***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Experimental evidence suggests that neutrophils and their metabolites play an important role in the pathogenesis of pyelonephritis . The aim of this study was to investigate the diagnostic value of polymorphonuclear elastase-a(1)-antitrypsin complex ( E-a(1)-Pi ) for the detection of  acute pyelonephritis in children . METHODS Eighty-three patients , 29 boys and 54 girls , 25 days to 14 years of age , with first-time symptomatic urinary tract infection were prospect ively studied . Fifty-seven healthy children served as controls .  Dimercaptosuccinic acid ( DMSA ) scan and voiding cystourethrography were performed in all patients . Plasma and urinary E-a(1)-Pi , C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR ) , neutrophil count , urinary N-acetyl-beta-glucosaminidase ( NAG ) , N-acetyl-beta-glucosaminidase b ( NAG b ) , and creatinine levels were measured in all patients on admission and 3 days after the introduction of antibiotics . The same markers were also measured in the control subjects . RESULTS Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83 children ( group A ) . It was normal in the remaining 53 children ( group B ) . The sex and age distributions were not significantly different between the 2 groups , as well as between the patients and the control subjects ( group C ) . Nineteen of the 53 children with a normal DMSA had body temperature > /=38 degrees C , whereas all but 4 children with abnormal DMSA had temperature > /=38 degrees C. Therefore , the temperature was significantly different between these 2 groups . The sensitivity and specificity of fever ( > /=38 degrees C ) as an indicator of renal involvement based on isotopic findings were 86 % and 64 % , respectively . Given the significant number of the febrile children with normal DMSA scintiscans , group B was subdivided into B(1 ) with 19 febrile children ( 14 boys and 5 girls ) and B(2 ) with 34 children whose body temperature was below 38 degrees C ( 8 boys and 26 girls ) . The sex and age distribution was significantly different between groups B(1 ) and B(2 ) . The mean age of group B(1 ) was.78 years ( range : 28 days to 9 years ; median:.25 years ; st and ard deviation : 2.1 ) . All but 1 child in this group were younger than 1 year of age . In contrast , in group B(2 ) , there were only 4 infants , the remaining 30 children were older than 2.5 years ( mean age : 6 years ; median : 7 years ; st and ard deviation : 3.5 ; range : 34 days to 12 years ) . The mean duration of fever before hospital admission was 2.8 days for group A and 1.8 days for group B(1 ) . This difference was not statistically significant . Similarly , body temperature was not significantly different between these 2 groups . The distribution of plasma E-a(1)-Pi values was normal in the control subjects . The sensitivity and specificity of plasma E-a(1)-Pi , as an indicator of renal involvement , were 96 % and 50 % , respectively , taking the 95th percentile of the reference range as a cutoff value . However , considering as a cutoff value the level of 72 microg/dL ( 95th percentile of group B(2 ) ) , its sensitivity and specificity were 74 % and 86 % , respectively . Plasma E-a(1)-Pi levels were significantly elevated in group A compared with group B and in both groups , the plasma E-a(1)-Pi values were significantly higher than in the control subjects . A significant difference also was noticed between group A and each of the subgroups B(1 ) and B(2 ) and also between the subgroups themselves . Plasma E-a(1)-Pi concentrations correlated significantly with neutrophil count in groups A ( r = .3 ) , B ( r = .4 ) , and B(2 ) ( r = .46 ) , but the correlation was not significant in group B(1 . ) ESR levels showed , among the different groups , similar differences with those of E-a(1)-Pi values . Unlike E-a(1)-Pi , CRP levels were comparable between groups A and B(1 ) , which both consisted of febrile children . Neutrophil count was not significantly different between subgroups B(1 ) and B(2 ) . ( ABSTRACT TRUNCATED Background . During the course of our routine renal ultrasound examinations , we noticed that some children who developed dilatation of a renal pelvis following voiding had reflux found on voiding