Podcasts about randomized

A lot of therapies address the context in which nonsuicidal self-injury (NSSI) and self-harm may occur, but only a few treatments have been designed to address NSSI specifically. In this episode, we dive into one of these treatments: Emotion Regulation Group Therapy (ERGT). Drs. Kim Gratz and Matthew Tull from the University of Toledo in Ohio walk us through in significant detail each of the 90-minute 14 sessions of ERGT. You can purchase their book "Acceptance-based emotion regulation therapy: A clinician's guide to treating emotion dysregulation and self-destructive behaviors using an evidence-based therapy drawn from ACT and DBT" on Amazon here or at New Harbinger Publications here.  Connect with Dr. Gratz on LinkedIn here and Dr. Tull here. Below are links to their research on ERGT referenced in this episode: Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with Borderline Personality Disorder. Behavior Therapy, 37(1), 25-35. Gratz, K. L., & Tull, M. T. (2011). Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Personality Disorders: Theory, Research, and Treatment, 2(4), 316–326. Gratz, K. L., Tull, M. T., & Levy, R. (2014). Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Psychological Medicine, 44, 2099–2112. Gratz, K. L., Bardeen, J. R., Levy, R., Dixon-Gordon, K., L., & Tull, M. T. (2015). Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Behaviour Research and Therapy, 65, 29-35. Sahlin, H., Bjureberg, J., Gratz, K. L., Tull, M. T., Hedman, E., Bjarehed, J., Jokinen, J., Lundh, L., Ljotsson, B., & Hellner, C. (2017). Emotion regulation group therapy for deliberate self-harm: A multi-site evaluation in routine care using an uncontrolled open trial design. BMJ Open, 7(10), e016220. Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

In this episode of The Behavioral View, Nissa Van Etten, Olivia Teal, Elizabeth Barajas, and Yagnesh Vadgama discuss the evolution of outcomes-based care within applied behavior analysis (ABA). Drawing from extensive experience in both clinical practice and payer systems, Vadgama outlines the differences between traditional fee-for-service models and outcomes-based care frameworks. The panel explores how standardized assessments, aggregate data analysis, and empirically supported dosing recommendations can create greater alignment between providers and payers while maintaining individualized clinical decision-making. The discussion addresses administrative burden, prior authorization processes, value-based payment arrangements, caregiver involvement, social determinants of health, and interdisciplinary collaboration. Emphasis is placed on transparency, data-driven decision making, and protecting the integrity of behavior analytic practice while demonstrating measurable outcomes at both the individual and population levels. This course provides practical insight into how outcomes-based care models may shape the future of ABA service delivery. To earn CEUs for listening, click here, log in or sign up, pay the CEU fee, + take the attendance verification quiz to generate your certificate! Don't forget to subscribe and follow and leave us a rating and review. Show Notes:   References  Frazier, T. W., Youngstrom, E. A., Speer, L., Embacher, R., Law, P., Constantino, J., Findling, R. L., Hardan, A. Y., & Eng, C. (2014). Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 28–40. https://doi.org/10.1016/j.jaac.2013.10.012  Frazier, T. W., Klingemier, E. W., Beukemann, M., Speer, L., Markowitz, L., Parikh, S., & Strauss, M. S. (2021). Development and validation of the Autism Impact Measure (AIM). Journal of Autism and Developmental Disorders, 51, 3407–3421. https://doi.org/10.1007/s10803-020-04795-1  Smith, P. C., Sagan, A., Siciliani, L., & Figueras, J. (2023). Building on value-based health care: Towards a health system perspective. Health Policy, 138, 104918. https://doi.org/10.1016/j.healthpol.2023.104918    AI.Measures Scientific Support   Ferguson, E. F., Frazier, T. W., Hardan, A. Y., & Uljarević, M. (2025). Challenging behavior domains in individuals with neurodevelopmental genetic syndromes: The role of psychological features. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 0(1), 1-12      Frazier, T. W., Huba, K., Frazier, A. R., Womack, R. A., Youngstrom, E. A., Chetcuti, L., Hardan, A. Y., & Uljarevic, M. (2025). Maximizing accurate detection of divergence from normative expectation in behavioral intervention outcome assessment. Research in Autism, 126, 202646.      Frazier, T. W., Youngstrom, E. A., Frazier, A. R., & Uljarevic, M. (2025). A critical appraisal of the measurement of adaptive social communication behaviors in the behavioral intervention context. Behavioral Sciences, 15(6), 722      Frazier, T.W., Helton, M., Akouri, C., Chetcuti, L., Uljarevic, M. (2025) Identifying Reliable Change In Outcome Assessments for Behavioral Intervention. Behavioral Interventions.      Frazier, T. W., Dimitropoulos, A., Abbeduto, L., Armstrong-Brine, M., Kralovic, S., Shih, A., Hardan, A. Y., Youngstrom, E. A., Uljarevic, M., Verbal Beginnings, T. (2024). Psychometric evaluation of the Autism Symptom Dimensions Questionnaire. Developmental Medicine and Child Neurology.      Frazier, T. W., Busch, R. M., Klaas, P., Lachlan, K., Jeste, S., Kolevzon, A., Loth, E., Harris, J., Speer, L., Pepper, T., Anthony, K., Graglia, J. M., Delagrammatikas, C., Bedrosian-Sermone, S., Beekhuyzen, J., Smith-Hicks, C., Sahin, M., Eng, C., Hardan, A. Y., & Uljarevic, M. (2023). Development of informant-report neurobehavioral survey scales for PTEN hamartoma tumor syndrome and related neurodevelopmental genetic syndromes. Am J Med Genet A, 191(7), 1741-1757. https://doi.org/10.1002/ajmg.a.63195      Frazier, T. W., Crowley, E., Shih, A., Vasudevan, V., Karpur, A., Uljarevic, M., & Cai, R. Y. (2022). Associations between executive functioning, challenging behavior, and quality of life in children and adolescents with and without neurodevelopmental conditions. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2022.1022700      Frazier, T. W., Dimitropoulos, A., Abbeduto, L., Armstrong-Brine, M., Kralovic, S., Shih, A., Hardan, A. Y., Youngstrom, E. A., Uljarevic, M., & Quadrant Biosciences - As You Are Team. (2023). The Autism Symptom Dimensions Questionnaire: Development and psychometric evaluation of a new, open-source measure of autism symptomatology. Developmental Medicine and Child Neurology. https://doi.org/10.1111/dmcn.15497      Frazier, T. W., Dimitropoulos, A., Abbeduto, L., Armstrong-Brine, M., Kralovic, S., Shih, A., Hardan, A. Y., Youngstrom, E. A., Uljarevic, M., Womack, R., Wolf, D., Chappell, N., & Verbal Beginnings Team. (2024). Psychometric Evaluation of the Autism Symptom Dimensions Questionnaire (ASDQ). Developmental Medicine and Child Neurology.      Frazier, T. W., Hyland, A. C., Markowitz, L. A., Speer, L. L., & Diekroger, E. A. (2020). Psychometric evaluation of the revised child and family quality of life questionnaire (CFQL-2). Research in Autism Spectrum Disorders, 70. https://doi.org/https://doi.org/10.1016/j.rasd.2019.101474      Frazier, T. W., Khaliq, I., Scullin, K., Uljarevic, M., Shih, A., & Karpur, A. (2022). Development and psychometric evaluation of the open-source challenging behavior scale. Journal of Autism and Developmental Disabilities. https://doi.org/https://doi.org/10.1007/s10803-022-05750-5      Frazier, T. W., Krishna, J., Klingemier, E., Beukemann, M., Nawabit, R., & Ibrahim, S. (2017). A Randomized, Crossover Trial of a Novel Sound-to-Sleep Mattress Technology in Children with Autism and Sleep Difficulties. J Clin Sleep Med, 13(1), 95-104. https://doi.org/10.5664/jcsm.6398      Frazier, T. W., Busch, R. M., Klass, P., Crowley, E., Lachlan, K., Jeste, S., Kolevzon, A., Loth, E., Harris, J., Pepper, T., Anthony, K., Graglia, J. M., Helde, K., Delagrammatikas, C., Bedrosian-Sermone, S., Smith-Hicks, C., Sahin, M., Eng, C., Hardan, A. Y., . . . Uljarevic, M. (2024). Quantifying Neurobehavioral Profiles across Neurodevelopmental Genetic Syndromes and Idiopathic Neurodevelopmental Disorders. Developmental Medicine and Child Neurology. https://doi.org/https://doi.org/10.1111/dmcn.16112      Uljarevic, M., Cai, R. Y., Hardan, A. Y., & Frazier, T. W. (2022). Development and validation of the Executive Functioning Scale. Front Psychiatry, 13, 1078211. https://doi.org/10.3389/fpsyt.2022.1078211      Uljarevic, M., Spackman, E. K., Cai, R. Y., Paszek, K. J., Hardan, A. Y., & Frazier, T. W. (2022). Daily living skills scale: Development and preliminary validation.   Frazier, T. W., Helton, M., Akouri, C., Chetcuti, L., & Uljarevic, M. (2025). Identifying reliable change in outcome assessments for behavioral interventions. Behavioral Interventions, 40, e70007. https://doi.org/https://doi.org/10.1002/bin.70007    Resources  CentralReach. (n.d.). AI Measures (AIM). https://centralreach.com 

Send a textKann eine transösophageale Echokardiographie (TEE) bereits präklinisch während laufender Reanimation eingesetzt werden, ohne die CPR-Qualität zu beeinträchtigen? In dieser Episode analysieren wir die erste randomisierte kontrollierte Pilotstudie zur prähospitalen TEE bei außerklinischem Herz-Kreislauf-Stillstand (OHCA) und diskutieren Effekte auf Chest Compression Fraction, EtCO₂ sowie diagnostische und prozedurale Konsequenzen.Katzenschlager S, Kaltschmidt N, Dietrich M, et al.Prehospital transesophageal echocardiography versus conventional advanced life support in out-of-hospital cardiac arrest (PHTEE–OHCA): a randomized controlled pilot study.Critical Care. 2026;30:45.DOI: 10.1186/s13054-025-05805-w Die Qualität der Thoraxkompressionen ist ein zentraler Determinant des Outcomes beim außerklinischen Herz-Kreislauf-Stillstand (OHCA). Während transthorakale Echokardiographie (TTE) in Leitlinien empfohlen wird, kann sie zu prolongierten Hands-off-Phasen führen. Die transösophageale Echokardiographie (TEE) erlaubt dagegen Bildgebung unter laufender Kompression und könnte sowohl die Reanimationsqualität als auch die Identifikation reversibler Ursachen verbessern.In dieser randomisierten, kontrollierten Pilotstudie wurden 32 erwachsene Patient:innen mit nicht-traumatischem OHCA in einem arztbesetzten zweistufigen Rettungsdienstsystem 1:1 zu Standard-ALS oder ALS plus TEE randomisiert. Primäre Endpunkte waren Hands-off-Zeit und Chest Compression Fraction (CCF). Sekundäre Endpunkte umfassten ROSC bei Krankenhausaufnahme, Überleben bis Entlassung, neurologisches Outcome (CPC 1–2), EtCO₂-Verlauf sowie TEE-basierte diagnostische Befunde.Die mediane Hands-off-Zeit betrug in beiden Gruppen 4 Sekunden; es zeigte sich kein signifikanter Unterschied. Die CCF war jedoch signifikant höher in der TEE-Gruppe (96,2 % vs. 91,6 %; mittlere Differenz 4,6 %, 95 %-KI 2,5–6,7; p < 0,001). EtCO₂-Werte lagen ebenfalls signifikant höher in der TEE-Gruppe (+7 mmHg; 95 %-KI 4–10; p < 0,001), was auf effektivere Perfusion hinweisen könnte.In der as-treated-Analyse wurden bei 23 % der Fälle eine initial falsche Area of Maximal Compression (AMC) sowie bei 14 % eine inadäquate Kompressionstiefe identifiziert und unter TEE-Guidance korrigiert. Perikardergüsse wurden in 23 % diagnostiziert, davon 60 % hämodynamisch relevant (Tamponade). In allen eCPR-Fällen war eine Visualisierung von Führungsdrähten und Kanülenlage möglich. TEE-bedingte Komplikationen wurden nicht beobachtet.Die Studie zeigt, dass prähospitale TEE technisch machbar ist und CPR-Metriken nicht beeinträchtigt. Darüber hinaus liefert sie relevante diagnostische Informationen und ermöglicht prozedurale Guidance. Aufgrund der geringen Fallzahl ist jedoch keine Aussage zu Überlebensvorteilen möglich.

