Moderate direct band-gap energies and high carrier mobilities of Janus XWSiP2 (X = S, Se, Te) monolayers via first-principles investigation.

Two-dimensional (2D) Janus materials with extraordinary properties are promising candidates for utilization in advanced technologies. In this study, new 2D Janus XWSiP2 (X = S, Se, Te) monolayers were constructed and their properties were systematically analyzed by using first-principles calculations. All three structures of SWSiP2, SeWSiP2, and TeWSiP2 exhibit high energetic stability for the experimental fabrication with negative and high Ecoh values, the elastic constants obey the criteria of Born-Huang, and no imaginary frequency exists in the phonon dispersion spectra. The calculated results from the PBE and HSE06 approaches reveal that the XWSiP2 are semiconductors with moderate direct band-gaps varying from 1.01 eV to 1.06 eV using the PBE method, and 1.39 eV to 1.44 eV using the HSE06 method. In addition, the electronic band structures of the three monolayers are significantly affected by the applied strains. Interestingly, the transitions from a direct to indirect semiconductor are observed for different biaxial strains εb. The transport parameters including the carrier mobility values along the x direction µx and y direction µy were also calculated to study the transport properties of the XWSiP2. The results indicate that the XWSiP2 monolayers not only have high carrier mobilities but also anisotropy in the transport directions for both holes and electrons. Together with the moderate and tunable energy gaps, the XWSiP2 materials are found to be potential candidates for application in the photonic, photovoltaic, optoelectronic, and electronic fields.

Activated sludge microbiome with H2O2-modified biochar enhances the treatment resilience and detoxification of oxytetracycline and its toxic byproducts.

The widespread presence of oxytetracycline (OTC) in aquatic ecosystems poses both health risks and ecological concerns. The present study revealed the beneficial role of hydrogen peroxide (H2O2)-pretreated biochar (BC) derived from agricultural hardwood waste in an activated sludge (AS) bioprocess. The BC addition significantly enhanced the removal and detoxification of OTC and its byproducts. BC was initially modified using H2O2 to improve its OTC adsorption. Two AS reactors were then established, one with H2O2-modified BC and one without, and both were exposed to OTC. The BC-added reactor exhibited significantly higher OTC removal rates during both the start-up (0.97 d-1) and steady-state (0.98 d-1) phases than the reactor without BC (0.54 d-1 and 0.83 d-1, respectively). Two novel transformation pathways for OTC were proposed, with four byproducts originating from OTC identified, some of which were found to be more toxic than OTC itself. The BC-added reactor had significantly higher system functioning in terms of its heterotrophic activity and the reduction of the toxicity of OTC and its byproducts, as illustrated by structure-based toxicity simulations, antimicrobial susceptibility experiments, analytical chemistry, and bioinformatics analysis. Bioinformatics revealed two novel bacterial populations closely related to the known OTC-degrader Pandoraea. The ecophysiology and selective enrichment of these populations suggested their role in the enzymatic breakdown and detoxification of OTC (e.g., via demethylation and hydrogenation). Overall, the present study highlighted the beneficial role of H2O2-modified BC in combination with the AS microbiome in terms of enhancing treatment performance and resilience, reducing the toxicological disruption to biodiversity, and detoxifying micropollutants.

Water quality characteristics and reuse potential using adsorption as a post-treatment option for a full-scale hydrocyclone, coagulation, flocculation, and dissolved air flotation system.

