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This podcast covers the JBJS July 21, 2021 issue. Featured are articles covering A Novel Genetic Marker for Risk of Degenerative Rotator Cuff Disease Surgery in the UK Biobank; recorded commentary by Dr. van Wijnen; Results of the First US FDA-Approved Hip Resurfacing Device at 10-Year Follow-up.

Five articles from the June 2021 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 for this month are, "Intra-articular Injection of Bevacizumab Enhances Bone Marrow Stimulation–Mediated Cartilage Repair in a Rabbit Osteochondral Defect Model", "Pertrochanteric Calcifications in Patients With Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation With Intraoperatively Diagnosed Hip Abductor Injuries", "Sex-Related Differences in the Incidence, Severity, and Recovery of Concussion in Adolescent Student-Athletes Between 2009 and 2019", "Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Versus Microfracture: A 6-Year Follow-up of a Prospective Randomized Trial", and "Lateral Extra-articular Tenodesis Contributes Little to Change In Vivo Kinematics After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial".   Click here to read the articles.

Five articles from the March 2021 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 for this month are, "Predicting Risk of Recurrent Patellofemoral Instability With Measurements of Extensor Mechanism Containment", "Structural Consequences of a Partial Anterior Cruciate Ligament Injury on Remaining Joint Integrity: Evidence for Ligament and Bone Changes Over Time in an Ovine Model", "The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System", "Outcomes of Open and Endoscopic Repairs of Chronic Partial- and Full-Thickness Proximal Hamstring Tendon Tears: A Multicenter Study With Minimum 2-Year Follow-up", and "Long-term Outcome After Nonoperative Treatment for Rockwood I and II Acromioclavicular Joint Injuries".   Click here to read the articles.

