High Rate of Regression From Micro-Macroalbuminuria to Normoalbuminuria in Children and Adolescents With Type 1 Diabetes Treated or Not With Enalapril: The influence of HDL cholesterol

OBJECTIVE: To evaluate the frequency of normalization, the persistence of remission, and the impact on normalization of glycemic control and lipid profile, we analyzed data from a retrospective observational cohort study of type 1 diabetic children and adolescents with abnormal urinary albumin excretion (UAE). RESEARCH DESIGN AND METHODS: All diabetic children and adolescents (n = 41) who had persistent abnormal UAE in the period of 1984 to 2008 and followed up until 2009 (follow-up duration = 13.1 \ub1 6.2 years) were included in the study. Nine patients progressed to macroalbuminuria; 24 patients were administered ACE inhibitor treatment. RESULTS: The cumulative prevalence of abnormal UAE was 9%. During follow-up, 14 of 17 untreated and 19 of 24 treated patients reverted to normoalbuminuria. In the remission group compared with the nonremission group, A1C levels during follow-up decreased (7.5 \ub1 1.0 vs. 9.4 \ub1 1.2%, P < 0.0001) and serum HDL cholesterol increased (52.7 \ub1 11.3 vs. 42.7 \ub1 8.6 mg/dL, P < 0.05). The micro-macroalbuminuric patients had lower HDL cholesterol (51.0 \ub1 11.4 vs. 62.4 \ub1 13.6 mg/dL, P < 0.0001) than 134 normoalbuminuric diabetic patients. CONCLUSIONS: Microalbuminuria and macroalbuminuria were not permanent in most of our diabetic children and adolescents. If abnormal UAE values are high and persist for >1 year, only long-lasting treatment with ACE inhibitors seems able to induce persistent remission, especially when associated with good metabolic control and high HDL cholesterol level

Idiopathic central precocious puberty in girls: presentation factors

<p>Abstract</p> <p>Background</p> <p>It is sometimes difficult to distinguish between premature thelarche and precocious puberty in girls who develop breasts before the age of 8 years. We evaluated the frequencies of the signs associated with breast development and the factors influencing the presentation of girls with idiopathic central precocious puberty (CPP).</p> <p>Methods</p> <p>353 girls monitored 0.9 ± 0.7 year after the onset of CPP.</p> <p>Results</p> <p>The age at CPP was < 3 years in 2%, 3–7 years in 38% and 7–8 years in 60% of cases. Pubic hair was present in 67%, growth rate greater than 2 SDS in 46% and bone age advance greater than 2 years in 33% of cases. Breast development was clinically isolated in 70 (20%) cases. However, only 31 of these (8.8% of the population) had a prepubertal length uterus and gonadotropin responses to gonadotropin releasing hormone and plasma estradiol. The clinical picture of CPP became complete during the year following the initial evaluation.</p> <p>25% of cases were obese. The increase in weight during the previous year (3.7 ± 1.4 kg) and body mass index were positively correlated with the statural growth and bone age advance (P < 0.0001).</p> <p>There was no relationship between the clinical-biological presentation and the age at puberty, the interval between the onset of puberty and evaluation, or the presence of familial CPP.</p> <p>Conclusion</p> <p>The variation in presentation of girls with CPP does not depend on their age, interval between the onset and evaluation, or familial factors. This suggests that there are degrees of hypothalamic-pituitary-ovarian activation that are not explained by these factors.</p

Autoantibodies against MHC class I polypeptide-related sequence A are associated with increased risk of concomitant autoimmune diseases in celiac patients

