Episodes

Tuesday Mar 17, 2020
Demystifying Polycystic Ovary Syndrome
Tuesday Mar 17, 2020
Tuesday Mar 17, 2020
Guest: Alice Y. Chang, M.D. (@AliceChangMDMSc)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Polycystic Ovary Syndrome (PCOS) has a prevalence of between 5-10% American women of child-bearing age. With a variety of symptoms, different diagnosis methods, misunderstood criterion, and both genetic and environmental causes, PCOS can be easily missed, especially in patients whose symptoms have developed sporadically. Alice Y. Chang, M.D., breaks down this complicated condition, including treatment strategies based on the patient’s primary concern related to the disease.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Deeper Dive:
- Ferriman-Gallwey Hirsutism Scoring System: https://education.endocrine.org/ferriman-gallwey-hirsutism-system

Thursday Mar 12, 2020
Opioid Edition 8: Family & Patient Counseling
Thursday Mar 12, 2020
Thursday Mar 12, 2020
Guest: Holly L. Geyer, M.D.
Host: Tracy McCray
Episode 8 of 10: What legal and ethical obligations do physicians have when prescribing opioids? How can we address systemic issues that need improvement? Dr. Holly Geyer, an internal medicine physician at Mayo Clinic in Arizona, shares her thoughts on what is currently being done to combat the opioid crisis and what additional steps can be taken to make a difference.
Claim CME credit at ce.mayo.edu/opioidpc.
Episode transcript: https://mcdn.podbean.com/mf/web/jit3rx/Ep_22-Opioid_Edition_8_Family_Patient_Counseling.pdf

Tuesday Mar 10, 2020
Hand and Wrist Disorders
Tuesday Mar 10, 2020
Tuesday Mar 10, 2020
Guest: Peter C. Amadio, M.D. (@AmadioPeter)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Dr. Peter Amadio discusses carpal tunnel, de Quervain's tenosynovitis, and others hand and wrist conditions and gives a few key pearls for helping your patients control symptoms and when to consider surgery.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Friday Mar 06, 2020
COVID-19 Miniseries Episode 5: SARS-CoV-2 and The Valley of Death
Friday Mar 06, 2020
Friday Mar 06, 2020
Episode Recorded March 5, 2020
To claim credit click here: https://ce.mayo.edu/covid19podcast
Guest: Gregory A. Poland, M.D. (@drgregpoland)
Host: Colin M. Bucks, M.D.
Why are we seeing very different severity and mortality rates as COVID-19 moves from country to country? Where are we at currently in regard to a COVID-19 vaccine? What does the pathway look like moving forward? Dr. Greg Poland lays out what you need to know about immunity and coronaviruses.
Watch Dr. Poland teach Jimmy Kimmel and Guillermo how to wash their hands:
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
For the most up to date COVID-19 information:

Thursday Mar 05, 2020
Opioid Edition 7: Treating Opioid Addiction
Thursday Mar 05, 2020
Thursday Mar 05, 2020
Guest: Holly L. Geyer, M.D.
Host: Tracy McCray
Episode 7 of 10: Dr. Holly Geyer, an internal medicine physician, who serves on the Opioid Stewardship Program at Mayo Clinic in Arizona, discusses issues of dependency and addiction. What’s the difference between dependency and addiction?
Claim CME credit at ce.mayo.edu/opioidpc.
Episode transcript: https://mcdn.podbean.com/mf/web/xvt7i9/Ep_21-Opioid_Edition_7_Treating_Opioid_Addiction.pdf

Tuesday Mar 03, 2020
The Skinny on Bariatric Surgery
Tuesday Mar 03, 2020
Tuesday Mar 03, 2020
Guest: James A. Madura, II M.D.
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Obesity is prevalent and places our patients at significantly higher risk for a variety of health conditions. Which patients stand to benefit the most from bariatric surgery? What does insurance coverage for these procedures look like? Dr. James Madura discusses bariatric surgery and the safety and efficacy of the procedures.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Thursday Feb 27, 2020
Opioid Edition 6: Assessing & Treating Opioid Misuse in the ED
Thursday Feb 27, 2020
Thursday Feb 27, 2020
Guest: Casey M. Clements, M.D., Ph.D. (@CaseyClmnts)
Host: Tracy McCray
Episode 6 of 10: How do you assess whether a patient has become addicted? What do you do if you suspect opioid use disorder or addiction? Dr. Casey Clements, an emergency physician and practice leader, who works in the Opioid Stewardship Program at Mayo Clinic in Rochester, shares his insights on treating opioid misuse in the emergency setting.
Claim CME credit at ce.mayo.edu/opioidpc.
Episode transcript: https://mcdn.podbean.com/mf/web/9rje3e/Ep_20-Opioid_Edition_6_Assessing_Treating_Opioid_Misuse_in_the_ED.pdf