cystourethrography ( VCUG ) . Purpose . To determine if increase in renal pelvic size on post-void ultrasound is an accurate predictor of vesicoureteral reflux . Material s and methods . Fifty-seven children ( 113 kidneys ) underwent renal ultrasound and VCUG on the same day . Anteroposterior dimensions of the renal pelves were prospect ively measured on ultrasound prior to and following patient voiding and correlated with the results of the VCUG . Results . The diameter of the renal pelvis increased in 12 and decreased in 38 kidneys on post-void ultrasound . Vesicoureteral reflux occurred in 19 kidneys and among these kidneys , renal pelvic diameter increased in 2 , decreased in 7 , and was unchanged in 10 following voiding . There was no significant correlation between post-void change in renal pelvic diameter and the presence of vesicoureteral reflux . Conclusion . Increase in renal pelvic size on post-void ultrasound is not a reliable indicator of vesicoureteral reflux UNLABELLED The results of serial dimercaptosuccinic acid ( DMSA ) imaging over 5 years are reported in 287 children with severe vesico-ureteral reflux entered into the European Branch of the International Reflux Study in Children . The children were r and omly allocated to medical ( n=147 ) or surgical ( n=140 ) management and DMSA studies were performed during the follow up period at least 6 months after any urinary tract infection . Abnormal images were classified into four types : ( 1 ) large polar hypodensity with normal renal outline ; ( 2 ) peripheral photon deficient defect(s ) in a non-deformed kidney ; ( 3 ) small renal image with normal contour ; and ( 4 ) peripheral defect(s ) with result ant irregularity of the renal outline . The DMSA findings were abnormal at entry in 235 ( 82 % ) with no difference in incidence or severity between the two treatment groups . During follow up , deterioration was observed in 25 medically and 23 surgically treated patients and comprised image deterioration alone in 17 , image deterioration with corresponding reduction in differential function in 16 and reduction in relative function without image change in 15 , with similar distribution between the two treatment groups . Deterioration was more frequent in children entering the study under the age of 2 years and in those with grade IV rather than grade III reflux . These findings , showing no difference in outcome between children managed surgically or medically , are consistent with the radiological results already published . CONCLUSION In the International Reflux Study the DMSA scintigraphic data showed no difference in outcome between children managed surgically or medically A prospect i ve blind study comparing the findings of ultrasonography , intravenous pyelography , and voiding cystourethrography was conducted on 81 patients to examine the place of ultrasonography in the initial radiologic evaluation of children with urinary tract infection . The patients ' mean age was 4.8 years ; 15 were male . Forty-eight were in patients ( mean age , 3.2 years ) and 33 were out patients ( mean age 7.2 years ) . In 29 patients ( 35.8 % ) abnormality of the urinary system was detected by one or more of the three imaging procedures ; 21 were in patients and eight were out patients . The most frequent finding was vesicoureteral reflux , occurring in 62.1 % of the pathologic cases . The findings at ultrasonography correlated well with those of intravenous pyelography in 73 of the 81 studies ( 90.1 % ) , but they failed to demonstrate double collecting systems and several of the minor changes . However , ultrasonography in combination with cystourethrography identified all patients who had abnormal urinary systems , except for two children with negligible findings . Moreover , ultrasonography and cystourethrography together identified all 11 patients , nine of them in patients , in whom surgical treatment was indicated . It is concluded that ultrasonography can successfully replace intravenous pyelography as a screening imaging procedure for the urinary system , but because of the superiority of intravenous pyelography in the detection of some types of lesions , intravenous pyelography will be required whenever ultrasonography or cystourethrography results are abnormal . ( ABSTRACT TRUNCATED AT 250 WORDS UNLABELLED Capabilities of color and power Doppler sonography ( DS ) were prospect ively evaluated for diagnosis of acute pyelonephritis and for prediction of scarring by comparison with 99mTc-dimercaptosuccinic acid scintigraphy ( DMSA ) . METHODS Fifty-seven children ( mean age , 5 + /- 3 y ) with acute pyelonephritis were investigated by biologic testing , DS ( DS 1 ) , and DMSA ( DMSA 1 ) .  