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Vesicoureteric reflux (VUR) diagnosed following investigation of prenatally-detected urinary tract dilatation (UTD), often remains asymptomatic and yet raises much parental and medical anxiety and management conundrums. Previous studies suggest that "prenatal" VUR appears to have a different natural history to that of VUR diagnosed following investigation of recurrent febrile urinary tract infections (UTIs). The concept is not new: reports from Great Ormond Street (1997) and the Society for Fetal Urology registry (1999) highlighted the characteristics of VUR patients diagnosed following investigation of prenatal hydronephrosis, who were noted to be predominantly male with high-grade VUR and established renal uptake defects on DMSA. To date, studies on VUR management and outcome have included both prenatally-diagnosed and symptomatic patients, confounding the results. Studies focussing specifically on the asymptomatic cohort are few, and generally only include patients on prophylaxis. Hence the true natural history of the condition is not known. A systematic review of 18 articles including 829 asymptomatic infants, of whom 473 (69.4 %) were males and 48.7 % had high grade (IV–V) VUR, revealed that 15.4 % of infants developed at least one breakthrough UTI despite initiation of CAP from birth. The limited data available showed no conclusive benefit of CAP, primarily due to lack of a strong comparator cohort. The recent PREDICT trial is the only randomised controlled trial to date, specifically on asymptomatic patients, assigned to prophylaxis or no treatment. Febrile UTI's mostly occurred in the first 6 months, in 21 % of the prophylaxis group vs 35 % of the no treatment group. Although the trial showed a small significant benefit of prophylaxis, this came at the expense of non-E Coli and resistant UTI's in the prophylaxis group. Importantly, there was no difference between the groups in the incidence of new scars at 2-year follow up. The authors concluded that prophylaxis might only be of benefit in girls, for the first year only. This thought-provoking study challenged current practice and led to this narrative review, aimed at a critical appraisal of the literature on this topic. [ABSTRACT FROM AUTHOR]

• Bloodstream infections are quite frequent in COVID-19 patients undergoing vv-ECMO. • Primary and secondary bloodstream infections have peculiar microbiological profiles. • Appropriate treatment of bloodstream infections enables to minimize their impact on clinical outcomes. COVID-19 patients undergoing ECMO are at highly increased risk of nosocomial infections. To study incidence, clinical outcomes and microbiological features of bloodstream infections (BSI) occurring during ECMO in COVID-19 patients. Observational prospective cohort study enrolling consecutive COVID-19 patients undergoing veno-venous-ECMO in an Italian ICU from March 2020 to March 2022. In the study population of 68 patients (age 53 [49-60] years, 82% males), 30 (44%) developed bloodstream infections (BSI group) while 38 did not (N-BSI group) with an incidence of 32 events/1000 days of ECMO. In BSI group pre-ECMO respiratory support was shorter (6 [4–9] vs 9 [5–12] days, p = 0.02) and ECMO treatment was longer (18 [10–29] vs 11 [7–18] days, p = 0.03) than in N-BSI group. The overall ECMO and ICU mortality were 50% and 59%, respectively, without any inter-group difference (p = 1.00). A longer ECMO treatment was independently correlated with higher rate of BSI (p = 0.04, OR [95% CI] 1.06 [1.02–1.11]). Sixteen primary and 14 secondary infectious events were documented. Gram-positive pathogens were more common in primary than secondary BSI (88% vs 43%, p = 0.02) and Enterococcus faecalis (56%) was the most frequent one. Conversely, Gram-negative microorganisms were more often isolated in secondary rather than primary BSI (57% vs 13%, p = 0.02), with Acinetobacter baumannii (21%) and Pseudomonas aeruginosa (21%) as most represented species. The administration of Sars-CoV-2 antiviral drug showed independent correlation with a reduced rate of ICU mortality (p = 0.01, OR [95% CI] 0.22 [0.07–0.73]). Bloodstream infections represented a frequent complication without worsening clinical outcomes in our COVID-19 patients undergoing ECMO. Primary and secondary BSI events showed peculiar microbiological profiles. [ABSTRACT FROM AUTHOR]

