Mechanisms of Adenovirus-Mediated Autophagy

A patient diagnosed with a glioma, generally, has an average of 14 months year to live after implementation of conventional therapies such as surgery, chemotherapy, and radiation. Glioblastomas are highly lethal because of their aggressive nature and resistance to conventional therapies and apoptosis. Thus other avenues of cell death urgently need to be explored. Autophagy, which is also known as programmed cell death type II, has recently been identified as an alternative mechanism to kill apoptosis- resistant cancer cells. Traditionally, researchers have studied how cells undergo autophagy during viral infection as an immune response mechanism, but recently researchers have discovered how viruses have evolved to manipulate autophagy for their benefit. Extensive studies of viral-induced autophagy provide a rationale to investigate other viruses, such as the adenovirus, which may be developed as part of a therapy against cancers resistant to apoptosis. Despite the present and relatively poor understanding of the mechanisms behind adenoviral-induced autophagy, adenovirus is a promising candidate, because of its ability to efficiently eradicate tumors. A better understanding of how the adenovirus induces autophagy will allow for the development of viruses with increased oncolytic potency. We hypothesized that adenovirus induces autophagy in order to aid in lysis. We found that replication, not infection, was required for adenovirus-mediated autophagy. Loss of function analysis of early genes revealed that, of the early genes tested, no single gene was sufficient to induce autophagy alone. Examination of cellular pathways for their role in autophagy during adenovirus infection revealed a function for the eIF2α pathway and more specifically the GCN2 kinase. Cells lacking GCN2 are more resistant to adenovirus-mediated autophagy in vitro; in vivo we also found these cells fail to undergo autophagy, but display more cell death. We believe that autophagy is a protective mechanism the cell employs during adenoviral infection, and in the in vivo environment, cells cannot recover from virus infection and are more susceptible to death. Congruently, infected cells deficient for autophagy through deletion of ATG5 are not able undergo productive cell lysis, providing evidence that the destruction of the cytoplasm and cell membrane through autophagy is crucial to the viral life cycle. This project is the first to describe a gene, other than a named autophagy gene, to be required for adenovirus- mediated autophagy. It is also the first to examine autophagic cell death as a means to aid in viral-induced cell lysis.

Variability in the Treatment of Elderly Patients with Stage IIIA (N2) Non–Small-Cell Lung Cancer

INTRODUCTION: We evaluated treatment patterns of elderly patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC). METHODS: The use of surgery, chemotherapy, and radiation for patients with stage IIIA (T1-T3N2M0) NSCLC in the Surveillance, Epidemiology, and End Results-Medicare database from 2004 to 2007 was analyzed. Treatment variability was assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census track variables. Overall survival was analyzed using the Kaplan-Meier approach and Cox proportional hazard models. RESULTS: The most common treatments for 2958 patients with stage IIIA (N2) NSCLC were radiation with chemotherapy (n = 1065, 36%), no treatment (n = 534, 18%), and radiation alone (n = 383, 13%). Surgery was performed in 709 patients (24%): 235 patients (8%) had surgery alone, 40 patients (1%) had surgery with radiation, 222 patients had surgery with chemotherapy (8%), and 212 patients (7%) had surgery, chemotherapy, and radiation. Younger age (p < 0.0001), lower T-status (p < 0.0001), female sex (p = 0.04), and living in a census track with a higher median income (p = 0.03) predicted surgery use. Older age (p < 0.0001) was the only factor that predicted that patients did not get any therapy. The 3-year overall survival was 21.8 ± 1.5% for all patients, 42.1 ± 3.8% for patients that had surgery, and 15.4 ± 1.5% for patients that did not have surgery. Increasing age, higher T-stage and Charlson Comorbidity Index, and not having surgery, radiation, or chemotherapy were all risk factors for worse survival (all p values < 0.001). CONCLUSIONS: Treatment of elderly patients with stage IIIA (N2) NSCLC is highly variable and varies not only with specific patient and tumor characteristics but also with regional income level.

Optimal target localization for subthalamic stimulation in patients with Parkinson disease

OBJECTIVE To further determine the causes of variable outcome from deep brain stimulation of the subthalamic nucleus (DBS-STN) in patients with Parkinson disease (PD). METHODS Data were obtained from our cohort of 309 patients with PD who underwent DBS-STN between 1996 and 2009. We examined the relationship between the 1-year motor, cognitive, and psychiatric outcomes and (1) preoperative PD clinical features, (2) MRI measures, (3) surgical procedure, and (4) locations of therapeutic contacts. RESULTS Pre- and postoperative results were obtained in 262 patients with PD. The best motor outcome was obtained when stimulating contacts were located within the STN as compared with the zona incerta (64% vs 49% improvement). Eighteen percent of the patients presented a postoperative cognitive decline, which was found to be principally related to the surgical procedure. Other factors predictive of poor cognitive outcome were perioperative confusion and psychosis. Nineteen patients showed a stimulation-induced hypomania, which was related to both the form of the disease (younger age, shorter disease duration, higher levodopa responsiveness) and the ventral contact location. Postoperative depression was more frequent in patients already showing preoperative depressive and/or residual axial motor symptoms. CONCLUSION In this homogeneous cohort of patients with PD, we showed that (1) the STN is the best target to improve motor symptoms, (2) postoperative cognitive deficit is mainly related to the surgery itself, and (3) stimulation-induced hypomania is related to a combination of both the disease characteristics and a more ventral STN location.

Perioperative use of crystalloids in patients undergoing open radical cystectomy: balanced Ringer's maleate versus a glucose 5%/potassium-based balanced solution: study protocol for a randomized controlled trial

BACKGROUND The optimal crystalloid solution to use perioperatively in patients undergoing open radical cystectomy remains unclear. Many of the fluids used for intravenous hydration contain supraphysiologic concentrations of chloride, which can induce hyperchloremia and metabolic acidosis, resulting in renal vasoconstriction and decreased renal function. In addition, patients receiving less fluid and less sodium show faster recovery of gastrointestinal (GI) function after colonic surgery. METHODS AND DESIGN This is an investigator-initiated, single-center, randomized, controlled, parallel group trial with assessor-blinded outcome assessment, in the Department of Urology, University Hospital Bern, Switzerland. The study will involve 44 patients with bladder cancer scheduled for radical cystectomy and urinary diversion. The primary outcome is the duration between the end of surgery and the return of the GI function (first defecation). Secondary outcomes are fluid balance (body weight difference postoperatively versus preoperatively) and the incidence of kidney function disorders according to the Risk-Injury-Failure-Loss-End Stage Renal Disease (RIFLE classification). An equal number of patients are allocated to receive Ringerfundin® solution or a glucose/potassium-based balanced crystalloid solution as baseline infusion during the entire time that intravenous administration of fluid is necessary during the perioperative period. The randomized crystalloid solution is infused at a rate of 1 ml/kg/h until the bladder has been removed, followed by 3 ml/kg/h until the end of surgery. Postoperative hydration is identical in both groups and consists of 1,500 ml of the randomized crystalloid solution per 24 hours. Postoperative patient care is identical in both groups; patients are allowed to drink clear fluids immediately after surgery, and liquid diet is started on postoperative day 1, as well as active mobilization and the use of chewing gum. Body weight is measured daily in the morning. Time of first flatus and first defecation are recorded. DISCUSSION This trial assesses the benefits and harms of two different balanced crystalloid solutions for perioperative fluid management in patients undergoing open radical cystectomy with urinary diversion, with regard to return of GI function and effects on postoperative renal function. TRIAL REGISTRATION Current Controlled Trials ISRCTN32976792 (registered on November 21 2013).

