Podcasts about Refractory

 As we celebrate yet another May the 4th (be with you), Mikey, d$ and #XlessDrEarl change up their Star Wars topics a bit - instead of fave scenes or ranking the movies, this time, its a look at all the movies that Star Wars inspired... some that turned out to be legendary... some that turned out to be legendarily bad... Can't Force alone, so the crew invites in Fan Fave and longtime friend of the show Hurricane Rhett Barnett, and he gives his own take on the 2024 comedy horror movie "Heretic" as well as a brief chat about the rerelease of "Revenge of the Sith", which has Mikey using the word "Refractory" and Rhett using the phrase "Marital Bed".   Then they play what turns about to be a disastrous version of "Everything Everywhere All At Once Upon a Time in Hollywood", which may end up being retired at some point because no one can play the stupid thing (note: d$'s opinion). Then, a top five of Star Wars Adjacent, with some classic Flash Gordon and a chat about Sam Jones and Jacko (OY!), plus star fighters and dark stars and stars with battles beyond them, plus a glave, a hole, Ridley Scott's inspiration, and even kitchen appliances in a classic short film.

Featuring a slide presentation from Dr Matthew Matasar and related discussion from Dr Carla Casulo, Dr Matasar and Dr Laurie H Sehn, including the following topics: Overview of Bispecific Antibodies for the Treatment of Relapsed/Refractory (R/R) Follicular Lymphoma (FL) (0:00) Clinical Data Available with Mosunetuzumab for R/R FL (1:54) Clinical Data Available with Epcoritamab for R/R FL (4:54) Clinical Data Available with Odronextamab for R/R FL (6:53) Clinical Considerations in Selecting Among Available Bispecific Antibodies for R/R FL (8:34) Practical Considerations in the Administration of Bispecific Antibodies (15:21) The Role of Vaccinations in the Prevention of Infections for Patients Receiving Bispecific Antibodies (18:34) Ongoing Clinical Trials Evaluating Bispecific Antibodies for FL (21:34) Case: A man in his late 60s with refractory FL who received mosunetuzumab monotherapy (24:24) Case: A woman in her late 50s with relapsed FL who received third-line epcoritamab monotherapy (30:14) Case: A man in his late 80s with a long-standing history of FL who received odronextamab in combination with a second novel bispecific antibody (33:48) CME information and select publications

Dr Carla Casulo from Wilmot Cancer Institute in Rochester, New York, Dr Matthew Matasar from Rutgers Cancer Institute of New Jersey in New Brunswick and Dr Laurie H Sehn from BC Cancer Centre for Lymphoid Cancer in Vancouver discuss recent updates on available and novel treatment strategies for relapsed/refractory follicular lymphoma. CME information and select publications here.

In this Fresh Thinking episode, we're discussing one of mining's toughest technical challenges: refractory gold ores. Dr Tarrant Elkington, Snowden Optiro General Manager sits down with metallurgical expert Dr Leon Lorenzen to explore why some gold refuses to come quietly, and the high-stakes processing paths needed to recover it. From pressure oxidation to bioleaching and ultrafine grinding, this episode uncovers the costs, complexities, and future of refractory ore treatment. If you're a geologist, metallurgist, or investor—this one's essential listening. This podcast at a glance: 00:00 – Welcome & Introduction 00:45 – What is refractory gold? And why is it a problem? 02:30 – The role of geology and early detection 04:00 – How refractory ore impacts project economics 05:15 – Overview of processing methods: POX, BIOX, Albion, roasting 07:30 – How to choose the right processing path 09:00 – Real-world examples of refractory gold plants 11:00 – The future: centralised hubs and economic scale 12:30 – Final thoughts and advice for developers and investors If you'd like to connect with Tarrant and Leon: contact@snowdenoptiro.com This video podcast is also available as a video podcast on our Snowden Optiro YouTube channel: https://www.youtube.com/@SnowdenOptiro

Dustin A. Deming, MD - Personalizing Treatment Pathways for Refractory Metastatic Colorectal Cancer: Informed Decision-Making When Disease Has Progressed

Dustin A. Deming, MD - Personalizing Treatment Pathways for Refractory Metastatic Colorectal Cancer: Informed Decision-Making When Disease Has Progressed

Dustin A. Deming, MD - Personalizing Treatment Pathways for Refractory Metastatic Colorectal Cancer: Informed Decision-Making When Disease Has Progressed

Dustin A. Deming, MD - Personalizing Treatment Pathways for Refractory Metastatic Colorectal Cancer: Informed Decision-Making When Disease Has Progressed

Dustin A. Deming, MD - Personalizing Treatment Pathways for Refractory Metastatic Colorectal Cancer: Informed Decision-Making When Disease Has Progressed

Dustin A. Deming, MD - Personalizing Treatment Pathways for Refractory Metastatic Colorectal Cancer: Informed Decision-Making When Disease Has Progressed

In this week's episode we'll learn about the role of interleukin-1 signaling in the bone marrow microenvironment in the development of myelodysplastic syndromes, the immune checkpoint regulator VISTA as a potential target for preventing graft-vs-host disease, and epcoritamab plus gemcitabine and oxaliplatin in transplant-ineligible relapsed/refractory diffuse large B-cell lymphoma.Featured Articles:IL-1R1 and IL-18 signals regulate mesenchymal stromal cells in an aged murine model of myelodysplastic syndromesTargeting cell-surface VISTA expression on allospecific naïve T cells promotes toleranceEpcoritamab plus GemOx in transplant-ineligible relapsed/refractory DLBCL: results from the EPCORE NHL-2 trial

Thanks to Dr. Abhinav Totapally who is a pediatric intensivist at Nicklaus Children's Hospital in Miami and Dr. Brian Bridges, the Division Chief of Pediatric Critical Care Medicine at the Medical University of South Carolina in Charleston for joining us for this series. Check out their paper published in PCCM in January 2025Learning Objectives:By the end of this podcast, listeners should be able to discuss:The rationale supporting and the limitations of using VA ECMO for children with refractory septic shock.Patient selection in the use of VA ECMO for children with refractory septic shock.The benefits and risks of common cannulation strategies for VA ECMO in children with refractory septic shock.An expert approach to supporting children with refractory septic shock on VA ECMO.Reference:Totapally A, Stark R, Danko M, Chen H, Altheimer A, Hardison D, Malone MP, Zivick E, Bridges B. Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021. Pediatr Crit Care Med. 2025 Jan 23.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Please visit answersincme.com/FXP860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in pulmonary infectious disease discusses management of refractory Mycobacterium avium complex (MAC) pulmonary disease. Upon completion of this activity, participants should be better able to: Identify patients with refractory Mycobacterium avium complex (MAC) pulmonary disease in a timely manner; Review guideline-recommended therapeutic approaches to enhance the treatment plan for patients with refractory MAC pulmonary disease; and Outline clinical strategies to optimize long-term care for patients with refractory MAC pulmonary disease.

