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1.
Front Psychol ; 14: 1249556, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37842714

RESUMO

Romantic love and jealousy seem antagonistic, but the expression of both emotions have evolutionary functions that can go in the same direction of maintaining a relationship. Considering natural selection designed adaptations to solve the problems surrounding reproduction, then love and romantic jealousy are emotions aimed at staying cooperative for a period of time, where love solves the adaptive challenges of promoting pair bonding, cooperation, and protecting offspring; and jealousy is triggered by a threat or the loss of a valuable cooperative relationship, either on behalf of descendants in need of resources, or a close romantic bond. Consequently, understanding love and romantic jealousy points in the same adaptive functional domain of protecting a romantic pair bond. Specifically, love can be comprehended in two different ways and in regard to jealousy. First, conceiving love as the attachment to significant others one develops throughout lifetime, and secondly, it contemplates affective dependence. Results from a sample of single and committed individuals (n = 332) show the predicted positive correlation between attachment and jealousy as stable traits, consistent with previous literature. In addition, there is a non-significant and low correlation, respectively, between attachment and love as a measure of dependence. Furthermore, in the single participants group, jealousy was associated with love. The discussion emphasizes the need for expanding a functional account of love and jealousy as complementary emotions of our human affective endowment. Finally, it would be informative to study attachment as a relational trait and love as a specific affection for a romantic partner that could be manipulated to elucidate the functional design of jealousy.

3.
Sci Rep ; 13(1): 4969, 2023 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-37041216

RESUMO

People vary both in their embrace of their society's traditions, and in their perception of hazards as salient and necessitating a response. Over evolutionary time, traditions have offered avenues for addressing hazards, plausibly resulting in linkages between orientations toward tradition and orientations toward danger. Emerging research documents connections between traditionalism and threat responsivity, including pathogen-avoidance motivations. Additionally, because hazard-mitigating behaviors can conflict with competing priorities, associations between traditionalism and pathogen avoidance may hinge on contextually contingent tradeoffs. The COVID-19 pandemic provides a real-world test of the posited relationship between traditionalism and hazard avoidance. Across 27 societies (N = 7844), we find that, in a majority of countries, individuals' endorsement of tradition positively correlates with their adherence to costly COVID-19-avoidance behaviors; accounting for some of the conflicts that arise between public health precautions and other objectives further strengthens this evidence that traditionalism is associated with greater attention to hazards.


Assuntos
COVID-19 , Humanos , Pandemias , Motivação , Saúde Pública
4.
Biomater Adv ; 144: 213227, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36470174

RESUMO

The three-dimensional (3D) organization of cells affects their mobility, proliferation, and overall response to treatment. Spheroids, organoids, and microfluidic chips are used in cancer research to reproduce in vitro the complex and dynamic malignant microenvironment. Herein, single- and double-channel microfluidic devices are used to mimic the spatial organization of brain tumors and investigate the therapeutic efficacy of molecular and nano anti-cancer agents. Human glioblastoma multiforme (U87-MG) cells were cultured into a Matrigel matrix embedded within the microfluidic devices and exposed to different doses of free docetaxel (DTXL), docetaxel-loaded spherical polymeric nanoparticles (DTXL-SPN), and the aromatic N-glucoside N-(fluorenylmethoxycarbonyl)-glucosamine-6-phosphate (Fmoc-Glc6P). We observed that in the single-channel microfluidic device, brain tumor cells are more susceptible to DTXL treatment as compared to conventional cell monolayers (50-fold lower IC50 values). In the double-channel device, the cytotoxicity of free DTXL and DTXL-SPN is comparable, but significantly lowered as compared to the single-channel configuration. Finally, the administration of 500 µM Fmoc-Glc6P in the double-channel microfluidic device shows a 50 % U87-MG cell survival after only 24 h, and no deleterious effect on human astrocytes over 72 h. Concluding, the proposed microfluidic chips can be used to reproduce the 3D complex spatial arrangement of solid tumors and to assess the anti-cancer efficacy of therapeutic compounds administrated in situ or systemically.


