Gastric supply manipulation to modulate ghrelin production and enhance vascularization to the cardia: proof of the concept in a porcine model.

Introduction. Selective embolization of the left-gastric artery (LGA) reduces levels of ghrelin and achieves significant short-term weight loss. However, embolization of the LGA would prevent the performance of bariatric procedures because the high-risk leakage area (gastroesophageal junction [GEJ]) would be devascularized. Aim. To assess an alternative vascular approach to the modulation of ghrelin levels and generate a blood flow manipulation, consequently increasing the vascular supply to the GEJ. Materials and methods. A total of 6 pigs underwent a laparoscopic clipping of the left gastroepiploic artery. Preoperative and postoperative CT angiographies were performed. Ghrelin levels were assessed perioperatively and then once per week for 3 weeks. Reactive oxygen species (ROS; expressed as ROS/mg of dry weight [DW]), mitochondria respiratory rate, and capillary lactates were assessed before and 1 hour after clipping (T0 and T1) and after 3 weeks of survival (T2), on seromuscular biopsies. A celiac trunk angiography was performed at 3 weeks. Results. Mean (±standard deviation) ghrelin levels were significantly reduced 1 hour after clipping (1902 ± 307.8 pg/mL vs 1084 ± 680.0; P = .04) and at 3 weeks (954.5 ± 473.2 pg/mL; P = .01). Mean ROS levels were statistically significantly decreased at the cardia at T2 when compared with T0 (0.018 ± 0.006 mg/DW vs 0.02957 ± 0.0096 mg/DW; P = .01) and T1 (0.0376 ± 0.008mg/DW; P = .007). Capillary lactates were significantly decreased after 3 weeks, and the mitochondria respiratory rate remained constant over time at the cardia and pylorus, showing significant regional differences. Conclusions. Manipulation of the gastric flow targeting the gastroepiploic arcade induces ghrelin reduction. An endovascular approach is currently under evaluation.

The psychometric properties of the WAI in a career counseling setting: Comparison with a personal counseling sample

This study investigated the psychometric properties of the Working Alliance Inventory-Client version (WAI-C) and Working Alliance Inventory-Short and revised (WAI-SR) in a career counseling setting. Moreover, it compared the impact of career versus personal counseling settings based on results obtained using the WAI-SR. Subjects were 188 French-speaking career counseling clients and 95 French-speaking personal counseling clients, mainly students. For the career counseling sample, total reliability was .87 for the WAI-C and .76 for the WAI-SR. The shape of the distribution was normal but the variance was significantly lower for the career counseling sample. Exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) confirmed the presence of an overall working alliance factor but indicated a clearer hierarchical structure for the WAI- SR than for the WAI-C. The psychometric properties seemed only slightly affected by the counseling setting, suggesting that this inventory is also relevant for career counseling, especially the WAI-SR, which has a more robust factorial structure.