Randomized controlled trials. Cohort studies. Abstracts. Methods sections.If your brain starts spinning just hearing those words, you're not alone.In this episode, I'm joined by Dr. Carlene Starck, a protein biochemist and nutrition scientist, to help clinicians who aren't researchers learn how to spot high-quality research in a world full of misinformation.Together, we walk through how a researcher evaluates a paper, what matters, what doesn't, and why social media influencers often get the science wrong. We even unpack a real paper that went viral online to show how misleading conclusions can spread when studies are misquoted or misunderstood.In this episode, you'll learn:A clear explanation and examples of the hierarchy of evidenceWhat information you can (and can't) get from an abstractWhy the methods section matters (even though many of us skip it)How sample size, study design, and bias affect conclusionsA simple framework for quickly assessing whether a paper is high qualityHere's the article we analyzed: A prospective birth cohort study on cord blood folate subtypes and risk of autism spectrum disorder - PubMedConnect with Carlene on LinkedInStarck ScienceAny Questions? Send Me a MessageSupport the showConnect with Colleen:InstagramLinkedInSign up for my FREE Newsletter - Nutrition hot-topics delivered to your inbox each week. Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

Five articles from the February 2026 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles this month are: Intraoperative Zoledronic Acid for Arthroscopic Rotator Cuff Repair: Short-Term Results From a Prospective, Randomized, Placebo-Controlled Phase II Trial Dermal Allograft Augmentation for Open Gluteus Medius Repair: A Case Series at 2-Year Follow-up Prediction of Contralateral Patellar Instability After Ipsilateral Medial Patellofemoral Ligament Reconstruction Arthroscopic Primary Labral Reconstruction in the Hip: Minimum 10-Year Outcomes With a Nested Propensity-Matched Control Using a Residual Pivot Shift as the Indication to Perform a Lateral Extra-articular Tenodesis During ACL Reconstruction Using Autologous Hamstring Grafts Is Associated With Improved Surgical Outcomes: A Retrospective Review of 4755 Cases Click here to read the articles.

 How to Naturally Boost Testosterone Data-backed ways to boost testosterone. (2:01) 1. Exercise. (3:18) 2. Sleep. (11:56) 3. Vitamin D. (16:51) 4. Zinc. (20:57) 5. Magnesium. (21:55) 6. Other supps/recommendations: (Fenugreek, Ashwagandha, Shilajit, Tonkat Ali, and red-light therapy.) (23:03) Related Links/Products Mentioned Boost Testosterone Guide: http://mindpumpmedia.com/testosterone-guide  Visit Crisp Power for an exclusive offer for Mind Pump listeners! ** Code MINDPUMP10 for 10% OFF. Give your snack game a serious upgrade. Crisp Power Protein Pretzels deliver super crunchy and delicious snacks that are up to 28g of protein, low carb, zero sugar, and high in fiber! ** January Promotion: Code NEWYEAR50 at checkout for 50% off the following programs: MAPS Starter, Transform, Anabolic, and Performance! Visit: http://mapsjanuary.com/  Mind Pump Store Various Factors May Modulate the Effect of Exercise on Testosterone Levels in Men Endogenous transient doping: physical exercise acutely increases testosterone levels-results from a meta-analysis Sleep and Testosterone: The Essential Connection for Optimal Health Association Between Vitamin D Deficiency and Testosterone Levels in Adult Males: A Systematic Review Effect of Zinc on Testosterone Levels and Sexual Function of Postmenopausal Women: A Randomized Controlled Trial Zinc status and serum testosterone levels of healthy adults Effect of fenugreek extract supplement on testosterone levels in male: A meta‐analysis of clinical trials A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha (Withania somnifera) in Aging, Overweight Males Tongkat Ali benefits, dosage, and side effects - Examine Mind Pump Podcast – YouTube Mind Pump Free Resources  

This week, please join author Mathew S. Maurer as he discusses the article "Coramitug, a Humanized Monoclonal Antibody for the Treatment of Transthyretin Amyloid Cardiomyopathy: A Phase 2, Randomized, Multicenter, Double-Blind, Placebo-Controlled Trial." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260126.13097

Kick off 2026 with the January episode of RAPM Focus, where RAPM Social Media Editor Alopi Patel, MD, converses with Josh Gleicher, MD, MSc, FRCPC, and Hermann dos Santos Fernandes, MD, PhD, following the September 2025 publication of their original research paper, “Outpatient continuous adductor canal block (CACB) for total knee arthroplasty: a double-blinded randomized placebo-controlled trial.” Dr. Gleicher is a staff anesthesiologist and regional anesthesia expert at Mount Sinai Hospital in Toronto, Canada. He completed his anesthesiology training and fellowship in regional anesthesia at the University of Toronto and holds a master's degree in quality improvement and patient safety. Dr. Gleicher has extensive experience leading clinical trials in acute postoperative pain, with multiple funded studies and recognized expertise in anesthesia research. He is also a co-developer of the ISAFE technique for adductor canal catheter placement. In his spare time, he enjoys skiing and spending time with his wife and three kids. Dr. dos Santos Fernandes is a specialist in anesthesiology and pain management, trained at University of São Paulo, where he also achieved his PhD and completed a post-doctorate program. He has fellowship training in regional anesthesia and medical education at Mount Sinai Hospital, University of Toronto, and holds multiple certifications, including the superior title in anesthesiology and European diploma in anesthesiology and intensive care. Currently, he is an assistant professor at the University of Toronto and a staff anesthesiologist at Mount Sinai Hospital, with research and clinical focus on regional anesthesia. A retired basketball player and aspiring tennis player, he likes to travel with the family in his free time. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

Most people with Diabetic Kidney Disease are told that damage is a one-way street. However, a major 2025 clinical trial published in Precision Clinical Medicine just challenged that. Researchers tested a traditional 6-herb blend called Shenzhuo Formula (SZF) against the global standard drug, Irbesartan.The Shocking Result: While the standard drug group saw their kidney filtration (eGFR) continue to drop, the group taking the herbal formula actually saw their filtration improve by an average of 5.91 mL/min/1.73m2. They also saw a significant drop in creatinine (a waste product that builds up when kidneys are failing), while levels rose in the drug group.How it works: Think of kidney damage as a "cellular fire" caused by inflammation. This study found that the herbs act like a fire extinguisher for two specific proteins (CX3CL1 and MCP-1) that cause scarring. By putting out the "fire" of inflammation, the kidneys were actually able to function better. Nearly 90% of the herbal group felt a significant improvement in symptoms like swelling and fatigue.________________________________________Wang A, Huang Y, Wei Y, et al. Randomized controlled clinical trial of Shenzhuo Formula in the treatment of macroalbuminuria in diabetic kidney disease and its inflammation-modulating mechanisms. Precis Clin Med. 2025;8:pbaf031. doi:10.1093/pcmedi/pbaf031________________________________________ Disclaimers• "This information is for educational purposes only and should not be interpreted as medical advice."• "The study discussed was conducted on human participants and animal models. Further research may be needed to confirm these findings."• "Always consult with a qualified healthcare professional before making any changes to your diet, supplement regimen, or treatment plan, especially if you have a medical condition or are taking medications."• "This channel does not provide medical advice.#KidneyRecovery #eGFRimprovement #DiabeticKidneyDisease #CreatinineLowering #ShenzhuoFormulaShenzhuo Formula DKD, how to improve eGFR, reverse kidney damage, diabetic nephropathy 2025, lower creatinine naturally, TCM for kidneys, SZF vs Irbesartan, kidney filtration recovery, albuminuria treatment, CX3CL1 inflammation, MCP-1 kidney, Astragalus kidney health, herbal kidney formula, chronic kidney disease breakthrough, renal fibrosis treatment, restore renal function, kidney inflammation research

Tracklist •⁠ ⁠(Intro) Anomaly (Extended Mix) de Kamilo Sanclemente & Sebastian Valencia (COL) •⁠ ⁠Nero de MPathy & Clawz SG •⁠ ⁠Control de Pablo Goyesi •⁠ ⁠Karma de VegaZ SL & Heaven inc •⁠ ⁠Randomized de Marc Romboy •⁠ ⁠Twelve Days de Dmitry Molosh & Michael A •⁠ ⁠Dione (Ewan Rill Remix) de Kamilo Sanclemente •⁠ ⁠Sonne de Erly Tepshi •⁠ ⁠Passi (Deborah De Luca Remix) de Io E Palmieri •⁠ ⁠Always (Monkey Safari Remix) de RÜFÜS DU SOL •⁠ ⁠Night After Night (CamelPhat Remix) de Fideles, CamelPhat & Be No Rain FUEGO SILENTE Fuego Silente es energía contenida. Un set que no explota, pero arde. Desde el inicio, el pulso es firme y directo, marcando un territorio claro. No hay adornos innecesarios: el sonido avanza con intención, sosteniendo una tensión constante que se siente más de lo que se explica. A lo largo del recorrido, el groove se vuelve más denso y físico. La repetición no adormece, enfoca. Cada elemento cumple una función precisa, construyendo una atmósfera cruda y concentrada, donde la fuerza no está en el volumen sino en la persistencia. En su núcleo, Fuego Silente encuentra su punto más intenso. La energía se sostiene sin desbordar, como un fuego interno que no necesita mostrarse para ser real. Es un momento de claridad, de decisión, donde el cuerpo responde y la mente se afirma. El cierre no apaga la llama: la integra. El set se repliega con control, dejando una sensación de potencia latente, como algo que sigue vibrando incluso después del silencio. Fuego Silente es presencia, tensión y fuerza consciente. Booking Madrid: coworkdj@gmail.com

Dr. Rena Malik, urologist and pelvic surgeon, addresses common questions about testosterone replacement therapy (TRT) and prostate cancer risk, urinary incontinence in women—including causes, symptoms, and treatment options like pelvic floor exercises—and explains the role of penile Doppler ultrasounds for evaluating erectile dysfunction. This evidence-based Ask Me Anything episode also covers practical advice for improving quality of life and emphasizes the importance of personalized, physician-guided care in sexual and urinary health. Become a Member to Receive Exclusive Content: renamalik.supercast.com Schedule an appointment with me: https://www.renamalikmd.com/appointments Videos mentioned in podcast: https://www.youtube.com/watch?v=vbXUdNxXyqc https://www.youtube.com/watch?v=tRAKyM_n-ik ▶️Chapters: 0:00 Introduction 00:47 Testosterone replacement therapy cancer risk 01:38 Low testosterone and prostate cancer 02:11 The Traverse trial findings 03:09 Testosterone and prostate cancer growth 04:27 Other risks of testosterone therapy 05:06 Randomized controlled trials explained 06:39 Stress urinary incontinence in women 13:19 Penile Doppler ultrasound 18:27 Podcast wrap-up and subscribe Let's Connect!: WEBSITE: http://www.renamalikmd.com YOUTUBE: https://www.youtube.com/@RenaMalikMD INSTAGRAM: http://www.instagram.com/RenaMalikMD TWITTER: http://twitter.com/RenaMalikMD FACEBOOK: https://www.facebook.com/RenaMalikMD/ LINKEDIN: https://www.linkedin.com/in/renadmalik PINTEREST: https://www.pinterest.com/renamalikmd/ TIKTOK: https://www.tiktok.com/RenaMalikMD ------------------------------------------------------ DISCLAIMER: This podcast is purely educational and does not constitute medical advice. The content of this podcast is my personal opinion, and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of information contained in this podcast including but not limited to economic loss, injury, illness or death. Learn more about your ad choices. Visit megaphone.fm/adchoices

The FiltrateJoel Topf‍ ‍@kidneyboy.bsky.social‬ (COI)Sophia Ambruso @sophia-kidney.bsky.socialSwapnil Hiremath @hswapnil.medsky.social and on LinkedInSpecial Guests Jonathan Barratt Professor of Renal Medicine, University of Leicester Google Scholar (COI: all the companies)Editing and Show Notes byNayan Arora @captainchloride.bsky.socialThe Kidney Connection written and performed by Tim YauShow NotesProteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy (Aliza Thompson, 2019 PubMed)The number, quality, and coverage of randomized controlled trials in nephrology (PubMed 2004)A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction (PubMed 2017)BLISS Belimumab in lupus nephritis (NephJC | PubMed)The Phase 2 trial of atacicept A phase 2b, randomized, double-blind, placebo-controlled, clinical trial of atacicept for treatment of IgA nephropathy (PubMed)The phase 3 trial of atacicept, the subject of this podcast A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (PubMed | NephJC)The use of Gd-IgA1 in the Testing Trial Role of Systemic Glucocorticoids in Reducing IgA and Galactose-Deficient IgA1 Levels in IgA Nephropathy (PubMed)If you can't get enough Jon Barratt, take a look at his grand rounds at The University of Ottawa. Updates to the KDIGO Guidelines for the treatment of IgA nephropathy, with Prof Jonathan Barratt (YouTube)Tubular SecretionSwapnil Hiremath Pluribus on Apple TV (Wikipedia)Jon Barratt Lynyrd Skynyrd (Wikipedia) Slow Horses (Wikipedia) on AppleTVJoel Topf the new ASN

