Relationship Between Vesicoureteral Reflux and Renal Scarring in Children with Urinary Tract Infection

Objective: To evaluate the association of vesicoureteral reflux (VUR) in comparison with the development of renal scarring in child patients with urinary tract infection (UTI). Methods: This study involved a retrospective review. Patients under 14 years old with a diagnosis of UTI with a positive urine culture and who had a voiding cystourethrogram (VCUG) and technetium 99 m dimercaptosuccinic acid (Tc-99m_DMSA) renal scintigraphy performed within 4-6 months after acute UTI were included in the study. The VCUG results were classified as positive or negative for vesicoureteral reflux (VUR). If reflux was present, the severity was graded according to the recommendation of the International Reflux Study in children.1 The Tc-99m DMSA results were interpreted as positive or negative for renal scarring. Statistical analysis was performed using the χ2 test or Fisher’s exact test and Mann–Whitney test to compare the presence of VUR and renal scarring as well as the grading of the VUR and renal scarring. Positive and negative likelihood ratios (LR) were calculated. Results: In total, 185 patients (74 girls and 111 boys; mean age, 3.5 years old) were included in the study. There were five children with only a single kidney, resulting in 365 kidneys for analysis. Vesicoureteral reflux was found in 203 (55.6%) kidneys, classified as grades 1, 2, 3, 4, and 5 in 19, 31, 81, 38, and 34 kidneys, respectively. Scarring was found in 110 of 203 kidneys (54.2%) with VUR and in 18 of 162 kidneys (11.1%) without VUR (p < 0.0001). The LR positive was 2.2 (95%CI, 1.9–2.5) and LR negative was 0.23 (95% CI, 0.1-0.4). Conclusion: There was a significant correlation between positive VUR and the development of renal scarring.  Patients with positive VUR should be considered for a Tc99m-DMSA scan to evaluate them for the development of renal scarring

Post-CEO retirement appointments and financial accounting—Evidence from CEO turnovers

Prior research has shown that when boards seek to appoint CEOs as outside directors, the director labor market rewards CEOs’ accounting performance. This study examines whether the external labor market’s assessment of the accounting performance is moderated by CEOs’ past exercise of financial reporting discretion in the form of accruals and real earnings management and financial statement readability. Our results show a positive association between post-CEO board opportunities and within-GAAP accruals management as well as to more readable financial statements. Earnings restatements are associated with fewer board positions and director pay. However, the director labor market appears to punish R&D expenditure above the industry median, suggesting that boards view overinvestment as a risky avenue for growth. Finally, the results suggest that for CEOs with planned retirement, the director labor market provides some mitigating effect on the horizon problem.The Social Sciences and Humanities Research Council (SSHRC

Wheat oral immunotherapy was moderately successful but was associated with very frequent adverse events in children aged 6-18 years

Aim: This study investigated oral immunotherapy (OIT) for children aged 6-18 years with wheat allergies. Methods: Well-cooked wheat spaghetti was given to 100 children with wheat allergies every day for 17 weeks, increasing from 0.3 to 2000 mg of wheat protein, followed by three- and nine-month maintenance phases. Blood samples were taken before therapy and at follow-up visits. The study was carried out in 2009-2015 in four Finnish paediatric allergology units. Results: The children (67% male) had a mean age of 11.6 years (range 6.1-18.6), and 57 were using wheat daily 16 months after the initiation of therapy. Allergic symptoms occurred in 94/100 children: mild in 34, moderate in 36 and severe in 24. Specific immunoglobulin E (IgE) for omega-5-gliadin was significantly higher in patients who did not reach the target dose and were related to the intensity of reactions. Conclusion: The majority (57%) of children with wheat allergies could use wheat in their daily diet 16 months after the initiation of OIT, but 94/100 had adverse reactions and 60 were moderate or severe. Specific IgE to omega-5-gliadin may provide a biomarker for how much wheat can be tolerated and the intensity of the reactions to immunotherapy.Peer reviewe

Allergy education and training for physicians.

