Explore the vast range of titles available.

The recent classification of pediatric thrombotic microangiopathies (TMA) takes into consideration mechanisms of disease for guidance to targeted therapies. We present our experience with seven patients with antibody mediated atypical hemolytic uremic syndrome (aHUS) and thrombotic thrombocytopenic purpura (TTP). Five children had aHUS with antibodies against complement factor H (CFH-ab) and two with TTP with antibodies against metalloproteinase ADAMTS13. In the aHUS cases diagnosed and treated before the eculizumab era, CFH-ab was detected using the ELISA assay. Mutational analysis of selected complement genes was performed. TTP was diagnosed if, in addition to microangiopathic hemolytic anemia and thrombocytopenia, ischemic organ involvement and severe deficiency in ADAMTS13 activity were present. Treatment protocol consisted of plasma exchanges (PE) and steroid pulses, followed by the combination of cyclophosphamide and rituximab to achieve long-term immunosuppression. Four patients with CFH-ab and the TTP patients with ADAMTS13 antibodies came into sustained remission. After a median follow-up of 11.7 (range 7.7–12.9) years without maintenance therapy, no disease recurrence was observed; nevertheless, six patients, two had hypertension and two had proteinuria as a late consequence. One patient, with late diagnosis of CFH-ab and additional genetic risk factors who was treated only with PE and plasma substitution, reached end-stage renal disease and was later successfully transplanted using eculizumab prophylaxis. In the cases of antibody-mediated TMAs, PE and early immunosuppressive treatment may result in sustained remission with preserved kidney function. Further data are needed to establish optimal treatment of anti-FH antibody-associated HUS.

Background and Objectives: Ensuring the optimal shear bond strength (SBS) is essential for the long-term success of prosthodontic restorations. Our in vitro study aimed to evaluate the SBS of three types of ceramics (feldspathic, alumina, and lithium disilicates) using three adhesive cements (Variolink Esthetic LC, Variolink Esthetic DC, and Maxcem Elite). Materials and Methods: Healthy molars were prepared, and ceramic blocks were cemented following universally accepted luting protocols. SBS tests were performed using a custom-made testing machine. A multiple linear regression model assessed the effects of ceramic type, surface treatment, and luting agent on SBS. Results: The regression model explained 61.3% of the variation in SBS values (R2 = 0.613); the adjusted R2 = 0.605 confirmed the model’s robustness. The global F-test was statistically significant (F = 78.96, p < 0.001). The total-etch technique (+4.47), the use of feldspathic ceramic, and 5% hydrofluoric acid treatment (+3.28) significantly affected SBS. Feldspathic ceramic and lithium disilicate showed superior performance against alumina. Light-cured and self-cured cement showed negative effects. Conclusions: Ceramic material and cement type have combined effects on SBS. Optimal results were obtained with the total-etch technique, feldspathic ceramic, 5% hydrofluoric acid treatment, and dual-cured cement.

Background Kidney transplantation (KTx) improves prognosis in children with kidney failure; still, these patients are prone to cardiovascular damage due to multiple risk factors. Our aim was to assess myocardial structure and function in pediatric KTx by conventional and speckle-tracking echocardiography (STE) in association with established cardiovascular risk factors. Methods Forty-two KTx and 39 healthy age- and gender-matched children were evaluated. KTx recipients were further categorized according to the control of hypertension assessed by 24-h ambulatory blood pressure monitoring (ABPM). Subjects underwent pulse wave velocity (PWV) measurement, conventional echocardiography, and 2-dimensional STE. Left and right ventricular (LV, RV) global longitudinal strain (GLS), and LV circumferential strain (GCS) were measured. Glomerular filtration rate (eGFR) was calculated according to the Schwartz formula. Results KTx patients had increased blood pressure and arterial stiffness. LV ejection fraction (EF) was preserved along with elevated LV mass index (LVMi) while LVGLS was significantly lower, whereas LVGCS and RVGLS were increased in KTx. Uncontrolled hypertensives had lower LVGLS compared to those with controlled hypertension. Using multiple forward stepwise regression analysis, 24-h SBP and relative wall thickness (RWT) were independent determinants of LVMi, whereas antihypertensive therapy, eGFR, and HOMA-IR were independent determinants of LVGLS. Conclusions Cardiac morphology and function show distinct changes after KTx. Along with comparable ventricular volumes, LV hypertrophy and subclinical myocardial dysfunction are present. Control of hypertension and kidney graft function are major factors of LV performance. STE may be useful to reveal early myocardial dysfunction in pediatric KTx. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information .

Background and Objectives: The most common method for treating malocclusions today is fixed orthodontic therapy, during which brackets and tubes are bonded to the surface of the teeth, which makes oral hygiene difficult to maintain. Increased plaque retention, gingival bleeding, and gingivitis can be diagnosed in the early phases of treatment. The periodontal response to plaque accumulation can be explained by quantitative and qualitative changes in the subgingival microbiota. The aim of our research was to investigate the changes in the subgingival microbiota that occurred within 6–8 weeks after bonding when two different orthodontic adhesives were used. Materials and Methods: Thirty patients were followed; molar tubes were bonded with a composite (C) in fifteen cases, and in the other fifteen cases, they were bonded with glass ionomer cementum (GIC). A microbiological sample was taken from the gingival sulcus of the maxillary first molars at the time of appliance placement (T1) and 6–8 weeks (T2) after bonding. Bacterial DNA detection was performed using the micro-IDent®plus11 (Hain Lifescience GmbH, Germany) PCR (polymerase chain reaction) method. The statistical analysis included McNemar’s test to analyze the paired binary data and Fisher’s Exact Test to compare the prevalence of each of the 11 bacteria at T1 and, ultimately, T2 between the two studied groups. The Bonferroni correction was also applied. Results: When analyzing GIC vs. C at T1 and T2, none of the studied pathogens showed significant differences. Conclusions: Given the lack of statistical significance, these trends do not confirm a definitive impact of the procedure on bacterial presence. The increased presence of periodontal pathogens might suggest that bonding does not reduce the bacterial loading of subgingival microbiota. Less protective effects of the GIC intervention against Tannerella forsythia and Eubacterium nodatum bacteria were detected.

