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Italian Abstract: Dall’inizio della sua presidenza, Xi Jinping ha progressivamente riorientato la politica estera al fine di meglio proteggere gli interessi cinesi nel mondo. A questo fine, Pechino ha significativamente aumentato la propria esposizione internazionale su vari fronti, alternando spesso approcci assertivi con altri piu cooperativi, ai quali si associa la proposta di un “modello alternativo” di cooperazione economica mondiale. La proiezione esterna dell’economia cinese ha continuato a crescere e a diversificarsi, come si desume dall’andamento della quota delle esportazioni, dalla loro composizione (oggi caratterizzate da maggiore valore aggiunto che in passato), dall’ammontare di investimenti esteri e di linee di credito internazionali accordate da istituti finanziari cinesi. Questa evoluzione si confronta con l’incompiutezza della trasformazione della Cina in economia di mercato, evidente nel perdurante ruolo dello Stato nell’indirizzare le decisioni economiche (anche attraverso la leva delle imprese e delle banche di proprieta pubblica), fonte di crescenti tensioni con i maggiori partner commerciali. English Abstract: [Since the beginning of his presidency, Xi Jinping has progressively redirected foreign policy in order to better protect Chinese interests around the world. To this end, Beijing has significantly increased its international exposure on various fronts, often combining assertive approaches with more cooperative ones, among them the proposal of an "alternative model" of world economic cooperation. The external projection of the Chinese economy has continued to grow and diversify, as can be seen from the trend in exports, their composition (today characterized by greater added value than in the past), the amount of foreign investments and the credit granted by Chinese financial institutions to foreign borrowers. This evolution faces up to the incompleteness of China’s transformation into a market economy, evident in the ongoing role of the State in directing economic decisions (also through the lever of companies and public-owned banks), a source of growing tensions with its major trading partners.]

We assessed renal function outcome in children with congenital solitary kidney and evaluated prognostic risk factors.We retrospectively studied the clinical charts of 210 children presenting with congenital solitary kidney at 2 pediatric nephrology and 5 pediatric units between January 2009 and October 2012. Children 0 to 18 years old with a congenital solitary kidney confirmed by scintigraphy were enrolled. Of the patients 146 were suitable for analysis. Median followup was 4.6 years. Primary outcome was decreased estimated glomerular filtration rate, and secondary outcome was occurrence of proteinuria and/or systemic hypertension. Primary outcome-free survival analysis was performed, including multiple regression analysis of significant risk factors.Decreased estimated glomerular filtration rate was present in 12% of children at a median age of 2.2 years. Primary outcome-free survival analysis revealed an estimated event-free survival of 82% (95% CI 74% to 91%) at 10 years. Estimated survival rate was significantly decreased in children with additional congenital anomalies of the kidney/urinary tract (54% vs 88% overall) or insufficient renal length vs expected for normal congenital solitary kidney. The latter was the strongest predictor of decreased estimated outcome-free survival (49% vs 89%, p0.001). Occurrence of proteinuria and/or systemic hypertension was present in less than 5% of children.Some children with congenital solitary kidney show decreased glomerular filtration rate. Associated anomalies of the kidney/urinary tract and insufficient renal length appear to be significant risk factors. Adequate length of the congenital solitary kidney is a key parameter for maintenance of renal function and should be examined routinely during followup.

Reactive arthritis is a rare complication ofClostridium difficileenterocolitis, especially in children. We review the 6 pediatric cases published in the English and non-English literature and discuss their clinical presentation, outcome, treatment, and pathophysiology. We also report the seventh case ofClostridium difficilereactive arthritis in a 6-year-old boy who was treated with amoxicillin-clavulanate for 10 days because of an upper respiratory infection. After the antibiotic course, the child developed at the same time diarrhea with positive stool culture forClostridium difficileand an asymmetric polyarthritis. Nonsteroidal anti-inflammatory drugs and metronidazole completely resolved the pain, joint swelling, and diarrhea. After twelve months of follow-up there has been no recurrence. This report confirms the self-limiting course ofClostridium difficilereactive arthritis.Clostridium difficiletesting in children with gastrointestinal symptoms and acute onset of joint pain should be always considered.

INTRODUCTION: The prevalence of maternal group-B-streptococcus (GBS) colonization and risk factors (RFs) for neonatal early-onset disease (EOD) in Europe are poorly defined. Large-scale information concerning adherence to recommendations for preventing GBS-EOD are lacking. MATERIALS AND METHODS: This was a 3-month retrospective area-based study including all regional deliveries ≥35 weeks' gestation (in 2012). The sensitivity, specificity, positive and negative predictive values, odds ratio and receiver operating characteristic (ROC) curve for intrapartum antibiotic prophylaxis (IAP) among full-term and preterm deliveries and prolonged membrane rupture (PROM) were calculated. RESULTS: Among 7133 women, 259 (3.6%) were preterm (35-36 weeks' gestation). Full-term women were 6874, and 876 (12.7%) had at least 1 RF. Most women (6495) had prenatal screening and 21.4% (1390) were GBS positive. IAP was given to 2369 (33.2%) women (preterm, n = 166; full term, n = 2203). Compared to full-term, preterm women were less likely to receive IAP when indicated (73.2% versus 90.3%, p

OBJECTIVE. We examined the diagnostic accuracy of routine imaging studies (ultrasonography and micturating cystography) for predicting long-term parenchymal renal damage after a first febrile urinary tract infection.METHODS. This study addressed the secondary objective of a prospective trial evaluating different antibiotic regimens for the treatment of acute pyelonephritis. Data for 300 children ≤2 years of age, with normal prenatal ultrasound results, who completed the diagnostic follow-up evaluation (ultrasonography and technetium-99m-dimercaptosuccinic acid scanning within 10 days, cystography within 2 months, and repeat technetium-99m-dimercaptosuccinic acid scanning at 12 months to detect scarring) were analyzed. Outcome measures were sensitivity, specificity, and negative and positive predictive values for ultrasonography and cystography in predicting parenchymal renal damage on the 12-month technetium-99m-dimercaptosuccinic acid scans.RESULTS. The kidneys and urinary tracts were mostly normal. The acute technetium-99m-dimercaptosuccinic acid scans showed pyelonephritis in 54% of cases. Renal scarring developed in 15% of cases. The ultrasonographic and cystographic findings were poor predictors of long-term damage, showing minor sonographic abnormalities for 12 and reflux for 23 of the 45 children who subsequently developed scarring.CONCLUSIONS. The benefit of performing ultrasonography and scintigraphy in the acute phase or cystourethrography is minimal. Our findings support (1) technetium-99m-dimercaptosuccinic acid scintigraphy 6 months after infection to detect scarring that may be related to long-term hypertension, proteinuria, and renal function impairment (although the degree of scarring was generally minor and did not impair renal function) and (2) continued surveillance to identify recurrent urinary tract infections that may warrant further investigation.