Patients who were < 6 mo old or had high- grade reflux or obstruction were excluded . Forty-five children had a clinical follow-up examination , biologic testing , DS ( DS 2 ) , and DMSA ( DMSA 2 ) at a mean of 7 + /- 2 mo after acute infection . Sonography ( gray-scale and DS ) was performed by 1 experienced radiologist who was unaware of patient data . DMSA studies were interpreted by 2 physicians who were unaware of patient data . RESULTS Temperature , neutrophil count , and C-reactive protein value were significantly higher in patients with abnormal DMSA 1 findings than in those with abnormal DS 1 findings ( P < 0.05 ) . When compared with DMSA 1 , DS 1 had a sensitivity and specificity of 80 % and 81 % , respectively . At follow-up , all clinical and biologic data had normalized . Scarring after infection occurred in 51 % of children . When compared with DMSA 2 , DS 1 had positive and negative predictive values of 57 % and 75 % , respectively , and DMSA 1 had respective values of 62 % and 100 % . Reflux was not considered a good predictor of scarring . CONCLUSION DS and DMSA results were concordant in 81 % of kidneys with acute pyelonephritis . The predictive value of DS for renal scarring was not considered sufficiently high for DS to be used in routine practice A system for defining renal scarring on ultrasound is proposed and compared with DMSA scintigraphy . Renal scarring was assessed with ultrasound in children following urinary tract infection ( UTI ) using the following criteria : ( 1 ) proximity of sinus echoes to cortical surface ; ( 2 ) loss of pyramids ; ( 3 ) irregularity of outline ; ( 4 ) loss of definition of capsular echo ; and ( 5 ) calyceal dilatation . Three hundred and thirty-nine consecutive ultrasound scans ( US ) and DMSA scintigrams , comprising 648 kidneys , were performed and reported blindly and the results were compared . Using DMSA scintigraphy as the gold st and ard , ultrasound had a positive predictive value of 93 % and a negative predictive value of 95 % . Ultrasound disagreed with DMSA scintigraphy in 5.2 % of kidneys . On review of the cases of disagreement where arbitration was possible by comparison with other imaging , ultrasound was incorrect in 10 kidneys and DMSA was incorrect in 13 . We conclude that the sensitivity in the ultrasound detection of renal scarring can be greatly improved using this method . If no scars were detected at ultrasound an alternative explanation for an abnormal DMSA scintigram should be sought This prospect i ve study was design ed to investigate the most relevant radiological approach for the evaluation of  urinary tract infections ( UTI ) in childhood . In the first 48 hours following the diagnosis of UTI , all patients underwent99mTc dimercaptosuccinic acid ( DMSA ) scanning , ultrasonography ( US ) and intravenous urography ( IVU ) . For the imaging of renal parenchymal infection the sensitivity of IVU and US as compared to DMSA scanning were found to be 9.09 % and 25 % , respectively . It was concluded that99mTc DMSA , where available , should be the first step for the accurate diagnosis and follow-up of patients with UTI Abstract . This prospect i ve study , performed in 101 children with a first symptomatic urinary tract infection ( UTI ) , evaluates the diagnostic value of clinical , biological , and ultrasound parameters in detecting children with acute renal infection documented by dimercaptosuccinic acid ( DMSA ) scintigraphy .  In children with a positive DMSA scan  , mean C-reactive protein ( CRP ) was higher than in children with a normal DMSA scan ( 114±64 vs. 67±38 mg/dl , mean±SD , P=0.0002 ) . The sensitivity and specificity of CRP was 64 % and 68 % , respectively . In children with severe kidney involvement , mean CRP and white 
    Output:
    
Conclusion There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI .