Byrne DW, Stollings JL, Kumar AB, Hughes CG, Hernandez A, Guillamondegui OD, May AK, Weavind L, Casey JD, Siew ED, Shaw AD, Bernard GR, Rice TW; SMART Investigators and the Pragmatic Critical Care Research Group. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018 Mar 1;378(9):829-839. doi: 10.1056/NEJMoa1711584. Epub 2018 Feb 27. PMID: 29485925; PMCID: PMC5846085.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com.  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Entenda como a dengue chegou ao território brasileiro e como ela fez parte da evolução da saúde pública no Brasil. Patronato do SciCast: 1. Patreon SciCast 2. Apoia.se/Scicast 3. Nos ajude via Pix também, chave: contato@scicast.com.br ou acesse o QRcode: Sua pequena contribuição ajuda o Portal Deviante a continuar divulgando Ciência! Contatos: contato@scicast.com.br https://twitter.com/scicastpodcast https://www.facebook.com/scicastpodcast https://www.instagram.com/PortalDeviante/ Fale conosco! E não esqueça de deixar o seu comentário na postagem desse episódio! Expediente: Produção Geral: Tarik Fernandes e André Trapani Equipe de Gravação: Gustavo Rebello, Crhisllane Vasconcelos, Iara Grisi, Izabelle Viana, Antônio Lucas Citação ABNT: Scicast #691: Dengue. Locução: Gustavo Rebello, Crhisllane Vasconcelos, Iara Grisi, Izabelle Viana, Antônio Lucas. [S.l.] Portal Deviante, 06/07/2026. Podcast. Disponível em: https://www.deviante.com.br/podcasts/scicast-691 Imagem de capa: Agência Santarém Referências e Indicações Sugestões de literatura: FRAIHA NETO, Habib. Oswaldo Cruz e a Febre Amarela no Pará. Belém: Conselho Regional de Medicina do Estado do Pará, 2011. SOUZA, K. S. C. et al. Perfil Soro Epidemiológico dos casos de dengue notificados no município de Belém, Pará. Brazilian Journal of Health Review, Curitiba, v. 2, n. 4, p. 3362-3372, jul./ago. 2019. Disponível em: https://www.researchgate.net/publication/334504244_Perfil_Soro_Epidemiologico_dos_casos_de_dengue_notificados_no_municipio_de_Belem_Para. Acesso em: 6 maio 2026.  MAIS de 5 mil armadilhas de combate à dengue são instaladas em Belém; vacinação está disponível. O Liberal, Belém, 22 abr. 2026. Disponível em: https://www.oliberal.com/belem/mais-de-5-mil-armadilhasde-combate-a-dengue-sao-instaladas-em-belem-vacinacao-esta-disponivel-1.1091823. Acesso em: 6 maio 2026.  REFERENCIAS: Winegard, T. C.  O mosquito: A incrível história do maior predador da humanidade. Editora Intrínseca, 2022.   Ujvari, S. C. História das Epidemias. Editora Contexto, 2020. Ministério da Saúde, Departamento Nacional de Epidemias. História da Febre Amarela no Brasil.  Rio de Janeiro, 1996.  Teixeira, M. G; Barreto, M. L. Porque devemos, de novo, erradicar o Aedes aegypti. ARTIGOS • Ciênc. saúde coletiva 1 (1) • 1996. Silvia, J. S. et. al. DENGUE NO BRASIL E AS POLÍTICAS DE COMBATE AO AEDES AEGYPTI: DA TENTATIVA DE ERRADICAÇÃO ÀS POLÍTICAS DE CONTROLE. HYGEIA, Revista Brasileira de Geografia Médica e da Saúde. 1996. BRAGA, Ima Aparecida; VALLE, Denise. Aedes aegypti: histórico do controle no Brasil. Epidemiol. Serv. Saúde,  Brasília ,  v. 16, n. 2, p. 113-118,  jun.  2007. NATURE EDUCATION. Dengue Viruses. Disponível em: https://www.nature.com/scitable/topicpage/dengue-viruses-22400925/. Acesso em: 01 fev. 2026. KHAN, M. B, et al. Dengue overview: An updated systemic review. Journal of Infection and Public Health, Volume 16, Issue 10, 2023, Pages 1625-1642, ISSN 1876-0341, https://doi.org/10.1016/j.jiph.2023.08.001. ANDRADE, P. S. Paridade, desenvolvimento ovariano e transmissão vertical do vírus dengue em fêmeas de Aedes aegypti e Aedes albopictus (Diptera: Culicidae), na cidade de São Paulo. 2018. Dissertação (Mestrado em Saúde Pública) – Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, 2018. Bäck A.T., Lundkvist A. Dengue viruses – an overview. Infect Ecol Epidemiol. 2013 Aug 30;3. doi: 10.3402/iee.v3i0.19839. PMID: 24003364; PMCID: PMC3759171. BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Departamento de Doenças Transmissíveis. Dengue: diagnóstico e manejo clínico – adulto e criança. 6. ed. Brasília: Ministério da Saúde, 2024. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/dengue/dengue-diagnostico-e-manejo-clinico-adulto-e-crianca. Acesso em: 01 fev. 2026 SABIN. Diagnóstico da dengue: avaliação clínica e exames laboratoriais. Blog Sabin, 09 maio 2024. Disponível em: https://blog.sabin.com.br/saude/diagnostico-da-dengue/. Acesso em: 01 fev. 2026 JOI, Priya. Why a second dengue infection can be deadlier than the first. Gavi – VaccinesWork, 30 jan. 2024. Disponível em: https://www.gavi.org/vaccineswork/why-second-dengue-infection-can-be-deadlier-first. Acesso em: 01 fev. 2026.

Are you noticing that you are tired all the time and cannot seem to hit your paces in training? Those are not symptoms to ignore. Sometimes, these are signs of low ferritin levels that warrant bloodwork and a doctor visit. In this episode, we examine the research on low ferritin and running, including the causes, how to treat, and how to prevent low ferritin.Thank you to our sponsors:✨ Mizuno: Shop Mizuno's newest bouncy supertrainer: https://runtothefinish.com/neovista3/In this episode, you'll learn:✅ Why general population reference ranges for iron are not appropriate for endurance athletes✅ Why iron and ferritin levels matter so much for runners✅ Signs and symptoms of low ferritin levels in runners✅ Why runners are so prone to low ferritin levels✅ How long it takes for iron levels to increase✅ What impacts your iron intake and absorptionReferences

Placenta previa has an incidence of about 0.4% to 0.5% (or 1 in 200 to 1 in 250 deliveries). Anterior placenta previa poses a unique obstacle in fetal extraction at CS: Is it best to transect (enter) the placenta or to cause a marginal abruption at the placental edge for fetal extraction? In this episode we will review an upcoming “Surgeon's Corner” in the AJOG (July 2026) which provides some tips and tricks for this very issue.1. Verspyck E, Douysset X, Roman H, Marret S, Marpeau L. Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery. Int J Gynaecol Obstet. 2015 Jan;128(1):44-7. doi: 10.1016/j.ijgo.2014.07.020. Epub 2014 Aug 27. PMID: 25218131.2. Nieto-Calvache AJ, Palacios-Jaraquemada JM, Basanta N, Suarez-Revelo MA, Benavides-Calvache JP, Meade P, Lopez-Franco MJ, Burgos-Luna JM. How to avoid placental transection during low transverse cesarean delivery for anterior placenta previa. Am J Obstet Gynecol. 2026 Jul;235(1):225-228. doi: 10.1016/j.ajog.2026.02.032. Epub 2026 Feb 25. PMID: 41759607.

Send us Fan MailIn this double-blind randomized controlled trial, Adrianne and Nim examine whether norepinephrine outperforms dopamine as a first-line vasoactive agent in neonates with fluid-refractory septic shock. The primary outcome, shock reversal at 30 minutes, was not significantly different between groups, at 32 percent for norepinephrine and 46 percent for dopamine. Secondary outcomes including mortality, IVH, NEC, and need for additional vasoactive support were also similar. The episode critically examines the methodological limitations of the study, including unclear sepsis definitions, absence of echo phenotyping, and unusually high starting doses, and asks whether the field needs better tools before these questions can be properly answered.----Norepinephrine versus Dopamine for Septic Shock in Neonates: A Randomized Controlled Trial.Mazhari MYA, Priyadarshi M, Singh P, Chaurasia S, Basu S.J Pediatr. 2025 Jul;282:114599. doi: 10.1016/j.jpeds.2025.114599. Epub 2025 Apr 17.PMID: 40252959 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!

Join us in the second half of our discussion with Dr. Aryan Sarparast and clinical researcher Will Lucas. This episode primarily discusses the practice of psychedelic integration.Articles, Books and other Resources: Hu X, Gorman I, Nielson E. Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice. Curr Top Behav Neurosci. 2026;77:397-416. doi: 10.1007/7854_2024_529. PMID: 39654004.Examples of Psychedelic Integration Trainings: CIIS, IPI, FLUENCE, TCAL, PCAL Moezzi, Melody. The Rumi Prescription: How an Ancient Mystic Poet Changed My Modern Manic Life. TarcherPerigee, 2020. [1]Grof, Stanislav. The Way of the Psychonaut: Stanislav Grof's Journey of Consciousness. Multidisciplinary Association for Psychedelic Studies (MAPS), 2019. [1, 2]The Shulgin Foundation: https://shulginfoundation.orgWomen's Visionary Council: https://visionarycongress.org

