Podcasts about randomised

In his weekly clinical update, Dr. Griffin with Vincent Racaniello rue about the continuation of the gutting of the American public health infrastructure, the continuing measles outbreak, an unreported outbreak of deadly E.coli human infections, meningococcal disease before Dr. Griffin reviews recent statistics on RSV, influenza and SARS-CoV-2 infections, the WasterwaterScan dashboard, ACIP recommended changes in guidelines for the RSV and COVID-19 vaccines, reactogenicity differences between Novavax and Pfizer COVID-19 vaccines, where to find PEMGARDA, provides information for Columbia University Irving Medical Center's long COVID treatment center, where to go for answers to your long COVID questions, long COVID interventions, effects of long COVID in children and adolescents and a list of ongoing clinical trials for long COVID treatment. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode Making America Healthy Again-purging of administrators at HHS (Politico) Making America Healthy Again-purging of data (Politico) Deep cuts of the federal government (NY Times) Cutting NIH, CDC and HHS promotes chronic disease research(Washington Post) Political ideology and trust in scientists in the USA(Nature Human Behavior) US political conservatives have deep, unbudging suspicion of science, survey suggests(CIDRAP) A deadly E. coli outbreak hit 15 states, but the FDA chose not to publicize it(NBC News) Invasive meningococcal disease – Kingdom of Saudi Arabia(WHO) The essential guide to understanding the differences between hajj and umrah (Marhabahaji) Measles Vaccination: Know the Facts(ISDA: Infectious Diseases Society of America) Measles booster? (Washington Post) How to stop an outbreak…….fire the experts (Washington Post) Measles cases and outbreaks (CDC Rubeola) Measles 159 in Texas…. (Texas Health and Human Services) 2025 Measles outbreak guidance (New Mexico Health) Measles and rubella weekly monitoring (Government of Canada) Measles vaccine recommendations from NYP (jpg) NAFMA: North American Free Measles agreement…..(NY Times) Get the FACTS about measles (NY State Department of Health) Measles (CDC Measles (Rubeola)) Measles vaccine (CDC Measles (Rubeola)) Presumptive evidence of measles immunity (CDC) Contraindications and precautions to measles vaccination (CDC) Measles (CDC Measles (Rubeola)) Doctors' talk measles (YouTube) Measles (CDC: Measles Rubeola) Adverse events associated with childhood vaccines: evidence bearing on causality (NLM) Measles Vaccination: Know the Facts(ISDA: Infectious Diseases Society of America) Deaths following vaccination: what does the evidence show (Vaccine) Influenza: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) Weekly surveillance report: clift notes (CDC FluView) Respiratory virus activity levels (CDC Respiratory Illnesses) 200 children die from flu (CIDRAP) Weekly surveillance report: clift notes (CDC FluView) FDA-CDC-DOD: 2025-2046 influenza vaccine composition (FDA) RSV: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) RSV-Network (CDC Respiratory Syncytial virus Infection) ACIP votes to expand recommendation for Pfizer'sRSV vaccine Abrysvo® to include adults aged 50 to 59 at increased risk of disease (Pfizer) Respiratory syncytial virus and incidence of cardiovascular events: a nationwide self-controlled case series analysis (JACC Journals) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Comorbidities associated with different degrees of severity in children and young people hospitalized with acute COVID-19 (Pediatric Infectious Disease Journal) SHIELD-Utah study shows Novavax's COVID-19 vaccine induces lower reactogenicity symptoms compared to mRNA (Novavax) Interim clinical considerations for use of COVID-19 vaccines in the United States (CDC Vaccines & Immunizations) Novavax says its COVID vaccine produces fewer, milder reactions than Pfizer version(CIDRAP) US CDC advisers discuss narrower use of COVID-19 vaccines (Reuters) Where to get pemgarda (Pemgarda) EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD) Fusion center (Prime Fusions) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Drug interaction checker (University of Liverpool) Infectious Disease Society guidelines for treatment and management (ID Society) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) When your healthcare provider is infected/exposed with SARS-CoV-2 (CDC) Managing healthcare staffing shortages (CDC) Steroids, dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) The answers: Long COVID Kidney Function following COVID-19 in children and adolescents(JAMA Network Open) Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records(Nature Communications) Great barrington declaration (gbdeclaration.org) Clinical trials: Effectiveness of transcranial direct current in patients with persistent COVID-19 with headaches and chronic pain. Home-based Brain Stimulation Treatment for Post-acute Sequelae of COVID-19 (PASC) Acupuncture for post COVID-19 Condition (Long COVID) neuropsychiatric symptoms Pain relief with integrative medicine (prime)?: feasibility of acupuncture for long COVID Electro-acupuncture for long COVID neuropsychiatric symptoms Randomised study to investigate the effectiveness of acupuncture for the relief of long COIVD-19 related fatigue (ACU-COVID) Vagus stimulation in female long COVID patients.(Vagus) Stellate ganglion block with lidocaine for the treatment of COVID-19-induced parosmia (Stella) Therapeutic updates on long COVID: Where things stand 5 years later (ID Society) Reaching out to US house representative Letters read on TWiV 1210 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene Ramsey. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv Content in this podcast should not be construed as medical advice.

There's a range of different interventions at your disposal when managing spine pain. Today we're focusing on spinal manipulative therapy, and asking questions like: does it matter how you apply a manipulation to get the best outcomes for the patient? Answering the questions is Dr Casper Nim from the University of Southern Denmark. Casper is an Associate Professor, chiropractor, and senior researcher at the Spine Centre of Southern Denmark. ------------------------------ RESOURCES Does it matter how you apply spinal manipulative therapy? Network meta-analysis: https://www.jospt.org/doi/10.2519/jospt.2025.12707 Does targeting a specific vertebral level make a difference? Systematic review: https://www.jospt.org/doi/10.2519/jospt.2023.11962 Effect on clinical outcomes when targeting spinal manipulative therapy. Randomised controlled trial: https://pubmed.ncbi.nlm.nih.gov/32884045/ Preference randomised trials: https://www.jospt.org/doi/10.2519/josptmethods.2025.0129 JOSPT Methods journal website: https://www.jospt.org/toc/jospt-methods/current

Join us as we discuss effective non-diet focused methods for IBS relief. In this episode, Kate and Dr. Riehl review key factors on how gender can influence common symptoms of IBS.Hormones significantly influence IBS symptoms, with women being diagnosed 2.5 times more often than men, in part due to differences in gut function and pain perception. This episode features the following key discussion areas:• Women's fluctuating estrogen and progesterone levels affect gut motility and pain sensitivity throughout the menstrual cycle• Visceral hypersensitivity causes normal digestive sensations to be interpreted as pain - like a car alarm going off unnecessarily• The "microgenderome" refers to gender differences in gut microbiome that may contribute to women's higher rates of IBS and autoimmune conditions• Gut-directed hypnotherapy helps reprogram the subconscious mind to interpret gut sensations more accurately, with 70-80% improvement rates• Pelvic floor physical therapy can help address muscle tension that contributes to both constipation and diarrhea symptoms• Non-diet approaches including medications, supplements like enteric-coated peppermint, and lifestyle factors are effective IBS management tools• Regular exercise (especially in nature), adequate sleep, and stress management techniques complement other treatmentsFor more information on IBS-C treatments, check out our dedicated three-part series in episodes 14, 15, and 16.This podcast has been sponsored by Ardelyx and Nerva by Mindset Health.References:Mulak A, Taché Y, Larauche M. Sex hormones in the modulation of irritable bowel syndrome. World J Gastroenterol. 2014;20(10):2433-2448. doi:10.3748/wjg.v20.i10.2433Chang L, Heitkemper MM. Gender differences in irritable bowel syndrome. Gastroenterology. 2002;123(5):1686-1701. doi:10.1053/gast.2002.36603Houghton LA, Jackson NA, Whorwell PJ, Morris J. Do male sex hormones protect from irritable bowel syndrome?. Am J Gastroenterol. 2000;95(9):2296-2300. doi:10.1111/j.1572-0241.2000.02314.xPeters SL, Yao CK, Philpott H, Yelland GW, Muir JG, Gibson PR. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(5):447-459. doi:10.1111/apt.13706Learn 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.

As part of the March issue, the European Respiratory Journal presents the latest in its series of podcasts. Deputy Chief Editor Don Sin interviews Associate Editor Yet Khor about the generalisability of pharmaceutical randomised controlled trial eligibility criteria for progressive pulmonary fibrosis.

Randomized Comparison Trial of Rehabilitation Very Early for Infants with Congenital HemiplegiaRoslyn N Boyd, Susan Greaves, Jenny Ziviani, Iona Novak, Nadia Badawi, Kerstin Pannek, Catherine Elliott, Margaret Wallen, Catherine Morgan, Jane Valentine, Lisa Findlay, Andrea Guzzetta, Koa Whittingham, Robert S Ware, Simona Fiori, Nathalie L Maitre, Jill Heathcock, Kimberley Scott, Ann-Christin Eliasson, Leanne SakzewskiPMID: 39477009 DOI: 10.1016/j.jpeds.2024.114381Free articleAbstractObjective: To compare efficacy of constraint-induced movement therapy (Baby-CIMT) with bimanual therapy (Baby-BIM) in infants at high risk of unilateral cerebral palsy.Study design: This was a single-blind, randomized-comparison-trial that had the following inclusion criteria: (1) asymmetric brain lesion (2) absent fidgety General Movements, (3) Hammersmith Infant Neurological Examination below cerebral palsy cut-points, (4) entry at 3-9 months of corrected age, and (5) greater than 3-point difference between hands on Hand Assessment Infants (HAI). Infants were randomized to Baby-CIMT or Baby-BIM, which comprised 6-9 months of home-based intervention. Daily dose varied from 20 to 40 minutes according to age (total 70-89.2 hours). Primary outcome measure was the HAI after intervention, with secondary outcomes Mini-Assisting Hand Assessment and Bayley III cognition at 24 months of corrected age.Results: In total, 96 infants (51 male, 52 right hemiplegia) born median at 37-weeks of gestation were randomized to Baby-CIMT (n = 46) or Baby-BIM (n = 50) and commenced intervention at a mean 6.5 (SD 1.6) months corrected age. There were no between group differences immediately after intervention on HAI (mean difference MD 0.98 HAI units, 95% CI 0.94-2.91; P = .31). Both groups demonstrated significant clinically important improvements from baseline to after intervention (Baby-BIM MD 3.48, 95% CI 2.09-4.87; Baby-CIMT MD 4.42, 95% CI 3.07-5.77). At 24 months, 64 infants were diagnosed with unilateral cerebral palsy (35 Baby-CIMT, 29 Baby-BIM). Infants who entered the study between 3 and 6 months of corrected age had greater change in HAI Both Hands Sum Score compared with those who entered at ≥6 months of corrected age (MD 7.17, 95% CI 2.93-11.41, P = .001).Conclusions: Baby-CIMT was not superior to Baby-BIM, and both interventions improved hand development. Infants commencing intervention at greater than 6 months corrected age had greater improvements in hand function.https://pubmed.ncbi.nlm.nih.gov/39477009/

Professor Ian Tannock (Princess Margaret Cancer Centre and the University of Toronto, Toronto, Canada) discusses his Policy Review on Common Sense Oncology principles for the design, analysis and reporting of phase 3 randomised clinical trials.Tell us what you thought about this episodeContinue this conversation on social!Follow us today at...https://twitter.com/thelancet & https://Twitter.com/TheLancetOncolhttps://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Admission to the intensive care unit (ICU) can be a challenging experience for patients and their families. Psychological burdens, including symptoms of anxiety, depression and post-traumatic stress, are among the most reported during the ICU stay.A recent study has been carried out as a joint project between France and the United States in which the experts have designed an intervention to improve outcomes for patients' families. For this intervention, they evaluated the nurse facilitator to support, model and teach communication strategies that will help in securing care aligned with patients' goals at the ICU. To learn more about this intervention, we interviewed one of the main authors, Nancy Kentish Barnes. Listen to our podcast for deeper insights into this study!

