Born with a solitary kidney : at risk of hypertension

Background: Subjects with a congenital solitary kidney (CSK) are believed to be at risk of hypertension due to their low number of nephrons. However, as CSK is a congenital abnormality of the kidney or urinary tract (CAKUT), subtle dysplastic changes contributing to hypertension cannot be excluded. Methods: We retrospectively compared office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) between two groups of children with CAKUT, aged 6\u201318 years: Group A with a CSK and Group B with two kidneys. All had normal renal parenchyma on scintigraphy and normal renal function. OBP and mean systolic and diastolic 24-h, daytime and nighttime ambulatory BP records were analyzed. The distribution of OBP and APBM as continuous values and the prevalence of hypertension (ambulatory/severe ambulatory or masked hypertension) in the two groups were compared. Results: There were 81 patients in Group A and 45 in Group B. Median OBP standard deviation scores were normal in both groups, without significant differences. Median ABPM standard deviation scores, although normal, were significantly higher in Group A and the prevalence of hypertension was higher (ambulatory/severe ambulatory or masked) (33.3 vs. 13.3%, p = 0.019), mainly because of the greater occurrence of masked hypertension. Conclusions: Our data show that a CSK per se can be associated with an increased risk of hypertension from the pediatric age. Therefore, ABPM, which has proved valuable in the screening of hypertension, is warranted in children with a CSK, even if laboratory and imaging assessment is otherwise normal

Clinical Outcome of Discordant Empirical Therapy and Risk Factors Associated to Treatment Failure in Children Hospitalized for Urinary Tract Infections

With the spread of antibiotic resistance in pediatric urinary tract infections (UTIs), more patients are likely to be started empirically on antibiotics to which pathogens are later found to be resistant (discordant therapy). However, in-vivo effectiveness may be different from in-vitro susceptibility. Aims of this study were to describe clinical outcomes of discordant empirical treatments in pediatric UTIs and to investigate risk factors associated to treatment failure. This observational, retrospective study was conducted on children hospitalized for febrile UTIs with positive urine culture and started on discordant empirical therapy. Failure rates of discordant treatments and associated risk factors were investigated. A total of 142/1600 (8.9%) patients were treated with inadequate empirical antibiotics. Clinical failure was observed in 67/142 (47.2%) patients, with no fatal events. Higher failure rates were observed for combinations of penicillin and beta-lactamase inhibitors (57.1%). Significant risk factors for failure of discordant treatment were history of recurrent UTIs (95% CI: 1.13–9.98, OR: 3.23, p < 0.05), recent use of antibiotics (95% CI: 1.46–21.82, OR: 5.02, p < 0.01), infections caused by Pseudomonas aeruginosa (95% CI: 1.85–62.10, OR: 7.30, p < 0.05), and empirical treatment with combinations of penicillin and beta-lactamase inhibitors (95% CI: 0.94–4.03, OR: 1.94, p = 0.05). This study showed that discordant empirical treatments may still be effective in more than half of pediatric UTIs. Clinical effectiveness varies between different discordant antibiotics in pediatric UTIs, and patients presenting risk factors for treatment failure may need a differentiated empirical approach

Retrospective 8-year study on the antibiotic resistance of uropathogens in children hospitalised for urinary tract infection in the emilia-romagna region, italy

The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospital-ised for UTI between January 1st, 2012, and June 30th, 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to anti-microbial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and ration-alise antibiotic consumption must be implemented

Optimal Insertion of Viscous Dampers into Shear Type Structures: Seismic Performances and Applicability of the MPD System

This paper provides illustrative examples regarding (a) the seismic performances offered by the MPD systems when applied to shear-type structures and (b) the implementation of MPD systems in actual building structures. As illustrated in a companion paper and in previous research works by the authors, the MPD system is an innovative system of added viscous dampers which is based upon the mass proportional damping component of Rayleigh viscous damping matrices and is characterized by a high dissipative efficiency. The seismic performances of two shear-type structures equipped with several systems of added viscous dampers (including, in addition to the MPD system, other optimal damping systems identified using genetic algorithms and inverse problem approach) are compared through numerical time-history simulations. The results, here obtained with reference to 40 historically recorded earthquake ground motions, confirm that systems characterized by dampers placed so that they connect each storey to a fixed point (as it is for the MPD system) display larger efficiency in energy dissipation than systems characterized by interstorey damper placement (traditional placement). The results also indicate that the forces exerted through the dampers of the MPD system and of the other damping systems considered are comparable in size. Two ways of implementing MPD systems in actual building structures are also presented: direct implementation (dampers connect each storey to the ground) and indirect implementation (dampers connect each storey of the base structure to a support structure: stiff vertical element, e.g. the conventional concrete core of the stairs/elevator typically found in r.c. constructions). Numerical results indicate that (provided that the support structure is characterized by a relatively large lateral stiffness) direct and indirect implementations lead to similar damping effect on the base structure without increasing the dynamic actions upon the support structure. Illustrative examples for the technical feasibility of both direct and indirect implementations are also provided