Gut health trends are everywhere, but which ones deserve a closer look, and which ones need a reality check?In this episode, we break down the biggest gut health trends getting clicks, likes, and follows online. From our "hard no" to "I'm curious," we share where each trend lands on our hype scale and explain the science, physiology, and gut-brain connection behind our take.We explore what actually helps symptoms like constipation, bloating, and digestive discomfort without fueling anxiety, wasting money, or creating unnecessary health risks.From viral wellness trends to evidence-based advice, here's what we're discussing:Does the viral chia seed "internal shower" actually cleanse your colon or is that just clever marketing?Are colonics and coffee enemas detox heroes, or do they go against how your gut is designed to work?Can lemon water and apple cider vinegar really "wake up" your digestion first thing in the morning?Can a simple self-care routine improve your gut symptoms, even if it doesn't "heal" your digestive system?Are fermented foods always packed with probiotics or is there more to the story? (Tune in for a revisit of Episode 20!)Can you make colonoscopy prep more tolerable with "prep mocktails" without interfering with the procedure?Can you have too much of a good thing? What happens when "fibermaxxing" goes too far?Are gut-healing protocols and at-home microbiome tests helping you understand your gut or making you more confused and anxious?Do lactose intolerance patches actually work, or does the science tell a different story?Are castor oil packs a legitimate digestive therapy?Whether you're tempted to try the latest gut health hack or just wondering what's worth your attention, this episode will help you separate science from social media. Resources:Chia seeds (Salvia hispanica L.): A therapeutic weapon in metabolic disorders. Food Sci Nutr. 2022 Dec 15;11(1):3-16. doi: 10.1002/fsn3.3035.Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024. doi: 10.1093/cid/ciae104.Fermented Foods via ISAPPMisselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut. 2019 Nov;68(11):2080-2091. doi: 10.1136/gutjnl-2019-318404. Epub 2019 Aug 19. PMID: 31427404; PMCID: PMC6839734.Learn more about Kate and Dr. Riehl:Website: www.katescarlata.com and www.drriehl.comInstagram: @katescarlata @drriehl and @theguthealthpodcastOrder Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Neuropathy treatment often falls short—and this episode explains why nerve pain persists even when tests appear normal and medications don't deliver real relief. In this in-depth conversation, Dr. Greg Jones sits down with Dr. Stephen Matta, a triple board-certified physician specializing in regenerative medicine, to uncover what's often missed in the diagnosis and treatment of neuropathy. In this episode, you'll learn what neuropathy really is, why standard tools like EMGs can miss underlying nerve dysfunction, and how chronic inflammation, poor blood flow, and structural issues contribute to ongoing nerve pain. Dr. Matta breaks down why medications like Gabapentin may only mask symptoms instead of addressing root causes—and what a more comprehensive, functional approach looks like. We also explore advanced treatment strategies, including ultrasound-guided hydrodissection, peptide therapy, regenerative injections, and full-body assessments designed to restore nerve function. Through real patient cases, Dr. Matta explains how identifying the true source of nerve irritation can lead to meaningful improvements in pain, mobility, and quality of life.If you're dealing with neuropathy, nerve pain, tingling, or unexplained symptoms—or you're a practitioner looking for a more effective framework—this episode provides a practical, science-informed roadmap to approaching nerve health differently.

In 2018, the ARIVE trial was published in the NEJM revealingthat induction of labor at 39 weeks reduced cesarean deliveries and gestational hypertension/preeclampsia in low-risk nulliparous women who had labor induced,compared to expectant management. Then, in 2025, and partly in response to L&D units across the country becoming saturated with low- risk, nulliparous patients awaiting their induction of labors at 39 weeks and 0 days, the ACOGreleased its clinical practice update in Jan 2025 stating, “The optimal timing of delivery for full-term pregnancies (39 0/7 to 40 6/7 weeks of gestation has not been determined”. Now there is new data, released as an article in press(June 26, 2026), out of the AJOG that raises some interesting questions about potential benefits of induction of labor LATER in the “full term” interval (40- 40 and 6 days) compared to earlier full term (39 weeks to 39 weeks 6 days). Thesefindings are “hypothesis- generating”.  Listen in for details. Strong Coffee Company - Protein Coffee PLUS MORE; Get 20%OFF | Promo Code: CHAPANOSPINOBG https://promocode.to/strong-coffee-company/chapanospinobg-hbv​     Grobman WA, Rice MM, Reddy UM, Tita ATN, et al;Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentMaternal–Fetal Medicine Units Network. Labor Induction versus ExpectantManagement in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug9;379(6):513-523. ​     Damri NT, Sheiner E, Wainstock T, GestationalAge at Full-Term Delivery and Long-Term Offspring Morbidity in Low-RiskPregnancies: A Population-Based Cohort Study, American Journal of Obstetricsand Gynecology (2026), ​     Management of Full-Term Nulliparous IndividualsWithout a Medical Indication for Delivery: ACOG Clinical Practice Update.Obstet Gynecol. 2025 Jan 1;145(1):e45-e50. doi: 10.1097/AOG.0000000000005783.Epub 2024 Nov 7. PMID: 39513607.

Send us Fan MailIn this double-blind randomized controlled trial from northern India, Nim and Adrianne review whether early hydrocortisone reduces 14-day all-cause mortality in preterm infants with fluid-refractory shock. The primary outcome showed no statistically significant difference between groups, though an 11 percent absolute reduction in mortality in the hydrocortisone group raised clinical interest. A major limitation was the high rate of open-label steroid crossover, with over 70 percent of both groups ultimately receiving hydrocortisone. The study highlights the difficulty of achieving equipoise when clinicians already believe strongly in a therapy, and raises important questions about study design in neonatal shock research.----Early hydrocortisone verses placebo in neonatal shock- a double blind Randomized controlled trial. Dudeja S, Saini SS, Sundaram V, Dutta S, Sachdeva N, Kumar P.J Perinatol. 2025 Mar;45(3):342-349. doi: 10.1038/s41372-025-02222-3. Epub 2025 Feb 13.PMID: 39948354 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!

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. Episode 2 was published in January and discussed the controversies in the management of developmental hip dislocations in the operating room. For the final episode we are joined by Drs. Rachel Goldstein from Children's Hospital of Los Angeles and Steve Frick from Atrium Health in Charlotte. This episode focuses on evaluation and management of residual dysplasia including nonoperative management with bracing, surveillance, and if/when to operate. Hosted by Will Morris (Scottish Rite for Children). Music by A. A. Aalto. Referenced Publications: Gans I, Flynn JM, Sankar WN. Abduction bracing for residual acetabular dysplasia in infantile DDH. J Pediatr Orthop. 2013 Oct-Nov;33(7):714-8. doi: 10.1097/BPO.0b013e31829d5704. PMID: 23812157. Swarup I, Talwar D, Sankar WN. Part-time Abduction Bracing in Infants With Residual Acetabular Dysplasia: Does Compliance Monitoring Support a Dose-dependent Relationship? J Pediatr Orthop. 2021 Feb 1;41(2):e125-e129. doi: 10.1097/BPO.0000000000001704. PMID: 33165268. Morris WZ, Kak A, Mayfield LM, Kang MS, Jo CH, Kim HKW. Does brace treatment following closed reduction of developmental dysplasia of the hip improve acetabular coverage? Bone Joint J. 2023 Dec 1;105-B(12):1327-1332. doi: 10.1302/0301-620X.105B12.BJJ-2023-0255.R1. PMID: 38035597. Albinana J, Dolan LA, Spratt KF, Morcuende J, Meyer MD, Weinstein SL. Acetabular dysplasia after treatment for developmental dysplasia of the hip. Implications for secondary procedures. J Bone Joint Surg Br. 2004 Aug;86(6):876-86. doi: 10.1302/0301-620x.86b6.14441. PMID: 15330030. Novais EN, Pan Z, Autruong PT, Meyers ML, Chang FM. Normal Percentile Reference Curves and Correlation of Acetabular Index and Acetabular Depth Ratio in Children. J Pediatr Orthop. 2018 Mar;38(3):163-169. doi: 10.1097/BPO.0000000000000791. PMID: 27261963. Haider S, Mayfield L, Kim HK, Gill CS, Sucato DJ, Podeszwa DA, Morris WZ. The Impact of Age on Outcomes Following Secondary Reconstructive Surgery for Residual Dysplasia in DDH. J Pediatr Orthop. 2026 Jan 1;46(1):e61-e66. doi: 10.1097/BPO.0000000000003067. Epub 2025 Jul 21. PMID: 40686010; PMCID: PMC12688450. Koura T, Tetsunaga T, Yamada K, Inoue T, Okuda R, Masada Y, Tetsunaga T, Okazaki Y, Ozaki T. MRI at 5 years predicts upsloping acetabular sourcil at skeletal maturity in developmental dysplasia of the hip. Hip Int. 2026 May 6:11207000261436397. doi: 10.1177/11207000261436397. Epub ahead of print. PMID: 42093127. Sucato DJ, Brabham CE, De La Rocha A, Podeszwa DA, Karol LA. Radiographic Outcome Following Treatment of Residual Hip Dysplasia with Pemberton Versus Salter Osteotomy: Comparison of Results in Patients Followed to Skeletal Maturity. J Bone Joint Surg Am. 2025 Jan 1;107(1):46-52. doi: 10.2106/JBJS.23.01346. Epub 2024 Nov 7. Erratum in: J Bone Joint Surg Am. 2025 Aug 20;107(16):e82. doi: 10.2106/JBJS.ER.23.01346. PMID: 39509475.  

Dr. Amy Vertrees reflects on the weekend screening of the documentary A Thousand and One Cuts and the coaching call that followed it, unpacking why women surgeons' careers are rarely derailed by one dramatic event but by an accumulation of small, repeated moments. She backs this up with hard data: female physicians and surgeons consistently produce lower mortality and complication rates than their male counterparts across multiple large studies, including a JAMA Internal Medicine analysis of 1.5 million Medicare hospitalizations and a 2025 meta-analysis spanning 13.4 million patients — yet women retire from medicine at 49 versus 62 for men. Amy then teaches the core coaching framework from that call: the difference between a fact (something everyone would agree happened) and a thought (your interpretation of it) — including why "microaggression" is a thought, not a fact, and why that distinction actually gives you more power, not less. She closes with tactical empathy, the "mythical white male" trap, and the idea that forcing yourself to be falsely polite is its own kind of self-inflicted harm.Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206–213. doi:10.1001/jamainternmed.2016.7875Heybati K, Chang A, Mohamud H, Satkunasivam R, Coburn N, Salles A, Tsugawa Y, Ikesu R, Saka N, Detsky AS, Ko DT, Ross H, Mamas MA, Jerath A, Wallis CJD. The association between physician sex and patient outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2025 Jan 17;25(1):93. doi: 10.1186/s12913-025-12247-1. PMID: 39819673; PMCID: PMC11740500.Saka N, Yamamoto N, Watanabe J, Wallis C, Jerath A, Someko H, Hayashi M, Kamijo K, Ariie T, Kuno T, Kato H, Mohamud H, Chang A, Satkunasivam R, Tsugawa Y. Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis. Ann Surg. 2024 Dec 1;280(6):945-953. doi: 10.1097/SLA.0000000000006339. Epub 2024 May 10. PMID: 38726676; PMCID: PMC11542977.Wallis CJD, Jerath A, Aminoltejari K, et al. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg. 2023;158(11):1185–1194. doi:10.1001/jamasurg.2023.3744Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, Eleveld A, Mannell J. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet. 2019 Feb 9;393(10171):560-569. doi: 10.1016/S0140-6736(18)33135-0. PMID: 30739691. Rittenberg E, Liebman JB, Rexrode KM. Primary Care Physician Gender and Electronic Health Record Workload. J Gen Intern Med. 2022 Oct;37(13):3295-3301. doi: 10.1007/s11606-021-07298-z. Epub 2022 Jan 6. PMID: 34993875; PMCID: PMC9550938. Branford GL, Bucala MD, Hepper A, Hadeed NM, Northway RM, Brenner MJ. The Gender Gap in EHR Workload: A Comparative Analysis of Primary Care Physician In Basket Usage. J Gen Intern Med. 2025 Jul;40(10):2255-2264. doi: 10.1007/s11606-025-09629-w. Epub 2025 May 29. PMID: 40439865; PMCID: PMC12344033. Rotenstein LS, He Z, Dziura J, Tsugawa Y, Venkatesh AK, Melnick ER, Gettel CJ. Sex Differences in Physician Attrition from Clinical Practice Across Specialties: A Nationwide, Longitudinal Analysis. J Gen Intern Med. 2026 Apr 2. doi: 10.1007/s11606-026-10362-1. Epub ahead of print. PMID: 41927984.