On episode #95 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 11/20/25 – 12/3/25. Host: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Early low-dose dexamethasone is associated with shorter acute symptom duration in Chikungunya virus infection: a retrospective cohort study (BMC Infectious Diseases) Noninferiority of One HPV Vaccine Dose to Two Doses (NEJM) Evidence to Action — Single-Dose HPV Vaccination and Cervical HPV Infection (NEJM) Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human InfectionModel (NEJM) Universal Hepatitis B Vaccination at Birth—Risks of Revising the recommendation (JAMA) Correlates of HIV-1 control after combination immunotherapy (Nature) Human-to-Human Rabies Transmission via Solid Organ Transplantation from a Donor with Undiagnosed Rabies — United States, October 2024–February 2025 (CDC: MMWR) Cytomegalovirus-specific cell-mediated immunity for prediction of post-prophylaxis CMV disease in a phase 3 trial of letermovir vs valganciclovir prophylaxis in donor CMV-seropositive recipient CMV-seronegative kidney transplant recipients (CID) An Analysis of Cytomegalovirus-Specific Cell-Mediated Immunity in a Phase 3, Randomized, Placebo-Controlled Trial of Letermovir Prophylaxis in Cytomegalovirus-Seropositive Recipients of an Allogeneic Hematopoietic Cell Transplant (CID) Bacterial Infectious Diseases Society of America (IDSA) Position Statement: Why IDSA Did Not Endorse the Community-Acquired Pneumonia Guidelines 2025 Update (CID) Lyme DiseaseIncidence in Massachusetts, 2012-2024 (JAMA: Open Network) Fungal The Last of US Season 2 (YouTube) Aspergillosis-Attributable Mortality in the United States: Analysis of Death CertificateData (CID) Oral itraconazole versus oral voriconazole for treatment-naive patients with chronic pulmonary aspergillosis in India (VICTOR-CPA trial): a single-centre, open-label, randomised, controlled, superiority trial (LANCET: Infectious Diseases) Parasitic Loa loa encephalopathy following treatment with benzimidazole derivatives: A systematic review (OFID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

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

This week, join author Hans-Josef Feistritzer and Associate Editor Stefan James as they discuss the article "Peri-Interventional Anesthesia Strategies for Transcatheter Aortic Valve Implantation: A Multicenter, Randomized, Controlled, Noninferiority Trial."   For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20251201.586148

Dr. Suresh Durgam (Intra-Cellular Therapies, a Johnson & Johnson Company, Bedminster, NJ) joins AJP Audio to discuss a phase 3 randomized controlled trial looking at the use of the antipsychotic medication lumateperone as adjunctive to antidepressant therapy in the treatment of patients with major depressive disorder. Afterwards, AJP Editor-in-Chief Dr. Ned Kalin discusses the rest of the December issue of the Journal. 00:48   Durgam interview 03:09   Mechanism of action 04:44   Patient-reported outcomes 06:31   Immediate clinical implications 07:32   Limitations 08:08   Further research 09:25   Kalin interview 09:38   Durgam et al. 13:09   Lin et al. 17:22   Brodsky et al. Transcript Be sure to let your colleagues know about the podcast, and please rate and review it on Apple Podcasts, Google Podcasts, Spotify, or wherever you listen to it. Subscribe to the podcast here. Listen to other podcasts produced by the American Psychiatric Association. Browse articles online. How authors may submit their work. Follow the journals of APA Publishing on Twitter. E-mail us at ajp@psych.org

Today, I am delighted to be joined by a friend and colleague, Mike Mutzel.  Mike has a master's in Clinical Nutrition from the University of Bridgeport. He is a graduate of the IFM, applies functional medicine in clinical practice, and is a consultant lecturer who teaches leading-edge science in a concise format for progressive clinicians to prevent chronic diseases.  In our discussion, Mike and I unpack the benefits of creatine monohydrate, highlighting the importance of ensuring the products we use are free of impurities. We explain how creatine monohydrate gets created, answer many listener questions, and describe current research specific to creatine monohydrate, discussing ways to support bone health, navigate dosing, and how to troubleshoot.  This conversation with Mike Mutzel is truly invaluable, and I look forward to having him back on the podcast to dive a little deeper into the science.  IN THIS EPISODE, YOU WILL LEARN: How creatine supports energy production across muscles, the brain, and other organ systems Why vegetarians and vegans should take creatine What to consider when choosing high-quality creatine supplements Dosing strategies based on diet, exercise, sleep, and individual needs How taking creatine with electrolytes while exercising can improve absorption Benefits of supplementing with amino acids alongside creatine for illness, recovery, or when protein intake is low Adjusting your creatine dosage for sleep, travel, or exercise demands How creatine supports bone and muscle health  The value of creatine for the eyes and ears Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Mike Mutzel On his website YouTube Instagram High Intensity Health Podcast Creatine Research: Creatine in Women's Health: Bridging the Gap From Menstruation Through Pregnancy to Menopause Effects of Creatine and Resistance Training on Bone Health in Postmenopausal Women Creatine Supplementation (3 g/d) and Bone Health in Older Women: A 2-Year, Randomized, Placebo-Controlled Trial Creatine Supplementation in Depression: A Review of Mechanisms, Efficacy, Clinical Outcomes, and Future Directions The Effects of 8-Week Creatine Hydrochloride and Creatine Ethyl Ester Supplementation on Cognition, Clinical Outcomes, and Brain Creatine Levels in Perimenopausal and Menopausal Women (CONCRET-MENOPA): A Randomized Controlled Trial

The FiltrateJoel Topf‍ ‍@kidneyboy.bsky.social‬ (COI)Sophia Ambruso @sophia-kidney.bsky.socialSwapnil Hiremath @hswapnil.medsky.social and on LinkedInSpecial Guests Jonathan Barratt Professor of Renal Medicine, University of Leicester Google Scholar (COI: all the companies)Editing and Show Notes byNayan Arora @captainchloride.bsky.socialThe Kidney Connection written and performed by Tim YauShow NotesProteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy (Aliza Thompson, 2019 PubMed)The number, quality, and coverage of randomized controlled trials in nephrology (PubMed 2004)Updated here (PubMed | NephJC discussion)A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction (PubMed 2017)BLISS Belimumab in lupus nephritis (NephJC | PubMed) The Phase 2 trial of atacicept A phase 2b, randomized, double-blind, placebo-controlled, clinical trial of atacicept for treatment of IgA nephropathy (PubMed)The phase 3 trial of atacicept, the subject of this podcast A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (PubMed | NephJC)Christos' Bluesky post:https://bsky.app/profile/christosargyrop.bsky.social/post/3m5bsujwg3s2q The use of Gd-IgA1 in the Testing Trial Role of Systemic Glucocorticoids in Reducing IgA and Galactose-Deficient IgA1 Levels in IgA Nephropathy (PubMed)If you can't get enough Jon Barratt, take a look at his grand rounds at The University of Ottawa. Updates to the KDIGO Guidelines for the treatment of IgA nephropathy, with Prof Jonathan Barratt (YouTube)Tubular SecretionSwapnil Hiremath Pluribus on Apple TV (Wikipedia)Jon Barratt Lynyrd Skynyrd (Wikipedia) Slow Horses (Wikipedia) on AppleTVJoel Topf the new ASN

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

The VICTORY Trial - A Randomized, Multicenter, Non-Inferiority Comparison

This week, join author Jonas Oldgren and Associate Editor Torbjørn Omland as they discuss the article "Biomarker-Based ABC-AF Risk Scores for Personalized Treatment to Reduce Stroke or Death in Atrial Fibrillation: A Registry-Based Multicenter, Randomized, Controlled Study." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20251124.61165

Broadcast from KSQD, Santa Cruz on 11-13-2025: Dr. Dawn discusses a New England Journal of Medicine study examining radiation exposure from medical imaging in over 4 million children showing increased hematological cancer risk. Head and brain CTs deliver highest bone marrow doses, with under-1-year-olds receiving 20 milligrays compared to background radiation of 1 milligray yearly. The study found 3,000 cancers in 4 million children over roughly 10 years, with relative risk increasing 1.6-fold per CT scan. However, methodological flaws include combining US and Canadian cohorts with different data quality, potential reverse causation where imaging detected pre-existing cancers, and arbitrary 6-month latency assumptions are significant flaws in this study.. Despite small absolute risk increases given low baseline cancer rates, she encourages parents to question necessity of repeat scans and request alternatives like MRI when appropriate. She reports on cutting-edge CRISPR therapy using lipid nanoparticles to deliver molecular scissors targeting the ANGPTL3 gene controlling LDL cholesterol production. Recent setbacks in several other CRISPR trials raise issues for unexplained liver toxicity. Concerns include off-target gene editing effects and partially repaired DNA creating mutated proteins triggering autoimmune reactions. Dr. Dawn emphasizes restricting gene therapy to life-threatening genetic diseases with no alternatives until safety improves. Stanford scientists used AI model Evo trained on 9 trillion gene samples to design 300 new bacteriophages from scratch, with 16 phages successfully killing E. coli bacteria. AI tools now predict protein structures, design custom drugs, create antivenoms, invent antibiotics, and break down PFAS forever chemicals. The research represents evolution through computation and requires guardrails on AI's ability to manipulate biological structures. An emailer shares the Rosencare model where hotel chain owner Harris Rosen created self-insured health coverage featuring direct provider contracting, imaging facilities charging one-third to one-half traditional costs, transparent pharmacy benefit management, and zero or $5 primary care copays. Employees receive proactive screening for colonoscopies, mammograms, cholesterol, diabetes, and hypertension during clinic visits. Ninety percent of medicines including insulin cost nothing, with remaining drugs $0-25, and hospital admissions cost flat $750. The model saved $600 million while providing superior preventive care by eliminating insurance middlemen and focusing on early chronic disease detection when 75-85% of costs originate. Dr. Dawn explains abdominophrenic dyssynergia causing bloating unrelated to gas or food. The diaphragm descends and abdominal wall muscles relax, pushing organs forward after meals. CT scans showed lettuce-related bloating involved no intestinal gas changes but demonstrated this abnormal muscle reflex. Randomized trials showed biofeedback training with chest-lifting and abdominal wall contracting exercises before and after eating for four weeks improved symptoms 66%. She warns that constant bloating in postmenopausal women unrelated to eating requires ovarian cancer screening. She discusses how genes drive personality using dopamine receptor gene DRD4 polymorphisms as an example. The 7-repeat variant present in 48% of Americans creates receptors binding dopamine poorly, associating with ADHD, pathological gambling, alcoholism, drug dependence, and bulimia, plus personality traits of novelty-seeking, impulsiveness, and optimism. The 2-repeat DRD4 variant common in Asia correlates with lower anger and higher forgiveness. DRD2 variations enhance the memory of negative outcomes, creating pessimistic bias and avoidance behavior. She presents the KETO trial showing "lean mass hyper-responder phenotype" where very low-carbohydrate dieters averaging age 55 maintained LDL cholesterol of 272 for five years but showed identical coronary artery calcium scores and plaque burden as matched controls with LDL under 150. Despite extreme LDL elevation, the very low insulin levels from carbohydrate restriction prevent LDL oxidation, the inflammatory "loading" process enabling arterial damage. She concludes with unusual cancer symptom where recurrent pain in specific body locations after alcohol consumption, lasting 1-2 days, occurs in 5% of Hodgkin lymphoma patients and in other cancers when alcohol induced blood vessel dilation and inflammatory chemical release in cancer-containing lymph nodes causes pain after drinking.

Carotid artery disease management has come a long way. From the days when every stroke meant an endarterectomy to a modern era defined by precision, evidence, and evolving technology. With advances in medical therapy and newer techniques like TCAR, the vascular surgeon has even more to consider when choosing the best treatment for carotid disease. Join us as we break down the major landmark trials NASCET, CREST and the Asymptomatic Carotid trials, and discuss how their findings shape our clinical decisions in practice today. Hosts: ·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center ·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center ·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center ·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center Learning Objectives: · Review the key findings and clinical implications of the NASCET, ACST, and CREST trials. · Discuss patient selection for carotid endarterectomy (CEA) vs carotid artery stenting (CAS). · Understand how age, calcification, and aortic arch anatomy affect stenting outcomes or choice between stent and CEA. · Identify how advances in medical therapy have influenced management of asymptomatic disease.  · Discuss appropriate screening/ follow up plans for patients who do not meet criteria for intervention References: -       North American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991). Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. The New England Journal of Medicine, 325(7), 445–453. https://pubmed.ncbi.nlm.nih.gov/1852179/ -       Brott, T. G., Hobson, R. W. II, Howard, G., Roubin, G. S., Clark, W. M., Brooks, W., ... & Howard, V. J. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England Journal of Medicine, 363(1), 11–23. https://pubmed.ncbi.nlm.nih.gov/20505173/ -       Halliday, A., Mansfield, A., Marro, J., Peto, C., Peto, R., Potter, J., & Thomas, D.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. (2004). Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomized controlled trial. The Lancet, 363(9420), 1491–1502. https://pubmed.ncbi.nlm.nih.gov/15135594/ -       Halliday, A., Bulbulia, R., Bonati, L. H., Chester, J., Cradduck-Bamford, A., Peto, R., & Pan, H., & the ACST-2 Collaborative Group. (2021). Second asymptomatic carotid surgery trial (ACST-2): A randomised comparison of carotid artery stenting versus carotid endarterectomy. The Lancet, 398(10305), 1065-1073. https://doi.org/10.1016/S0140-6736(21)01910-3 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Mindfulness Training and Stress Reactivity in Substance Abuse: Results from a Randomized, Controlled Stage I Pilot StudyIn this episode, Dr. Jud delves into groundbreaking research comparing mindfulness training (MT) and cognitive behavioral therapy (CBT) for individuals with substance use disorders. This pilot study investigates the role of mindfulness in managing stress and addiction, highlighting its potential to reduce psychological and physiological stress responses. Learn how MT could become a viable treatment option alongside traditional therapies, the challenges faced during the study, and what these findings mean for the future of addiction treatment.Reference: Brewer, J. A., Sinha, R., Chen, J. A., Michalsen, R. N., Babuscio, T. A., Nich, C., ... & Rounsaville, B. J. (2009). Mindfulness Training and Stress Reactivity in Substance Abuse: Results from a Randomized, Controlled Stage I Pilot Study. Substance Abuse, 30(4), 306-317. DOI: 10.1080/08897070903250241Let's connect on Instagram