This study established a full-scale hybrid water treatment system combining a hydrocyclone, coagulation, flocculation, and dissolved air flotation unit (HCFD) and evaluated its performance in treating anthropogenically impacted lake water. The HCFD system offered the stable and efficient treatment of fluctuating influent loadings, meeting most of the highest water reclamation quality criteria except for that of organic matter. Adsorption was subsequently examined as a post-treatment process for the HCFD effluent, which has not been examined in many previous studies. As the adsorbent for the post-treatment, pine bark, a locally available agricultural waste feedstock, was modified using H2O2 to maximize its adsorption capacity. The surface modification increased its adsorption capacity for organic matter by 53-112%. The HCFD system in conjunction with the synthesized adsorbent thus demonstrated the ability to meet the highest standards for all water quality parameters, highlighting their synergistic potential for enhancement of water treatment. Liquid chromatography-organic carbon detection and Fourier transform infrared analysis were then employed to determine the mechanisms involved in the removal of specific contaminants using the HCFD system and post-adsorption unit. While the HCFD system successfully eliminated particulate and colloidal matter (e.g., phosphorous and biopolymers with a high molecular weight) using centrifugal and floating separation with the aid of two complementary polymers, the post-adsorption unit effectively adsorbed small-sized dissolved substances (e.g., low molecular weight acids and building blocks) via surface functional groups (-CH, -OH, -CH2, C=O, C=C, and C=O) using van der Waals forces, hydrogen bonding, and π-π or n-π interactions.

2021 update on the urinary tract dilation (UTD) classification system: clarifications, review of the literature, and practical suggestions.

In 2014, a multidisciplinary consensus on the classification of pre- and postnatal urinary tract dilation (UTD classification) was developed. Its goal was to provide a standardized system for evaluating and reporting urinary tract dilation both in the prenatal and postnatal periods. In this review, we summarize insights learned from the implementation of the UTD classification system since its inception, providing clarifications on common points of confusion. In addition, we review current literature in the clinical validation of the UTD classification system to provide credence for its use in managing fetuses and children with urinary tract dilation.

Population Pharmacokinetics of Intraperitoneal Bupivacaine Using Manual Bolus Atomization Versus Micropump Nebulization and Morphine Requirements in Young Children.

BACKGROUND: Intraperitoneal (IP) administration of local anesthetics is used in adults and children for postoperative analgesia after laparoscopic surgery. Population pharmacokinetics (PK) of IP bupivacaine has not been determined in children. Objectives of this study were (1) to develop a population PK model to compare IP bupivacaine administered via manual bolus atomization and micropump nebulization and (2) to assess postoperative morphine requirements after intraoperative administration. We hypothesized similar PK profiles and morphine requirements for both delivery methods. METHODS: This was a prospective, sequential, observational study. After institutional review board (IRB) approval and written informed parental consent, 67 children 6 months to 6 years of age undergoing robot-assisted laparoscopic urological surgery received IP bupivacaine at the beginning of surgery. Children received a total dose of 1.25 mg/kg bupivacaine, either diluted in 30-mL normal saline via manual bolus atomization over 30 seconds or undiluted bupivacaine 0.5% via micropump nebulization into carbon dioxide (CO2) insufflation tubing over 10-17.4 minutes. Venous blood samples were obtained at 4 time points between 1 and 120 minutes intraoperatively. Samples were analyzed by liquid chromatography with mass spectrometry. PK parameters were calculated using noncompartmental and compartmental analyses. Nonlinear regression modeling was used to estimate PK parameters (primary outcomes) and Mann-Whitney U test for morphine requirements (secondary outcomes). RESULTS: Patient characteristics between the 2 delivery methods were comparable. No clinical signs of neurotoxicity or cardiotoxicity were observed. The range of peak plasma concentrations was 0.39-2.44 µg/mL for the manual bolus atomization versus 0.25-1.07 µg/mL for the micropump nebulization. IP bupivacaine PK was described by a 1-compartment model for both delivery methods. Bupivacaine administration by micropump nebulization resulted in a significantly lower Highest Plasma Drug Concentration (Cmax) and shorter time to reach Cmax (Tmax) (P < .001) compared to manual bolus atomization. Lower plasma concentrations with less interpatient variability were observed and predicted by the PK model for the micropump nebulization (P < .001). Adjusting for age, weight, and sex as covariates, Cmax and area under the curve (AUC) were significantly lower with micropump nebulization (P < .001). Regardless of the delivery method, morphine requirements were low at all time points. There were no differences in cumulative postoperative intravenous/oral morphine requirements between manual bolus atomization and micropump nebulization (0.14 vs 0.17 mg/kg; P = .85) measured up to 24 hours postoperatively. CONCLUSIONS: IP bupivacaine administration by micropump nebulization demonstrated lower plasma concentrations, less interpatient variability, low risk of toxicity, and similar clinical efficacy compared to manual bolus atomization. This is the first population PK study of IP bupivacaine in children, motivating future randomized controlled trials to determine efficacy.