In this episode, Kevin and Mike interview Eric Bruns and discuss policy challenges, highlight a few examples of policy work he has done with Wraparound care, discuss some reasons why policy may not receive adequate attention in implementation science, and Eric took our quiz on some of his favorite musicians.  Discussed on this episode: Arean and Pullmann, High Quality Psychosocial Interventions Research: https://global.oup.com/academic/product/high-quality-psychosocial-interventions-research-9780197681923?cc=us&lang=en& Walker, S.C., Gubner, N., Iztguttinov, A. et al. The implementation potential of a method to monitor empirically-supported children's mental health treatment through claims data. BMC Health Serv Res 21, 1349 (2021). https://doi.org/10.1186/s12913-021-07317-z Purtle, J., Peters, R. & Brownson, R.C. A review of policy dissemination and implementation research funded by the National Institutes of Health, 2007–2014. Implementation Sci 11, 1 (2015). https://doi.org/10.1186/s13012-015-0367-1 Efficacy of modular cognitive behavior therapy for childhood anxiety disorders, Bruce F. Chorpita Daleiden EL, Chorpita BF, Donkervoet C, Arensdorf AM, Brogan M. Getting better at getting them better: health outcomes and evidence-based practice within a system of care. J Am Acad Child Adolesc Psychiatry. 2006 Jun;45(6):749-56. doi: 10.1097/01.chi.0000215154.07142.63. PMID: 16721326.

If you practice obstetrics, you already know that our entire world is ruled by a stopwatch. Think about it: we are obsessed with time. We wait exactly 60 or 120 minutes for a gestational diabetes challenge. We stare at a monitor for a strict 30 minutes timing a biophysical profile. The entire pregnancy is dictated by an Estimated Date of Delivery that has us counting down the literal days. But what happens when we step into the OR? Once that scalpel hits the skin for a cesarean section, does the clock matter just as much? There are two separate intervals which have generated data: the skin incision to delivery interval, and the uterine incision to delivery interval. In today's episode, we are CUTTING INTO the data. First, we are summarizing a hot-off-the-press study from AJOG-MFM (Pink) that takes a hard look at the macro clock—the skin incision-to-delivery interval. Then, we are going to contrast those findings with the recent Bart 2026 study published in the AJOG (Grey) Journal, which tracked over 5,800 routine deliveries to see exactly what happens to a baby's pH and clinical outcome when that uterine extraction takes longer than 120 seconds. These two are somewhat at odds. Listen in for details. Strong Coffee Company - Protein Coffee PLUS MORE; Get 20% OFF | Promo Code: CHAPANOSPINOBG https://promocode.to/strong-coffee-company/chapanospinobg-hbv​ Zayat N, Bertozzi-Villa C, Cavallino A, et al. Skin incision-to-delivery interval and neonatal outcomes: A retrospective cohort study. Am J Obstet Gynecol MFM2026;00:101980.​ Bart Y, Sibai BM, Fishel Bartal M, Mazaki-Tovi S, Yoeli R. Uterine incision-to-delivery interval and neonatal outcomes among nonurgent, term, cesarean deliveries. Am J Obstet Gynecol. 2026 May;234(5):1459-1469. doi: 10.1016/j.ajog.2025.12.059. Epub 2025 Dec 30. PMID: 41478544.

Repeatedly missing your running goals is a frustrating experience, especially if you are training hard for a race. In this episode, we discuss what causes a half marathon plateau and solutions to break through to the next performance level. You will learn how to know if you need more speed, goal pace training, endurance, or strength when training for a half marathon. Even if your races have not plateaued, the advice in this episode will help you keep progressing in your half marathon times.Thank you to our sponsors:✨Title Nine: Comfortable sports bras that actually fit, from a women-owned company. Use code RUNTOTHEFINISH for free shipping at https://runtothefinish.com/title-nine/✨ Tailwind: Complete sport nutrition made simple, including hydration mixes, high-carb sport drinks, endurance fuel, and recovery mixes. Use code TREADLIGHTLY20 at https://tailwindnutrition.com/TREADLIGHTLY for 20% off your first purchase.In this episode, you'll learn about:✅ What defines and causes a performance plateau✅ Recovery variables that could cause a plateau✅ Why more is not always the solution to a performance plateau✅ If speed, endurance, or another variable is your limitation✅ Why overdoing half marathon pace could plateau youIf You Enjoyed this Episode, You May Like:

LISTENER DISCRETION IS ADVISED!!! References: Carunchio, M. (July 2020). Atypical Stroke Presentations. EMS World. Available: https://www.hmpgloballearningnetwork.com/site/emsworld/article/1224541/atypical-stroke-presentations Clawson, J. J., Scott, G., Gardett, I., et al. (2016). Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes. Journal of Stroke and Cerebrovascular Diseases, 25, 2031-2042. Gardett, Olola, Scott, Broadbent, & Clawson. (March 22, 2017). Comparison of EMD Stroke Identification and Paramedic On-Scene Stroke Assessment. Annals of Emergency Dispatch & Response. Peter Antevy Substack Article on RQI. Available: https://handtevymd.substack.com/p/jalen-brunson-didnt-win-a-championship?r=khz4&utm_campaign=post-expanded-share&utm_medium=post%20viewer&triedRedirect=true Prehospital Stroke ID Article: Caffarelli M, Wood AJ, Crowe RP, Amorim E, Kamel H, Kim AS, Guterman EL. PMID: 39398987.

As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons annual meeting 2026. In this episode, we explore the intersection of rectal cancer, fertility, and pregnancy through a multidisciplinary, case-based discussion. We review how surgery, chemotherapy, and pelvic radiation can affect fertility and sexual function in both men and women, and why early counseling and referral to reproductive endocrinology specialists are essential. The discussion also emphasizes that evaluation and treatment during pregnancy can often be performed safely, with care individualized based on tumor stage, gestational age, and the patient's goals and values. Hosts and discussants ·      Dr. Betelhem Yohannes, General surgery resident at the University of Washington ·      Dr. Griffen Allen, General surgery resident at the University of Washington  ·      Dr. Raga Siddharthan, Assistant Professor of Surgery in the Section of Colorectal Surgery at the University of Washington  ·      Dr. Stacey Cohen, Professor in the Division of Hematology and Oncology at the University of Washington and a gastrointestinal medical oncologist at Fred Hutch Cancer Center, specializing in colorectal and other GI cancers. Learning objectives ·      Describe the impact of rectal cancer surgery on fertility, sexual function, and future childbearing potential. ·      Review the effects of chemotherapy and pelvic radiation on reproductive health and fertility preservation. ·      Discuss available fertility preservation strategies and the importance of early pre-treatment counseling and referral. ·      Recognize the diagnostic challenges of rectal cancer during pregnancy, including overlapping gastrointestinal symptoms. ·      Review appropriate staging and workup considerations for suspected rectal cancer in pregnant patients. ·      Discuss multidisciplinary management strategies for rectal cancer during pregnancy, including individualized treatment sequencing. ·      Examine ethical and patient-centered considerations when balancing maternal cancer treatment and fetal outcomes. References  Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067 [https://pubmed.ncbi.nlm.nih.gov/38240409/] Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022;140(2):348-366. doi:10.1097/AOG.0000000000004873 [https://pubmed.ncbi.nlm.nih.gov/35640237/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis. 2023;17(10):1631-1638. doi:10.1093/ecco-jcc/jjad079 [https://pubmed.ncbi.nlm.nih.gov/37341355/] Ito M, Tsukada Y, Watanabe J, et al. Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial). Ann Surg. Published online April 1, 2024. doi:10.1097/SLA.0000000000006290 [https://pubmed.ncbi.nlm.nih.gov/38629555/] Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968.  Johnson GGRJ, Park J, Helewa RM, Goldenberg BA, Nashed M, Hyun E. Total neoadjuvant therapy for rectal cancer: a guide for surgeons. Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. PMID: 37085291; PMCID: PMC10125160. [https://pubmed.ncbi.nlm.nih.gov/37085291/] Naren G, Guo J, Bai Q, Fan N, Nashun B. Reproductive and developmental toxicities of 5-fluorouracil in model organisms and humans. Expert Rev Mol Med. 2022 Jan 31;24:e9. doi: 10.1017/erm.2022.3. PMID: 35098910; PMCID: PMC9884763. [https://pubmed.ncbi.nlm.nih.gov/35098910/] National Comprehensive Cancer Network. (2026). NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer (Version 2.2026). Retrieved from NCCN Guidelines for Rectal Cancer [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1449] Oktay, Kutluk M.D., Ph.D.. Expert Commentary on Fertility Preservation in Colorectal Cancers: Current State and Practical Tips for the Cancer Practitioner. Diseases of the Colon & Rectum 63(6):p 726-727, June 2020. | DOI: 10.1097/DCR.0000000000001688 [https://pubmed.ncbi.nlm.nih.gov/32479532/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Gentile G, Ciccarone M. Management of fertility preservation in young female patients with gastrointestinal cancer: A case series and systematic literature review. Curr Probl Cancer. 2025;57:101221. doi:10.1016/j.currproblcancer.2025.101221 [https://pubmed.ncbi.nlm.nih.gov/39598263/] Saif MW. Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer. 2005;5(4):247-256. doi:10.3816/ccc.2005.n.035 [https://pubmed.ncbi.nlm.nih.gov/16183863/] Rogers JE, Dasari A, Eng C. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May;21(5):563-70. doi: 10.1634/theoncologist.2015-0362. Epub 2016 Mar 21. PMID: 27000464; PMCID: PMC4861360. [https://pubmed.ncbi.nlm.nih.gov/27000464/] Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist. 2024;29(10):e1237-e1245. doi:10.1093/oncolo/oyae141 [https://pubmed.ncbi.nlm.nih.gov/39292850/] Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet. 2015;32(8):1233-1237. doi:10.1007/s10815-015-0533-z [https://pubmed.ncbi.nlm.nih.gov/26162569/ Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol. 2017;24(1):28-35. doi:10.1016/j.jmig.2016.08.831 [https://pubmed.ncbi.nlm.nih.gov/27599763/] Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis. 2022;24(6):706-707. doi:10.1111/codi.16086 [https://pubmed.ncbi.nlm.nih.gov/35191146/] Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer. 2023;33(12):1837-1842. Published 2023 Dec 4. doi:10.1136/ijgc-2023-004723 [https://pubmed.ncbi.nlm.nih.gov/38104863/] Haggar F, Pereira G, Preen D, et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc. 2013;27(7):2327-2336. doi:10.1007/s00464-012-2774-6 [https://pubmed.ncbi.nlm.nih.gov/23645367/] 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: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral 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-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-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

