Exclusive and Partial Enteral Nutrition in Crohn’s Disease

Exclusive enteral nutrition (EEN) is a well-establised primary therapy in active pediatric Crohn’s disease (CD). EEN promotes mucosal healing, restores bone mineral density, and improves growth. On the contrary, treatment of active CD with corticosteroids (CS) has a strong negative impact on the linear growth and bone density. Therefore, EEN is recommended as a first-line therapy in children with active CD. EEN has been evaluated in a number of clinical studies including randomized controlled trials. While meta-analyses of adult studies suggest superiority of CS, pediatric studies have shown that EEN is at least as effective as CS in inducing remission. The mechanisms by which EEN suppresses inflammation are not yet fully elucidated. Hypotheses include improvement in nutritional status, decreasing of the inflammatory cascade mechanism, limiting luminal antigen exposure, improving intestinal permeability, and modification of intestinal microbiota

Nutritional Therapy for Inflammatory Bowel Disease

The components of a diet influence intestinal microbiota, epithelial barrier function, immune system, and many other factors that play important role in both development and treatment of inflammation in gastrointestinal tract. We briefly review potential role of specific dietary compounds as a risk or protective factor, but we predominantly concentrate on nutritional status and nutritional intervention in patients with inflammatory bowel disease. Besides exclusive enteral nutrition as a potential first-line treatment in active Crohn’s disease, other nutritional therapeutic modalities such as partial enteral nutrition, parenteral nutrition, diets based on carbohydrate modifications, anti-inflammatory diet, and the use of specific dietary compounds with anti-inflammatory properties, known as pharmaconutrition, are presented

Partial Enteral Nutrition in Crohn’s Disease

Exclusive enteral nutrition (EEN) has proven to be a highly effective treatment option in inducing remission in active Crohn’s disease (CD) in the paediatric population. In adults with CD, the results of meta-analyses demonstrated that therapy with corticosteroids was more effective in comparison with EEN. The most important limitation of the success of EEN treatment is patients’ compliance. Exclusivity of enteral nutrition and its substantial impact on the quality of life are the main reasons why EEN is not acceptable to many patients. Therefore, the treatment with partial enteral nutrition (PEN), where patients are allowed to eat some ordinary food besides enteral formulas, is becoming an important treatment option, not only in inducing, but also in maintaining remission in CD. However, strong evidence on the efficacy of PEN for induction and maintenance of CD remission is still lacking. Due to the excellent safety profile of the treatment with enteral nutrition in comparison with other treatment modalities, further well-designed, randomised, controlled studies are necessary to elucidate the exact role of PEN in inducing and maintaining of remission in CD patients. Herein, the most relevant studies on the efficacy and the role of PEN in active and quiescent CD are reviewed

Non-alcoholic fatty liver disease in a pediatric patient with heterozygous familial hypobetalipoproteinemia due to a novel APOB variant: a case report and systematic literature review

BackgroundFamilial hypobetalipoproteinemia (FHBL) is an autosomal semi-dominant disorder usually caused by variants in the APOB gene that frequently interferes with protein length. Clinical manifestations include malabsorption, non-alcoholic fatty liver disease, low levels of lipid-soluble vitamins, and neurological, endocrine, and hematological dysfunction.MethodsGenomic DNA was isolated from the blood samples of the pediatric patient with hypocholesterolemia and his parents and brother. Next-generation sequencing (NGS) was performed, and an expanded dyslipidemia panel was employed for genetic analysis. In addition, a systematic review of the literature on FHBL heterozygous patients was performed.Case reportGenetic investigation revealed the presence of a heterozygous variant in the APOB (NM_000384.3) gene c.6624dup[=], which changes the open reading frame and leads to early termination of translation into the p.Leu2209IlefsTer5 protein (NP_000375.3). The identified variant was not previously reported. Familial segregation analysis confirmed the variant in the mother of the subject, who also has a low level of low-density lipoprotein and non-alcoholic fatty liver disease. We have introduced therapy that includes limiting fats in the diet and adding lipid-soluble vitamins E, A, K, and D and calcium carbonate. We reported 35 individuals with APOB gene variations linked to FHBL in the systematic review.ConclusionWe have identified a novel pathogenic variant in the APOB gene causing FHBL in pediatric patients with hypocholesterolemia and fatty liver disease. This case illustrates the importance of genetic testing for dyslipidemias in patients with significant decreases in plasma cholesterol as we can avoid damaging neurological and ophthalmological effects by sufficient vitamin supplementation and regular follow-ups