Listen to the Q&A between An Teunkens and Per Moller as they discuss the article, "Bacterial contamination and greenhouse gas emissions: A randomised study of reuse versus single-use of infusion-set components for intravenous anaesthesia", found in the December 2024 issue of the EJA.

If you're looking to heal leaky gut and to strengthen your gut lining, there are a couple of different components to consider. Luckily, we have a new, science-based supplement that provides several lines of defense for your gut health. In this episode, I'll explain the best nutrients for your gut lining, and why Gut Rebuild Nutrients is the perfect all-around supplement for healing. 

Send us a textDiese Woche geht es im Journal Club um eine Arbeit von Köhl et al. aus Anaesthesia: Hyperangulated vs. Macintosh videolaryngoscopy in adults with anticipated difficult airway management: a randomised controlled trial. (doi:10.1111/anae.16326). Dabei geht es um den Vergleich unterschiedlicher Spatel bei der Videolaryngoskopie.Mit im Studio dabei: Konstantin Urbach, wissenschaftlicher Mitarbeiter der Klinik für Anästhesiologie am UKHD.

An exciting new study finds that these herbal treatments and probiotics are very effective in healing SIBO! In this episode,I'll break down the study and provide the best protocol for approaching SIBO naturally. Watch now!  

We hear a lot about healing leaky gut, but how do we know we have it in the first place? Is a stool test enough? In this episode, I'll review the most effective and least effective leaky gut tests. Let's get the most accurate results, so you can move closer to healing! Watch now.   

Dr. Lacey Shiue, emergency ultrasound faculty, sits down with Alex and Venk to talk through ultrasound guided nerve blocks and plane blocks. We talk through key differences in commonly used medications, how to manage toxicity from those medications as well as a detailed discussion of several different specific blocks including: Erector Spinae Plane Block, Fascia Iliaca Compartment Block, Supraclavicular Block, Interscalene Block among others. In addition, she discusses the keys to advancing an emergency regional anesthesia program.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com   RESOURCES FOR PRACTICE: MDCALC for anesthetic dose calculation: https://www.mdcalc.com/calc/10205/local-anesthetic-dosing-calculator  Safe Local app for anesthetic dose calculation: https://apps.apple.com/us/app/safelocal/id1440999841  New York School of Regional Anesthesia: https://www.nysora.com/filter-topics/  Highland County Emergency Medicine Website: https://highlandultrasound.com/  ASRA - American Society of Regional Anesthesia - Checklist for treatment of LAST: https://www.asra.com/news-publications/asra-updates/blog-landing/guidelines/2020/11/01/checklist-for-treatment-of-local-anesthetic-systemic-toxicity    REFERENCES: American College of Emergency Physicians Policy Statements: Ultrasound-Guided Nerve Blocks, published April 2021. Document accessed June 20, 2024 via: https://www.acep.org/patient-care/policy-statements/ultrasound-guided-nerve-blocks American College of Emergency Physicians Policy Statements: Guideline for ultrasound transducer cleaning and disinfection, approved April 2021. Document accessed June 20, 2024 via: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.acep.org/siteassets/new-pdfs/policy-statements/guideline-for-ultrasound-transducer-cleaning-and-disinfection.pdf  Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement. J Ultrasound Med. 2020; online before print. https://doi.org/10.1002/jum.15653  Ramesh S, Ayyan SM, Rath DP,Sadanandan DM. Efficacy and safety of ultrasound-guidederector spinae plane block compared to sham procedure inadult patients with rib fractures presenting to the emergencydepartment: A randomized controlled trial. Acad Emerg Med.2024;31:316-325. doi:10.1111/acem.14820 New York School of Regional Anesthesia: Ultrasound-guided fascia iliaca nerve block. Accessed June 21, 2024 via: https://www.nysora.com/techniques/lower-extremity/ultrasound-guided-fascia-iliaca-block/  Downs T, Jacquet J, Disch J, Kolodychuk N, Talmage L, Krizo J, Simon EL, Meehan A, Stenberg R. Large Scale implementation of fascia iliaca compartment blocks in an emergency department. West J Emerg Med. 2023 May 3;24(3):384-389 Makkar JK, Singh NP, Bhatia N, Samra T, Singh PM. Fascia iliaca block for hip fractures in the emergency department: meta-analysis with trial sequential analysis. Am J Emerg Med. 2021 Dec:50:654-660 Rukerd MRZ, Erfaniparsa L, Movahedi M, et al. Ultrasound-guided femoral nerve block versus fascia iliaca compartment block for femoral fractures in emergency department: a randomized controlled trial. Acute Med Surg. 2024 Mar 6;11(1):e936 Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91 Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the 3-in-1 block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32:685-689 Schulte SS, Fernandez I, Van Tienderen R, Reich MS, Adler A, Nguyen MP. Impact of the fascia iliaca block on pain, opioid consumption, and ambulation for patients with hip fractures: a prospective, randomized study. J Orthop Trauma. 2020 Oct;34(10):533-538   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs  

Essa foi uma semana de recomeços para quem vive no RS. Apesar do barulho dos helicópteros em alguns momentos do episódio, estamos retornando com os nossos programas regulares. Neste episódio do Journal Club, trazemos os seguintes artigos para vocês:1.     Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula A Randomized Clinical Trial - Resultados do Neurodesenvolvimento de Prematuros Extremos Alimentados com Leite Humano de Banco ou Fórmula de Prematuro - Um Ensaio Clínico RandomizadoExiste diferenças em relação ao neurodesenvolvimento com dois anos de idade, quando comparamos uso de leite humano de banco e fórmula para prematuros?Descubra em: https://jamanetwork.com/journals/jama/article-abstract/2814657?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jama.2023.27693 2.     Dextrose gel prophylaxis for neonatal hypoglycaemia and neurocognitive function at early school age: a randomised dosage trial - Profilaxia com gel de dextrose para hipoglicemia neonatal e função neurocognitiva em idade escolar precoce: um ensaio clínico randomizado O uso da profilaxia para hipoglicemia utilizando gel de dextrose é capaz de reduzir prejuízos ao desenvolvimento neuropsicomotor?Disponível em: https://fn.bmj.com/content/early/2024/02/12/archdischild-2023-3264523.     Effect of human milk-based fortification in extremely preterm infants fed exclusively with breast milk: a randomized controlled trial - Efeito da fortificação à base de leite humano em prematuros extremos alimentados exclusivamente com leite materno: ensaio clínico randomizado e controladoVale a pena investir no fortificante de leite materno a base de leite humano? Descubra em: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2823%2900552-7 4.     Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins - Estudo randomizado de um novo monitor de função respiratória (Juno) para melhorar a vedação da máscara e a ventilação em manequins neonataisQue a vedação da máscara é importante para a eficácia da VPP na reanimação neonatal não há dúvidas. Esse artigo mostra formas de detectar a vedação e corrigir a técnica em manequins. Disponível em: https://fn.bmj.com/content/early/2024/02/09/archdischild-2023-326256  Não esqueça: você pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1 Se estiver gostando do nosso Podcast, por favor deixe sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. O nosso objetivo é democratizar a informação. Se quiser entrar em contato, nos mandar sugestões, comentários, críticas e elogios, manda um e-mail pra gente: incubadora@the-incubator.org

The Government says it'll roll out randomised roadside drug testing later this year. Legislation's being introduced to allow Police to randomly screen drivers for drugs, similarly to testing for drink-driving. Doing two roadside tests would make false positives less likely. Transport Minister Simeon Brown says it's one of the biggest killers on our road. "In the last 10 years, it's been, I think a third of deaths on our roads have been because of people who've taken drugs and driven. So that is something that we need to do everything we can to reduce." LISTEN ABOVESee omnystudio.com/listener for privacy information.

Leaky gut can't be fixed by diet alone! Gut health is largely affected by a combination of your lifestyle habits and nutrition. If you want to heal a leaky gut, It's important to do these three things DAILY. Watch now! 

Technology supported learning. Read the accompanying article here: https://doi.org/10.1111/medu.15198

Dr. Natalie Scheeler, a naturopathic doctor specializing in integrative treatments for gastrointestinal conditions, shares her perspective and valuable insights on gut health. She discusses the difference between naturopathic doctors and traditional MDs, the use of fecal microbiota transplant (FMT) and Helminthic therapies in treating inflammatory bowel disease (IBD), the impact of food and probiotics on IBD, and trends in flare management and remission. Dr. Scheeler also provides information about her practice, Modrn Med, and offers a final message of hope and encouragement for patients seeking alternative or complementary treatment options. Takeaways Naturopathic doctors focus on preventative medicine and finding the root cause through a whole person approach using integrative treatments that can be used alongside conventional therapies. Fecal microbiota transplant (FMT) and Helminthic therapies are alternative treatments for IBD that show promise in inducing remission and maintaining gut health. Diet plays a significant role in creating a diverse microbiome. Modrn Med is an integrative and functional medicine practice that offers telehealth consultations and works in collaboration with other healthcare providers. There are other treatment options available for patients who have not found success with conventional therapies, and it is important to work with a knowledgeable practitioner to explore these options. Topics covered in the interview Difference Between Naturopathic Doctors (ND) and traditional doctors (MD or DO) Integrative Treatments for Gastrointestinal Conditions Fecal Microbiota Transplant (FMT) Impact of Food and Probiotics on IBD Trends in Flare Management and Remission Helminthic Therapies About Modrn Med From the show Stephanie: What are some of the trends that you've seen with helping people to get out of a flare and into remission? Dr. Scheeler: …the dietary aspect is a large trend I'm seeing I think, too, with social media. There's just the ability to spread so much information and so that is oftentimes how people coming into our office and have said, ‘I've tried these diets' or ‘I've done these diets' versus us kind of introducing them to that idea. So that's interesting. The other one is an herb called Qing Dai. It's a Chinese herb…which is an herb that can be really helpful for inducing remission, typically. We usually reserve it for remission induction versus maintenance therapy because there are some safety risks to that…I would always, always recommend working with a provider who's familiar with that herb…something that is important to say is that natural medicine isn't always safer, and it isn't always safe in general. There is risks associated with any treatments that you do. And so knowing those risks, having somebody who is familiar with those risks is important, especially if you are on the kind of quote-unquote conventional medications and add this stuff in, there could be interactions. Stephanie: Can you talk a little bit about the Modrn Med practice and what types of patients you see? Dr. Scheeler: Yeah, so ModernMed, we are a practice, we are all naturopathic doctors. There's four of us there. And we do integrative and functional medicine. A large part of our practice is gastrointestinal disease, including inflammatory bowel disease. I personally see patients exclusively via telehealth…but there is a location in LA, too, if people are interested. With that, since I do telehealth, I'm licensed in California, Arizona, Maryland, Vermont, and Connecticut, as of now. But all of us depending can either see you as patient if we're licensed in that state or do what we consider educational consults. So with patients who live out of state, we can share some of this information with you and help you do things safely or talk with your provider too…it's very common for us to work with other providers, especially myself working with gastroenterologists. I think when we all work as a team is when we get the best outcomes. And so patients, who may be in a state that we're not licensed in, we're comfortable talking to providers and usually there's no issues with that as long as we explain what we're doing. We always do evidence-based medicine. So as long as we share, even if they're not familiar with it off the bat, most people are open to working together and helping the patient out. Links and studies from the show Modern Med: https://www.modrnmed.com/dr-natalie-scheeler FMT for UC: Nishida A, Inoue R, Inatomi O, Bamba S, Naito Y, Andoh A. Gut microbiota in the pathogenesis of inflammatory bowel disease. Clin J Gastroenterol. 2018;11(1):1-10. doi:10.1007/s12328-017-0813-5 (PMID: 29285689)  FMT for CD: Zhou S, Cui Y, Zhang Y, Zhao T, Cong J. Fecal microbiota transplantation for induction of remission in Crohn's disease: a systematic review and meta-analysis. Int J Colorectal Dis. 2023;38(1):62. Published 2023 Mar 8. doi:10.1007/s00384-023-04354-4 (PMID: 36882658)  Helminthic Therapy in CD (Trichuris suis specific): Schölmerich J, Fellermann K, Seibold FW, et al. A Randomised, Double-blind, Placebo-controlled Trial of Trichuris suis ova in Active Crohn's Disease. J Crohns Colitis. 2017;11(4):390-399. doi:10.1093/ecco-jcc/jjw184 (PMID: 27707789)  Helminthic Therapy in CD (Trichuris suis specific):  Garg SK, Croft AM, Bager P. Helminth therapy (worms) for induction of remission in inflammatory bowel disease. Cochrane Database Syst Rev. 2014;2014(1):CD009400. Published 2014 Jan 20. doi:10.1002/14651858.CD009400.pub2 (PMID: 24442917)  Paper co-written by Dr. Scheeler on Qing Dai (Pronounced "Ching Dye") a.k.a. Indigo Naturalis: https://www.naturalmedicinejournal.com/journal/clinical-application-of-indigo-naturalis Support the podcast ❤️ at https://www.crohnsfitnessfood.com Get your copy of Crohn's Fitness Food and My Rocky Road to Health, Shop my favorite products, Read my favorite books, Subscribe to the podcast, Send a little love/coffee

Leaky gut can get better or worse depending on your diet and health routine. I'll break down how some foods can affect your gut health, and what to incorporate into your diet in order to heal. 