In this episode of RetinaLIVE, Kourous Rezaei, MD is joined by Lejla Vajzovic, MD, FASRS and Aleksandra Rachitskaya, MD, FASRS to discuss their experiences with UNITY® VCS in vitreoretinal surgery. The conversation covers instrument design, workflow, training and the integration of new technology in clinical practice, offering perspectives on collaboration and adapting to evolving surgical tools.  For Important Product Information, visit unityvcs.com. Featured surgeons are paid Alcon consultants. The views expressed are their own. Disclaimers: 1:15, 19:31, 26:25: Compared to CONSTELLATION® Vision System. Based on bench data. 1:47, 2:15, 2:42, 3:19, 9:55: Compared to HYPERVIT 20K 2:15, 2:21, 7:24: Based on bench data. For both 25 Ga and 27 Ga vitrectomy probes. 7:24, 7:54, 18:46: Versus Alcon's Non-Dynamic Stiffener 27+ technology 9:55, 12:21: When the Dynamic Stiffener is fully retracted 16:20: MSLP(4) is 3 times faster than SSLP 23:58: Compared to CONSTELLATION® Vision System. Based on bench data. Mean fluctuation at flow vs. setpoint of 2.36 ± 2.13, 4.19 ± 1.97, 1.84 ± 2.82, and 2.13 ± 2.86 mmHg during phacoemulsification, irrigation/aspiration (IA), vitrectomy, and extrusion/fragmentation, respectively. †IOP setpoint as low as 16 mmHg (posterior) and 20 mmHg (anterior) without exceeding a mean fluctuation of 4.19 ± 1.97 mmHg.   References: Hypervit Directions for Use. TetraSpot Multi-spot Laser Probe Directions for Use. UNIFEYE Directions for Use. Alcon Data on File, 2024. [REF-24644] Alcon Data on file, 2024. [REF-24615] Alcon Data on File, 2024. [REF-24379] Alcon Data on File, 2024. [REF-24615] Alcon Data on File, 2024. [REF-24576] UNITY VCS and CS User Manual. Alcon Data on File, 2024. [REF-27800] Gerardo GS, Chow DR. Shovel and Cut Technique: Beveled Vitrectomy Probes to Address Diabetic Tractional Retinal Detachments. Retina. 2023. 1;43(7):1207-1208 Berrocal MH. All-probe vitrectomy dissection techniques for diabetic tractional retinal detachments: Lift and shave. Lift and Shave. Retina. 2018 Sep;38 Suppl 1:S2-S4. González-Saldivar G, Chow DR. The Shovel and cut technique: Beveled vitrectomy probes to address diabetic tractional retinal detachments. Retina. Published online ahead of print. doi:10.1097/IAE.0000000000002938. Po-Lin Chen, Yan-Ting Chen, San-Ni Chen, Comparison of 27-gauge and 25-gauge vitrectomy in the management of tractional retinal detachment secondary to proliferative diabetic retinopathy. Plos One. 2021:16(3) Kasi SK, Hsu J, Hariprasad SM. Making the Jump to 27-Gauge Vitrectomy: Perspectives. Ophthalmic Surgery, Lasers and Imaging Retina. 2017;48(6):450-456. doi:10.3928/23258160-20170601-02 James M. Lai, et all. Mechanical Property Comparison of 23-, 25- and 27-gauge Vitrectors Across Vitrectomy Systems. Ophthalmology Retina. 2022. Alcon Data on File, 2024. [REF-09694] Alcon Data on File, 2024. [REF-25374] Alcon Data on File, 2024. [REF-24899] Scarfone HA, Rodriguez EC, Rufiner MG, Riera JJ, Fanego SE, Charles M, Albano R. Vitreous-lens interface changes after cataract surgery using active fluidics and active sentry with high and low infusion pressure settings. J Cataract Refract Surg. 2024 Apr 1;50(4):333-338. doi: 10.1097/j.jcrs.0000000000001359. PMID: 37938025; PMCID: PMC10959530. Liu Y, Hong J, Chen X. Comparisons of the clinical outcomes of Centurion® active fluidics system with a low IOP setting and gravity fluidics system with a normal IOP setting for cataract patients with low corneal endothelial cell density. Front Med (Lausanne). 2023 Nov 23;10:1294808. doi: 10.3389/fmed.2023.1294808. PMID: 38076276; PMCID: PMC10704024. Taiki Kokubun, et al. Verification for the usefulness of normal tension cataract surgery. Hanga Beres, et al. Does low infusion pressure microinsision cataract surgery (LIPMiCS) reduce the frequency of post-occulsion breaks? 2022. 66(2) Rauen MP, Joiner H, Kohler RA, O'Connor S. Phacoemulsification using an Active Fluidics System at Physiologic versus High IOP: Impact on Anterior and Posterior Segment Physiology. J Cataract Refract Surg. 2024 Apr 8. doi: 10.1097/j.jcrs.0000000000001457. Epub ahead of print. PMID: 38595209.   © 2026 Alcon Inc.   04/26   US-UVC-2600054

Chuck and Chris catch up and discuss the new JBJS 'What's New in Hand Surgery', written by Eric Wagner and Nina Suh.  This takes us through 2025 and highlights new and impactful scientific articles on our field. Wagner ER, Suh N. What's New in Hand and Wrist Surgery. J Bone Joint Surg Am. 2026 Mar 18;108(6):401-409. doi: 10.2106/JBJS.25.01568. Epub 2026 Feb 3. PMID: 41632853.We are still need of a podcast intern!  We would appreciate any referrals!See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.As always, thanks to @iampetermartin for the amazing introduction and concluding music.For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

In this episode of PICU Doc on Call, hosts Dr. Monica Gray and Dr. Pradip Kamat explore procedural sedation in the pediatric ICU. They cover sedation levels, pre-screening, risk stratification using ASA classifications, and medication selection tailored to each patient's hemodynamic and respiratory status. Through real-world case discussions involving respiratory failure, septic shock, and acute neurological decline, they highlight the importance of end-tidal CO2 monitoring and early adverse event recognition. Key takeaways include avoiding the term "conscious sedation," preparing rescue plans, and prioritizing patient safety through careful assessment and monitoring.Show Highlights:Definitions and levels of sedation (minimal, moderate, deep sedation, and general anesthesia)Importance of terminology in procedural sedationMonitoring sedation levels using scales like the Richmond Agitation-Sedation Scale (RASS)Pre-screening and risk stratification considerations for pediatric patientsASA physical status classification system for assessing patient riskUnique challenges of procedural sedation in critically ill childrenAdverse events associated with pediatric procedural sedation, particularly respiratory complicationsManagement strategies for specific cases requiring sedation (e.g., respiratory failure, septic shock)Importance of end-tidal CO2 monitoring during sedationKey takeaways for safe sedation practices in the pediatric ICU settingReferences: Nir Atlas; Rahul C. Damania; Pradip P. Kamat In Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 135, 1624-1628Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia by Committee on Quality Management and Departmental Administration. Last Amended: October 23, 2024.Coté CJ, Wilson S; AMERICAN ACADEMY OF PEDIATRICS; AMERICAN ACADEMY OF PEDIATRIC DENTISTRY. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Pediatrics. 2019 Jun;143(6):e20191000. doi: 10.1542/peds.2019-1000. PMID: 31138666.xKrauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006 Mar 4;367(9512):766-80. doi: 10.1016/S0140-6736(06)68230-5. PMID: 16517277.Sharif S, Kang J, Sadeghirad B, Rizvi F, Forestell B, Greer A, Hewitt M, Fernando SM, Mehta S, Eltorki M, Siemieniuk R, Duffett M, Bhatt M, Burry L, Perry JJ, Petrosoniak A, Pandharipande P, Welsford M, Rochwerg B. Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials. Br J Anaesth. 2024 Mar;132(3):491-506. doi: 10.1016/j.bja.2023.11.050. Epub 2024 Jan 6. PMID: 38185564.Smith, Heidi A. B. MD, MSCI (Chair)1,2; Besunder, James B. DO, FCCM3,4; Betters, Kristina A. MD1; Johnson, Peter N. PharmD, BCPS, BCPPS, FCCM, FPPA, FASHP5,6; Srinivasan, Vijay MBBS, MD, FCCM7,8; Stormorken, Anne MD9,10; Farrington, Elizabeth PharmD, FCCM11; Golianu, Brenda MD12,13; Godshall, Aaron J. MD14; Acinelli, Larkin CPNP-AC, ACHPN15; Almgren, Christina CPNP16; Bailey, Christine H. MD17; Boyd, Jenny M. MD18,19; Cisco, Michael J. MD20; Damian, Mihaela MD, MPH21,22; deAlmeida, Mary L. MD23,24; Fehr, James MD13,25; Fenton, Kimberly E. MD, FCCM14; Gilliland, Frances DNP, CPNP-AC/PC26,27; Grant, Mary Jo C. CPNP-AC, PhD, FAAN28; Howell, Joy MD29; Ruggles, Cassandra A. PharmD, BCCCP, BCPPS30; Simone, Shari DNP31,32; Su, Felice MD21,22; Sullivan, Janice E. MD33,34; Tegtmeyer, Ken MD, FAAP, FCCM35,36; Traube, Chani MD, FCCM29; Williams, Stacey CPNP-AC37; Berkenbosch, John W. MD, FAAP, FCCM (Chair)33,34. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatric Critical Care Medicine 23(2):p e74-e110, February 2022. | DOI: 10.1097/PCC.0000000000002873Benzoni T, Agarwal A, Cascella M. Procedural Sedation. [Updated 2025 Mar 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551685/Kerson AG, DeMaria R, Mauer E, Joyce C, Gerber LM, Greenwald BM, Silver G, Traube C. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. J Intensive Care. 2016 Oct 26;4:65. doi: 10.1186/s40560-016-0189-5. PMID: 27800163; PMCID: PMC5080705.Tel-Dan SF, Shavit D, Nates R, Samuel N, Shavit I. Emergency Physician-Administered Sedation for Thoracostomy in Children With Pleuropneumonia. Pediatr Emerg Care. 2021 Dec 1;37(12):e1209-e1212. doi: 10.1097/PEC.0000000000001975. PMID: 31929389.Cosgrove P, Krauss BS, Cravero JP, Fleegler EW. Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Ann Emerg Med. 2022 Dec;80(6):485-496. doi: 10.1016/j.annemergmed.2022.05.002. Epub 2022 Jun 23. PMID: 35752522.Cravero JP, Blike GT, Beach M, Gallagher SM, Hertzog JH, Havidich JE, Gelman B; Pediatric Sedation Research Consortium. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics. 2006 Sep;118(3):1087-96. doi: 10.1542/peds.2006-0313. PMID: 16951002.