Classification of pediatric urinary tract dilation: the new language.

The multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system) was created to unify the language used to describe urinary tract dilation on antenatal and postnatal ultrasound examinations and thereby facilitate communication among providers and improve outcomes research. The background and new classification system are described in this review, with imaging examples.

Robotic surgery and anesthesia for pediatric urologic procedures.

PURPOSE OF REVIEW: Minimally invasive approaches to pediatric surgery have become increasingly popular over the last 15 years. With the advent of robotically controlled instruments, common pediatric urologic surgeries such as pyeloplasty and ureteral reimplantation, which were previously technically challenging, are now commonly performed laparoscopically. It is important to recognize the unique physiologic considerations with this approach and how to provide safe and effective anesthesia for these procedures. RECENT FINDINGS: Although there are multiple studies in the surgical literature describing robot-assisted laparoscopic approaches for pediatric urologic surgery, there are few articles that describe the anesthetic considerations for this type of surgery in children. As the first pediatric hospital in the USA to obtain a surgical robot in 2001, a consistent, collaborative approach has been developed to care for infants and children undergoing robot-assisted laparoscopic surgery. SUMMARY: Robot-assisted laparoscopic surgery is increasingly utilized for common pediatric urologic surgeries. To provide safe and effective anesthesia for this type of surgery, it is important to have a thorough understanding of the multiple physiologic derangements that occur with robot-assisted laparoscopic surgery in infants and children, the potential complications that can occur with this approach and have a consistent approach to the anesthetic management and postoperative pain control for these procedures.

Evaluation of a mobile voiding diary for pediatric patients with voiding dysfunction: a prospective comparative study.

PURPOSE: One potential strategy for improving voiding diary completion rates and data quality is use of a mobile electronic format. We evaluated the acceptability and feasibility of mobile voiding diaries for patients with nonneurogenic lower urinary tract dysfunction, and compared mobile and paper voiding diaries. MATERIALS AND METHODS: We prospectively enrolled children presenting with daytime symptoms of lower urinary tract dysfunction between July 2012 and April 2013. We enrolled an initial cohort of patients who were provided a paper voiding diary and a subsequent cohort who were provided a mobile voiding diary. We conducted in person interviews and assessed completion rates and quality, comparing paper and mobile voiding diary groups. RESULTS: We enrolled 45 patients who received a paper voiding diary and 38 who received a mobile voiding diary. Completion rates were 78% for paper voiding diaries and 61% for mobile voiding diaries (p = 0.10). Data quality measures for patients completing paper vs mobile voiding diaries revealed a larger proportion (63% vs 52%) providing a full 5 days of data and a smaller proportion (20% vs 65%) with data gaps. However, the paper voiding diary also demonstrated a lower proportion (80% vs 100%) that was completely legible and a lower proportion (40% vs 65%) with completely prospective data entry. CONCLUSIONS: The use of a mobile voiding diary was acceptable and feasible for our patients with lower urinary tract dysfunction, although completion rates were somewhat lower compared to paper voiding diaries. Data quality was not clearly better for either version. The mobile voiding diary format may offer data quality advantages for select groups but it did not display significant superiority when provided universally.

Surgical outcomes and cultural perceptions in international hypospadias care.

PURPOSE: This study was designed to assess perceptions of untreated hypospadias and quality of life in culturally disparate low or middle income countries, to highlight the demographic and care differences of patient groups treated for hypospadias in the surgical workshop context, and to evaluate the long-term outcomes achieved by these workshop groups. MATERIALS AND METHODS: Family member perceptions of hypospadias, perioperative process measures and urethrocutaneous fistula rates were compared between 60 patients from Vietnam and Senegal treated for hypospadias through training workshops by local surgeons and pediatric urologists from the U.S. between 2009 and 2012, of whom approximately 42% had previously undergone repair attempts. RESULTS: More than 90% of respondents surveyed believed that untreated hypospadias would affect the future of their child at least to some degree. Patient cohorts between the 2 sites differed from each other and published high income country cohorts regarding age, weight for age and frequency of reoperation. Telephone based outcomes assessment achieved an 80% response rate. Urethrocutaneous fistula was reported in 39% and 47% of patients in Vietnam and Senegal, respectively. CONCLUSIONS: Family members perceived that the social consequences of untreated hypospadias would be severe. Relative to patient cohorts reported in practices of high income countries, our patients were older, presented with more severe defects, required more reoperations and were often undernourished. Urethrocutaneous fistula rates were higher in cohorts from low or middle income countries relative to published rates for cohorts from high income countries. Our study suggests that outcomes measurement is a feasible and essential component of ethical international health care delivery and improvement.

Environmental consequences of transformation products from an antibiotic mixture and their mitigation in a wastewater microbiome using an HCl-modified adsorbent.

This study enhanced our understanding of antibiotic mixtures' occurrence, transformation, toxicity, and ecological risks. The role of acid-modified biochar (BC) in treating antibiotic residues was explored, shedding light on how BC influences the fate, mobility, and environmental impact of antibiotics and transformation products (TPs) in an activated sludge (AS) microbiome. A mixture of oxytetracycline and sulfamethoxazole was found to synergistically (or additively) inhibit cell growth of AS and disrupt the microbiome structure, species richness/diversity, and function. The formation of TPs with potentially higher toxicity and persistence than the original compounds was identified, explaining the microbiome disruption. Agricultural waste-derived BC was optimized for contaminant adsorption, leading to a reduction in toxicity when added to AS by sequestering TPs on its surface. This work highlighted adsorbents as a practical engineering strategy for mitigating liquid-phase contaminants' toxicological consequences, proactively controlling the fate and effects of antibiotics and TPs.

Urological complications and vesicoureteral reflux following pediatric kidney transplantation.

PURPOSE: Ureteral complications of renal transplantation can dramatically impact renal outcomes. We studied whether complications are associated with preexisting genitourinary pathology or transplant using a deceased donor allograft. MATERIALS AND METHODS: We retrospectively reviewed all patients undergoing renal transplantation at our institution between 2000 and 2010. We abstracted patient demographic details, donor type (living vs deceased), end-stage renal disease etiology, reimplant technique, stent use, preoperative and postoperative imaging, history of lower genitourinary pathology and postoperative complication management. RESULTS: A total of 211 kidneys were transplanted into 206 patients (mean age 13.7 years, mean followup 4.6 years). Most patients (89%) underwent extravesical ureteroneocystostomy without stenting (97%), with roughly half (47%) of transplants being from living donors. Preexisting urological pathology was present in 34% of cases. Postoperative obstruction or extravasation occurred in 16 cases (7.6%), of which 15 were acute. Complications were not associated with donor type, preexisting urological pathology other than posterior urethral valves, surgical technique, etiology of end-stage renal disease or patient age. However, posterior urethral valves or other preexisting genitourinary pathology was not associated with an increased likelihood of genitourinary complications. Posterior urethral valves were associated with development of postoperative vesicoureteral reflux (OR 6.7, p = 0.004) but were not associated with stent placement, surgical technique, donor type or etiology of end-stage renal disease. CONCLUSIONS: Patients with posterior urethral valves undergoing renal transplantation are at increased risk for postoperative vesicoureteral reflux but not for other acute surgical complications. There is no association between donor type, etiology of end-stage renal disease, surgical technique or patient age and increased complications.

