Addition of Sodium Bicarbonate to Irrigation Solution May Assist in Dissolution of Uric Acid Fragments During Ureteroscopy

Introduction: We hypothesized that adding sodium bicarbonate (bicarb) to normal saline (NS) irrigation during ureteroscopy in patients with uric acid (UA) nephrolithiasis may assist in dissolving small stone fragments produced during laser lithotripsy. In vitro testing was performed to determine whether dissolution of UA fragments could be accomplished within 1 hour. Materials and Methods: In total 100% UA renal calculi were fragmented, filtered, and separated by size. Fragment sizes were <0.5 mm and 0.5 to 1 mm. Similar amounts of stone material were agitated in solution at room temperature. Four solutions were tested (NS, NS +1 ampule bicarb/L, NS +2, NS +3). Both groups were filtered to remove solutions after fixed periods. Filtered specimens were dried and weighed. Fragment dissolution rates were calculated as percent removed per hour. Additional testing was performed to determine whether increasing the temperature of solution affected dissolution rates. Results: For fragments <0.5 mm, adding 2 or 3 bicarb ampules/L NS produced a dissolution rate averaging 91% ± 29% per hour. This rate averaged 226% faster than NS alone. With fragments 0.5 to 1 mm, addition of 2 or 3 bicarb ampules/L NS yielded a dissolution rate averaging 22% ± 7% per hour, which was nearly five times higher than NS alone. There was a trend for an increase in mean dissolution rate with higher temperature but this increase was not significant (p = 0.30). Conclusions: The addition of bicarbonate to NS more than doubles the dissolution rate of UA stone fragments and fragments less than 0.5 mm can be completely dissolved within 1 hour. Addition of bicarb to NS irrigation is a simple and inexpensive approach that may assist in the dissolution of UA fragments produced during ureteroscopic laser lithotripsy. Further studies are needed to determine whether a clinical benefit exists

Preoperative Bladder Urine Culture as a Predictor of Intraoperative Stone Culture Results: Clinical Implications and Relationship to Stone Composition

Purpose We examine the relationship between urine and stone cultures in a large cohort of patients undergoing percutaneous stone removal and compare the findings in infectious vs metabolic calculi. Materials and Methods A total of 776 patients treated with percutaneous nephrolithotomy who had preoperative urine cultures and intraoperative stone cultures were included in the study. Statistical analysis used chi-square or logistic fit analysis as appropriate. Results Preoperative urine culture was positive in 352 patients (45.4%) and stone cultures were positive in 300 patients (38.7%). There were 75 patients (9.7%) with negative preoperative cultures who had positive stone cultures, and in patients with both cultures positive the organisms differed in 103 (13.3%). Gram-positive organisms predominated in preoperative urine and stone cultures. Conclusions Preoperative urine cultures in patients undergoing percutaneous nephrolithotomy are unreliable as there is a discordance with intraoperative stone cultures in almost a quarter of cases. There has been a notable shift toward gram-positive organisms in this cohort of patients

Sensitivity of Non-Contrast Computed Tomography for Small Renal Calculi with Endoscopy as the Gold Standard

Objectives To compare the sensitivity of non-contrast CT to endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray (KUB), ultrasound (US), and non-contrast computed tomography (CT). Sensitivities of 58-62% (KUB), 45% (US), and 95-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings. Methods Idiopathic calcium oxalate stone formers with symptomatic calculi requiring ureteroscopy (URS) were studied. At the time of surgery, the number and location of all calculi within the kidney were recorded followed by basket retrieval. Each calculus was measured and sent for micro CT and infrared spectrophotometry. All CT scans were reviewed by the same genitourinary radiologist who was blinded to the endoscopic findings. The radiologist reported on the number, location, and size of each calculus. Results 18 renal units were studied in 11 patients. Average time from CT scan to URS was 28.6 days. The mean number of calculi identified per kidney was 9.2±6.1 for endoscopy and 5.9±4.1 for CT (p<0.004). The mean size of total renal calculi (sum of longest stone diameters) per kidney was 22.4±17.1 mm and 18.2±13.2 mm for endoscopy and CT, respectively (p=0.06). Conclusions CT scan underreports the number of renal calculi, probably missing some small stones and unable to distinguish those lying in close proximity to one another. However, the total stone burden seen by CT is, on average, accurate when compared to that found on endoscopic examination

A Proposed Grading System to Standardize the Description of Renal Papillary Appearance at the Time of Endoscopy in Patients with Nephrolithiasis

BACKGROUND AND PURPOSE: The appearance of the renal papillae in patients with nephrolithiasis can be quite variable and can range from entirely healthy to markedly diseased. The implications of such findings remain unknown. One potential reason is the lack of a standardized system to describe such features. We propose a novel grading scale to describe papillary appearance at the time of renal endoscopy. METHODS: Comprehensive endoscopic renal assessment and mapping were performed on more than 300 patients with nephrolithiasis. Recurring abnormal papillary characteristics were identified and quantified based on degree of severity. RESULTS: Four unique papillary features were chosen for inclusion in the PPLA scoring system- ductal Plugging, Pitting, Loss of contour, and Amount of Randall's plaque. Unique scores are calculated for individual papillae based on reference examples. CONCLUSIONS: The description and study of renal papillary appearance in stone formers have considerable potential as both a clinical and research tool; however, a standardized grading system is necessary before using it for these purpos

Spiro-containing derivatives show antiparasitic activity against trypanosoma brucei through inhibition of the trypanothione reductase enzyme

Trypanothione reductase (TR) is a key enzyme that catalyzes the reduction of trypa-nothione, an antioxidant dithiol that protects Trypanosomatid parasites from oxidative stress induced by mammalian host defense systems. TR is considered an attractive target for the development of novel anti-parasitic agents as it is essential for parasite survival but has no close homologue in humans. We report here the identification of spiro-containing derivatives as inhibitors of TR from Trypanosoma brucei (TbTR), the parasite responsible for Human African Trypanosomiasis. The hit series, identified by high throughput screening, was shown to bind TbTR reversibly and to compete with the trypanothione (TS2) substrate. The prototype compound 1 from this series was also found to impede the growth of Trypano-soma brucei parasites in vitro. The X-ray crystal structure of TbTR in complex with compound 1 solved at 1.98 Å allowed the identification of the hydrophobic pocket where the inhibitor binds, placed close to the catalytic histidine (His 461’) and lined by Trp21, Val53, Ile106, Tyr110 and Met113. This new inhibitor is specific for TbTR and no activity was detected against the structurally similar human glutathione reductase (hGR). The central spiro scaffold is known to be suitable for brain active compounds in humans thus represent-ing an attractive starting point for the future treatment of the central nervous system stage of T. brucei infections

222^{222}Rn contamination mechanisms on acrylic surfaces

In this work, the $^{222}$Rn contamination mechanisms on acrylic surfaces have been investigated. $^{222}$Rn can represent a significant background source for low-background experiments, and acrylic is a suitable material for detector design thanks to its purity and transparency. Four acrylic samples have been exposed to a $^{222}$Rn rich environment for different time periods, being contaminated by $^{222}$Rn and its progenies. Subsequently, the time evolution of radiocontaminants activity on the samples has been evaluated with $\alpha$ and $\gamma$ measurements, highlighting the role of different decay modes in the contamination process. A detailed analysis of the alpha spectra allowed to quantify the implantation depth of the contaminants. Moreover, a study of both $\alpha$ and $\gamma$ measurements pointed out the $^{222}$Rn diffusion inside the samples

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

The large scale polarization explorer (LSPE) for CMB measurements: performance forecast

The measurement of the polarization of the Cosmic Microwave Background (CMB) radiation is one of the current frontiers in cosmology. In particular, the detection of the primordial divergence-free component of the polarization field, the B-mode, could reveal the presence of gravitational waves in the early Universe. The detection of such a component is at the moment the most promising technique to probe the inflationary theory describing the very early evolution of the Universe. We present the updated performance forecast of the Large Scale Polarization Explorer (LSPE), a program dedicated to the measurement of the CMB polarization. LSPE is composed of two instruments: LSPE-Strip, a radiometer-based telescope on the ground in Tenerife-Teide observatory, and LSPE-SWIPE (Short-Wavelength Instrument for the Polarization Explorer) a bolometer-based instrument designed to fly on a winter arctic stratospheric long-duration balloon. The program is among the few dedicated to observation of the Northern Hemisphere, while most of the international effort is focused into ground-based observation in the Southern Hemisphere. Measurements are currently scheduled in Winter 2022/23 for LSPE-SWIPE, with a flight duration up to 15 days, and in Summer 2022 with two years observations for LSPE-Strip. We describe the main features of the two instruments, identifying the most critical aspects of the design, in terms of impact on the performance forecast. We estimate the expected sensitivity of each instrument and propagate their combined observing power to the sensitivity to cosmological parameters, including the effect of scanning strategy, component separation, residual foregrounds and partial sky coverage. We also set requirements on the control of the most critical systematic effects and describe techniques to mitigate their impact. LSPE will reach a sensitivity in tensor-to-scalar ratio of σr < 0.01, set an upper limit r < 0.015 at 95% confidence level, and improve constraints on other cosmological parameters

High-resolution and color doppler sonography in the evaluation of skin metastases.

Objective. To evaluate high-resolution sonography in differentiating cutaneous metastases from other benign dermatologic diseases with the final objective of proposing high-resolution sonography in the diagnostic protocol for asymptomatic patients and those with neoplasms who have 1 or more rapidly growing skin nodules. Methods. We selected 57 patients (24 women and 33 men; mean age ± SD, 53 ± 25 years) who underwent high-resolution and color Doppler sonography because they recently noticed 1 or more superficial nodules. Patients were mostly asymptomatic, but 15 had previously diagnosed malignancies. Each nodule was classified by measurement of fundamental sonographic parameters (major diameter, shape, borders, echo texture, and homogeneity) and by assessment of vascularity (presence or absence of flow and vascular pattern) with color Doppler sonography. All nodules were ablated and histologically examined. Results. Of 68 nodules, 23 were malignant (21 metastases and 2 B-cell lymphomas), and 45 were benign (22 sebaceous cysts, 18 granulomas of different origins, 3 fibromas, and 2 neurofibromas). The nodules were all localized in the subcutaneous space, had clearly demarcated borders, and were hypoechoic; a circular or oval shape was predominant, but 7 metastases had an irregular, polycyclic shape. On color Doppler sonography, none of the benign nodules or B-cell lymphomas showed signs of vascularity, whereas the metastatic nodules were all vascularized, with 1 or more peripheral poles (21 of 21 nodules) and internal vessels (11 of 21 nodules). Conclusions. A polycyclic shape and hypervascularity, with multiple peripheral poles and, eventually, internal vessels, should be considered the most indicative signs of metastasis