Pediatric renal transplant recipients (RTx) were studied for longitudinal changes in blood pressure (BP), arterial stiffness by pulse wave velocity (PWV), and graft function. Patients and Methods: 52 RTx patients (22 males) were included; office BP (OBP) and 24 h BP monitoring (ABPM) as well as PWV were assessed together with glycemic and lipid parameters and glomerular filtration rate (GFR) at 2.4[1.0–4.7] (T 1 ) and 9.3[6.3–11.8] years (T 2 ) after transplantation (median [range]). Results: Hypertension was present in 67 and 75% of patients at T 1 and T 2 , respectively. Controlled hypertension was documented in 37 and 44% by OBP and 40 and 43% by ABPM. Nocturnal hypertension was present in 35 and 30% at T 1 and T 2 ; 24 and 32% of the patients had masked hypertension, while white coat hypertension was present in 16 and 21% at T 1 and T 2 , respectively. Blood pressure by ABPM correlated significantly with GFR and PWV at T 2 , while PWV also correlated significantly with T 2 cholesterol levels. Patients with uncontrolled hypertension by ABPM had a significant decrease in GFR, although not significant with OBP. Anemia and increased HOMAi were present in ~20% of patients at T 1 and T 2 . Conclusion: Pediatric RTx patients harbor risk factors that may affect their cardiovascular health. While we were unable to predict the evolution of renal function based on PWV and ABPM at T 1 , these risk factors correlated closely with GFR at follow-up suggesting that control of hypertension may have an impact on the evolution of GFR.

In this paper, I would like to provide refined relative chronological data to loess-paleosol section situated on the IV. and V. terraces of Red Hill (Moravia), based on a comparison with Heirich events, North and South hemispheric ice core records. The last glacial–interglacial loess section is almost complete, all of the interstadial soils can be identified in the series instead of the eroded upper part of the PK I complex. The onset of the formation of recent soil can be parallelized to H0 event (~12 000), the double structural soils to H1 and H2 events, the eroded soils of PK I to H3 and H4, while the lower part of the complex has been correlated with H5 and H6 events (~63 ka BP). The loess series above PK I has been classifi ed into Würm-3, the strata between PK I and PK II belong to the Würm-2. The lower part, under PK II is mostly clayey, cannot be regarded as a cold climate deposit. After the Riss/Würm interglacial the climate has changed slowly, and the typical glacial climate has started only after 75 ka BP.

Our study investigates the paleoenvironmental conditions of an Upper Paleolithic site found in the excavation of the North Adriatic Susak Island. Our research explores the range of the loess and loesslike sediments deposited on rudist limestone which is the substratum of the island. We studied the Quaternary sediments by a coherent paleoenvironmental assessment method. The geomorphological and the various chronological analysis contribute significantly to the extension of our knowledge on the paleoenvironmental conditions of the Upper Paleolithic site (Radiocarbon age is 31,830 ±720 yr BP) on Susak Island.

Chronic kidney disease (CKD) is a major factor contributing to cardiovascular (CV) morbidity and mortality with the highest risk in patients on dialysis. An estimation of CV risk is important not only to identify potential modifiable risk factors but also to evaluate the effect of treatments aimed to reduce the risk. Non-invasive methods of measuring vascular changes and circulating biomarkers are available to assess the presence and severity of cardiovascular damage. These include measures of structural (carotid intima-media thickness and coronary artery calcification score) and functional (aortic pulse wave velocity, 24-h ambulatory blood pressure monitoring, ambulatory arterial stiffness index, heart rate variability and flow-mediated dilatation) changes in the vessel wall. In addition, a number of circulating biomarkers of vascular damage and its progression have been studied. Many of these tests are well validated as surrogate markers of future cardiovascular events and death in adult CKD patients, but need technical adaptation, standardization and validation for use in children. With our current state of knowledge, these are best reserved for research studies and scarce clinical resources may be better utilized for preventative strategies to reduce the modifiable risk factors for calcification from early CKD stages.

Contrast-enhanced voiding urosonography (VUS) is becoming more widely used for the diagnosis of vesicoureteric reflux (VUR). The purpose of this study was to evaluate the sensitivity of VUS using a second-generation ultrasound (US) contrast agent and compare it with standard fluoroscopic voiding cystourethrography (VCUG). A total of 183 children with 366 kidney-ureter units (KUUs) underwent VUS and VCUG in the same session with the same catheterization. VUS was performed after intravesical administration of 1 ml of a second-generation ultrasound contrast agent (UCA; SonoVue, Bracco, Italy). VUR was detected in 140 out of 366 cases (38%); in 89 (24.3%) by both methods, in 37 (10.1%) by VUS only, and in 14 (3.8%) by VCUG only. Although there was considerable agreement in the diagnosis of VUR by VUS and VCUG (κ=0.68, standard error [κ]=0.04), the difference in the detection rate of reflux between VUS and VCUG was significant ( p <0.00001). The grade of VUR detected with VUS showed moderate agreement with grading by VCUG. Our findings suggest that contrast-enhanced harmonic VUS using a second-generation contrast agent is superior to VCUG in the detection and grading of VUR, and it should be the method of choice for this clinical indication.