Join Professor Peter Nash from the Griffith University in Brisbane, and Maria Antonietta D'Agostino, the Head of the Rheumatology Department at the Catholic University of the Sacred Heart in Rome, as they discuss her recent paper 'Effects of Secukinumab on Synovitis and Enthesitis in Patients with Psoriatic Arthritis: 52-week Clinical and Ultrasound Results from the Randomised, Double-blind ULTIMATE Trial with Open Label Extension'.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: October 11, 2018 As the name suggests, "evidence-based medicine" is dependent on published evidence to support our clinical practice and medical decision-making. Implicit in this is the notion that all published evidence reflects the truth that underlies the biology, pathophysiology, and pharmacology of our health. This is not the case. Clinical research and published findings can be extremely limited, and what you read in Lancet and NEJM should be interpreted with caution. In this week's episode of the "I wonder" series, where Jim Siegler speaks with Ali Hamedani on various topics in medicine and neurology, the speakers review the major biases inherent to the practice and interpretation of clinical research. Produced by James E Siegler. Music by Jahzzar, Kai Engel, and Lee Rosevere. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Anonymous. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988;2(8607):349-60. PMID 2899772Kazui H, Miyajima M, Mori E, Ishikawa M; SINPHONI-2 Investigators. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. Lancet Neurol 2015;14(6):585-94. PMID 25934242Montalban X, Hauser SL, Kappos L, et al. Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med 2017;376(3):209-20. PMID 28002688Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003;327(7429):1459-61. PMID 14684649 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Pre-Hospital Rule-Out of Non-ST-Segment Elevation Acute Coronary Syndrome by a Single Troponin Measurement: Final One-Year Outcomes of the ARTICA Randomised Trial (AHA 2023)

Needle through the rectum or needle through the skin?? Transrectal vs transperienal prostate biopsy is certainly a hot topic in prostate cancer, with the vast majority of men having their biopsy through the rectum rather than through the skin. It is quick, cheap and easy (for the urologist and the health system), but leaves the patient at risk of serious harm from infectious complications, at least according to historic reports. Today Declan and Renu chat with Dr Jim Hu, Urologist at Cornell University in New York, and leader of the PREVENT trial, a randomised study of transrectal vs transperineal biopsy which has just been published in European Urology. We are also joined by Associate Professor Jeremy Grummet, Urologist at Alfred Health in Melbourne, and long-time advocate of transperineal biopsy. Did this trial finally establish transperineal as the new standard of care for men undergoing prostate biopsy?? Tune in to find out! Even better on our YouTube channelLinks:PREVENT trial in European Urology 

Sustained inflation and chest compression versus 3:1 chest compression to ventilation ratio during cardiopulmonary resuscitation of asphyxiated newborns (SURV1VE): A cluster randomised controlled trial.Schmölzer GM, Pichler G, Solevåg AL, Law BHY, Mitra S, Wagner M, Pfurtscheller D, Yaskina M, Cheung PY; SURV1VE- Trial Investigators.Arch Dis Child Fetal Neonatal Ed. 2024 Jan 11:fetalneonatal-2023-326383. doi: 10.1136/archdischild-2023-326383. Online ahead of print.PMID: 38212104 As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

A new study entitled, “The Efficacy of Palmitoylethanolamide (Levagen+) on the Incidence and Symptoms of Upper Respiratory Tract Infection-A Double Blind, Randomised, Placebo-Controlled Trial” aimed to evaluate the effectiveness of a signaling lipid called Palmitoylethanolamide (PEA) in reducing the occurrence, duration, and severity of upper respiratory tract infections(URTIs). The results showed that participants who took PEA experienced fewer URTI episodes and had reduced symptoms compared to those who took a placebo, suggesting that PEA may be a safe and effective treatment option for URTIs. Palmitoylethanolamide (PEA) is a lipid compound that belongs to the N-acylethanolamine (NAE) family and has similar properties to endocannabinoids. In the context of cold and flu infections, PEA is suggested to regulate interleukins and inhibit mast cell production, thereby reducing inflammation. PEA activates NF-κB pathways through peroxisome proliferator-activated receptors (PPAR), particularly PPAR-α, and concentration-dependent mechanisms to decrease NLRP3 and inflammasome activation, ultimately leading to a decrease in the expression of cytokines and alleviation of upper respiratory tract infection symptoms. It is worth noting that the natural levels of PEA in the body and the use of PEA supplements have been found to be ineffective in producing significant clinical results due to poor absorption, resulting in low levels of PEA in the bloodstream. However, when PEA is combined with dispersion technology, such as Levagen+, the absorption of PEA is greatly improved, leading to higher concentrations in the bloodstream, which may enable a therapeutic effect. This study was conducted over a period of 12 weeks. It was a double-blind, randomized, placebo-controlled trial, where participants were divided into two groups: an active group receiving 300 mg of Levagen+ PEA twice a day and a placebo group receiving maltodextrin. The purpose of the study was to investigate the efficacy of Levagen+ PEA compared to the placebo in terms of the incidence, severity, and duration of upper respiratory tract infections (URTI).   During the study, 87 participants out of the total enrolled experienced at least one URTI, resulting in a total of 103 URTI episodes. The group receiving Levagen+ PEA reported significantly fewer URTI episodes (39) compared to the placebo group (64), and a lower number of participants who fell sick at least once during the study (32 vs. 55) when compared to the placebo group. Participants in the Levagen+ PEA group reported a significantly lower severity score for scratchy throat and cough. Overall, compliance with the study was high for both groups in terms of capsule consumption. The findings of the study indicate that individuals in the Levagen+ PEA group had a significantly lower number of upper respiratory tract infection (URTI) episodes compared to the placebo group. The study suggests that Levagen+ PEA could be a viable treatment for preventing upper respiratory tract infections (URTIs) and alleviating symptoms of cold and flu. The findings indicate that Levagen+ PEA is safe and effective in reducing the frequency of URTI episodes and relieving scratchy throats and coughing in individuals with URTI symptoms. I use PEA Luteolin Select from Moss Nutrition, which contains 300 mg of Levagen+ PEA and 50 mg of the flavonoid luteolin per capsule. PEA and luteolin have been shown to work synergistically in COVID-19-related illnesses such as Long COVID. I have patients take 1 capsule twice a day with meals of PEA Luteolin Select during COVID-19, cold, and flu season for prevention and then increase to 2 capsules three times a day when they feel like they're coming down with something. Hedberg Institute Members can download my latest upper respiratory tract infection protocols by logging in. Click here to learn more about the Hedberg Institute Membership.

There's still a lot we don't understand about the science of leaky gut. Does it cause disease or is it a symptom? What's the best way to test for it? Which treatments actually work to repair it?  Today's guest is one of the best people to begin to answer these questions.  Dr. Camilleri is a renowned gastroenterology researcher and professor at the Mayo Clinic.  Tune in to hear about cutting-edge innovations and informed understandings around leaky gut testing and treatment.  If you have any additional questions you would like answered in the future, let me know in the comments!   Watch/Read Next… What is Leaky Gut: https://drruscio.com/what-is-leaky-gut/  Leaky Gut Suplements: https://drruscio.com/leaky-gut-supplements/  Probiotics for Stomach Issues: https://drruscio.com/probiotics-for-stomach  Learn more about Dr. Camilleri's work: https://www.mayo.edu/research/faculty/camilleri-michael-m-d-d-sc/bio-00026245    Timestamps 00:00 Intro  03:25 Dr. Camilleri's background with leaky gut 05:05 Bile-acid supplementation  07:20 The small intestine  11:07 The prevalence of leaky gut  14:25 Leaky gut & diseases 20:08 Leaky gut & inflammation 30:18 Treatment: Where to start  36:09 Biomarkers of leaky gut 48:53 Leaky gut testing  53:24 Gluten intolerance prevalence  59:52 Food elimination & reintroduction  01:04:47 Prebiotics & FODMAPs 01:15:26 Probiotics   Featured Studies  What to do about the leaky gut: https://pubmed.ncbi.nlm.nih.gov/34509978/ Leaky gut: mechanisms, measurement and clinical implications in humans: https://pubmed.ncbi.nlm.nih.gov/31076401/ Development and Validation of Test for "Leaky Gut" Small Intestinal and Colonic Permeability Using Sugars in Healthy Adults: https://pubmed.ncbi.nlm.nih.gov/33865841/  A case for improved assessment of gut permeability: a meta-analysis quantifying the lactulose:mannitol ratio in coeliac and Crohn's disease: https://pubmed.ncbi.nlm.nih.gov/35012471/  Food Emulsifiers and Metabolic Syndrome: The Role of the Gut Microbiota: https://pubmed.ncbi.nlm.nih.gov/35892789/ Food Additive Emulsifiers and Their Impact on Gut Microbiome, Permeability, and Inflammation: Mechanistic Insights in Inflammatory Bowel Disease: https://pubmed.ncbi.nlm.nih.gov/33336247/ Serum zonulin and its diagnostic performance in non-coeliac gluten sensitivity: https://pubmed.ncbi.nlm.nih.gov/32060130/ Psychological and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome Undergoing a Low-FODMAP Diet: The Role of the Intestinal Barrier: https://pubmed.ncbi.nlm.nih.gov/34371976/  Probiotics fortify intestinal barrier function: a systematic review and meta-analysis of randomized trials: https://pubmed.ncbi.nlm.nih.gov/37168869/  Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome: https://pubmed.ncbi.nlm.nih.gov/30108163/    Get the Latest Updates Facebook - https://www.facebook.com/DrRusciodc Instagram - https://www.instagram.com/drrusciodc/ Pinterest - https://www.pinterest.com/drmichaelrusciodc    DISCLAIMER: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Music featured in this video: "Modern Technology" by Andrew G, https://audiojungle.net/user/andrew_g  *Full transcript available on YouTube by clicking the “Show transcript” button on the bottom right of the video.