The fight against relapsed/refractory multiple myeloma is evolving rapidly, with groundbreaking research and clinical trials paving the way for innovative treatments. But as new therapies emerge, addressing healthcare disparities and improving access to these life-changing advancements has never been more critical. In this episode, Dr. Rahul Banerjee, Assistant Professor of Medicine at Fred Hutchinson Cancer Center and co-chair of i3 Health's Multiple Myeloma Task Force activity, shares his expert perspective on the latest developments in CAR T-cell therapy and bispecific antibodies. He also highlights ongoing efforts to make these cutting-edge treatments more practical and accessible for patients, ensuring no one is left behind in the fight against this challenging disease. Don't miss this engaging discussion packed with actionable insights for healthcare professionals. After listening, take the next step by exploring the full Task Force activity and related resources to deepen your understanding and make a difference in your practice. Click below to access these valuable resources: Accredited CME/NCPD Podcast: bit.ly/3B4gSB1 Position Statement in Blood Cancer Journal: www.nature.com/articles/s41408-024-01129-0 Live Task Force Recording: www.youtube.com/live/TILCPB6w3Ig?…=1Z8m4dA2qwLJd6rN

Thanks to Dr. Abhinav Totapally who is a pediatric intensivist at Nicklaus Children's Hospital in Miami and Dr. Brian Bridges, the Division Chief of Pediatric Critical Care Medicine at the Medical University of South Carolina in Charleston for joining us for this series. Check out their paper published in PCCM in January 2025Learning Objectives:By the end of this podcast, listeners should be able to discuss:The rationale supporting and the limitations of using VA ECMO for children with refractory septic shock.Patient selection in the use of VA ECMO for children with refractory septic shock.The benefits and risks of common cannulation strategies for VA ECMO in children with refractory septic shock.An expert approach to supporting children with refractory septic shock on VA ECMO.Reference:Totapally A, Stark R, Danko M, Chen H, Altheimer A, Hardison D, Malone MP, Zivick E, Bridges B. Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021. Pediatr Crit Care Med. 2025 Jan 23.Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Beyond refractory ascites and variceal bleeds, the TIPS procedure has evolved to address new indications over the past two decades, including acute and chronic mesenteric venous ischemia, Budd-Chiari Syndrome, hepatorenal syndrome, pre-liver transplant preparation, and palliative care for cancer-related complications. This podcast will feature a candid discussion among experienced interventional radiologists about case selection, the procedures, pitfalls encountered, and future directions.

- Review of Chronic Lymphocytic Leukemia - Significant Role of Testing in Informing Your Treatment Choices - First-Line Treatment Options - Treatment of Relapsed & Refractory CLL - Re-Testing Importance in Determining Treatment for 2nd & 3rd Line Treatments - Current Perspectives on New & Emerging Treatments of CLL - Updates on Clinical Trials & Their Significance for CLL - Key Questions to Ask & Re-Ask Your Health Care Team - Practical and Psychosocial Support to Cope with CLL - Questions for Our Panel of Expert

- Review of Chronic Lymphocytic Leukemia - Significant Role of Testing in Informing Your Treatment Choices - First-Line Treatment Options - Treatment of Relapsed & Refractory CLL - Re-Testing Importance in Determining Treatment for 2nd & 3rd Line Treatments - Current Perspectives on New & Emerging Treatments of CLL - Updates on Clinical Trials & Their Significance for CLL - Key Questions to Ask & Re-Ask Your Health Care Team - Practical and Psychosocial Support to Cope with CLL - Questions for Our Panel of Expert

- Review of Chronic Lymphocytic Leukemia - Significant Role of Testing in Informing Your Treatment Choices - First-Line Treatment Options - Treatment of Relapsed & Refractory CLL - Re-Testing Importance in Determining Treatment for 2nd & 3rd Line Treatments - Current Perspectives on New & Emerging Treatments of CLL - Updates on Clinical Trials & Their Significance for CLL - Key Questions to Ask & Re-Ask Your Health Care Team - Practical and Psychosocial Support to Cope with CLL - Questions for Our Panel of Expert

In this World Shared Practice Forum Podcast, Dr. Graeme MacLaren shares his expert insight on the outcomes of central versus peripheral cannulation techniques for Extracorporeal Membrane Oxygenation (ECMO) in pediatric patients with refractory septic shock as published in the February issue of Pediatric Critical Care Medicine. The discussion focuses on the implications of ECMO modality choices, the conditions affecting cannulation strategy, and how institutional resources can impact patient outcomes. LEARNING OBJECTIVES - Differentiate between central and peripheral venoarterial ECMO strategies in pediatric septic shock - Analyze key papers in the literature to provide context for decision-making around ECMO deployment in refractory septic shock - Identify factors influencing the success and outcome of ECMO in refractory pediatric septic shock cases - Apply considerations for patient selection and institutional resource availability in ECMO planning AUTHORS Graeme MacLaren, MBBS, MSc, FRACP, FCICM, FCCM, FELSO Director of Cardiothoracic Intensive Care, National University Hospital, Singapore Clinical Director of ECMO, National University Heart Centre, Singapore Adjunct Professor, Department of Surgery, National University of Singapore Past President, Extracorporeal Life Support Organization Jeffery 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: March 24, 2025. ARTICLES REFERENCED 1) MacLaren, Graeme MBBS, MSc, FELSO, FCCM. Cannulation Strategies for Extracorporeal Membrane Oxygenation in Children With Refractory Septic Shock. Pediatric Critical Care Medicine ():10.1097/PCC.0000000000003707, February 10, 2025. | DOI: 10.1097/PCC.0000000000003707 2) Totapally A, Stark R, Danko M, et al. Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021. Pediatr Crit Care Med. Published online January 23, 2025. doi:10.1097/PCC.0000000000003692 3) Schlapbach LJ, Chiletti R, Straney L, et al. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study. Crit Care. 2019;23(1):429. Published 2019 Dec 30. doi:10.1186/s13054-019-2685-1 4) Bréchot N, Hajage D, Kimmoun A, et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. Lancet. 2020;396(10250):545-552. doi:10.1016/S0140-6736(20)30733-9 TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/at/84gbxthfmhvp7v9fsnjb87mh/0320425_WSP_MacLaren_Transcript.pdf 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. CITATION MacLaren G, Burns JP. Pediatric ECMO Cannulation Strategies in Refractory Septic Shock. 03/2025. OPENPediatrics. https://soundcloud.com/openpediatrics/pediatric-ecmo-cannulation-strategies-in-refractory-septic-shock-by-g-maclaren-openpediatrics.