Summary In this episode, Ryan Bucciantini and Jason Leydon discuss the importance of structured programming in training, contrasting systems versus chaos. They explore the role of variance in exercise selection and the need for individualized program design. The conversation highlights the significance of having a game plan, understanding the timeline of training seasons, and the pitfalls of constantly varied programming without purpose. They emphasize the value of mentorship and the challenges of online programming in the fitness industry.   Takeaways   Structured programming is crucial for effective training. Variance in exercise selection can enhance athlete development. Individualized program design is essential for progress. Constantly varied programming should have a purpose. Mentorship is valuable for developing programming skills. Online programming presents unique challenges. Understanding training season timelines is important. A game plan is necessary for successful training. Exercise variation should target specific athlete needs. Communication with athletes is key to program success.   Topics    Mastering Training Systems: From Chaos to Structure The Art of Exercise Variance in Programming Why Individualized Program Design Matters Avoiding the Pitfalls of Randomized Training Mentorship: A Key to Programming Success Navigating the Challenges of Online Programming Training Timelines: Planning for Success The Importance of a Game Plan in Training Targeted Exercise Variation for Athletes Effective Communication in Program Design   Sound bites "Structured programming is crucial for effective training." "Variance in exercise selection enhances athlete development." "Individualized program design is essential for progress." "Constantly varied programming should have a purpose." "Mentorship is valuable for developing programming skills." "Online programming presents unique challenges." "Understanding training season timelines is important." "A game plan is necessary for successful training." "Exercise variation should target specific athlete needs." "Communication with athletes is key to program success."   Chapters 00:00:00 Introduction to Training Systems 00:00:00 The Role of Variance in Exercise 00:00:00 Importance of Individualized Program Design 00:00:00 Challenges of Online Programming 00:00:00 Mentorship and Skill Development 00:00:00 Planning Training Timelines  

Whether to close the capsule at the conclusion of hip arthroscopy remains a matter of great debate.  Prior data has been mixed. Dr. Bjarne Mygind-Klavsen from Aarhus University Hospital in Denmark joints us to discuss the results of his team's randomized controlled study comparing interportal capsulotomy closure versus no closure at 1 year following hip arthroscopy.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Marc Pelletier, division chief of cardiac surgery for the Department of Surgery at Yale School of Medicine, about patient blood management. Chapters 00:00 Intro 01:45 EACTS 2025 07:19 JANS 1, HVD Management Guidelines 16:26 JANS 2, Low-Risk AVR Evidence 19:21 JANS 3, Warden Procedure Selection 20:36 JANS 4, Primary Repair of CAT 21:48 JANS 5, NEWTON-CABG Cardiolink-5 23:20 Video 1, Acute Aortic Syndrome 24:54 Video 2, Redo TVR Under Bypass 27:13 Video 3, Giant Tension Bulla 28:47 Dr. Pelletier Interview 34:25 Outro They delve into the Society of Thoracic Surgeons (STS) guidelines on patient blood management, along with key tips. They also explore preoperative optimization, provide an example, and discuss cell savers and reducing dead space during surgery. Additionally, they touch on postoperative transfusion and the importance of performing meticulous surgery.  Joel also highlights recent JANS articles on the 2025 ESC/EACTS guidelines for the management of valvular heart disease, low-risk aortic valve replacement at the crossroads of evidence, ideal age and weight for the Warden procedure in patients with partial anomalous pulmonary venous return, a systematic meta-analysis of short- and long-term outcomes of the primary repair of common arterial trunk, and an international, randomized, double-blind, placebo-controlled trial on the effect of Evolocumab on saphenous vein graft patency after coronary artery bypass surgery.  In addition, Joel explores the surgical treatment of acute aortic syndrome, a redo tricuspid valve replacement technique under right heart bypass for a previously repaired tricuspid valve, and thoracoscopic resection of a giant tension bulla. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)   2.) Low-Risk Aortic Valve Replacement at the Crossroads of Evidence  3.) Is There an Ideal Age or Weight for the Warden Procedure in Patients With Partial Anomalous Pulmonary Venous Return?  4.) Primary Repair of Common Arterial Trunk: A Systematic Meta-Analysis of Short- and Long-Term Outcomes  5.) Effect of Evolocumab on Saphenous Vein Graft Patency After Coronary Artery Bypass Surgery (NEWTON-CABG CardioLink-5): An International, Randomized, Double-Blind, Placebo-Controlled Trial  CTSNet Content Mentioned  1.) Surgical Treatment of Acute Aortic Syndrome   2.) Redo Tricuspid Valve Replacement Technique Under Right Heart Bypass for a Previously Repaired Tricuspid Valve   3.) Thoracoscopic Resection of a Giant Tension Bulla   Other Items Mentioned  1.) STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management  2.) Transcatheter vs Surgical Aortic Valve Replacement in Lower-Risk Patients: An Updated Meta-Analysis of Randomized Controlled Trials  3.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani  4.) Career Center   5.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

November 2025 Journal Club Podcast Title: Thrombectomy for Patients With Large-Volume Ischemic Stroke: A Systematic Review and Meta-Analysis of 6 Randomized Trials To read journal article: https://journals.lww.com/neurosurgery/fulltext/2025/11000/thrombectomy_for_patients_with_large_volume.5.aspx Author: Mark Harrigan Guest Faculty: David Altschul Moderator: Zachary Sorrentino Committee Co-Chair: Kimberly Hoang

Dans cet épisode, nous plongeons au cœur d'une thérapie qui suscite autant de curiosité que de controverse : l'EFT, ou Emotional Freedom Technique. Est-ce une approche révolutionnaire pour traiter traumatismes, anxiété et douleurs, ou une thérapie non scientifique aux affirmations miraculeuses ? Nous décortiquons les promesses de l'EFT, ses fondements théoriques basés sur les méridiens énergétiques, et la comparons à d'autres approches comme l'acupuncture et l'EMDR.

Episode Summary Bill and Pete get personal about a shared health detour—early-detected prostate cancer—and how “health meets wealth” shows up in real life. They unpack the emotional and practical steps (baselines, deltas, options, decisions), then pivot to Pete's new niche venture: Certified Exit Planning Advisor (CEPA) work and the launch of The Confident Exit podcast for business owners. Time-Stamped Show Notes 00:00 – Welcome & context Bill opens the show and explains they've been on a brief hiatus; Pete joins remotely from San Francisco (actual hotel room, not a virtual background). 00:43 – Where's Pete? Pete's calling in from San Francisco, CA; quick banter about travel and being “alongside on screen.” 01:13 – Why the hiatus It's “been a minute.” They tee up a candid health conversation and a new podcast announcement. 01:30 – Health Meets Wealth (Chapter call-back) Bill frames the pause through the lens of the book's “health meets wealth” theme. 01:39 – Pete's health journey (early detection) A year-long series of tests escalates from “yellow flag” to “red flags.” Diagnosis: prostate cancer, caught early. Pete opts for surgery (early May), good recovery, and gratitude for proactive care and skilled medical teams. 03:18 – Bill's parallel path Family history heightens vigilance. Bill tracks PSA trend (delta) even while within “normal,” leading to MRI → biopsy. 04:34 – Valentine's Day twist: both brothers end up getting biopsies the same day—unknowingly. 04:45 – Diagnosis details & options Bill's Gleason score is a bit lower; he explores alternatives (incl. TULSA-PRO) and clinical trials comparing it to standard surgery. Randomized to surgery; undergoes laparoscopic removal at end of July. Two months post-op at recording—healing well. 06:32 – The headspace & decision process Choosing among credible options; balancing personal values, family impact, and medical clarity. Pete's approach: execute step-by-step (don't over-project), while noting loved ones may process differently. 10:24 – September awareness It's Prostate Cancer Awareness Month; heightened appreciation this year. 10:36 – Community support: Blue Ribbon Soirée involvement becomes part of their ongoing advocacy. 10:51 – “Snakes on the runway” Bill's milestone moments: heart scare at 50; prostate surgery at 60. The “snake in the grass” metaphor from the book—find it, step over it, deal with it—and the humor (what happens at 70/80?). 11:35 – The big takeaway: baselines Be proactive: get baseline labs and track the delta annually. You owe it to yourself and your tribe (family, partners, employees). Tie-in to CYA360 themes: key-person health risk to a business. 12:54 – Bites & Insights + “Glimpse of the Future” At Horizon lunches, they use the handout to project yourself—and your tribe—forward in 5-year increments. Planning for your future self is easier when you visualize loved ones aging too. 15:28 – Cognitive risk in later years Stats awareness (e.g., dementia/Alzheimer's prevalence in the 80s) reminds listeners to pre-plan for wealth protection as cognition can decline—even for once-meticulous stewards. 16:26 – Making the future “feel real” Bill's example of projecting his daughter's milestones to make his future tangible (weddings, timing, costs). 17:16 – Time flies 59½ used to feel far away; now it's in view or in the rear-view. Keep thinking ahead; stay systematic about savings, investing, and health check-ups. 18:02 – Programming note: Pete's new focus This is Pete's last regular Runway Decade episode for a while. He's leaning into exit planning (CEPA) with a new podcast: The Confident Exit. 18:29 – Why exit planning now Background: client exits, Horizon's own acquisitions, and a maturing ecosystem (valuation, legal, tax). Show format returns to guests—experts surrounding business owners. 20:08 – Where to find it HorizonFG.com → Business Exit Planning page; podcast hosted there and on Apple/Libsyn. Three episodes recorded and rolling out. 20:34 – The niche Just like Runway Decade targets 50-somethings, The Confident Exit targets owners with most of their wealth locked in one illiquid asset—the business. Goal: help monetize and design “what's next.” 21:36 – Wrap & contacts Bill: bbush@horizonfg.com, RunwayDecade.com contact box, or HorizonFG.com. Pete: pbush@horizonfg.com; follow his exit-planning articles and podcast clips on LinkedIn and Horizon's site. Safe travels & sign-off. Key Takeaways Early detection saves futures: Get annual baselines and watch the trend (delta), not just “normal ranges.” Decisions are personal: Multiple credible pathways (surgery, radiation, ablation/TULSA-PRO, etc.); choose with your values, facts, and family in mind. Health ↔ wealth: Your wellbeing is a key-person risk to your family and business; plan accordingly. Future-you planning: Use “glimpse of the future” to make timelines, costs, and care needs real. New resource for owners: Check out Pete's The Confident Exit for valuation, legal, tax, and deal-prep insights. Pull Quotes / Sound Bites “Get a baseline on everything—and track the delta.” “Step over the snake: find the problem, choose the path, execute.” “Life goes fast—think ahead: health and wealth both reward early action.” Resources & Links Runway Decade site & contact: RunwayDecade.com Horizon Financial Group: HorizonFG.com → Business Exit Planning The Confident Exit podcast (Pete) — also on Apple/Libsyn Email: Bill — bbush@horizonfg.com | Pete — pbush@horizonfg.com Disclosure The views depicted in this material are for information purposes only and are not necessarily those of Cetera Advisors LLC. They should not be considered specific advice or recommendations for any individual. Neither Cetera Advisors LLC nor any of its representatives may give legal or tax advice. Bill Bush, Andy Bush, and Pete Bush are registered representatives offering securities and advisory services through Cetera Advisors LLC, member FINRA/SIPC, a broker-dealer, and registered investment advisor. Cetera is under separate ownership from any other named entity. 15015 Jamestown Boulevard, Suite 100, Baton Rouge, Louisiana, 70810.