Assuntos
Antineoplásicos , Neoplasias Encefálicas , Nanopartículas , Humanos , Docetaxel , Neoplasias Encefálicas/tratamento farmacológico , Dispositivos Lab-On-A-Chip , Microambiente Tumoral
5.
Proc Natl Acad Sci U S A ; 119(42): e2214005119, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36215511

RESUMO

How does the mind make moral judgments when the only way to satisfy one moral value is to neglect another? Moral dilemmas posed a recurrent adaptive problem for ancestral hominins, whose cooperative social life created multiple responsibilities to others. For many dilemmas, striking a balance between two conflicting values (a compromise judgment) would have promoted fitness better than neglecting one value to fully satisfy the other (an extreme judgment). We propose that natural selection favored the evolution of a cognitive system designed for making trade-offs between conflicting moral values. Its nonconscious computations respond to dilemmas by constructing "rightness functions": temporary representations specific to the situation at hand. A rightness function represents, in compact form, an ordering of all the solutions that the mind can conceive of (whether feasible or not) in terms of moral rightness. An optimizing algorithm selects, among the feasible solutions, one with the highest level of rightness. The moral trade-off system hypothesis makes various novel predictions: People make compromise judgments, judgments respond to incentives, judgments respect the axioms of rational choice, and judgments respond coherently to morally relevant variables (such as willingness, fairness, and reciprocity). We successfully tested these predictions using a new trolley-like dilemma. This dilemma has two original features: It admits both extreme and compromise judgments, and it allows incentives-in this case, the human cost of saving lives-to be varied systematically. No other existing model predicts the experimental results, which contradict an influential dual-process model.


Assuntos
Julgamento , Princípios Morais , Humanos , Motivação , Comportamento Social
6.
Proc Biol Sci ; 289(1982): 20220978, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-36069015

RESUMO

Differences in attitudes on social issues such as abortion, immigration and sex are hugely divisive, and understanding their origins is among the most important tasks facing human behavioural sciences. Despite the clear psychological importance of parenthood and the motivation to provide care for children, researchers have only recently begun investigating their influence on social and political attitudes. Because socially conservative values ostensibly prioritize safety, stability and family values, we hypothesized that being more invested in parental care might make socially conservative policies more appealing. Studies 1 (preregistered; n = 376) and 2 (n = 1924) find novel evidence of conditional experimental effects of a parenthood prime, such that people who engaged strongly with a childcare manipulation showed an increase in social conservatism. Studies 3 (n = 2610, novel data from 10 countries) and 4 (n = 426 444, World Values Survey data) find evidence that both parenthood and parental care motivation are associated with increased social conservatism around the globe. Further, most of the positive association globally between age and social conservatism is accounted for by parenthood. These findings support the hypothesis that parenthood and parental care motivation increase social conservatism.


Assuntos
Comparação Transcultural , Motivação , Atitude , Criança , Feminino , Humanos , Política , Gravidez , Inquéritos e Questionários
7.
J Colloid Interface Sci ; 594: 409-423, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-33774397

RESUMO

HYPOTHESIS: The selective permeation of molecules and nanomedicines across the diseased vasculature dictates the success of a therapeutic intervention. Yet, in vitro assays cannot recapitulate relevant differences between the physiological and pathological microvasculature. Here, a double-channel microfluidic device was engineered to comprise vascular and extravascular compartments connected through a micropillar membrane with tunable permeability. EXPERIMENTS: The vascular compartment was coated by endothelial cells to achieve permeability values ranging from ~0.1 µm/sec, following a cyclic adenosine monophosphate (cAMP) pre-treatment (25 µg/mL), up to ~2 µm/sec, upon exposure to Mannitol, Lexiscan or in the absence of cells. Fluorescent microscopy was used to monitor the vascular behavior of 250 kDa Dextran molecules, 200 nm polystyrene nanoparticles (PB), and 1,000 × 400 nm discoidal polymeric nanoconstructs (DPN), under different permeability and flow conditions. FINDINGS: In the proposed on-chip microvasculature, it was confirmed that permeation enhancers could favor the perivascular accumulation of ~200 nm, in a dose and time dependent fashion, while have no effect on larger particles. Moreover, the microfluidic device was used to interrogate the role of particle deformability in vascular dynamics. In the presence of a continuous endothelium, soft DPN attached to the vasculature more avidly at sub-physiological flows (100 µm/sec) than rigid DPN, whose deposition was larger at higher flow rates (1 mm/sec). The proposed double-channel microfluidic device can be efficiently used to systematically analyze the vascular behavior of drug delivery systems to enhance their tissue specific accumulation.