Tuesday Feb 25, 2020
COVID-19 Miniseries Episode 4: Prepare for a Pandemic
Tuesday Feb 25, 2020
Tuesday Feb 25, 2020
Episode Recorded February 25, 2020
To claim credit, click here: https://ce.mayo.edu/covid19podcast
Guest: Pritish K. Tosh, M.D. (@DrPritishTosh)
Host: John M. Wilkinson, M.D.
“At this point, we need to prepare for a pandemic within the United States and try to shift our mode from thinking about taking care of 1 or 2 of these patients, if it were to come up, to really transforming thinking about, well how we’re going to do this across the country?”
- Pritish K. Tosh, M.D.
As the spread of COVID-19 expands and index cases become harder to trace the advice is shifting to community preparedness for a pandemic. Family physician, Dr. John Wilkinson, sits down with infectious disease expert Dr. Pritish Tosh to discuss updates for health care providers on the COVID-19 outbreak.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
For the most up to date COVID-19 (Novel 2019 Coronavirus) information:

Tuesday Feb 25, 2020
Armchair Physician with a Retrospectoscope: Leg Pain Edition
Tuesday Feb 25, 2020
Tuesday Feb 25, 2020
Guest: Jonathan T. Finnoff, D.O. (@FinnoffJonathan)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Diagnosing leg pain can be very challenging. Dr. Jonathan Finnoff walks through a case study near and dear to Dr. Chutka, offering pearls for your practice along the way.
Episode transcript: https://mcdn.podbean.com/mf/web/wfcd2u/Ep_131-Armchair_Physician_with_a_Retrospectoscope-Leg_Pain_Edition.pdf
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Thursday Feb 20, 2020
Opioid Edition 5: Acute Prescribing: Emergency Room Prescribing
Thursday Feb 20, 2020
Thursday Feb 20, 2020
Guest: Casey M. Clements, M.D., Ph.D. (@CaseyClmnts)
Host: Tracy McCray
Episode 5 of 10: Dr. Casey Clements, an emergency physician and practice leader, who works in the opioid stewardship program at Mayo Clinic-Rochester, shares his insights on opioid therapy from the Emergency Department perspective. What is drug diversion? How do you know a patient isn’t receiving prescriptions from multiple physicians?
Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.
Episode transcript: https://mcdn.podbean.com/mf/web/z7mbxj/Ep_19-Opioid_Edition_5_Acute_Prescribing_Emergency_Room_Prescribing.pdf

Tuesday Feb 18, 2020
Location! Location! Location! How to Effectively Decipher Hip Pain
Tuesday Feb 18, 2020
Tuesday Feb 18, 2020
Guest: Aaron J. Krych, M.D. (@DrKrych)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Hip pain is common, but the pain generators don’t always present in a typical fashion. When do you order x-rays or MRI’s? Dr. Aaron Krych, orthopedist, covers beyond the classic symptoms into atypical presentations you won’t want to miss. He’ll also cover how to help your patient decide when it’s time for a hip replacement and how long should you expect a hip arthroplasty to last.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Thursday Feb 13, 2020
Opioid Edition 4: Treating Special Populations & Situations
Thursday Feb 13, 2020
Thursday Feb 13, 2020
Guest: David C. Patchett, D.O.
Host: Tracy McCray
Episode 4 of 10: Family practitioner, Dr. David Patchett, from Mayo Clinic in Arizona shares the additional challenges associated with prescribing opioids to special populations, and discusses how and when to reassess a patient’s therapy. How do you know when to taper a patient? What are the symptoms of opioid withdrawal and how can you mitigate them?
Claim CME credit at ce.mayo.edu/opioidpc.
Episode transcript: https://mcdn.podbean.com/mf/web/pxsjez/Ep_18-Opioid_Edition_4_Treating_Special_Populations_Situations.pdf

Tuesday Feb 11, 2020
Harnessing Pharmacogenomics in your Current Practice
Tuesday Feb 11, 2020
Tuesday Feb 11, 2020
Guest: Eric T. Matey, Pharm.D., R.Ph. (@MateyPh)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Pharmacogenomics can help us predict an effective therapeutic response or avoid an adverse drug reaction before ever starting a medication. Listen in for the scoop on what this is and how it’ll impact your practice from a leading pharmacogenomics pharmacist at Mayo Clinic, Dr. Eric Matey.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Deeper Dive:
- Pharmacogenomics for Your Practice – Online Course
- Use of Codeine and Tramadol Products in Breastfeeding Women - Questions and Answers https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/use-codeine-and-tramadol-products-breastfeeding-women-questions-and-answers
- PharmGKB is a comprehensive resource that curates knowledge about the impact of genetic variation on drug response for clinicians and researchers https://www.pharmgkb.org/
- The Genetic Information Nondiscrimination Act (GINA) of 2008 https://www.genome.gov/about-genomics/policy-issues/Genetic-Discrimination

Thursday Feb 06, 2020
Opioid Edition 3: Family Practitioners - Assessing the Patient
Thursday Feb 06, 2020
Thursday Feb 06, 2020
Guest: David C. Patchett, D.O.
Host: Tracy McCray
Episode 3 of 10: Dr. David Patchett, family practitioner at Mayo Clinic in Arizona, answers common questions family practitioners often face when treating patients with pain management issues. What are best practices when prescribing opioid therapy? How do you weigh the potential benefits of opioid therapy with the identified risks?
Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.
Episode transcript: https://mcdn.podbean.com/mf/web/vgd4rt/Ep_17-Opioid_Edition_3_Family_Practitioners-Assessing_the_Patient.pdf

Tuesday Feb 04, 2020
How to Approach the Diagnostic Challenge of Lupus
Tuesday Feb 04, 2020
Tuesday Feb 04, 2020
Guest: Ronald R. Butendieck, Jr. M.D.
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Lupus can be challenging to diagnosis. Dr. Ron Butendieck discusses common presentation and some of the more enigmatic symptoms. What role does genetics play? Geography? Race? Dr. Butendieck details when you should include lupus on your differential and how to approach lab testing and treatment.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Deeper Dive:
- 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus https://doi.org/10.1002/art.40930

Friday Jan 31, 2020
COVID-19 Miniseries Episode 3: Inside an Outbreak – Expert Perspective
Friday Jan 31, 2020
Friday Jan 31, 2020
Guest: Colin M. Bucks, M.D.
Host: Amit K. Ghosh, M.D.
“I think that fear can be valuable…we’re at a time when it’s just fine to be fearful if it provokes you to vigilance and discipline…You’re disciplined because you’re afraid, that keeps you sharp, but panic is dangerous. I don’t mind fear, panic is dangerous.” - Colin M. Bucks, M.D.
What is it like in the field during an outbreak? What global response lessons have we learned from SARS and Ebola? Dr. Colin Bucks discusses how access to information accelerates response time in present day outbreaks and the role public education, infrastructure, disparities, and access to supplies, plays in helping to contain one.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
To claim credit click here: https://ce.mayo.edu/covid19podcast
For the most up to date COVID-19 (Novel 2019 Coronavirus) information:
- CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
- WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Other Resources mentioned in the episode:
- Ontario The SARS Commission: Spring of Fear http://www.archives.gov.on.ca/en/e_records/sars/report/index.html
- Lancet Infectious Diseases - Immunogenicity of chimeric haemagglutinin-based, universal influenza virus vaccine candidates: interim results of a randomised, placebo-controlled, phase 1 clinical trial https://doi.org/10.1016/S1473-3099(19)30393-7

Friday Jan 31, 2020
Friday Jan 31, 2020
Guest: Matthew J. Binnicker, Ph.D. (@DrMattBinnicker)
Host: Justin D. Kreuter, M.D. (@KreuterMD)
In a special crossover episode from Mayo Clinic Lab Medicine Rounds, Dr. Justin Kreuter discusses what we know so far, what clinicians should be looking for, and what this means for lab testing with Dr. Matthew Binnicker.
Time Stamps
00:00 Podcast Intro
00:41 What do we know so far about the novel coronavirus?
02:35 How does this novel coronavirus stack up to influenza?
04:35 Is there still value in getting your flu shot now (this year) if you haven’t gotten it yet?
05:08 Where should people go to get the latest and best information related to the novel coronavirus?
06:36 What should the health care provider be looking for related to the novel coronavirus?
08:18 I’m glad you mentioned the incubation period, is that something we know with this novel coronavirus?
09:15 What do the laboratorians need to have in mind and what does this mean for the hospital clinical labs?
10:50 So, people can test positive for the coronavirus without having this specific novel coronavirus strain?
12:02 So if somebody sent a sample down to a clinical lab, and I was truly positive for the novel coronavirus, I could have a negative result?
12:45 Can you elaborate on when a physician should pick up the phone relative to the new novel coronavirus outbreak?
14:43 Is there a risk to laboratory personnel for the infection to spread when they are handling the samples?
15:20 When should we be suspecting this novel coronavirus?
16:03 What should someone do if they suspect their patient has novel coronavirus?
16:33 As this is an evolving outbreak, where should folks go for the latest information?
WHAT IS LAB MEDICINE ROUNDS?
A Mayo Clinic curated podcast for physicians, laboratory professionals, and students; hosted by Dr. Justin Kreuter (the Bow Tie Bandit of Blood) and featuring trending topics from subject-matter experts.
Subscribe to Lab Medicine Rounds at: https://podcasts.apple.com/us/podcast/lab-medicine-rounds/id1478310691
For feedback and suggestions email MCLEducation@mayo.edu
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
To claim credit click here: https://ce.mayo.edu/covid19podcast
Deeper Dive:
For the most Up-To-Date COVID-19 (Novel 2019 Coronavirus) information visit:

Friday Jan 31, 2020
Friday Jan 31, 2020
Recorded Monday, January 27, 2020, at the 32nd Annual Selected Topics in Internal Medicine Conference
Speaker: Pritish K. Tosh, M.D. (@DrPritishTosh)
Dr. Pritish Tosh, a Mayo Clinic infectious disease, emergency preparedness, pandemic planning, and biodefense expert; gives a concise overview of the 2019 novel coronavirus (2019-nCoV) and what the numbers really mean.
Want to attend live next year? https://ce.mayo.edu/internal-medicine/content/33rd-annual-selected-topics-internal-medicine-2021
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Click here to claim credit: https://ce.mayo.edu/covid19podcast
Deeper Dive:
For the most Up-To-Date COVID-19 information visit:

Thursday Jan 30, 2020
Opioid Edition 2: Managing Acute and Chronic Pain
Thursday Jan 30, 2020
Thursday Jan 30, 2020
Guest: Halena M. Gazelka, M.D. (@hmgazelkamd)
Host: Tracy McCray
Episode 2 of 10: What are the different guidelines when treating chronic versus acute pain with opioid therapy? Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic in Rochester, talks about the importance of “starting low and going slow.” What are the alternatives for chronic pain management? Dr. Gazelka also covers non-pharmacological and implantable device alternatives for the treatment of pain.
Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.
Episode transcript: https://mcdn.podbean.com/mf/web/bkc6ac/Ep_16-Opioid_Edition_2_Managing_Acute_and_Chronic_Pain.pdf

Tuesday Jan 28, 2020
A Deep Dive into Hyperbaric Oxygen Therapy
Tuesday Jan 28, 2020
Tuesday Jan 28, 2020
Guest: Gary N. Toups, M.D.
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
What is hyperbaric oxygen therapy? What types of conditions outside of decompression illness can benefit from it? Dr. Gary Toups gives a fascinating look at the history of the practice and current advances in the field. He also discusses what conditions and types of non-healing wounds can benefit from oxygen therapy and which are not good candidates.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Deeper Dive:
- Healing with Hyperbaric Oxygen Therapy https://youtu.be/Uc0FiCEd1fQ?list=PLnAoNb5Mx-v68JrYbNCDavCSZ5lnFNaMf
- Hyperbaric Oxygen Therapy at Mayo Clinic https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380