Show notes at pharmacyjoe.com/episode1010. In this episode, I’ll discuss the use of dexmedetomidine to reduce vasopressor resistance in refractory septic shock. The post 1010: Does Dexmedetomidine Improve Vasopressor Sensitivity in Refractory Septic Shock? appeared first on Pharmacy Joe.

In today's episode, we'll discuss time-limited triplet therapy in relapsed or refractory CLL. Zanubrutinib, venetoclax and obinutuzumab induced deep remissions, and was well tolerated, even in very high-risk patients, and those with prior exposure to targeted therapies. After that: researchers chronicle the development of a patient-reported outcome measure for sclerosis associated with chronic GVHD—graft-versus-host disease. The new symptom scale—currently undergoing validation studies—may provide valuable information regarding severity, functional impact, and response to therapy. Finally, a study of changes in population dynamic rates that underlie inflammation-associated myeloid bias. The work demonstrates the use of mathematical models to deliver critical biological insights and uncover underlying mechanisms.Featured Articles:MRD-guided zanubrutinib, venetoclax, and obinutuzumab in relapsed CLL: primary end point analysis from the CLL2-BZAG trialDevelopment of the Lee Symptom Scale–Skin Sclerosis for chronic GVHD–associated sclerosisPopulation dynamics modeling reveals that myeloid bias involves both HSC differentiation and progenitor proliferation biases

Refractory hypoxemia in the intubated patient is one of the scariest situations any emergency physician can face. In this episode of EMRA*Cast, Drs. Peter Lorenz and Steven Haywood discuss a stepwise approach to managing this worst-case scenario.

A puzzling pair of Case Reports from the most recent issue of the journal. First up (1:35) is a man in his mid-fifties, presenting with lumbar spine fractures, which then developed into confusion, vomiting, and abdominal pain. An x-ray showed  dilated intestinal loops and his blood sodium levels were low. https://pn.bmj.com/content/25/1/87 The second case (23:06) involves a 21-yo woman, who presented  at 18 weeks pregnant with  multiple episodes of right upper limb tonic extension, and subsequently developed new-onset refractory status epilepticus (NORSE). https://pn.bmj.com/content/25/1/56    The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Xin You Tai³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Academic Fellow, Nuffield Department of Clinical Neurosciences, Oxford University, and Neurology Specialty registrar, Oxford University Hospital.  Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Letícia Amorim and Brian O'Toole. Thank you for listening. 