SADMFR guidelines for the use of Cone-Beam Computed Tomography/ Digital Volume Tomography

Cone-Beam Computed Tomography (CBCT) has been introduced in 1998. This radiological imaging procedure has been provided for dentistry and is comparable to computed tomography (CT) in medicine. It is expected that CBCT will have the same success in dental diagnostic imaging as computed tomography had in medicine. Just as CT is responsible for a significant rise in radiation dose to the population from medical X-ray diagnostics, CBCT studies will be accompanied by a significant increase of the dose to our patients by dentistry. Because of the growing concern for an uncritical and consequently rapidly increasing use of CBCT the Swiss Society of Dentomaxillofacial Radiology convened a first consensus conference in 2011 to formulate indications for CBCT, which can be used as guidelines. In this meeting, oral and maxillofacial surgery, orthodontics and temporomandibular joint disorders and diseases were treated and the most important and most experienced users of DVT in these areas were asked to participate. In general, a highly restrictive use of CBCT is required. Justifying main criterion for CBCT application is that additional, therapy-relevant information is expected that should lead to a significant benefit in patient care. All users of CBCT should have completed a structured, high-level training, just like that offered by the Swiss Society of Dentomaxillofacial Radiology.

Patientensicherheit in der Shuntchirurgie

Zusammenfassung Hintergrund. Hämodialysepatienten, die operativ mit einem Gefäßzugang versorgt werden müssen, sind eine vulnerable Patientengruppe, die aufgrund von Multimorbidität, der intensiven und oft fragmentierten Behandlung und vieler Schnittstellen ein erhöhtes Risiko für vermeidbare unerwünschte Ereignisse tragen. Fragestellung. Aktuelle Entwicklungen und Maßnahmen zur Förderung der Patientensicherheit mit Fokus auf die Shuntchirurgie. Material und Methoden. Auswertung und Aufarbeitung aktueller Daten zur Patientensicherheit und Instrumenten zu ihrer Förderung. Ergebnisse. Fehler im nicht operativen Management verursachen einen wesentlichen Anteil der unerwünschten Ereignisse. Checklisten, präoperative Seitenmarkierung, Zählkontrollen und interprofessionelle Teamtrainings sind wichtige Instrumente der Patientensicherheit im OP. Standardisierungen von postoperativen Übergaben durch einfache Protokolle können erheblich zur Reduktion von Fehlern und Schädigungen beitragen. Die Sicherheitskultur einer Abteilung ist ein Umgebungsfaktor, der für die Effektivität dieser Sicherheitsbarrieren wesentlich ist. Schlussfolgerungen. Es existieren wirksame Instrumente, die die Patientensicherheit in der Shuntchirurgie fördern. Gerade an den Schnittstellen zur weiteren Versorgung können durch die konsequente Implementierung und Nutzung dieser Maßnahmen und ein aktives Sicherheitsmanagement unerwünschte Ereignisse vermieden werden. Die interprofessionelle und interdisziplinäre Zusammenarbeit und der Einbezug der Patienten sind wichtige Ressource für die Behandlungssicherheit, die stärker genutzt werden sollten.

Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures.

OBJECTIVE Vertebroplasty and balloon kyphoplasty are effective treatment options for osteoporotic vertebral compression fractures but are limited in correction of kyphotic deformity. Lordoplasty has been reported as an alternative, cost-effective, minimally invasive, percutaneous cement augmentation technique with good restoration of vertebral body height and alignment. The authors report on its clinical and radiological midterm results. METHODS A retrospective review was conducted of patients treated with lordoplasty from 2002 to 2014. Inclusion criteria were clinical and radiological follow-up evaluations longer than 24 months. Radiographs were accessed regarding initial correction and progressive loss of reduction. Complications and reoperations were recorded. Actual pain level, pain relief immediately after surgery, autonomy, and subjective impression of improvement of posture were assessed by questionnaire. RESULTS Sixty-five patients (46 women, 19 men, age range 38.9-86.2 years old) were treated with lordoplasty for 69 vertebral compression and insufficiency fractures. A significant correction of the vertebral kyphotic angle (mean 13°) and segmental kyphotic angle (mean 11°) over a mean follow-up of 33 months (range 24-108 months) was achieved (p < 0.001). On average, pain was relieved to 90% of the initial pain level. In 24% of the 65 patients a second spinal intervention was necessary: 16 distant (24.6%) and 7 adjacent (10.8%) new osteoporotic fractures, 4 instrumented stabilizations (6.2%), 1 new adjacent traumatic fracture (1.5%), and 1 distant microsurgical decompression (1.5%). Cement leakage occurred in 10.4% but was only symptomatic in 1 case. CONCLUSIONS Lordoplasty appeared safe and effective in midterm pain alleviation and restoration of kyphotic deformity in osteoporotic compression and insufficiency fractures. The outcomes of lordoplasty are consistent with other augmentation techniques.