Drs Sandhya Srinivas and Tanya B. Dorff discuss metastatic hormone-sensitive prostate cancer, which patients are the best candidates for doublets vs triplets, and how we pick these patients. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988737). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Prostate Cancer https://emedicine.medscape.com/article/1967731-overview Metastatic Hormone-Sensitive Prostate Cancer: Toward an Era of Adaptive and Personalized Treatment https://pubmed.ncbi.nlm.nih.gov/37220335/ Triplet or Doublet Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Updated Network Meta-Analysis Stratified by Disease Volume https://pubmed.ncbi.nlm.nih.gov/37055323/ PSMA PET in Imaging Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35155262/ Risks and Cancer Associations of Metachronous and Synchronous Multiple Primary Cancers: a 25-Year Retrospective Study https://pubmed.ncbi.nlm.nih.gov/34556087/ The Promise of Metastasis-Directed Therapy for Oligometastatic Prostate Cancer: Going Beneath the Surface With Molecular Imaging https://pubmed.ncbi.nlm.nih.gov/35058322/ Gleason Score https://www.ncbi.nlm.nih.gov/books/NBK553178/ Luteinizing Hormone-Releasing Hormone (LHRH) Receptor Agonists Vs Antagonists: a Matter of the Receptors? https://pubmed.ncbi.nlm.nih.gov/23418666/ The Role of CYP17A1 in Prostate Cancer Development: Structure, Function, Mechanism of Action, Genetic Variations and Its Inhibition https://pubmed.ncbi.nlm.nih.gov/29372682/ Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Long-Term Survival Analysis of the Randomized Phase III E3805 CHAARTED Trial https://pubmed.ncbi.nlm.nih.gov/29384722/ Abiraterone for Prostate Cancer Not Previously Treated With Hormone Therapy https://pubmed.ncbi.nlm.nih.gov/28578639/ Abiraterone Plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/28578607/ Health-Related Quality of Life in Metastatic, Hormone-Sensitive Prostate Cancer: ENZAMET (ANZUP 1304), an International, Randomized Phase III Trial Led by ANZUP https://pubmed.ncbi.nlm.nih.gov/34928708/ Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/35179323/ Abiraterone Plus Prednisone Added to Androgen Deprivation Therapy and Docetaxel in De Novo Metastatic Castration-Sensitive Prostate Cancer (PEACE-1): a Multicentre, Open-Label, Randomised, Phase 3 Study With a 2 × 2 Factorial Design https://pubmed.ncbi.nlm.nih.gov/35405085/

In this podcast Dr Sasha Vereecken describes and evaluates the randomised trial of holmium laser vs thulium laser vs bipolar enucleation of large prostate gland. (https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.16174) The aim of the trial is to compare the outcome and morbidity of bipolar transurethral enucleation of the prostate (B-TUEP) and thulium laser enucleation of the prostate (ThuLEP) with those of holmium laser enucleation of the prostate (HoLEP) in the treatment of large symptomatic benign prostatic obstruction (BPO) through a non-inferiority randomised controlled trial (NCT03916536).

We've been using the same MS clinical course descriptors (relapsing-remitting, secondary progressive, and primary progressive) for almost three decades. As research has provided so much additional information and insight, is it time to update the way we describe, diagnose, and treat MS? The International Advisory Committee on Clinical Trials in Multiple Sclerosis has established a working group to explore this question. And, as a means of eliciting feedback from stakeholders around the world, a global survey was launched. The National MS Society's Chief Advocacy, Services, and Science Officer, Dr. Tim Coetzee, joins me to share the results of this survey, which may represent a first step toward delivering next-generation MS care. We're just two days away from the Hispanic/Latinx MS Experience Summit! We'll tell you why you don't want to miss this free online event, and we'll even tell you how to register. We're sharing the results of a study that provides strong evidence for adopting hematopoietic stem cell transplantation (aHSCT) as a standard treatment option for people living with relapsing-remitting MS. And we're sharing evidence from a Phase 3 clinical trial that demonstrates how cognitive behavioral therapy delivered over the internet significantly reduces depressive symptoms and improves the quality of life for people with MS. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: When it comes to adopting a new framework for describing MS, the survey says...  :22 The Hispanic-Latinx MS Experience Summit is just two days away! 2:02 Swedish study shows that autologous hematopoietic stem cell transplantation (aHSCT) is an effective treatment for adults with relapsing-remitting MS   3:41 Phase 3 clinical trial shows that cognitive behavioral therapy delivered over the internet significantly reduces depressive symptoms among people liviing with MS  6:07 Dr. Tim Coetzee shares the results of a global survey that asked whether it's time to update the way we describe, diagnose, and treat MS  9:36 Share this episode  27:21 Have you downloaded the free RealTalk MS app?  27:42 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/319 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com Do the Current MS Clinical Course Descriptors Need to Change and If So, How?: A Survey of the MS Community https://journals.sagepub.com/doi/10.1177/13524585231196786 RealTalk MS Episode 280: How the Proposed Framework for Diagnosing and Treating MS Will Affect You with Dr. Tim Coetzee https://realtalkms.com/280 Register for the Hispanic/Latinx MS Experience Summit https://nationalmssociety.org/Resources-Support/Library-Education-Programs/Hispanic-Latinx-MS-Experience-Summit STUDY: Heaematopoietic Stem Cell Transplantation for Treating Multiple Sclerosis in Sweden: An Observational Cohort Study https://jnnp.bmj.com/content/early/2023/08/14/jnnp-2023-331864 National MS Society Recommendations for aHSCT-Bone Marrow Transplant for MS https://www.nationalmssociety.org/About-the-Society/News/National-MS-Society-Releases-Recommendations-for-a STUDY: Internet-Derived Cognitive Behavioural Therapy Programme to Reduce Depressive Symptoms in Patients with Multiple Sclerosis: A Multicentre, Randomised, Controlled Phase 3 Trial https://sciencedirect.com/science/article/pii/S2589750023001097 Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 319 Guest: Dr. Tim Coetzee Privacy Policy

GO TO https://visit.therippleco.com/barrabruvvas TO GET 15% OFF YOUR ORDER!!!Another draft, another debut. Let us know the performance ratings in the comments. Welcome to Barra Bruvvas.Join the Bruvvahood:https://instagram.com/BarraBruvvashttps://twitter.com/BarraBruvvashttps://www.tiktok.com/@barrabruvvas Hosted on Acast. See acast.com/privacy for more information.

A Rebelião Saudável nasceu da união de diversos profissionais de saúde que pensam diferente e cujo foco é promover saúde e bem estar, com comida de verdade e sem medicamentos. Semanalmente a Rebelião se reune no app Telegram para discussão de tópicos importantes relacionados a Nutrição Humana e Qualidade de vida. Nessa semana, a Rebelião discutiu sobre Manteiga X Margarina. Artigos citados no podcast: Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, Ringel A, Davis JM, Hibbeln JR. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ. 2013 Feb 4;346:e8707. doi: 10.1136/bmj.e8707. Erratum in: BMJ. 2013;346:f903. PMID: 23386268; PMCID: PMC4688426. Khaw KT, Sharp SJ, Finikarides L, Afzal I, Lentjes M, Luben R, Forouhi NG. Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women. BMJ Open. 2018 Mar 6;8(3):e020167. doi: 10.1136/bmjopen-2017-020167. PMID: 29511019; PMCID: PMC5855206. Makhmudova U, Schulze PC, Lütjohann D, Weingärtner O. Phytosterols and Cardiovascular Disease. Curr Atheroscler Rep. 2021 Sep 1;23(11):68. doi: 10.1007/s11883-021-00964-x. PMID: 34468867; PMCID: PMC8410723. DiNicolantonio JJ, O'Keefe JH. Omega-6 vegetable oils as a driver of coronary heart disease: the oxidized linoleic acid hypothesis. Open Heart. 2018 Sep 26;5(2):e000898. doi: 10.1136/openhrt-2018-000898. PMID: 30364556; PMCID: PMC6196963. Ramsden CE, Zamora D, Majchrzak-Hong S, Faurot KR, Broste SK, Frantz RP, Davis JM, Ringel A, Suchindran CM, Hibbeln JR. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). BMJ. 2016 Apr 12;353:i1246. doi: 10.1136/bmj.i1246. PMID: 27071971; PMCID: PMC4836695. Phytosterols may play role in atherosclerosis: https://www.ajmc.com/view/jun04-1804p3# Deol P, Evans JR, Dhahbi J, Chellappa K, Han DS, Spindler S, Sladek FM. Soybean Oil Is More Obesogenic and Diabetogenic than Coconut Oil and Fructose in Mouse: Potential Role for the Liver. PLoS One. 2015 Jul 22;10(7):e0132672. doi: 10.1371/journal.pone.0132672. PMID: 26200659; PMCID: PMC4511588. Dias CB, Wood LG, Garg ML. Effects of dietary saturated and n-6 polyunsaturated fatty acids on the incorporation of long-chain n-3 polyunsaturated fatty acids into blood lipids. Eur J Clin Nutr. 2016 Jul;70(7):812-8. doi: 10.1038/ejcn.2015.213. Epub 2016 Jan 13. PMID: 26757835. Spiteller G. Linoleic acid peroxidation--the dominant lipid peroxidation process in low density lipoprotein--and its relationship to chronic diseases. Chem Phys Lipids. 1998 Oct;95(2):105-62. doi: 10.1016/s0009-3084(98)00091-7. PMID: 9853364. Alvheim AR, Malde MK, Osei-Hyiaman D, Lin YH, Pawlosky RJ, Madsen L, Kristiansen K, Frøyland L, Hibbeln JR. Dietary linoleic acid elevates endogenous 2-AG and anandamide and induces obesity. Obesity (Silver Spring). 2012 Oct;20(10):1984-94. doi: 10.1038/oby.2012.38. Epub 2012 Feb 15. PMID: 22334255; PMCID: PMC3458187. Guyenet SJ, Carlson SE. Increase in adipose tissue linoleic acid of US adults in the last half century. Adv Nutr. 2015 Nov 13;6(6):660-4. doi: 10.3945/an.115.009944. PMID: 26567191; PMCID: PMC4642429. Penzo D, Tagliapietra C, Colonna R, Petronilli V, Bernardi P. Effects of fatty acids on mitochondria: implications for cell death. Biochim Biophys Acta. 2002 Sep 10;1555(1-3):160-5. doi: 10.1016/s0005-2728(02)00272-4. PMID: 12206909. Livros para Pesquisa: SHANAHAN, Catherine. The Fatburn Fix: boost energy, end hunger, and lose weight by using body fat for fuel. New York: Flat Iron Books, 2020. 352 p. TEICHOLZ, Nina. Gordura sem Medo: por que a manteiga, a carne e o queijo devem fazer parte de uma dieta saudável. São Paulo: Wmf Martins Fontes, 2020. 464 p. Você também pode nos acompanhar no instagram, http://www.instagram.com/henriqueautran.

Five years, 7 years, or 10 years: How long should follow-up last in melanoma? Dr Sapna Patel and Professor James Larkin discuss the challenges and opportunities. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/989039). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Malignant Melanoma https://emedicine.medscape.com/article/280245-overview NCCN Guidelines. Melanoma: Cutaneous https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1492 Malignant Melanoma Staging https://emedicine.medscape.com/article/2007147-overview A Practical Guide to Understanding Kaplan-Meier Curves https://pubmed.ncbi.nlm.nih.gov/20723767/ SWOG Cancer Research Network https://www.swog.org/ Adjuvant Pembrolizumab Versus IFNα2b or Ipilimumab in Resected High-Risk Melanoma https://pubmed.ncbi.nlm.nih.gov/34764195/ Long-Term Outcomes With Nivolumab Plus Ipilimumab or Nivolumab Alone Versus Ipilimumab in Patients With Advanced Melanoma https://pubmed.ncbi.nlm.nih.gov/34818112/ Estimands — A Basic Element for Clinical Trials https://pubmed.ncbi.nlm.nih.gov/34857075/ Neoadjuvant-Adjuvant or Adjuvant-Only Pembrolizumab in Advanced Melanoma https://pubmed.ncbi.nlm.nih.gov/36856617/ Definitions of Additional Oncology Drug Endpoints https://www.ncbi.nlm.nih.gov/books/NBK137753/ Adjuvant Nivolumab Versus Ipilimumab in Resected Stage IIIB-C and Stage IV melanoma (CheckMate 238): 4-Year Results From a Multicentre, Double-Blind, Randomised, Controlled, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/32961119/ Adjuvant Ipilimumab Versus Placebo After Complete Resection of High-Risk Stage III Melanoma (EORTC 18071): A Randomised, Double-Blind, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/25840693/ Adjuvant Pembrolizumab Versus Placebo in Resected Stage III Melanoma (EORTC 1325-MG/KEYNOTE-054): Distant Metastasis-Free Survival Results From a Double-Blind, Randomised, Controlled, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/33857412/ Pembrolizumab Versus Placebo as Adjuvant Therapy in Completely Resected Stage IIB or IIC Melanoma (KEYNOTE-716): A Randomised, Double-Blind, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/35367007/ The Validity of Progression-Free Survival 2 as a Surrogate Trial End Point for Overall Survival https://pubmed.ncbi.nlm.nih.gov/34985773/ Neoadjuvant Talimogene Laherparepvec Plus Surgery Versus Surgery Alone for Resectable Stage IIIB-IVM1a Melanoma: A Randomized, Open-Label, Phase 2 Trial https://pubmed.ncbi.nlm.nih.gov/34608333/