Episode 181 Artificial Intelligence and Electronic Music Playlist Time Track Time Start Introduction 05:42 00.00 1.     Cornelius Cardew, “Treatise: String Orchestra (2025). The first of three AI interpretations of a piece by Cardew composed between 1963 and 1967. The work was written as a graphic score. Produced by the team of Professor Shlomo Dubnov of the University of California at San Diego, they used as the basis for an improvisation Cardew's graphical musical score comprising 193 pages of lines, symbols, and various geometric or abstract shapes that largely stray from conventional musical notation (pages 1 to 33 were used). The recordings from Dubnov's team interpreted this graphic score with the help of Open AI's ChatGPT 40 and a program they developed themselves called Music Latent Diffusion Model (MusicLDM), an AI-like algorithm. The recordings show how AI can transform visual stimuli into sound and expand on their interpretation in an experimental music composition. This version is arranged for digital string orchestra. 11:23 05:54 2.     Cornelius Cardew, “Treatise” Sinewave” (2025). This version from Dubrov's lab was arranged for sinewave generator. 11:15 17:10 3.     Cornelius Cardew, “Treatise: Experimental” (2025). This version from Dubrov's lab was arranged for a mix of instruments defined as “experimental” by the team. 11:32 28:24 4.     Valérie Philippin, “Extraits de recherche” (2024). Vocal interaction experiment conducted with vocalist Valérie Philippin while she was in artistic residence at European Research Council REACH project (ERC) at IRCAM. AI interaction in real-time using the Somax2 program. Voice: Valérie Philippin, Somax2 & electronics: Mikhail Malt. 03:52 39:48 5.     Horse Lords and The Who/Men, “Zero Degree Machine” (2023). Horse Lords Concert at ERC REACH. Music using Somax2 to interact with the performers and add new parts and instruments in real time. If you hear something other than a guitar, drums, bass, and sax, then it was created by Somax2. You might detect loops of instruments (e.g., saxophone) as well because Somax2 adds to the mix. Horse Lords (Max Eilbacher bass/electronics, Sam Haberman percussion, Owen Gardner guitar, Andrew Bernstein percussion/saxophone). The Who/Men: Gérard Assayag, Mikhail Malt, Reach interactive AI: Somax2; Marco Fiorini, Reach interactive AI: Somax2 and electric guitar; Manuel Poletti, computer music production at IRCAM). The Who/Men are providing guidance for Somax2 in real-time, operating different instances of the program on their laptops. 18:45 43:42 6.     PintoCreation “AI-generated Sci-Fi Sci-Fi and Visual Storytelling” (2025). This is just an example of how task-specific AI is being used to generate videos with electronic music soundtracks. This is an excerpt from one of the soundtracks for the many videos they have generated for their YouTube channel. 07:54 01:02:26 7.     Artificial Intelligence Music, “Melodic Techno” (2025). Excerpt of AI-generated techno music found on this YouTube site. They explain that the music found here “was composed by an AI, meticulously trained on the nuances of this captivating genre.' I have no idea what AI engine was used, but this is just one example of how many music producers are getting onto the AI train. 06:51 01:10:17 8.     Atmoscapia, “Calm Ambient” (2025). This is a purpose-built generative ambient music creator for “Films, Games, YouTube, and Creative Projects.” Billed as an “Instant Ambient Music Generator For Content Creators,” you use it by selecting styles and lengths up to an hour long. In this case, I chose the style “Calm, Meditative, Dreamy.” Two other categories are also provided for “Cinematic, Dramatic, Emotional” and “Dark, Horror, Suspense.” Those are the extent of the current choices in the free version. It delivers a soundtrack that you can download. 10:00 01:17:08 9.     Thom Holmes, “Thom DeepAI Noise Music” (2025). In an attempt to generate something more experimental using an AI system, I turned to DeepAI and gave it the following instructions: “Experimental, noise sounds. No melody, no harmony, no rhythm. Randomized intervals of silence. Randomized mood swings.” It was short as I was not using the premium version, but it came closer than some other AI programs to creating a work that was more closely aligned with experimental.   1:45 01:41:49                                                                                                                                                                                                             Opening background music: Ambient music generated by the Atmoscapia AI system using the “Dark, Horror, Suspense” setting (excerpt). Introduction to the podcast voiced by Anne Benkovitz. Additional opening, closing, and other incidental music by Thom Holmes. My Books/eBooks: Electronic and Experimental Music, sixth edition, Routledge 2020. Also, Sound Art: Concepts and Practices, first edition, Routledge 2022. See my companion blog that I write for the Bob Moog Foundation. For a transcript, please see my blog, Noise and Notations. Original music by Thom Holmes can be found on iTunes and Bandcamp.  

Continuing our AACPDM 2025 Preview series!Effect of high-frequency, low magnitude vibration on physical activity and physical function in children with cerebral palsy: a randomised controlled trialThis paper is a contender for the AACPDM's highest abstract honour - the Gayle G Arnold Award!There is still time to register for the conference in beautiful New Orleans - Visit https://www.aacpdm.org/events/2025 for all the details!

Why are we still treating acute uncomplicated diverticulitis with antibiotics? There is plenty of evidence from several randomized controlled trials demonstrating that symptomatic management alone yields similar results. If we should continue prescribing antibiotics for acute uncomplicated diverticulitis, which patients should undergo treatment and when? Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss the management of uncomplicated diverticulitis while reviewing groundbreaking literature. Hosts: -Jared Hendren, MD Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio - Elissa Dabaghi, MD Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio - Joseph Trunzo, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter @joseph_trunzo - Ajaratu Keshinro, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter- @AJKesh - David Rosen, MD Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio Social Media Handle: X/Twitter- @davidrrosenmd Learning Objectives: By the end of this episode, listeners will be able to: 1.     Identify criteria for managing acute uncomplicated diverticulitis without antibiotics based on recent literature 2.     Define uncomplicated and complicated diverticulitis 3.     Discuss nuanced management decisions of patients with uncomplicated diverticulitis to determine when antibiotics may be appropriate for management References: 1.     Azhar, N., Aref, H., Brorsson, A., Lydrup, M.‑L., Jörgren, F., Schultz, J. K., & Buchwald, P. (2022). Management of acute uncomplicated diverticulitis without antibiotics: Compliance and outcomes – a retrospective cohort study. BMC Emergency Medicine, 22(1), Article 28. https://doi.org/10.1186/s12873‑022‑00584‑X  2.     Mora‑López, L., Ruiz‑Edo, N., Estrada‑Ferrer, O., Piñana‑Campón, M. L., Labró‑Ciurans, M., Escuder‑Perez, J., Sales‑Mallafré, R., Rebasa‑Cladera, P., Navarro‑Soto, S., Serra‑Aracil, X., & DINAMO‑study Group. (2021). Efficacy and safety of nonantibiotic outpatient treatment in mild acute diverticulitis (DINAMO‑study): A multicentre, randomised, open‑label, noninferiority trial. Annals of Surgery, 274(5), e435–e442. https://doi.org/10.1097/SLA.0000000000005031 3.     Daniels, L., Ünlü, Ç., de Korte, N., van Dieren, S., Stockmann, H. B., Vrouenraets, B. C., Consten, E. C., van der Hoeven, J. A., Eijsbouts, Q. A., Faneyte, I. F., Bemelman, W. A., Dijkgraaf, M. G., & Boermeester, M. A. (2017). Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT‑proven uncomplicated acute diverticulitis. British Journal of Surgery, 104(1), 52‑61. https://doi.org/10.1002/bjs.10309 4.     Chabok, A., Påhlman, L., Hjern, F., Haapaniemi, S., & Smedh, K.; AVOD Study Group. (2012). Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. British Journal of Surgery, 99(4), 532–539. https://doi.org/10.1002/bjs.8688 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Molly Jacobson speaks with Dr. Erica Ancier about Pulsed Electromagnetic Field (PEMF) therapy and its applications for dogs with cancer, chronic pain, arthritis, and more. They discuss the safety of PEMF therapy, how it works, its benefits, and how to use it at home to improve your dog's quality of life. Topics Covered: • What is PEMF therapy? • How PEMF therapy helps with pain relief, inflammation, and healing. • The debate about PEMF therapy and cancer safety. • Combining PEMF therapy with chemotherapy for better results. • Practical tips for using PEMF devices at home. • Dr. Ancier's personal experience using PEMF therapy for her dog. Key Takeaway: PEMF therapy is a safe, affordable, and effective tool to improve your dog's quality of life, especially when managing pain and inflammation. Your Voice Matters! If you have a question for our team, or if you want to share your own hopeful dog cancer story, we want to hear from you! Go to https://www.dogcancer.com/ask to submit your question or story, or call our Listener Line at +1 808-868-3200 to leave a question. Related Videos: https://www.youtube.com/watch?v=ZvA7W9XlciM https://www.youtube.com/watch?v=s2w5AyaLqrw Related Links: Assisi Animal Health/Zomedica https://assisianimalhealth.com/ Respond Systems https://respondsystems.com/pemf/ BEMER https://life.bemergroup.com/pemf-pulse-electro-magnetic-field/ Effect of Targeted Pulsed Electromagnetic Field Therapy on Canine Postoperative Hemilaminectomy: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial: https://meridian.allenpress.com/jaaha/article-abstract/55/2/83/184239/Effect-of-Targeted-Pulsed-Electromagnetic-Field?redirectedFrom=fulltext Chapters: 00:00 Introduction 00:30 - Dr. Ancier's Experience with PEMF Therapy 01:15 - What is PEMF Therapy? How It Works 03:00 - Benefits of PEMF: Pain Relief and Inflammation Reduction 04:45 - Controversy Around PEMF Therapy and Cancer Safety 06:30 - FDA-Approved Uses for PEMF in Humans and Dogs 08:15 - Situations to Avoid PEMF Therapy (Contraindications) 10:00 - Using PEMF Devices at Home: Tips and Safety 13:00 - Combining PEMF Therapy with Chemotherapy 16:00 - Practical Uses for PEMF: Arthritis, Recovery, and Anxiety 22:00 - Device Options: Loops, Mats, and Costs 25:30 - Longevity of Devices and Maintenance Tips 27:15 - Enhancing Quality of Life for Dogs with PEMF Therapy 30:00 - Closing Thoughts and Life Quality vs. Quantity Get to know Dr. Erica Ancier: https://www.dogcancer.com/people/erica-ancier-dvm-cva-ccrp/ For more details, articles, podcast episodes, and quality education, go to the episode page: https://www.dogcancer.com/podcast/ Learn more about your ad choices. Visit megaphone.fm/adchoices

I sat down with Dr. Layne Norton, PhD, one of the most respected names in evidence-based fitness and nutrition, to cut through the noise that dominates our feeds. If you've ever been confused by conflicting advice from influencers, or wondered how to separate hype from science, this conversation is for you.Layne walks us through how to actually read research, spot red flags, and apply the right evidence to your own health and performance. We talk about adherence, why consistency beats hacks, how to think about n=1 experimentation, and why muscle is way more than just something that moves your body—it's one of the most powerful protectors of long-term health.If you want to stop guessing and start making decisions that are backed by data (and not just feelings), you'll love this episode. Listen in, and you'll walk away with a practical blueprint for training smarter, fueling better, and staying resilient—without falling for the myths.Timeline Mitopure Gummies: GET 20% Off Now!

Los artículos que se tratan en el episodio de hoy están listados aquí: Legge, N., Schneuer, F. J., Shand, A. W., Fitzgerald, D., Popat, H., & Nassar, N. (2025). Educational Performance of Extremely Preterm Infants in Primary School. Pediatrics, 156(1), e2024069425. https://doi.org/10.1542/peds.2024-069425Dudeja, S., Saini, S. S., Sundaram, V., Dutta, S., Sachdeva, N., & Kumar, P. (2025). Early hydrocortisone versus placebo in neonatal shock- a double blind Randomized controlled trial. Journal of perinatology : official journal of the California Perinatal Association, 45(3), 342–349. https://doi.org/10.1038/s41372-025-02222-3Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal.Soy tu host, Maria Flores Cordova, MD.Este podcast está presentado por los médicos neonatólogos Dani de Luis Rosell, Elena Itriago, Carolina Michel y Juliana Castellanos.No dudes en enviarnos preguntas, comentarios o sugerencias a nuestro correo electrónico: nicupodcast@gmail.comSíguenos en nuestras redes:Twitter: @incubadorapodInstagram: @laincubadorapodcastCreado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org  Bienvenidos a La Incubadora: una conversación sobre neonatología y medicina basada en evidencia. Nuestros episodios ofrecen la dosis ideal (en mg/kg) de los más recientes avances para el neonato y para las increíbles personas que forman parte de la medicina neonatal. Soy tu host, Maria Flores Cordova, MD. Este podcast está presentado por los médicos neonatólogos Dani de Luis Rosell, Elena Itriago, Carolina Michel y Juliana Castellanos. No dudes en enviarnos preguntas, comentarios o sugerencias a nuestro correo electrónico: nicupodcast@gmail.comSíguenos en nuestras redes:Twitter: @incubadorapodInstagram: @laincubadorapodcast Creado originalmente por Ben Courchia MD y Daphna Yasova Barbeau MD http://www.the-incubator.org

Send us a textBom-vindos ao episódio 61 do Podcast A Incubadora. Esse é o nosso Journal Club 40 – Especial Agosto Dourado. A cada quinze dias, trazemos uma seleção de artigos recentes em neonatologia para discussão em português, com o objetivo de tornar a literatura científica mais acessível para profissionais da área.Neste episódio, vamos conversar sobre quatro estudos que exploram diferentes dimensões do leite humano no cuidado neonatal:Potential Epigenetic Effects of Human Milk on Infants' Neurodevelopment - https://www.mdpi.com/2072-6643/15/16/3614Effect of Neonatal Unit Interventions Designed to Increase Breastfeeding in Preterm Infants: An Overview of Systematic Reviews - https://karger.com/neo/article/121/4/411/896932/Effect-of-Neonatal-Unit-Interventions-Designed-toSeverity of Bronchopulmonary Dysplasia in Infants Born Extremely Preterm and Randomized to Early Human Milk Fortification with a Donor Milk-Derived Fortifier for Two Weeks - https://www.jpeds.com/article/S0022-3476(25)00291-4/abstractNon-nutritional Use of Human Milk as a Therapeutic Agent in Neonates: Brain, Gut, and Immunologic Targets - https://pubmed.ncbi.nlm.nih.gov/39348773/ Não esqueça: você pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1 Lembrando que o Podcast está no Instagram, @incubadora.podcast, onde a gente posta as figuras e tabelas de alguns artigos. Se estiver gostando do nosso Podcast, por favor dedique um pouquinho do seu tempo para deixar sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. Isso é importante para a gente poder continuar produzindo os episódios. 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

We recently hosted a session on the DHS's proposed rule to replace the current H-1B lottery with a weighted-based selection system. Although the rule has not yet been made public, there is speculation that it could prioritize H-1B cap registrations for occupations offering higher wages, potentially impacting future cap seasons starting in FY 2027.Partner and Attorney ⁠Min Kim⁠ and Client Services Manager ⁠Arianna Gonzalez, MBA⁠ explained what is known so far, how it compares to the 2021 proposal, and what employers should expect as the rule moves through the required notice and comment federal review process.Listen in to know more!

Program notes:0:40 Alteplase after stroke1:40 Expand time window2:40 Imaging crucial in use3:20 Use of health care and mortality in those with dementia4:20 Women used much less healthcare5:20 Focus on prevention in women5:50 IVF outcomes and weight loss6:50 Did not appear to increase success with IVF7:45 Ultraprocessed foods versus minimally processed foods8:45 Randomized to one diet or the other for 8 weeks9:45 Minimally processed foods improved risk factors10:45 Short period of study11:42 End

In this episode, Mo and Marc are joined by special guest Professor Ted Miclau (Orthopaedic Trauma Institute International Chair, UCSF Department of Orthopaedic Surgery) in a discussion focusing on innovations and recent work in fracture-healing.    Link  Gouhari F, Shariatpanahi ZV, Talebi S, Mehrvar A, Momeny M, Ehsani A, Ahmadi-Abdashti A, Zandi R. Therapeutic Effects of Bovine Colostrum on Bone Healing, Rehabilitation, and Postoperative Complications: A Prospective, Randomized, Double-Blinded Comparative Trial. J Bone Joint Surg Am. 2025 Apr 18;107(12):1307-1315. doi: 10.2106/JBJS.24.00542. PMID: 40249794. https://www.jbjs.org/reader.php?rsuite_id=bf628643-fcfe-4fc5-9f9e-b46db1bd70d2&source=The_Journal_of_Bone_and_Joint_Surgery/107/12/1307&topics=hp+ta#info    Subspecialties:  Basic Science  Hip  Orthopaedic Essentials  Trauma  Chapters (00:00:03) - Orthojoe Podcast(00:00:49) - Bovine Colostrum and Bone Healing(00:03:23) - Mental Fitness: Ted McLow(00:03:52) - Osteomyelitis and fracture healing(00:09:48) - Breastfeeding and hip fracture(00:11:20) - Hip Fracture and the International RCT

Oral methadone versus sublingual buprenorphine for the treatment of acute opioid withdrawal: A triple-blind, double-dummy, randomized control trial  Drug and Alcohol Dependence Researchers compared oral methadone to sublingual buprenorphine for the management of acute opioid withdrawal. Patients at an inpatient drug treatment center in India were randomly assigned to receive either methadone or buprenorphine titrated over days 1-3 to control opioid withdrawal symptoms. Over days 4-10 medications were tapered and stopped by day 11. Completion of treatment was similar in both groups (83% methadone, 82% buprenorphine). Both subjective (SOWS) and objective (COWS) withdrawal symptoms decreased during the treatment, however the buprenorphine group had significantly greater withdrawal symptoms than the methadone group (p=0.009) at the end of treatment (day 10). Opioid craving also decreased in both groups with no significant difference between groups. Authors conclude that methadone is a safe and effective alternative to buprenorphine for management of opioid withdrawal.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM  

Podcast Summary This episode of the Pain Exam Podcast, hosted by Dr. David Rosenblum, discusses an interesting article about Ketorolac injections for musculoskeletal conditions. The podcast covers: Ketorolac is an NSAID that provides analgesic and anti-inflammatory effects through inhibition of prostaglandin synthesis Multiple studies comparing Ketorolac injections to corticosteroids and hyaluronic acid for various conditions Research shows Ketorolac injections are equally effective as corticosteroids for subacromial conditions, adhesive capsulitis, carpal-metacarpal joint issues, and hip/knee osteoarthritis Ketorolac may be a safer alternative to steroids for certain patients, though it has its own contraindications for those with renal, gastrointestinal, or cardiovascular disease Dr. Rosenblum considers the potential of using Ketorolac injections directly at pain sites rather than intramuscularly Upcoming Courses and Conferences Ultrasound courses in New York and Costa Rica (check unwrappedpain.org) Private ultrasound sessions available Dr. Rosenblum will be speaking at Pain Week about ultrasound in pain practice and PRP Presenting at a primary care conference in London Teaching ultrasound at ISPN LAPSES conference in Chile (Dr. Rosenblum won't attend this year) Ketorolac Injections: An Effective Alternative for Musculoskeletal Pain Management Musculoskeletal conditions such as bursitis, adhesive capsulitis, and osteoarthritis affect millions and often require injectable therapies to reduce pain and inflammation. Traditionally, corticosteroid injections have been the mainstay treatment. However, concerns over side effects like tendon rupture, cartilage damage, and systemic hyperglycemia have prompted exploration of alternatives. A recent narrative review by Kiel et al. (2024) highlights ketorolac—a parenteral nonsteroidal anti-inflammatory drug (NSAID)—as a promising substitute for corticosteroids in musculoskeletal injections. Warning: OFF Label use of Ketorolac discussed. Please consult your physician. See full article  for details. Subacromial Ketorolac Injections for Shoulder Pain Subacromial bursitis and impingement syndrome are common causes of shoulder pain and disability. Several randomized controlled trials have shown that subacromial ketorolac injections provide pain relief and functional improvement comparable to corticosteroids: Goyal et al. demonstrated significant reductions in pain scores after subacromial injection of 60 mg ketorolac versus 40 mg methylprednisolone, with no difference in outcomes between groups. Taheri et al. found similar short-term pain relief at 1 and 3 months with either ketorolac or corticosteroid subacromial injections. Kim et al. reported equivalent clinical improvement in rotator cuff syndrome patients receiving ketorolac or triamcinolone injections. Min et al. noted ketorolac led to better forward flexion and patient satisfaction at 4 weeks compared to corticosteroids. These studies support ketorolac as an effective agent for subacromial injection, offering an alternative for patients where corticosteroid use is limited. Intra-articular Ketorolac Injections for Adhesive Capsulitis and Osteoarthritis Adhesive capsulitis (frozen shoulder) and osteoarthritis of the hip, knee, and carpometacarpal joint are often treated with intra-articular corticosteroids. Ketorolac injections have shown comparable efficacy in these conditions: Akhtar et al. found intra-articular ketorolac significantly reduced shoulder pain at 4 weeks in adhesive capsulitis compared to hyaluronic acid. Ahn et al. reported similar pain relief between intra-articular ketorolac and corticosteroid injections in adhesive capsulitis, with ketorolac providing superior shoulder mobility at 3 and 6 months. Koh et al. showed that adding ketorolac to hyaluronic acid injections in carpometacarpal osteoarthritis resulted in faster onset of pain relief compared to hyaluronic acid alone. Park et al. observed equivalent functional improvements with intra-articular ketorolac or corticosteroids in hip osteoarthritis. Jurgensmeier et al. demonstrated similar symptom improvement at 1 and 3 months post-injection for ketorolac and triamcinolone in hip and knee osteoarthritis. Xu et al. and Bellamy et al. confirmed ketorolac's comparable pain relief and functional benefits to corticosteroids for knee osteoarthritis, with ketorolac being more cost-effective. Lee et al. noted quicker pain reduction with intra-articular ketorolac combined with hyaluronic acid versus hyaluronic acid alone in knee osteoarthritis. aSafety and Pharmacologic Considerations Ketorolac's anti-inflammatory action stems from cyclooxygenase inhibition, reducing prostaglandin synthesis. Its half-life is approximately 5.2–5.6 hours, and it is metabolized in the liver. Unlike corticosteroids, ketorolac avoids systemic hyperglycemia and cartilage damage risks. Animal and in vitro studies suggest ketorolac may protect cartilage by inhibiting inflammatory cytokines. While gastrointestinal, renal, and cardiovascular risks associated with NSAIDs remain considerations, localized intra-articular and subacromial ketorolac injections may limit systemic exposure and adverse effects. Mild, transient post-injection pain has been reported but resolves without intervention. Conclusion Ketorolac injections, administered intra-articularly or subacromially, are a safe, effective, and economical alternative to corticosteroids for managing common musculoskeletal conditions. Their comparable efficacy in reducing pain and improving function, combined with a more favorable side effect profile, makes ketorolac an appealing option for clinicians and patients alike. Further research is warranted to fully elucidate long-term safety and optimal dosing strategies. FAQS Ketorolac Injections for Musculoskeletal Conditions: Frequently Asked Questions Musculoskeletal pain from conditions like bursitis, adhesive capsulitis, and osteoarthritis often requires injectable treatments. Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is emerging as a promising alternative to corticosteroids. Below are common questions and answers based on a recent narrative review by Kiel et al. (2024). 1. What is ketorolac and how does it work? Ketorolac is a parenteral NSAID that reduces pain and inflammation by inhibiting cyclooxygenase enzymes, which decreases prostaglandin synthesis. It can be administered orally, intramuscularly, intravenously, or by injection directly into joints or around bursae. 2. How effective is ketorolac for musculoskeletal conditions? Studies show ketorolac injections provide significant pain relief and functional improvement comparable to corticosteroids in conditions like: Subacromial bursitis and shoulder impingement (subacromial injections) Adhesive capsulitis (frozen shoulder) (intra-articular injections) Osteoarthritis of the hip, knee, and thumb carpometacarpal joint (intra-articular injections) 3. What evidence supports subacromial ketorolac injections? Randomized controlled trials found: Goyal et al. and Taheri et al. reported similar pain reduction and functional outcomes between ketorolac and corticosteroids for subacromial injections. Kim et al. and Min et al. observed comparable or better patient satisfaction and shoulder mobility with ketorolac versus corticosteroids. 4. How does intra-articular ketorolac compare to corticosteroids for adhesive capsulitis? Akhtar et al. showed ketorolac reduced shoulder pain more than hyaluronic acid. Ahn et al. found ketorolac and corticosteroids equally effective for pain relief, with ketorolac providing better shoulder mobility at 3 and 6 months. 5. What about ketorolac for osteoarthritis? Ketorolac combined with hyaluronic acid provided faster pain relief than hyaluronic acid alone in thumb carpometacarpal joint osteoarthritis (Koh et al.). Intra-articular ketorolac had similar efficacy to corticosteroids in hip (Park et al., Jurgensmeier et al.) and knee osteoarthritis (Bellamy et al., Xu et al.). Ketorolac injections were more cost-effective compared to corticosteroids (Bellamy et al.). 6. Are ketorolac injections safe? Ketorolac's side effects are similar to other NSAIDs, mainly involving gastrointestinal, renal, and cardiovascular risks. However, localized intra-articular and subacromial injections may reduce systemic exposure. Animal studies suggest ketorolac does not harm cartilage and may protect against inflammatory damage. Mild, transient local pain post-injection is possible but usually resolves without treatment. 7. What are the limitations of ketorolac use? Ketorolac is not suitable for patients with: Renal impairment Gastrointestinal ulcers or bleeding risk Cardiovascular disease or hypertension NSAID hypersensitivity, especially in asthma or chronic urticaria patients Clinicians should assess individual risks before choosing ketorolac injections. 8. How does ketorolac's pharmacokinetics affect its use? Ketorolac has a plasma half-life of about 5.2 to 5.6 hours and is metabolized in the liver. Pharmacokinetics for subcutaneous or intra-articular administration are less defined but systemic absorption occurs. Its relatively short half-life supports repeated dosing if needed. 9. Why consider ketorolac over corticosteroids? Ketorolac avoids corticosteroid-associated risks such as tendon rupture, cartilage damage, and steroid-induced hyperglycemia. It is also more cost-effective, making it a favorable option for patients and healthcare systems. 10. What further research is needed? More large-scale, long-term studies are needed to fully understand ketorolac's intra-articular effects, optimal dosing, and safety profile compared to corticosteroids and other treatments. Summary: Ketorolac injections, whether intra-articular or subacromial, offer a safe, effective, and economical alternative to corticosteroids for managing various musculoskeletal conditions. This makes ketorolac an important option in pain management and inflammation control.     Reference: Kiel J, Applewhite AI, Bertasi TGO, Bertasi RAO, Seemann LL, Costa LMC, Helmi H, Pujalte GGA. Ketorolac Injections for Musculoskeletal Conditions: A Narrative Review. Clinical Medicine & Research. 2024;22(1):19-27. DOI: https://doi.org/10.3121/cmr.2024.1847 Disclaimer: This Podcast, website and any content from NRAP Academy (PMRexam.com) otherwise known as Qbazaar.com, LLC is  for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.    