Molecular mechanisms of response in gastrointestinal stromal tumors treated with imatinib mesylate

Gastrointestinal stromal tumors (GIST) represent 80% of sarcoma arising from the GI tract. The inciting event in tumor progression is mutation of the kit or, rarely, platelet derived growth factor receptor-α (PDGFR) gene. These mutations encode ligand independent, constitutively active proteins: Kit or PDGFR. ^ These tumors are notoriously chemo and radio resistant. Historically, patients with advanced disease realized a median overall survival of 9 months. However, with modern management of GIST with imatinib mesylate (Novartis), a small molecule inhibitor of the Kit, PDGFR, and Abl tyrosine kinases, patients now realize a median overall survival greater than 30 months. However, almost half of patients present with surgically resectable GIST and the utility of imatinib in this context has not been prospectively studied. Also, therapeutic benefit of imatinib is variable from patient to patient and alternative targeted therapy is emerging as potential alternatives to imatinib. Thus, elucidating prognostic factors for patients with GIST in the imatinib-era is crucial to providing optimal care to each particular patient. Moreover, the exact mechanism of action of imatinib in GIST is not fully understood. Therefore, physicians find difficulty in accurately predicting which patient will benefit from imatinib, how to assess response to therapy, and the time at which to assess response. ^ I have hypothesized that imatinib is tolerable and clinically beneficial in the context of surgery, VEGF expression and kit non-exon 11 genotypes portend poor survival on imatinib therapy, and imatinib's mechanism of action is in part due to anti-vascular effects and inhibition of the Kit/SCF signaling axis of tumor-associated endothelial cells. ^ Results herein demonstrate that imatinib is safe and increases the duration of disease-free survival when combined with surgery. Radiographic and molecular (namely, apoptosis) changes occur within 3 days of imatinib initiation. I illustrate that non-exon 11 mutant genotypes and VEGF are poor prognostic factors for patients treated with imatinib. These findings may allow for patient stratification to emerging therapies rather than imatinib. I show that imatinib has anti-vascular effects via inducing tumor endothelial cell apoptosis perhaps by abrogation of the Kit/SCF signaling axis. ^

Outcomes associated with chemotherapy in elderly patients with early stage operable breast cancer

Background. Various clinical trials have proved the efficacy of adjuvant chemotherapy in women with breast cancer. Chemotherapy efficacy and guidelines for its use differ by stage of tumor and age of the patient with no clear recommendations for patients aged 70 and above. Objective. To examine the clinical and economic outcomes associated with chemotherapy use in and to examine the disparities in treatment and survival in elderly patients with early stage operable breast cancer by age and axillary node status. Methods. We studied a cohort of 23,110 node positive and 31,572 node negative women aged 65 and over diagnosed with incident American Joint Committee on Cancer (AJCC) stage I, II or IIIa breast cancer between January 1, 1991 and December 31, 2002 using SEER-Medicare data. Total patient costs were estimated using the phase of care approach and adjusted cost estimates were obtained from regression analysis using a 3% discount rate. Cox proportional hazard ratio of mortality was used to determine the effectiveness of chemotherapy. Propensity score approach was also used to minimize the bias associated with receipt of chemotherapy. To assess disparity in treatment, multivariate logistic regression analyses were performed to assess the relative odds of receiving surgery, chemotherapy and radiation after BCS for African Americans compared to Whites. Results. Regression adjusted cost estimates for all node positive patients receiving chemotherapy was approximately $2,300 and was significantly higher (p<0.05) than for patients not receiving chemotherapy. Mortality was significantly lower in node positive and node negative women aged 65-74 years receiving chemotherapy. There was a significant difference between African American and White women in receiving BCS and radiation after BCS; however this difference was explained by patient demographics, tumor characteristics and socioeconomic status (SES). African American node positive women were 21% less likely to receive chemotherapy than White women (OR, 0.79; CI, 0.68-0.92) in multivariate analysis. Conclusion. Chemotherapy is associated with increased survival in patients aged 65-74 and total costs attributable to chemotherapy differ by phase and age of the patient. Underutilization of systemic adjuvant chemotherapy in African American women requires attention and may serve as potential areas for appropriate intervention.^

Resonancias de los paradigmas científicos en las arquitecturas de la Escuela de Madrid