Background: Overexpression of autologous proteins can lead to the formation of autoantibodies and autoimmune diseases. MHC class I polypeptide-related sequence A (MICA) is highly expressed in the enterocytes of patients with celiac disease, which arises in response to gluten. The aim of this study was to investigate anti-MICA antibody formation in patients with celiac disease and its association with other autoimmune processes. Methods: We tested serum samples from 383 patients with celiac disease, obtained before they took up a gluten-free diet, 428 patients with diverse autoimmune diseases, and 200 controls for anti-MICA antibodies. All samples were also tested for anti-endomysium and anti-transglutaminase antibodies. Results: Antibodies against MICA were detected in samples from 41.7% of patients with celiac disease but in only 3.5% of those from controls (P <0.0001) and 8.2% from patients with autoimmune disease (P <0.0001). These antibodies disappeared after the instauration of a gluten-free diet. Anti-MICA antibodies were significantly prevalent in younger patients (P <0.01). Fifty-eight patients with celiac disease (15.1%) presented a concomitant autoimmune disease. Anti-MICA-positive patients had a higher risk of autoimmune disease than MICA antibody-negative patients (P <0.0001; odds ratio = 6.11). The risk was even higher when we also controlled for age (odds ratio = 11.69). Finally, we found that the associated risk of developing additional autoimmune diseases was 16 and 10 times as high in pediatric patients and adults with anti-MICA, respectively, as in those without. Conclusions: The development of anti-MICA antibodies could be related to a gluten-containing diet, and seems to be involved in the development of autoimmune diseases in patients with celiac disease, especially younger ones

A validated normative model for human uterine volume from birth to age 40 years

Transabdominal pelvic ultrasound and/or pelvic Magnetic Resonance Imaging are safe, accurate and non - invasive means of determining the size and configuration of the internal female genitalia. The assessment of uterine size and volume is helpful in the assessment of many conditions including disorders of sex development, precocious or delayed puberty, infertility and menstrual disorders. Using our own data from the assessment of MRI scans in healthy young females and data extracted from four studies that assessed uterine volume using transabdominal ultrasound in healthy females we have derived and validated a normative model of uterine volume from birth to age 40 years. This shows that uterine volume increases across childhood, with a faster increase in adolescence reflecting the influence of puberty, followed by a slow but progressive rise during adult life. The model suggests that around 84% of the variation in uterine volumes in the healthy population up to age 40 is due to age alone . The derivation of a validated normative model for uterine volume from birth to age 40 years has important clinical applications by providing age-related reference values for uterine volume.Publisher PDFPeer reviewe

Wage differentials associated with race between 2002 and 2014 in Brazil: Evidence from a quantile decomposition

Throughout the 2000s Brazil went through a great phase of economic development. The present study seeks to investigate whether this movement was accompanied by a reduction in inequality in the labor market, measured here by the wage gap between whites and non-whites. To do so, three cohorts of time (2002-2004, 2007-2009 and 2012-2014) were analyzed from the microdata of the National Household Sampling Survey (Pesquisa Nacional de Amostragem Domiciliar - PNAD). The applied method is the counterfactual Oaxaca-Blinder along with the Recentered Influence Function Regression (RIF-Regression) so that the main determinants of wages inequalities can be detailed throughout the salary distribution. Our results showed that wage gap (totals, due to observed factors and discrimination) are higher in the higher quantiles of the distribution, that is, in professions or activities with higher wages. The results also point to a salary approximation between the groups during the analyzed period, which was mainly due to observable characteristics, specially education levels. However, discrimination decreased only between the first and second triennium and in low magnitude. Apart from that, the main determinants of racial wage gap are returns to education, experience and professions considered unregulated (self-employment and informal workers)

Presentazione [della sezione "Le tecnologie ‘morali’ emergenti e i diritti fondamentali in Europa"]

Today the European bioethical debate has to face the challenge of frontier issues like robotics, artificial intelligence, and moral bioenhancement. In the European scenario, the ethical debate about these issues is strictly interrelated with the legal one. The attempt is indeed to find adequate legal tools to regulate those frontier issues that can profoundly impact on the framework of fundamental rights. The present introduction to the Forum, which collects some papers dealing with different frontier issues, gives a brief overview of the contents of the papers and highlights their relevance for the public European ethical and legal discussio

Short-and long-term impact of violence on education: The case of timor leste

This paper analyzes the impact of the wave of violence that occurred in Timor Leste in 1999 on education outcomes. We examine the short-term impact of the violence on school attendance in 2001 and its longer-term impact on primary school completion of the same cohorts of children observed again in 2007. We compare the educational impact of the 1999 violence with the impact of other periods of high-intensity violence during the 25 years of Indonesian occupation. The short-term effects of the conflict are mixed. In the longer term, we find evidence of a substantial loss of human capital among boys in Timor Leste who were exposed to peaks of violence during the 25-year long conflict. The evidence suggests that this result may be due to household trade offs between education and economic welfare. © The Author 2013. Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development / THE WORLD BANK. All rights reserved

Transizione universit\ue0 e lavoro: il Progetto Sperimentale di Inserimento Lavorativo PSILA (Universit\ue0 di Verona e Comune di Verona).