Assuntos
Células Endoteliais , Nanopartículas , Microvasos , Nanomedicina , Polímeros
8.
Artigo em Inglês | MEDLINE | ID: mdl-32140459

RESUMO

Fine-tuning loading and release of therapeutic and imaging agents associated with polymeric matrices is a fundamental step in the preclinical development of novel nanomedicines. Here, 1,000 × 400 nm Discoidal Polymeric Nanoconstructs (DPNs) were realized via a top-down, template-based fabrication approach, mixing together poly(lactic-co-glycolic acid) (PLGA) and poly(ethylene glycol)-diacrylate (PEG-DA) chains in a single polymer paste. Two different loading strategies were tested, namely the "direct loading" and the "absorption loading." In the first case, the agent was directly mixed with the polymeric paste to realize DPNs whereas, in the second case, DPNs were first lyophilized and then rehydrated upon exposure to a concentrated aqueous solution of the agent. Under these two loading conditions, the encapsulation efficiencies and release profiles of different agents were systematically assessed. Specifically, six agents were realized by conjugating lipid chains (DSPE) or polymeric chains (PEG) to the near-infrared imaging molecule Cy5 (DSPE-Cy5 A and DSPE-Cy5 B); the chemotherapeutic molecules methotrexate (DSPE-MTX and PEG-MTX) and doxorubicin (LA-DOX and DSPE-DOX). Moderately hydrophobic compounds with low molecular weights (MW) returned encapsulation efficiencies as high as 80% for the absorption loading. In general, direct loading was associated with encapsulation efficiencies lower than 1%. The agent hydrophobicity and MW were shown to be critical also in tailoring the release profiles from DPNs. On triple-negative breast cancer cells (MDA-MB-231), absorption loaded DOX-DPNs showed cytotoxic activities comparable to free DOX but slightly delayed in time. Preliminary in vivo studies demonstrated the high stability of Cy5-DPNs. Collectively, these results demonstrate that the pharmacological properties of DPNs can be finely optimized by changing the loading strategies (direct vs. absorption) and compound attributes (hydrophobicity and molecular weight).

9.
Mol Med ; 24(1): 2, 2018 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30134785

RESUMO

Trisomy of chromosome 21 (TS21) is the most common autosomal aneuploidy compatible with postnatal survival with a prevalence of 1 in 700 newborns. Its phenotype is highly complex with constant features, such as mental retardation, dysmorphic traits and hypotonia, and variable features including heart defects, susceptibility to Alzheimer's disease (AD), type 2 diabetes, obesity and immune disorders. Overexpression of genes on chromosome-21 (Hsa21) is responsible for the pathogenesis of Down syndrome (DS) phenotypic features either in a direct or in an indirect manner since many Hsa21 genes can affect the expression of other genes mapping to different chromosomes. Many of these genes are involved in mitochondrial function and energy conversion, and play a central role in the mitochondrial dysfunction and chronic oxidative stress, consistently observed in DS subjects.Recent studies highlight the deep interconnections between mitochondrial dysfunction and DS phenotype. In this short review we first provide a basic overview of mitochondrial phenotype in DS cells and tissues. We then discuss how specific Hsa21 genes may be involved in determining the disruption of mitochondrial DS phenotype and biogenesis. Finally we briefly focus on drugs that affect mitochondrial function and mitochondrial network suggesting possible therapeutic approaches to improve and/or prevent some aspects of the DS phenotype.