Los años cincuenta y sesenta son los años de la incorporación definitiva de la arquitectura española al panorama internacional. Entre los arquitectos que protagonizan ese salto sin retorno, se encuentra el grupo de aquellos que unos años más tarde serán denominados por Juan Daniel Fullaondo como Escuela de Madrid. Carlos Flores, en su libro Arquitectura Española Contemporánea 1880-1950, se refiere a esos arquitectos como aquellos que se aplicaban a la difícil tarea de restablecer en España un tipo de arquitectura que conectaba con las teorías, soluciones y lenguajes establecidos por Europa durante las primeras décadas del siglo XX. Sigfried Giedion plantea en Espacio, Tiempo y Arquitectura el origen de una nueva tradición, surgida a partir de la revolución óptica de principios de siglo. Con tradición se refiere a una nueva cultura, que abarca la interrelación de las diferentes actividades del hombre: la similitud de los métodos que se usan en la arquitectura, la construcción, la pintura, el urbanismo o la ciencia. Esa novedad, fundamentada en su independencia y desvinculación con el periodo anterior, se inscribe dentro del esquema evolutivo que Thomas Kuhn plantea en su texto La Estructura de la Revoluciones Científicas, conforme a periodos no acumulativos. Kuhn habla del surgimiento de anomalías en cada periodo, origen de las crisis de pensamiento cuya explicación precisará un necesario cambio paradigmático. En la ciencia, en el campo de la óptica Thomas Young demuestra a principios del siglo XIX la naturaleza ondulatoria de la luz con su experimento de doble rendija; en el electromagnetismo se produce el salto conceptual que supone la postulación de la existencia del campo eléctrico por parte de Michael Faraday, y en termodinámica la consideración apuntada por Planck de que la radiación de la energía de produce de forma discreta, a través de cuantos. En las artes plásticas, paralelamente, Gleizes y Metzinger, en su recopilación de logros cubistas recogida en Sobre el Cubismo, hablan de la evolución sufrida durante el siglo XIX por la pintura: desde el idealismo de principios de siglo, para pasando por el realismo y la representación impresionista de la realidad, concluir prescindiendo de la perspectiva clásica. También la matemática, una vez desarrolladas por Gauss o Lobachevsky y Bolyai geometrías coherentes que incumplen el quinto postulado de Euclides, terminará dando validez a través de Riemann a los espacios ambiente en los que habitan dichas geometrías, desvinculando la relación directa entre espacio geométrico –el espacio ambiente al que da lugar un tipo de geometría- y el espacio físico. Capi Corrales refleja en su libro Contando el Espacio, cómo hasta la teoría de la relatividad y el cubismo, las geometrías no euclídeas no se hicieron notorias también fuera del campo de las matemáticas. El origen de la nueva tradición con la que Giedion se refiere a la nueva cultura de la modernidad coincide con los saltos paradigmáticos que suponen la teoría de la relatividad en las ciencias y el cubismo en las artes plásticas. Ambas se prolongan durante las primeras décadas hasta la teoría cuántica y la abstracción absoluta, barreras que los dos principales precursores de la relatividad y el cubismo, Einstein y Picasso, nunca llegan a franquear. En ese sentido Giedion habla también, además del origen, de su desarrollo, e incorpora las aportaciones periféricas en la arquitectura de Brasil, Japón o Finlandia, incluyendo por tanto la revisión orgánica propugnada por Zevi como parte de esa nueva tradición, quedando abierta a la incorporación tardía de nuevas aportaciones al desarrollo de esa cultura de la modernidad. Eliminado el concepto de la estética trascendental de Kant del tiempo como una referencia absoluta, y asumido el valor constante de la velocidad de la luz, para la teoría de la relatividad no existe una simultaneidad auténtica. Queda así fijada la velocidad de la luz como uno de los límites del universo, y la equivalencia entre masa y energía. En el cubismo la simultaneidad espacial viene motivada por la eliminación del punto de vista preferente, cuyo resultado es la multiplicidad descriptiva de la realidad, que se visualiza en la descomposición en planos, tanto del objeto como del espacio, y la consecuente continuidad entre fondo y figura que en arquitectura se refleja en la continuidad entre edificio y territorio. Sin la consideración de un punto de vista absoluto, no existe una forma auténtica. El cubismo, y su posterior desarrollo por las vanguardias plásticas, hacen uso de la geometría como mecanismo de recomposición de la figura y el espacio, adoptando mecanismos de penetración, superposición y transparencia. Gyorgy Kepes indica en El Lenguaje de la Visión que la descomposición cubista del objeto implica la sucesiva autonomía de los planos, hasta convertirse en elementos constituyentes. Algo que refleja las axonometrías arquitectónicas de Van Doesburg y que culmina con los espacios propuestos por Mies van der Rohe en sus primeros proyectos europeos. Estos mecanismos, encuentran eco en los primeros planteamientos de Javier Carvajal: en la ampliación del Panteón de españoles del cementerio de Campo Verano, un recinto virtual reconstruido mentalmente a partir del uso de tres únicos planos; o en el Pabellón de Nueva York, que organiza su planta baja desde el recorrido, introduciendo el parámetro temporal como una dimensión más. Al uso diferenciado del plano como elemento constituyente, Carvajal incorpora su plegado y su disposición conformando envolventes como mecanismo de cualificación espacial y formal, potenciando la prolongación entre arquitectura y territorio. Una continuidad que quedará culminada en las dos viviendas unifamiliares construidas en Somosaguas. La descomposición volumétrica conduce a unos niveles de abstracción que hace precisa la incorporación de elementos de la memoria -fuentes, patios, celosías…- a modo de red de señales, como las que Picasso y Braque introducen en sus cuadros para permitir su interpretación. Braque insiste en el interés por el espacio que rodea a los objetos. Una búsqueda de la tactilidad del espacio contraria a la perspectiva que aleja el objeto del observador, y que en los jardines de las viviendas de Somosaguas parece emanar de su propia materialidad. Un espacio táctil alejado del espacio geométrico y que Braque identifica con el espacio representativo en el que Poincaré, en La Ciencia y la Hipótesis, ubica nuestras sensaciones. Desdibujar los límites del objeto prolonga el espacio indefinidamente. Con el paso en el arte griego del mito al logos, se abre paso a la matemática como herramienta de comprensión de la naturaleza hasta el siglo XIX. Leon Lederman, en Simetría y la Belleza del Universo, apunta a que una de las mayores contribuciones de la teoría de Einstein es hacer cambiar el modo de pensar la naturaleza, orientándolo hacia la búsqueda de los principios de simetría que subyacen bajo las leyes físicas. Considerando que la simetría es la invariancia de un objeto o un sistema frente a una transformación y que las leyes físicas son las mismas en cualquier punto del espacio, el espacio de nuestro universo posee una simetría traslacional continua. En la ocupación del espacio de las primeras propuestas de Corrales y Molezún aparecen estructuras subyacentes que responden a enlosetados: paralelogramos sometidos a transformaciones continuas, que la naturaleza identifica tridimensionalmente con los grupos cristalográficos. Las plantas del museo de Arte Contemporáneo de la Castellana, la residencia de Miraflores, el pabellón de Bruselas o la torre Peugeot pertenecen a este grupo. La arquitectura como proceso de ocupación continua del territorio y de su trasposición al plano de cubierta, se materializa en líneas estructurales coincidentes con la estructura matemática de sus simetrías de traslación cuya posibilidad de prolongación infinita queda potenciada por el uso de la envolvente transparente. Junto a esta transparencia literal, inherente al material, Colin Rowe y Robert Slutzky nos alertan sobre otra transparencia inherente a la estructura: la transparencia fenomenal, ilustrada por los cuadros de Juan Gris, y cuya intuición aparece reflejada en la casa Huarte en Puerta de Hierro de Madrid. Corrales y Molezún insisten en una lectura de su volumetría alejada de la frontalidad, en la que los contornos de sus cubiertas inclinadas y las visuales tangenciales sugeridas por la organización de sus recorridos introducen una estructura diagonal que se superpone al entendimiento ortogonal de su planta, dibujando una intrincada red de líneas quebradas que permiten al espacio fluctuar entre las secuencia volumétrica propuesta. Los datos relativos al contenido energético de la luz y el concepto de átomo parten de la consideración de la emisión de energía en cuantos realizada por Planck, y concluyen con una circunstancia paradójica: la doble naturaleza de la luz -demostrada por la explicación de Einstein del efecto fotoeléctrico- y la doble naturaleza de la materia -asumida por Bohr y demostrada por el efecto Compton-. Schrödinger y Heisenberg formularán finalmente la ecuación universal del movimiento que rige en las ondas de materia, y cuya representación