Podcast Summary This episode of the Pain Exam Podcast, hosted by Dr. David Rosenblum, discusses an interesting article about Ketorolac injections for musculoskeletal conditions. The podcast covers: Ketorolac is an NSAID that provides analgesic and anti-inflammatory effects through inhibition of prostaglandin synthesis Multiple studies comparing Ketorolac injections to corticosteroids and hyaluronic acid for various conditions Research shows Ketorolac injections are equally effective as corticosteroids for subacromial conditions, adhesive capsulitis, carpal-metacarpal joint issues, and hip/knee osteoarthritis Ketorolac may be a safer alternative to steroids for certain patients, though it has its own contraindications for those with renal, gastrointestinal, or cardiovascular disease Dr. Rosenblum considers the potential of using Ketorolac injections directly at pain sites rather than intramuscularly Upcoming Courses and Conferences Ultrasound courses in New York and Costa Rica (check unwrappedpain.org) Private ultrasound sessions available Dr. Rosenblum will be speaking at Pain Week about ultrasound in pain practice and PRP Presenting at a primary care conference in London Teaching ultrasound at ISPN LAPS  conference in Chile (Dr. Rosenblum won't attend this year) Ketorolac Injections: An Effective Alternative for Musculoskeletal Pain Management Musculoskeletal conditions such as bursitis, adhesive capsulitis, and osteoarthritis affect millions and often require injectable therapies to reduce pain and inflammation. Traditionally, corticosteroid injections have been the mainstay treatment. However, concerns over side effects like tendon rupture, cartilage damage, and systemic hyperglycemia have prompted exploration of alternatives. A recent narrative review by Kiel et al. (2024) highlights ketorolac—a parenteral nonsteroidal anti-inflammatory drug (NSAID)—as a promising substitute for corticosteroids in musculoskeletal injections. Warning: OFF Label use of Ketorolac discussed. Please consult your physician. See full article  for details. Subacromial Ketorolac Injections for Shoulder Pain Subacromial bursitis and impingement syndrome are common causes of shoulder pain and disability. Several randomized controlled trials have shown that subacromial ketorolac injections provide pain relief and functional improvement comparable to corticosteroids: Goyal et al. demonstrated significant reductions in pain scores after subacromial injection of 60 mg ketorolac versus 40 mg methylprednisolone, with no difference in outcomes between groups. Taheri et al. found similar short-term pain relief at 1 and 3 months with either ketorolac or corticosteroid subacromial injections. Kim et al. reported equivalent clinical improvement in rotator cuff syndrome patients receiving ketorolac or triamcinolone injections. Min et al. noted ketorolac led to better forward flexion and patient satisfaction at 4 weeks compared to corticosteroids. These studies support ketorolac as an effective agent for subacromial injection, offering an alternative for patients where corticosteroid use is limited. Intra-articular Ketorolac Injections for Adhesive Capsulitis and Osteoarthritis Adhesive capsulitis (frozen shoulder) and osteoarthritis of the hip, knee, and carpometacarpal joint are often treated with intra-articular corticosteroids. Ketorolac injections have shown comparable efficacy in these conditions: Akhtar et al. found intra-articular ketorolac significantly reduced shoulder pain at 4 weeks in adhesive capsulitis compared to hyaluronic acid. Ahn et al. reported similar pain relief between intra-articular ketorolac and corticosteroid injections in adhesive capsulitis, with ketorolac providing superior shoulder mobility at 3 and 6 months. Koh et al. showed that adding ketorolac to hyaluronic acid injections in carpometacarpal osteoarthritis resulted in faster onset of pain relief compared to hyaluronic acid alone. Park et al. observed equivalent functional improvements with intra-articular ketorolac or corticosteroids in hip osteoarthritis. Jurgensmeier et al. demonstrated similar symptom improvement at 1 and 3 months post-injection for ketorolac and triamcinolone in hip and knee osteoarthritis. Xu et al. and Bellamy et al. confirmed ketorolac's comparable pain relief and functional benefits to corticosteroids for knee osteoarthritis, with ketorolac being more cost-effective. Lee et al. noted quicker pain reduction with intra-articular ketorolac combined with hyaluronic acid versus hyaluronic acid alone in knee osteoarthritis. aSafety and Pharmacologic Considerations Ketorolac's anti-inflammatory action stems from cyclooxygenase inhibition, reducing prostaglandin synthesis. Its half-life is approximately 5.2–5.6 hours, and it is metabolized in the liver. Unlike corticosteroids, ketorolac avoids systemic hyperglycemia and cartilage damage risks. Animal and in vitro studies suggest ketorolac may protect cartilage by inhibiting inflammatory cytokines. While gastrointestinal, renal, and cardiovascular risks associated with NSAIDs remain considerations, localized intra-articular and subacromial ketorolac injections may limit systemic exposure and adverse effects. Mild, transient post-injection pain has been reported but resolves without intervention. Conclusion Ketorolac injections, administered intra-articularly or subacromially, are a safe, effective, and economical alternative to corticosteroids for managing common musculoskeletal conditions. Their comparable efficacy in reducing pain and improving function, combined with a more favorable side effect profile, makes ketorolac an appealing option for clinicians and patients alike. Further research is warranted to fully elucidate long-term safety and optimal dosing strategies. FAQS Ketorolac Injections for Musculoskeletal Conditions: Frequently Asked Questions Musculoskeletal pain from conditions like bursitis, adhesive capsulitis, and osteoarthritis often requires injectable treatments. Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is emerging as a promising alternative to corticosteroids. Below are common questions and answers based on a recent narrative review by Kiel et al. (2024). 1. What is ketorolac and how does it work? Ketorolac is a parenteral NSAID that reduces pain and inflammation by inhibiting cyclooxygenase enzymes, which decreases prostaglandin synthesis. It can be administered orally, intramuscularly, intravenously, or by injection directly into joints or around bursae. 2. How effective is ketorolac for musculoskeletal conditions? Studies show ketorolac injections provide significant pain relief and functional improvement comparable to corticosteroids in conditions like: Subacromial bursitis and shoulder impingement (subacromial injections) Adhesive capsulitis (frozen shoulder) (intra-articular injections) Osteoarthritis of the hip, knee, and thumb carpometacarpal joint (intra-articular injections) 3. What evidence supports subacromial ketorolac injections? Randomized controlled trials found: Goyal et al. and Taheri et al. reported similar pain reduction and functional outcomes between ketorolac and corticosteroids for subacromial injections. Kim et al. and Min et al. observed comparable or better patient satisfaction and shoulder mobility with ketorolac versus corticosteroids. 4. How does intra-articular ketorolac compare to corticosteroids for adhesive capsulitis? Akhtar et al. showed ketorolac reduced shoulder pain more than hyaluronic acid. Ahn et al. found ketorolac and corticosteroids equally effective for pain relief, with ketorolac providing better shoulder mobility at 3 and 6 months. 5. What about ketorolac for osteoarthritis? Ketorolac combined with hyaluronic acid provided faster pain relief than hyaluronic acid alone in thumb carpometacarpal joint osteoarthritis (Koh et al.). Intra-articular ketorolac had similar efficacy to corticosteroids in hip (Park et al., Jurgensmeier et al.) and knee osteoarthritis (Bellamy et al., Xu et al.). Ketorolac injections were more cost-effective compared to corticosteroids (Bellamy et al.). 6. Are ketorolac injections safe? Ketorolac's side effects are similar to other NSAIDs, mainly involving gastrointestinal, renal, and cardiovascular risks. However, localized intra-articular and subacromial injections may reduce systemic exposure. Animal studies suggest ketorolac does not harm cartilage and may protect against inflammatory damage. Mild, transient local pain post-injection is possible but usually resolves without treatment. 7. What are the limitations of ketorolac use? Ketorolac is not suitable for patients with: Renal impairment Gastrointestinal ulcers or bleeding risk Cardiovascular disease or hypertension NSAID hypersensitivity, especially in asthma or chronic urticaria patients Clinicians should assess individual risks before choosing ketorolac injections. 8. How does ketorolac's pharmacokinetics affect its use? Ketorolac has a plasma half-life of about 5.2 to 5.6 hours and is metabolized in the liver. Pharmacokinetics for subcutaneous or intra-articular administration are less defined but systemic absorption occurs. Its relatively short half-life supports repeated dosing if needed. 9. Why consider ketorolac over corticosteroids? Ketorolac avoids corticosteroid-associated risks such as tendon rupture, cartilage damage, and steroid-induced hyperglycemia. It is also more cost-effective, making it a favorable option for patients and healthcare systems. 10. What further research is needed? More large-scale, long-term studies are needed to fully understand ketorolac's intra-articular effects, optimal dosing, and safety profile compared to corticosteroids and other treatments. Summary: Ketorolac injections, whether intra-articular or subacromial, offer a safe, effective, and economical alternative to corticosteroids for managing various musculoskeletal conditions. This makes ketorolac an important option in pain management and inflammation control.     Reference: Kiel J, Applewhite AI, Bertasi TGO, Bertasi RAO, Seemann LL, Costa LMC, Helmi H, Pujalte GGA. Ketorolac Injections for Musculoskeletal Conditions: A Narrative Review. Clinical Medicine & Research. 2024;22(1):19-27. DOI: https://doi.org/10.3121/cmr.2024.1847 Disclaimer: This Podcast, website and any content from NRAP Academy (PMRexam.com) otherwise known as Qbazaar.com, LLC is  for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.  

In this conversation, Dr. Elizabeth Klodas, a preventive cardiologist and founder of Step One Foods, discusses the critical role of nutrition in managing heart disease and the challenges faced in integrating dietary changes into medical practice. She shares her journey from traditional medicine to creating a food company aimed at reducing reliance on medications through nutrition. The discussion highlights the importance of randomized controlled trials in validating the effectiveness of food-based interventions, the impact of pharmaceuticals on healthcare, and the need for a shift in consumer perceptions towards whole food ingredients. Dr. Klodas emphasizes the potential for a healthier future where cardiologists are less needed due to preventive measures and lifestyle changes.Takeaways:Nutrition is often overlooked in favor of pharmaceuticals in healthcare.Patients are rarely asked about their diet by healthcare providers.Changing dietary habits can lead to significant health improvements.Pharmaceuticals are easier to prescribe than dietary changes.There is a lack of nutrition education in medical training.Step One Foods aims to fill nutritional gaps in patients' diets.Randomized controlled trials can validate the effectiveness of food products.Consumer perceptions of health foods can be influenced by marketing.The food industry often prioritizes cost over nutrition.A better world would mean fewer cardiologists needed due to preventive health measures.Sound bites:“There is very little to no nutrition education for physicians. As I look back on this I consider this educational malpractice.”“All the medical evidence of what we should be doing is very heavily pharma biased, because guidelines are based on randomized control clinical trials.”“So there's loads of reasons why nutrition is not used in clinical care the way it should be. None of that is an excuse though, because it works and it's so vital.”“What if I asked you to like eat this food twice a day and I otherwise left you alone? What started happening is people calling and saying, hey, my cholesterol dropped 39 points. Then I'm like, okay, we're gonna subject our products to a randomized control trial. Let's see. Let's prove it. Does this actually work?”“If I reduce, LDL, the bad cholesterol across the US population by an average of 9%, I will finally dethrone heart disease as our number one killer.”“In that trial, we replicated what people were calling in with our highest LDL reduction was close to 40 % in 30 days. That's a medication level cholesterol reduction. And we did that with food, without turning people's lives upside down.”“It's not just the nutrient of interest that's important. It's the delivery vehicle. You can stuff a bunch of fiber into a Twinkie. But in the end, you're still eating a Twinkie, right? Food and nutrition is complex.”“At Step One Foods I take the complexity out for people. I take whole food ingredients, each and every single one that has data behind it in terms health benefits, and put them in my foods.”“We are probably the most overfed and undernourished society in the history of our species.”“If you truly believe in your mission, you have to ignore all the no's.”Promo Offer:Code: BETTERWORLDLink: https://www.steponefoods.com/discount/BETTERWORLDOffer: 10% off first order for both one time and subscription orders. Offer can be stacked with the subscription discount to save 30% on their first order. Exclusions: Limited to one use per customer. Limited to a customer's first order and only applies to the first recurring order. Code must be entered at checkout for the discount to be applied. Links:Dr Elizabeth Klodas on LinkedIn - https://www.linkedin.com/in/eklodas/Step One Foods- https://www.steponefoods.com/Step One Foods on LinkedIn - https://www.linkedin.com/company/steponefoods/Step One Foods on Facebook - https://www.facebook.com/StepOneFoodsStep One Foods on Instagram - https://www.instagram.com/steponefoods/Step One Foods on YouTube - https://www.youtube.com/StepOneFoods…“Slay the Giant: The Power of Prevention in Defeating Heart Disease” book - https://www.steponefoods.com/products/slay-the-giant…Brands for a Better World Episode Archive - http://brandsforabetterworld.com/Brands for a Better World on LinkedIn - https://www.linkedin.com/company/brand-for-a-better-world/Modern Species - https://modernspecies.com/Modern Species on LinkedIn - https://www.linkedin.com/company/modern-species/Gage Mitchell on LinkedIn - https://www.linkedin.com/in/gagemitchell/…Print Magazine Design Podcasts - https://www.printmag.com/categories/printcast/…Heritage Radio Network - https://heritageradionetwork.org/Heritage Radio Network on LinkedIn - https://www.linkedin.com/company/heritage-radio-network/posts/Heritage Radio Network on Facebook - https://www.facebook.com/HeritageRadioNetworkHeritage Radio Network on X - https://x.com/Heritage_RadioHeritage Radio Network on Instagram - https://www.instagram.com/heritage_radio/Heritage Radio Network on Youtube - https://www.youtube.com/@heritage_radioChapters:03:00 Introduction to Preventive Cardiology and Nutrition05:58 The Shift from Nutrition to Medication in Healthcare08:45 The Role of Pharmaceuticals in Patient Care11:41 The Challenges of Nutrition Education in Medicine14:41 The Complexity of Food and Nutrition Science17:59 Step One Foods: A New Approach to Nutrition20:57 The Impact of Randomized Controlled Trials on Nutrition23:59 The Importance of Ingredient Quality in Food Products26:49 Pushback from the Medical and Food Industries29:52 The Insurance Industry's Role in Healthcare Costs32:52 Step One Foods: Product Overview and Benefits38:43 Introduction to Whole Foods and Health Claims40:56 The Importance of Real Ingredients42:56 Navigating Organic Ingredients and Supply Chain Challenges44:59 Stepwise Approach to Health and Nutrition48:58 Challenges in Scaling Food Production51:49 Milestones and Industry Changes56:55 Advice for Aspiring Food Entrepreneurs59:50 Personal Indulgences and Food Preferences01:03:00 Innovative Thinkers in Nutrition01:05:50 Vision for a Healthier WorldSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