Emergency treatment may be necessary after a person's first seizure or at the onset of abnormal acute repetitive (cluster) seizures; it is required for status epilepticus. Treatment for these emergencies is dictated by myriad clinical factors and informed by published guidance as well as emerging research.   In this episode, Lyell K. Jones, MD, FAAN, speaks with David G. Vossler, MD, FAAN, FACNS, FAES, author of the article “First Seizures, Acute Repetitive Seizures, and Status Epilepticus,” in the Continuum® February 2025 Epilepsy issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Vossler a clinical professor of neurology at the University of Washington School of Medicine in Seattle, Washington. Additional Resources Read the article: First Seizures, Acute Repetitive Seizures, and Status Epilepticus Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ  Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Dave Vossler, who has recently authored an article on emergent seizure management, taking care of patients with the first seizure, acute repetitive seizures, and status epilepticus, which is an article in our latest issue of Continuum covering all topics related to epilepsy. Dr Vossler is a neurologist at the University of Washington, where he's a clinical professor of neurology and has an active clinical and research practice in epileptology. Dr Vossler, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Vossler: Thank you very much for the introduction, Lyell. It's a pleasure to speak with you on this podcast, and I hope to go over a lot of important new information in the management of seizure emergencies. As you said, I'm a clinical professor in neurology at University of Washington, been in medicine for many decades now and have published and done research in this area. So, I'm anxious to give you not only my academic experience, but also talk about my own management of patients with status epilepticus over the last four decades. Dr Jones: Yeah, that's fantastic. And I always appreciate hearing from experienced clinicians, and I think our readers and our listeners do appreciate that voice of clinical expertise. And I'll tell you this is a topic, you know, as a neurologist who doesn't see many patients with acute seizure emergencies in my own practice, I think this is a topic that gives many clinicians, including neurologists, some anxiety. Your article, Dr Vossler, is really chock-full of helpful and clinically relevant considerations in the acute management of seizures. So, you now have the full attention of a huge audience of mostly neurologists. What's the one most important practice change that you would like to see in the care of patients with either first or acute prolonged seizures? Dr Vossler: Without a doubt, the most important clinical takeaway with regard to the status epilepticus---and for status epilepticus, many, many clinical trials, research trials have been done over the last couple decades and they all consistently show the same thing, that by and large most patients who have status epilepticus are underdosed and undertreated and treated too slowly in the initial stages of the status epilepticus. And it's important to use full bolus dosages of benzodiazepines to prevent mortality, morbidity, and later disability of these patients. To prevent the respiratory depression, many physicians are afraid to use higher doses of benzodiazepines, even guideline-recommended doses of benzodiazepines for fear of respiratory depression. But it's actually counterintuitive. It turns out that most cases of respiratory depression are due to inadequate doses and due to the status epilepticus itself. We know there's greater mortality, we know there's greater morbidity and we know that there's greater need for higher dose, subsequent, anti-seizure medications, prolonged status, if we don't use the proper doses. So, we'll kind of go over that a little bit, but that is the one clinical takeaway that I really would like our listeners to have. Dr Jones: Let's follow that thread a little bit. Dave, I know obviously we will speak in hypotheticals here. We're not going to talk about actual patients, but I think we've all been in the clinical situation where you have a patient who comes into the emergency room usually who's actively seizing, unknown history, don't know much about the patient, don't know much about the circumstances of the onset of the seizure. But we now have a patient with prolonged convulsive seizures. How do we walk through that? What are the first steps in the management of that patient? Dr Vossler: Yeah, well, I'll try to be brief for the purposes of the podcast. We do, of course, go through all of that in detail in the Continuum article, which hopefully everybody will look at very carefully. Really in the first table, the very first table of the article, I go through the recommended guideline for the American Epilepsy Society on the management of what we call established status epilepticus. The scenario you're talking about is just exactly that: established status epilepticus. It's not sort of evolving or developing status. We're okay they're having a few seizures and we're kind of getting there. No, this patient is now having evidence of convulsive seizure activity and it's continuing or it's repeated seizures without recovery. And so, the first phase is definitely a benzodiazepine and then the second phase is then a longer-acting bolus of a drug like phosphenotoine, valproic acid or levetiracetam. I could get into the details about dosing of the benzodiazepines, but maybe I'll let you guide me on whether we wanted to get into that kind of detail right at the outset. It's going to be a little bit different. For children, its weight-based dosing, but for adults, whether you use lorazepam or you use diazepam or you use midazolam, the doses are a little bit different. But they are standardized, and gets back to this point that I made earlier, we're acting too slow. We're not getting these patients quick enough, for various reasons, and the doses that are most commonly used are below what the guidelines call for. Dr Jones: That's great to know, and I think it's fine for the details to refer our listeners to the article because there are great details in there about a step-by-step approach to the established status epilepticus. The nomenclature and the definitions have evolved, haven't they, Dr Vossler, over time? Refractory status epilepticus, new-onset refractory status epilepticus, super refractory status epilepticus. Tell us about those entities, how they're distinguished and how you approach those. Dr Vossler: That's an important thing to kind of go over. They- in 2015, the International League Against Epilepsy, ILAE, which is, again, our international organization that guides our understanding of all kinds of things epileptic in nature around the world. In 2015 they put out a definition of status epilepticus, but it used to be that patients had thirty minutes of continuous seizure activity or repetitive obvious motor seizures with impairment of awareness and they don't recover impairment between these seizures. And that goes on for thirty minutes. That was the old definition of status epilepticus. Now, the operational definition is five minutes. And I think that's key to understand that, after five minutes of this kind of overt seizure activity, you need to intervene. And that's what's called T1 in the 2015 guideline, the international guideline. There are a bunch of different axes in the classification of status that talk about semiology, etiology, EEG patterns, and what age group you're talking about. We won't really get into those in the Continuum article because that's really more detailed than a clinician really should be. Needing to think about the stages, what we call the stages of status epilepticus that you mentioned and I alluded to earlier are important. And that is sort of new nomenclature, and I think probably general neurologists and most emergency room physicians aren't familiar with those. So, it just briefly goes through those. Developing status epilepticus is where you're starting- the patient's starting to have more frequent seizures, and it's heading essentially in the wrong direction, if you will. Established status epilepticus, as I mentioned, is, you know, this seizure act, convulsive or major, major outward overt seizure activity lasting five minutes or more, at which time therapy needs to begin. Again, getting back to my point, what doesn't happen often enough is we're not- we're intervening too late. Third is refractory status epilepticus, which refers to status epilepticus which continues despite adequate doses of an initial benzodiazepine given parenterally followed by a full loading dose of a single non-sedating anti-seizure medicine, which today includes phosphenotoine IV valproic acid or IV levetiracetam. In the United States, and increasingly around the world, people really are using levetiracetam. First, it has some advantages. There's now proof from a class one NIH-funded trial. We know that these three drugs are equivalent at the full doses that I go over in the article. You have your kind of dealer's choice on those. Phenobarbital, which we used to use and I used as a resident as long as forty years ago, is really a second choice drug because of its sedating and other side effects. But around the world in resource-poor countries phenobarbital can be used and, in a pinch, certainly is an appropriate drug. And then finally, you mentioned super refractory status epilepticus and that's status that's persisting for more than twenty four hours. Now, despite initial benzo and non-sedating anti-seizure medicine, but also lasting more than twenty four hours while receiving an intravenous infusional sedating, anesthetizing anti-seizure medicine like ketamine, propofol, pentobarbital or midazolam drips. Dr Jones: So, it sounds like the definitions have evolved in a way that improves the outcomes, right? To do earlier identification of status epilepticus and more aggressive management, I think that's a great takeaway. If we move all the way to the other end of the spectrum, let's move to the ambulatory setting and we have a patient who comes in and they've had one seizure, they're an adult; one seizure, the first seizure. The key question is, how do we anticipate the risk of future seizures? But walk us through how you talk to that patient, how you evaluate that patient to decide if and when to start anti-seizure medicines. Dr Vossler: Well, it depends a little bit if it's an adult or a child, but the decision making process and the data behind it is pretty robust now. And the decision making process is pretty similar for adults and children, with some differences which I can talk about. First of all, first seizures. I think it's really important to stress that there's been so much research in this area. I'd like to get a cross point that they're not as innocuous as I think many general neurologists might suspect. We know that there is a two- to threefold increased risk of death in children and adults following a first seizure. Moreover, the risk of a second seizure, both in kids and adults, is about 36% two years after that first seizure. It's about 46% five years after that first seizure. It's really pretty substantial. The risk of a second seizure is increased twofold. It doubled in the presence of any kind of a history of prior brain insults that could result in seizures. Could be infections, it could be a prior stroke, it could be prior significant brain trauma. It's also doubled in the presence of an EEG, which shows epileptiform discharges like spikes and sharp waves---and not just a sort of borderline things like sharply contoured rhythmic Theta activity. That's really not what we're talking about. We're talking about overt epileptiform discharges. It's doubled in the presence of lesion that can be seen on imaging studies, and it's doubled in the presence of seizures if that first seizure occurs during sleep. So, we have a number of things that double the risks, above the risk of a second seizure, above that 36% at two years and 46% at five years that I spoke about. And so those things need to be considered when you're counseling a patient about that. Should you be on an anti-seizure medicine after that first seizure? Specifically, to the point of anti-seizure medications, the guideline that was done, the 2015 guideline that was done by the American Academy of Neurology for adults, and the 2003 guideline was actually a practice parameter that was done by the Academy and the American Epilepsy Society for children, are really kind of out of date. They talk about the adverse effects of anti-seizure medications, but when you look back at the studies that were included in developing that practice parameter for kids and guidelines for adults, they are the old drugs: carbamazepine, phenytoin, phenobarbital and valproate. Well, I don't think I need to tell this audience, this well-educated audience, that we don't use those drugs anymore. We are using more modern anti-seizure medicines that have been developed since 1995; things like lamotrigine, levetiracetam, and lecosamide. Those three in particular have very low adverse events. So, the guideline that the Academy, American Academy Neurology and American Epilepsy Society put together for kids and for adults talks about this high adverse event profile. And so, you need to take a look at the risks that I talked about of a seizure recurrence and balance that against adverse effects. But I'm here to tell you that the newer anti-seizure medicines---and by newer I'm talking in the last thirty years since lamotrigine was approved in 1995---these drugs have much better side effect profiles. And I think all epileptologists would agree with that. They're not necessarily more effective, but they are better tolerated. That makes the discussion of the risk of a second seizure, the risk of mortality versus side effects of drugs, it really pushes the risk category higher on the first side and not on the side of drugs. We know that if you take an anti-seizure medicine, you reduce your risk of a second seizure by half. Now, that's not sustained over five years, but over the first two years, you've reduced it by half. In a person who's driving, needs to get to work, has to take the kids to school, whatever, most of my patients are like, yeah, okay, sign me up. These drugs are really pretty well tolerated. There's a substantial risk of a second seizure. So, I'll do that. In a kid,  a child that's, you know, not driving yet, that might be a different discussion. And the parents might say, well, I'd rather not have my son exposed, my daughter exposed to this. They're trying to go to school. They're trying to learn. We don't want to hinder that. We'll wait for a second seizure and then if they have a second seizure, which by the way is, you know, one of the definitions of epilepsy, well then they have epilepsy, then they probably will need to go on the seizure medication. Dr Jones: Great summary, Dr Vossler, and it is worth our audience being aware that the evidence has evolved alongside the improvement in the adverse effect profile. And sounds like your threshold is a little lower to treat then maybe it would have been some time ago, right? Dr Vossler: I would say that's exactly correct in my opinion. Particularly for adults, absolutely. Dr Jones: That's fantastic, Dr Vossler. I imagine there are a lot of aspects of caring for these patients that are challenging, and I imagine many scenarios are actually pretty rewarding. What do you find the most rewarding aspect of caring for patients with acute seizure management? Dr Vossler: Yes, I mean, that is really true. I would say that the most challenging things are treating refractory status epilepticus, but worse yet, new onset refractory status epilepticus and the super refractory status epilepticus, which I talk extensively about or write extensively about in the article and provide a lot of guidance on. Really, those conditions are so challenging because they can go on for such a long time. Patients are hospitalized for a long time. A lot of really good clinical guidance doesn't exist yet. There is a tremendous amount of research in that area which I find exciting, and really there's an amazing amount of international research on that, I think most of our audience probably is unaware of. And certainly, with those conditions, there is a high risk of later disability and mortality. We go through all of that in the article. The rewards really come from helping these people. When someone was super refractory status and it were non- sorry, new onset refractory status epilepticus, has been in the hospital for thirty days, it gets really hard for everybody; the family, the patient. And for us, it wears on us. Yet when they walk out the door, and I've had these people come back to the epilepsy clinic and see me later. We're managing their anti-seizure medications. They've survived. The NORSE patients often have substantial disability. They have cognitive and memory and even some psychiatric disability. But yet we can help them. It's not just management in the hospital, but it's getting to know these people, and I take them from the hospital and see them in my clinic and manage them long-term. I get a lot of great satisfaction out of that. We're hoping to do even better, stop patients' status early and get them to recover with no sequelae. Dr Jones: What a great visual, seeing those patients who have a devastating problem and they come back to clinic and you get the full circle. And what a great place to end. Dr Vossler, thank you so much for joining us, and thank you for such a thorough and fascinating discussion on the importance of understanding and managing patients with the first seizure, acute repetitive seizures, and status epilepticus. Dr Vossler: Thank you very much, Lyell. Dr Jones: Again, we've been speaking with Dr Dave Vossler, author of an article on emergent seizure management, first seizures, acute repetitive seizures and status epilepticus in Continuum's most recent issue on epilepsy. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