FDA 批准布格替尼作为ALK阳性的非小细胞肺癌的一线用药Lancet Respir Med 急性呼吸衰竭患者机械通气强度与死亡率的关系NEJM 对危重机械通气患者采取非镇静或浅镇静的比较JAMA 质子泵抑制剂或H2受体抑制剂对机械通气患者住院死亡率的影响Nature Fc区优化的抗体可以诱导CD8对病毒性呼吸道感染的免疫布格替尼（brigatinib）布格替尼（Brigatinib）是一种间变性淋巴瘤激酶（ALK）抑制剂。2017年布格替尼被批准用于治疗ALK阳性的晚期非小细胞肺癌；2020年5月，布格替尼被FDA批准用于治疗ALK阳性的转移性非小细胞肺癌的一线治疗。《ALTA研究2年随访：布格替尼在克唑替尼难治性、ALK阳性的非小细胞肺癌的2期临床研究》Journal of Thoracic Oncology，2020年3月 (1)这项多中心、随机对照、2期临床研究，纳入克唑替尼难治性、ALK阳性的非小细胞肺癌患者共222人，随机分为口服布格替尼 90mg qd组（A组）、 布格替尼 180mg qd 7天后90mg qd 维持治疗组（B组），中位随访时间:19.6个月和24.3个月经治疗后客观缓解率分别为46%对56%，无进展生存期为9.2个月和16.7个月，总生存期为29.5个月和34.1个月。基线时，A组和B组分别有71%和67%的脑转移。脑转移患者经治疗后，颅内客观缓解率为50%和67%，颅内缓解持续时间为9.4和16.6个月，颅内无进展生存期为12.8个月和18.4个月。随访中没有观察到新发的安全事件。结论：克唑替尼难治性、ALK阳性的非小细胞肺癌中，布格替尼180 mg qd 7天后、予90mg qd维持治疗，显示了良好而持久的抗肿瘤效果，显著延长生存期和颅内病灶缓解时间。《ALTA-1L研究的第二个中期分析：布格替尼与克唑替尼在治疗晚期ALK阳性的非小细胞肺癌疗效的比较》Journal of Clinical Oncology，2020年11月 (2)在开放标签3期ALTA-1L试验中，纳入晚期ALK阳性、非小细胞肺癌患者共275人，随机分为布格替尼组（180 mg qd，7天后90mg qd），或克唑替尼250 mg bid。中位随访时间为24.9个月，布格替尼显著延长无进展生存期（P < .0001，24.0 vs 11.0个月）。布格替尼延缓了生活质量评分恶化的进展（P = 0.049）。研究同时发现，布格替尼的血浆浓度-时间曲线下的面积不是无进展生存期的预测因子。结论：布格替尼作为一种一日一次的ALK抑制剂在疗效上优于克唑替尼，有望成为ALK阳性的非小细胞肺癌的一线疗法。机械通气机械通气又称为正压通气，可完全替代或部分替代自主呼吸，目的是改善氧合不足、肺泡通气不足或两者同时。在急性和慢性呼吸衰衰竭期间，机械通气的主要受益是改善气体交换和减少呼吸做功。正压通气的肺部不良影响包括：肺气压伤、呼吸机相关肺损伤、内源性呼气末正压通气、通气/血流比例失调、膈肌萎缩、呼吸机无力和黏液腺毛运动减弱。此外，正压通气可能降低心输出量并影响血液动力学检测，与胃肠道应激性溃疡、内脏灌注减少、胃肠动力不足、液体潴留、急性肾衰竭、颅内压升高、肌无力、炎症和睡眠障碍相关。《前瞻性队列研究：急性呼吸衰竭患者机械通气强度与死亡率的关系》Lancet Respiratory Medicine，2020年9月 (3)尽管使用了肺保护性通气，但急性呼吸衰竭的死亡率仍然很高。最近的研究表明，基线通气参数与急性呼吸窘迫综合征患者预后之间存在相关性。该前瞻性队列研究的目的是评估急性呼吸衰竭患者长期暴露于不同强度的、机械通气与ICU死亡率之间的关系，共纳入13408例、接受≥4小时机械通气的患者。研究中，18%的患者死于ICU，对年龄和疾病严重程度进行调整后，发现机械通气驱动力 （driving pressure）与死亡风险显著升高有关（风险比1·064）；机械通气的机械功率（mechanical power）与死亡风险显著升高有关（风险比1·060）。这些关联在机械通气期间持续存在。结论：即使持续时间很短，高强度机械通气的累计暴露量是有害的。在进一步的研究中，应当对限制高强度机械通气以降低急性呼吸衰竭患者死亡率的治疗策略进行评估。《对照研究：健康受试者和危重病人膈肌的组织多普勒成像》American Journal of Respiratory and Critical Care Medicine，2020年10月 (4)组织多普勒成像是一种测量组织运动速度的超声心动图方法。该研究将此技术应用于膈肌，以评估膈肌在收缩和放松时的运动速度。研究对20名健康志愿者进行膈肌组织多普勒检查，以评估膈肌运动速度模式，测量其正常值，并确定测量值在观察者间的变异性。然后，在116例连续的ICU患者中，对脱机期间膈肌的偏移、增厚和组织多普勒参数（峰值收缩速度、峰值松弛速度、速度-时间积分和组织多普勒导出的最大松弛率）进行了评估。在一个18例患者亚组中，同时使用组织多普勒记录跨膈压（Pdi）、峰值Pdi、压力-时间乘积和膈肌最大舒张率。在可重复性方面，所有组织多普勒参数的相关系数为>0.89（P < 0.001）。除速度-时间积分外，健康志愿者和脱机成功患者的组织多普勒参数均低于脱机失败患者，分别为：峰值收缩速度1.35±0.34 cm/s、1.50±0.59 cm/s、2.66±2.14 cm/s（P < 0.001）；峰值松弛速度1.19±0.39 cm/s、1.53±0.73 cm/s、3.36±2.40 cm/s（P < 0.001）；组织多普勒最大舒张率分别为3.64±2.02 cm/s2、10.25±5.88 cm/s2、29.47±23.95 cm/s2（P < 0.001）。收缩速度峰值、与跨膈压峰值和压力-时间乘积有显著相关性，而最大舒张速率与最大舒张速率有显著相关性。结论：膈组织多普勒可实时评估膈肌组织的运动速度。膈肌组织多普勒衍生参数区分了脱机试验失败的患者和成功的患者，并与Pdi衍生参数有良好的相关性。《荟萃分析：危重病人的肌力与临床预后之间的关系》European Respiratory Journal，2020年9月 (5)研究的目的是评估肌无力与机械通气死亡率、或脱机成功率之间的联系，以及每种评估工具预测结果的能力。荟萃分析共分析了60项研究，包括4382名患者。ICU相关肌无力与总死亡率增加相关，风险比从1.2到4.48不等。其中刺激双侧膈神经产生的颤搐性跨膈压（transdiaphragmatic twitch pressure，TwPdi）对总死亡率的预测能力最高，敏感度为87%、特异性36%、曲线下面积 0.74。肌无力与机械通气脱机失败率增加相关，风险比为2.64至19.07不等。隔肌 增厚分数（diaphragm thickening fraction，DTF）对脱机失败率的预测能力最高，敏感性76%、特异性86%、曲线下面积为0.86。结论：ICU相关肌无力与高死亡率和更长时间机械通气相关。《综述：肺和膈保护通气》American Journal of Respiratory and Critical Care Medicine，2020年6月 (6)机械通气可引起急性膈肌萎缩和损伤，这与不良临床结果有关。肺部保护性通气的重要性和影响已得到广泛认识和确认，而膈肌保护性通气的概念最近已成为一种潜在的补充治疗策略。这一观点是在欧洲重症医学学会胸膜压工作组召开的一次国际专家会议的讨论中提出的，基于越来越多的损伤机制的证据，提出了一种综合肺和膈膜保护机械通气的概念框架。文章提出隔肌保护的目标基于呼吸努力和病人-呼吸机同步。讨论了在一定条件下隔肌保护与肺保护之间可能发生的冲突；我们强调，当冲突发生时，肺保护必须优先于隔肌保护。为了实施肺和膈保护通气，需要新的监测、设置呼吸机和滴定镇静的方法。未来，体外生命支持技术、膈神经刺激和临床决策支持系统等辅助干预措施也可能在特定的患者中发挥重要作用。由于干预的复杂性，评估这种新模式的临床影响将具有挑战性。结论：肺和膈保护通气的概念为显著改善危重病人的临床结果提供了一个引人注目的新理念。小羽点评：机械通气本身会导致膈肌功能障碍（ventilator induced diaphragmatic dysfunction，VIDD），控制型机械通气时甚至在第一天就可以发生，显著延长了通气和住院时间、导致撤机困难、并发症风险升高，这可能与膈肌损伤、萎缩、蛋白水解有关，通过氧化应激介导，但临床上有效避免该现象的最佳方法尚无定论。目前主要的策略是：保持适当水平的自主呼吸、避免病人-呼吸机不同步、根据膈肌活动监测指标调整呼吸机参数等。 《随机对照研究：对危重机械通气患者采取非镇静或浅镇静的比较》New England Journal of Medicine，2020年3月 (7)在危重的机械通气患者中，每日唤醒已被证明能够缩短通气时间和ICU住院时间。该研究的目的是讨论非镇静与浅镇静计划相比是否会影响死亡率。这项多中心、随机、对照试验中，随机分为非镇静组、和每日唤醒的浅镇静组，共纳入700名患者。非镇静组的平均Richmond躁动和镇静评分（RASS评分）从第1日的－1.3分提高至第7日的－0.8分；浅镇静组则从第1日的－2.3分提高至第7日的－1.8分。非镇静组和镇静组的90日死亡率分别为42.4%和37.0%（P=0.65）。两组患者离开ICU的天数、和不使用呼吸机的天数无显著差异。非镇静组患者中，无昏迷且无谵妄的中位天数为27日；浅镇静组患者中，无昏迷且无谵妄的中位天数为26日。非镇静组1例患者和浅镇静组10例患者发生了血栓栓塞事件。结论：在接受机械通气的ICU患者中，非镇静和浅镇静治疗策略90天死亡率无显著差异。《PEPTIC研究：质子泵抑制剂与抗组胺-2受体抑制剂剂对ICU有创机械通气患者住院死亡率的影响》JAMA，2020年1月 (8)研究的目的比较应用质子泵抑制剂（PPI）与组胺-2受体抑制剂（H2RB），在ICU有创机械通气患者中，预防应激性溃疡的疗效和对住院死亡率的影响。共26 982名患者被随机分配至PPI组或H2RB组，平均年龄58岁。PPI组和H2RB组中，90天住院死亡率分别为18.3%和17.5%（P=0.054），严重上消化道出血发生率分别为1.3%和1.8%的H2RB组（P = .009)。治疗组艰难梭菌感染率、ICU和住院时间无显著差异。在PPI组1例患者出现过敏反应。结论：在需要机械通气的ICU患者中，使用质子泵抑制剂与组胺-2受体阻滞剂相比，在预防应激性溃疡的医院死亡率方面没有统计学差异。