matemática es lo que se conoce como función de onda. El objeto es así identificado con su función de onda. Su ondulatoriedad expresará la probabilidad de encontrarse en un lugar determinado. Gyorgy Kepes subraya la necesidad de simplificar el lenguaje para pasar de la objetividad que aún permanece en la pintura cubista a la abstracción total del espacio. Y es así como los artistas plásticos reducen los objetos a simples formas geométricas, haciendo aflorar a la vez, las fuerzas plásticas que los tensionan o equilibran, en un proceso que acaba por eliminar cualquier atisbo de materia. Robert Rosenblum en La Pintura Moderna y la Tradición del Romanticismo Nórdico habla de cómo ese rechazo de la materia en favor de un vacío casi impalpable, campos luminosos de color denso que difunden un sereno resplandor y parecen engendrar las energías elementales de la luz natural, está directamente vinculado a la relación con la naturaleza que establece el romanticismo nórdico. La expresión de la energía de la naturaleza concentrada en un vacío que ya había sido motivo de reflexión para Michael Faraday en su postulación del concepto de campo eléctrico. Sáenz de Oíza incide en la expresión de la condición material de la energía en su propuesta junto a José Luis Romany para la capilla en el Camino de Santiago. La evocación de diferentes fuerzas electromagnéticas, las únicas junto a las gravitatorias susceptibles de ser experimentadas por el hombre, aparecerán visualizadas también en el carácter emergente de algunas de sus obras: el Santuario de Aránzazu o Torres Blancas; pero también en la naturaleza fluyente de sus contornos, la dispersión perimetral de los espacios -el umbral como centro del universoo la configuración del límite como respuesta a las tensiones germinales de la naturaleza. Miguel Fisac, a la vuelta de su viaje a los países nórdicos, aborda una simplificación lingüística orientada hacia la adecuación funcional de los espacios. En el Instituto de Daimiel, el Instituto de formación del profesorado o los complejos para los Padres Dominicos en Valladolid o Alcobendas, organiza progresivamente la arquitectura en diferentes volúmenes funcionales, incidiendo de un modo paralelo en la manifestación de los vínculos que se establecen entre dichos volúmenes como una visualización de las fuerzas que los tensionan y equilibran. En ellos la prolongación de la realidad física más allá de los límites de la envolvente ya es algo más que una simple intuición. Un proceso en el que el tratamiento de la luz como un material de construcción más, tendrá un especial protagonismo. En la iglesia de la Coronación, la iluminación del muro curvo escenifica la condición ondulatoria de la luz, manifestándose como si de un patrón de interferencia se tratara. Frente a la disolución de lo material, el espacio se manifiesta aquí como un medio denso, alejado de la tradicional noción de vacío. Una doble naturaleza, onda y partícula, que será intuido también por Fisac en la materia a través de su uso comprometido del hormigón como único material de construcción. Richard Feynmann nos alerta de la ocupación del espacio por multitud de fuerzas electromagnéticas que, al igual que la luz, precisan de receptores específicos para captar su presencia. Sus célebres diagramas suponen además la visualización definitiva de los procesos subatómicos. Al igual que la abstracción absoluta en las artes plásticas, esas representaciones diagramáticas no son asimilables a imágenes obtenidas de nuestra experiencia. Una intuición plasmada en el uso del diagrama, que irán adquiriendo progresivamente los dibujos de Alejandro de la Sota. La sección del gimnasio Maravillas recoge los trazos de sus principales elementos constructivos: estructura, cerramientos, compartimentaciones…, pero también, y con la misma intensidad, los de las fuerzas que generan su espacio, considerando así su condición de elementos constituyentes. El vacío, nos deja claro Sota, es el lugar donde habitan dichas tensiones. La posterior simplificación de las formas acompañadas de la obsesión por su aligeramiento, la casi desaparición de la envolvente, incide en aquella idea con la que Paul Klee define la actividad del artista en su Teoría del Arte Moderno, y en la que se transmite el distanciamiento hacia lo aparente: No se trata de reproducir lo visible, se trata de volver visible. Así, en Bankunión y Aviaco, como en tantos otros proyectos, frente al objetivo de la forma, Sota plantea el límite como la acotación de un ámbito de actuación. Su propia representación aséptica y diagramática transmite la renuncia a una especificidad espacial. Gilles Deleuze expresa ese posicionamiento en Pintura, el Concepto de Diagrama: el diagrama como la posibilidad de cuadros infinitos, o la posibilidad infinita de cuadros. Aparece así una concepción probabilística del espacio en la que frente a la renuncia por la forma, la tendencia al aligeramiento, y lo difuso de su definición – ideas claras, definición borrosa, en palabras de Llinás referidas al modo de operar de Sota-, la insistente atención a algunos elementos como escaleras, protecciones o miradores parece trasmitir la idea de que la arquitectura queda condensada en aquellos acontecimientos que delatan su condición dinámica, transitoria. Primando la relación frente al objeto, el vínculo frente a lo tangible. English summary. The fifties and sixties were the years of the final incorporation of Spanish architecture to the international scene. Among the architects who star that no return leap, is the group of those who a few years later will be named by Juan Daniel Fullaondo as Escuela de Madrid. Carlos Flores, in his book Arquitectura Española Contemporánea 1880-1950, refers to those architects as those that applied to the difficult task of restoring in Spain an architecture that connected with theories, solutions and established languages in Europe during the first decades of the twentieth century. Sigfried Giedion proposes in Space, Time and Architecture, the origin of a new tradition, arising from the optical revolution at the beginning of the century. With tradition he refers to a new culture, covering the interplay of different human activities: the similarity of the methods used in architecture, building, painting, urban planning or science. This new feature, based on its independence and detachment from the previous period, is part of the evolutionary scheme that Thomas Kuhn proposes in his text The Structure of Scientific Revolutions, according to non-accumulative periods. Kuhn talks about the emergence of anomalies in each period, origin of thought crisis whose explanation will require a paradigm shift needed. In science, in the field of optical Thomas Young demonstrates at the early nineteenth century the wave nature of light with its double-slit experiment , in electromagnetism the postulation of the existence of the electric field by Michael Faraday involves a conceptual leap, and in thermodynamic, the consideration pointed by Planck about quantum energy radiation. In the arts, in a parallel process, Gleizes and Metzinger , in his collection of cubism achievements on their book Du Cubisme, speak of evolution occurring during the nineteenth century by the painting: from the idealism of beginning of the century, going for realism and impressionist representation of reality, and finishing regardless of the classical perspective . Mathematics also, once developed by Gauss and Lobachevsky and Bolyai consistent geometries that violate Euclid's fifth postulate , will end validating Riemann’s ambient spaces in which these geometries inhabit, decoupling the direct relationship between geometric space -the space environment that results in a type of geometry- , and physical space. Capi Corrales reflectes in his book Contando el Espacio, that non-Euclidean geometries were not noticeable outside the field of mathematics until the theory of relativity and cubism. The origin of the new tradition that Giedion relates to the new culture of modernity coincides with paradigmatic leaps pointed by the theory of relativity in science and Cubism in the visual arts. Both are extended during the first decades until quantum theory and absolute abstraction, barriers that the two main precursors of relativity and cubism, Einstein and Picasso never overcome. In that sense Giedion speaks about the origin, but also the development, and incorporates peripheral inputs from Brazil, Japan and Finland architecture, thus including organic revision advocated by Zevi as part of this new tradition, being open to the late addition of new contributions to the development of that culture of modernity. Removed the concept of Kant's transcendental aesthetics, of time as an absolute reference, and assumed the constant value of the speed of light, theory of relativity says there is no authentic concurrency. It is thus fixed the speed of light as one of the limits of the universe, and the equivalence of mass and energy. In cubism, spatial simultaneity results from the elimination of preferential points of view, resulting in the multiplicity descriptive of reality, which is displayed in decomposition levels, both the object and the space, and the resulting continuity between