Inserting the mass proportional damping (MPD) system in a concrete shear-type structure

This paper presents an illustrative example of the advantages offered by inserting added viscous dampers into shear-type structures in accordance with a special scheme based upon the mass proportional damping (MPD) component of the Rayleigh viscous damping matrix. In previous works developed by the authors, it has been widely shown that, within the class of Rayleigh damped systems and under the "equal total cost" constraint, the MPD system provides best overall performance both in terms of minimising top-storey mean square response to a white noise stochastic input and maximising the weighted average of modal damping ratios. A numerical verification of the advantages offered by the application of MPD systems to a realistic structure is presented herein with reference to a 4-storey reinforced-concrete frame. The dynamic response of the frame subjected to both stochastic inputs and several recorded earthquake ground motions is here analysed in detail. The results confirm the good dissipative properties of MPD systems and indicate that this is achieved at the expense of relatively small damping forces

Прогноз развития рынка в России. Стратегический аспект

Abstract: В данной работе разработан новый подход к прогнозированию. В отличие от известных методологий: экспертных оценок, факторных моделей, целевых сценариев, - используется методология, которую условно можно назвать информационно-структурной. Речь идет о том, что переход к рынку в воспроизводственном плане строится на формировании ступеней взаимодействия между макро- и микроструктурами. На каждой такой ступени раскрываются новые горизонты развития и адекватные им ступени прогнозирования. И уже на этой базе возможно рассчитывать прогнозные сценарии и анализировать в этой связи разные программы реформ. Делается вывод о наиболее реалистичной 14-летней программе рыночной трансформации. К основному докладу приданы два приложения. В первом рассматриваются воспроизводственные проблемы рыночной трансформации, начиная с определения воспроизводственных предпосылок реформирования экономики. Второе приложение носит постановочный характер о взаимодействии цикличности экономического роста и сбалансированности денежных потоков

Seismic design of pre-cast reinforced concrete structures using additional viscous dampers

Pre-cast concrete structures are commonly assembled at construction site so that structural systems obtained are not capable of transmitting bending moments at joints. Such structural systems show a relatively large flexibility with respect to lateral seismic loads. This characteristic often hampers the satisfaction of the interstorey drift limitations imposed by most of the seismic codes. In this paper, the use of added viscous dampers is compared with the use of traditional lateral-resisting bracing systems in order to provide such structures with the necessary lateral stiffness and resistance. The comparison is here developed with reference to the executive design of a shopping mall building in Rimini (Italy). The results obtained indicate that the use of viscous dampers may provide substantial advantages in the seismic design of such structures

L\u2019inserimento di smorzatori in strutture in c.a. per la mitigazione dell\u2019azione sismica: un esempio applicativo

Strutture prefabbricate caratterizzate da nodi senza trasmissione di momento presentano un comportamento sismico che pu\uf2 rendere difficoltoso il soddisfacimento dei requisiti prestazionali imposti dalla normativa sia in termini di resistenze che di deformabilit\ue0. In questa memoria vengono presentati, attraverso l\u2019illustrazione di un esempio applicativo relativo alla progettazione esecutiva di un centro commerciale di due piani con struttura in c.c.a., i vantaggi offerti dall\u2019inserimento in tali strutture di smorzatori viscosi aggiuntivi rispetto all\u2019utilizzo di sistemi di controventamento di tipo tradizionale (croce di S.Andrea). Gli smorzatori sono introdotti nella struttura secondo uno schema (sistema proporzionale alle masse, MPD) identificato dagli autori come ottimale in ricerche precedenti

Practical seismic design of structures equipped with viscous dampers: procedure and application

Viscous dampers have widely proved their effectiveness in mitigating the effects of the seismic action upon building structures. In view of the large impact that use of such dissipative devices is already having and would most likely have soon in earthquake engineering applications, this paper presents a practical procedure for the seismic design of structures equipped with viscous dampers. The four-step procedure is evolved from the today\u2019s knowledge of manufactured viscous dampers and aims at guiding the professional engineer from the choice of an appropriate target damping ratio to the final design technical specifications of non-linear commercially available viscous dampers. A numerical application of the procedure is then provided with reference to a two-storey precast reinforced-concrete shopping mall building. Noticing that precast concrete structures (commonly assembled at construction site) are not capable of transmitting bending moments at joints and show a relatively large flexibility with respect to lateral seismic loads, the use of added viscous dampers turns out to be strongly recommended (with respect to traditional lateral-resisting bracing systems) to keep, at the same time, inter-storey drifts within the limitations imposed by seismic codes, and actions in the dissipative braces, in the structural elements and at foundation level within acceptable levels