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Urology

Does Twinkle Artifact on Ultrasound Indicate a Kidney Stone in Pediatric Patients?
 Does Twinkle Artifact on Ultrasound Indicate a Kidney Stone in Pediatric Patients? 150 150 Abbie Roth
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The presence of twinkle artifact on ultrasound is a useful, though imperfect, tool for diagnosing kidney stones in children. For pediatric patients, ultrasound is the recommended imaging modality used to diagnose kidney stones. Several findings are used to identify stones on ultrasound, including the presence of an echogenic focus, posterior acoustic shadowing, or twinkle artifact.…

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A New Kind of Rectal Diversion in Classic Bladder Exstrophy
 A New Kind of Rectal Diversion in Classic Bladder Exstrophy 1024 754 Jeb Phillips
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  This article appeared in the Spring/Summer 2021 print issue. Download the full issue.   Medical illustrations by Mandy Root-Thompson for Nationwide Children’s Hospital Source: V. Rama Jayanthi, chief of Urology at Nationwide Children’s Hospital To learn more about the procedure and it’s applications, read A Surprising Approach to Classic Bladder Exstrophy.

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Girls’ Perineal Microbiomes Change Over Development, After Urinary Tract Infection
 Girls’ Perineal Microbiomes Change Over Development, After Urinary Tract Infection 150 150 Mary Bates, PhD
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Next-generation sequencing reveals different flora associated with developmental milestones in girls, as well as disruptions in patients with a history of urinary tract infection. In a new pilot study, researchers from Nationwide Children’s Hospital evaluated the microbiomes of girls at specific developmental timepoints. They found shifts in the perineal microbiome corresponding with important developmental milestones,…

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Does Psychosocial Functioning Differ Among Children With and Without Differences of Sex Development?
 Does Psychosocial Functioning Differ Among Children With and Without Differences of Sex Development? 1024 575 Lauren Dembeck
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Parent and child holding hands

A multidisciplinary team of researchers recently found that children with differences of sex development (DSD) appear to be at greater risk for psychosocial problems relative to children with cleft lip and/or palate (CL/P) and unaffected peers. The study, which was published in the Journal of Pediatric Psychology, highlights the increased need for integrated interdisciplinary care with…

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Novel Roles of the Urothelium in the Development of Congenital Anomalies of the Kidney and Urinary Tract
 Novel Roles of the Urothelium in the Development of Congenital Anomalies of the Kidney and Urinary Tract 150 150 Lauren Dembeck
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In addition to genetic defects, interactions of the developing urothelium with its underlying mesenchyme and superficial plaque may contribute to congenital anomalies of the kidney and urinary tract. Congenital anomalies of the kidney and urinary tract (CAKUTs) are the leading cause of chronic and end-stage kidney disease in children. Collaborative translational research at Nationwide Children’s…

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An Imbalance of Immune Cells Leads to Kidney Scarring After Infection
 An Imbalance of Immune Cells Leads to Kidney Scarring After Infection 1024 732 Mary Bates, PhD
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In a preclinical mouse model, researchers identify the immune cell balancing act that determines whether renal scarring will occur following kidney infection More than half of urinary tract infections in children spread from the bladder to the kidneys, causing acute kidney infections that can lead to renal scarring. Renal scarring can have serious repercussions in…

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Do Surgical Outcomes Differ Between Minimally Invasive Pyeloplasty Procedures in Treating Ureteropelvic Junction Obstruction?
 Do Surgical Outcomes Differ Between Minimally Invasive Pyeloplasty Procedures in Treating Ureteropelvic Junction Obstruction? 1024 575 JoAnna Pendergrass, DVM
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Dr. Jayanthi standing in OR

Minimally invasive pyeloplasty has become increasingly popular over open dismembered pyeloplasty, the traditional treatment for ureteropelvic junction obstruction. Robotic-assisted pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) are minimally invasive procedures that produce smaller scars and less postoperative pain. These are advantages that appeal to parents of patients undergoing these procedures. In a recent Journal of Pediatric Urology publication, Rama…

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Does Low Baseline Renal Volume Lead to Renal Insufficiency in Children With Cloacal Anomalies?
 Does Low Baseline Renal Volume Lead to Renal Insufficiency in Children With Cloacal Anomalies? 1024 683 Lauren Dembeck
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According to the results of a recent study published in Urology, children with cloacal anomalies have baseline renal volumes similar to those of children without cloacal anomalies, indicating that the increased risk of renal insufficiency in children with cloacal anomalies appears to be due to postnatal renal injury. “Before we can determine if surgical interventions or…