What's best for skin closure at C-Section? Staples or suture? This debate has raged for over 20 years. Past data has shown greater odds of wound complications with metal staples compared to suture. But new a meta-analysis from June 2025 is challenging the prior results. In this episode, we will explore the data from 2010 to present day. PLUS, we will summarize a separate meta-analysis examining if wound dressing removal is tied to any wound complication. This was just published July 15, 2025 in the “Pink” journal. Listen in for details. 1. 2010: Basha SL, Rochon ML, Quiñones JN, Coassolo KM, Rust OA, Smulian JC. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol. 2010 Sep;203(3):285.e1-8. doi: 10.1016/j.ajog.2010.07.011. PMID: 20816153.2. 2015: Mackeen AD, Schuster M, Berghella V. Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol. 2015 May;212(5):621.e1-10. doi: 10.1016/j.ajog.2014.12.020. Epub 2014 Dec 19. PMID: 25530592.3. Jan 2025: Gabbai D, Jacoby C, Gilboa I, Maslovitz S, Yogev Y, Attali E. Comparison of complications and surgery outcomes in skin closure methods following cesarean sections. Arch Gynecol Obstet. 2025 Jul;312(1):125-129. doi: 10.1007/s00404-024-07911-6. Epub 2025 Jan 25. PMID: 39862268; PMCID: PMC12176926.4. June 2025: Post-cesarean skin closure with metal staples versus subcuticular suture in obese patients: A systematic review and meta-analysis of randomized controlled trials. Luis Sanchez-Ramos et al (Univ Florida). https://onlinelibrary.wiley.com/doi/pdf/10.1002/pmf2.700615. DRESSING REMOVAL: July 15, 2025: Leshae A Cenac, Serena Guerra, Alicia Huckaby, Gabriele Saccone, Vincenzo Berghella. Early Wound Dressing (soft gauze/tape dressing) Removal after Cesarean Delivery: A Meta-Analysis of Randomized Trials: Short title: early wound dressing removal after cesarean, American Journal of Obstetrics & Gynecology MFM, 2025; https://doi.org/10.1016/j.ajogmf.2025.101739.6. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

For full review of the trials, please visit https://cardiologytrials.substack.com/ Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Host Dr. Ben Young invites Drs. Roni Levin and Evan Silverstein to review the current state of amblyopia treatment, ranging from the mainstays of patching and atropine drops to novel advances such as dichoptic therapy. Below are some references regarding dichoptic therapy that were discussed in this episode: Xiao S, Angjeli E, Wu HC, Gaier ED, et al. Luminopia Pivotal Trial Group. Randomized controlled trial of a dichoptic digital therapeutic for amblyopia. Ophthalmology. 2022 Jan;129(1):77-85. Wygnanski-Jaffe T, Kushner BJ, Moshkovitz A, Belkin M, Yehezkel O. CureSight Pivotal Trial Group. An eye-tracking-based dichoptic home treatment for amblyopia: A multicenter randomized clinical trial. Ophthalmology. 2023 Mar;130(3):274-285. Koc I, Bagheri S, Chau RK, Hoyek S, et al. Cost-effectiveness analysis of digital therapeutics for amblyopia. Ophthalmology. 2025 Jun;132(6):654-660. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

In the ruins of a fallen tower, the crew of the Little Snail found themselves (and their egos) battered and bruised. Worse, Elena, Veile, and Nicky found themselves missing one ingredient to the special stew that was their group: Jonathan! Where had he been taken? And could it, perhaps, lead them towards the eternal flame which they were sent to retrieve?  This week on Perpetua: The Shadow of the Dragon Tower Pt. 4 Perpetua Guide [In Progress v.01] - Some Feedback [Page 01 of 03] Alukard83 Hey, this FAQ rules! Normally I buy the official guide but they want FIFTY dollars for this one, and I just don't have that sorta cash right now, so this is a lifesaver.  HOWEVER, your map on the final puzzle area in the Dragon Tower isn't right at ALL. Not sure what you were on when you made it, but it's totally wrong. Otherwise, keep up the good work XD TheUnforgivenIII Yeah I was coming here to post the same thing. This guide sucks bigtime. In my opinion, it's PROOF you should not be releasing this guide without finishing the full game first, because you're going to be in such a hurry that you're going to make stupid mistakes like this (or maybe even make things up entirely, which is my guess.) Take the FAQ down because it doesn't have any REAL answers in it. CarlsSr That's not what OP said, Unforgiveniii. Your bias is showing. FriendOfNei Thanks for the kudos Alukard, but listen, I loaded the save FIVE TIMES and checked it again and again and it's right. I don't know what YOU'RE on but maybe you're the one who is mistaken. As for you, Unforgiven, you're not even worth my keystrokes. XxZelgadyskXx I'm not OP or the FAQ writer but we did some testing over in the IRC channel it turns out that the bomb placement is RANDOMIZED for every player. So the FAQ isn't *wrong* it's just not right for anyone except for Nei. n.n;;;;   Hosted by Austin Walker (austinwalker.bsky.social) Featuring Ali Acampora (ali-online.bsky.social), Art Martinez-Tebbel (amtebbel.bsky.social), Jack de Quidt (notquitereal.bsky.social), and Andrew Lee Swan (swandre3000.bsky.social) Produced by Ali Acampora Music by Jack de Quidt (available on bandcamp) Cover Art by Ben McEntee (https://linktr.ee/benmce.art) With thanks to Amelia Renee, Arthur B., Aster Maragos, Bill Kaszubski, Cassie Jones, Clark, DB, Daniel Laloggia, Diana Crowley, Edwin Adelsberger, Emrys, Greg Cobb, Ian O'Dea, Ian Urbina, Irina A., Jack Shirai, Jake Strang, Katie Diekhaus, Ken George, Konisforce, Kristina Harris Esq, L Tantivy, Lawson Coleman, Mark Conner, Mike & Ruby, Muna A, Nat Knight, Olive Perry, Quinn Pollock, Robert Lasica, Shawn Drape, Shawn Hall, Summer Rose, TeganEden, Thomas Whitney, Voi, chocoube, deepFlaw, fen, & weakmint This episode was made with support from listeners like you! To support us, you can go to friendsatthetable.cash.

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

The FiltrateJoel TopfAC GomezSophia AmbrusoNayan AroraSpecial Guest Charles Edelstein, MD, PhD Professor, Medicine-Renal Med Diseases/HypertensionExtra-Special GuestMichelle Rheault, MD Professor of Pediatrics, University of MinnesotaEditing bySimon and Joel TopfThe Kidney Connection written and performed by by Tim YauShow NotesKDIGO ADPKD Guidelines:WebsiteGuideline PDFExecutive Summary PDFNephJC coverageConsortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP)Hy's Law (Wikipedia) has three components:ALT or AST by 3-fold or greater above the upper limit of normalAnd total serum bilirubin of greater than 2× the upper limit of normal, without findings of cholestasis (defined as serum alkaline phosphatase activity less than 2× the upper limit of normal)And no other reason can be found to explain the combination of increased aminotransferase and serum total bilirubin, such as viral hepatitis, alcohol abuse, ischemia, preexisting liver disease, or another drug capable of causing the observed injuryMeeting this definition yields a very high risk of fulminant kidney failure (76% in one series)Clinical Pattern of Tolvaptan-Associated Liver Injury in Subjects with Autosomal Dominant Polycystic Kidney Disease: Analysis of Clinical Trials Database (PubMed) Two of 957 patients on tolvaptan met Hy's law criteria. None had fulminant kidney failure.Effects of Hydrochlorothiazide and Metformin on Aquaresis and Nephroprotection by a Vasopressin V2 Receptor Antagonist in ADPKD: A Randomized Crossover Trial (PubMed) Patients had a baseline urine volume on tolvaptan of 6.9 L/24 h. Urine volume decreased to 5.1 L/24 h with hydrochlorothiazide and to 5.4 L/24 h on metformin.TEMPO 3:4 Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease (NEJM)Reprise Trial Tolvaptan in Later-Stage Autosomal Dominant Polycystic Kidney Disease ( NEJM | NephJC )Unified ultrasonographic diagnostic criteria for polycystic kidney disease by Edelstein in JASN (PubMed)Tolvaptan and Kidney Function Decline in Older Individuals With Autosomal Dominant Polycystic Kidney Disease: A Pooled Analysis of Randomized Clinical Trials and Observational Studies (PubMed)Charles' draft choice Recommendation 4.1.1.1: We recommend initiating tolvaptan treatment in adults with ADPKD with an estimated glomerular filtration rate (eGFR) ‡25 ml/min per 1.73 m2 who are at risk for rapidly progressive disease (1B).Sophia's draft choice Recommendation 1.4.2.1: We recommend employing the Mayo Imaging Classi cation (MIC) to predict future decline in kidney function and the timing of kidney failure (1B).Progression to kidney failure in ADPKD: the PROPKD score underestimates the risk assessed by the Mayo imaging classification (Frontiers of Science)AC's draft choice Recommendation 9.2.1: We recommend targeting BP to ≤ 50th percentile for age, sex, and height or ≤ 110/70 mm Hg in adolescents in the setting of ADPKD and high BP (1D).HALT-PKD Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease (NEJM)Nayan's draft choice Recommendation 6.1.2: We recommend screening for ICA in people with ADPKD and a personal history of SAH or a positive family history of ICA, SAH, or unexplained sudden death in those eligible for treatment and who have a reasonable life expectancy (1D).Screening for Intracranial Aneurysms in Patients with Autosomal Dominant Polycystic Kidney Disease (CJASN)Surgical Clipping Versus Endovascular Coiling in the Management of Intracranial Aneurysms (PubMed) Clipping is associated with a higher rate of occlusion of the aneurysm and lower rates of residual and recurrent aneurysms, whereas coiling is associated with lower morbidity and mortality and a better postoperative course.Joel's editorial pick Recommendation 6.1.1: We recommend informing adults with ADPKD about the increased risk for intracranial aneurysms (ICAs) and subarachnoid hemorrhage (1C).Joel's first draft pick The bring out your dead pick:Recommendation 4.3.1: We recommend not using mammalian target of rapamycin (mTOR) inhibitors to slow kidney disease progression in people with ADPKD (1C).Recommendation 4.4.1: We suggest not using statins specfiically to slow kidney disease progression in people with ADPKD (2D).Recommendation 4.5.1: We recommend not using metformin specifically to slow the rate of disease progression in people with ADPKD who do not have diabetes (1B).Recommendation 4.6.1: We suggest that somatostatin analogues should not be prescribed for the sole purpose of decreasing eGFR decline in people with ADPKD (2B).Perfect match: mTOR inhibitors and tuberous sclerosis complex (Orphanet Journal of Rare Diseases)Navitor Pharmaceuticals Announces Janssen Has Acquired Anakuria Therapeutics, Inc. (BioSpace) This is press release about acquiring the mTor1 inhibitor.Joel's second draft pick Recommendation 4.2.1.1: We suggest adapting water intake, spread throughout the day, to achieve at least 2–3 liters of water intake per day in people with ADPKD and an eGFR ≥ 30 ml/min per 1.73 m2 without contraindications to excreting a solute load (2D).Nayan's bonus draft Practice Point 4.7.1: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) should not be used to slow eGFR decline in people with ADPKD.Open-Label, Randomized, Controlled, Crossover Trial on the Effect of Dapagliflozin in Patients With ADPKD Receiving Tolvaptan (KIReports)SMART Trial of GLP-1ra in non-diabetics: Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial (PubMed)Tubular SecretionsNayan: Landman on Paramount Plus (IMDB)Sophia: PassNayan: steps in with The Pitt on HBO (Wikipedia)Charles: The White Lotus, Yellowstone 1923, Poirot (IMDB)AC: The PittMichael Crichton's Estate Sends The Pitt to the Courtroom (Vulture)Joel: I Must Betray you by Ruta Sepetys (Amazon)