If you were looking for some motivation to follow your doctor's advice or remember to take your medicine, look no further than this grisly tale.
A 64-year-old man went to the emergency department of Brigham and Women’s Hospital in Boston with a painful festering ulcer spreading on his left, very swollen ankle. It was a gruesome sight; the open sore was about 8 by 5 centimeters (about 3 by 2 inches) and was rimmed by black, ashen, and dark purple tissue. Inside, it oozed with streaks and fringes of yellow pus around pink and red inflamed flesh. It was 2 cm deep (nearly an inch). And it smelled.
The man told doctors it had all started two years prior, when dark, itchy lesions appeared in the area on his ankle—the doctors noted that there were multiple patches of these lesions on both his legs. But about five months before his visit to the emergency department, one of the lesions on his left ankle had progressed to an ulcer. It was circular, red, tender, and deep. He sought treatment and was prescribed antibiotics, which he took. But they didn't help.
You can view pictures of the ulcer and its progression here, but be warned, it is graphic. (Panel A shows the ulcer five months prior to the emergency department visit. Panel B shows the ulcer one month prior. Panel C shows the wound on the day of presentation at the emergency department. Panel D shows the area three months after hospital discharge.)
The ulcer grew. In fact, it seemed as though his leg was caving in as the flesh around it began rotting away. A month before the emergency room visit, the ulcer was a gaping wound that was already turning gray and black at the edges. It was now well into the category of being a chronic ulcer.
In a Clinical Problem-Solving article published in the New England Journal of Medicine this week, doctors laid out what they did and thought as they worked to figure out what was causing the man's horrid sore.
With the realm of possibilities large, they started with the man's medical history. The man had immigrated to the US from Korea 20 years ago. He owned and worked at a laundromat, which involved standing for more than eight hours a day. He had a history of eczema on his legs, high cholesterol, high blood pressure, and Type 2 diabetes. For these, he was prescribed a statin for his cholesterol, two blood pressure medications (hydrochlorothiazide and losartan), and metformin for his diabetes. He told doctors he was not good at taking the regimen of medicine.
His diabetes was considered "poorly controlled." A month prior, he had a glycated hemoglobin (A1C or HbA1C) test—which indicates a person's average blood sugar level over the past two or three months. His result was 11 percent, while the normal range is between 4.2 and 5.6 percent.
His blood pressure, meanwhile, was 215/100 mm Hg at the emergency department. For reference, readings higher than 130/80 mm Hg on either number are considered the first stage of high blood pressure. Over the past three years, the man's blood pressure had systolic readings (top number, pressure as heart beats) ranging from 160 to 230 mm Hg and diastolic readings (bottom number, pressure as heart relaxes) ranging from 95 to 120 mm Hg.
Given the patient's poorly controlled diabetes, a diabetic ulcer was initially suspected. But the patient didn't have any typical signs of diabetic neuropathy that are linked to ulcers. These would include numbness, unusual sensations, or weakness. His responses on a sensory exam were all normal. Diabetic ulcers also typically form on the foot, not the lower leg.
X-rays of the ankle showed swelling in the soft tissue but without some signs of infection. The doctors wondered if the man had osteomyelitis, an infection in the bone, which can be a complication in people with diabetic ulcers. The large size and duration of the ulcer matched with a bone infection, as well as some elevated inflammatory markers he had on his blood tests.
To investigate the bone infection further, they admitted the man to the hospital and ordered magnetic resonance imaging (MRI). But the MRI showed only a soft-tissue defect and a normal bone, ruling out a bone infection. Another MRI was done with a contrast agent. That showed that the man's large arteries were normal and there were no large blood clots deep in his veins—which is sometimes linked to prolonged standing, as the man did at his laundromat job.
As the doctors were still working to root out the cause, they had started him on a heavy-duty regimen of antibiotics. This was done with the assumption that on top of whatever caused the ulcer, there was now also a potentially aggressive secondary infection—one not knocked out by the previous round of antibiotics the man had been given.
With a bunch of diagnostic dead ends piling up, the doctors broadened their view of possibilities, newly considering cancers, rare inflammatory conditions, and less common conditions affecting small blood vessels (as the MRI has shown the larger vessels were normal). This led them to the possibility of a Martorell's ulcer.
These ulcers, first described in 1945 by a Spanish doctor named Fernando Martorell, form when prolonged, uncontrolled high blood pressure causes the teeny arteries below the skin to stiffen and narrow, which blocks the blood supply, leading to tissue death and then ulcers. The ulcers in these cases tend to start as red blisters and evolve to frank ulcers. They are excruciatingly painful. And they tend to form on the lower legs, often over the Achilles’ tendon, though it's unclear why this location is common.
The doctors performed a punch biopsy of the man's ulcer, but it was inconclusive—which is common with Martorell's ulcers. The doctors turned to a "deep wedge biopsy" instead, which is exactly what it sounds like.
A pathology exam of the tissue slices from the wedge biopsy showed blood vessels that had thickened and narrowed. It also revealed extensive inflammation and necrosis. With the pathology results as well as the clinical presentation, the doctors diagnosed the man with a Martorell's ulcer.
They also got back culture results from deep-tissue testing, finding that the man's ulcer had also become infected with two common and opportunistic bacteria—Serratia marcescens and Enterococcus faecalis. Luckily, these are generally easy to treat, so the doctors scaled back his antibiotic regimen to target just those germs.
The man underwent three surgical procedures to clean out the dead tissue from the ulcer, then a skin graft to repair the damage. Ultimately, he made a full recovery. The doctors at first set him on an aggressive regimen to control his blood pressure, one that used four drugs instead of the two he was supposed to be taking. But the four-drug regimen caused his blood pressure to drop too low, and he was ultimately moved back to his original two-drug treatment.
The finding suggests that if he had just taken his original medications as prescribed, he would have kept his blood pressure in check and avoided the ulcer altogether.
In the end, "the good outcome in this patient with a Martorell’s ulcer underscores the importance of blood-pressure control in the management of this condition," the doctors concluded.
In mid-June, a federal judge issued a stinging rebuke to the Trump administration, declaring that its decision to cancel the funding for many grants issued by the National Institutes of Health was illegal, and suggesting that the policy was likely animated by racism. But the detailed reasoning behind his decision wasn't released at the time. The written portion of the decision was finally issued on Wednesday, and it has a number of notable features.
For starters, it's more limited in scope due to a pair of Supreme Court decisions that were issued in the intervening weeks. As a consequence, far fewer grants will see their funding restored. Regardless, the court continues to find that the government's actions were arbitrary and capricious, in part because the government never bothered to define the problems that would get a grant canceled. As a result, officials within the NIH simply canceled lists of grants they received from DOGE without bothering to examine their scientific merit, and then struggled to retroactively describe a policy that justified the actions afterward—a process that led several of them to resign.
The issue before Judge William Young of the District of Massachusetts was whether the government had followed the law in terminating grants funded by the National Institutes of Health. After a short trial, Young issued a verbal ruling that the government hadn't, and that he had concluded that its actions were the product of "racial discrimination and discrimination against America’s LGBTQ. community." But the details of his decisions and the evidence that motivated them had to wait for a written ruling, which is now available.
In the meantime, however, the Supreme Court had shifted the ground on a couple of issues. For example, while Young still feels that policy decisions were motivated by discrimination against the LGBTQ community, the United States v. Skrmetti decision limits what he can do about it. Young writes that the decision "leads this Court to conclude that, while here there is federal government discrimination based on a person’s status, not all discrimination is pejorative."
Separately, Trump v. Casa blocked the use of a national injunction against illegal activity. So, while the government's actions have been determined to be illegal, Young can only protect the people who were parties to this suit. Anyone who lost a grant but wasn't a member of any of the parties involved, or based in any of the states that sued, remains on their own.
Those issues aside, the ruling largely focuses on whether the termination of grants violates the Administrative Procedures Act, which governs how the executive branch handles decision- and rule-making. Specifically, it requires that any decisions of this sort cannot be "arbitrary and capricious." And, Young concludes that the government hasn't cleared that bar.
The grant cancellations, Young concludes, "Arise from the NIH’s newly minted war against undefined concepts of diversity, equity, and inclusion and gender identity, that has expanded to include vaccine hesitancy, COVID, influencing public opinion and climate change." The "undefined" aspect plays a key part in his reasoning. Referring to DEI, he writes, "No one has ever defined it to this Court—and this Court has asked multiple times." It's not defined in Trump's executive order that launched the "newly minted war," and Young found that administrators within the NIH issued multiple documents that attempted to define it, not all of which were consistent with each other, and in some cases seemed to use circular reasoning.
He also noted that the officials who sent these memos had a tendency to resign shortly afterward, writing, "it is not lost on the Court that oftentimes people vote with their feet."
As a result, the NIH staff had no solid guidance for determining whether a given grant violated the new anti-DEI policy, or how that might be weighed against the scientific merit of the grant. So, how were they to identify which grants needed to be terminated? The evidence revealed at trial indicates that they didn't need to make those decisions; DOGE made them for the NIH. In one case, an NIH official approved a list of grants to terminate received from DOGE only two minutes after it showed up in his inbox.
"There is no reasoned decision-making at all with respect to the NIH’s 'abruptness' in the 'robotic rollout' of this grant-termination action," Young concludes. "Based upon a fair preponderance of the evidence and on the sparse administrative record, the Court finds and rules that HHS and, in turn, NIH, are being force-fed unworkable 'policy' supported with sparse pseudo-reasoning, and wholly unsupported statements."
Young also noted that the termination of grants to Columbia University was equally arbitrary. "How the scientific and research activities had any connection with unrest issues on Columbia’s campus is conspicuously never explained," Young noted. "The record evidence certainly reveals none."
Given all that, it's little surprise that the ruling declares the grant terminations to be arbitrary and capricious. "The Public Officials [at the NIH] in their haste to appease the Executive, simply moved too fast and broke things," Young concluded, "including the law." That provides the legal reasoning behind his earlier decision to restore the cancelled grants, although as noted, this has now been limited to only those grants held by researchers who are covered by one of the organizations or governments that filed the suit.
But Young also appears to lament the fact that he had to intervene here, writing:
The American people have enjoyed a historical norm of a largely apolitical scientific research agency supporting research in an elegant, merit-based approach that benefits everyone. That historical norm changed on January 20, 2025. The new Administration began weaponizing what should not be weaponized—the health of all Americans through its abuse of HHS and the NIH systems, creating chaos and promoting an unreasonable and unreasoned agenda of blacklisting certain topics, that on this Administrative Record, has absolutely nothing to do with the promotion of science or research.
So, while the decision restores money to individual research programs, it does nothing to reverse the larger damage caused by the politicization of funding decisions.
There is a growing buzz in the astronomy community about a new object with a hyperbolic trajectory that is moving toward the inner Solar System.
Early on Wednesday, the European Space Agency confirmed that the object, tentatively known as A11pl3Z, did indeed have interstellar origins.
"Astronomers may have just discovered the third interstellar object passing through the Solar System!" the agency's Operations account shared on Bluesky. "ESA’s Planetary Defenders are observing the object, provisionally known as #A11pl3Z, right now using telescopes around the world."
Only recently identified, astronomers have been scrambling to make new observations of the object, which is presently just inside the orbit of Jupiter and will eventually pass inside the orbit of Mars when making its closest approach to the Sun this October. Astronomers are also looking at older data to see if the object showed up in earlier sky surveys.
An engineer at the University of Arizona's Catalina Sky Survey, David Rankin, said recent estimates of the object's eccentricity are about 6. A purely circular orbit has an eccentricity value of 0, and anything above 1 is hyperbolic. Essentially, this is a very, very strong indication that A11pl3Z originated outside of the Solar System.
NASA's Center for Near Earth Object Studies has begun to post preliminary data about the object here. It poses no threat to Earth and, unfortunately, it appears that our planet will be on the opposite side of the Sun when the object makes its closest approach.
This is the third object suspected to be of interstellar origin that has been observed passing through the Solar System. Astronomers expect to find more with new tools designed to identify near-Earth objects. The first of these was ʻOumuamua, discovered in 2017, when it was already moving away from the Sun. It was likely cigar-shaped, and astronomers could only speculate about its nature and age. A couple of years later, astronomers found another object, 2I/Borisov, that was determined to be a rogue comet passing through the Solar System.
Now, with A11pl3Z, the hunt begins anew as astronomers will attempt to glean details about this interstellar interloper.
CBS owner Paramount has reached a $16 million settlement with President Donald Trump over his claim that 60 Minutes deceptively manipulated a pre-election interview with Kamala Harris. Trump's lawsuit has been widely described as frivolous, but Paramount seemed motivated to settle because its pending $8.4 billion merger with Skydance needed regulatory approval from the Trump administration.