Il \u201cProgetto Sperimentale di Inserimento Lavorativo dell\u2019Universit\ue0 degli Studi di Verona - PSILA\u201d \ue8 un percorso formativo e di inserimento lavorativo risultato dalla una collaborazione fra l\u2019Universit\ue0 degli Studi di Verona ed il Comune di Verona; il suo obiettivo \ue8 di agevolare la transizione dagli studi al lavoro dei laureandi dell\u2019Ateneo di Verona. PSILA ha avuto avvio nel novembre 2006 e si concluder\ue0 nel mese di luglio 2008. I destinatari del progetto sono i laureandi dell\u2019Ateneo di Verona. PSILA prevede tre momenti principali: Aula (formazione mediante didattica frontale - lezioni e seminari, 100 ore), Stage in azienda (tirocinio di formazione ed orientamento al lavoro, 400 ore) e Contratto di lavoro per la durata di 12 mesi. L\u2019ammissione al progetto \ue8 preceduta da un colloquio motivazionale che si propone di verificare la sintonia delle motivazioni individuali dei laureandi rispetto agli obiettivi e alle finalit\ue0 specifiche del percorso, questo strumento permette di individuare i 45 studenti che possono partecipare. La fase d\u2019aula prevede approfondimenti su tematiche aziendali quali: organizzazione aziendale e del lavoro, processi decisionali d\u2019impresa, mercato e relazioni di lavoro e principi e tecniche di comunicazione (gli studenti che nella loro carriera universitaria hanno gi\ue0 accumulato Crediti Formativi Universitari \u2013CFU\u2013 in ambiti disciplinari riconducibili alle tematiche d\u2019aula non sono tenuti a frequentare, analogamente chi frequenta vede riconosciuti dei CFU). Per accedere alle fasi successive dello PSILA (stage e inserimento lavorativo) i laureandi che hanno completato la formazione d\u2019aula (misurata mediante il superamento della prova finale e/o il riconoscimento degli esami) sostengono un colloquio di selezione presso le aziende partecipanti al Progetto PSILA l\u2019obiettivo di questa fase \ue8 quello di permettere alle aziende coinvolte di individuare i candidati pi\uf9 adatto a svolgere lo stage di 400 ore e il successivo anno di lavoro (con contratto a tempo determinato) nella posizione da esse proposta (vengono quindi avviati 12 stage in 9 aziende, confermati poi in 11 contratti di lavoro). Il progetto \ue8 Coordinato da un Comitato Tecnico Scientifico e prevede un processo di monitoraggio continuo. In questa ottica, vengono utilizzati degli strumenti creati ad hoc con l\u2019obiettivo di rilevare specifici elementi relativi alle varie fasi (es. soddisfazione nei partecipanti e nei tutor aziendali, competenze presenti ed acquisite,\u2026). Il monitoraggio, fino ad ora realizzato, permette di evidenziare nei partecipanti una sostanziale soddisfazione relativamente alle informazioni ricevute inizialmente, al colloquio motivazionale, al percorso formativo, al coordinamento e tutoraggio, al clima di lavoro, al coinvolgimento, all\u2019esperienza di colloquio con le aziende, alla fase di stage e di inserimento lavorativo. Le aziende, coinvolte soprattutto in queste ultime fasi, stanno indicando che l\u2019esperienza si svolge positivamente. Le attivit\ue0 in corso sono dedicate alla rilevazione delle competenze percepite dal giovane (ora lavoratore), riconosciute dal tutor aziendale e valutate attraverso strumenti standardizzati