Join experts Drs Kevin Kalinsky and Priyanka Sharma as they discuss their current approach to neoadjuvant therapy in triple negative breast cancer and how the SCARLET trial might change that. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/991256). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Pembrolizumab for Early Triple-Negative Breast Cancer https://pubmed.ncbi.nlm.nih.gov/32101663/ Clinical and Biomarker Results of Neoadjuvant Phase II Study of Pembrolizumab and Carboplatin Plus Docetaxel in Triple-Negative Breast Cancer (TNBC) (NeoPACT) https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.16_suppl.513 CALGB 40603 (Alliance): Long-Term Outcomes and Genomic Correlates of Response and Survival After Neoadjuvant Chemotherapy With or Without Carboplatin and Bevacizumab in Triple-Negative Breast Cancer https://pubmed.ncbi.nlm.nih.gov/35044810/ NCCN Guidelines® Insights: Breast Cancer, Version 4.2023 https://pubmed.ncbi.nlm.nih.gov/37308117/ Pembrolizumab vs. Observation in People With Triple-negative Breast Cancer Who Had a Pathologic Complete Response After Chemotherapy Plus Pembrolizumab https://classic.clinicaltrials.gov/ct2/show/NCT05812807 Shorter Chemo-Immunotherapy Without Anthracycline Drugs for Early-Stage Triple Negative Breast Cancer https://clinicaltrials.gov/study/NCT05929768 Neoadjuvant Atezolizumab in Combination With Sequential Nab-Paclitaxel and Anthracycline-Based Chemotherapy Versus Placebo and Chemotherapy in Patients With Early-Stage Triple-Negative Breast Cancer (IMpassion031): A Randomised, Double-Blind, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/32966830/ Adjuvant Capecitabine for Breast Cancer After Preoperative Chemotherapy https://pubmed.ncbi.nlm.nih.gov/28564564/ Impact of Neoadjuvant Chemotherapy on Axillary Nodal Involvement in Patients With Clinically Node Negative Triple Negative Breast Cancer https://pubmed.ncbi.nlm.nih.gov/25266871/ Neoadjuvant Chemotherapy With or Without Anthracyclines in the Presence of Dual HER2 Blockade for HER2-Positive Breast Cancer (TRAIN-2): A Multicentre, Open-Label, Randomised, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/30413379/

Experts Drs Matthew A. Sparks and Dana V. Rizk discuss the pathology, presentation, and management of IgA nephropathy. Looking for the latest on clinical trials and approved treatments? Tune in! Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/991603). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Chronic Kidney Disease (CKD) https://emedicine.medscape.com/article/238798-overview IgA Nephropathy https://emedicine.medscape.com/article/239927-overview Polycystic Kidney Disease https://emedicine.medscape.com/article/244907-overview Biomarkers for IgA Nephropathy on the Basis of Multi-Hit Pathogenesis https://pubmed.ncbi.nlm.nih.gov/29740706/ Galactose-Deficient IgA1 as a Candidate Urinary Marker of IgA Nephropathy https://pubmed.ncbi.nlm.nih.gov/35683557/ Immunological Drivers of IgA Nephropathy: Exploring the Mucosa-Kidney Link https://pubmed.ncbi.nlm.nih.gov/34821031/ Nephrotic Syndrome https://emedicine.medscape.com/article/244631-overview Podocytopathies https://pubmed.ncbi.nlm.nih.gov/32792490/ Minimal-Change Disease https://emedicine.medscape.com/article/243348-overview IgA Vasculitis (Henoch-Schönlein Purpura) https://emedicine.medscape.com/article/984105-overview Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK576405/ Dapagliflozin in Patients With Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/32970396/ Empagliflozin in Patients With Chronic Kidney Disease https://pubmed.ncbi.nlm.nih.gov/36331190/ A Controlled Trial of Fish Oil in IgA Nephropathy. Mayo Nephrology Collaborative Group https://pubmed.ncbi.nlm.nih.gov/7935657/ Fish Consumption, Omega 3 Fatty Acids and Cardiovascular Disease. The Science and the Clinical Trials https://pubmed.ncbi.nlm.nih.gov/19326716/ Tonsillectomy in a European Cohort of 1,147 Patients With IgA Nephropathy https://pubmed.ncbi.nlm.nih.gov/26586175/ Sparsentan in Patients With IgA Nephropathy: A Prespecified Interim Analysis From a Randomised, Double-Blind, Active-Controlled Clinical Trial https://pubmed.ncbi.nlm.nih.gov/37015244/ Intensive Supportive Care Plus Immunosuppression in IgA Nephropathy https://pubmed.ncbi.nlm.nih.gov/26962737/ Effect of Oral Methylprednisolone on Clinical Outcomes in Patients With IgA Nephropathy: The TESTING Randomized Clinical Trial https://pubmed.ncbi.nlm.nih.gov/28763548/ Targeted-Release Budesonide Versus Placebo in Patients With IgA Nephropathy (NEFIGAN): A Double-Blind, Randomised, Placebo-Controlled Phase 2b Trial https://pubmed.ncbi.nlm.nih.gov/28363480/ Results From Part A of the Multi-Center, Double-Blind, Randomized, Placebo-Controlled NefIgArd Trial, Which Evaluated Targeted-Release Formulation of Budesonide for the Treatment of Primary Immunoglobulin A Nephropathy https://pubmed.ncbi.nlm.nih.gov/36270561/ Crescents and IgA Nephropathy: A Delicate Marriage https://pubmed.ncbi.nlm.nih.gov/35806856/ Crescentic, Proliferative IgA Nephropathy: Clinical and Histological Response to Methylprednisolone and Intravenous Cyclophosphamide https://pubmed.ncbi.nlm.nih.gov/12808169/ Hydroxychloroquine Inhibits Macrophage Activation and Attenuates Renal Fibrosis After Ischemia-Reperfusion Injury https://pubmed.ncbi.nlm.nih.gov/33936063/ New Treatment Strategies for IgA Nephropathy: Targeting Plasma Cells as the Main Source of Pathogenic Antibodies https://pubmed.ncbi.nlm.nih.gov/35628935/

Drs Sandhya Srinivas and Heather Cheng discuss PARP inhibitors, clinical trials, and germline vs somatic testing for patients with prostate cancer, as well as the optimal time for this testing. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988734). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Germline Testing in Prostate Cancer: When and Who to Test https://pubmed.ncbi.nlm.nih.gov/34669358/ Germline and Somatic Mutations in Prostate Cancer for the Clinician https://pubmed.ncbi.nlm.nih.gov/31085765/ Genetic and Genomic Testing for Prostate Cancer: Beyond DNA Repair https://pubmed.ncbi.nlm.nih.gov/37207301/ Genome-Wide Association Study of Prostate Cancer-Specific Survival https://pubmed.ncbi.nlm.nih.gov/26307654/ Inherited DNA-Repair Gene Mutations in Men With Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/27433846/ NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Prostate Cancer https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf PARP Inhibitors in Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/37168382/ Rucaparib in Men With Metastatic Castration-Resistant Prostate Cancer Harboring a BRCA1 or BRCA2 Gene Alteration https://pubmed.ncbi.nlm.nih.gov/32795228/ Olaparib for Metastatic Castration-Resistant Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/32343890/ Abiraterone and Olaparib for Metastatic Castration-Resistant Prostate Cancer https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200043 Rucaparib or Physician's Choice in Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/36795891/ FDA Approves Olaparib With Abiraterone and Prednisone (or Prednisolone) for BRCA-Mutated Metastatic Castration-Resistant Prostate Cancer https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-olaparib-abiraterone-and-prednisone-or-prednisolone-brca-mutated-metastatic-castration Niraparib and Abiraterone Acetate for Metastatic Castration-Resistant Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/36952634/ Talazoparib Plus Enzalutamide in Men With First-line Metastatic Castration-Resistant Prostate Cancer (TALAPRO-2): A Randomised, Placebo-Controlled, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/37285865/

Join us as we discuss a randomized controlled trial on the use of glutamine for post-infectious IBS. Very clinically useful information! We also discuss Adam's move and Josh's struggles with the start of the kiddos' school year. Learn more, subscribe, and browse our continuing education courses on https://drjournalclub.com/Zhou Q, Verne ML, Fields JZ, Lefante JJ, Basra S, Salameh H, Verne GN. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019 Jun;68(6):996-1002. doi: 10.1136/gutjnl-2017-315136. Epub 2018 Aug 14. PMID: 30108163; PMCID: PMC9549483.Learn more and become a member at www.DrJournalClub.comCheck out our complete offerings of NANCEAC-approved Continuing Education Courses.

Drs Sapna Patel and David Polsky explore biomarker development and the clinical utilization of liquid biopsy in melanoma. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/989037). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Genomic Profiling of Circulating Tumor DNA From Cerebrospinal Fluid to Guide Clinical Decision Making for Patients With Primary and Metastatic Brain Tumors https://pubmed.ncbi.nlm.nih.gov/33192972/ Digital Droplet PCR in Hematologic Malignancies: A New Useful Molecular Tool https://pubmed.ncbi.nlm.nih.gov/35741115/ Circulating Tumour DNA in Patients With Advanced Melanoma Treated With Dabrafenib or Dabrafenib Plus Trametinib: A Clinical Validation Study https://pubmed.ncbi.nlm.nih.gov/33587894/ Association of Circulating Tumor DNA Kinetics With Disease Recurrence in Patients With Stage IIIB/C/IV Melanoma Treated With Adjuvant Immunotherapy in CheckMate 238 https://meetings.asco.org/abstracts-presentations/220160 Clinical and Molecular Response to Tebentafusp in Previously Treated Patients With Metastatic Uveal Melanoma: A Phase 2 Trial https://pubmed.ncbi.nlm.nih.gov/36229663/ TERT Expression Induces Resistance to BRAF and MEK Inhibitors in BRAF-mutated Melanoma In Vitro https://pubmed.ncbi.nlm.nih.gov/37296851/ Adjuvant Nivolumab Versus Ipilimumab in Resected Stage III/IV Melanoma: 5-year Efficacy and Biomarker Results From CheckMate 238 https://pubmed.ncbi.nlm.nih.gov/37058595/ Adjuvant Therapy of Nivolumab Combined With Ipilimumab Versus Nivolumab Alone in Patients With Resected Stage IIIB-D or Stage IV Melanoma (CheckMate 915) https://pubmed.ncbi.nlm.nih.gov/36162037/ Adjuvant Atezolizumab Versus Observation in Muscle-invasive Urothelial Carcinoma (IMvigor010): A Multicentre, Open-label, Randomised, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/33721560/ ctDNA Guiding Adjuvant Immunotherapy in Urothelial Carcinoma https://pubmed.ncbi.nlm.nih.gov/34135506/ Distant Metastasis-free Survival Results From the Randomized, Phase 2 mRNA-4157-P201/KEYNOTE-942 Trial https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.17_suppl.LBA9503 Melanoma Recurrence Patterns and Management After Adjuvant Targeted Therapy: A Multicentre Analysis https://pubmed.ncbi.nlm.nih.gov/33087895/ From Validity to Clinical Utility: The Influence of Circulating Tumor DNA on Melanoma Patient Management in a Real-world Setting https://pubmed.ncbi.nlm.nih.gov/30113761/ Five-year Analysis of Adjuvant Dabrafenib Plus Trametinib in Stage III Melanoma https://pubmed.ncbi.nlm.nih.gov/32877599/

Drs Michael S. Saag and Rajesh Gandhi discuss HIV and Antiretroviral Therapy Guidelines. When to begin treatment, which treatment to choose, and how to treat the whole person, not just the HIV. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/986509). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources HIV Infection and AIDS https://emedicine.medscape.com/article/211316-overview Zidovudine (Rx) https://reference.medscape.com/drug/retrovir-zdv-zidovudine-342639 ddI and d4T Plus Protease Inhibitors https://pubmed.ncbi.nlm.nih.gov/11364012/ HIV-Protease Inhibitors https://pubmed.ncbi.nlm.nih.gov/9562584/ Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection https://pubmed.ncbi.nlm.nih.gov/26192873/ Early Symptomatic HIV Infection https://reference.medscape.com/article/211873-overview IAS-USA https://www.iasusa.org/ Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel https://pubmed.ncbi.nlm.nih.gov/36454551/ Integrase Strand Transfer Inhibitors Are Effective Anti-HIV Drugs https://pubmed.ncbi.nlm.nih.gov/33572956/ Dolutegravir (Rx) https://reference.medscape.com/drug/tivicay-tivicay-pd-dolutegravir-999861 Bictegravir/Emtricitabine/Tenofovir Alafenamide (Biktarvy) https://www.medscape.com/viewarticle/941921_4 Dolutegravir/Lamivudine as a First-Line Regimen in a Test-and-Treat Setting for Newly Diagnosed People Living With HIV https://pubmed.ncbi.nlm.nih.gov/34115650/ Tenofovir DF (Rx) https://reference.medscape.com/drug/viread-tenofovir-df-342633 Tenofovir AF (Rx) https://reference.medscape.com/drug/vemlidy-tenofovir-af-1000007 Abacavir (Rx) https://reference.medscape.com/drug/ziagen-abacavir-342600 HLA B 5701 Testing https://www.ncbi.nlm.nih.gov/books/NBK560797/ Dolutegravir/Rilpivirine (Rx) https://reference.medscape.com/drug/juluca-dolutegravir-rilpivirine-1000216 Efficacy and Safety of Dolutegravir-Rilpivirine for Maintenance of Virological Suppression in Adults With HIV-1: 100-Week Data From the Randomised, Open-Label, Phase 3 SWORD-1 and SWORD-2 Studies https://pubmed.ncbi.nlm.nih.gov/31307948/ Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) https://clinicalinfo.hiv.gov/en/glossary/non-nucleoside-reverse-transcriptase-inhibitor-nnrti Cabotegravir/Rilpivirine: The Last FDA-Approved Drug to Treat HIV https://pubmed.ncbi.nlm.nih.gov/35596583/ Anticipating and Managing Drug Interactions: Pharmacokinetics of Long-Acting HIV Treatment and Prevention Formulations https://www.medscape.com/viewarticle/986504 Mpox Vaccination Basics https://www.cdc.gov/poxvirus/mpox/vaccines/index.html COVID-19 Treatment Guidelines https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/summary-recommendations/ Mpox in People With Advanced HIV Infection: A Global Case Series https://pubmed.ncbi.nlm.nih.gov/36828001/ Information for Healthcare Providers: Tecovirimat (TPOXX) for Treatment of Mpox https://www.cdc.gov/poxvirus/mpox/clinicians/obtaining-tecovirimat.html HIV and Opioid Use Disorder: Screening Tools, Chronic Pain Management, and Access to Care in the Outpatient Setting https://www.medscape.com/viewarticle/986506

Drs Sandhya Srinivas and Rana R. McKay discuss bone health and survivorship, including risk factors and potential side effects with androgen deprivation therapy in patients with prostate cancer. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988732). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Metastases in Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/29661810/ Do Dietary Calcium and Vitamin D Matter in Men With Prostate Cancer? https://pubmed.ncbi.nlm.nih.gov/29765146/ Zoledronic Acid: A Review of Its Use in the Management of Bone Metastases and Hypercalcaemia of Malignancy https://pubmed.ncbi.nlm.nih.gov/12558465/ Denosumab in Osteoporosis https://pubmed.ncbi.nlm.nih.gov/24289327/ Alpha Emitter Radium-223 and Survival in Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/23863050/ Effect of Longer-Interval vs Standard Dosing of Zoledronic Acid on Skeletal Events in Patients With Bone Metastases: A Randomized Clinical Trial https://pubmed.ncbi.nlm.nih.gov/28030702/ The Prevention of Fragility Fractures in Patients With Non-Metastatic Prostate Cancer: A Position Statement by the International Osteoporosis Foundation https://pubmed.ncbi.nlm.nih.gov/29088899/ Decreased Fracture Rate by Mandating Bone Protecting Agents in the EORTC 1333/PEACEIII Trial Combining Ra223 With Enzalutamide Versus Enzalutamide Alone: An Updated Safety Analysis. https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.5002 Addition of Radium-223 to Abiraterone Acetate and Prednisone or Prednisolone in Patients With Castration-Resistant Prostate Cancer and Bone Metastases (ERA 223): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/30738780/

Drs Sandhya Srinivas and Shilpa Gupta discuss castration-resistant prostate cancer and the sequence, method of therapy, and specific patient populations in which these drugs will be most effective. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/988733). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Prostate Cancer. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf Patient-Reported Outcomes Following Enzalutamide or Placebo in Men With Non-Metastatic, Castration-Resistant Prostate Cancer (PROSPER): A Multicentre, Randomised, Double-Blind, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/30770294/ Apalutamide and Overall Survival in Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/32907777/ Darolutamide in Nonmetastatic, Castration-Resistant Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/30763142/ Long-term Safety and Tolerability of Darolutamide and Duration of Treatment in Patients With Nonmetastatic Castration-Resistant Prostate Cancer (nmCRPC) From the ARAMIS Rollover Study. https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.6_suppl.147 Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Long-Term Survival Analysis of the Randomized Phase III E3805 CHAARTED Trial https://pubmed.ncbi.nlm.nih.gov/29384722/ An International Prospective Open-label, Randomized, Phase III Study Comparing 177Lu-PSMA-617 in Combination With SoC, Versus SoC Alone, in Adult Male Patients With mHSPC (PSMAddition) https://clinicaltrials.gov/ct2/show/NCT04720157 Cabazitaxel versus Abiraterone or Enzalutamide in Metastatic Prostate Cancer https://pubmed.ncbi.nlm.nih.gov/31566937/ Lutetium Lu 177 Vipivotide Tetraxetan: First Approval https://pubmed.ncbi.nlm.nih.gov/35553387/

Join Drs Amelia Langston and Loretta Nastoupil as they discuss current CAR T-cell therapy for B-cell lymphomas as leading researchers and practitioners in the field. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/987068). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Axicabtagene Ciloleucel CAR T-cell Therapy in Refractory Large B-cell Lymphoma https://pubmed.ncbi.nlm.nih.gov/29226797/ Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-cell Lymphoma https://pubmed.ncbi.nlm.nih.gov/30501490/ Lisocabtagene Maraleucel for Patients With Relapsed or Refractory Large B-cell Lymphomas (TRANSCEND NHL 001): A Multicentre Seamless Design Study https://pubmed.ncbi.nlm.nih.gov/32888407/ Axicabtagene Ciloleucel as Second-line Therapy for Large B-cell Lymphoma https://pubmed.ncbi.nlm.nih.gov/34891224/ Lisocabtagene Maraleucel Versus Standard of Care With Salvage Chemotherapy Followed by Autologous Stem Cell Transplantation as Second-line Treatment in Patients With Relapsed or Refractory Large B-cell Lymphoma (TRANSFORM): Results From an Interim Analysis of an Open-label, Randomised, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/35717989/ Second-line Tisagenlecleucel or Standard Care in Aggressive B-cell Lymphoma https://pubmed.ncbi.nlm.nih.gov/34904798/ KTE-X19 CAR T-cell Therapy in Relapsed or Refractory Mantle-cell Lymphoma https://pubmed.ncbi.nlm.nih.gov/32242358/ Axicabtagene Ciloleucel in Relapsed or Refractory Indolent Non-Hodgkin Lymphoma (ZUMA-5): A Single-arm, Multicentre, Phase 2 Trial https://pubmed.ncbi.nlm.nih.gov/34895487/ Study to Compare Axicabtagene Ciloleucel With Standard of Care Therapy as First-line Treatment in Participants With High-risk Large B-cell Lymphoma (ZUMA-23) https://clinicaltrials.gov/ct2/show/NCT05605899 Axicabtagene Ciloleucel in the Management of Follicular Lymphoma: Current Perspectives on Clinical Utility, Patient Selection and Reported Outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122857/

Drs. Nick Strasser and Joe Park co-host this conversation with award winner Andrew J. Goldberg, OBE, MD, FRCS(Tr&Orth). This paper was presented live at the 2022 AOFAS Annual Meeting in Quebec City. For additional educational resources, visit: https://aofas.org Looking for CME? AOFAS Podcast CME only on the ConveyMED Podcast App: Apple Store click here Google Play click here

Drs Stanley Cohen and Philip Mease review the 2022 ACR meeting topics, including new treatments, trial data, and what they think are the most pressing unmet needs in the field. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984271). The topics and discussions are planned, produced, and reviewed independently of the advertisers. This podcast is intended only for US healthcare professionals. Resources Etanercept in the Treatment of Psoriatic Arthritis and Psoriasis: A Randomised Trial https://pubmed.ncbi.nlm.nih.gov/10972371/ Group for Research and Assessment of Psoriasis and Psoriatic Arthritis https://www.grappanetwork.org/ American College of Rheumatology (ACR) Convergence https://www.rheumatology.org/Annual-Meeting Bimekizumab Treatment in Biologic DMARD-Naïve Patients With Active Psoriatic Arthritis: 52-Week Efficacy and Safety Results From a Phase 3, Randomized, Placebo-Controlled, Active Reference Study https://acrabstracts.org/abstract/bimekizumab-treatment-in-biologic-dmard-naive-patients-with-active-psoriatic-arthritis-52-week-efficacy-and-safety-results-from-a-phase-3-randomized-placebo-controlled-active-reference-study/ Bimekizumab Treatment in Patients With Active Psoriatic Arthritis and Inadequate Response to Tumor Necrosis Factor Inhibitors: 16-Week Efficacy and Safety From a Phase 3, Randomized, Double-Blind, Placebo-Controlled Study https://acrabstracts.org/abstract/bimekizumab-treatment-in-patients-with-active-psoriatic-arthritis-and-inadequate-response-to-tumor-necrosis-factor-inhibitors-16-week-efficacy-and-safety-from-a-phase-3-randomized-double-blind-pla/ Bimekizumab Improvements in Efficacy on Disease Activity Assessed via Composite Endpoints in Biologic DMARD-Naïve and TNFi-IR Patients With Active PsA: Pooled 16-Week Results From Phase 3 Randomized, Placebo-Controlled Studies https://acrabstracts.org/abstract/bimekizumab-improvements-in-efficacy-on-disease-activity-assessed-via-composite-endpoints-in-biologic-dmard-naive-and-tnfi-ir-patients-with-active-psa-pooled-16-week-results-from-phase-3-randomized/ Bimekizumab Versus Adalimumab in Plaque Psoriasis https://pubmed.ncbi.nlm.nih.gov/33891379/ A Head-to-Head Comparison of the Efficacy and Safety of Ixekizumab and Adalimumab in Biological-Naïve Patients With Active Psoriatic Arthritis: 24-Week Results of a Randomised, Open-Label, Blinded-Assessor Trial https://pubmed.ncbi.nlm.nih.gov/31563894/ GRAPPA Treatment Recommendations: 2021 Update https://pubmed.ncbi.nlm.nih.gov/35293339/ Deucravacitinib Prescribing Information https://packageinserts.bms.com/pi/pi_sotyktu.pdf Safety and Efficacy of Deucravacitinib, an Oral, Selective Tyrosine Kinase 2 Inhibitor, in Patients With Psoriatic Arthritis: 52-Week Results From a Randomized Phase 2 Trial https://acrabstracts.org/abstract/safety-and-efficacy-of-deucravacitinib-an-oral-selective-tyrosine-kinase-2-inhibitor-in-patients-with-psoriatic-arthritis-52-week-results-from-a-randomized-phase-2-trial/ Deucravacitinib Reduces Interferons, B Cell Pathways, and Serological Biomarkers of Systemic Lupus Disease Activity: Pharmacodynamic Analysis From the Phase 2 PAISLEY Study https://acrabstracts.org/abstract/deucravacitinib-reduces-interferons-b-cell-pathways-and-serological-biomarkers-of-systemic-lupus-disease-activity-pharmacodynamic-analysis-from-the-phase-2-paisley-study/ Nanobody: A Promising Toolkit for Molecular Imaging and Disease Therapy https://pubmed.ncbi.nlm.nih.gov/33464410/

This piece focuses upon the “REMAP-CAP” trial; A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia. It's a wide ranging discussion which looks behind the headlines of this fascinating piece of research. Their website is here: https://www.remapcap.org/ In the podcast you will hear Monty Mythen speaking with Steve Webb, Professor of Critical Care Research at Monash University, Director of Research for St John of God Healthcare, and a ICU consultant at St John of God Subiaco and the Mount Hospital and Doug Campbell, Anaesthetic specialist at Auckland City Hospital.