N Engl J Med 2013;369:1115-23Background: The COURAGE trial was published in 2007. It compared up-front PCI to medical therapy alone in patients with stable CAD. Preventive PCI did not reduce the chance of dying or having a heart attack over a median follow up time of 5 years. The results rocked the cardiology world because for years prior to the publication of COURAGE, the standard of care called for revascularization of obstructive coronary stenosis. Despite what we would consider minor criticisms of COURAGE, the results have held over time as a preventive PCI strategy has failed repeatedly to reduce death or MI compared to medicine alone in subsequent large trials (BARI 2D, FAME 2, ISCHEMIA and ISCHEMIA-CKD) involving patients with stable CAD. But what about patients with acute coronary syndromes who have, a clearly defined “culprit” lesion and stable coronary stenosis of a non-infarct vessel? On the surface, the answer might seem simple - treat the “culprit” lesion with PCI and leave the stable disease alone. Continue optimal medical treatment of stable CAD indefinitely with consideration of revascularization only if new symptoms arise. But what if a stable coronary stenosis behaves differently in a patient with an acute coronary syndrome than in patients without it? Are these patients predisposed or particularly susceptible to acute plaque rupture and thrombogenesis to such an extent that they would benefit from a preventive revascularization strategy? The Primary Angioplasty in Myocardial Infarction (PRAMI) trial sought to test the hypothesis that immediate preventive PCI of non-culprit vessels plus the culprit vessel compared to culprit vessel only PCI would improve outcomes in patients with a STEMI and coronary stenosis of a non-infarct related artery.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: From 2008 through 2013, patients were enrolled from 5 coronary care centers in the United Kingdom. Patients could be any age with acute STEMI and multivessel CAD detected at the time of emergency PCI. The trial was limited to patients with STEMI because ST-segment elevation, unlike ST-segment depression, localizes the area of ischemia in the myocardium and an “infarct-artery” is usually easy to distinguish. Clinically stable patients were considered for eligibility after undergoing PCI of the infarct artery while they were in the catheterization lab. They were eligible if successful PCI of infarct artery was performed and there was stenosis of 50% or more in one or more non-infarct arteries. Exclusion criteria included cardiogenic shock, previous CABG, had left main or significant disease in the ostia of both the LAD and circumflex vessels, or if the only non-infarct stenosis was a chronic total occlusion.Baseline characteristics: The trial screened 2,428 patients and randomized 465 patients (19%) with 234 to preventive PCI and 231 to no preventive-PCI. The majority of patients were excluded for single vessel disease (1122/1922 [58%]). The average age of patients was 62 years and more than 75% were men. Close to 50% were current smokers. The infarct artery was anterior in 35%, inferior in 60% and lateral in 5%. Approximately 65% of patients had 2 vessel disease and 35% had 3 vessel disease.Procedures: After completion of PCI in the infarct artery, eligible patients were randomized and those assigned to the preventive-PCI group underwent the procedure immediately in all non-infarct arteries with a coronary stenosis >50%. PCI was discouraged at a later date (sometimes this strategy is referred to as “staged PCI”) in the no preventive-PCI group unless it was symptom driven. Any patient in the trial with subsequent symptoms of angina that were not controlled with medicine was required to undergo objective assessment of ischemia to secure a diagnosis of refractory angina. Follow-up information was collected at 6 weeks and then yearly thereafter.Endpoints: The primary endpoint was a composite of death from cardiac causes, nonfatal MI, or refractory angina. Secondary outcomes included the individual components of the composite endpoint along with noncardiac death and repeat revascularization. Myocardial infarction was defined as symptoms of cardiac ischemia and a troponin level >99% URL. However, within 14 days after randomization, MI diagnosis also required ECG evidence of new STE or left bundle branch block and angiographic evidence of coronary artery occlusion (essentially this makes it so only in-stent thrombosis or spontaneous STEMI count and other causes of peri-procedural MI do not - this would bias the trial in favor of the preventive-PCI group).Refractory angina was defined as angina despite medical therapy and objective evidence of myocardial ischemia (i.e., ischemia on ECG during spontaneous episode of pain or abnormal results on functional testing).It was determined that 600 patients would be needed to achieve 80% power to detect a 30% relative reduction in the preventive-PCI group, at a 5% level of significance, assuming an annual rate of the primary outcome of 20% in the control group. Stopping criteria were prespecified if the results from the trial showed a primary outcome difference at the 0.001 level of significance. Results: The trial was stopped early based on a significant difference (P50%, preventive PCI significantly reduced a primary composite outcome of cardiac death, nonfatal MI and refractory angina in the PRAMI trial with an estimated NNT of 7 patients over 2 years. Individual components of the primary endpoint that were significantly reduced included nonfatal MI and refractory angina by similarly large margins. These results may seem impressive at first glance but we urge extreme caution in their interpretation. First, this is a relatively small trial with a historically large effect size, especially when considering hard endpoints like cardiac death and nonfatal MI were included. Such results are often later found to be falsely positive when larger, confirmatory studies are conducted. Second, the trial was stopped early and early stopping is prone to yield false positive and/or exaggerated results. Third, inclusion of refractory angina in the primary endpoint, an endpoint susceptible to bias in an unblinded study (see earlier discussion of “faith healing” and “subtraction anxiety” in FAME 2; consideration also must be given to nocebo effects in patients who know they have “untreated blockages”), clouds the main findings by inflating the effect size and making the trial susceptible to large differences in underpowered endpoints before sufficient data can be accumulated on hard outcomes. For example, if the trial had sought to detect a conservative difference of 30% in a primary composite endpoint that only included cardiac death or nonfatal MI, based on an event rate of 12% in the control group (the actual event rate in the trial), over 2,200 patients would be needed for 80% power at a 5% level of significance. The estimated number of actual events would be around 230. However, only 47 events occurred in PRAMI making the results highly susceptible to noise.While results of PRAMI suggest a beneficial role for preventive-PCI in patients with STEMI, more evidence is needed to confirm the results.Thanks for reading Cardiology Trial's Substack! This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Prof Martin Hutchings from Copenhagen University Hospital in Denmark, Dr Manali Kamdar from the University of Colorado Cancer Center, Dr Matthew Lunning from the University of Nebraska Medical Center and Prof Gilles Salles from Memorial Sloan Kettering Cancer Center in New York summarize currently available data guiding treatment decision-making for patients with relapsed/refractory diffuse large B-cell lymphoma and present cases from their practices.CME information and select publications here.

Featuring slide presentations and related discussion from Prof Martin Hutchings, Dr Manali Kamdar, Dr Matthew Lunning and Prof Gilles Salles, including the following topics: Evolving Role of Chimeric Antigen Receptor (CAR) T-Cell Therapy in Diffuse Large B-Cell Lymphoma (DLBCL) — Dr Kamdar (0:00) Case: A 61-year-old man with Stage IV non-GCB DLBCL receives R-CHOP but experiences disease progression 8 months later (30:39) Case: A 68-year-old man with double-hit DLBCL who experiences disease progression on chemotherapy and second-line CAR T-cell therapy receives glofitamab (39:22) Incorporation of Bispecific Antibody Therapy into DLBCL Management — Prof Hutchings (45:25) Case: A 42-year-old man with progressive DLBCL refractory to 2 lines of therapy receives glofitamab with a durable response (1:07:30) Case: An 81-year-old woman with multiregimen-refractory DLBCL experiences a prolonged response to epcoritamab (1:14:25) Case: A 69-year-old man with follicular lymphoma transformed to DLBCL and refractory to 3 lines of treatment receives glofitamab (1:21:48) Selection and Sequencing of Other Available Therapies for Relapsed/Refractory (R/R) DLBCL — Prof Salles (1:24:37) Case: An 82-year-old woman with follicular lymphoma transformed to DLBCL receives tafasitamab/lenalidomide (1:42:05) Case: A 69-year-old man with urinary bladder carcinoma and recurrent GCB DLBCL receives loncastuximab tesirine (1:46:26) Promising Investigational Approaches for Patients with R/R DLBCL — Dr Lunning (2:00:37) Case: An 80-year-old woman with multiregimen-refractory GCB DLBCL seeks treatment requiring minimal clinic visits and receives loncastuximab tesirine (2:15:59) Case: A 54-year-old man with primary refractory non-GCB DLBCL receives CAR T-cell therapy, and follow-up imaging on day 29 demonstrates a Deauville score of 4 (2:25:22) CME information and select publications

Prof Martin Hutchings from Copenhagen University Hospital in Denmark, Dr Manali Kamdar from the University of Colorado Cancer Center, Dr Matthew Lunning from the University of Nebraska Medical Center and Prof Gilles Salles from Memorial Sloan Kettering Cancer Center in New York summarize currently available data guiding treatment decision-making for patients with relapsed/refractory diffuse large B-cell lymphoma and present cases from their practices.CME information and select publications here.

Toni Choueiri discusses the updated data from different cohorts of this novel HIF inhibitor.

Laurence Albiges joins the show to discuss novel combos in refractory RCC and an update of the Ipi/Nivo/Cabo COSMIC OS data

CardioNerds (Dr. Colin Blumenthal and Dr. Saahil Jumkhawala) join Dr. Rohan Ganti, Dr. Nikita Mishra, and Dr. Jorge Naranjo from the Rutgers – Robert Wood Johnson program for a college basketball game, as the buzz around campus is high. They discuss the following case involving a patient with ventricular tachycardia:  The case involves a 61-year-old man with a medical history of hypothyroidism, hypertension, hyperlipidemia, seizure disorder on anti-epileptic medications, and major depressive disorder, who presented to the ER following an out-of-hospital cardiac arrest. During hospitalization, he experienced refractory polymorphic ventricular tachycardia (VT), requiring 18 defibrillation shocks. Further evaluation revealed non-obstructive hypertrophic cardiomyopathy (HCM). We review the initial management of electrical storm, special ECG considerations, diagnostic approaches once ischemia has been excluded, medications implicated in polymorphic VT, the role of multi-modality imaging in diagnosing hypertrophic cardiomyopathy, and risk stratification for implantable cardioverter-defibrillator (ICD) placement in patients with HCM.  Expert commentary is provided by Dr. Sabahat Bokhari.   Episode audio was edited by CardioNerds Intern and student Dr. Pacey Wetstein.   US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - A Curious Case of Refractory Ventricular Tachycardia - Rutgers-Robert Wood Johnson Diagnostic Uncertainty in VT Storm: In VT storm, ischemia is a primary consideration; when coronary angiography excludes significant epicardial disease, alternative causes such as cardiomyopathies, channelopathies, myocarditis, electrolyte disturbances, or drug-induced arrhythmias must be explored.  ST elevations in ECG lead aVR:  ST elevations in lead aVR and diffuse ST depressions can sometimes represent post-arrest oxygen demand and myocardial mismatch rather than an acute coronary syndrome. This pattern may occur in the context of polymorphic VT (PMVT), where myocardial oxygen demands outstrip supply, especially after an arrest. While these ECG changes could suggest myocardial ischemia, caution is needed, as they might not always indicate coronary pathology. However, PMVT generally should raise suspicion for underlying coronary disease and may warrant a coronary angiogram for further evaluation.  Medication Implications in PMVT and HCM: Certain medications, including psychotropic drugs (e.g., antidepressants, antipsychotics) and anti-epileptic drugs, can prolong the QT interval or interact with other drugs, thereby increasing the risk of polymorphic VT in patients with underlying conditions like HCM. Careful management of these medications is critical to avoid arrhythmic events in predisposed individuals.  Multi-Modality Imaging in HCM: Cardiac MRI with late gadolinium enhancement (LGE) is invaluable in assessing myocardial fibrosis, a key predictor of arrhythmic risk, and can guide decisions regarding ICD implantation. Echocardiography and contrast-enhanced CT can provide additional insights into structural abnormalities and risk assessment.  Polymorphic VT in Nonobstructive HCM: Polymorphic ventricular tachycardia (PMVT) can occur in nonobstructive hypertrophic cardiomyopathy due to myocardial fibrosis and disarray, even in the absence of significant late gadolinium enhancement and left ventricular outflow tract obstruction.  ICD Risk Stratification in HCM: Risk stratification for ICD placement in HCM includes assessment of clinical features such as family history of sudden cardiac death, history of unexplained syncope, presence of nonsustained VT on ambulatory monitoring,

In this week's episode we'll find out about longer term results from a pivotal trial of mosunetuzumab in relapsed/refractory follicular lymphoma, potential use of CD70 CAR T-cells that secrete an anti-CD33/anti-CD3 bispecific antibody as a therapy for acute myeloid leukemia, and how ferroptosis regulates hemolysis in stored red blood cells.Featured Articles:Long-term 3-year follow-up of mosunetuzumab in relapsed or refractory follicular lymphoma after ≥2 prior therapiesCD70 CAR T cells secreting an anti-CD33/anti-CD3 dual-targeting antibody overcome antigen heterogeneity in AMLFerroptosis regulates hemolysis in stored murine and human red blood cells

This week, we talk all about disseminated testicular cancer, highlighting our current treatment modalities and why we do what we do. We also cover refractory disease. This episode builds on our prior discussions in Parts 1 and 2, so be sure to check these out if you haven't already!Episode contents:- A history lesson about how we developed our current risk stratification model - Our current treatment paradigms and regimens for disseminated seminoma and non-seminoma - To resect or not to resect? - How we approach relapsed/refractory disease ****Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

In this episode, Shaji K. Kumar, MD, reviews key data on bispecific antibodies used to treat patients with relapsed/refractory multiple myeloma recently presented at the 2024 annual American Society of Hematology meeting, including:Early results with teclistamab combined with anti-CD38 therapyReal-world data with teclistamab including its use after other BCMA-targeted therapiesTalquetamab as bridging therapy to BCMA-targeted CAR T-cell therapyEvaluation of prophylactic tocilizumab for cytokine-release syndrome associated with bispecific antibody therapyPresenter:Shaji K. Kumar, MDMark and Judy Mullins Professor of Hematologic MalignanciesConsultant, Division of HematologyProfessor of MedicineChair, Myeloma, Amyloidosis and Dysproteinemia GroupResearch Chair, Division of HematologyAssociate Chair for Research, Department of MedicineMayo ClinicRochester, MinnesotaLink to full program:https://bit.ly/40bjFCZ

Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.Chapters: • Defining refractory cardiac arrest • Antiarrhythmic drugs: amiodarone vs. lidocaine • Defibrillation strategies: vector change and double sequential defibrillation • Emerging therapies: stellate ganglion blocks and electrical storm management • ECPR: who qualifies and what the trials say • Equity and feasibility challenges in cardiac arrest management • ICU recovery clinics and patient-centered outcomes • Clinical trials: barriers to enrollment and the need for changeReferences: 1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1] 2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736 3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396 4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112 Disclaimer:This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Lee M. Akst, MD, and Associate Editor Christopher M. Johnson, MD, to discuss diagnosis of, treatments, and solutions for refractory chronic cough as outlined in the paper “Refractory Chronic Cough: A State-of-the-Art Review for Otolaryngologists” which published in the February 2025 issue of Otolaryngology–Head and Neck Surgery. They discuss both the paper's findings and their own experiences caring for patients with this condition.  Click here to read the full article.

Show notes at pharmacyjoe.com/episode997. The post 997: The use of methylene blue for the treatment of refractory anaphylaxis without hypotension appeared first on Pharmacy Joe.

In this week's episode we'll learn more about a phase 2 trial of first-line zanubrutinib, obinutuzumab, and venetoclax in TP53-mutated mantle cell lymphoma; early development of hyperdiploidy in multiple myeloma; and a phase 1 trial of the asparaginase pegcrisantaspase plus venetoclax in relapsed/refractory acute myeloid leukemia.Featured Articles:Zanubrutinib, obinutuzumab, and venetoclax for first-line treatment of mantle cell lymphoma with a TP53 mutationDevelopment of hyperdiploidy starts at an early age and takes a decade to completeA phase 1 study of the amino acid modulator pegcrisantaspase and venetoclax for relapsed or refractory acute myeloid leukemia

Listen to a soundcast of the 12.18.2024 FDA approval of Ryoncil (remestemcel-L-rknd) for steroid-refractory acute graft versus host disease in pediatric patients.

Host Dr. Nick Athanasiou is joined by Dr. David Fiellin and Dr. Eric Strain to discuss the concept of Treatment Refractory Addiction.  Why does the field of addiction medicine need this term, how is it defined and how the current treatment system aligns with the idea? Listen to the full interview to learn more!   Treatment Failure Versus Failed Treatments: The Risks of Embracing Treatment Refractory Addiction [Dr. David Fiellin] The Concept of Treatment-Refractory Addiction: A Call to the Field [Dr. Eric Strain] The Concept of Treatment-Refractory Addiction: Implications for Addiction Treatment Systems and Research [Dr. Edward Nunes & Dr. Thomas McLellan] - Subscribe to the ASAM Weekly

Wanna collapse the timelines to your success? Mouthy bartender turned mouthy millionaire in her first year, Nicole Cherie Hesse has lots of unpopular unicorn opinions to share…Anything but conventional, Nicole paved a path to seven figures using existing skills from her colorful life as a kick-ass bartender. By repositioning what she already knew into the online coaching industry, she catapulted to the 1% overnight.This podcast details the adventures she's had along the way and is sprinkled with helpful AF unicorn hacks to help you to follow in her unicorn hoof prints.Whether you are a bartender who wants to unlock another revenue stream or an experienced entrepreneur looking to scale to six figure months, Nicole will f*ck you up in all of the best ways. Take off your pants and get your ass to the podcast this and every week to level up and crush your unicorn goals. Join her FB group to fully immerse yourself in Wonder World, your future self will thank you... For even more money-making strategies, hop on over to the Facebook group! Ready to attract unicorn clients!? Book a call with the Wonder Team!And as always, for more trouble go to Real Unicorns Don't Wear Pants!

This week, we round out our AML series with a detailed discussion about the approach to management of relapsed and refractory disease. This has been a VERY long road going through all management of AML. We hope that you have continued to build on our discussions week-to-week. An exciting treatment paradigm that is ever-evolving! Episode contents: - How do we define primary induction failure in AML? - What are options for treatment of refractory disease? What is the mechanism of action of these treatment options? - What are options for relapsed disease? - What targeted therapies are available for relapsed AML? ****This episode is sponsored by our global research partners! Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Please visit answersincme.com/GPV860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in oncology discusses bispecific antibodies in the current treatment landscape of relapsed/refractory multiple myeloma. Upon completion of this activity, participants should be better able to: Review the role of bispecific antibodies in the current treatment landscape of relapsed/refractory (R/R) multiple myeloma (MM); Discuss the clinical profiles of approved and late-stage emerging bispecific antibodies in heavily pretreated R/R MM; and Describe strategies to optimize outcomes with bispecific antibodies for the treatment of R/R MM. This activity is intended for US healthcare professionals only.

Dr Alexander Perl from Abramson Cancer Center in Philadelphia, Pennsylvania, Dr Richard M Stone from Dana-Farber Cancer Institute in Boston, Massachusetts, Dr Eunice S Wang from Roswell Park Comprehensive Cancer Center in Buffalo, New York, Prof Andrew H Wei from Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, and moderator Dr Eytan M Stein from Memorial Sloan Kettering Cancer Center in New York, New York, discuss updated data from ASH 2024 influencing the current and future treatment paradigm for treatment-naïve and relapsed/refractory acute myeloid leukemia. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/ASHAML24).

Dirk Arnold, MD, PhD - Still in the Game! Optimising Treatment Sequencing in the Management of Relapsed or Refractory mCRC

In this week's episode, we'll be comparing BTK inhibitors in relapsed/refractory CLL. Then, we'll hear how researchers in the UK unraveled the genetic background of the AnWj blood group.  Finally we'll learn about the role of BCL-2 and BAFF in CLL cell survival following venetoclax therapy. Featured Articles:Deletions in the MAL gene result in loss of Mal protein, defining the rare inherited AnWj-negative blood group phenotypeSustained benefit of zanubrutinib vs ibrutinib in patients with R/R CLL/SLL: final comparative analysis of ALPINEVenetoclax dose escalation rapidly activates a BAFF/BCL-2 survival axis in chronic lymphocytic leukemia

Join Michael Lloyd and his guests Wendy Tzou, and Jason Jacobson as they discuss this late breaker in person at APHRS 2024 in Sydney, Australia. https://www.hrsonline.org/education/TheLead https://pubmed.ncbi.nlm.nih.gov/39331050/ Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Membership on Advisory Committees: Boston Scientific   Contributor Disclosure(s): J. Jacobson: Honoraria/Speaking/Teaching/Consulting: Zoll Medical, Vektor Medical, Inc., Abbott Medical, Research (Contracted Grants): CardioFocus, Inc., Stocks, Privately Held: Atlas 5D W. Tzou: Research (Contracted Grants): Abbott Medical, Membership on Advisory Committees: Medtronic, Inc., Biosense Webster, Inc., Kardium, BioTelemetry, Inc., Honoraria/Speaking/Teaching/Consulting: Biotronik, Mediasphere Medical, American Heart Association, Medtronic, Abbott, Biosense Webster, Inc., Boston Scientific

In this episode, Lillian Erdahl, MD, FACS, is joined by Fatemeh Shojaeian, MD, MPH, from the Johns Hopkins University School of Medicine. They discuss Dr Shojaeian's recent article, “Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial,” in which the authors found that, for resistant or relapsing patients with idiopathic granulomatous mastitis, combining methotrexate and corticosteroids offers a promising strategy. This integration of disease-modifying antirheumatic drugs with corticosteroids not only reduces the necessity for high steroid doses but also effectively alleviates associated side effects.   Disclosure Information: Drs Erdahl and Shojaeian have nothing to disclose.   To earn 0.25 AMA PRA Category 1 Credits™ for this episode of the JACS Operative Word Podcast, click here to register for the course and complete the evaluation. Listeners can earn CME credit for this podcast for up to 2 years after the original air date.   Learn more about the Journal of the American College of Surgeons, a monthly peer-reviewed journal publishing original contributions on all aspects of surgery, including scientific articles, collective reviews, experimental investigations, and more.   #JACSOperativeWord