figure and background that architecture is reflected in the continuity between building and land. Without the consideration of an absolute point of view, there isn’t an authentic shape. Cubism, and its subsequent development by the vanguard arts, make use of geometry as a means of rebuilding the figure and space, taking penetration mechanisms, overlapping and transparency. Gyorgy Kepes suggest in Languaje of Vision, that cubist decomposition of the object involves successive planes autonomy, to become constituent elements. Something that reflects the Van Doesburg’s architectural axonometrics and culminates with the spaces proposed by Mies van der Rohe in his first European projects. These mechanisms are reflected in the first approaches by Javier Carvajal: the extension of Spanish Pantheon in Campo Verano Cemetery, virtual enclosure mentally reconstructed from 24 the use of only three planes, or in the Spanish Pavilion of New York, which organizes its ground floor from the tour, introducing the time parameter as an additional dimension. Carvajal adds to the differential use of the plane as a constituent, Carvajal incorporates its folding and forming enclosures available as a mechanism for spatial and formal qualification, promoting the extension between architecture and territory. A continuity that will be completed in the two houses built in Somosaguas. Volumetric decomposition, as the fragmentation achieved in the last cubist experiences, needs the incorporation of elements of memory - fountains, patios, shutters...- as a network of signals, such as those introduced by Picasso and Braque in their paintings to allow their interpretation. Braque insists in his interest in the space surrounding the objects. A search of the tactility of space contrary to the perspective, which moves the observer away from the object, and that in the gardens of Somosaguas seems to emanate from its own materiality. A tactile space away from the geometric space and Braque identified with the representative space in which Poincaré in La Science et l´hypothèse, located our feelings. To blur those boundaries of the object extends the space indefinitely. With the passage in Greek art from myth to logos, it opens up to mathematics as a tool for understanding the nature until the nineteenth century. Leon Lederman, in Symmetry and beautiful Universe, suggests that one of the greatest contributions of Einstein's theory is to change the mindset of nature, namely the search for symmetry principles that underlie physical laws. Considering that symmetry is the invariance of an object or system from a transformation and that physical laws are the same at any point in space, the space of our universe has a continuous translational symmetry. In the space occupation of the first proposals by Corrales and Molezún underlying structures appear that match enlosetados: parallelograms under continuous transformations, which nature identifies tridimensionally with the crystallographic groups. Plants in the Contemporary Art Museum in La Castellana, the residence in Miraflores, the Brussels pavilion or the Peugeot tower belong to this group. The architecture as a process of continuous occupation of the territory and of its transposition to the deck, embodied in structural lines coincide with the mathematical structure of the translational symmetry and infinite extension whose possibility is enhanced by the use of the transparent cover. Alongside this literal transparency inherent to the material, Colin Rowe and Robert Slutzky alert us another transparency inherent in the structure: phenomenal transparency, illustrated by the Juan Gris’ works, and whose intuition is reflected in the Huarte’s house in Puerta de Hierro in Madrid. Corrales and Molezún insist on a reading of its volume away from the frontal, in which the outline of their inclined roofs and tangential visual suggested by the organization of his circulations introduce a diagonal structure which overlaps the orthogonal understanding of its plant, drawing an intricate web of broken lines that allow the space fluctuate between the volumetric sequence proposal. Information concerning to the energy mean of light and the concept of atom start from the consideration by Plank about the energy emission, and conclude with a paradoxical situation: the dual nature of light - demonstrated by the explanation of Einstein's photoelectric effect-, and the dual nature of matter -assumed by Bohr and demonstrated by the Compton effect-. Finally, Schrödinger and Heisenberg will formulate the universal movement equation governing in undulatory matter, whose mathematical representation is what is known as a wave function. The object is thus identified with its wave function. Its undulatory expression speaks about the probability of being found in a certain place. Gyorgy Kepes emphasizess the need to simplify the language to move from the objectivity that still remains in the cubist painting to the total abstraction of the space. And this is how artists reduced the objects to simple geometric shapes, making emerge at a time, the plastic forces that tense or balance them, in a process that eventually eliminate any trace of matter. Robert Rosenblum in Modern Painting and the Northern Romantic Tradition. Friedrich to Rothko talks about how this rejection of matter in an almost impalpable vacuum: dense color light fields that broadcast a serene glow and seem to generate the elemental energies of natural light is directly linked to the relationship with nature that sets the northern romanticism. An expression of the power of nature concentrated in a vacuum which had been reason for thought by Michael Faraday in his application of the concept of electric field. Saenz de Oíza touches upon the material expression of the energy in its proposal with Jose Luis Romany to the chapel on the Camino de Santiago. The presence of electromagnetic forces, the only ones with the gravitational one capable of being experienced by the man will also visualize in the emerging nature of some of his works: the sanctuary of Aránzazu or Torres Blancas, but also in the flowing nature of its contours, and the inclusion of interest in the realization of space fluctuating boundary: the threshold as the center of the universe. Miguel Fisac, back from his trip to the Northern Countries, starts on a linguistic simplification oriented to the functional adequacy of spaces. In the Daimiel Institute, in the Institute to Teacher Formation or in the complex to the Dominican Fathers in Valladolid or Alcobendas, progressively organized into different functional volumes architecture, focusing in a parallel way in the manifestation of the links established between these volumes as a visualization of the forces that tense and balance them. The prolongation of the physical reality beyond the limits of the envelope is already something more than a simple intuition. A process in which the treatment of light as a construction material, have a special role. In the Coronation church, curved wall lighting dramatizes the undulatory condition of the light, manifesting as if an interference pattern is involved. Versus the dissolution of the material, the space is expressed here as a dense atmosphere, away from the traditional notion of the vacuum. A dual nature, wave and particle, which is also sensed by Fisac in his committed use of concrete as a unique construction material. Richard Feynman alerts us to the occupation of space by many electromagnetic forces, which like the light, require specific receptors to capture their presence. His famous diagrams also involve the final visualization of atomic processes. As absolute abstraction in the visual arts, these representations are not assimilated to images obtained from our experience. A diagrammatic nature, abstracted from figuration, which will obtein the pictures of Alejandro de la Sota. The section of Maravillas gym collects traces of its main building blocks: structure, enclosures... but also, and with the same intensity, of the forces that generate their space as constituent elements. Sota makes it clear: the vacuum is where inhabit these tensions. The subsequent simplification of forms, accompanied by the obsession with his lightening, the near disappearance of the envelope, touches upon that idea which Paul Klee defines the activity of the artist in his Modern Art Theory, the spacing out to the apparent: it is not to reproduce the visible, it is to turn visible. Thus, in Bankunión and Aviaco, as in many other projects, against the shape, raises the limit as the dimension of a scope. His own aseptic and diagrammatic representation transmits waiver to a spatial specificity that Gilles Deleuze clearly expressed in Painting. The Concept Diagram: The diagram as the possibility of infinite pictures, or infinite possibility of the picture. Thus appears the probabilistic concept of space in which, opposite to the diffuse of its definition -clear ideas, diffuse definition, as Llinas said- the insistent attention to some elements like stairs, guards or lookouts seems to concentrate the architecture in its dynamic condition, transitional. The relationship opposite the object, the link opposite the tangible.