呼吸机相关性肺炎呼吸机相关性肺炎（VAP）是指患者气管插管48小时后发生的肺炎，与以下因素相关：进入下呼吸道的微生物数量和宿主的机械、体液、细胞防御受损。约75%的重症患者在入院48小时内发生院内微生物定植。此外，肺部感染的主要途径是微量吸入已定植于口咽部、胃肠道的微生物，因此广泛使用的抑酸药提高胃液的pH值会改变上消化系统几乎无菌的状态，增加呼吸机相关性肺炎的发生几率。多重耐药菌危险因素包括：住院时间较长（>5天）和/或过去90天使用过抗生素。《双盲随机对照研究：心脏停搏后早发性呼吸机相关性肺炎的预防》New England Journal of Medicine，2019年11月 (9)院外心脏停搏、电击复律后后，接受体温管理的患者发生呼吸机相关性肺炎的风险增加。目前尚未证明抗生素短期预防性用药的益处。这项多中心、双盲、随机、安慰剂对照试验，纳入心脏停搏后、在ICU接受机械通气治疗、并且接受32～34℃目标体温管理的成人患者共 198例。于入院6小时内开始阿莫西林克拉维酸或安慰剂2日。7天内，抗生素预防组的早发呼吸机相关性肺炎发生率低于安慰剂组（19% vs 34%；风险比 0.53；P=0.03）。晚发性呼吸机相关性肺炎发生率、不使用呼吸机的天数、ICU停留时间和第28天时死亡率，两组均无差异。第7天未发现耐药菌增多。结论：院外发生心脏停搏后，接受32～34℃目标体温管理策略的患者，2日的阿莫西林克拉维酸降低了早发性呼吸机相关性肺炎的发生率。《2项前瞻性研究：英国ICU疑似呼吸机相关肺炎患者的肺曲霉菌病》American Journal of Emergency Medicine，2020年11月 (10)疑似呼吸机相关肺炎患者中，曲霉菌感染仍然缺乏十分敏感的诊断。这篇文章的目的是评估疑似呼吸机相关肺炎的曲霉菌感染的患病率和预后。文章纳入的这2项前瞻性研究招募了360名影像学、临床、实验室检查疑似的、呼吸机相关性肺炎的危重症患者，并获得了194名患者的血清样本和肺泡灌洗液，并进行了真菌学测试。最后根据临床、影像学和真菌学标准的定义诊断曲霉菌感染。在评估的194名患者中，曲霉菌感染患病率为12.4%，24例曲霉菌感染中有4人血清中半乳甘露聚糖阳性，16例肺泡灌洗液中半乳甘露聚糖阳性，两者均阳性共4例，3例肺泡灌洗液中培养出曲霉菌。疑似曲霉菌感染的患者ICU住院时间更长（25.5天 vs 15.5天，P = 0.02），死亡率略高（33.3% vs. 22.8%，P = 0.23）。结论：在调查疑似呼吸机相关肺炎患者时，即使不是曲霉菌感染高危，仍应考虑曲霉菌感染的可能。《DEDECAP研究：气管切开拔管前应用高流量氧疗联合堵管或联合吸引的比较》New England Journal，2020年9月 (11)应用气管切开套管的患者拔管前，通常做法是将气管切开套管堵管24小时，确定患者可否能自主呼吸。该研究的目的是比较这种做法是否比根据呼吸道吸引频率更好决定是否能够拔管更好。来自西班牙的研究人员在5个ICU进行了这项研究，纳入330例、气管切开后、有意识的、危重成人患者，患者的平均年龄58岁，68.2%为男性。一组接受24小时堵管试验+间歇性高流量氧疗（对照组），另一组接受连续高流量氧疗+将吸引频率作为拔管准备指标（干预组）。干预组至拔管的时间比对照组短（中位数，6天 vs. 13天）。干预组的肺炎和气管支气管炎发生率低于对照组，住院时长也比对照组短。 结论：与24小时堵管试验+间歇性高流量吸氧相比，依据吸引频率制定的拔管决策+连续高流量氧疗缩短了拔管时间，失败率不存在差异。《基础研究：Fc区优化的抗体可以诱导CD8对病毒性呼吸道感染的免疫》Nature，2020年10月(12)针对病毒病原体的抗体是控制病毒感染的一种很有前途的治疗方式，之前的一些研究已经证实，抗体的抗病毒效果需要Fab区和Fc区的协同作用。抗体Fc区在免疫系统中的各类细胞上的受体结合，激活免疫系统清除病毒、杀死被感染的细胞。这项研究的目的是，通过对抗流感IgG单抗的Fc区选择性的修饰，使之能够特异性的与已激活的Fcγ受体、Fcγ IIa受体结合，则能够进一步增强树突状细胞成熟、诱导保护性CD8+T细胞应答，从而提高预防或治疗致命性呼吸道病毒感染的疗效。结论：当IgG抗体选择性激活树突状细胞-T细胞通路时，能够诱导对病毒感染的保护性、适应性免疫，这对发展抗体疗法，提高对抗病毒的疗效具有重要意义。参考文献1.Huber RM, Hansen KH, Paz-Ares Rodríguez L, West HL, Reckamp KL, Leighl NB, et al. Brigatinib in Crizotinib-Refractory ALK+ NSCLC: 2-Year Follow-up on Systemic and Intracranial Outcomes in the Phase 2 ALTA Trial. J Thorac Oncol. 2020;15(3):404-15.2.Camidge DR, Kim HR, Ahn MJ, Yang JCH, Han JY, Hochmair MJ, et al. Brigatinib Versus Crizotinib in Advanced ALK Inhibitor-Naive ALK-Positive Non-Small Cell Lung Cancer: Second Interim Analysis of the Phase III ALTA-1L Trial. J Clin Oncol. 2020;38(31):3592-603.3.Urner M, Juni P, Hansen B, Wettstein MS, Ferguson ND, Fan E. Time-varying intensity of mechanical ventilation and mortality in patients with acute respiratory failure: a registry-based, prospective cohort study. Lancet Respir Med. 2020;8(9):905-13.4.Soilemezi E, Savvidou S, Sotiriou P, Smyrniotis D, Tsagourias M, Matamis D. Tissue Doppler Imaging of the Diaphragm in Healthy Subjects and Critically Ill Patients. Am J Respir Crit Care Med. 2020;202(7):1005-12.5.Medrinal C, Combret Y, Hilfiker R, Prieur G, Aroichane N, Gravier FE, et al. ICU outcomes can be predicted by noninvasive muscle evaluation: a meta-analysis. Eur Respir J. 2020;56(4).6.Goligher EC, Dres M, Patel BK, Sahetya SK, Beitler JR, Telias I, et al. Lung and Diaphragm-Protective Ventilation. Am J Respir Crit Care Med. 2020.7.Olsen HT, Nedergaard HK, Strøm T, Oxlund J, Wian K-A, Ytrebø LM, et al. Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. New England Journal of Medicine. 2020;382(12):1103-11.8.Australian PIft, New Zealand Intensive Care Society Clinical Trials Group AHSCCSCN, the Irish Critical Care Trials G, Young PJ, Bagshaw SM, Forbes AB, et al. Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers on In-Hospital Mortality Among ICU Patients Receiving Invasive Mechanical Ventilation: The PEPTIC Randomized Clinical Trial. JAMA. 2020;323(7):616-26.9.François B, Cariou A, Clere-Jehl R, Dequin P-F, Renon-Carron F, Daix T, et al. Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest. New England Journal of Medicine. 2019;381(19):1831-42.10.Loughlin L, Hellyer TP, White PL, McAuley DF, Conway Morris A, Posso RB, et al. Pulmonary Aspergillosis in Patients with Suspected Ventilator-associated Pneumonia in UK ICUs. Am J Respir Crit Care Med. 2020;202(8):1125-32.11.Hernández Martínez G, Rodriguez ML, Vaquero MC, Ortiz R, Masclans JR, Roca O, et al. High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation. N Engl J Med. 2020;383(11):1009-17.12.Bournazos S, Corti D, Virgin HW, Ravetch JV. Fc-optimized antibodies elicit CD8 immunity to viral respiratory infection. Nature. 2020.

FDA 批准治疗Cushing综合征的新药BMJ 妊娠期糖尿病患者16年后的2型糖尿病患病率比对照组高8.5倍Science Advance 可监测血糖、治疗糖网的隐形眼镜奥西卓司他（osilodrostat）奥西卓司他（osilodrostat）是一种新型的口服11‐β‐羟化酶和醛固酮合成酶抑制剂，可以直接阻断肾上腺皮质醇合成。2020年3月，FDA批准奥西卓司他上市，用于治疗库欣综合征，这是FDA批准的首个口服11‐β‐羟化酶抑制剂。《LINC3研究：奥西卓司他治疗库欣氏病的多中心、双盲、随机停药的III期临床试验》Lancet Diabetes Endocrinology，2020年8月 (1)LINC 3研究是一项前瞻性、多中心、开放标签、III期研究，旨在研究奥西卓司对库欣氏病治疗的安全性和有效性。研究共入组137人（平均年龄41岁、3/4为女性、未接受过垂体切除手术或接受过垂体切除手术但未治愈、24小时皮质醇>1.5*ULN）。研究采用双盲随机停药，包括四个期：（1）所有参与者服用开放标签的奥西卓司他直到第12周，每2周调整一次剂量直至30mg bid；（2）第13-24周，继续使用奥西卓司他；（3）26周开始，双盲、随机停药8周；（4）35-48周，所有患者开放标签的奥西卓司他直到研究结束。研究发现在，第34周，与随机停药组29%的患者相比，随机服药组86%的患者保持完全缓解状态。137例患者在第12周后完全缓解，滴度没有上升。结论：每天两次奥西卓司快速降低了平均24小时皮质醇浓度，同时改善了临床症状。2型糖尿病的预防2型糖尿病的高危人群包括：年龄≥45岁，有妊娠期糖尿病病史，BMI≥25kg/m2，一级亲属有糖尿病，久坐的生活方式，高血压高血脂。预防糖尿病的发生主要通过：锻炼和减重，戒烟或服用二甲双胍。其他用于预防的糖尿病的药，如利拉鲁肽、比格列酮、阿卡波糖、维生素D等，尚有争议。《荟萃分析：维生素D对糖尿病发病率的影响》Journal of Clinical Endocrinology and Metabolism，2020年8月 (2)这项荟萃分析的目的是平均25-羟基维生素D（25[OH]D）血液水平低与胰岛素分泌受损、胰岛素抵抗增加和2型糖尿病发病率增加相关。研究者对9项随机对照试验进行了荟萃分析，涵盖43,600名参与者，随访至少一年。在接受较大剂量维生素D（≥1000IU/d）的、糖尿病前期的、人群中，2型糖尿病的发病率较低（相对风险比 0.88），这一结果勉强达到统计学显著性。在接受较小剂量维生素D（

Five articles from the August 2020 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 for this month are, "Dyslipidemia With Perioperative Statin Usage Is Not Associated With Poorer 24-Month Functional Outcomes After Arthroscopic Rotator Cuff Surgery", "Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex (ACLC) Reconstruction: A Comparative Biomechanical Analysis in Cadaver Specimens", "An In-Depth Analysis of Graft Rupture and Contralateral ACL Rupture Rates After Pediatric ACL Reconstruction", "Concussion Symptom Cut-offs for Identification and Prognosis of Sports related Concussion: The Role of Time Since Injury", and "Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study".   Click here to read the articles.

Qu’est-ce que la surveillance active ?Quelles en sont les modalités et avec quels outils ?Pour qui et comment faire en pratique ?Le Pr N. MOTTET (CHU de Saint-Etienne) répond à toutes vos questions !L’orateur n’a pas reçu de rémunération pour la réalisation de cet épisode.Pour aller plus loin :PROTECT : Hamdy, et al. « 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer ». New England Journal of Medicine 375, n°15 (13 octobre 2016): 141524.Lire ici Bill Axelson et al « Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29 -Year Follow-up | NEJM ».Lire iciRéalisé avec le soutien institutionnel du laboratoire Janssen.Musique du générique : Via AudioNetworkResponsable projet AFUF : Dr Benjamin PradèreProduction : La Toile Sur Ecoute See acast.com/privacy for privacy and opt-out information.

I am delighted to talk with Dr Enda King on his recent paper published this year in the American Journal of Sport Medicine "Factors Influencing Return to Play and Second Anterior Cruciate Ligament Injury Rates in Level 1 Athletes After Primary Anterior Cruciate Ligament Reconstruction: 2-Year Follow-up on 1432 Reconstructions at a Single Center." This podcast links to my weekly research review and a full review and link to the paper are in that via the link at the bottom of the page notes. Enda is a chartered physiotherapist and former Gaelic footballer, who is Head of Performance at the Sports Surgery clinic and has just completed his PhD in the Biomechanics of ACL Rehabilitation with Dr Siobhan Strike at University of Roehampton, London and is in current great demand for the rehabilitation of elite athletes around the world using 3D biomechanics as a tool to guide that process. We discuss the paper, including challenges behind the data set, where this might go, the differences in outcome in Return to play and why that might be and the differences in re-injury rate between bone patellar bone and Hamstring grafts. You can follow Enda on twitter @Enda_King and our clinic @sscsportsmed @sscsantry I write a weekly 4 paper research review summary in sports medicine, science, and performance and you can subscribe at www.drandyfranklynmiller.com/review

Interview with Paulina Salminen, MD, PhD, and Suvi Sippola, MD, authors of Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis: A Secondary Analysis of a Randomized Clinical Trial

Interview with Paulina Salminen, MD, PhD, and Suvi Sippola, MD, authors of Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis: A Secondary Analysis of a Randomized Clinical Trial