Parent and patient perceptions of robotic vs open urological surgery scars in children.

PURPOSE: Cumulative evidence shows that robot-assisted laparoscopic surgery is safe and at least as efficacious as open surgery for several pediatric urological procedures. Scars resulting from robotic surgery are often assumed to have a cosmetic advantage. However, no study has clearly demonstrated that parents and patients consistently prefer such scars. MATERIALS AND METHODS: We developed 3 distinct surveys consisting of photographs and diagrams of scars resulting from open and robot-assisted laparoscopic surgery for ureteral reimplantation, pyeloplasty and bladder augmentation. Surveys were distributed to parents of patients being evaluated for 1 of the 3 procedures. The surveys evaluated information such as scar preference, reason for preference and demographics. Patients older than 7 years also completed surveys. RESULTS: Robot-assisted laparoscopic surgical scars were preferred by parents for all procedures studied (85% for ureteral reimplant, 63% for pyeloplasty and 93% for bladder augmentation). Patients also preferred the robotic scars (76%, 62% and 91%, respectively). Patients and parents did not differ significantly in scar preference or in rating of factors affecting decision. Scar size was important or very important to 80% of parents for reimplant, 83% for pyeloplasty and 86% for bladder augmentation. However, the majority of parents would ultimately base their choice of surgical approach on clinical efficacy rather than scar preference. CONCLUSIONS: Parents and patients prefer robot-assisted laparoscopic surgical scars to open surgical scars for pediatric ureteral reimplantation, pyeloplasty and bladder augmentation. Scar appearance is an important influence on the decisions of parents and patients, and should be discussed when surgical treatment is presented.

Development and initial validation of a scoring system to diagnose testicular torsion in children.

PURPOSE: Testicular torsion is a surgical emergency requiring prompt intervention. Although clinical diagnosis is recommended, scrotal ultrasound is frequently ordered, delaying treatment. We created a scoring system to diagnose testicular torsion, decreasing the indication for ultrasound. MATERIALS AND METHODS: We prospectively evaluated 338 patients with acute scrotum, of whom 51 had testicular torsion. Physical examination was performed by a urologist, and all patients underwent scrotal ultrasound. Univariate analysis and logistic regression were performed, and a scoring system for risk stratification of torsion was created. Retrospective validation was performed with 2 independent data sets. RESULTS: The scoring system consisted of testicular swelling (2 points), hard testicle (2), absent cremasteric reflex (1), nausea/vomiting (1) and high riding testis (1). Cutoffs for low and high risk were 2 and 5 points, respectively. Ultrasound would be indicated only for the intermediate risk group. In the prospective data set 69% of patients had low, 19% intermediate and 11.5% high risk. Negative and positive predictive values were 100% for cutoffs of 2 and 5, respectively (specificity 81%, sensitivity 76%). Retrospective validation in 1 data set showed 66% of patients at low, 16% intermediate and 17% high risk. Negative and positive predictive values for cutoffs of 2 and 5 were 100% (specificity 97%, sensitivity 54%). The second retrospective data set included only torsion cases, none of which was misdiagnosed by the scoring system. CONCLUSIONS: This scoring system can potentially diagnose or rule out testicular torsion in 80% of cases, with high positive and negative predictive values for selected cutoffs. Ultrasound orders would be decreased to 20% of acute scrotum cases. Prospective validation of this scoring system is necessary.

Nomogram and scoring system for predicting stone-free status after extracorporeal shock wave lithotripsy in children with urolithiasis.

