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In the twenty-teens, music has been wrapped up in politics and ethics in several prominent events, including violent attacks at the Bataclan theatre in Paris and the Pulse Nightclub in Orlando, and the profiling of musical listening habits in the French governments "stop jihadism" campaign. Significant scholarship exists on music and politics, and interest in music and ethical philosophy is growing. More work, however, is needed in theorizing the connections between music, ethics, and politics. In 1951, Heidegger's essay "Building Dwelling Thinking" lists the words in the title without punctuation in an attempt to show how these three terms are intertwined even though they are often considered separate. While these words and concepts are not interchangeable, each relies upon or invokes the other. My title structurally mirrors Heidegger's, and my aim here is to elucidate how music is intertwined with ethics and politics.

Background Third kidney retransplants have technical and immunologic hurdles that may preclude success, which is of particular importance in the contemporary context of discrepancy between organ supply and demand. Methods The outcomes of third renal transplant recipients (TRTR) were compared with those receiving a first transplant from paired donor kidneys to assess transplant success and complication rates. The Ontario-based Trillium Gift of Life Network database was used to identify deceased donors (n=28) who donated one kidney to a TRTR and the mate kidney to a primary renal transplant recipient (PRTR) from June 1977 to August 2006. Results As anticipated, TRTR were sensitized versus PRTR based on % panel reactive antibodies (24%+/-34% vs. 7%+/-14%, P=0.03). Delayed graft function (46% vs. 22%, P=0.05) and biopsy-proven rejection episodes (50% vs. 29%, P=0.01) occurred more frequently with TRTR despite greater frequency of induction therapy (74% vs. 35%, P=0.004). However, 1- and 5-year patient survival were similar at 93%, 83% and 96%, 87% for TRTR and PRTR, respectively. Accordingly, 1- and 5-year allograft survival censored for mortality, were comparable at 78%, 66% and 78%, 75%. Renal function was similar in both groups. Bacterial infections (43% vs. 18%, P=0.001) and wound problems (28% vs. 11%, P=0.09) were the only postoperative complications to occur more frequently in the TRTR. Conclusion We conclude that third renal transplantation should not be discouraged based on functional outcomes alone.

Introduction: To assess the efficacy of calcineurin inhibitor (CNI)-free immunosuppression vs. calcineurin-based immunosuppression in patients receiving expanded criteria donor (ECD) kidneys. Patient and methods: Thirteen recipients of ECD kidneys were enrolled in this pilot study and treated with induction therapy and maintained on sirolimus, mycophenolate mofetil (MMF) and prednisone. A contemporaneous control group was randomly selected comprised of 13 recipients of ECD kidneys who had been maintained on CNI plus MMF and prednisone. Results: For the study group vs. the control group, two-yr graft survival was 92.3% vs. 84.6% (p = NS), two-yr patient survival was 100% vs. 92.3% (p = NS) and the acute rejection rates were 23% vs. 31% (p = NS), respectively. Renal function was significantly better in the study group compared with control up to the six-month mark, after which, it remained numerically but not statistically significant. Complications were more common in the study group, but serious adverse events requiring discontinuation were rare. Conclusion: This pilot study demonstrates that CNI-free regimens can be safely implemented in patients receiving ECD kidneys with excellent two-yr patient and graft survival and good renal allograft function. Longer follow-up in larger randomized controlled trials are necessary to establish these findings.

It is clear that Levinas’ ethical concepts have the ability to encourage psychology with its emphasis on the Other – allowing the Other to speak on her own terms without appropriating her into the ...

Background: Delayed graft function (DGF) following transplantationnecessitates support in the form of hemodialyis (HD) orperitoneal dialysis (PD). However, post-transplant PD-related complicationand failure rates are unknown.Methods: We studies patients who were on PD at the time of kidneytransplantation over a 4-year period at two separate institutions.Results: Of the 137 PD patients, 19 had their catheters removedat the time of transplant. Of the remaining 118 patients, 89% hadimmediate graft function. PD-related complications in this groupincluded peritonitis (n=5), catheter-related infections (n=2) andemergency laparotomy (n=1). Of the 15 patients requiring posttransplantPD, 33% developed peritonitis and 20% had fluid-leaksnecessitating HD. Overall, leaving a PD catheter in situ post- transplantationis associated with 7% rate of peritonitis versus 0% ifremoved (p < 0.05).Conclusions: PD catheter removal should be considered at thetime of renal transplantation, as postoperative PD-related failure/complication rates are high.

Introduction and Objectives The ImmuKnow assay measures cell-mediated immunity by quantifying ATP release from CD4+ T-cells in peripheral blood. Herein, we hypothesized that this assay could predict complications associated with over-/under-immunosuppression in patients with kidney transplant (KT). Methods Sixty-seven patients undergoing KT were recruited prospectively and had ATP levels measured preoperatively, and at specified intervals over two months. Clinicians were blinded to ATP levels. Clinical events including rejection and infection/cancer were documented with a median follow-up of 21 months. Parameters including absolute ATP levels and changes in ATP patterns (slopes, delta) were analyzed. Association between ATP parameters and clinical outcomes was compared using the likelihood-ratio test and Kaplan–Meier curves. Results Absolute ATP values postoperatively had poor predictive value with regard to rejection or infection/malignancy. As well, changes in ATP values were poorly associated with complications. Importantly, patients with pre-transplant ATP values 300 ng/mL (p

Bclw is a death-protecting member of the Bcl2 family of apoptosis-regulating proteins. Mice that are mutant for Bclw display progressive and nearly complete testicular degeneration. We performed a morphometric evaluation of testicular histopathology in Bclw-deficient male mice between 9 days postnatal (p9) through 1 yr of age. Germ cell loss began by p22, with only few germ cells remaining beyond 7 mo of age. A complete block to elongated spermatid development at step 13 occurred during the first wave of spermatogenesis, whereas other types of germ cells were lost sporadically. Depletion of Sertoli cells commenced between p20 and p23 and continued until 1 yr of age, when few, if any, Sertoli cells remained. Mitochondria appeared to be swollen and the cytoplasm dense by electron microscopy, but degenerating Bclw-deficient Sertoli cells failed to display classical features of apoptosis, such as chromatin condensation and nuclear fragmentation. Macrophages entered seminiferous tubules and formed foreign-body giant cells that engulfed and phagocytosed the degenerated Sertoli cells. Leydig cell hyperplasia was evident between 3 and 5 mo of age. However, beginning at 7 mo of age, Leydig cells underwent apoptosis, with dead cells being phagocytosed by macrophages. The aforementioned cell losses culminated in a testis-containing vasculature, intertubular phagocytic cells, and peritubular cell "ghosts." An RNA in situ hybridization study indicates that Bclw is expressed in Sertoli cells in the adult mouse testis. Consequently, the diploid germ cell death may be an indirect effect of defective Sertoli cell function. Western analysis was used to confirm that Bclw is not expressed in spermatids; thus, loss of this cell type most likely results from defective Sertoli cell function. Because Bclw does not appear to be expressed in Leydig cells, loss of Leydig cells in Bclw-deficient mice may result from depletion of Sertoli cells. Bclw-deficient mice serve as a unique model to study homeostasis of cell populations in the testis.

INTRODUCTION AND OBJECTIVES: We prospectively assessed the impact of multiple factors affecting early, intermediate and late renal function after LPN. METHODS: Between 2004–2009, sixty-eight patients with 2 functioning renal units undergoing LPN were prospectively analysed. MDRD and Cockcroft Gault-calculated glomerular filtration rates (GFR), MAG-3 renograms with GFR and differential function were obtained at 1) preoperatively 2) immediately post-op ( 3 days) 3) intermediate post-op (6–12wks) and late post-op (one year). The impact of patient demographics, tumour characteristics and surgical factors on functional renal outcomes were assessed. Correlation analysis was first performed using Spearman correlation to elucidate factors correlated with GFR decline. Subsequent multivariate analysis was performed at each of the postop periods. Paired t-test was used to compare baseline GFR and renograms to these outcomes at each of the postoperative time periods. RESULTS: Spearman correlation determined that age, weight, pre-operative GFR, piece size and warm ischemia time (WIT) were correlated with early decline in GFR. However, multivariate analysis showed that in the immediate time period, only tumor weight and WIT were predictive of decreased renal function (p 0.01). As well, in the late post-op period, only the degree of early/intermediate reduction in renal function was predictive of persistent impaired renal function (p 0.00001). Paired t-test analysis showed that there was significant decline in renal function in the immediate and intermediate time points (p 0.001); this decline did not persist at one year, indicating capacity for late renal recovery (p NS). However, paired t-test using nuclear renogram studies showed that there was persistent dysfunction of the affected kidney at one year postop (41.7% vs 49.4% preop; p 0.001). Taken together, this indicates that late renal recovery may occur as a result of compensation from the contralateral renal unit. CONCLUSIONS: This study confirms the negative impact of warm ishemic time upon early renal function post-LPN. Importantly, this is the first study to show that the degree of initial renal functional loss is a key determinant to renal recovery at one year. Additionally, the function of the affected kidney remains compromised at one year, and recovery of renal function is primarily by compensation from the contralateral kidney.