Arquitectura antidesertización. Fluidez, biodiversidad, hidrofilia y transpirabilidad

La escasez de recursos, la desertización creciente y el previsible calentamiento global forman un escenario físico sin precedentes que urge la revisión de las relaciones entre arquitectura y agua en la urbanización de los paisajes secos, donde la aridez es el factor limitante principal. Cuestionar la idea de escasez, la de residuo o la de confort es el punto de partida para analizar la hidrología urbana. La condición ubicua y dinámica del agua, sus continuos cambios de estado y las implicaciones energéticas y ambientales involucradas argumentan a favor de un entendimiento integral, holístico, que aborda el diseño en relación a lo paisajístico, lo infraestructural y lo ambiental como un único ámbito de investigación, planteado en términos no solo de materia o de escasez, sino de energía. Este trabajo se interesa por el rol de la arquitectura en este proyecto conjunto, integral, del espacio físico con el ciclo hidrológico donde lo orgánico, lo geológico y lo atmosférico están ligados, y donde las categorías de lo hidrológico y lo hidráulico se confunden. Las profundas implicaciones culturales en la construcción de la naturaleza urbana y en la relación con el cuerpo humano adquieren especial notoriedad en los modelos de paisaje y de espacio público adoptados, importados desde las geografías húmedas, y en la estigmatización del agua desde los presupuestos del higienismo decimonónico, que conduce al hidrofugado general de una ciudad aséptica y estéril, que se extiende hasta las envolventes de fachadas estancas y los interiores blancos y satinados. La búsqueda de referentes salta la modernidad hacia contextos de baja energía como el oasis tradicional de las tierras áridas, que concilia la formación de un ecosistema productivo con la climatización de un espacio público exterior, o los ambientes aislados de la investigación aeroespacial, con ciclos cerrados de materia. Las condiciones del ciclo del agua, como la vinculación con el suelo y el territorio, la capacidad de disolver, de mezclarse y de lavar, su volumen variable y su papel como termorregulador señalan el interés que características físicas como la fluidez, la biodiversidad, la hidrofilia y la transpirabilidad tienen para una arquitectura con competencias hidráulicas y un espacio urbano transparente a los procesos del agua. La morfología y localización, la elección de escalas, jerarquías y relaciones entre espacios y la reformulación de los sistemas constructivos aparecen como herramientas y categorías propias desde las que proponer mejores respuestas a problemas como la deshidratación, la erosión y la contaminación. Una urbanización permeable e hidrófila que absorba el agua como un recurso valioso, nuevos ensamblajes para la bioquímica urbana (que introduzcan una idea de limpieza más próxima a fertilidad que a la desinfección), y el diseño de las condiciones atmosféricas a través de una arquitectura transpirable, que se empapa y rezuma frescor, son las claves de este nuevo proyecto. La ciudad se piensa como una síntesis multiescalar de espacios hidráulicos que aporta mayor resiliencia frente a la desertificación y las condiciones climáticas extremas, y mayor visibilidad en la escena pública al agua y a las inevitables conexiones entre ecología y economía. Pero también es una oportunidad para revisar las categorías disciplinares, para renovar las consistencias materiales, las calidades ambientales y las relaciones entre el cuerpo y el espacio. ABSTRACT The shortage of resources, foreseeable global warming and increasing desertification create an unprecedented prospect that question the existing relationships between water and architecture, in the urbanization of the arid lands. The awareness of the huge volumes of water that pierce unnoticed through urban space, their impact on the landscape as well as on environmental qualities, promote a design field where cultural, social and political considerations intersect, related to the body and the physical experience of space within the built environment. Fluidity and ubiquity, solution ability, variability and cyclical processes are characteristic of water as material, directly related with the fields of potential, chemical and thermal energy and the reality of its mass, as it occupies a changing volume in space. These are also the imposing cross sections that water introduces into the project, that argue in favor of a comprehensive and holistic understanding, of addressing design in relationship to landscape, infrastructure and environmental issues as a one single area of research. This work attempts to investigate how architecture, with its specific tools, can partake in the design of water cycle in the space, linking the organic, geological, and atmospheric, blurring the lines between hydrology and hydraulic. It aims to identify issues, within the continuous query associated with water, that deal with the architectural project and may have here better results. The deep cultural implications in the construction of urban nature and the relationship with the body, acquire special notoriety in the models of landscape and public space adopted, imported from humid geographies. Also in the stigmatization of water from the premises of nineteenth- century hygienics, which lead to the entire waterproofing of an aseptic and sterile city, to the sealed facades and white and polished interiors. The search for alternative references goes beyond modernity towards a mindset of low energy, as the traditional oasis of arid lands, which aims to reconcile the formation of a productive ecosystem with the conditioning of an outdoor public space, or the controlled environments of aerospace research, with closed cycles of matter. Fluidity, biodiversity, hydrophilicity and breathability are characteristic of an architecture with hydraulic competences. The distributing phenomenon of water, its necessary connectivity to the ground and to small cycles in the ecosystems, shows strong affinities with an infrastructural architecture, as an alternative to large-scale centralized networks. Its volume has approximated to the dimensions of the built space, promoting a new found condition of coexistence. A permeable and hydrophilic urbanization absorbs water as a valuable resource; new assemblies for urban biochemistry introduce an idea of sanitation closer to fertility than to disinfection; a breathable architecture that soaks and exudes freshness design the atmospheric conditions: these are the essential components of this new project. The city is understood as a synthesis of multi-scale hydraulic spaces that provides greater resilience against desertification and increases the visibility of water and the linkages between ecology and economy in the public scene. It is also an opportunity to review the disciplinary categories of architecture, the material consistencies, the environmental qualities and the relationship between body and space.

