Atypical Hemolytic Uremic Syndrome with Severe Extrarenal Manifestations: a Case Report

Atypical hemolytic uremic syndrome (aHUS) is a rare and life-threatening disease that may lead to end-stage renal failure (ESRF) or death, and may be accompanied by a variety of extrarenal manifestations. We presented a child with aHUS accompanied by severe extrarenal manifestations. A 12-year-old girl was visited in the emergency departments with acute renal failure, symptoms of fluid overload, vomiting, and somnolence. Laboratory tests revealed microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure with severe electrolyte imbalance.  Diagnosis of HUS was made and emergency hemodialysis was performed to decrease the circulating volume, restore the electrolyte disturbance, and support the treatment of HUS, but conventional medical therapies were ineffective. The patient experienced frequent seizures and multiple cardiac arrests and became comatose. Thereafter, although she was diagnosed with aHUS, plasma infusions and plasmapheresis were performed. Upper gastrointestinal endoscopy and colonoscopy revealed erosive pangastritis, widespread gastric hemorrhagic ulcers, bulbitis, and hemorrhagic colitis. Since there was no improvement, the patient was transferred to a central university hospital where eculizumab was started. She responded to eculizumab. In conclusion, as aHUS can progress rapidly and is frequently fatal if untreated, it is important to be aware of unusual presentations and diagnose the condition promptly, particularly if supportive treatment is of little or no help

Development and application of the Commitment to Profession of Medicine Scale using classical test theory and item response theory

Aim To determine the level of professional commitment of medical students by developing and applying a new scale. Methods The study enrolled 999 students of Çanakkale Onsekiz Mart University, School of Medicine. Factor analysis, reliability analysis, and item analysis were performed based on the classical test theory and item response theory. The data obtained through scale application were analyzed using factorial ANOVA. Results The Commitment to Profession of Medicine Scale was identified as a unidimensional scale consisting of nine items. The scale in its present form explained 51% of the variance in commitment to profession of medicine. The reliability was 0.88. The scale application revealed that female students had higher commitment than male students. The highest level of commitment was observed in third- and first-year students, students with the lowest level of family income, and students whose ideal profession was medicine. Conclusion There are many factors affecting professional commitment levels of university students. Therefore, it is of great importance to examine students’ commitment at an early stage. In addition, the experiences of students during university years are important since they directly affect the commitment level. Considering these factors, teachers should support their students and strive to increase their commitment levels

Can the adhesion of universal adhesives to the root canal be optimized by surface pre-treatment?