Robot-assisted pyeloplasty (RAP) has been established recently as an option in the management of ureteropelvic junction obstruction (UPJO). We present the first Canadian experience with RAP with respect to operative results and outcomes. We compare the surgical outcomes between experienced and trainee surgeons, with respect to operating room times and success rates.Eighty-eight patients underwent transperitoneal RAP for UPJO using the da Vinci robotic platform. Two surgeons performed Anderson-Hynes dismembered pyeloplasty in 85 cases and YV-plasty in 5 cases. Five patients had RAP for secondary UPJO after failure of other treatments. Diuretic renography was performed at 6 weeks, and 6, 12, 18, 24, and 36 months postpyeloplasty. The mean follow-up was 14.1 ± 8.5 months.The mean operative time was 167.7 ± 43.2 minutes, and the mean anastomotic time was 41.9 ± 14.1 minutes. The mean operative duration significantly decreased with time (P0.05). Ten patients needed simultaneous nephroscopic stone management via the pyelotomy incision. The mean blood loss was 56.6 ± 55.4 mL, and the mean hospital stay was 2.5 ± 0.5 days. There were five major postoperative (stent migration, urinoma) and three minor complications that were associated with the RAP procedures. Postoperative renal scintigraphy demonstrated only four cases with persistent obstruction. Eighty-three (94.3%) patients experienced improvement of symptoms whereas 5 continued to be symptomatic. Two patients needed secondary procedures to relieve persisting obstruction. There were no statistical differences in outcomes between the experienced surgeons and trainees (P = 0.28).In the first large case series of RAP from Canada, we demonstrate that RAP can be performed with relatively short operative times and is safe and effective, achieving similar long-term results with standard open repair. We show that robot-assisted surgery can be safely transitioned to surgical trainees. With its cost and availability, its role in the Canadian system needs further study.

A simple analytical model for the signal acquisition range for a laser guided mortar is presented. The signal consists of a repetitively pulsed laser of fixed pulse duration and fixed pulse repetition frequency. The pulses are detected by a seeker consisting of a quadrant photodiode and a trans-impedance amplifier. Noise is introduced from solar irradiance and from the detector/amplifier electronics. The model maximizes the acquisition range by optimizing trans-impedance amplifier circuit components. A comparison of integrating multiple low energy pulses (MPLD) versus detecting each pulse individually (conventional) is made.

SUMMARY Irritable bowel syndrome, constipation, and diarrhea may complicate a pregnancy. Complaints of IBS and constipation may be managed by nonpharmaceutical methods. A careful history should be conducted to determine whether these complaints are of an acute or a long-standing nature. Conservative treatment of IBS is recommended and may include stool-bulking agents, a high-fiber diet, elimination of offensive foods, and the behavioral treatment of passive muscle relaxation, biofeedback or supportive psychotherapy. Constipation is generally self-limiting. It also may be treated conservatively with stool-bulking agents, increases in dietary fiber, and the addition of pelvic muscle exercises, preferably using electromyographic biofeedback. Laxatives should be used judiciously (Table 1). Diarrhea is caused most often by infectious agents in pregnancy but may also be from food poisoning or a viral disease. Infectious diarrhea may be treated by mild antidiarrheal agents and safe antibiotics. Fluid replacement is the mainstay of treatment, and care should be taken, remembering that the treatment involves two patients. These complaints can generally be managed conservatively, but persistent cases should be investigated as in a nonpregnant patient.