OBJECTIVE: To determine the stone-free rate after extracorporeal shock wave lithotripsy (ESWL) and its associated factors to formulate a nomogram table and scoring system to predict the probability of stone-free status in children. PATIENTS AND METHODS: A total of 412 children (427 renal units [RUs]) with urolithiasis were treated with ESWL using a lithotriptor between 1992 and 2008. Cox proportional hazards regression was used to model the number of treatment sessions to stone-free status as a function of statistically significant demographic characteristics, stones and treatment variables. A bootstrap method was used to evaluate the model's performance. Based on the multivariate model, the probabilities of being stone-free after each treatment session (1, 2 and >3) were then determined. A scoring system was created from the final multivariate proportional hazard model to evaluate each patient and predict their stone-free probabilities. RESULTS: Complete data were available for 395 RUs in 381 patients. Of the 395 RUs, 303 (76.7%) were considered to be stone-free after ESWL. Multivariate analysis showed that previous history of ipsilateral stone treatment is related to stone-free status (hazard ratio [HR]: 1.49; P = 0.03). Stone location was a significant variable for stone-free status, but only in girls. Age (HR 1.65, P = 0.02) and stone burden (HR 4.45, P = 0.002) were significant factors in the multivariate model. CONCLUSION: We believe that the scoring system, and nomogram table generated, will be useful for clinicians in counselling the parents of children with urolithiasis and in recommending treatment.

Current controversies in pediatric urologic robotic surgery.

PURPOSE OF REVIEW: Minimally invasive surgeries such as conventional laparoscopic surgery and robotic assisted laparoscopic surgery (RALS) have significant advantages over the traditional open surgical approach including lower pain medication requirements and decreased length of hospitalization. However, open surgery has demonstrated better success rates and shorter surgery time when compared to the other modalities. Currently, it is unclear which approach has better long-term clinical outcomes, greater benefits and less cost. RECENT FINDINGS: There are limited studies in the literature comparing these three different surgical approaches. In this review, we will evaluate the advantages and disadvantages of RALS compared to conventional laparoscopic surgery and open surgery for commonly performed pediatric urological procedures such as pyeloplasty, ureteral reimplantation, complete and partial nephrectomy, bladder augmentation and creation of continent catheterizable channels. SUMMARY: Although it is not yet possible to demonstrate the superiority of one single surgical modality over another, RALS has been shown to be feasible, well tolerated and advantageous in reconstructive urological procedures. With experience, the outcomes of RALS are improving, justifying its usage. However, cost remains a significant issue, limiting the accessibility of RALS, which in the future may improve with market competition and device innovation.

Current management of antenatal hydronephrosis.

The strategy for the management of children with urinary tract anomalies has changed considerably as a result of the development of ultrasound equipment and techniques that allow for detailed fetal evaluation. Hydronephrosis is the most common urogenital anomaly detected, suggesting that an obstructive process may be potentially present. The goal of postnatal management is to identify and treat those patients whose renal function is at risk, while leaving alone the high percentage of patients who are at no risk of renal damage. This management involves a spectrum of radiological, medical, and surgical interventions for diagnosis, surveillance, and treatment. In this article, we review our current understanding of the natural history of antenatal hydronephrosis and its management.

Relationship of Recurrence Rate with some Characteristics in Patients with Thyroid Carcinoma.