A pedagogically-supported TEL solution for learning nontechnical minimally invasive surgical skills across Europe

Residents learning nontechnical skills in Europe face two problems: (1) the difficulty to fit learning time in their overloaded schedules; and (2) the lack of standard pedagogical models for all countries. Online video-based repositories such as WeBSurg or WebOP provide ubiquitous access to surgical contents. However, their pedagogical facets have not been fully exploited and they are often seen as quick-reference repositories rather than full e-learning alternatives. We present a new pedagogically-supported Technology Enhanced Learning (TEL) solution, MISTELA, designed by surgeons, pedagogical experts and engineers. MISTELA aims at building a common European pedagogical model supported by ICT technologies and elearning. The solution proposes a pedagogical model based on a framework for pedagogically-informed design of e-learning platforms. It is composed of (1) an authoring tool for editing and augmenting videos; (2) a media asset management system; and (3) a virtual learning environment. Support of the European Association for Endoscopic Surgery (EAES) and validation of the solution, will help to determine its full potential.

Efeito da cirurgia bariátrica sobre parâmetros clínicos, laboratoriais e fatores de risco cardiovascular

Introdução - Na prevenção primária das doenças cardiovasculares, a adoção de estilo de vida saudável representa uma das estratégias mais importantes. Entretanto, baixos índices de adesão e o abandono da dieta constituem obstáculo importante ao tratamento. Neste sentido, as intervenções cirúrgicas surgiram como um mecanismo promotor da restrição alimentar e têm ganhado importância não só pelo tratamento da obesidade como também no controle dos fatores de risco cardiovascular e na possível redução da mortalidade. Através de estudos clínicos foi possível observar que estas estratégias cirúrgicas promovem profundas modificações estruturais no trato gastrointestinal gerando aumento da saciedade e da sensibilidade à insulina. Em especial para os pacientes diabéticos, por si só associados a maior risco cardiovascular, as cirurgias bariátricas seriam capazes de promover um efeito muito intenso e agudo sobre os marcadores relacionados ao desenvolvimento da aterosclerose. Um evento muito definido no tempo como uma intervenção cirúrgica pode ser muito útil para o estudo e identificação de mecanismos que ainda não estão completamente estabelecidos no processo aterosclerótico. Objetivos - Analisar o comportamento das variáveis laboratoriais, clínicas e estruturais relacionadas ao desenvolvimento e progressão da aterosclerose em indivíduos diabéticos submetidos à cirurgia bariátrica. Métodos - Foram incluídos vinte voluntários diabéticos refratários ao tratamento clínico e que apresentavam obesidade abdominal. Deste grupo, metade foi aleatoriamente selecionada para realização da cirurgia bariátrica e metade foi mantida em tratamento clínico otimizado. Todos os participantes foram submetidos a exames clínicos e bioquímicos nas mesmas ocasiões, até trinta dias antes da cirurgia, três e vinte e quatro meses após a cirurgia. Nestas ocasiões além do perfil lipídico e da glicemia, determinamos os hormônios incretínicos, adipocinas. A avaliação da quantidade de gordura epicárdica e a presença de esteatose hepática será realizada somente após dois anos de seguimento em conjunto com as demais variáveis,. Foram incluídos também 10 indivíduos saudáveis e com IMC dentro da normalidade, como parte do grupo controle. Estes indivíduos foram submetidos à coleta de sangue em dois momentos para avaliação dos mesmos metabólitos. Resultados - No momento pré-intervenção os indivíduos do grupo cirúrgico e clinico eram diferentes em relação ao IMC, Glicemia e Triglicérides, sendo assim, os resultados obtidos foram ajustados minimizando o impacto destas diferenças. Após o seguimento de 3 meses, o grupo cirúrgico apresentou redução significativa nos valores de peso, IMC (33,4 ± 2,6 vs. 27,4±2,8 kg/m2, p < 0,001), HbA1c (9,26 ± 2,12 vs. 6,18±0,63%, p < 0,001), CT (182,9 ± 45,4 vs. 139,8 ± 13 mg/dl, p < 0,001), HDL (33,1 ± 7,7 vs. 38,4 ± 10,6 mg/dL, p < 0,001), TG (369,5 ± 324,6 vs. 130,8 ± 43,1 mg/dL, p < 0,001), Pro-insulina (12.72±9,11 vs. 1,76±1,14 pM, p < 0,001), RBP-4 (9,85±2,53 vs. 7,3±1,35 ng/ml, p < 0,001) e CCK (84,8±33,2 vs. 79,9 ± 31,1, ng/ml, p < 0,001), houve também aumento significativo nos níveis de HDL-colesterol (33,1 ± 7,7 vs. 38,4 ± 10,6 mg/dL, p < 0,001), Glucagon (7,4 ± 7,9 vs. 10,2±9,7 pg/ml, p < 0,001) e FGF- 19 (74,1 ± 45,8 vs. 237,3 ± 234 pg/ml, p=0,001). Um dado interessante foi que os valores de Pro-insulina, RBP-4, HbA1c e HDL- colesterol no grupo cirúrgico atingiram valores similares àqueles do grupo controle três meses após a intervenção, sendo que o FGF-19 apresentava valor duas vezes maior do que o encontrado no grupo de indivíduos saudáveis (237 ± 234 vs. 98 ± 102,1 pg/ml). O grupo clínico não apresentou variação nas variáveis clinicas, apenas nos valores de glucagon com redução significativa no período pós-intervenção (18,1 ± 20,7 vs. 16,8 ± 18,4 pg/ml, p < 0,001). Conclusão - Concluímos que indivíduos diabéticos descompensados e refratários ao tratamento clínico, quando submetidos à cirurgia bariátrica, apresentam uma alteração profunda do ponto de vista clínico, metabólico e hormonal, em relação ao indivíduos de mesmo perfil mantidos em tratamento clínico otimizado. Esta importante alteração, observada já com três meses após a intervenção, pode representar uma importante redução do risco cardiovascular nestes indivíduos. Individualmente, a notável modificação dos valores de FGF-19 associadas à intervenção devem ser estudadas com maior profundidade para compreensão de seu significado e sua potencial utilidade como marcador ou como um dos protagonistas no mecanismo de prevenção cardiovascular

Notebook of Moses Appleton, 1794-1837 (inclusive)

Contains notes taken by Moses Appleton (1773-1849) on anatomy lectures delivered at Harvard by John Warren (1753-1815). Other lecture topics included midwifery and surgery. Also includes a transcript of an examination given by Warren to his students on anatomy and surgery, as well as exams given by Harvard Professor Benjamin Waterhouse (1754-1846) and Harvard Professor Aaron Dexter (1750-1829) on the theory and practice of physic, and chemistry, respectively. There are additionally patient case notes and transcriptions of notes and correspondence from physicians Appleton consulted, and a list of operations Appleton performed between 1796 and 1828, primarily repairing dislocated joints and fractured bones. Also includes obituaries of citizens of Waterville, Maine, from 1807 to 1837.