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/125/

Wendy Walrabenstein is a lecturer at the Amsterdam University of Applied Science on Nutrition and Dietetics. She is one of the two lead researchers on a recently completed study on the impact of a plant-based diet for rheumatoid arthritis patients called the Plants For Joints Study, conducted in the Netherlands, and today we talk with her about some very interesting findings. For the transcription and for more helpful information visit http://www.rheumatoidsolutions.com

A conversation with Stephan van Vliet, assistant professor of nutrition studies at the Center for Human Nutrition Studies at Utah State University, about nutrient density food, human health and the world's first randomized clinical trial of 14 weeks comparing a whole diet of supermarket food vs food grown using agro-ecological and regenerative practices.This episode is part of the Nutrient Density in Food series!This series is supported by the A Team Foundation, who support food and land projects that are ecologically, economically and socially conscious. They contribute to the wider movement that envisions a future where real food is produced by enlightened agriculture and access to it is equal. The A Team are looking to make more investments and grants in the space of bionutrients. You can find out more on ateamfoundation.org.---------------------------------------------------Join our Gumroad community, discover the tiers and benefits on www.gumroad.com/investinginregenag. Support our work:Share itGive a 5-star ratingBuy us a coffee… or a meal! www.Ko-fi.com/regenerativeagriculture----------------------------------------------------Stephan van Vliet is one of the leaders in the scientific world when it comes to measuring nutrient density and connecting that to soil health and importantly human health.More about this episode on https://investinginregenerativeagriculture.com/stephan-van-vliet.Find our video course on https://investinginregenerativeagriculture.com/course.----------------------------------------------------The above references an opinion and is for information and educational purposes only. It is not intended to be investment advice. Seek a duly licensed professional for investment advice. Support the showFeedback, ideas, suggestions? - Twitter @KoenvanSeijen - Get in touch www.investinginregenerativeagriculture.comJoin our newsletter on www.eepurl.com/cxU33P! Support the showThanks for listening and sharing!

ReferencesWe considered the effect of a high protein diet and potential metabolic acidosis on kidney function. This review is of interest by Donald Wesson, a champion for addressing this issue and limiting animal protein: Mechanisms of Metabolic Acidosis-Induced Kidney Injury in Chronic Kidney DiseaseHostetter explored the effect of a high protein diet in the remnant kidney model with 1 ¾ nephrectomy. Rats with reduced dietary acid load (by bicarbonate supplementation) had less tubular damage. Chronic effects of dietary protein in the rat with intact and reduced renal massWesson explored treatment of metabolic acidosis in humans with stage 3 CKD in this study. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rateIn addition to the effect of metabolic acidosis from a diet high in animal protein, this diet also leads to hyperfiltration. This was demonstrated in normal subjects; ingesting a protein diet had a significantly higher creatinine clearance than a comparable group of normal subjects ingesting a vegetarian diet. Renal functional reserve in humans: Effect of protein intake on glomerular filtration rate.This finding has been implicated in Brenner's theory regarding hyperfiltration: The hyperfiltration theory: a paradigm shift in nephrologyOne of multiple publications from Dr. Nimrat Goraya whom Joel mentioned in the voice over: Dietary Protein as Kidney Protection: Quality or Quantity?We wondered about the time course in buffering a high protein meal (and its subsequent acid load on ventilation) and Amy found this report:Effect of Protein Intake on Ventilatory Drive | Anesthesiology | American Society of Anesthesiologists Roger mentioned that the need for acetate to balance the acid from amino acids in parenteral nutrition was identified in pediatrics perhaps because infants may have reduced ability to generate acid. Randomised controlled trial of acetate in preterm neonates receiving parenteral nutrition - PMCHe also recommended an excellent review on the complications of parenteral nutrition by Knochel https://www.kidney-international.org/action/showPdf?pii=S0085-2538%2815%2933384-6 which explained that when the infused amino acids disproportionately include cationic amino acids, metabolism led to H+ production. This is typically mitigated by preparing a solution that is balanced by acetate. Amy mentioned this study that explored the effect of protein intake on ventilation: Effect of Protein Intake on Ventilatory Drive | Anesthesiology | American Society of AnesthesiologistsAnna and Amy reminisced about a Skeleton Key Group Case from the renal fellow network Skeleton Key Group: Electrolyte Case #7JC wondered about isolated defects in the proximal tubule and an example is found here: Mutations in SLC4A4 cause permanent isolated proximal renal tubular acidosis with ocular abnormalitiesAnna's Voiceover re: Gastric neobladder → metabolic alkalosis and yes, dysuria. The physiology of gastrocystoplasty: once a stomach, always a stomach but not as common as you might think Gastrocystoplasty: long-term complications in 22 patientsSjögren's syndrome has been associated with acquired distal RTA and in some cases, an absence of the H+ ATPase, presumably from autoantibodies to this transporter. Here's a case report: Absence of H(+)-ATPase in cortical collecting tubules of a patient with Sjogren's syndrome and distal renal tubular acidosisCan't get enough disequilibrium pH? Check this out- Spontaneous luminal disequilibrium pH in S3 proximal tubules. Role in ammonia and bicarbonate transport.Acetazolamide secretion was studied in this report Concentration-dependent tubular secretion of acetazolamide and its inhibition by salicylic acid in the isolated perfused rat kidney. | Drug Metabolism & DispositionIn this excellent review, David Goldfarb tackles the challenging case of a A Woman with Recurrent Calcium Phosphate Kidney Stones (spoiler alert, many of these patients have incomplete distal RTA and this problem is hard to treat). Molecular mechanisms of renal ammonia transport excellent review from David Winer and Lee Hamm. OutlineOutline: Chapter 11- Regulation of Acid-Base Balance- Introduction - Bicarb plus a proton in equilibrium with CO2 and water - Can be rearranged to HH - Importance of regulating pCO2 and HCO3 outside of this equation - Metabolism of carbs and fats results in the production of 15,000 mmol of CO2 per day - Metabolism of protein and other “substances” generates non-carbonic acids and bases - Mostly from sulfur containing methionine and cysteine - And cationic arginine and lysine - Hydrolysis of dietary phosphate that exists and H2PO4– - Source of base/alkali - Metabolism of an ionic amino acids - Glutamate and asparatate - Organic anions going through gluconeogenesis - Glutamate, Citrate and lactate - Net effect on a normal western diet 50-100 mEq of H+ per day - Homeostatic response to these acid-base loads has three stages: - Chemical buffering - Changes in ventilation - Changes in H+ excretion - Example of H2SO4 from oxidation of sulfur containing AA - Drop in bicarb will stimulate renal acid secretion - Nice table of normal cid-base values, arterial and venous- Great 6 bullet points of acid-base on page 328 - Kidneys must excrete 50-100 of non-carbonic acid daily - This occurs by H secretion, but mechanisms change by area of nephron - Not excreted as free H+ due to minimal urine pH being equivalent to 0.05 mmol/L - No H+ can be excreted until virtually all of th filtered bicarb is reabsorbed - Secreted H+ must bind buffers (phosphate, NH3, cr) - PH is main stimulus for H secretion, though K, aldo and volume can affect this.- Renal Hydrogen excretion - Critical to understand that loss of bicarb is like addition of hydrogen to the body - So all bicarb must be reabsorbed before dietary H load can be secreted - GFR of 125 and bicarb of 24 results in 4300 mEq of bicarb to be reabsorbed daily - Reabsorption of bicarb and secretion of H involve H secretion from tubular cells into the lumen. - Thee initial points need to be emphasized - Secreted H+ ion are generated from dissociation of H2O - Also creates OH ion - Which combine with CO2 to form HCO3 with the help of zinc containing intracellular carbonic anhydrase. - This is how the secretion of H+ which creates an OH ultimately produces HCO3 - Different mechanisms for proximal and distal acidification - NET ACID EXCRETION - Free H+ is negligible - So net H+ is TA + NH4 – HCO3 loss - Unusually equal to net H+ load, 50-100 mEq/day - Can bump up to 300 mEq/day if acid production is increased - Net acid excretion can go negative following a bicarb or citrate load - Proximal Acidification - Na-H antiporter (or exchanger) in luminal membrane - Basolateral membrane has a 3 HCO3 Na cotransporter - This is electrogenic with 3 anions going out and only one cation - The Na-H antiporter also works in the thick ascending limb of LOH - How about this, there is also a H-ATPase just like found in the intercalated cells in the proximal tubule and is responsible for about a third of H secretion - And similarly there is also. HCO3 Cl exchanger (pendrin-like) in the proximal tubule - Footnote says the Na- 3HCO3 cotransporter (which moves sodium against chemical gradient NS uses negative charge inside cell to power it) is important for sensing acid-base changes in the cell. - Distal acidification - Occurs in intercalated cells of of cortical and medullary collecting tubule - Three main characteristics - H secretion via active secretory pumps in the luminal membrane - Both H-ATPase and H-K ATPase - H- K ATPase is an exchange pump, k reabsorption - H-K exchange may be more important in hypokalemia rather than in acid-base balance - Whole paragraph on how a Na-H exchanger couldn't work because the gradient that H has to be pumped up is too big. - H-ATPase work like vasopressin with premise H-ATPase sitting on endocarditis vesicles a=which are then inserted into the membrane. Alkalosis causes them to be recycled out of the membrane. - H secretory cells do not transport Na since they have few luminal Na channels, but are assisted by the lumen negative tubule from eNaC. - Minimizes back diffusion of H+ and promotes bicarb resorption - Bicarbonate leaves the cell through HCO3-Cl exchanger which uses the low intracellular Cl concentration to power this process. - Same molecule is found on RBC where it is called band 3 protein - Figure 11-5 is interesting - Bicarbonate resorption - 90% in the first 1-22 mm of the proximal tubule (how long is the proximal tubule?) - Lots of Na-H exchangers and I handed permeability to HCO3 (permeability where?) - Last 10% happens distally mostly TAL LOH via Na-H exchange - And the last little bit int he outer medullary collecting duct. - Carbonic anhydrase and disequilibrium pH - CA plays central role in HCO3 reabsorption - After H is secreted in the proximal tubule it combines with HCO# to form carbonic acid. CA then dehydrates it to CO2 and H2O. (Step 2) - Constantly moving carbonic acid to CO2 and H2O keeps hydrogen combining with HCO3 since the product is rapidly consumed. - This can be demonstrated by the minimal fall in luminal pH - That is important so there is not a luminal gradient for H to overcome in the Na-H exchanger (this is why we need a H-ATPase later) - CA inhibitors that are limited tot he extracellular compartment can impair HCO3 reabsorption by 80%. - CA is found in S1, S2 but not S3 segment. See consequence in figure 11-6. - The disequilibrium comes from areas where there is no CA, the HH formula falls down because one of the assumptions of that formula is that H2CO3 (carbonic acid) is a transient actor, but without CA it is not and can accumulate, so the pKa is not 6.1. - Bicarbonate secretion - Type B intercalated cells - H-ATPase polarity reversed - HCO3 Cl exchanger faces the apical rather than basolateral membrane- Titratable acidity - Weak acids are filtered at the glom and act as buffers in the urine. - HPO4 has PKA of 6.8 making it ideal - Creatinine (pKa 4.97) and uric acid (pKa 5.75) also contribute - Under normal cinditions TA buffers 10-40 mEa of H per day - Does an example of HPO4(2-):H2PO4 (1-) which exists 4:1 at pH of 7.4 (glomerular filtrate) - So for 50 mEq of Phos 40 is HPO4 and 10 is H2PO4 - When pH drops to 6.8 then the ratio is 1:1 so for 50 - So the 50 mEq is 25 and 25, so this buffered an additional 15 mEq of H while the free H+ concentration increased from 40 to 160 nanomol/L so over 99.99% of secreted H was buffered - When pH drops to 4.8 ratio is 1:100 so almost all 50 mEq of phos is H2PO4 and 39.5 mEq of H are buffered. - Acid loading decreases phosphate reabsorption so more is there to act as TA. - Decreases activity of Na-phosphate cotransporter - DKA provides a novel weak acid/buffer beta-hydroxybutyrate (pKa 4.8) which buffers significant amount of acid (50 mEq/d).- Ammonium Excretion - Ability to excrete H+ as ammonium ions adds an important amount of flexibility to renal acid-base regulation - NH3 and NH4 production and excretion can be varied according to physiologic need. - Starts with NH3 production in tubular cells - NH3, since it is neutral then diffuses into the tubule where it is acidified by the low pH to NH4+ - NH4+ is ionized and cannot cross back into the tubule cells(it is trapped in the tubular fluid) - This is important for it acting as an important buffer eve though the pKa is 9.0 - At pH of 6.0 the ratio of NH3 to NH4 is 1:1000 - As the neutral NH3 is converted to NH4 more NH3 from theintracellular compartment flows into the tubular fluid replacing the lost NH3. Rinse wash repeat. - This is an over simplification and that there are threemajor steps - NH4 is produced in early proximal tubular cells - Luminal NH4 is partially reabsorbed in the TAL and theNH3 is then recycled within the renal medulla - The medullary interstitial NH3 reaches highconcentrations that allow NH3 to diffuse into the tubular lumen in the medullary collecting tubule where it is trapped as NH4 by secreted H+ - NH4 production from Glutamine which converts to NH4 and glutamate - Glutamate is converted to alpha-ketoglutarate - Alpha ketoglutarate is converted to 2 HCO3 ions - HCO3 sent to systemic circulation by Na-3 HCO3 transporter - NH4 then secreted via Na-H exchanger into the lumen - NH4 is then reabsorbed by NaK2Cl transporter in TAL - NH4 substitutes for K - Once reabsorbed the higher intracellular pH causes NH4 to convert to NH3 and the H that is removed is secreted through Na-H exchanger to scavenge the last of the filtered bicarb. - NH3 diffuses out of the tubular cells into the interstitium - NH4 reabsorption in the TAL is suppressed by hyperkalemia and stimulated by chronic metabolic acidosis - NH4 recycling promotes acid clearance - The collecting tubule has a very low NH3 concentration - This promotes diffusion of NH3 into the collecting duct - NH3 that goes there is rapidly converted to NH4 allowing more NH3 to diffuse in. - Response to changes in pH - Increased ammonium excretion with two processes - Increased proximal NH4 production - This is delayed 24 hours to 2-3 days depending on which enzyme you look at - Decreased urine pH increases diffusion of ammonia into the MCD - Occurs with in hours of an acid load - Peak ammonium excretion takes 5-6 days! (Fig 11-10) - Glutamine is picked up from tubular fluid but with acidosis get Na dependent peritublar capillary glutamine scavenging too - Glutamine metabolism is pH dependent with increase with academia and decrease with alkalemia - NH4 excretion can go from 30-40 mEq/day to > 300 with severe metabolic acidosis (38 NaBicarb tabs) - Says each NH4 produces equimolar generation of HCO3 but I thought it was two bicarb for every alpha ketoglutarate?- The importance of urine pH - Though the total amount of hydrogren cleared by urine pH is insignificant, an acidic urine pH is essential for driving the reactions of TA and NH4 forward.- Regulation of renal hydrogen excretion - Net acid excretion vary inverse with extracellular pH - Academia triggers proximal and distal acidification - Proximally this: - Increased Na-H exchange - Increased luminal H-ATPase activity - Increased Na:3HCO3 cotransporter on the basolateral membrane - Increased NH4 production from glutamine - In the collecting tubules - Increased H-ATPase - Reduction of tubular pH promotes diffusion of NH3 which gets converted to NH4…ION TRAPPING - Extracellular pH affects net acid excretion through its affect on intracellular pH - This happens directly with respiratory disorders due to movement of CO2 through the lipid bilayer - In metabolic disorders a low extracellular bicarb with cause bicarb to diffuse out of the cell passively, this lowers intracellular pH - If you manipulate both low pCO2 and low Bicarb to keep pH stable there will be no change in the intracellular pH and there is no change in renal handling of acid. It is intracellular pH dependent - Metabolic acidosis - Ramps up net acid secretion - Starts within 24 hours and peaks after 5-6 days - Increase net secretion comes from NH4 - Phosphate is generally limited by diet - in DKA titratable acid can be ramped up - Metabolic alkalosis - Alkaline extracellular pH - Increased bicarb excretion - Decrease reabsorption - HCO3 secretion (pendrin) in cortical collecting tubule - Occurs in cortical intercalated cells able to insert H-ATPase in basolateral cells (rather than luminal membrane) - Normal subjects are able to secrete 1000 mmol/day of bicarb - Maintenance of metabolic alkalosis requires a defect which forces the renal resorption of bicarb - This can be chloride/volume deficiency - Hypokalemia - Hyperaldosteronism - Respiratory acidosis and alkalosis - PCO2 via its effect on intracellular pH is an important determinant of renal acid handling - Ratios he uses: - 3.5 per 10 for respiratory acidosis - 5 per 10 for respiratory alkalosis - Interesting paragraph contrasting the response to chronic metabolic acidosis vs chronic respiratory acidosis - Less urinary ammonium in respiratory acidosis - Major differences in proximal tubule cell pH - In metabolic acidosis there is decreased bicarb load so less to be reabsorbed proximally - In respiratory acidosis the increased serum bicarb increases the amount of bicarb that must be reabsorbed proximally - The increased activity of Na-H antiporter returns tubular cell pH to normal and prevents it from creating increased urinary ammonium - Mentions that weirdly more mRNA for H-Na antiporter in metabolic acidosis than in respiratory acidosis - Net hydrogen excretion varies with effective circulating volume - Starts with bicarb infusions - Normally Tm at 26 - But if you volume deplete the patient with diuretics first this increases to 35+ - Four factors explain this increased Tm for bicarb with volume deficiency - Reduced GFR - Activation of RAAS - Ang2 stim H-Na antiporter proximally - Ang2 also stimulates Na-3HCO3 cotransporter on basolateral membrane - Aldosterone stimulates H-ATPase in distal nephron - ALdo stimulates Cl HCO3 exchanger on basolateral membrane - Aldo stimulates eNaC producing tubular lumen negative charge to allow H secretion to occur and prevents back diffusion - Hypochloremia - Increases H secretion by both Na-dependent and Na-independent methods - If Na is 140 and Cl is 115, only 115 of Na can be reabsorbed as NaCl, the remainder must be reabsorbed with HCO3 or associated with secretion of K or H to maintained electro neutrality - This is enhanced with hypochloridemia - Concurrent hypokalemia - Changes in K lead to trans cellular shifts that affect inctracellular pH - Hypokalemia causes K out, H in and in the tubular cell the cell acts if there is systemic acidosis and increases H secretion (and bicarbonate resorption) - PTH - Decreases proximal HCO3 resorption - Primary HyperCard as cause of type 2 RTA - Does acidosis stim PTH or does PTH stim net acid excretion