The Georgia Wrestling History Awards have finally been announced so the Tapped Out guys sit down and not only discuss the winners but also break down a little beyond and get into the numbers as well. Sit back as the fellas discuss the winners of the Ga Indie Scene including: Announcer of the Year Booker of the Year Female Wrestler of the Year Feud of the Year Legend Award Male Performer of the Year Manager/Valet of the Year Mentor of the Year Most Improved of the Year Overall Wrestler of the Year Promoter of the Year Promotion of the Year Referee of the Year Show of the Year Tag Team/Stable of the Year Technician of the Year Follow us on: Patreon: Patreon.com/tappedoutpod FB, IG, and Twitter: @tappedoutpod Website: tappedoutpod.com Email: tappedoutpod@gmail.com Buy a shirt at prowrestlingtees.com/tappedoutwrestlingpodcast Subscribe on: Apple Podcast, Google Podcast, iHeart Media, Spotify, and all your favorite podcast players And watch us on Facebook Live Wednesday nights at 7PM

Five articles from the January 2020 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 for this month are, "Peripheral-Track and Central-Track Hill-Sachs Lesions: A New Concept of Assessing an On-Track Lesion", "Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up", "Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction", "Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome", and "High Prevalence of Connective Tissue Gene Variants in Professional Ballet".   Click here to read the articles.

On this week's episode of High Spot Podcast, Jeff & Bryan are recapping AEW Full Gear and the ramifications of the Kenny Omega vs Jon Moxley Match. The guys also contemplate whether or not the WWE misses John Cena and would the wrestling fans be interested in a potential Cena vs Randy Orton match at WrestleMania. Plus, the guys unveil their first category in their 2019 HSP End of Year Award Show. Who has the early lead for Male Wrestler of the Year?Follow us on Facebook, Twitter, Instagram, & Snapchat @HighSpotPodcast. Listen to us on Spreaker. Check out what the Jersey Wrecking Crew is up to by going to www.highspotpodcast.com.

We introduce you to our new HeartSuccess team member. Our episode includes two TCT 2019 trials (EXCEL, TWILIGHT), the Polypill study, Role of Beta Blockers in HFpEF, Use of lung zone US in HF in predicting outcomes, Hemodynamics of lung congestion in HFpEF, CITRIS-ALI study, Hypothermia in non-shockable rhythm cardiac arrest and 20-Year Follow-up of Statins in Children with Familial Hypercholesterolemia. Listen, Like, Subscribe and don't forget to give us a Rating!!

Welcome to the 2019 St. Louis Cardinal Baseball Season and Locked On Cardinals, part of the Locked On Podcast Network.  Moose Michaels (@MooseMichaels on Twitter) will be bringing your Cardinals news and opinions every weekday morning! Segment 1: The Three Big Things and Waino shows he can still get it done! Segment 2: Will Mike Shildt get any love for Manager of the Year? Follow us on Twitter @LockedOnSTL or @MooseMichaels!  Learn more about your ad choices. Visit megaphone.fm/adchoices

When your patient has heel pain with their first few steps in the morning, after sitting for a while or at the start of a run, a diagnosis of plantar heel pain (PHP) or plantar fasciopathy might jump straight to the top of your list. How will you treat your patients with PHP? How long will it take? How can you explain PHP, the rehab and recovery to your patients? In this podcast with Henrik Riel (Physiotherapist, researcher and PhD candidate at Aalborg University) we take a deep dive into PHP, and how you can treat it, including: How to describe plantar heel pain to your patients How to explain to your patient why they developed PHP, recovery timeframes and rehab Plantar fasciitis, plantar fasciopathy, plantar heel pain? What's the most appropriate terminology? Differential diagnosis for PHP including Neuropathic pain Fat pad irritation, contusion or atrophy Calcaneal stress fracture Other diagnoses How to systematically perform an objective assessment and diagnose PHP Assessment tests to identify factors contributing to your patients pain Whether your patients require imaging How long PHP takes to recover What factors affect your patients prognosis and recovery times How to differentiate your treatment for active or sedentary patients Whether your patients can continue to run with PHP Factors that may hinder the recovery of your sedentary patients, and how to address these Whether your patients should include stretching in their rehab Types of strengthening to include in your rehab - isometric, isotonic or otherwise How many sets and reps should your patients perform of their strengthening exercises Whether orthotics are useful Corticosteroid injections - do they help or increase the risk of plantar fascia rupture? Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using my favourite podcast app - Overcast Improve your confidence and plantar fasciopathy results with a free trial Clinical Edge membership, and get access to the 3 part webinar series on PHP with Henrik Riel Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Twitter - @Henrik_Riel Research Gate - Henrik Riel Articles associated with this episode: Alshami et al. 2008. A review of plantar heel pain of neural origin: differential diagnosis and management. Chimutengwende-Gordon et al. 2010. Magnetic resonance imaging in plantar heel pain. Dakin et al. 2018. Chronic inflammation is a feature of Achilles tendinopathy and rupture. David et al. 2017. Injected corticosteroids for treating plantar heel pain in adults. Digiovanni et al. 2006. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. Hansen et al. 2018. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination. Lemont et al. 2003. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Rathleff et al. 2015. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Riel et al. 2017. Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on. Riel et al. 2018. The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial. Riel et al. 2019. Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial. Other Episodes of Interest: PE 062 - How to treat plantar fasciopathy in runners with Tom Goom PE 061 - How to assess and diagnose plantar fasciopathy in runners with Tom Goom PE 060 - Plantar fasciopathy in runners with Tom Goom PE 038 - Plantar fasciopathy loading programs with Michael Rathleff PE 012 - Plantar Fascia, Achilles Tendinopathy And Nerve Entrapments With Russell Wright

Five articles from the December 2018 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 for this month are, "Seventeen-Year Follow-up After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction in a Pediatric and Adolescent Population", "Performance on a Single-Legged Drop-Jump Landing Test Is Related to Increased Risk of Lateral Ankle Sprains Among Male Elite Soccer Players","Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction With the Docking Technique Versus Repair With Internal Bracin" , "Long-term Outcomes of Primary Repair of the Anterior Cruciate Ligament Combined With Biologic Healing Augmentation to Treat Incomplete Tear" and "Prognostic Factors for Functional Outcome After Rotator Cuff Repair: A Prospective Cohort Study With 2-Year Follow-up."    Click here to read the articles.

