Pediatric nonalcoholic fatty liver disease.

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The impact of nonalcoholic fatty liver disease on renal function in children with overweight/obesity

The association between nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease has attracted interest and attention over recent years. However, no data are available in children. We determined whether children with NAFLD show signs of renal functional alterations, as determined by estimated glomerular filtration rate (eGFR) and urinary albumin excretion. We studied 596 children with overweight/obesity, 268 with NAFLD (hepatic fat fraction >= 5% on magnetic resonance imaging) and 328 without NAFLD, and 130 healthy normal-weight controls. Decreased GFR was defined as eGFR < 90 mL/min/1.73 m(2). Abnormal albuminuria was defined as urinary excretion of >= 30 mg/24 h of albumin. A greater prevalence of eGFR < 90 mL/min/1.73 m2 was observed in patients with NAFLD compared to those without liver involvement and healthy subjects (17.5% vs. 6.7% vs. 0.77%; p < 0.0001). The proportion of children with abnormal albuminuria was also higher in the NAFLD group compared to those without NAFLD, and controls (9.3% vs. 4.0% vs. 0; p < 0.0001). Multivariate logistic regression analysis revealed that NAFLD was associated with decreased eGFR and/or microalbuminuria (odds ratio, 2.54 (confidence interval, 1.16-5.57); p < 0.05) independently of anthropometric and clinical variables. Children with NAFLD are at risk for early renal dysfunction. Recognition of this abnormality in the young may help to prevent the ongoing development of the disease

Advances in psychometrics: from Classical Test Theory to Item Response Theory

In the 20th century, development and evaluation of psychometric properties of tests was mainly based on the Classical Test Theory (CTT). Many tests are long and redundant, with measures influenced by the characteristics of the sample of the individuals being evaluated. Some of the limitations are a consequence of the use of the CTT. The Item Response Theory (IRT) has been proposed as a solution to some limitations of the CTT, improving the quality of assessment of the tests structure. In this paper we critically compare the characteristics of CTT and IRT methods in determining the psychometric properties of tests. We discuss the advantages and limitations of each method.No século XX, o desenvolvimento e avaliação das propriedades psicométricas dos testes se embasou principalmente na Teoria Clássica dos Testes (TCT). Muitos testes são longos e redundantes, com medidas influenciáveis pelas características da amostra dos indivíduos avaliados durante seu desenvolvimento, sendo algumas destas limitações consequências do uso da TCT. A Teoria de Resposta ao Item (TRI) surgiu como uma possível solução para algumas limitações da TCT, melhorando a qualidade da avaliação da estrutura dos testes. Neste texto comparamos criticamente as características da TCT e da TRI como métodos para avaliação das propriedades psicométricas dos testes. São discutidas as vantagens e limitações de cada método.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Pediatric nonalcoholic fatty liver disease.

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Nutritional evaluation and food intake of celiac disease patients compliant or not with a gluten-free diet

OBJECTIVE: This study evaluated the nutritional status and intakes of energy and macronutrients of celiac disease patients compliant or not with a gluten-free diet. METHODS: We studied 63 patients with celiac disease, 34 children and 29 adolescents. Noncompliance with a gluten-free diet was characterized by detection of antibodies to tissue transglutaminase in serum by recombinant human tissue transglutaminase antigen. Nutritional status was classified according to the weight-for-age, height-for-age, and body mass index Z-scores. Dietary intake was assessed by a 24-hour recall. RESULTS: The percentages of children and adolescents noncompliant with a gluten-free diet were 41.2% and 34.5%, respectively. Noncompliant children had a lower mean height-for-age Z-score than compliant children (p=0.024). However, noncompliant children had higher mean body mass index Z-score than compliant children (p=0.021). On the other hand, compliant adolescents had higher BMI than noncompliant adolescents (p=0.037). The food intake between the groups did not differ, but the energy intakes of 70.0% of the children and adolescents exceeded 120.0% of their requirements. CONCLUSION: Children who do not comply with a gluten-free diet have lower height-for-age Z-scores and higher body mass index Z-scores than children who comply. Compliant adolescents have a higher mean body mass index than noncompliant adolescents. High energy intake was observed in both children and adolescents.OBJETIVO: Avaliar o estado nutricional e a ingestão de energia e de macronutrientes de pacientes com diagnóstico de doença celíaca que transgrediam ou não a dieta isenta de glúten. MÉTODOS: Foram estudados 63 pacientes com doença celíaca: 34 crianças e 29 adolescentes. Transgressão à dieta isenta de glúten foi caracterizada por meio da dosagem sérica do anticorpo antitransglutaminase tissular recombiante humana. O estado nutricional foi avaliado com base nos escores-Z de peso/idade, estatura/idade e no índice de massa corporal. A ingestão alimentar foi avaliada por meio do inquérito alimentar de 24 horas. RESULTADOS: A transgressão à dieta sem glúten foi constatada em 41,2% das crianças e em 34,5% dos adolescentes. Nas crianças com transgressão alimentar, a média do escore-Z de estatura/idade foi inferior à das crianças do grupo que não transgredia (p=0,024). Todavia, o grupo com transgressão apresentou maior escore-Z do índice de massa corporal em relação aos que não transgrediam (p=0,021). Os adolescentes que não transgrediam apresentaram maior índice de massa corporal quando comparados aos que transgrediam a dieta (p=0,037). Em relação à ingestão alimentar, não se observou diferença estatística entre os grupos. Todavia, cerca de 70,0% das crianças e adolescentes apresentaram consumo de energia acima de 120,0% da recomendação. CONCLUSÃO: As crianças que transgrediam a dieta apresentaram menor escore-Z de estatura/idade e maior escore-Z para índice de massa corporal do que crianças que seguem sem transgressões alimentares. Os adolescentes que não transgrediam a dieta apresentaram maior média de índice de massa corporal quando comparados aos que transgrediam a dieta. Consumo energético elevado foi observado tanto nas crianças quanto nos adolescentes.Instituto Federal de Ouro PretoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