Assuntos
Síndrome de Down/metabolismo , Mitocôndrias/metabolismo , Animais , Síndrome de Down/genética , Humanos
10.
ACS Nano ; 12(2): 1433-1444, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29314819

RESUMO

The effect of nanoparticle size, shape, and surface properties on cellular uptake has been extensively investigated for its basic science and translational implications. Recently, softness is emerging as a design parameter for modulating the interaction of nanoparticles with cells and the biological microenvironment. Here, circular, quadrangular, and elliptical polymeric nanoconstructs of different sizes are realized with a Young's modulus ranging from ∼100 kPa (soft) to 10 MPa (rigid). The interaction of these nanoconstructs with professional phagocytic cells is assessed via confocal microscopy and flow cytometry analyses. Regardless of the size and shape, softer nanoconstructs evade cellular uptake up to 5 times more efficiently, by bone-marrow-derived monocytes, as compared to rigid nanoconstructs. Soft circular and quadrangular nanoconstructs are equally uptaken by professional phagocytic cells (<15%); soft elliptical particles are more avidly internalized (<60%) possibly because of the larger size and elongated shape, whereas over 70% of rigid nanoconstructs of any shape and size are uptaken. Inhibition of actin polymerization via cytochalasin D reduces the internalization propensity for all nanoconstruct types. High-resolution live cell microscopy documents that soft nanoconstructs mostly establish short-lived (<30 s) interactions with macrophages, thus diminishing the likelihood of recognition and internalization. The bending stiffness is identified as a discriminating factor for internalization, whereby particles with a bending stiffness slightly higher than cells would more efficiently oppose internalization as compared to stiffer or softer particles. These results confirm that softness is a key parameter in modulating the behavior of nanoparticles and are expected to inspire the design of more efficient nanoconstructs for drug delivery, biomedical imaging, and immunomodulatory therapies.


Assuntos
Nanoestruturas/química , Fagócitos/química , Polímeros/química , Animais , Células Cultivadas , Sistemas de Liberação de Medicamentos , Camundongos , Imagem Óptica , Tamanho da Partícula , Polímeros/síntese química , Células RAW 264.7
11.
Am J Gastroenterol ; 110(10): 1485-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26372508

RESUMO

OBJECTIVES: In 2012, European Society of Pediatric Gastroenterology, Hepatology, and Nutrition published novel guidelines on celiac disease (CD) diagnosis. Symptomatic children with serum anti-transglutaminase (anti-tTG) antibody levels ≥10 times upper limit of normal (ULN) could avoid duodenal biopsies after positive HLA test and serum anti-endomysial antibodies (EMAs). So far, both asymptomatic and symptomatic patients with anti-tTG titer <10 times ULN should undergo upper endoscopy with duodenal biopsies to confirm diagnosis. The aim of this study was to assess the accuracy of serological tests to diagnose CD in asymptomatic patients. METHODS: We retrospectively reviewed data of 286 patients (age range: 10 months to 17 years) with CD diagnosis based on elevated titer of anti-tTG, EMA positivity, and histology. All patients were distinguished between symptomatic and asymptomatic; histological lesions were graded according to the Marsh-Oberhuber (MO) criteria. Fisher exact test was applied to analyze both groups in terms of diagnostic reliability of serological markers. RESULTS: A total of 196 patients (68.53%) had anti-tTG titers ≥10 times ULN. Among them, a group of 156 patients (79.59%) also had symptoms suggestive of CD ("high-titer" symptomatic); of these, 142 patients (91.02%) showed severe lesion degree (3a, 3b, 3c MO). Conversely, 40 out of 196 patients (20.40%) were asymptomatic ("high-titer" asymptomatic) and 37 patients (92.5%) of them showed severe lesion degree (3a, 3b, 3c MO). No difference in histological damage was found between "high-titer" symptomatic and "high-titer" asymptomatic children (Fisher exact test, P=1.000). CONCLUSIONS: If confirmed in large multicenter prospective studies, the "biopsy-sparing" protocol seems to be applicable to both symptomatic and asymptomatic patients with anti-tTG titer ≥10 times ULN, positive EMA, and HLA-DQ2/DQ8.