Background: Determining the clinical and subclinical characteristics related to the recurrence status in patients with a thyroid carcinoma has great significance for prognosis, prediction of recurrence and monitoring of treatment outcomes. This study aimed to determine the association between recurrence rate and some characteristics in patients with thyroid carcinoma. Patients and Methods: The study was conducted by descriptive method with longitudinal follow-up on 102 thyroid carcinoma patients at 103 Military Hospital, Hanoi, Vietnam, from July 2013 to December 2016. Results: Univariate analysis showed that there was a relationship between the recurrence characteristics in the studied patients and the characteristics of lymph node metastasis (P = 0.026; OR = 15; 95% CI = 1.4-163.2) and BRAF V600E mutation status (P = 0.01; OR = 3.41; 95% CI = 1.31-8.88). When analysing the multivariable Logistic regression model, there was a positive correlation between the occurrence of BRAF V600E gene mutation (P = 0.032; OR = 17.649; 95% CI = 1.290-241.523) and male sex (P = 0.036; OR = 12.788; 95% CI = 1.185-137.961) and the occurrence of recurrence in study patients. The mean time to relapse was earlier in male patients than in female patients (P = 0.02). The mean time to relapse in patients with the BRAF V600E mutation (31.81 ± 1.14 months) was shorter than the mean time to relapse in the group without the mutation (57.82 ± 2.08 months) (P = 0.01). The group of patients with mutations in the BRAF V600E gene increased the risk of recurrence compared with the group without the mutation (HR = 9.14, P = 0.04). Conclusion: There is a positive correlation between recurrence and masculinity, lymph node metastasis and the occurrence of BRAF V600E mutations in thyroid carcinoma patients.

Update of PAX2 mutations in renal coloboma syndrome and establishment of a locus-specific database.

Renal coloboma syndrome, also known as papillorenal syndrome is an autosomal-dominant disorder characterized by ocular and renal malformations. Mutations in the paired-box gene, PAX2, have been identified in approximately half of individuals with classic findings of renal hypoplasia/dysplasia and abnormalities of the optic nerve. Prior to 2011, there was no actively maintained locus-specific database (LSDB) cataloguing the extent of genetic variation in the PAX2 gene and phenotypic variation in individuals with renal coloboma syndrome. Review of published cases and the collective diagnostic experience of three laboratories in the United States, France, and New Zealand identified 55 unique mutations in 173 individuals from 86 families. The three clinical laboratories participating in this collaboration contributed 28 novel variations in 68 individuals in 33 families, which represent a 50% increase in the number of variations, patients, and families published in the medical literature. An LSDB was created using the Leiden Open Variation Database platform: www.lovd.nl/PAX2. The most common findings reported in this series were abnormal renal structure or function (92% of individuals), ophthalmological abnormalities (77% of individuals), and hearing loss (7% of individuals). Additional clinical findings and genetic counseling implications are discussed.

Protective locus against renal scarring on chromosome 11 in affected sib pairs with familial vesicoureteral reflux identified by single nucleotide polymorphism linkage analysis.

PURPOSE: We identified the loci associated with renal scarring risk and protection in affected sib pairs with familial vesicoureteral reflux. MATERIALS AND METHODS: A genome-wide analysis of vesicoureteral reflux with high density single nucleotide polymorphisms was conducted in 43 families with 2 or more affected children. A total of 43 probands and 58 affected siblings were included in the analysis. Genomic DNA was extracted from blood or saliva from all patients. All nuclear families had complete parental genotypes and all were Caucasian. Renal scarring was present in 23 of the 43 probands as detected by dimercapto-succinic acid imaging. easyLINKAGE software was used for the genome-wide linkage analysis. A LOD (logarithm [base 10] of odds) score of 3.3 or greater was considered significant evidence of linkage and a LOD score of 2.4 or greater but less than 3.3 was considered suggestive evidence of linkage. RESULTS: Using the affected sib pair method of analysis, a statistically significant linkage peak with a multipoint LOD score of 3.66 for patients without renal scarring was identified on chromosome 11 at 47.97 cM. For the scarring group a peak with a multipoint LOD score of 2.69 was identified on chromosome 17, which provides suggestive evidence of linkage. CONCLUSIONS: Our results suggest that a locus on chromosome 11 is associated with protection against renal scarring in patients with vesicoureteral reflux. In addition, a new locus on chromosome 17 may be linked to renal scarring. Our results suggest that multiple genes contribute to the formation of the vesicoureteral reflux phenotype, with patients having a unique susceptibility to renal injury/damage.