You have loved our episodes on how to run your first half marathon and marathon - so today, we have an episode for those of you who feel ready to go further. We discuss how to train for your first ultra marathon, whether you are doing a 50K, 50 miler, or 100mile. You will learn how to structure workouts and long runs, how to prepare for elevation gain, how to fuel, and more! Thank you to our sponsors:✨Title Nine: Comfortable sports bras that actually fit, from a women-owned company. Use code RUNTOTHEFINISH for free shipping at https://runtothefinish.com/title-nine/✨ Tailwind: Complete sport nutrition made simple, including hydration mixes, high-carb sport drinks, endurance fuel, and recovery mixes. Use code TREADLIGHTLY20 at https://tailwindnutrition.com/TREADLIGHTLY for 20% off your first purchase.In this episode, you'll learn about:✅ The physiological demands of ultra marathons✅ How to use back to back long runs in ultra training✅ How to prepare for uphills and downhills ✅ Types of workouts to include in your first ultra build✅ If hiking can help you prepare for your first ultra✅ Nutrition and hydration for your first ultra race✅ Recommended gear for ultra marathonsIf You Enjoyed this Episode, You May Like:

You're not depressed. You're not in crisis. You're functioning, showing up, holding it all together. But something is still off, and you can't quite name it.This episode is for that person.Brandi and Dr. Desiree Caruso, ND sit down to break down the real biology behind low-grade mood dysregulation — the kind that doesn't show up in standard bloodwork but is absolutely happening in your body. We're talking about two specific functional mushrooms, lion's mane and reishi, and going straight into the mechanisms: the actual compounds, the actual pathways, and the actual research that explains why these mushrooms have a genuine relationship with how you feel.This is not a vibe episode. This is the science.We've been asked over and over again whether functional mushrooms can do something for mood, and if so, how. Today we answer that question properly. If you've ever walked out of a doctor's appointment feeling dismissed — told everything looks normal, maybe it's stress, maybe it's your age — this episode is what comes next.What you'll learn:Why mood is a physiological state, not just a feeling, and what that means for how you address itThe specific terpenoid compounds in lion's mane (hericenones) that can cross the blood-brain barrier and what they do once they get thereWhy BDNF is the mechanism most antidepressants are thought to work through, and how lion's mane stimulates it directlyHow 90% of your serotonin is produced in your gut, and exactly how lion's mane supports that pathwayThe three-directional approach lion's mane takes: blood-brain barrier, neuroinflammation, and gut-brain axis simultaneouslyWhat the HPA axis is, why chronic stress dysregulates it, and how reishi's ganoderic acids help restore the natural cortisol rhythmReishi's relationship with GABA, the brain's calming neurotransmitter, and why that explains the felt sense of settling downThe 2026 randomized controlled trial showing measurable reductions in anxiety, cortisol, and inflammation at 12 weeksHow disrupted sleep literally changes how your brain processes emotional information, and the two specific mechanisms reishi addresses to help with thatHow to self-diagnose which mushroom fits your experience right now, and what to track over four weeks to know whether it's workingResources Mentioned:Dr. Andrew Huberman episode on adenosine and coffee: https://www.hubermanlab.com/episode/using-caffeine-to-optimize-mental-and-physical-performanceVigna, L. et al. (2019). "Hericium erinaceus Improves Mood and Sleep Disorders in the Elderly." Journal of Medicinal Food, 22(5).Contato, A.G. & Conte-Junior, C.A. (2025). "Lion's Mane Mushroom (Hericium erinaceus): A Neuroprotective Fungus with Antioxidant, Anti-Inflammatory, and Antimicrobial Potential — A Narrative Review." Nutrients, 17(8), 1307.Frontiers in Nutrition (2025). "Benefits, side effects, and uses of Hericium erinaceus as a supplement: a systematic review." Frontiers in Nutrition, 12, 1641246.Ratto, D. et al. (2023). "Hericium erinaceus: Acute and Chronic Effects on Cognitive Function, Stress, and Mood in Young Adults." Nutrients, 15(22), 4842.Cui, X.Y. et al. (2012). "Extract of Ganoderma lucidum prolongs sleep time in rats." Journal of Ethnopharmacology / Pharmacology Biochemistry and Behavior. PMID: 22297086.Yong, V.K.J. et al. (2026). "A blend of medicinal mushrooms including Reishi reduces anxiety, cortisol and CRP in a 12-week randomized controlled trial." Brain and Behavior.Your Next Steps:Follow us on Instagram: https://www.instagram.com/eversiowellness/Shop Eversio Wellness and save 15% with code PODCAST15: https://www.eversiowellness.com/discount/PODCAST15?redirect=%2Fcollections%2Fall-productsTake our wellness quiz to find the right mushroom for you: https://www.eversiowellness.com/pages/take-our-quiz

Welcome back to the show, everybody! Today, we are diving deep into the intersection of maternal-fetal medicine and cardiology. We're tackling a condition that keeps every OB/GYN, MFM, and cardiologist up at night: Peripartum Cardiomyopathy, or PPCM. And to keep our clinical gears turning, we are framing this discussion squarely through the lens of Society for Maternal-Fetal Medicine (SMFM) Consult Series #73, which focuses on right and left heart failure in pregnancy, alongside the foundational data from ACOG Practice Bulletin #212. PPCM presents fundamentally as acute left heart failure with reduced ejection fraction. Think of the left ventricle as the primary engine pump of the systemic circulation. When it stalls, everything upstream gets backed up. While this was traditionally called IDIOPATHIC, newer data says otherwise. We are going to cover presentation, eval, care and prognosis. So, get your palpitations in check- here we go. 16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. SMFM CS 73; 20252. ACOG PB 212; 20193. Arany Z. Peripartum Cardiomyopathy. The NEJM. 2024. 4. Sliwa K, Hilfiker-Kleiner D, Damasceno A, Al Farhan H, Goland S, Johnson MR, Bauersachs J. Peripartum cardiomyopathy. Lancet. 2025 Nov 22;406(10518):2483-2493. doi: 10.1016/S0140-6736(25)01451-5. Epub 2025 Oct 28. PMID: 41173010.

In this episode of the Epigenetics Podcast, we talked with Tae-Kyung Kim from POSTECH in South Korea about the discovery and characterisation of enhancer RNAs. Dr. Kim describes joining Danny Reinberg's lab as a graduate student, where he was trained in protein biochemistry and general transcription mechanisms. He recalls this period as a formative time, when research on transcription factors and RNA polymerase II was rapidly advancing and many findings were still novel. Kim then moved into neurobiology through Michael Greenberg's lab, where he first worked on a project related to L-type voltage-gated channels. He says his work shifted toward chromatin and gene regulation in neurons after learning that chromatin immunoprecipitation could be applied to neuronal systems and after the arrival of next-generation sequencing. He explains that eRNAs were discovered in his lab through RNA-seq and ChIP-seq data from neuronal activity experiments, especially around the FOS locus. He later showed that eRNAs are transcribed from enhancers, are typically unstable, often lack splicing and polyadenylation, and have defined initiation sites, suggesting regulated transcription. Kim says eRNAs can interact with transcription and epigenetic regulators, including factors involved in pause release and mediator complexes. He describes experiments showing that eRNA knockdown reduced ARC induction and that eRNA production depends on proper enhancer-promoter contact. He concludes by describing newer work in his lab using spatial transcriptomics and eRNA-based reporter systems to map active neural populations, including studies related to cocaine-responsive circuits. He says his future work will focus on spatial technologies to better understand brain organization and function at molecular resolution. References Kim TK, Hemberg M, Gray JM, Costa AM, Bear DM, Wu J, Harmin DA, Laptewicz M, Barbara-Haley K, Kuersten S, Markenscoff-Papadimitriou E, Kuhl D, Bito H, Worley PF, Kreiman G, Greenberg ME. Widespread transcription at neuronal activity-regulated enhancers. Nature. 2010 May 13;465(7295):182-7. doi: 10.1038/nature09033. Epub 2010 Apr 14. PMID: 20393465; PMCID: PMC3020079. Schaukowitch K, Joo JY, Liu X, Watts JK, Martinez C, Kim TK. Enhancer RNA facilitates NELF release from immediate early genes. Mol Cell. 2014 Oct 2;56(1):29-42. doi: 10.1016/j.molcel.2014.08.023. Epub 2014 Sep 25. PMID: 25263592; PMCID: PMC4186258. Kim SK, Liu X, Park J, Um D, Kilaru G, Chiang CM, Kang M, Huber KM, Kang K, Kim TK. Functional coordination of BET family proteins underlies altered transcription associated with memory impairment in fragile X syndrome. Sci Adv. 2021 May 19;7(21):eabf7346. doi: 10.1126/sciadv.abf7346. PMID: 34138732; PMCID: PMC8133748. Gorbovytska V, Kim SK, Kuybu F, Götze M, Um D, Kang K, Pittroff A, Brennecke T, Schneider LM, Leitner A, Kim TK, Kuhn CD. Enhancer RNAs stimulate Pol II pause release by harnessing multivalent interactions to NELF. Nat Commun. 2022 May 4;13(1):2429. doi: 10.1038/s41467-022-29934-w. PMID: 35508485; PMCID: PMC9068813. Related Episodes Enhancer Communities in Adipocyte Differentiation (Susanne Mandrup) Enhancer-Promoter Interactions During Development (Yad Ghavi-Helm) Enhancers and Chromatin Remodeling in Mammary Gland Development (Camila dos Santos) Contact Epigenetics Podcast on Mastodon Epigenetics Podcast on Bluesky Dr. Stefan Dillinger on LinkedIn Active Motif on LinkedIn Active Motif on Bluesky Email: podcast@activemotif.com

Send us Fan MailThis episode comes from two threads that have been weaving together in my practice lately: training in Polarity Champissage — a beautiful Ayurvedic marma-based body therapy developed by my friend and mentor Caroline Crichton — and developing Somatic Stretch and Shake, the movement class I've been teaching at Soma in Belfast, Maine.I want to be upfront: these ideas are still in process for me. I'm researching this both academically and in my own body, and it doesn't feel fully cooked yet. But there has been so much synchronicity around this topic lately that it felt like a sign to share what I have so far — and keep exploring from here.What we cover:The neurogenic tremor — the natural, involuntary shaking response that animals use to discharge stress (and that we've learned to suppress), and why somatic shaking gives this built-in mechanism somewhere to goWhat shaking does to fascia — the connective tissue web running through the entire body, richer in nerve endings than muscle tissue, and how trauma and chronic stress can cause it to tighten, thicken, and lose its fluid qualityMechanotransduction and hyaluronan — how vibration triggers cellular responses in fascia, including the cycling of hyaluronan, the gel-like substance that keeps fascial tissue hydrated and gliding freelyThe interstitium — the recently mapped, fluid-filled connective tissue network discovered somewhat by accident in 2015, and why it was invisible to traditional biopsy methods for so longA possible bridge between systems — emerging research suggesting the interstitium may be the physical substrate for the meridians of Traditional Chinese Medicine, and how this connects to marma points and Polarity ChampissageThe rasa dhatu connection — why interstitial fluid flow decreasing with age (especially after 50) may be one physical mechanism behind the dryness and depletion of rasa dhatu in perimenopause, and how movement and shaking help keep this fluid circulatingHow to actually shake — shaking in sets of three to six minutes, followed by a minute of stillness to let the body integrate; why subtle shaking is just as effective as big movement; and why consistency matters more than intensityThe synchronicities: Thinking about a chapter on the interstitium in Abigail Rose Clark's book Returning Home to Our Bodies — and getting an email from her about an emboided anatomy class she is teaching on the interstitium hours laters. A New York Times article on the interstitium. An interview with Dr. Neil Theise, the NYU pathologist at the center of the 2015 discovery, on fascia, the interstitium, and consciousness. All arriving within days of each other.Somatic Stretch and Shake: In-person classes are held Thursdays from 9:30–10:30am at Soma in Belfast, Maine. Online on-demand classes and a live series are coming soon — join the email list to stay in the loop.Bibliography & ReferencesThe Interstitium — Discovery & ResearchBenias, P.C., Wells, R.G., Sackey-Aboagye, B., et al. (2018). Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Scientific Reports, 8, 4947. https://doi.org/10.1038/s41598-018-23062-6Theise, N.D., & Mahler, S. (2024). Fascia, the Interstitium, and the Living Matrix: Implications for Consciousness Research. [Interview/lecture referenced]Fascia & MechanotransductionEffectiveness of Vibration on Myofascial Trigger Points. World Journal of Yoga, Physical Therapy and Rehabilitation. https://irispublishers.com/wjypr/pdf/WJYPR.MS.ID.000583.pdfDynamic Responses of Human Skin and Fascia to an Innovative Stimulation Device — Shear Wave Stimulation. PMC/NIH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351488/Understanding Fascial Tissue on the Molecular Level — The Calcium-Hyaluronan (CHA) Axis. PMC/NIH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12785924/Interstitial Fluid Flow & AgingInterstitial fluid flow decreases with age, especially after 50 years. NMR Biomed, 2024 Jul;37(7):e5030. PMID: 37675787. https://pubmed.ncbi.nlm.nih.gov/38796942/Regulation of interstitial fluid flow along adventitia of vasculature by heartbeat and respiration. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S258900422400628XSomatic Shaking & TRE ResearchThe Science of Shaking Medicine: Unlocking Neurogenic Tremoring for Trauma Release and Nervous System Balance. https://www.shakingmedicine.com/science-of-shaking-medicineThe science of somatics: how shaking resets the nervous system — Rori Cross Brown Yoga. https://www.roriyoga.co.uk/resources/the-science-of-somatics-and-shakingBooks MentionedClark, A.R. Returning Home to Our Bodies. [Chapter on the interstitium]Resources:Free Masterclass:  The Alchemy of the Perimenopause PortalAyurvedic Dosha Quick Reference GuideAbhyanga Self Massage GuideWeekend Nervous System ResetNourished For Resilience Workbook Find me at www.nourishednervoussystem.comand @nourishednervoussytem on Instagram

I doubt anyone listening to this podcast would argue that weight stigma, also called weight bias, or more crudely known as fat shaming, is wrong. Inexcusable. Not okay – no matter what. We collectively feel outrage about fat shaming on social media, in boardrooms or in the classrooms. What then, do you think about, and how do you feel about the internalized weight stigma, weight bias, fat shaming that takes place in your own head – about yourself. This episode will get you thinking about how you likely shame yourself about having a disease … and how you may even participate in stigmatizing others who have the disease of obesity. You'll want to listen to every bit of this episode!The Weight Loss Winformation Podcast gives you essential psychological information to help you lose weight and more importantly, to help keep you at a healthy weight for your body! No matter how you are working to lose weight and no matter how much weight you want to lose, Weight Loss Winformation will keep you moving in a positive direction.Resources:·      BariAfterare: www.bariaftercare.com·      Connie Stapleton PhD website: www.conniestapletonphd.com·      BariAftercare website: https://www.conniestapletonphd.com/bariaftercare·      BariAftercare Facebook page (for members only): https://www.facebook.com/groups/BariAftercare·      Kevin Stephens: Your Bariatric Buddy   https://www.facebook.com/groups/yourbariatricbuddy/people·      Instagram: @ (Caleshia Haynes)·      Instagram: @therealbariboss (Tabitha Johnson)·      Instagram @drsusanmitchell (Dr. Susan Mitchell)·      Instagram: @lauraleepreston (Laura Preston)·      ProCare Vitamins (10% off with code ConnieStapleton)·      Rob DiMedio: https://www.busybariatrics.com/·      Dr. Joan Brugman: drjbrugman@outlook.com·      Nutter S, Saunders JF, Waugh R. Current trends and future directions in internalized weight stigma research: a scoping review and synthesis of the literature. J Eat Disord. 2024 Jul 15;12(1):98. doi: 10.1186/s40337-024-01058-0. PMID: 39010124; PMCID: PMC11247756.https://pmc.ncbi.nlm.nih.gov/articles/PMC11247756/·      The Stigma of Being Overweight: 7 Core Themes by Mehta, PhD https://www.psychologytoday.com/us/blog/head-games/202303/the-stigma-of-being-overweight-7-core-themes·      Internalized Weight Bias: Recognizing Its Impact by Melinda Watman , RN, BSN, MSN, CNM, MBA https://www.obesityaction.org/resources/internalized-weight-bias-recognizing-its-impacts/

You're the one everyone leans on. The one who reads the room, holds it all together, always knows the right thing to say. You are surrounded by people who love you, and yet no one in your life truly knows the woman underneath.For the women carrying chronic illness and autoimmune disease, the emotional patterns underneath the symptoms are rarely the ones you'd expect, and this is one almost no one ever connects to their body. But the cost of going through your life unseen is real, and it shows up in places you would never think to look.In this episode, you'll discover:How a lifetime of not being truly seen may be driving the symptoms no one can explainThe hidden habit keeping you invisible, even to the people closest to youWhat changes in your body when you stop hiding and let yourself be seenYou might already sense your emotions and your health are connected, but untangling it feels like one more enormous thing to take on. So I made it simple. My free ChatGPT prompt takes your actual symptoms and shows you what could be going on underneath them in under thirty seconds. No digging. No working it out on your own. Right now, it is completely free, and that will not always be the case. CLICK HERE before that changes.Research referenced in this episode - PMID: 17854483.For women navigating Chronic Illness, Autoimmune Disease, IBS, Digestive Disorders, Migraines, Chronic Fatigue, Fibromyalgia, Pain, PCOS, and Endometriosis.

