Evaluation and Treatment of a Ureterosciatic Hernia Causing Hydronephrosis and Renal Colic

Abstract An 87-year-old female presented with complaints of intermittent severe right renal colic. CT imaging demonstrated a ureterosciatic hernia and moderate hydronephrosis proximal to the portion of the ureter that was herniated through the sciatic foramen. A retrograde pyelogram demonstrated a transition point in the ureter at the location of the hernia. A ureteral stent was placed resulting in straightening of the ureter, resolution of hydronephrosis, and complete resolution of the patient's symptoms

Statin Use and Risk of Sepsis After Percutaneous Nephrolithotomy

Purpose: To examine the association between statin medication use and sepsis risk after percutaneous nephrolithotomy (PCNL). Materials and Methods: Using medical claims data, we identified working-age adults with urinary stone disease who were treated with PCNL. Among this cohort, we determined which patients had a prescription fill for a statin agent that encompassed their surgery date. We then fitted logistic regression models to examine for differences in rates of postoperative sepsis between statin users and nonusers. In addition, we evaluated the frequency of nonfebrile urinary tract infections (UTIs) and intensive care unit (ICU) services utilization and hospital length of stay (LOS) as a function of statin use. Results: During the study period, at total of 2046 patients underwent PCNL, 382 (18.7%) of whom had a prescription fill for a statin agent preceding their surgery. The overall rate of sepsis in this population was 3.8%. After adjusting for patient health status and sociodemographic factors, the rate of postoperative sepsis was comparable between statin users and nonusers (5.3% vs 3.5%, respectively; P=0.105). In addition, UTI and ICU utilization rates did not relate to statin use (P>0.05 for all associations). Adjusted hospital LOS was shorter among statin users, but the difference was clinically trivial (3.6 vs 4.1 days; P=0.007). Conclusions: Statin use is not associated with reductions in postoperative sepsis, nonfebrile UTIs, ICU utilization, or hospital LOS after PCNL. To increase the safety of PCNL, urologists will have to consider other processes of care (e.g., clinical care pathways).Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140081/1/end.2015.0042.pd

Validation of TOI-1221 b: A warm sub-Neptune exhibiting TTVs around a Sun-like star

We present a validation of the long-period ($91.68278^{+0.00032}_{-0.00041}$ days) transiting sub-Neptune planet TOI-1221 b (TIC 349095149.01) around a Sun-like (m$_{\rm V}$=10.5) star. This is one of the few known exoplanets with period >50 days, and belongs to the even smaller subset of which have bright enough hosts for detailed spectroscopic follow-up. We combine TESS light curves and ground-based time-series photometry from PEST (0.3~m) and LCOGT (1.0~m) to analyze the transit signals and rule out nearby stars as potential false positive sources. High-contrast imaging from SOAR and Gemini/Zorro rule out nearby stellar contaminants. Reconnaissance spectroscopy from CHIRON sets a planetary scale upper mass limit on the transiting object (1.1 and 3.5 M$_{\rm Jup}$ at 1$\sigma$ and 3$\sigma$, respectively) and shows no sign of a spectroscopic binary companion. We determine a planetary radius of $R_{\rm p} = 2.91^{+0.13}_{-0.12} R_{\oplus}$, placing it in the sub-Neptune regime. With a stellar insolation of $S = 6.06^{+0.85}_{-0.77}\ S_{\oplus}$, we calculate a moderate equilibrium temperature of $T_{\rm eq} =$ 440 K, assuming no albedo and perfect heat redistribution. We find a false positive probability from TRICERATOPS of FPP $= 0.0014 \pm 0.0003$ as well as other qualitative and quantitative evidence to support the statistical validation of TOI-1221 b. We find significant evidence (>$5\sigma$) of oscillatory transit timing variations, likely indicative of an additional non-transiting planet.Comment: 17 pages, 9 figures, 4 table

What Happened to the Bondholding Class? Public Debt, Power and the Top One Per Cent

In 1887 Henry Carter Adams produced a study demonstrating that the ownership of government bonds was heavily concentrated in the hands of a ‘bondholding class’ that lent to and, in Adams's view, controlled the government like dominant shareholders control a corporation. The interests of this bondholding class clashed with the interests of the masses, whose burdensome taxes financed the interest payments on government bonds. Since the late nineteenth century there has been plenty of debate about the ownership of the public debt. But the empirical evidence offered to support the various arguments has been scant. As a result, political economists have few answers to questions first raised by Adams over century ago: how has the pattern of public debt ownership changed? Can we still speak of a powerful ‘bondholding class’? Does public debt redistribute income from taxpayers to public creditors? This article develops a new framework to address these questions. Anchored within a ‘capital as power’ approach, the research indicates a staggering pattern of concentration in the ownership of US public debt in the hands of the top one per cent of US households over the past three decades. Accordingly, the bondholding class is still alive and well in contemporary US capitalism

Sepsis Enhances Epithelial Permeability with Stretch in an Actin Dependent Manner

Ventilation of septic patients often leads to the development of edema and impaired gas exchange. We hypothesized that septic alveolar epithelial monolayers would experience stretch-induced barrier dysfunction at a lower magnitude of stretch than healthy alveolar epithelial monolayers. Alveolar epithelial cells were isolated from rats 24 hours after cecal ligation and double puncture (2CLP) or sham surgery. Following a 5-day culture period, monolayers were cyclically stretched for 0, 10, or 60 minutes to a magnitude of 12% or 25% change in surface area (ΔSA). Barrier function, MAPk and myosin light chain (MLC) phosphorylation, tight junction (TJ) protein expression and actin cytoskeletal organization were examined after stretch. Significant increases in epithelial permeability were observed only in 2CLP monolayers at the 12% ΔSA stretch level, and in both 2CLP and sham monolayers at the 25% ΔSA stretch level. Increased permeability in 2CLP monolayers was not associated with MAPk signaling or alterations in expression of TJ proteins. 2CLP monolayers had fewer actin stress fibers before stretch, a more robust stretch-induced actin redistribution, and reduced phosphorylated MLCK than sham monolayers. Jasplakinolide stabilization of the actin cytoskeleton in 2CLP monolayers prevented significant increases in permeability following 60 minutes of stretch to 12% ΔSA. We concluded that septic alveolar epithelial monolayers are more susceptible to stretch-induced barrier dysfunction than healthy monolayers due to actin reorganization

Investigating variation in replicability

Although replication is a central tenet of science, direct replications are rare in psychology. This research tested variation in the replicability of 13 classic and contemporary effects across 36 independent samples totaling 6,344 participants. In the aggregate, 10 effects replicated consistently. One effect – imagined contact reducing prejudice – showed weak support for replicability. And two effects – flag priming influencing conservatism and currency priming influencing system justification – did not replicate. We compared whether the conditions such as lab versus online or US versus international sample predicted effect magnitudes. By and large they did not. The results of this small sample of effects suggest that replicability is more dependent on the effect itself than on the sample and setting used to investigate the effect

Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19)

The SARS-CoV-2 virus spreading across the world has led to surges of COVID-19 illness, hospitalizations, and death. The complex and multifaceted pathophysiology of life-threatening COVID-19 illness including viral mediated organ damage, cytokine storm, and thrombosis warrants early interventions to address all components of the devastating illness. In countries where therapeutic nihilism is prevalent, patients endure escalating symptoms and without early treatment can succumb to delayed in-hospital care and death. Prompt early initiation of sequenced multidrug therapy (SMDT) is a widely and currently available solution to stem the tide of hospitalizations and death. A multipronged therapeutic approach includes 1) adjuvant nutraceuticals, 2) combination intracellular anti-infective therapy, 3) inhaled/oral corticosteroids, 4) antiplatelet agents/anticoagulants, 5) supportive care including supplemental oxygen, monitoring, and telemedicine. Randomized trials of individual, novel oral therapies have not delivered tools for physicians to combat the pandemic in practice. No single therapeutic option thus far has been entirely effective and therefore a combination is required at this time. An urgent immediate pivot from single drug to SMDT regimens should be employed as a critical strategy to deal with the large numbers of acute COVID-19 patients with the aim of reducing the intensity and duration of symptoms and avoiding hospitalization and death

Management of Ureteroiliac Artery Fistula

We present a case of ureteroiliac artery fistula in a patient with a history of malignant extrinsic ureteral obstruction and prior pelvic radiation therapy. Successful angiographic diagnosis and endovascular treatment were performed in this patient. High index of suspicion is critical to diagnosis of this condition