This podcast, Dr. Lucas Dingman and Dr. Cady Welch, emergency medicine physicians with EMPAC and Ridgeview, discuss six articles on various topics related to emergency medicine, as part of this first ED journal review. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify emergency medicine journal articles that may be potentially practice-changing Describe how to rule out a pulmonary embolism (PE) in the emergency department using the YEARS criteria and age adjusted d-dimer. Differentiate when antibiotics for treating diverticulitis is warranted. Describe the benefits of using a small percutaneous catheter chest tube for treating a traumatic hemothorax. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  Study #1: Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study) A Multicentre, Randomised, Open-label, Noninferiority Trial - DINAMO study & diverticulitis - Multicenter, randomized, open label, non-inferiority trial (Nov.2016 - Jan.2020) - 480 randomized participants  and put into two groups - Results: admission to hospitals, ED revisits, no complications, no major significant findings - Nonantibiotic outpatient treatment of mild acute diverticulitis is safe and effective and is not inferior to current standard treatment. Study #2: Anterior–Lateral Versus Anterior–Posterior Electrode Position for Cardioverting Atrial Fibrillation - EPIC Atrial Fibrilation ( EPIC AF) - Two positions for pad placement for cardioverting patients - Multicenter, randomized, open label trial - 467 randomized patients, scheduled for elective cardioversion - Results: 50% successful conversion to normal sinus rhythm after one biphasic shock, many patients needed multiple shocks to cardioconvert (4-5 shocks). - AHA Guidelines: pad placement for AF and VF, treatment recommendations - Anterior-lateral electrode positioning was more effective than anterior-posterior electrode positioning for biphasic cardioversion of atrial fibrillation. There were no significant differences in any safety outcome. Study #3: The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial - Poiseuille's law and chest tubes - and involves components of rate of flow, radius of the tube, change in pressure and viscosity. - 120 participants - 8 years and older, traumatic hemothorax or pneumothorax, hemodynamically stable patient only - Treatment arm: 14 Fr cook catheter used (seldinger techique, anterior axillary or midaxillary line) - Control arm: 28-32 Fr. chest tube placed (standard way - 4th-5th intercostal, midaxillary line) - Results: Failure rate of the tube, repeat hemothorax requiring intervention, drainage outputs at different designated times, total chest tube days, insertion complications, ventilator days, ICU length of days, hospital length of stay - Patients had better experience with percutaneous catheter - Hemlich valve - Study discussed looks specifically at hemothoraces which require drainage of blood and chest tubes connected to traditional pleuro vac chamber - Small caliber 14 Fr PCs are equally as effective as 28- to 32-Fr chest tubes in their ability to drain traumatic HTX with no difference in complications. Patients reported better IPE scores with PCs over chest tubes, suggesting that PCs are better tolerated. Study #4: Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial - ScienceDirect - Single center, placebo controlled, blinded, randomized trial - Sample: 120 healthy adults, median age 40 years old presenting to ED with chief complaint of nausea/vomiting -  Change in nausea score at 30 min. (drop in mm on VAS) - Mean nausea baseline = 50 - Limitations: fairly young healthy participants, difficult to blind (can smell difference) - Among ED patients with acute nausea and not requiring immediate IV access, aromatherapy with or without ondansetron provides greater nausea relief than oral ondansetron alone. Study #5: Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial - YEARS criteria with age adjusted vs only age adjusted - Cluster, randomized, crossover, non-inferiority trial to determine if YEARS plus age-adjusted could be used to rule out PE, age 18 or older, not pregnant - Sample size: 1414 patients within 18 EDs, PERC positive - Outcome: PE diagnosed in 100 patients, no missed PEs with patients with YEARS score of "0", - Among ED patients with suspected PE, the use of the YEARS rule combined with the age-adjusted D-dimer threshold in PERC-positive patients, compared with a concential diagnostic strategy, did not result in an inferior rate of thromboembolic events. Study #6: Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial - Randomized, single masked study (providers were masked), controlled clinical trial, non-inferiority study design, single center study - Participants: children - aged 8 weeks to 3 years, moderately dehydrated (dehydration score greater than 3, but less than 7) - Outcomes: Successful rehydration at 4 hours, hospitalization rate, time to initiation of treatment, repeat ED visits within 72 hrs -Results: no difference between the groups with succesful rehydration at 4 hours - Limitations: small sample size - Oral rehydration therapy (ORT) is as good as intravenous fluid therapy (IVF) in rehydration of moderately dehydration children due to gastroenteritis. In addition, the study found that less time was required to intiate ORT when compared with IVF in the ED. Patients treated with ORT had fewerer hospitalizations. Results of the study suggested that ORT be the initial treatment of choice for moderately dehydrated children less than three years old with gastroeneritis. Thanks to Dr. Lucas Dingman and Dr. Cady Welch for their knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.