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Abstract We present new field data from three outcrops of Miocene methane-derived authigenic carbonates in the foredeep of the northern Apennines that contain chemosynthetic fauna and record a long history (∼1 Ma) of shallow fluid seepage linked to seafloor anaerobic oxidation of methane. The studied outcrops show similar features in terms of carbonate morphology, facies, spatial distribution and lateral and vertical contacts with the enclosing sediments. Methane-derived carbonates occur in two structural positions: 1) on the slope of the accretionary wedge in hemipelagites draping buried thrust-related anticlines, and 2) at the leading edge of the deformation front in the inner foredeep, within fault-related anticlines standing above the adjacent deep seafloor as intrabasinal ridges. We compare fossil seeps with two extensively investigated modern analogues: the Hikurangi Margin, offshore New Zealand and Hydrate Ridge, on the Cascadia margin, offshore the U.S.A. These analogues share a similar compressive structural setting and are marked by the presence of variably extensive and voluminous methane-derived carbonate bodies and chemosynthetic fauna on the present-day seafloor. The comparison allows us to propose a model for the evolution of fluid seeps on thrust-related ridges. At the deformation front, uplift and geometry of the anticlinal ridges are controlled by the growth of splay faults, mostly blind, connected to the basal detachment, favoring the migration of fluids toward the incipient anticline. Fold development generates extensional stresses in the hinge zone of the anticline, promoting the development of normal faults; fluid migration pathways and seafloor seeps shift from the forelimb toward the crest of the ridge as the structures evolve. In the slope setting, far from the deformation front, thrust faults and extensional faults in buried anticlines remain the main fluid migration pathways to sustain seepage at the seafloor. After reaching a mature stage within the wedge, the structure is less active and buried in the slope environment of the evolved prism. Highlights • We provide summary of recurring features at seep outcrops in the northern Apennines. • Fossil seeps are compared with analogues from modern compressive settings. • The onset and evolution of seeps are linked to the development of anticlinal ridges. • We propose a new evolutionary model for seeps on accretionary ridges. [ABSTRACT FROM AUTHOR]

Background: Kidney stone disease is common and can lead to complications such as AKI, urinary tract obstruction, and urosepsis. In kidney transplant recipients, complications from kidney stone events can also lead to rejection and allograft failure. There is limited information on the incidence of kidney stone events in transplant recipients., Methods: We identified 83,535 patients from the United States Renal Data System who received their first kidney transplant between January 1, 2007, and December 31, 2018. We examined the incidence of kidney stone events and identified risk factors associated with a kidney stone event in the first 3 years after transplantation., Results: We found 1436 patients (1.7%) who were diagnosed with a kidney stone in the 3 years after kidney transplant. The unadjusted incidence rate for a kidney stone event was 7.8 per 1000 person-years. The median time from transplant to a kidney stone diagnosis was 0.61 (25%-75% range 0.19-1.46) years. Patients with a history of kidney stones were at greatest risk of a kidney stone event after transplant (hazard ratio [HR], 4.65; 95% confidence interval [CI], 3.82 to 5.65). Other notable risk factors included a diagnosis of gout (HR, 1.53; 95% CI, 1.31 to 1.80), hypertension (HR, 1.29; 95% CI, 1.00 to 1.66), and a dialysis of vintage of ≥9 years (HR, 1.48; 95% CI, 1.18 to 1.86; ref vintage ≤2.5 years)., Conclusions: Approximately 2% of kidney transplant recipients were diagnosed with a kidney stone in the 3 years after kidney transplant. Risk factors of a kidney stone event include a history of kidney stones and longer dialysis vintage., (Copyright © 2023 by the American Society of Nephrology.)

Importance: Approximately 3% to 5% of patients with kidney stones have primary hyperparathyroidism (PHPT), a treatable cause of recurrent stones. However, the rate of screening for PHPT in patients with kidney stones remains unknown., Objectives: To estimate the prevalence of parathyroid hormone (PTH) testing in veterans with kidney stones and hypercalcemia and to identify the demographic, geographic, and clinical characteristics of veterans who were more or less likely to receive PTH testing., Design, Setting, and Participants: This cohort study obtained Veterans Health Administration (VHA) health records from the Corporate Data Warehouse for veterans who received care in 1 of the 130 VHA facilities across the United States from January 1, 2008, through December 31, 2013. Historical encounters, medical codes, and laboratory data were assessed. Included patients had diagnostic or procedural codes for kidney or ureteral stones, and excluded patients were those with a previous serum PTH level measurement. Data were collected from January 1, 2006, to December 31, 2014. Data analysis was conducted from June 1, 2019, to January 31, 2020., Exposures: Elevated serum calcium concentration measurement between 6 months before and 6 months after kidney stone diagnosis., Main Outcomes and Measures: Proportion of patients with a serum PTH level measurement and proportion of patients with biochemical evidence of PHPT who underwent parathyroidectomy., Results: The final cohort comprised 7561 patients with kidney stones and hypercalcemia and a mean (SD) age of 64.3 (12.3) years. Of these patients, 7139 were men (94.4%) and 5673 were white individuals (75.0%). The proportion of patients who completed a serum PTH level measurement was 24.8% (1873 of 7561). Across the 130 VHA facilities included in the study, testing rates ranged from 4% to 57%. The factors associated with PTH testing included the magnitude of calcium concentration elevation (odds ratio [OR], 1.07 per 0.1 mg/dL >10.5 mg/dL; 95% CI, 1.05-1.08) and the number of elevated serum calcium concentration measurements (OR, 1.08 per measurement >10.5 mg/dL; 95% CI, 1.06-1.10) as well as visits to both a nephrologist and a urologist (OR, 6.57; 95% CI, 5.33-8.10) or an endocrinologist (OR, 4.93; 95% CI, 4.11-5.93). Of the 717 patients with biochemical evidence of PHPT, 189 (26.4%) underwent parathyroidectomy within 2 years of a stone diagnosis., Conclusions and Relevance: This cohort study found that only 1 in 4 patients with kidney stones and hypercalcemia were tested for PHPT in VHA facilities and that testing rates varied widely across these facilities. These findings suggest that raising clinician awareness to PHPT screening indications may improve evaluation for parathyroidectomy, increase the rates of detection and treatment of PHPT, and decrease recurrent kidney stone disease.

Competing Interests: Competing interests We have read and understood BMJ policy on declaration of interests. All authors work in the Improvements Analytics Unit, a joint project between NHS England and the Health Foundation, which provided support for work reported in references of this report.133760

Despite controversy about their effectiveness, low-dose heparin therapy and elastic stockings were the methods most frequently selected by surgeons in a national survey on thromboembolism prophylaxis. These methods were selected even for patients with an extremely high risk of thrombosis. Surgeons responding to this survey apparently did not discriminate between degrees of patient risk, did not recognize the limitations of low-dose heparin and elastic stockings in protecting high-risk patients, and were unfamiliar with more effective methods of prophylaxis, ie, warfarin, dextran, and intermittent pneumatic compression. There is clearly a need for more specific data regarding the safe use of effective thromboembolism prophylaxis in surgical patients.