🧭 REBEL Rundown Click here for Direct Download of the Podcast. 💨 What Is Nitrous Oxide? Nitrous Oxide (N2O) is a colorless, odorless inhaled anesthetic that has been used for centuries, particularly in the surgical world. Mechanistically, it can induce euphoria, anxiolysis, and intoxication via NMDA receptor antagonism.During the late twentieth century, nitrous oxide was increasingly used recreationally due its accessibility and perceived benign nature.The modern day slang term for nitrous oxide is “whippets” – which tends to refer to the canisters that contain this agent and are frequently used as whipped cream foaming agents.Despite the legal nature and benign perception of nitrous, frequent use can lead to lasting and permanent neurologic effects. 🧠 How Nitrous Oxide Causes Toxicity Nitrous oxide toxicity results from its ability to oxidize the cobalt moiety in Vitamin-B12, thus leading to a functional B12 deficiency, despite adequate consumption and absorption.1Functioning B12 is needed as a cofactor for methionine synthase.2 This enzyme has two critical roles:The conversion of 5-methyl tetrahydrofolate to tetrahydrofolate; tetrahydrofolate is essential for the synthesis of our DNA.And the conversion of homocysteine to methionine; methionine is needed to maintain the integrity of the myelin sheath of our axons.As a result, nitrous toxicity leads to: a megaloblastic anemia and demyelination of both the dorsal columns and the lateral corticospinal tracts (also known as subacute combined degeneration). 🚶‍️ Clinical Manifestations of Nitrous Oxide Toxicity These patients will have a combination of both upper and lower motor neuron symptoms due to demyelination of the dorsal columns, lateral corticospinal tracts, and peripheral nerves. As a result, the following may manifest:Dorsal Columns: diminished sense of proprioception, vibration, and fine touch.Lateral Corticospinal Tracts: upgoing plantars, hyperreflexia, weakness of voluntary distal muscle controlPeripheral Nerves: numbness/tingling and weakness in a glove and stocking pattern (symptoms that start initially in the feet and hands that progressively spread proximally to the ankles and wrists)Taking all of this into account, patients may present with difficulty ambulating, positive Romberg sign, dysmetria (difficulty with finger to nose or heel to shin), upgoing Babinski reflex, and decreased strength and sensation in a glove and stocking pattern. 🔍 How to Diagnose Nitrous Oxide Neurotoxicity History is key! As with a lot of pathologies in toxicology, identifying the exposure will expedite management.A thorough neurologic exam will narrow the differential – with a particular focus to fine, peripheral motor and sensory deficits, dysmetria, proprioception, and ability to ambulate.Magnetic resonance imaging of the spine may identify enhancement and/or edema of the dorsal columns, specifically on T2 weight axial imaging – sometimes referred to as the “inverted V” or “inverted rabbit ears appearance.”3Serum B12 concentrations may be normal as the issue is with a functional deficiency as opposed to a vitamin absence. However, patients have elevated concentrations of both homocysteine and methylmalonic acid, both of which are metabolized in the presence of functional B12. 💉 Management of Nitrous Oxide Toxicity First and foremost, cessation of nitrous oxide abuse is crucial to limit/prevent toxicity.While there is no universally agreed upon treatment regimen, supplementation with intramuscular B12 is recommended.Approaches vary from daily or every other day injections until symptoms improve at which point injections can be spaced out to weekly and then monthly.Physical and occupational therapy may be needed depending on the degree of functional debility.It is important to note, that depending of the severity and chronicity of toxicity, some proportion of patients may not fully return to their baseline. 📌 Take-Home Points Though legal and seemingly benign, nitrous oxide abuse can lead to permanent neurologic dysfunction.Nitrous oxide toxicity can affect the dorsal columns, lateral corticospinal tracts, and peripheral nerves.Thus leading to a constellation of both upper and lower motor neuron deficits, particular in a glove and stocking pattern: deficits in proprioception and fine motor skills, positive Romberg, upgoing Babinski, peripheral numbness, tingling, and weakness.Magnetic resonance imaging may identify symmetric high signal intensity in the dorsal columns.Treatment includes B12 supplementation and physical/occupational therapy as needed. 📚 References Long H. Chapter 81. Inhalants. In: Nelson LS, et al. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill; 2019Shah K, Murphy C. Nitrous Oxide Toxicity: Case Files of the Carolinas Medical Center Medical Toxicology Fellowship. J Med Toxicol. 2019 Oct;15(4):299-303. doi: 10.1007/s13181-019-00726-x. Epub 2019 Aug 6. PMID: 31388940; PMCID: PMC6825085.Schmitz ZP, Hoffman RS. Magnetic resonance imaging in a patient with nitrous oxide-induced subacute combined degeneration of the spinal cord. Clin Toxicol (Phila). 2023 Nov;61(11):1006-1008. doi: 10.1080/15563650.2023.2286205. Epub 2023 Dec 19. PMID: 38060330. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Associate Editor Anand Swaminathan MD, MPH All Things REBEL EM Meet The Team 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator When you take the airway, you take the wheel and ... Thoracic and Respiratory Read More REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Mechanical ventilation can feel overwhelming, especially when faced with a ... Thoracic and Respiratory Read More REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes For many medical residents, the ICU can feel like stepping ... Thoracic and Respiratory Read More REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine The sicker the patient, the more likely an IO line ... Procedures and Skills Read More REBEL Core Cast 139.0: Pneumothorax Decompression On this episode of the Rebel Core Cast, Swami takes ... Procedures and Skills Read More Showing Slide 1 of 7 The post REBEL Core Cast—Nitrous Oxide Toxicity: Whippets and Neurologic Injury appeared first on REBEL EM - Emergency Medicine Blog.

Pourquoi je mange alors que je n'ai pas faim ? Et que je ne suis pas stressé.e ? Episode pour cet été, mais clairement pas que ! Quand on parle de comportements alimentaires, on évoque souvent le stress, les émotions difficiles, la fatigue ou encore les compulsions alimentaires. Pourtant, les recherches en psychologie montrent que l'ennui peut lui aussi influencer notre rapport à la nourriture et nos envies de manger, même en l'absence de faim "physique".Dans cet épisode, je vous explique pourquoi notre cerveau supporte parfois difficilement les moments de vide, de monotonie ou de sous-stimulation, et comment la nourriture peut devenir une manière rapide de retrouver de l'intérêt, du plaisir ou simplement une sensation de mouvement dans la journée.À travers des études scientifiques récentes sur le comportement alimentaire, nous allons explorer les mécanismes qui expliquent le grignotage d'ennui, le rôle de la dopamine, la recherche de stimulation sensorielle et les différences entre faim physiologique, faim émotionnelle et envie de manger.Vous découvrirez également pourquoi le problème n'est pas forcément un manque de volonté ou de contrôle de soi. Derrière certaines envies de biscuits, de chocolat ou d'autres aliments à grignoter se cache parfois un besoin tout à fait différent, je vous explique tout dans cet épisode ! Je partage aussi des pistes concrètes pour mieux comprendre vos envies alimentaires sans culpabilité :✅ Comment reconnaître un grignotage lié à l'ennui ;✅ Pourquoi lutter contre une envie de manger n'est pas toujours la meilleure stratégie ;✅ Comment identifier le besoin qui se cache derrière une envie alimentaire ;✅ Quelles alternatives peuvent apporter la stimulation que votre cerveau recherche ;✅ Comment développer une relation plus apaisée avec l'alimentation.✅Si vous avez déjà pensé : « Je n'ai pas faim, alors pourquoi est-ce que je mange ? », cet épisode est fait pour vous.

Pronation can be misunderstood as a scary, dangerous risk for injury - and people use that to sell you something. In reality, a certain degree of pronation is a normal part of the running gait. However, excessive or limited pronation can be problematic for some runners. So how do you know if you need to worry about overpronation or buy stability shoes? In episode 171, we take an evidence-based approach and guide you through anatomy and recent research surrounding pronation. Thank you to our sponsors:✨ Good Ranchers: American-grown meat, delivered frozen to your doorstep. Use code IRON for $40 off the first order, or $100 off across the first three orders when customers start a subscription. Plus free protein with every order (choice of burgers, bacon, or chicken breasts). Be sure to mention “Tread Lightly Podcast” for how you heard about the company! https://www.goodranchers.com/In this episode, you'll learn:✅ Why pronation is a normal part of a healthy running gait✅ If stability shoes are appropriate for you or not✅ Whether pronation causes an injury or is a symptom of an injury✅ Should you change your running gait?✅ The difference between overstriding and heel striking✅ Should you increase your running cadence?If You Enjoyed this Episode, You May Like:

Welcome to the latest Midlife Minute. Today, I'm taking a closer look at oral contraceptive use in perimenopause and menopause, exploring how oral contraceptives work, how they suppress or blunt perimenopausal and menopausal symptoms, alter hormone signaling and testing, what women may experience when they stop taking them, and why the gut microbiome is an essential part of the conversation. IN THIS EPISODE, YOU WILL LEARN: How oral contraceptives suppress certain key signaling hormones, making it difficult to assess women's menopausal status accurately What women may experience when transitioning off oral contraceptives How long-term oral contraceptive use can alter gut microbial function and inflammatory pathways The association between long-term oral contraceptive use and nutrient depletion Why the standard reproductive hormone markers used to assess menopause (especially FSH/LH) are unreliable while on the pill How the microbiome changes that occur as women age may compound the effects of previous oral contraceptive use Helpful dietary, microbiome, and lifestyle strategies to support women navigating the post-pill transition Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website. Submit your questions to support@cynthiathurlow.com  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia's book, The Menopause Gut. Cynthia's Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Resources:  Sitruk-Ware R, Nath A. Characteristics and metabolic effects of estrogen and progestins contained in oral contraceptive pills. Best Practice and Research: Clinical Endocrinology and Metabolism. 2013;27(1):13–24. doi:10.1016/j.beem.2012.09.004 Schaffir J, Worly BL, Gur TL. Combined hormonal contraception and its effects on mood: a critical review. European Journal of Contraception and Reproductive Health Care. 2016;21(5):347–355. doi:10.1080/13625187.2016.1217327 Panzer C, Wise S, Fantini G, Kang D, Munarriz R, Guay A, Goldstein I. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. Journal of Sexual Medicine. 2006;3(1):104–113. doi:10.1111/j.1743-6109.2005.00198.x Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences. 2013;17(13):1804–1813. PMID:23852908 Khalili H, Higuchi LM, Ananthakrishnan AN, Richter JM, Feskanich D, Fuchs CS, Chan AT. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut. 2013;62(8):1153–1159. doi:10.1136/gutjnl-2012-302362 Flores R, Shi J, Fuhrman B, Xu X, Veenstra TD, Gail MH, Gajer P, Ravel J, Goedert JJ. Fecal microbial determinants of fecal and systemic estrogens and estrogen metabolites: a cross-sectional study. Journal of Translational Medicine. 2012;10:253. doi:10.1186/1479-5876-10-253 Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: physiological and clinical implications. Maturitas. 2017;103:45–53. doi:10.1016/j.maturitas.2017.06.025 Hua X, Cao Y, Morgan DM, Miller K, Chin SM, Bellavance D, Khalili H. Longitudinal analysis of the impact of oral contraceptive use on the gut microbiome. Journal of Medical Microbiology. 2022;71(4):001512. doi:10.1099/jmm.0.001512 Mihajlovic J, Leutner M, Hausmann B, Kohl G, Schwarz J, et al. Combined hormonal contraceptives are associated with minor changes in composition and diversity in gut microbiota of healthy women. Environmental Microbiology. 2021;23(6):3037–3047. doi:10.1111/1462-2920.15461 Seelig MS. Increased magnesium need with use of combined oestrogen and calcium supplementation. Magnesium Research. 1990;3(3):197–215. PMID:2133742 Donders GGG, Bellen G, Mendling W. Management of recurrent vulvo-vaginal candidosis as a chronic illness. Gynecologic and Obstetric Investigation. 2010;70(4):306–321. doi:10.1159/000314022 Krog MC, Hugerth LW, Fransson E, et al. The healthy female microbiome across body sites: effect of hormonal contraceptives and the menstrual cycle. Human Reproduction. 2022;37(7):1525–1543. doi:10.1093/humrep/deac094