In a statement provided to Ars today, Paramount said it "has reached an agreement in principle to resolve the lawsuit filed by President Trump and Representative [Ronny] Jackson in the Northern District of Texas and a threatened defamation action concerning a separate 60 Minutes report."
Senator Elizabeth Warren (D-Mass.) called for a bribery investigation into Paramount. "With Paramount folding to Donald Trump at the same time the company needs his administration's approval for its billion-dollar merger, this could be bribery in plain sight," she said in a statement today. "Paramount has refused to provide answers to a congressional inquiry, so I'm calling for a full investigation into whether or not any anti-bribery laws were broken."
Sens. Warren, Bernie Sanders (I-Vt.), and Ron Wyden (D-Ore.) previously told Paramount Chair Shari Redstone in a letter that settling the lawsuit could violate the federal bribery law making it "illegal to corruptly give anything of value to public officials to influence an official act."
NPR reported that "Trump declared victory in holding 'the Fake News media accountable for their wrongdoing and deceit,' according to a spokesperson for his legal team, who said Paramount and CBS had no choice but to settle. 'President Trump will always ensure that no one gets away with lying to the American People as he continues on his singular mission to Make America Great Again.'"
Paramount told us that the settlement terms were proposed by a mediator and that it will pay $16 million, including plaintiffs' fees and costs. That amount, minus the fees and costs, will be allocated to Trump's future presidential library, Paramount said. Trump's complaint sought at least $20 billion in damages.
Paramount also said that "no amount will be paid directly or indirectly to President Trump or Rep. Jackson personally" and that the settlement will release Paramount from "all claims regarding any CBS reporting through the date of the settlement, including the Texas action and the threatened defamation action."
Warren's statement said the "settlement exposes a glaring need for rules to restrict donations to sitting presidents' libraries," and that she will "introduce new legislation to rein in corruption through presidential library donations. The Trump administration's level of sheer corruption is appalling and Paramount should be ashamed of putting its profits over independent journalism."
Trump previously obtained settlements from ABC, Meta, and X Corp.
Paramount said the settlement "does not include a statement of apology or regret." It "agreed that in the future, 60 Minutes will release transcripts of interviews with eligible US presidential candidates after such interviews have aired, subject to redactions as required for legal or national security concerns."
Trump and Paramount previously told the court that they were in advanced settlement negotiations and are scheduled to file a joint status report on Thursday.
Federal Communications Commission Chairman Brendan Carr has been probing CBS over the Harris interview and holding up Paramount's merger with Skydance. Carr revived a complaint that was previously dismissed by the FCC and which alleges that CBS intentionally distorted the news by airing two different answers given by Harris to the same question about Israeli Prime Minister Benjamin Netanyahu.
CBS released an unedited transcript and camera feeds of the interview that show the two clips simply showed two different sentences from the same answer. But Carr wasn't satisfied with CBS's response and has said he would consider the news distortion complaint in the FCC's review of the Paramount/Skydance merger.
Now that Paramount has settled with Trump, it wouldn't be surprising to see Carr end the news distortion investigation and approve the merger. But Paramount has insisted that the "lawsuit is completely separate from, and unrelated to, the Skydance transaction and the FCC approval process."
In April, 60 Minutes Executive Producer Bill Owens resigned and reportedly told staff in a memo that "over the past months, it has become clear that I would not be allowed to run the show as I have always run it, to make independent decisions based on what was right for 60 Minutes, right for the audience." CBS News CEO Wendy McMahon resigned in May, saying it had "become clear that the company and I do not agree on the path forward."
The Freedom of the Press Foundation told Redstone in May that it plans to file a shareholder derivative lawsuit on behalf of Paramount if the company settles with Trump.
"As you know, the prospect of settling has drawn widespread backlash from CBS News employees as well as outside journalists and First Amendment advocates and led to ridicule from late-night talk show hosts," the group's letter said. "Disinterested experts almost unanimously agree that Trump's lawsuit is frivolous. Everyone from US senators to respected financial writers have noted that a settlement could amount to a bribe to Trump and his administration in exchange for their approving and not impeding the Paramount-Skydance merger."
Paramount itself said in a court filing that the "lawsuit is an affront to the First Amendment and is without basis in law or fact." The company's motion to dismiss Trump's lawsuit is still pending, but the case would be closed once the settlement is approved and finalized.
None of the people being laid off were responsible for the decisions that have led to these layoffs
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