The choroid plexus as a sex hormone target: Functional implications

The choroid plexuses (CPs) are highly vascularized branched structures that protrude into the ventricles of the brain, and form a unique interface between the blood and the cerebrospinal fluid (CSF). In recent years, novel functions have been attributed to this tissue such as in immune and chemical surveillance of the central nervous system, brain development, adult neurogenesis and circadian rhythm regulation. Sex hormones (SH) are widely recognized as modulators in several neurodegenerative diseases, and there is evidence that estrogens and androgens regulate several fundamental biological functions in the CPs. Therefore, SH are likely to affect the composition of the CSF impacting on brain homeostasis. This review will look at implications of the CPs' sex-related specificities.Portuguese Foundation for Science and Technology (FCT, Portugal – http://www.fct.pt) project grants (PTDC/SAU-NEU/114800/2009); and by FEDER funds through the POCI – COMPETE 2020 – Operational Programme Competitiveness and Internationalisation in Axis I – Strengthening research, technological development and innovation (Project No. 007491) and National Funds by FCT – Foundation for Science and Technology (Project UID/Multi/00709). Joana Tomás was supported by a grant from CENTRO-07-ST24-FEDER-002015. Telma Quintela is a recipient of a FCT fellowship (SFRH/BPD/70781/2010). The work at ICVS/3B’s has the support of Portuguese North Regional Operational Program (ON.2 – O Novo Norte) under the National Strategic Reference Framework (QREN), through the European Regional Development Fund (FEDER). Fernanda Marques is a recipient of a FCT Investigator award (IF/00231/2013) of the Fundação para a Ciência e Tecnologia (FCT, Portugal)info:eu-repo/semantics/publishedVersio

R generalizations of fermat point

Če nad stranicami trikotnika z zunanje strani narišemo enakostranične trikotnike APB, BQC in CRA, se daljice AQ, BR in CP sekajo v Fermatovi točki Fe trikotnika ABC. Diplomsko delo prinaša nekatere posplošitve tega rezultata. Pri eni nad stranicami narišemo podobne enakostranične trikotnike. Pri drugi nad stranicami na primeren način narišemo podobne (ne nujno enakokrake) trikotnike. Obe omenjeni situaciji sta posebna primera splošnejše situacije, kjer pri vsakem oglišču od obeh stranic, ki se stikata v tem oglišču, navzven odmerimo enake kote. V naslednji posplošitvi iz trikotnika na primeren način ustvarimo šestkotnik in nad stranicami tega narišemo enakostranične trikotnike. Tudi tokrat smo priča dejstvu, da se tri daljice sekajo v skupni točki. Isto se zgodi, če enakostranične trikotnike namesto navznoter narišemo navzven.If we draw equilateral triangles APB, BQC in CRA on the outside of the given triangle ABC, the three segments AQ, BR and CP intersect in the Fermat point Fe of a triangle ABC. In the diploma thesis we present some generalizations of this result. Instead of equilateral triangles we draw similar isosceles triangles. Next we draw (in an appropriate manner) similar scalene triangles. Both mentioned situations are special cases of a more general situation, where at every vertex of a triangle we draw two rays, forming the same angle with the sides of a triangle that meet in that specific vertex. Repeating this in all three vertices with possibly different angles at different vertices, we end up with three triangles APB, BQC in CRA and concurrent lines AQ, BR and CP. Finally we start with a triangle and form a certain hexagon out of it. On the sides of this hexagon we again erect equilateral triangles and end up again with three concurrent lines. The same is true if the equilateral triangles are erected on the inside