Send us Fan MailIs five days of antibiotics enough to treat a urinary tract infection in a NICU infant? In this Journal Club episode, Ben and Daphna review a single-center study from Nationwide Children's Hospital examining adherence and safety of a five-day antibiotic treatment guideline for culture and urinalysis-proven UTIs in the NICU. Among 77 infants with 93 bacterial UTIs, the five-day course was associated with a 1% failure rate, defined as reinitiation of antibiotics within seven days for the same organism. The episode also explores the potential role of enteral antibiotic therapy and what shorter treatment courses could mean for babies still weeks away from discharge.----Urinary tract infection in the neonatal intensive care unit. Magers J, Burton A, Prusakov P, White NO, Miller RR, Moraille R, Theile AR, Sánchez PJ; Nationwide Children's Hospital Neonatal Antimicrobial Stewardship Program (NEO-ASP).J Perinatol. 2026 May;46(5):754-760. doi: 10.1038/s41372-026-02690-1. Epub 2026 Apr 29.PMID: 42056240 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 is my personal favorite topic, but probably your least favorite: strength training.  Before you run away, hear me out! Because whether you’re bed-bound, housebound, or just convinced your body can’t handle it right now, this episode is for you. I’m breaking down exactly WHY resistance and strength training isn’t just helpful for vestibular disorders—it’s essential.  You Have to Move Your Body to Manage Your Dizziness From the dizzy-anxious-dizzy cycle to blood sugar regulation to better sleep to reduced inflammation, strength training touches virtually every struggle vestibular warriors face. I’m not letting anyone off the hook, but I am meeting you exactly where you are. Starting with 3 minutes? That counts.  Walking to the mailbox and back? That counts too.  Because the goal here is progress, not perfection. And you know I have the science to back every single word of it! In this episode, we'll dig into: Why strength training is non-negotiable for vestibular disorder management How exercise helps break the dizzy-anxious-dizzy cycle “In the moment” vs. “hangover” dizziness and how to adjust your approach Why EDS, HSD, or MCAS makes building muscle even more critical The truth about the fear of getting “bulky” How to start exercising when you’re bedbound or couch-bound What physical activity guidelines actually say, and where most people fall short How functional movements like the deadlift directly support vestibular patients How Vestibular Group Fit makes strength and resistance training accessible Whether you start with 3 minutes or 30, the most important thing is that you start. Because your vestibular system, your mood, your balance, and your future self are all counting on it. Links Mentioned: Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit Free Resources: ⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n ⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd ⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership ⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit ⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor Work with Dr. Madison: For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com Otherwise, I'll see ya in Vestibular Group Fit! Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/ Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit Citations: Adriano Oliveira, Andressa Fidalgo, Paulo Farinatti, Walace Monteiro,Effects of high-intensity interval and continuous moderate aerobic training on fitness and health markers of older adults: A systematic review and meta-analysis,Archives of Gerontology and Geriatrics,Volume 124,2024,105451,ISSN 0167-4943,https://doi.org/10.1016/j.archger.2024.105451.(https://www.sciencedirect.com/science/article/pii/S0167494324001274) Yu Y, Wang J, Xu J. Optimal dose and type of exercise to improve cognitive function in patients with mild cognitive impairment: a systematic review and network meta-analysis of RCTs. Front Psychiatry. 2024 Sep 12;15:1436499. doi: 10.3389/fpsyt.2024.1436499. PMID: 39328348; PMCID: PMC11424528. Zhang Y, Zhou M, Yin Z, Zhuang W, Wang Y. Relationship between physical activities and mental health in older people: a bibliometric analysis. Front Psychiatry. 2024 Oct 21;15:1424745. doi: 10.3389/fpsyt.2024.1424745. PMID: 39497901; PMCID: PMC11532734. Garcia Meneguci, C. A., Meneguci, J., Sasaki, J. E., Tribess, S., & Júnior, J. S. V. (2021). Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis. PloS one, 16(1), e0246275. https://doi.org/10.1371/journal.pone.0246275 Mennitti C, Farina G, Imperatore A, De Fonzo G, Gentile A, La Civita E, Carbone G, De Simone RR, Di Iorio MR, Tinto N, Frisso G, D’Argenio V, Lombardo B, Terracciano D, Crescioli C, Scudiero O. How Does Physical Activity Modulate Hormone Responses? Biomolecules. 2024 Nov 7;14(11):1418. doi: 10.3390/biom14111418. PMID: 39595594; PMCID: PMC11591795. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010 Jun 3;411(11-12):785-93. doi: 10.1016/j.cca.2010.02.069. Epub 2010 Feb 25. PMID: 20188719; PMCID: PMC3629815.  Chastin, S.F.M., Abaraogu, U., Bourgois, J.G. et al. Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis. Sports Med 51, 1673–1686 (2021). https://doi.org/10.1007/s40279-021-01466-1 Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022 Jan;70(1):49-59. doi: 10.1111/jgs.17477. Epub 2021 Sep 24. PMID: 34536288. Rey-Lopez JP, Rimm EB, Tabung FK, Giovannucci EL. Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults. Circulation. 2022 Aug 16;146(7):523-534. doi: 10.1161/CIRCULATIONAHA.121.058162. Epub 2022 Jul 25. PMID: 35876019; PMCID: PMC9378548. Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Barthélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(19):1262-7. doi: 10.1136/bjsports-2014-094306. Epub 2015 Aug 3. PMID: 26238869. Chandrasekaran B, Ganesan TB. Sedentarism and chronic disease risk in COVID 19 lockdown – a scoping review. Scott Med J. 2021 Feb;66(1):3-10. doi: 10.1177/0036933020946336. Epub 2020 Jul 27. PMID: 32718266; PMCID: PMC8685753. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging. 2021;25(7):824-853. doi: 10.1007/s12603-021-1665-8. PMID: 34409961; PMCID: PMC12369211. Bunnell E, Stratton MT. The Impact of Functional Training on Balance and Vestibular Function: A Narrative Review. J Funct Morphol Kinesiol. 2024 Dec 3;9(4):251. doi: 10.3390/jfmk9040251. PMID: 39728235; PMCID: PMC11679947. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr;100(2):126-31. PMID: 3920711; PMCID: PMC1424733. Warner A, Vanicek N, Benson A, Myers T, Abt G. Agreement and relationship between measures of absolute and relative intensity during walking: A systematic review with meta-regression. PLoS One. 2022 Nov 3;17(11):e0277031. doi: 10.1371/journal.pone.0277031. PMID: 36327341; PMCID: PMC9632890. “Metabolic Equivalent (MET): Pick the Best Exercise for Longevity.” Whyiexercise.com, www.whyiexercise.com/metabolic-equivalent.html. Love what you heard?Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you! This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— strength and resistance training, exercises for vestibular disorders, living with vestibular migraine, guidelines of physical activity, anxiety and depression, chronic dizziness, couch bound, bed bound, dizzy-anxious-dizzy cycle, physical therapist

Contributor: Aaron Lessen, MD Educational Pearls:   UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment.  UTI signs and symptoms Burning sensation when urinating Strong urge to urinate Urinating often and passing small amounts of urine.  Pelvic pain    There are currently more guidelines and studies on treatments to prevent these recurrent UTIs in women that we can start in the Emergency Department. Vaginal estrogen has been shown to significantly reduce this issue of recurrence. Very simple prescriptions can be prescribed in the ED It has little systemic absorption and is generally very safe and effective.   References Wells BA, De EJB, Visingardi J, Feustel PJ. IP15-36 IMPACT OF VAGINAL ESTROGEN ON SERIOUS ADVERSE OUTCOMES IN POSTMENOPAUSAL WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: A RETROSPECTIVE STUDY. Journal of Urology [Internet]. 2025 May 1;213(5S):e778. Available from: https://doi.org/10.1097/01.JU.0001109984.67114.74.36 Ackerman AL, Bradley M, D'Anci KE, Hickling D, Kim SK, Kirkby E. Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). J Urol. 0(0). doi: 10.1097/JU.0000000000004723 Kaufman MR, Ackerman LA, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 0(0). doi:10.1097/JU.0000000000004589 Meister MR, Wang C, Lowder JL, Mysorekar IU. Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e39-e44. doi: 10.1097/SPV.0000000000000790. PMID: 31725016; PMCID: PMC7737516. Nazarko L. Recurrent lower urinary tract infection in older women [Internet]. Urology & Continence Care Today. Available from: https://www.ucc-today.com/journals/issue/launch-edition/article/recurrent-lower-urinary-tract-infection-in-older-women-ucct   Summarized by Aaryn David & Ahmed Abdel-Hafiz | Edited by Aaryn David & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf

Send us Fan MailIn this Journal Club episode, Ben and Daphna review a nationwide Swedish cohort study examining the association between phototherapy duration and neonatal outcomes in very preterm infants (22 to 31 weeks). The study's primary outcome, late neonatal mortality on days 8 to 27, was not significantly associated with phototherapy duration. However, longer phototherapy exposure was associated with increased odds of severe neonatal morbidity, including IVH and BPD, in infants born at 26 to 31 weeks. The findings prompt an important conversation about the near-universal use of phototherapy in preterm neonates and whether current practice warrants reassessment.----Phototherapy, Morbidity, and Mortality in Very Preterm Newborns. Deschmann E, Håkansson S, Söderling J, Norman M.JAMA Netw Open. 2026 May 1;9(5):e2614107. doi: 10.1001/jamanetworkopen.2026.14107.PMID: 42166159 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!

Historically we were taught as surgeons that 1-centimeter bites that between suture throws on a Pfannenstiel (low transverse) fascial closure was enough to prevent hernia formation and optimize facial healing. But is this still evidence based? We can extrapolate data from a May 2026 systematicreview/meta-anlysis as well as a separate study from the Dutch published in 2021. Both of these studies were in the journal Hernia. The evidence does favor one technique over the other! Listen in for details.1.     Golling M, Baumann P, Kuger F, Fortelny RH.Impact of the SUture BIte TEchnique on clinical outcomes after midlinelaparotomy closure: SUBITE-a systematic review and meta-analysis. Hernia. 2026May 19;30(1):221. doi: 10.1007/s10029-026-03700-z. PMID: 42154339; PMCID:PMC13186860.2.     Paulsen CB, Zetner D, Rosenberg J. Variation inabdominal wall closure techniques in lower transverse incisions: a nationwidesurvey across specialties. Hernia. 2021 Apr;25(2):345-352. doi:10.1007/s10029-020-02280-w. Epub 2020 Aug 8. PMID: 32770366.