A Scoping Review on Teacher Agency for Inclusive Education: Mapping Existing Evidence and Conceptual Frameworks

In recent years, inclusive education research in Italy and internationally has reflected upon teacher agency and its implications for students’ full inclusion. Since teacher agency for inclusive education is an emerging theoretical construct, interpreted in different ways in the literature, it is first necessary to aggregate existing studies, appraising both theoretical conceptualizations and available evidence. To this objective, we conducted a systematic scoping review of recent international literature on the topic. Eight theoretical frameworks emerged from the literature. Also, barriers to teacher agency were mapped. Among those, the absence of structural resources, the dominant ableist culture, the perceived inadequacy in the relationship with the students with disability, the special education teacher unpreparedness on specific learning contents, the marginalization of the special education teacher, the absence of shared planning, and the lack of school administration support. On the other hand, teachers proved they are capable of change towards more inclusive practices thanks to resilience, teamwork, and beliefs on students’ abilities

The Relationship Between Widespread Pollution Exposure and Oxidized Products of Nucleic Acids in Seminal Plasma and Urine in Males Attending a Fertility Center

BACKGROUND: In recent decades, there has been an increase in male infertility, and in many cases, the etiology remains unclear. Several studies relate male hypo-fertility to xenobiotic exposure, even if no data exist about multiple exposure at the environmental level. METHODS: The study involved 86 males with diagnosis of idiopathic male infertility (IMI), and 46 controls with no alteration in sperm characteristics. Seminal plasma (SP) and urine samples were analyzed by liquid chromatography tandem mass spectrometry (LC-MS/MS) to quantify biomarkers of exposure (the main metabolites of benzene, toluene, 1,3-butadiene, 3-monochloropropanediol, styrene, and naphthol) and effect (oxidized products of nucleic acids). RESULTS: Biomarker concentrations were similar in subjects with IMI and controls even if a stronger correlation between biomarkers of exposure and effects were observed in SP. Data show that, both in SP and urine, most metabolites were inter-correlated, indicating a simultaneous co-exposure to the selected substances at the environmental level. Principal component analysis showed in SP the clustering of mercapturic acids indicating a preferential metabolic pathway with Glutathione (GSH) depletion and, consequently, an increase of oxidative stress. This result was also confirmed by multivariable analysis through the development of explanatory models for oxidized products of nucleic acids. CONCLUSIONS: This study highlights how oxidative stress on the male reproductive tract can be associated with a different representation of metabolic pathways making the reproductive tract itself a target organ for different environmental pollutants. Our results demonstrate that SP is a suitable matrix to assess the exposure and evaluate the effects of reproductive toxicants in environmental/occupational medicine. The statistical approach proposed in this work represents a model appropriate to study the relationship between multiple exposure and effect, applicable even to a wider variety of chemicals

Biochemical analysis of the DNA unwinding and strand annealing activities catalyzed by human RECQ1

RecQ helicases play an important role in preserving genomic integrity, and their cellular roles in DNA repair, recombination, and replication have been of considerable interest. Of the five human RecQ helicases identified, three are associated with genetic disorders characterized by an elevated incidence of cancer or premature aging: Werner syndrome, Bloom syndrome, and Rothmund-Thomson syndrome. Although the biochemical properties and protein interactions of the WRN and BLM helicases defective in Werner syndrome and Bloom syndrome, respectively, have been extensively investigated, less information is available concerning the functions of the other human RecQ helicases. We have focused our attention on human RECQ1, a DNA helicase whose cellular functions remain largely uncharacterized. In this work, we have characterized the DNA substrate specificity and optimal cofactor requirements for efficient RECQ1-catalyzed DNA unwinding and determined that RECQ1 has certain properties that are distinct from those of other RecQ helicases. RECQ1 stably bound to a variety of DNA structures, enabling it to unwind a diverse set of DNA substrates. In addition to its DNA binding and helicase activities, RECQ1 catalyzed efficient strand annealing between complementary single-stranded DNA molecules. The ability of RECQ1 to promote strand annealing was modulated by ATP binding, which induced a conformational change in the protein. The enzymatic properties of the RECQ1 helicase and strand annealing activities are discussed in the context of proposed cellular DNA metabolic pathways that are important in the maintenance of genomic stability

Renal function and physical fitness after 12-mo supervised training in kidney transplant recipients

To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations