Background. The aim of this study was to examine the novel renal biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) to assist pediatricians in the assessment of longer duration of inflammation and acute kidney injury (AKI) development during urinary tract infection (UTI). Methods. The patients enrolled in the study comprised 50 children (mean age was 6 months) with UTI. NGAL in serum and urine (sNGAL and uNGAL, resp.) and KIM-1 in urine were measured by enzyme-linked immunosorbent assays. Results. uNGAL levels in subjects with longer duration of inflammation were higher (115.37 ng/mL) than uNGAL levels in subjects with shorter duration of inflammation (67.87 ng/mL, P = 0.022). Difference in sNGAL and KIM-1 levels was not significant (P = 0.155 and P = 0.198, resp.). Significant difference was seen in KIM-1 excretion among groups with and without AKI (P = 0.038). KIM-1 was not able to discriminate between subjects with and without AKI (area under the curves (AUC) = 0.620, P = 0.175). Conclusions. uNGAL cannot be used for screening of the duration of inflammation during UTI. Accuracy of KIM-1 in screening of AKI development in children with UTI is low. We suggest larger studies to check the negative predictive value of KIM-1 for the development of AKI.

IntroductionAcute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) who undergo cardiac surgery. The economic impact of a biomarker-based diagnostic strategy for AKI in pediatric populations undergoing CHD surgery is unknown. The aim of this study was to perform the cost effectiveness analysis of using serum cystatin C (sCysC), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine liver fatty acid-binding protein (uL-FABP) for the diagnosis of AKI in children after cardiac surgery compared with current diagnostic method (monitoring of serum creatinine (sCr) level).Materials and methodsWe developed a decision analytical model to estimate incremental cost-effectiveness of different biomarker-based diagnostic strategies compared to current diagnostic strategy. The Markov model was created to compare the lifetime cost associated with using of sCysC, uNGAL, uL-FABP with monitoring of sCr level for the diagnosis of AKI. The utility measurement included in the analysis was quality-adjusted life years (QALY). The results of the analysis are presented as the incremental cost-effectiveness ratio (ICER).ResultsAnalysed biomarker-based diagnostic strategies for AKI were cost-effective compared to current diagnostic method. However, uNGAL and sCys C strategies yielded higher costs and lower effectiveness compared to uL-FABP strategy. uL-FABP added 1.43 QALY compared to current diagnostic method at an additional cost of $8521.87 per patient. Therefore, ICER for uL-FABP compared to sCr was $5959.35/QALY.ConclusionsOur results suggest that the use of uL-FABP would represent cost effective strategy for early diagnosis of AKI in children after cardiac surgery.

Experimental autoimmuno-oophoritis 375 cific activity. Cooper et al. [ 3 0 ] have described cell surface immunoglobulins in the bursa of Fabricius of chick embryos. Also, the statement that "the establishment of a functional system of cells must proceed well before external foreign antigens arrive, i.e. when only antigens of the host himself are available" is a central tenet of Jerne's theory of immunogenesis [ 3 1 1. Our observation of early immunoglobulin production in the fetal gut reinforces the possibility that intestinal lymphoid tissue is a first-level lymphoid organ [ 141. J.C.P. was supported by a fellowship from the Fondation pour la Recherche Mkdicale Franqise. The secretarial assistance of Mrs. L. Guglielmi is gratefully acknowledged. The authors thank Mrs. J. Riddaway for her editorial work on the manuscript.

Bovine serum albumin (BSA) and human 0 red blood cells (0 RBC) were injected into six thymic lobes or into the vein of 8‐week old normal and neonatally bursectomized New Hampshire chickens in order to study the antibody production. Thymus and spleen cells from donors immunized by the intrathymic or intravenous route with BSA were used in the transfer of antibody response to homologous bursaless nonimmunized recipients. The thymus, spleen and bursa of chickens immunized with 0 RBC were inspected for the presence of plaque‐forming cells. Intrathymic injection of BSA induced a prompt appearance of 2‐mercaptoethanol (ME)‐sensitive anti‐BSA antibodies in a number of chickens, and progressive increase of antibody titer. Bursectomized chickens showed very weak primary antibody response (only antibody of ME‐sensitive type) following intrathymic or intravenous stimulation with BSA. The amount of ME‐sensitive hemagglutinins increased 2 days after intrathymic or intravenous administration of 0 RBC, but there was no immediate rise of hemagglutinin titer in intrathymically injected birds. Intravenous injection of 0 RBC was superior to intrathymic injection in inducing ME‐sensitive and ME‐resist ant he magglutinins. Thymus cells from donors immunized intrathymically with BSA were capable of transferring antibody response to neonatally bursectomized recipients. The most effective were thymus cells from BSA‐injected lobes. Thymus and spleen cells from intravenously immunized chickens exhibited a lower capacity for transferring the production of antibody. On the other hand, thymus and spleen cells from bursaless donors immunized intrathymically with BSA failed completely to induce antibody production in nonimmunized bursectomized recipients. Plaque‐forming cells were found in the thymus, spleen and bursa of chickens immunized intrathymically or intravenously with human erythrocytes. The results were interpreted as further support for the concept that the thymus is actively involved in immune reactions, and that the chicken thymus shares properties of both primary and secondary lymphoid tissues.

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