Intensive Diabetes Treatment and Cardiovascular Outcomes in Type 1 Diabetes: The DCCT/EDIC Study 30-Year Follow-up. Diabetes Care. 2016 May;39(5):686-93

Finally a randomized controlled trial comparing physical therapy management to surgery for femoroacetabular impingement syndrome (FAIS)!!! And what were the findings? Well, not impressive on either end. Of course this generates more questions than answers but that's what good research does. Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Am J Sports Med. 2018 May;46(6):1306-1314. doi: 10.1177/0363546517751912. Epub 2018 Feb 14. Here is the pretrial registration: ClinicalTrials.gov Here is the article that they cited that describes the physical therapy interventions: https://doi.org/10.1186/s12891-016-0914-1 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission  

Five articles from the May 2018 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 for this month are "Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases", "Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment", "The Integrity of the Acromioclavicular Capsule Ensures Physiological Centering of the Acromioclavicular Joint Under Rotational Loading", "Does Capsular Laxity Lead to Microinstability of the Native Hip?", and "Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up."   Click here to read the articles.  

Thanks for rockin with us for the past 16 weeks! In this seasons finale the guys, the group discusses the following topics: Net Neutrality The N word Best Albums of the Year Follow us on Instagram @Social_Criticss Driss @Just_driss Alpha @Alpha_omega5 Bashir @Grrrdad Sumie @Suma_wrestla4 Curtis @groundtenpro Want to share a story or give us suggestions?! For all business purposes, or anything under the sun, feel free to send us an email at Soulsundays.podcast@gmail.com for chance to get a shout out on the podcast. Don't forget to like and subscribe!Support the show (https://www.patreon.com/Social_Criticss)

Femoroacetabular impingement (FAI) may contribute to hip and groin pain, buttock pain, pelvic or low back pain and referred pain into the thigh. Is conservative management effective in patients with FAI, or is surgery required? If we can treat FAI conservatively, what is the best treatment, and how can you tailor your treatment to your individual patients? In episode 74 of the Physio Edge podcast with Dr Joanne Kemp you will discover: What is FAI, and how can you identify it? Common clinical presentations Key subjective questions to ask Types of FAI morphology and how they are identified Is FAI just a normal finding? How you can perform an objective assessment in patients with FAI Differential diagnosis Components you need to include in your conservative treatment for FAI Which objective markers to use when treating FAI How to address common impairments in your rehabilitation, including strength, functional tasks, cardiovascular training and range of movement When to refer for a surgical opinion Outcomes of surgical treatment Future risk of developing OA in presence of FAI Sports Injuries virtual conference presentation As mentioned in this episode Joanne will be part of the Sports Injury virtual conference. Her pre conference presentation will discuss FAI and the diagnostic process in more detail. Her subsequent conference presentation will be available on 9-10 December 2017, with access for up to 12 months following the conference, and will discuss: • Conservative management of FAI • Specific exercise progressions you can use • Return to sport for athletes Enrol on the 2017 Sports Injuries virtual conference by CLICKING HERE Download this podcast and subscribe on iTunes Links associated with this episode: Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino Enrol on the 2017 Sports Injuries virtual conference Twitter - @JoannaLKemp Joanna Kemp - Research gate David Pope on Twitter Clinical Edge on Facebook Have a free trial Clinical Edge membership LaTrobe Sports and Exercise Medicine Research Blog Twitter - @LaTrobeSEM GLA:D Australia Lake Health Group Articles associated with this episode: Griffin et al. 2016. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Articola et al. 2014. A Cam Deformity Is Gradually Acquired During Skeletal Maturation in Adolescent and Young Male Soccer Players. A Prospective Study With Minimum 2-Year Follow-up. Other episodes of interest: Physio Edge 054 - Hip and groin pain part 2 with Benoy Matthew Physio Edge 053 - Hip and groin pain part 1 with Benoy Matthew Physio Edge 009 - Lateral hip pain with Dr Alison Grimaldi Physio Edge 004 - Hip injuries and labral tears with Nicole Hamilton

This podcast covers the JBJS issue for September 2017. Featured are articles covering Influence of Arthritis in Major Joints and Spine on One-Year Outcome of Total Hip Replacement; recorded commentary by Dr. Bogoch; Flexion-Type Supracondylar Humeral Fractures - Ulnar Nerve Injury Increases Risk of Open Reduction; Blood Metal Ion Thresholds for MoM Hip Implants at Risk of Adverse Reactions to Metal Debris; recorded commentary by Dr. Campbell; MRI Findings in Patients After Small-Head Metal-on-Metal THA with a Minimum 10-Year Follow-up.

This podcast covers the JBJS issue for September 2017. Featured are articles covering Influence of Arthritis in Major Joints and Spine on One-Year Outcome of Total Hip Replacement; recorded commentary by Dr. Bogoch; Flexion-Type Supracondylar Humeral Fractures - Ulnar Nerve Injury Increases Risk of Open Reduction; Blood Metal Ion Thresholds for MoM Hip Implants at Risk of Adverse Reactions to Metal Debris; recorded commentary by Dr. Campbell; MRI Findings in Patients After Small-Head Metal-on-Metal THA with a Minimum 10-Year Follow-up.

Five articles from the October 2017 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 for this month are "Professional Athletes’ Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture", "A 20-Year Follow-up After First-Generation Autologous Chondrocyte Implantation", "Pectoralis Major Repair: A Biomechanical Analysis of Modern Repair Configurations Versus Traditional Repair Configuration", "In Vivo Performance of a Novel, Anatomically Shaped, Total Meniscal Prosthesis Made of Polycarbonate Urethane: A 12-Month Evaluation in Goats", and "Risk of Engagement of Bipolar Bone Defects in Posterior Shoulder Instability".   Click here to read the articles.

Five articles from the July 2017 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 for this month are "The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football", "Femoroacetabular Impingement in Professional Football Players: Return to Play and Predictors of Career Length After Hip Arthroscopy", "High Rate of Osteoarthritis After Osteochondritis Dissecans Fragment Excision Compared With Surgical Restoration at a Mean 16-Year Follow-up", "Objectively Measured Physical Activity in Patients After Anterior Cruciate Ligament Reconstruction", and "Intratendon Delivery of Leukocyte-Poor Platelet-Rich Plasma Improves Healing Compared With Leukocyte-Rich Platelet-Rich Plasma in a Rabbit Achilles Tendinopathy Model".   Click here to read the articles.

This podcast covers the JBJS issue for May 2017. Featured are articles covering Synovial Fluid Cell Count for Diagnosis of Chronic Periprosthetic Hip Infection; recorded commentary by Dr. Bibbo; Return to Play and Patient Satisfaction After ACL Reconstruction - Study with Minimum 2-Year Follow-up; Leptin Elevation as a Risk Factor for SCFE Independent of Obesity Status; recorded commentary by Dr. Adamczyk; Sclerostin Antibody Enhances Rotator Cuff Tendon-to-Bone Healing in an Animal Model.

This podcast covers the JBJS issue for May 2017. Featured are articles covering Synovial Fluid Cell Count for Diagnosis of Chronic Periprosthetic Hip Infection; recorded commentary by Dr. Bibbo; Return to Play and Patient Satisfaction After ACL Reconstruction - Study with Minimum 2-Year Follow-up; Leptin Elevation as a Risk Factor for SCFE Independent of Obesity Status; recorded commentary by Dr. Adamczyk; Sclerostin Antibody Enhances Rotator Cuff Tendon-to-Bone Healing in an Animal Model.

Interview with Archana Singh-Manoux, author of Trajectories of Depressive Symptoms Before Diagnosis of Dementia: A 28-Year Follow-up Study

Five articles from the December 2016 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 for this month are “Factors Related to Increased Ulnar Collateral Ligament Thickness on Stress Sonography of the Elbow in Asymptomatic Youth and Adolescent Baseball Pitchers”, “No Effects of Early Viscosupplementation After Arthroscopic Partial Meniscectomy: A Randomized Controlled Trial”,  “Arthroscopic Bankart Repair Versus Open Bristow-Latarjet for Shoulder Instability: A Matched-Pair Multicenter Study Focused on Return to Sport”, “Modified Broström Procedure for Chronic Lateral Ankle Instability in Patients With Generalized Joint Laxity”, and "Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 5-Year Follow-up".   Click here to read the articles.

On this week's show, we discuss some of the latest research and findings in our News & Views segment. Our stories are about how the soda industry plays politics to advance its agenda, whether salt is good or bad in the human diet, and whether calcium supplements pose a heart-health risk. The Moment of Paleo segment offers ideas about how we can think about areas of our lives, by analogy, based on what we know about whole foods vs. processed foods and supplements. In the After the Bell segment a truly thought-provoking talk about how we create ourselves with our thoughts. Links for this episode:This Episode's Homepage on latestinpaleo.comLatest in Paleo on Facebook — Leave a Comment About this Episode or Post a News LinkThe Latest in Paleo Health News TickerFood & Product RecommendationsThe Paleo Answer - Loren CordainThe End of Dieting - Dr. Joel FuhrmanMore Book & Audiobook RecommendationsSponsorship of National Health Organizations by Two Major Soda Companies - American Journal of Preventive MedicineCoke and Pepsi Give Millions to Public Health, Then Lobby Against It - The New York TimesBig soda is buying off big health orgs to keep profits and Americans fat | Ars TechnicaPepsi gets aggressive on cutting sugar from its drinks - Oct. 17, 2016Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention. - PubMed - NCBIHold the salt this Thanksgiving for a longer life: study | CTV NewsLowering Salt Intake Reduces Mortality, Study Confirms - Renal and Urology NewsMore Research Cites Salt's Potential Health RisksCalcium Intake From Diet and Supplements and the Risk of Coronary Artery Calcification and its Progression Among Older Adults: 10?Year Follow?up of the Multi?Ethnic Study of Atherosclerosis (MESA)Calcium Supplements May Damage the Heart - 10/11/2016Calcium supplements could increase risk of heart disease, new study finds - The Washington PostStudy: Calcium Supplements Actually Increases Risk of Heart Disease - NBC NewsIsaac Lidsky: What reality are you creating for yourself? | TED Talk | TED.com

Interview with Jeanne M. Clark, MD, MPH, author of Impact of Bariatric Surgery on Health Care Costs of Obese Persons: A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data