Assuntos
Doenças Assintomáticas , Autoanticorpos/imunologia , Doença Celíaca/diagnóstico , Duodeno/patologia , Guias de Prática Clínica como Assunto , Adolescente , Biomarcadores , Biópsia/métodos , Doença Celíaca/genética , Doença Celíaca/imunologia , Criança , Pré-Escolar , Estudos de Coortes , Endoscopia do Sistema Digestório , Feminino , Proteínas de Ligação ao GTP/imunologia , Antígenos HLA-DQ/genética , Haplótipos , Humanos , Lactente , Masculino , Proteína 2 Glutamina gama-Glutamiltransferase , Reprodutibilidade dos Testes , Estudos Retrospectivos , Transglutaminases/imunologia
12.
N Engl J Med ; 371(14): 1295-303, 2014 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-25271602

RESUMO

BACKGROUND: The relationship between the risk of celiac disease and both the age at which gluten is introduced to a child's diet and a child's early dietary pattern is unclear. METHODS: We randomly assigned 832 newborns who had a first-degree relative with celiac disease to the introduction of dietary gluten at 6 months (group A) or 12 months (group B). The HLA genotype was determined at 15 months of age, and serologic screening for celiac disease was evaluated at 15, 24, and 36 months and at 5, 8, and 10 years. Patients with positive serologic findings underwent intestinal biopsies. The primary outcome was the prevalence of celiac disease autoimmunity and of overt celiac disease among the children at 5 years of age. RESULTS: Of the 707 participants who remained in the trial at 36 months, 553 had a standard-risk or high-risk HLA genotype and completed the study. At 2 years of age, significantly higher proportions of children in group A than in group B had celiac disease autoimmunity (16% vs. 7%, P=0.002) and overt celiac disease (12% vs. 5%, P=0.01). At 5 years of age, the between-group differences were no longer significant for autoimmunity (21% in group A and 20% in group B, P=0.59) or overt disease (16% and 16%, P=0.78 by the log-rank test). At 10 years, the risk of celiac disease autoimmunity was far higher among children with high-risk HLA than among those with standard-risk HLA (38% vs. 19%, P=0.001), as was the risk of overt celiac disease (26% vs. 16%, P=0.05). Other variables, including breast-feeding, were not associated with the development of celiac disease. CONCLUSIONS: Neither the delayed introduction of gluten nor breast-feeding modified the risk of celiac disease among at-risk infants, although the later introduction of gluten was associated with a delayed onset of disease. A high-risk HLA genotype was an important predictor of disease. (Funded by the Fondazione Celiachia of the Italian Society for Celiac Disease; CELIPREV ClinicalTrials.gov number, NCT00639444.).


Assuntos
Doença Celíaca/prevenção & controle , Dieta , Proteínas Alimentares/administração & dosagem , Glutens , Antígenos HLA/genética , Fatores Etários , Idade de Início , Autoanticorpos/sangue , Aleitamento Materno , Doença Celíaca/diagnóstico , Doença Celíaca/genética , Criança , Pré-Escolar , Feminino , Proteínas de Ligação ao GTP/imunologia , Genótipo , Gliadina/imunologia , Glutens/administração & dosagem , Humanos , Lactente , Recém-Nascido , Intestino Delgado/patologia , Estimativa de Kaplan-Meier , Masculino , Estudos Prospectivos , Proteína 2 Glutamina gama-Glutamiltransferase , Risco , Transglutaminases/imunologia
13.
J Pediatr Gastroenterol Nutr ; 59(6): 799-802, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25162363

RESUMO

OBJECTIVES: Metabolic bone disease remains a significant and common complication of celiac disease (CD). Several studies have demonstrated low bone mineral density (BMD) at the time of CD diagnosis in both children and adults. Low BMD in children and adolescents is defined as an areal BMD <2 SD below the age-adjusted mean value (z score <-2 SD). The aim of the study was to evaluate the BMD in a pediatric population with CD at diagnosis and to correlate z score value, anti-tissue transglutaminase type 2 antibody (anti-tTG2) titer, symptoms, and Marsh-Oberhuber (MO) grading. METHODS: We enrolled 99 patients with celiac disease (male 35, female 64) ages 4 to 15 years at the diagnosis. All of the patients had positive test results for anti-tTG2 antibodies and histological lesions graded according to MO classification, and underwent lumbar dual-energy x-ray absorptiometry. BMD was estimated by z score. RESULTS: Low BMD (z score ≤-2 SD) was found in 13 (13.13%) patients; 22 (22.22%) patients with CD showed -2 < z score ≤ -1; -1 < z score < 0 was found in 41 (41.41%) patients. z score ≥ 0 was detected only in 23 (23.23%) patients with CD. Mean BMD value in patients with CD is z score -0.68. No correlations were found between z score value and anti-tTG2 titer (Spearman ρ 0.13), between z score value and MO degree (Spearman ρ -0.17), and between z score and symptoms (Spearman ρ-0.10). CONCLUSIONS: BMD of patients with CD at diagnosis does not seem to correlate with MO degree, anti-tTG2 titer, and symptoms. At the moment, we do not have clinical predictors for low mineral density in children with CD.


Assuntos
Densidade Óssea , Doença Celíaca/complicações , Doença Celíaca/patologia , Adolescente , Autoanticorpos/análise , Doenças Ósseas Metabólicas/complicações , Doença Celíaca/imunologia , Criança , Pré-Escolar , Feminino , Proteínas de Ligação ao GTP , Humanos , Imunoglobulina A/análise , Masculino , Proteína 2 Glutamina gama-Glutamiltransferase , Estudos Retrospectivos , Transglutaminases/imunologia
14.
BMC Pediatr ; 14: 156, 2014 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-24947584

RESUMO

BACKGROUND: Chronic granulomatous disease is a rare inherited disorder of the innate immune system. In patients with a clinical history of recurrent or persistent infections, especially infections caused by uncommon species, chronic granulomatous disease should be considered. CASE PRESENTATION: We report the case of a 5-year-old boy with a presumptive diagnosis of Crohn's disease with extraintestinal manifestations. Chronic granulomatous disease was suspected in this case after Serratia marcescens was isolated from a skin ulcer culture. Granulomas were confirmed on histology and chronic granulomatous disease was diagnosed. CONCLUSION: This case emphasizes the importance of high clinical suspicion of an alternative diagnosis of immune deficiency in patients with presumed inflammatory bowel disease and opportunistic infections, especially when disease occurs in early life.


Assuntos
Doença de Crohn/diagnóstico , Doença Granulomatosa Crônica/diagnóstico , Infecções por Serratia/etiologia , Serratia marcescens/isolamento & purificação , Pré-Escolar , Diagnóstico Diferencial , Doença Granulomatosa Crônica/complicações , Humanos , Masculino , Infecções por Serratia/diagnóstico
15.
J Clin Gastroenterol ; 48(3): 264-6, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24504079

RESUMO

Autoimmune enteropathy (AIE) is a rare cause of small bowel villous atrophy, characterized by malabsorption, unresponsiveness to dietary restriction, circulating autoantibodies to enterocytes, and an overall predisposition to autoimmunity. Albeit mainly regarded as a disease of early childhood, several adult-onset AIE cases have been identified. This report describes for the first time the life-threatening clinical presentation and the management of overlapping AIE in a compliant-to-diet young celiac girl. A 13-year-old celiac girl was admitted because of vomiting, weight loss, diarrhea, hypoproteinemia, and neurological disturbances such as head tremors, vertical nystagmus, and lower limb hyperesthesia. Before this, she had always been compliant on a strict gluten-free diet and her medical history was unremarkable. The diagnosis of AIE was established on histologic findings and on the presence of antienterocyte antibodies. She was initially treated with high-dose Methylprednisolone and Azathioprine. However, only Infliximab proved itself as a highly effective tool for achieving clinical remission and restoring small bowel villous architecture.


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Fármacos Gastrointestinais/uso terapêutico , Jejuno/efeitos dos fármacos , Poliendocrinopatias Autoimunes/tratamento farmacológico , Adolescente , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Feminino , Humanos , Infliximab , Jejuno/imunologia , Jejuno/patologia , Poliendocrinopatias Autoimunes/diagnóstico , Poliendocrinopatias Autoimunes/imunologia , Indução de Remissão , Resultado do Tratamento
16.
Gastrointest Endosc ; 79(1): 95-100, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23886355

RESUMO

BACKGROUND: Despite great improvements in serologic testing, duodenal biopsies are still required to diagnose the majority of celiac disease (CD) cases. Nevertheless, the histologic pattern of CD is often patchy, leading to the risk of missing the diagnosis. OBJECTIVE: To evaluate the patchiness of the CD histologic lesions along the small bowel (SB), push enteroscopy has been performed instead of conventional upper GI endoscopy. DESIGN: Prospective, single-center study. SETTING: Tertiary-care referral center. PATIENTS: A total of 41 pediatric patients with suspected CD. INTERVENTION: Prospective evaluation of bulb, duodenal, and jejunal biopsy specimens in the diagnosis of CD. MAIN OUTCOME MEASUREMENTS: Pattern of lesion distribution along the SB (from bulb up to 60 cm beyond the ligament of Treitz) and yield as well accuracy of pediatric CD diagnosis by using push enteroscopy. RESULTS: There was a homogeneous pattern of histologic damage in 17 patients (41.5%), whereas 24 patients (58.5%) had a lesion pattern of patchiness. The second and fourth duodenal regions were involved in 38 children (92.7%) and 37 children (90.2%), respectively; the bulb was involved in 37 patients (90.2%); both distal and proximal jejunal samples showed histologic lesions in 38 children (92.7%). In 1 patient, without lesions in the bulb and duodenum, CD was diagnosed according to proximal and distal jejunal biopsies only (3B and C, respectively). A significant correlation was found between the degree of villous atrophy and the serum anti-transglutaminase titer. LIMITATIONS: Small sample size; academic tertiary-care setting. CONCLUSION: CD histologic lesions often have a discontinuous distribution along the SB, occasionally with an exclusive jejunal involvement. A high degree of villous atrophy correlates with a high anti-transglutaminase titer. When the new ESPGHAN "biopsy-sparing" criteria are not applicable, in case of potential CD, push enteroscopy might be a valuable second-step tool to re-evaluate and identify false "potential" CD hiding exclusive jejunal lesions.


Assuntos
Doença Celíaca/patologia , Duodeno/patologia , Endoscopia Gastrointestinal/métodos , Jejuno/patologia , Adolescente , Anticorpos/sangue , Biópsia , Doença Celíaca/sangue , Criança , Pré-Escolar , Feminino , Proteínas de Ligação ao GTP , Humanos , Lactente , Masculino , Estudos Prospectivos , Proteína 2 Glutamina gama-Glutamiltransferase , Transglutaminases/imunologia
17.
Nutrients ; 5(11): 4653-64, 2013 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-24264227