In the last decade, the manufacturing domain has been marked by a veritable flood of technological breakthroughs. Collaborative robotics, in particular, has enabled workstations to be shared between humans and their robotic counterparts. The ability of collaborative robots to work side-by-side with humans has opened up new possibilities for task and activity design in manufacturing. However, despite the promising outlook, actual collaboration between humans and cobots in existing applications is very limited, so the potential of the technology is only partially realised. In this paper, a framework is proposed to help practitioners and researchers in implementing human-aware collaborative robotics systems. The framework supported the development of a collaborative screwdriving application in which both the operator and the robot support and perceive each other to optimise process performance and worker well-being. [ABSTRACT FROM AUTHOR]

Chronic Kidney Disease (CKD) is characterized by a progressive and irreversible loss of kidney function which gradually leads to end-stage kidney disease (ESKD). Virtually all the organs are damaged by the toxicity of uremic compounds. The lungs may be affected and the impaired pulmonary function may be the direct result of fluid retention and metabolic, endocrine and cardiovascular alterations, as well as systemic activation of the inflammation. An increased prevalence in sleep disorders (SD) is also reported in patients with CKD, leading to a further negative impact on overall health and quality of life. While these complex relationships are well documented in the adult population, these aspects remain relatively little investigated in children. The aim of this review is to provide a brief overview of the pathophysiology between lung and kidney and to summarize how CKD may affect respiratory function and sleep in children. [ABSTRACT FROM AUTHOR]

Previous studies reported a poor outcome in patients with coronavirus 2019 (COVID-19) undergoing cardiac surgery. Complications most frequently described were respiratory failure, renal failure, and thromboembolic events. In their recent experience, the authors observed a very high incidence of bleeding complications. The purpose of the study was to investigate a possible significant correlation between perioperative COVID-19 infection and hemorrhagic complications compared to non-COVID-19 patients. Single-center, observational, retrospective, matched case-control (1:2) study involving patients who underwent open-heart cardiac surgery from February 2020 and March 2021 with positive perioperative diagnosis of COVID-19 infection, matched with patients without COVID-19 infection. Cardiac surgery unit and intensive care unit of a university tertiary center in a metropolitan area. In the study period, 773 patients underwent cardiac surgery on cardiopulmonary bypass (CPB). Among them, 23 consecutive patients had perioperative diagnosis of COVID-19 infection (study group). These patients were compared with 46 corresponding controls (control group) that matched for age, sex, body mass index, and Society of Thoracic Surgeons score. Open-heart cardiac surgery on CPB. In the study group, 2 patients (9%) died in the intensive care unit from severe respiratory failure, shock, and multiple organ failure. In the study group, patients showed a significantly higher incidence of bleeding complications (48% v 2%, p = 0.0001) and cases of surgical reexploration for bleeding (35% v 2%, p = 0.0001), a higher incidence of severe postoperative thrombocytopenia (39% v 6%, p = 0.0007), and a higher need of blood components transfusions (74% v 30%, p = 0.0006). Chest tubes blood loss and surgical hemostasis time were markedly prolonged (p = 0.02 and p = 0.003, respectively). A worrisome increased risk of early and late bleeding complications in COVID-19 patients was observed, and it should be considered when assessing the operative risk. CPB-related inflammatory reaction could exacerbate the deleterious effect of COVID-19 on the coagulation system and likely deviate it toward a hemorrhagic pattern. [Display omitted] • Coronavirus infection is confirmed to markedly increase the postoperative risk. • A higher rate of hemorrhagic complications and surgical reexplorations for bleeding was observed. • Coronavirus infection should be taken in account as a risk factor for postoperative bleeding. [ABSTRACT FROM AUTHOR]

In the context of the Industry 4.0 approach, applications and solutions supporting monitoring, simulation, optimisation and decision-making in production systems are exponentially growing. These solutions are commonly built on digital twins, i.e., comprehensive, structured and effective digital representations of the production system and its entities, whose current status is constantly updated by the plugged data sources. The arising of the Industry 5.0 paradigm and the established key role of workers in manufacturing require new Digital Twins to represent also humans. In fact, as cognitive automation becomes more and more pervasive and its behaviour unintelligible to humans, it becomes essential for improving performance and well-being, at the same time, to model humans as data-driven agents and to represent their interaction with the factory systems. Currently, a standardised solution for creating Digital Twins is missing, forcing industrial solution architects to resort to ad-hoc implementations and models. These solutions lack re-usability, scalability and extensibility, preventing the introduction of a human digital representation in existent twins, so hindering the complete shift to the new Industry 5.0 paradigm. In this paper, such limitations are faced by introducing an extensible and flexible IIoT-industrial internet of things-based platform with a twofold benefit: on the one hand, to support the creation of customised data representations of production systems and their entities including humans; on the other hand, to provide a modular infrastructure, along with its interchangeable components, for easy digital twin instantiation and ramp-up. An implementation of the platform has been tested with different applications in a laboratory setting and released as a public resource. Finally, potential future applications of the proposed digital twin are discussed, highlighting its main benefits. [ABSTRACT FROM AUTHOR]

Multiple and diverse factory digital twins have been proposed in the literature. However, despite the recognized growing importance of workers in smart and autonomous industrial settings, such models still lack or oversimplify human representation. Human digital twins must include human monitoring and behavioural data and models based on psychophysical status, knowledge, skills, and personal needs to manage production systems that aim, at the same time, to achieve process performance and workers' wellbeing. This paper proposes a metamodel based on data, events, and connectors that supports the modular composition of tailored human digital twins. This work also addresses an industrial application of the metamodel for preliminary validation. [ABSTRACT FROM AUTHOR]

This paper proposes an adaptive human-machine collaboration paradigm based on machine learning. Human-machine collaboration requires more than letting humans and machines interact according to fixed rules. A decision-maker is needed to assess production status and to activate adaptations that improve productivity and workers' well-being. The proposed solution has been tested in an injection moulding manufacturing line. By introducing a physiological monitoring system and a smart decision-maker, relief from fatigue and mental stress is pursued by adjusting the level of support offered through a cobot. Results reported a reduction of operators' physical and mental workload as well as productivity increase. [ABSTRACT FROM AUTHOR]

Biomedical applications need tailor-made scaffolds that exhibit biomimetic mechanical properties. In this context, electrospinning has emerged as a technique with promising features for their production. However, the electrospun scaffolds mechanical behavior as a function of the microstructure and nanofiber properties is still poorly understood. Besides, multiscale constitutive modeling appears as a powerful design tool, not only able to characterize electrospun structures, but also to determine the fiber properties and scaffold microstructure that would achieve the objective response. With focus in this last aspect, we developed a multiscale constitutive model for nanofibrous structures that takes into account the material constitutive properties, scaffold microstructure, and nanofiber progressive recruitment. A statistical approach of the nanofibers tortuosity with a modified Gaussian distribution was adopted, which allowed for reproducing the scaffolds macroscopic nonlinear mechanical behavior. It was observed that such behavior arises even if the nanofibers response is considered as mechanically linear. Experimental data from pressure vs. diameter inflation tests of electrospun tubular scaffolds was used to validate the model. In addition, the influence of the microstructural parameters upon the macroscopic constitutive behavior was studied. Finally, the model parameters were adjusted to obtain a vascular graft able to reproduce the mechanical response of a target natural tissue. The current study presents a step towards understanding, characterizing, and optimizing the mechanical properties of nanofibrous biomaterials. Image 1 [ABSTRACT FROM AUTHOR]

A 29-year-old man presented to Emergency Department with nonspecific symptoms. Through a series of radiological and invasive diagnostic studies we finally reach an unexpected diagnosis of hypersentivity pneumonitis; this is a complex and heterogeneous disease which diagnosis can be challenging as its clinical, radiologic and histopathologic features overlap with those of other interstitial lung diseases (ILDs). Diagnosing an ILD is a dynamic process, and that is the reason why complex cases discussed in a multidisciplinary team may need to be reconsidered in light of evolution of the disease and the results of the performed exams with a flexible approach. [ABSTRACT FROM AUTHOR]

Summary Epidemiological studies show that circulating polyunsaturated fatty acids contribute to preserve renal function. In renal disease states there is generally a lack of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) as measured in biological samples, but despite intense research for more than 30 years, it is still unclear how and to what extent their supplementation would benefit kidney disorders. Studies evaluating the n-6 series and the kidney are less frequent. The last compilation of clinical trials with n-3 LCPUFA supplements focusing on renal function and damage dates back to 2012. We here discuss n-3 and n-6 fatty acids in relation to the kidney summarizing single- and double blind randomized controlled trials performed between 2012 and 2016. Nine were sub-studies/post-hoc analyses of previous parent trials. Twelve out of the twenty trials reported on fatty acid profile or fatty acid species. Factors that may explain inconsistent results obtained after supplementation with the n-3 LCPUFA EPA and DHA in kidney disease are discussed such as baseline levels determining response, drug interaction. The need of evaluating fatty acid status before and after intervention is emphasized, to match changes in outcome measure with changes of any fatty acid potentially involved. Graphical abstract Highlights • Epidemiological studies indicate that n-3 and n-6 polyunsaturated fatty acids (PUFA) contribute to preserve kidney health. • In renal disease states there is generally a lack of n-3 long chain (LC)PUFA. • Fatty acid status in biological samples is frequently unknown in renal disease n-3 LCPUFA intervention trials. • Inconsistent results after n-3 LCPUFA supplementation in kidney disease may be explained by several factors. • Monitoring basal and final fatty acid status in n-3 LCPUFA interventions is essential to match changes in outcome measure. [ABSTRACT FROM AUTHOR]

Hydrogen generation from water using solar energy has grown into a promising approach for sustainable energy production. Over the last years, graphitic carbon nitrides (g-C 3 N 4 , CN), polymers based on the heptazine-group, have been widely applied as photocatalysts for H 2 evolution. The poor charge separation efficiency of CN is considered the major drawback. Here, we investigated the effect of coupling CN with different types of carbon nanotubes on the charge transfer properties and the photocatalytic H 2 evolution. We used carbon nanotubes (CNTs) of different wall number (single (SWCNTs), double (DWCNTs) and multi-walled (MWCNTs) CNTs) for the development of full-organic CN based composite photocatalysts. Photoactivity was drastically affected by the content but more importantly by the nature of the CNTs. The SWCNTs functionalized CN composites were the most active presenting approximately 2–5 times higher H 2 evolution than the corresponding DWCNTs and MWCNTs functionalized CN under both solar and pure visible light irradiation. Photoactivity was primarily controlled by the improved electronic properties linked with the abundance and stability of photogenerated charges as evidenced by electron paramagnetic resonance spectroscopy. Transient absorption spectroscopy verified the transfer of reactive electrons from CN to CNTs. CNTs functioned as electron acceptors improving charge separation. The data suggest that charge transfer is inversely proportional to the wall number of the CNTs and that photoactivity is directly controlled by the size at the nanoscale of the CNTs used. In the CNTs/CN nanocomposites, photogenerated electrons are transferred more efficiently from CN when SWCNTs are used, providing more available electrons for H 2 production. [ABSTRACT FROM AUTHOR]

To these days, the production of a small diameter vascular graft (<6 mm) with an appropriate and permanent response is still challenging. The mismatch in the grafts mechanical properties is one of the principal causes of failure, therefore their complete mechanical characterization is fundamental. In this work the mechanical response of electrospun bilayered small-diameter vascular grafts made of two different bioresorbable synthetic polymers, segmented poly(ester urethane) and poly( L -lactic acid), that mimic the biomechanical characteristics of elastin and collagen is investigated. A J-shaped response when subjected to internal pressure was observed as a cause of the nanofibrous layered structure, and the materials used. Compliance values were in the order of natural coronary arteries and very close to the bypass gold standard-saphenous vein. The suture retention strength and burst pressure values were also in the range of natural vessels. Therefore, the bilayered vascular grafts presented here are very promising for future application as small-diameter vessel replacements. [ABSTRACT FROM AUTHOR]

The intensified use of palladium nanoparticles (PdNPs) in many chemical reactions, jewellery, electronic devices, in car catalytic converters and in biomedical applications lead to a significant increase in palladium exposure. Pd can cause allergic contact dermatitis when in contact with the skin. However, there is still a lack of toxicological data related to nano-structured palladium and information on human cutaneous absorption. In fact, PdNPs, can be absorbed through the skin in higher amounts than bulk Pd because NPs can release more ions. In our study, we evaluated the absorption of PdNPs, with a size of 10.7 ± 2.8 nm, using intact and damaged human skin in Franz cells. 0.60 mg cm −2 of PdNPs were applied on skin surface for 24 h. Pd concentrations in the receiving solutions at the end of experiments were 0.098 ± 0.067 μg cm −2 and 1.06 ± 0.44 μg cm −2 in intact skin and damaged skin, respectively. Pd flux permeation after 24 h was 0.005 ± 0.003 μg cm −2 h −1 and 0.057 ± 0.030 μg cm −2 h −1 and lag time 4.8 ± 1.7 and 4.2 ± 3.6 h, for intact and damaged skin respectively. This study indicates that Pd can penetrate human skin. [ABSTRACT FROM AUTHOR]

• Simple coppicing is the best suited coppice system for a light demanding species such as the chestnut tree. • The growing performance of chestnut coppices is a function of stool and standard densities. • Any standard release is detrimental for the growing performance of the chestnut shoots. • We recommend simple coppicing to produce high quality chestnut wood. In the last decades, releasing standards have become a very common and in some cases even mandatory management options in coppice systems in Europe. As for the chestnut tree, a light demanding and fast-growing species, however, there is a lively debate and a lack of scientific evidences about the pros and cons of releasing standards, especially in stands devoted to quality wood production. In this paper we used nine chestnut coppice stands growing on similar site conditions - but differing in stool density and number of standard trees released - to analyze the effects of the stand structure (i.e., stool and standard density) on the growing performance in terms of diameter increment of the dominant shoots and overall basal area production. Simple coppicing (i.e., no standards release) confirmed to be the most suitable system to enable an initial full growing performance of a light-demanding species such as the chestnut. We thus recommend avoiding the release of standards in quality-wood chestnut coppices in order to allow the new shoots generation to develop undisturbed until the stage of the first thinning. The release of standards in chestnut coppices may however be appropriate in particular cases, such as in stands whose main aim is to protect against shallow landslides along steep slopes. [ABSTRACT FROM AUTHOR]

Abstract: Waste disposal is an issue that is becoming increasingly important in policy terms in the European Union, and in Italy, a country showing strong geographical heterogeneity in waste management. This paper analyses the process of decoupling/delinking between economic growth and landfilling trends in a framework where economic, policy, geographical elements and spatial issues are all considered as drivers behind the phenomenon. We exploit an original and very rich provincial panel dataset over 1999–2005 for the 103 Italian provinces. Evidence shows that the observed ‘absolute’ decoupling between economic growth and landfilling is driven by a mix of structural factors. Among the main factors, population density, more than the provincial income level, emerges as a crucial driver: local opportunity costs and landfill externalities matter in shaping waste policies and local commitment to a transition away from landfilling of waste (landfill diversion). However, not only structural factors are relevant. If on the one hand landfill taxes are not a significant driver of the phenomenon, waste management tools, such as separated collection for recycling, and the tariff system connected to waste services, bring about significant effect on the amount of landfilled waste. Moreover, regarding the analysis of spatial interrelations across provinces, we note that the presence of incinerators in nearby provinces increases landfill diversion, due probably to free riding behaviour or intra-provinces ‘agreements’ on waste management; this is not true for nearby landfill sites, that cause for a given province a strong lock in effect. Future research could strengthen the analysis of policy effectiveness at regional level, focusing on policy endogeneity, and the full investigation of spatial correlations in waste disposal performances. [Copyright &y& Elsevier]