The development, advancement and clinical integration of robotictechnology in surgery continue at a staggering pace. In no otherdiscipline has this rapid evolution occurred to a greater degreethan in urology. Although radical prostatectomy has grown tobecome the prototypical application for the robot, the role of therobot in renal surgery remains controversial. Herein we reviewthe literature on robotic renal surgery. A comprehensive PubMedliterature search was performed to identify all published reportsrelating to robotic renal surgery. All clinically related articlesinvolving human participants were critically appraised in thisreview. Fifty-one clinical articles were included, encompassingrobot-assisted pyeloplasty, nephrectomy, nephroureterectomy,living-donor nephrectomy and partial nephrectomy. Feasibilityhas been shown for each of these procedures. Robot-assisted techniqueshave been described for almost all renal-related procedures.However, the intersect between feasibility and necessityas it pertains to robotic renal surgery has yet to be defined. Also,the high cost of surgical robotic technology mandates criticalappraisal before adoption, especially in a publicly funded healthcare system, such as the one present in Canada.Le développement, le perfectionnement et l’intégration en milieuclinique de la technologie robotique en contexte opératoire sepoursuit à un rythme stupéfiant. Aucune autre discipline n’a vucette évolution rapide à un niveau aussi élevé que l’urologie.Alors que la prostatectomie radicale en est devenue l’applicationprototype, le rôle de la robotique en chirurgie rénale demeurecontroversé. Dans l’article qui suit, nous passons en revue lalittérature portant sur l’emploi de la robotique en chirurgie rénale.Une recherche exhaustive dans la base de données PubMed aété effectuée afin de cerner les rapports sur le sujet. Tous les rapportscliniques portant sur des sujets humains ont été évalués.Cinquante et un articles cliniques ont été inclus dans notreanalyse, incluant des cas, tous assistés par robot, de pyéloplastie,de néphrectomie, de néphro-urétérectomie, de néphrectomiechez des donneurs vivants et de néphrectomie partielle. Pour chacunede ces interventions, la faisabilité a été démontrée. Des techniquesassistées par robot ont été décrites pour pratiquement tousles types d’interventions rénales. Néanmoins, le point d’intersectionentre faisabilité et nécessité concernant l’utilisation de larobotique reste à définir. Par ailleurs, le coût élevé de la robotiquechirurgicale justifie une évaluation critique avant l’adoptionde cette technologie, en particulier dans un système de santépublic comme celui du Canada.

The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.

The worldwide evolution of robotic surgery continues to advance at a staggering pace. In less than 20 years, the technology has grown exponentially from theoretical military application to daily use in operating rooms around the globe. In fact, the overwhelming success of robotic surgery with regards to invention, innovation, and adaptation is an excellent example of collaboration between surgeons, industry, and government. While the first robotic device to be used clinically dates back to computerized tomography-guided stereotactic neurosurgery by Kwoh et al in 1988 1, the first urological application in a human was not described until Davies et al2 used a modified industrial robotic arm to perform a transurethral resection of the prostate three years later. The first commercial application in laparoscopy did not come until the Automated Endoscopic System for Optimal Positioning (AESOPTM) was FDA approved in the United States in 19937. Originally designed by the U.S. military, the table-mounted device could precisely guide a laparoscope and was later put into production by Computer Motion Inc. (Santa Barbara, California).3 Computer Motion Inc. would later introduce the ZEUSTM robotic system onto the U.S. market in 1998, just months after the unveiling of another surgical robot, the da Vinci® (Intuitive Surgical, Sunnyvale, California). The da Vinci® system was born out of technology designed by NASA, also originally intended for use by the U.S. military, but quickly adopted for civilian use. In 2003, Intuitive Surgical took over Computer Motion Inc., thereby paving the way for the da Vinci® robot, along with it’s newly FDA approved EndoWristTM, to dominate surgical robotic use worldwide.3 Today, the vast majority of published literature on robotic-assisted renal surgery has employed the use of the da Vinci® system, and it is the only commercially available master-slave robotic system in production today. Few studies have addressed the comparative performance and efficiency between the three most cited robotic platforms, namely AESOP, ZEUS and da Vinci®. Sung et al4 initially looked at this question in a porcine model, and we later compared our results in a cohort of patients undergoing pyeloplasty for ureteropelvic junction obstruction (UPJO).5 Both groups concluded that the da Vinci® system was superior in terms of shorter operative time, quicker anastomotic time, and flatter learning curve. We also found the majority of technical manoeuvering inherently more intuitive with the da Vinci® system compared to the ZEUS system. There does exist some earlier reports of experience with the ZEUS O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m

Changing chronic ureteral stents in patients with kidney transplants may be technically difficult because of the site of ureterocystostomy. The technique described simplifies this procedure.

Posterior urethral valves (PUV) are the most common cause of male pediatric obstructive uropathy. Recent advancements in antenatal ultrasound and endoscopy have altered the presentation and management of PUV. Herein we describe the presentation, management and outcome of PUV patients in Eastern Ontario/Western Quebec over the last 3 decades. A comparison analysis of those cases identified pre and post widespread utilization of antenatal ultrasound diagnosis was performed to discern the clinical evolution of PUV with respect to long-term outcome.Retrospective systematic chart review of all PUV cases diagnosed and treated at the Children's Hospital of Eastern Ontario over the last 3 decades. Charts were reviewed for initial presentation, method of diagnosis, radiological and clinical findings at diagnosis, initial management, and long-term clinical outcome. The evolution of PUV was interpreted by dividing the cohort into two groups chronologically delineated by the first case detected by antenatal ultrasound in the mid-1980s. These pre- and post- antenatal ultrasound eras were compared with respect to the parameters outlined above.Fifty-three cases were reviewed - 21 prior to widespread antenatal ultrasound screening in the mid-1980s and 32 after. There were 13/53 cases (32%) discovered by prenatal ultrasound evidence of hydronephrosis, none prior to 1985. VCUG confirmed the diagnosis in all cases. Mean age at presentation in the remaining post-natally diagnosed patients was 33 months. Of the cases diagnosed post-natally, ultrasound investigation complemented VCUG findings in 19/40 cases (47%), whereas IVP was utilized in 14/40 (35%). IVP has not been utilized for this purpose since 1987. Overall, 26/53 cases (49%) had documented VUR - 16/26 (62%) bilateral; 42/53 (79%) had hydronephrosis on ultrasound - 37/42 (88%) bilateral; 26/53 (49%) had radiological evidence of renal parenchymal damage at diagnosis; 41/53 (77%) cases had a thickened bladder wall on ultrasound at diagnosis, and 23/53 (43%) had at least one bladder diverticulum. Techniques of initial management comprised: valve ablation 32/53, vesicostomy 11/53, and high diversion 10/53. Clinically significant bladder dysfunction was found in 31% of cases, ranging from bladder instability to myogenic failure. Globally impaired renal function, as determined by significantly elevated serum creatinine levels, reduced GFR, or both, was found in 12/53 (23%). 6/53 (11%) progressed to ESRD, of which 4 received transplants. Two patients died - one from complications related to renal failure. Of the six cases of myogenic bladder failure identified, three (50%) had concurrently significant renal impairment. Average length of follow-up was 8.3 years, varying between 1 month and 18 years.The presentation of PUV is variable, and currently antenatal detection is the most common mode. Despite this, it still does not make up the majority of diagnoses. Complete radiological work up should include abdominal and pelvic U/S in conjunction with VCUG. Concurrent VUR in 50% of boys mandates suppressive antibiotic use. Primary valve ablation remains the gold standard for treatment of PUV, with vesicostomy reserved for selected cases. Long-term bladder and renal dysfunction is common in this population, and mandates long-term urological and nephrological follow-up.

What would we learn if we could merge parts of our brains with other species? Might we hear the sounds of the past? Would we have a very different psychology? Or live in naked troops, wordlessly swapping intimate experiences? Jeff Warren phoned some friends

Jeff Warren thought textbook descriptions of consciousness missed a lot of the first-person fun, insightful stuff, so he set out on his own voyage of exploration

Introduction: Our objective was to compare the impact of extracapsular (ECAN) versus intracapsular allograft nephrectomy (ICAN) on allosensitization and surgical outcomes. Methods: Between 1990 and 2004, 96 allograft nephrectomies were performed at our institution. Of these, 29 procedures were performed within 1 month of the transplant and were therefore omitted from analysis. Overall, the results of 44 ECAN and 23 ICAN were reviewed. Results: The mean operative times were 110.9 versus 130.4 min for ICAN versus ECAN (p = 0.02) and the estimated blood loss was 226 mL for ICAN versus 483 mL for ECAN (p = 0.004). Intraoperative and postoperative complications were low using either technique and differences were not statistically significant. Overall, the preoperative to postoperative change in the percentage of panel reactive antibody was +2.1% for ICAN versus +1.2% for ECAN (NS) at 3 to 12 months postoperatively, respectively (NS). The percentage of patients relisted was 33.3% versus 54.3% (NS), and the percentage of patients re-transplanted once relisted was also very similar: 63.2% for ECAN versus 66.7% for ICAN (NS), after a mean follow-up of 4.5 and 8.4 years, respectively. Conclusions: ICAN can be performed with shorter operative times and less blood loss versus the extracapsular approach. As well, this operative approach does not appear to affect allosensitization and the ability to re-transplant patients.