RESUMO

A gluten-free diet (GFD) is currently the only available treatment for patients with celiac disease (CD). Several clinical trials have demonstrated that most celiac patients can tolerate a medium-high quantity of oats without any negative clinical effects; however, the inclusion of oats in GFD is still a matter of debate. In this study, Italian children with CD were enrolled in a 15-month, randomized, double-blind, placebo-controlled multicenter trial. Participants were randomized in two groups following either A-B treatment (6 months of diet "A", 3 months of standard GFD, 6 months of diet "B"), or B-A treatment (6 months of diet "B", 3 months of standard GFD, 6 months of diet "A"). A and B diets included gluten-free (GF) products (flour, pasta, biscuits, cakes and crisp toasts) with either purified oats or placebo. Clinical data (Gastrointestinal Symptoms Rate Scale [GSRS] score) and intestinal permeability tests (IPT), were measured through the study period. Although the study is still blinded, no significant differences were found in GSRS score or the urinary lactulose/mannitol (L/M) ratio between the two groups after 6 months of treatment. These preliminary results suggest that the addition of non-contaminated oats from selected varieties in the treatment of children with CD does not determine changes in intestinal permeability and gastrointestinal symptoms.


Assuntos
Avena , Doença Celíaca , Dieta Livre de Glúten , Mucosa Intestinal/patologia , Adolescente , Doença Celíaca/complicações , Doença Celíaca/dietoterapia , Doença Celíaca/urina , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Gastroenteropatias/etiologia , Humanos , Itália , Lactulose/urina , Masculino , Manitol/urina , Permeabilidade , Sementes
19.
Surg Endosc ; 26(9): 2678-80, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22476825

RESUMO

A 2 month-old boy was admitted to the authors' hospital because of regurgitation and persistent cough during breastfeeding. A chest X-ray examination and a barium esophagogram disclosed small amounts of barium passing in the trachea, suggesting a tracheoesophageal fistula (TEF). Bronchoscopy combined with upper gastrointestinal (GI) endoscopy performed with the patient under general anesthesia confirmed the fistula. The TEF was treated by injection of 1 ml Glubran 2 from the esophageal side. A nasogastric tube was placed for feedings, and 7 days later, a barium esophagogram showed a reduction of caliber but not complete closure of the TEF. Unsuccessful fistula obliteration with Glubran was attributed to technical difficulties in catheterization of the fistula orifice, mainly resulting from its close proximity to the upper esophageal sphincter and to its small caliber. Therefore, an argon plasma coagulator (APC) probe with a circumferentially oriented nozzle was used from the esophageal side as an alternative technique to fulgurate the residual fistula orifice (see video). A nasogastric tube was placed for feedings. Oral feeding was started 7 days later when a barium esophagogram confirmed complete fistula closure. At the 2-year follow-up visit, the boy was asymptomatic, and the barium esophagogram was negative. This report describes a case in which esophagoscopy gave a clear view of the fistula due to its direction from esophagus to trachea. Complete fistula obliteration was not obtained with Glubran. However, APC was successfully used to close the residual fistula orifice. The authors suggest that APC can be used as an alternative endoscopic technique to repair TEF when other techniques fail.


Assuntos
Coagulação com Plasma de Argônio , Fístula Traqueoesofágica/cirurgia , Pré-Escolar , Humanos , Masculino
20.
J Pediatr Surg ; 47(2): 426-9, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22325407

RESUMO

Sporadic juvenile polyp of the jejunum is exceedingly rare, reported only once in the English literature. We describe a 3-year-old girl with a long-lasting history of chronic iron deficiency anemia and a delayed diagnosis of jejunal polyp. The lesion was eventually discovered by ultrasonography and successfully resected using a laparoscopic-assisted transumbilical approach.


Assuntos
Pólipos Intestinais/cirurgia , Neoplasias do Jejuno/cirurgia , Laparoscopia/métodos , Anemia Ferropriva/etiologia , Pré-Escolar , Diagnóstico Tardio , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Pólipos Intestinais/complicações , Pólipos Intestinais/diagnóstico por imagem , Intussuscepção/complicações , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico por imagem , Ultrassonografia
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