Im Rahmen dieser Arbeit wurde der Einfluss verschiedener Vorbehandlungen auf die Langzeithaftung von glasfaserverstärkten Kompositwurzelstiften, die entweder mit Universaladhäsiven, dual-härtenden selbstkonditionierenden Adhäsiven oder einem selbst-adhäsiven Kompositzement (SAR) befestigt wurden, untersucht. Zwei Universaladhäsive, FU: Futurabond U mit Rebilda DC (Voco; Cuxhaven, Deutschland) und LU: LuxaBond Universal mit LuxaCore Z dual (DMG; Hamburg, Deutschland), zwei selbstätzende Adhäsive, CL: Clearfil DC Bond mit Clearfil DC Core Plus (Kuraray Noritake; Okayama, Japan) und GR: Gradia Core SE Bond mit Gradia Core (GC Europe NV; Leuven, Belgien) sowie ein SAR-Zement, RX: RelyX Unicem 2 (3M; Minnesota, USA), wurden für die Stiftsetzung verwendet. Vor Stiftzementierung wurden die wurzelkanalbehandelten Oberkieferinzisivi entweder mit einer 99%igen Ethanolspülung (VB1), einer Ethanol-Tertiäre-Butanol-Wasser-Lösung (AH Plus Cleaner, Dentsply Sirona; York, USA) (VB2) oder einer Kontrolle mit Aqua Dest. (VB3) vorbehandelt. Aus der koronalen, mittleren und apikalen Wurzelregion jeder Zahnprobe wurden zwei je 1 mm dicke Probenscheiben gewonnen. Eine Scheibe wurde direkt durch den Push-out getestet, während die andere vor der Testung einer thermomechanischen Alterung mittels Thermocycling (5°C-55°C, 6.000 Zyklen) mit anschließender sechsmonatiger Lagerung in einer Kochsalzlösung (0,9%, 37°C) ausgesetzt wurde. Eine qualitative Darstellung der Hohlräume und Hybridschichten erfolgte mittels Mikro-Computertomografie und Fluoreszenzmikroskopie. Die Auswertung der Daten erfolgte durch eine Messwiederholungs-ANOVA mit Post-hoc-Test (MW±SA) (p<0,05). Das Material (p=0,000), die Vorbehandlung (p=0,016) und die Lagerung (p=0,000; Messwiederholungs-ANOVA) hatten einen signifikanten Einfluss auf die Haftung. LuxaBond Universal (18,8±8,1 MPa) erzeugte im Durchschnitt die höchsten Haftwerte (p=0,000, Tukey). Die Übersichtsanalyse ergab für VB1 (16,5±6,9 MPa) signifikant höhere Haftwerte als für VB3 (14,5±5,7 MPa; p=0,011; Tukey). Genauer wurde dies für die Materialien LuxaBond Universal (p=0,000) und RelyX Unicem 2 (p=0,003) beobachtet. Die Ethanol-Vorbehandlung hatte einen positiven Einfluss auf die Haftwerte eines selbstkonditionierten Universaladhäsives ebenso wie auf die eines SAR-Zements. Eine 99%ige Ethanolspülung kann daher als Vorbehandlung für alle untersuchten Materialien empfohlen werden.This study investigated the influence of various pre-treatments on the longterm bond strength of fiberglass-reinforced composite posts cemented with universal adhesives, dual-curing self-etch adhesives or a self-adhesive resin (SAR) cement. Two universal adhesives, FU: Futurabond U with Rebilda DC (Voco; Cuxhaven, Germany) and LU: LuxaBond Universal with LuxaCore Z dual (DMG; Hamburg, Germany), two self-etch adhesives, CL: Clearfil DC Bond with Clearfil DC Core Plus (Kuraray Noritake; Okayama, Japan) and GR: Gradia Core SE Bond with Gradia Core (GC Europe NV; Leuven, Belgium), as well as a SAR cement, RX: RelyX Unicem 2 (3M; Minnesota, USA), were used for post cementation. Prior to post insertion, the root-filled maxillary incisors were either pre-treated with a 99% ethanol solution (PT1), an ethanol-tertiary-butanol-water-solution (AH Plus Cleaner, Dentsply Siro-na; York, USA) (PT2) or a control with distilled water (PT3). Two sample slices, each 1 mm thick, were obtained from the coronal, middle and apical region of the root. One slice was tested directly using push-out, while the other one was subjected to thermomechanical ageing (5°C-55°C, 6,000 cycles) followed by a six months storage in saline solution (0.9%, 37°C) before push-out. Qualitative imaging of the voids and hybrid layers was performed using micro-computed tomography and fluorescence microscopy. Data analysis was carried out using repeated-measures ANOVA with post-hoc tests (MW±SA) (p<0.05). Material (p=0.000), pre-treatment (p=0.016) and storage (p=0.000; repeated-measures ANOVA) had a significant influence on the overall bond strength. LuxaBond Universal (18.8±8.1 MPa) revealed the highest bond strength among all materials (p=0.000, Tukey) while PT1 (16.5±6.9 MPa) revealed significantly higher bond strength than PT3 (14.5±5.7 MPa; p=0.011; Tukey). This was especially the case for the materials LuxaBond Universal (p=0.000) and RelyX Unicem 2 (p=0.003). The Ethanol pre-treatment had a positive influence on the bond strength of a self-conditioned universal adhesive and that of a SAR cement. A 99% ethanol rinse can therefore be suggested as pre-treatment for all examined materials

DGCLUSTER: A Neural Framework for Attributed Graph Clustering via Modularity Maximization

Graph clustering is a fundamental and challenging task in the field of graph mining where the objective is to group the nodes into clusters taking into consideration the topology of the graph. It has several applications in diverse domains spanning social network analysis, recommender systems, computer vision, and bioinformatics. In this work, we propose a novel method, DGCluster, which primarily optimizes the modularity objective using graph neural networks and scales linearly with the graph size. Our method does not require the number of clusters to be specified as a part of the input and can also leverage the availability of auxiliary node level information. We extensively test DGCluster on several real-world datasets of varying sizes, across multiple popular cluster quality metrics. Our approach consistently outperforms the state-of-the-art methods, demonstrating significant performance gains in almost all settings.Comment: Accepted to AAAI'2

Surgery of pulmonary aspergillomas in immunocompromised patients

Introduction: Pulmonary aspergillosis is a devastating complication in immunocompromised patients. Timing of surgery is controversial and depends on the patients' general condition