This is a comparative analysis of the variations in styles of cultural life and political activism in the gay community. The central contention is that culture and context affect the construction of a community, which in turn affects the choice of political campaigns to improve the status of community members. Differences in social and political perspectives of gay activists in San Francisco and Honolulu were used as the case examples. Data were gathered via long-term participant observation in both contexts. The major finding is that regional context or locality exerts a powerful influence on the political goals and strategies of gay activists. [ABSTRACT FROM AUTHOR]

Patients with T-cell immunodeficiencies are generally treated with allogeneic hematopoietic stem cell transplantation, but alternatives are needed for patients without matched donors. An innovative intrathymic gene therapy approach that directly targets the thymus might improve outcomes. We sought to determine the efficacy of intrathymic adeno-associated virus (AAV) serotypes to transduce thymocyte subsets and correct the T-cell immunodeficiency in a zeta-associated protein of 70 kDa (ZAP-70)–deficient murine model. AAV serotypes were injected intrathymically into wild-type mice, and gene transfer efficiency was monitored. ZAP-70−/− mice were intrathymically injected with an AAV8 vector harboring the ZAP70 gene. Thymus structure, immunophenotyping, T-cell receptor clonotypes, T-cell function, immune responses to transgenes and autoantibodies, vector copy number, and integration were evaluated. AAV8, AAV9, and AAV10 serotypes all transduced thymocyte subsets after in situ gene transfer, with transduction of up to 5% of cells. Intrathymic injection of an AAV8–ZAP-70 vector into ZAP-70−/− mice resulted in a rapid thymocyte differentiation associated with the development of a thymic medulla. Strikingly, medullary thymic epithelial cells expressing the autoimmune regulator were detected within 10 days of gene transfer, correlating with the presence of functional effector and regulatory T-cell subsets with diverse T-cell receptor clonotypes in the periphery. Although thymocyte reconstitution was transient, gene-corrected peripheral T cells harboring approximately 1 AAV genome per cell persisted for more than 40 weeks, and AAV vector integration was detected. Intrathymic AAV-transduced progenitors promote a rapid restoration of the thymic architecture, with a single wave of thymopoiesis generating long-term peripheral T-cell function. [ABSTRACT FROM AUTHOR]

B Background: b There are many evidences suggesting a major role of epithelial-mesenchymal transition (EMT) in promoting cancer development and aggressiveness. EMT is also implicated in the modulation of proteins linked to stemness and aggressiveness of tumor cells. B Results: b After Ethical Committee approval in 2016, 38 patients affected by PSM of different origins have been enrolled: 19 pseudomyxoma peritoneii (PMP), 12 colorectal carcinoma (CRC), 7 peritoneal malignant mesothelioma (MM). [Extracted from the article]

• A new silicate-based material (SUNSPACE) is proposed to provide air remediation. • SUNSPACE synthesis is also slightly modified to promote its application in building. • SUNSPACE capability in PM trapping is investigated in wet and dry conditions. Air pollution accounts as a critical environmental issue in different populated cities. With the introduction of smart cities concept, suitable measures to reduce people exposition to pollutants must be part of the policies for a suitable urban development. Generally urban policy makers have proposed some restrictions (for example for traffic), that were resulted insufficient. Then probably, different approaches may be considered to face the air pollution problem. This paper proposes a new porous hybrid material (SUNSPACE) based on the use of industrial silicate minerals and alginate materials to promote PM sequestration in urban areas. It was designed to be applied as a coating on all available external cities surfaces. The synthesis conditions were slightly modified, with respect to the original material, to avoid thermal treatment, and make the material directly applicable. SUNSPACE was characterized by using different techniques: nitrogen physisorption, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Results identify the presence of ink-bottle pores shape, suitable to sequestrate nano and micro PM. Moreover, PM reduction in the atmosphere generally occurs as a consequence of wet or dry deposition conditions, monodisperse Fe 3 O 4 nanoparticles and indoor/outdoor exposure were used to investigate the ability of SUNSPACE in ultrafine PM sequestration. [ABSTRACT FROM AUTHOR]

Primary vesicoureteral reflux (VUR) is the most common urological anomaly in children. Voiding cystourethrography (VCUG) is considered the reference standard for the diagnosis of VUR. Even if it is a secure and standardized technique, it is still an invasive method, hence, the effort to find an alternative method to diagnose VUR. The aim of the study is to evaluate the diagnostic accuracy of 99mTC-MAG3 scintigraphy with indirect cystography in detecting VUR and to estimate any interobserver variability in 99mTC-MAG3 scintigraphy interpretation. The authors retrospectively reviewed all the pediatric patients who underwent both a VCUG and a 99mTC-MAG3 renal scintigraphy at the study institution between 2012 and 2016. A total of 86 children (and 168 renal units) were included. MAG3 scan revealed a sensitivity of 54% and a specificity of 90% with positive predictive value of 79% and negative predictive value of 73%. Each MAG3 scintigraphy was then independently and blindly evaluated by a pediatric urologist and two nuclear physicians. After revision, the concordance between VCUG and MAG3 in reflux cases dropped from 54% to 27% (on average), and the reviewers reclassified most examinations as non-conclusive. 99mTC-MAG3 renal scintigraphy with indirect cystography showed low sensitivity in detecting VUR of any grade and cannot, therefore, be proposed as completely alternative to VCUG in the diagnosis of VUR. Moreover, MAG3 scintigraphy interpretation for the diagnosis of VUR has a very high interobserver variability, mostly because of the lack of a correct and complete voiding phase. Patient subgroup (No. of renal units) All (168/168) Time interval < 2 months (82/168) Age > 36 months (40/168) Febrile UTI (33/168) Sensitivity, % (95% CI, %) 54 (46–62) 45 (34–56) 68 (52–82) 72 (60–82) Specificity, % (95% CI, %) 90 (84–94) 89 (79–94) 85 (70–94) 93 (84–98) Positive predictive value (PPV), % (95% CI, %) 79 (72–85) 68 (58–78) 81 (65–91) 93 (83–97) Negative predictive value (NPV), % (95% CI, %) 73 (66–80) 75 (64–83) 75 (58–87) 74 (61–83) Positive likelihood ratio (LR+) 5.3 4 4.8 10.83 Negative likelihood ratio (LR-) 0.51 0.62 0.37 0.3 Accuracy (%) 75 73 78 82 UTI, urinary tract infection; CI, confidence interval. [ABSTRACT FROM AUTHOR]

We evaluated the association between MCP-1, CCR2, RANTES, and CCR5 gene polymorphisms and upper urinary tract infection in 273 children recruited in Northeast Italy. Statistical analysis of RANTES-403 G>A genotype frequencies showed that children carrying the RANTES-403 G allele are at higher risk for urinary tract infection, irrespective of vesicoureteral reflux. [ABSTRACT FROM AUTHOR]

Introduction: Chemokines play a key-role in leukocytes recruitment in the site of inflammation, through the interaction with trans-membrane receptors. Genes that codify these chemokines and their receptors may present polymorphisms, which influence the proteins'' level of expression and/or function. We have recently described an increased susceptibility to the development of acute pyelonephritis in children with interleukin 8 –251A>T polymorphism, presenting the first episode of upper urinary tract infection. Functional polymorphism of RANTES chemokine and its receptor CCR5 have been also identified. Material and Methods: We carried out an association study of RANTES-403G>A and CCR5Δ32 in 273 children with the first episode of upper urinary tract infection (UTI). Control population was represented by 326 blood umbilical cord DNAs coming from the same geographic area. Results: Statistical analysis showed that RANTES-403G>A phenotypic frequencies in the UTI group significantly differed from those of the control population (p=0,007). A significant difference persisted when the genotype AA+GA was compared with the GG one (p=0,002). Furthermore, comparing the frequencies observed in acute dimercaptosuccinic acid scan (DMSA)-positive and DMSA-negative patient with those observed in controls, a significant difference did emerge (p=0,023 and p=0,008 respectively). In addition, RANTES-403G>A polymorphism frequency was significantly different in patients with vesico-ureteric reflux compared with the control population (p=0,020). No difference were observed in the genotype distribution of CCR5Δ32 polymorphism. Conclusions: Our results show that RANTES-403GG genotype is associated with an increased susceptibility to upper urinary tract infection. [Copyright &y& Elsevier]