Thursday Jan 23, 2020
Opioid Edition 1: The Opioid Crisis and Pain Management
Thursday Jan 23, 2020
Thursday Jan 23, 2020
Guest: Halena M. Gazelka, M.D. (@hmgazelkamd)
Host: Tracy McCray
Episode 1 of 10: Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic in Rochester walks us through the basics of opioids and the current state of this national crisis. What is an opioid? How bad is the opioid epidemic and how did we get here?
Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.
Episode transcript: https://mcdn.podbean.com/mf/web/5d7ztu/Ep_15-Opioid_Edition_1_The_Opioid_Crisis_and_Pain_Management.pdf

Tuesday Jan 21, 2020
A Public Health Emergency – The State of Sleep in Children
Tuesday Jan 21, 2020
Tuesday Jan 21, 2020
Guest: Robin M. Lloyd, M.D. (@DrRobinLloyd)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Insomnia has a 25 – 50% incidence rate in children. Dr. Robin Lloyd discusses the patterns and differences of disordered sleep in pediatric patients. She covers the impact technology integration has had, sleep apnea, genetic conditions, and obesity. What are red flag snoring symptoms in children? What are the signs of sleep apnea?
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Deeper Dive:
- BEARS Screening Tool for Assessment of Sleep in Children: https://doi.org/10.1016/j.sleep.2004.07.015
- American Academy of Sleep Medicine Recommended Amount of Sleep for Pediatric Populations: https://doi.org/10.5664/jcsm.5866

Tuesday Jan 14, 2020
Statins vs PCSK9- Inhibitors: The Great Debate
Tuesday Jan 14, 2020
Tuesday Jan 14, 2020
Guest: Stephen L. Kopecky, M.D. (@DrSteveKopecky) and R. Scott Wright, M.D.
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Dr. Stephen Kopecky and Dr. Steve Wright throw down in this debate over best practice and appropriate use of cholesterol-lowering medications. Listen in to get the perspective of two leading cardiologists on statins, PCSK9i's, fish oil, side effects, and patient education.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Tuesday Jan 07, 2020
“Sell the Boat.” An Orthopedist’s Insight on Elbow Pain
Tuesday Jan 07, 2020
Tuesday Jan 07, 2020
Guest: Jonathan D. Barlow, M.D. (@JonBarlowMD)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
Golfer’s Elbow, Tennis Elbow, Boat-antifouling-pain-elbow…medial and lateral epicondylitis can result from a variety of repetitive activities. Dr. Jon Barlow lays out the differences between some commonly seen elbow pain generators and extends the discussion to radial tunnel syndrome, olecranon bursitis, stress fractures, and more.
Dr. Barlow shares recommendations for treatment, including why you shouldn’t use steroid injections for elbow pain, when bracing may be beneficial, how to determine ulnar nerve involvement in medial epicondylitis, and ruling out referred pain.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Tuesday Dec 31, 2019
Exercise is Medicine, But Are We Taking It?
Tuesday Dec 31, 2019
Tuesday Dec 31, 2019
Guest: Edward R. Laskowski, M.D. (@DrEdSportsMed)
Host: Darryl S. Chutka, M.D. (@ChutkaMD)
A MUST listen episode: 70% of Americans are overweight or obese and inactive and it’s not getting better. Dr. Ed Laskowski gives an eye-opening overview on our current state of health at a global level and what we can do about it for ourselves and for our patients. As little as 10 minutes of physical activity a week lowers all-cause mortality! To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Deeper Dive:
- Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old; N Engl J Med 2006; 355:763-778 DOI: 10.1056/NEJMoa055643 https://www.nejm.org/doi/full/10.1056/NEJMoa055643?query=recirc_curatedRelated_article
- Physical Activity Guidelines for Americans https://www.hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.html
- Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults. British Journal of Sports Medicine 2019 http://dx.doi.org/10.1136/bjsports-2018-099254