The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of "allergy" as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence  to manage  mild disease and recognize when referral is required. The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly. In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and post-graduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care. We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergy-related competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide

. DS-70, a novel and potent \uf0614 integrin antagonist, is an effective treatment for experimental allergic conjunctivitis in guinea pigs

BACKGROUND AND PURPOSE Allergic conjunctivitis is an eye inflammation that involves the infiltration of immune cells into the conjunctiva via cell surfaceadhesion receptors, such as integrin \u3b14\u3b21. These receptors interact with adhesion molecules expressed on the conjunctival endothelium and may be a target to treat this disease. We synthesized DS-70, a novel \u3b1/\u3b2-peptidomimetic \u3b14 integrin antagonist, to prevent the conjunctival infiltration of immune cells and clinical symptoms in a model of allergic conjunctivitis. EXPERIMENTAL APPROACH In vitro, DS-70 was pharmacologically characterized using a scintillation proximity procedure to measure its affinity for \u3b14\u3b21 integrin, and its effect on cell adhesion mediated by different integrins was also evaluated. The effects of DS-70 on vascular cell adhesion molecule-1 (VCAM-1)-mediated degranulation of a human mast cell line and an eosinophilic cell line, which both express \u3b14\u3b21, and on VCAM-1-mediated phosphorylation of ERK 1/2 in Jurkat E6.1 cells were investigated. Effects of DS-70 administered in the conjunctival fornix of ovalbumin-sensitized guinea pigs were evaluated. KEY RESULTS DS-70 bound to integrin \u3b14\u3b21 with nanomolar affinity, prevented the adhesion of \u3b14 integrin-expressing cells, antagonized VCAM-1- mediated degranulation of mast cells and eosinophils and ERK 1/2 phosphorylation. Only 20% was degraded after an 8 h incubation with serum. DS-70 dose-dependently reduced the clinical symptoms of allergic conjunctivitis, conjunctival \u3b14 integrin expression and conjunctival levels of chemokines and cytokines in ovalbumin-sensitized guinea pigs. CONCLUSIONS AND IMPLICATIONS These findings highlight the role of \u3b14 integrin in allergic conjunctivitis and suggest that DS-70 is a potential treatment for this condition

Immunotherapy for IgE-mediated wheat allergy

Among various routes of immunotherapy for food allergy, oral immunotherapy (OIT) appears to have a promising result due to its ability to modify abnormal immunologic mechanism of IgE-mediated food allergy. Other methods for immunomodulation such as sublingual (SLIT) or epicutaneous (EPIT) immunotherapy which carry lower rates of systemic reactions, may have less efficacy. Wheat has recently been recognized as a more common cause of food-induced anaphylaxis than previously recognized, especially among young children, around the world. In wheat allergic patients, avoidance recommended as standard recommendation is not easy to follow, because wheat has been used as a common constituents in various kinds of consumed foods in every day's life. Therefore, wheat OIT may be considered as an alternative treatments of those in which wheat avoidance is not sufficient to avert frequent events of anaphylaxis resulting from inadvertent exposure to small amount of wheat among this population. Currently, only few clinical trials about wheat OIT are available. In this review, we discuss available protocols of wheat OIT, initial starting dose, maintenance dose, and the strategies to minimize the side effects during the treatment

Managerial replacement strategies and severance pay

This paper demonstrates the benefits to shareholders of offering severance packages to managers. We show that severance pay is not merely a way to coax underperforming managers to step aside. Rather, a manager's efforts can pave the way for the manager's successor, and thereby attract more talented potential replacements. We consider two settings that differ on whether or not the shareholder can fully commit to a replacement strategy. In both settings the shareholder makes replacement decisions based on output and the availability of a suitable replacement candidate at the end of the first period. When the shareholder can fully commit to the circumstances of replacement, severance pay serves solely to improve contract efficiency, because the probability of the replacement candidate emerging is influenced by the incumbent manager's effort. In the setting without full commitment, severance pay not only improves contract efficiency but also allows the shareholder to expand the set of credible output–contingent replacement strategies. Generally, severance pay motivates managers to build value in the firm despite the possibility that in doing so, they make their own services obsolete

Current perspectives in the management of common pediatric food allergies

Asian Pacific Journal of Allergy and Immunology304 SUPPLS13-S16APJI