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Can a Kidney Failure Risk Equation Validated in Adults Predict Kidney Failure in Children?
 Can a Kidney Failure Risk Equation Validated in Adults Predict Kidney Failure in Children? 1024 575 Lauren Dembeck
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Novel disease-specific biomarkers are needed to improve prediction models in pediatric disease. Obstructive uropathy is a frequent cause of kidney injury in children, and it is estimated to cause approximately one-sixth of pediatric kidney failure cases in North America. However, risk equations to predict kidney disease progression have not yet been developed for children. To…

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Determining Ureteropelvic Junction Obstruction Surgical Success Using Biomarkers
 Determining Ureteropelvic Junction Obstruction Surgical Success Using Biomarkers 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Biomarkers initially found to differ among patients with ureteropelvic junction obstruction and healthy controls may also objectively gauge post-surgical resolution of obstruction. A follow-up study of a trial that initially identified four biomarkers that differ between healthy controls and pediatric patients about to undergo surgery for ureteropelvic junction obstruction (UPJO) has confirmed that two of…

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Improving the Care and Management of Urinary Tract Infections Through Collaboration
 Improving the Care and Management of Urinary Tract Infections Through Collaboration 150 150 JoAnna Pendergrass, DVM
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The Urinary Tract Infection Global Alliance (UTIGA) is a new professional society that is dedicated to combatting the many challenges in UTI management and care through collaboration. With nearly 150 million people affected by urinary tract infections (UTIs) annually across the globe, UTIs are a major health problem. Both the term ‘UTI’ and the infection’s…

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Transforming Medical Science Through Research Affinity Groups
 Transforming Medical Science Through Research Affinity Groups 150 150 Katie Brind'Amour, PhD, MS, CHES
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Purposeful synergy drives the most meaningful medical science. Nephrology physician-scientists require tissue samples, urologists desire tests to know which patients truly require surgery, and basic scientists must find ways to meaningfully assess new animal models to yield clinically valuable data. If each of these professionals had a defined network of colleagues from the other disciplines…

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Keeping Options Open in Complex Pediatric Nephrolithiasis
 Keeping Options Open in Complex Pediatric Nephrolithiasis 1024 575 Lauren Dembeck
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Urologists in the Pediatric Urology Midwest Alliance recently looked at how endoscopic assisted robotic pyelolithotomy could reduce the number of procedures for children with ureteropelvic junction obstruction. The Pediatric Urology Midwest Alliance (PUMA) recently published a new report demonstrating that endoscopic assisted robotic pyelolithotomy (EARP) is an acceptable treatment option for complex cases of pediatric…

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Answers to Burning Questions About Pediatric Urinary Tract Infections
 Answers to Burning Questions About Pediatric Urinary Tract Infections 1024 683 Abbie Roth
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Nationwide Children’s urologists and nephrologists recently co-hosted a Twitter chat for primary care providers, answering common questions about pediatric urinary tract infections (UTIs). Below is a summary of the questions and answers, adapted for brevity and clarity. Q: What causes UTIs in children? A: UTIs are typically caused by uropathogenic E. coli bacteria that invade the urinary…

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What Are Long-Term Outcomes for a Child With Bladder Exstrophy?
 What Are Long-Term Outcomes for a Child With Bladder Exstrophy? 1024 575 Kevin Mayhood
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A study from the Pediatric Urology Midwest Alliance (PUMA) suggests the condition requires lifelong management for most children with bladder exstrophy. Half of infants with classic bladder exstrophy (BE) undergo bladder augmentation or diversion by age 10 and the percentage increases with age, a 36-year retrospective study from five Midwestern children’s hospitals shows. Whether they…

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Predicting Urinary Continence For a Child With Anorectal Malformation
 Predicting Urinary Continence For a Child With Anorectal Malformation 150 150 Kevin Mayhood
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Researchers suggest objective, measurable factors can be used to provide families with reasonable expectations In a child born with an anorectal malformation (ARM), anatomical features including a low-complexity ARM, high sacral ratio and a normal spine each independently predicts the child has a higher chance of urinary continence, research at Nationwide Children’s Hospital shows. “When…

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Multicenter Data Reveals Distal Hypospadias Repair Overall Success Rate
 Multicenter Data Reveals Distal Hypospadias Repair Overall Success Rate 150 150 Katie Brind'Amour, PhD, MS, CHES
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Despite its use as an indicator of a department’s surgical skill, the reoperation rate for distal hypospadias repair has long been based on publications covering data from single-center studies — until now. Among its indicators for urologic surgery quality, U.S. News & World Report examines the complication rate for children undergoing distal hypospadias repair (relocation of the…

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Forging the Way Forward on DSD
 Forging the Way Forward on DSD 1024 575 Jeb Phillips
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Experts are learning how a focus on behavioral health and psychosocial support can lead to better outcomes among youth with disorders/differences of sex development. In some ways, the DSD field began only in 2006. That year, the phrase “disorders of sex development” as coined in a landmark consensus statement, the same publication that called behavioral…

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In Defense Against Peritonitis, Antimicrobial Peptides May Help on Multiple Fronts
 In Defense Against Peritonitis, Antimicrobial Peptides May Help on Multiple Fronts 150 150 Kevin Mayhood
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Study suggests AMPs have potential as biomarkers for peritonitis, risk stratification and treatment. Antimicrobial peptides (AMPs) in the Ribonuclease A Superfamily exhibit distinct patterns when children and adults undergoing chronic peritoneal dialysis (PD) suffer from peritonitis, researchers have found. The findings, published in Scientific Reports, suggest that AMPs in peritoneal fluid are potentially useful as…

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Research Collaborative Improves Outcome Prediction in Children With Posterior Urethral Valves
 Research Collaborative Improves Outcome Prediction in Children With Posterior Urethral Valves 150 150 Lauren Dembeck
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Combining data from five centers allowed researchers to address novel research questions for this rare disease. The Pediatric Urology Midwest Alliance (PUMA) recently published the results of its first collaborative study in Pediatrics. Using data from five institutions, the team demonstrated that the risk of renal replacement therapy and recommendation for clean intermittent catheterization increased with…

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RNase 7: Paving the Way for a Natural, Antibiotic-Free Treatment for Urinary Tract Infections
 RNase 7: Paving the Way for a Natural, Antibiotic-Free Treatment for Urinary Tract Infections 150 150 Katie Brind'Amour, PhD, MS, CHES
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The latest in the body of antimicrobial peptide research suggests RNase7 may be a useful prognostic marker and potential therapeutic option for UTIs. Building on their body of research focused on the naturally occurring antimicrobial peptides in the urinary tract, clinician-scientists at Nationwide Children’s Hospital have now confirmed the suspected role of Ribonuclease 7 (RNase…

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Pushing the Boundaries of Regional Anesthesia for Complex Urological Surgery
 Pushing the Boundaries of Regional Anesthesia for Complex Urological Surgery 150 150 Katie Brind'Amour, PhD, MS, CHES
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Physician-researchers extend the possibilities for regional anesthesia using combined spinal/caudal catheter anesthesia, allowing even complex, time-consuming pediatric urological surgeries to be completed without general anesthesia. In an effort to extend more regional anesthetic options to children undergoing urological procedures — and to obviate concerns about airway safety and theoretical neurocognitive effects of general anesthesia (GA)…

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Uroplakin Plaque Key to Protecting Kidney During Urinary Tract Obstruction
 Uroplakin Plaque Key to Protecting Kidney During Urinary Tract Obstruction 150 150 Kevin Mayhood
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Plaque appears to help remodel urothelium, allowing kidney to hold excess urine without damage, Urinary tract obstruction (UTO) is the leading cause of chronic kidney disease and end-stage renal disease in children. But the extent of damage caused by obstruction differs from child to child. Researchers at Nationwide Children’s Hospital studying why suggest that uroplakin…

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Worth It: Why Wrestling Through the Logistical Challenges of a Multidisciplinary Colorectal Center Matters
 Worth It: Why Wrestling Through the Logistical Challenges of a Multidisciplinary Colorectal Center Matters 150 150 Jeb Phillips
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Consider the complex case of a girl born with rectal, vaginal and urinary tracts fused into a common channel – a cloacal malformation. The child needs reconstructive procedures across three different organ systems and three different surgical specialties. It could take months or years to manage the surgeries needed for the colorectal portion, then the…

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Opening the Door to Adult Medicine
 Opening the Door to Adult Medicine 1024 575 Katie Brind'Amour, PhD, MS, CHES
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Care transition plans aren’t just for kids with congenital conditions anymore. Could your practice benefit from a proactive transition plan for all patients? In the shift from pediatric to adult care, young patients have the responsibility to adjust to a new life of self-management. But health care providers also play an important role in this…

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Can Ultrasound or MRI Help Monitor Dysgenetic Gonads for Tumors?
 Can Ultrasound or MRI Help Monitor Dysgenetic Gonads for Tumors? 150 150 Jeb Phillips
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Dysplastic gonads that have neoplasms are often deemed “normal” in imaging studies. Patients with gonadal dysgenesis and a Y chromosome have a substantial risk of gonadal neoplasm, so providers have traditionally recommended bilateral gonadectomy for them. But relatively recent concerns about caring for children with differences of sex development (DSDs) have called that recommendation into…

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Could Antimicrobial Peptides Be Biomarkers for Obstructive Uropathy?
 Could Antimicrobial Peptides Be Biomarkers for Obstructive Uropathy? 1024 683 Katie Brind'Amour, PhD, MS, CHES
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New research reveals the expression of antimicrobial peptides — long associated only with infections — in children with obstructive uropathy, creating the potential for a wide range of clinical applications. Previously only studied in the context of urinary tract and other infections, antimicrobial peptides (AMPs) — naturally occurring antibiotic molecules that our bodies may use…

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Can Spinal Replace General Anesthesia in Pediatric Urology Patients?
 Can Spinal Replace General Anesthesia in Pediatric Urology Patients? 150 150 Jeb Phillips
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Spinal anesthesia offers a viable low-risk alternative to general anesthesia for a wide range of pediatric procedures, particularly for urology patients. As research continues to illuminate the possibility of neurotoxic effects from general anesthesia in pediatric patients, surgeons and anesthesiologists at Nationwide Children’s Hospital have already sought out an alternative among children 2 years of…

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How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares
 How to Reduce Unnecessary Antibiotic Use for UTI in Urgent Cares 150 150 Jeb Phillips
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A quality improvement project shows children with negative urine cultures take antibiotics they don’t need. Even before a urine culture confirms the diagnosis, urgent care physicians often prescribe antibiotics when children present with symptoms of urinary tract infection (UTI). Early treatment is important for relief of symptoms and prevention of complications. But what if the…

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Childhood Kidney Stones: Their Surprising Connection to Future Disease
 Childhood Kidney Stones: Their Surprising Connection to Future Disease 150 150 Jeb Phillips
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Once thought to be an adult condition, urinary stone disease is increasingly found in children – and may be related to the development of cardiovascular disease, chronic kidney disease and low bone density. By one well-regarded estimate, the risk of developing urinary stone disease in childhood doubled between 1997 and 2012. That’s worrying enough on…

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A Novel, Promising Strategy for Diagnosing UTIs in Children
 A Novel, Promising Strategy for Diagnosing UTIs in Children 150 150 Tiasha Letostak, PhD
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Antimicrobial peptides may be effective biomarkers for diagnosing urinary tract infections in children. Urinary tract infections (UTIs) are one of the most common infections in children and account for millions of unplanned pediatrician and urgent care visits each year in the United States. Previous research has shown that antimicrobial peptides, referred to as AMPs, are…

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A Novel Approach to Pediatric Fecal and Urinary Incontinence
 A Novel Approach to Pediatric Fecal and Urinary Incontinence 150 150 Jeb Phillips
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A 9-year-old girl with caudal regression syndrome is the first child in the United States to be treated with pudendal nerve stimulation. Neuromodulation of the sacral nerve, or sacral nerve stimulation, is rarely but increasingly used in children to help control fecal and urinary incontinence when standard medical management has failed. The treatment involves the implantation of a device…

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InSight: Restoring Normal Habits
 InSight: Restoring Normal Habits 471 285 Tiasha Letostak, PhD
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SACRAL NERVE STIMULATION (SNS) is a new treatment that helps control urinary incontinence and fecal soiling. For some children, the nerves that control urination and bowel movements do not work correctly. The SNS unit consists of a small, safe battery and wire under the skin and sends signals to the sacral nerve. The signals help restore…

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Designing a Center for Collaborative Care
 Designing a Center for Collaborative Care 150 150 Marc Levitt, MD
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A Shift in the Antibiotic Prophylaxis Debate?
 A Shift in the Antibiotic Prophylaxis Debate? 150 150 Katie Brind'Amour, PhD, MS, CHES
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The RIVUR trial laid to rest certain questions surrounding antimicrobial prophylaxis in children with vesicoureteral reflux. But it also launched a new debate. The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trialwas supposed to provide clear direction for pediatric urologists. To date, it is the largest double-blind, placebo-controlled, randomized, multicenter study examining urinary tract infection…

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How to Build and Lead a Successful Medical Department
 How to Build and Lead a Successful Medical Department 150 150 V. Rama Jayanthi, MD
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Fostering an environment that supports evidence-based medicine, professional development and equal footing for clinician-researchers is a critical challenge for medical leadership. You can spot the collaborative leader because he’s rejected the heroic, solitary model of leadership. He doesn’t try to dominate his organization as its all-seeing visionary, leading idea generator and controlling intelligence. Instead, he…

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Body, Heal Thyself: Harnessing Our Innate Immunity
 Body, Heal Thyself: Harnessing Our Innate Immunity 150 150 Katie Brind'Amour, PhD, MS, CHES
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What the urinary tract’s front-line defenses can teach us about our innate ability to self-heal …. and thwart antibiotic resistance. Antibiotic resistance is on the rise, health care-acquired infections are becoming harder to treat and even simple infectious illnesses account for billions of dollars per year in spending in the United States alone. As with…

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