La ficción autobiográfica y la identidad narrativa.

Los estudios literarios permiten la reformulación de sus propias interpretaciones, de modo que las posibilidades de comprensión de los mismos se establezcan a partir de procesos de lectura que aproximan la obra al mundo. El mundo es la matriz de la obra literaria, por consiguiente, en el proceso de creación hay una interpretación del mundo, una exposición de una tesis de y sobre el mundo. La propuesta teórica de Paul Ricoeur permite realizar una lectura de la obra literaria que favorece su apertura a los diferentes significados. Así, el método hermenéutico se propone como una posibilidad de diálogo, mediado por algunas categorías epistemológicas como ficción, autobiografía, identidad narrativa, formuladas por Ricoeur, en algunas de sus obras.

Milton Hatoum: la narración transcultural y nómada que reconstruye el amazonas.

La noción teórica de que constituye el dispositivo conceptual de la propuesta aquí presentada, asociada a las categorías de multiculturalismo, figura del extranjero, difuminación de fronteras e imagen del Amazonas, orientan el trabajo heurístico con los textos escogidos como corpus, el libro de cuentos A cidade ilhada (2009) y circunscriben sus alcances y limitaciones. Lo que se pretende en esta investigación es construir una teoría de análisis del discurso hatoumiano desde su intelección ideológico-política. Y para ello, el «recorte» procedimental de las categorías enunciadas, sirve como línea transversal de lectura que despliega las significaciones narrativas y las transforma en enunciados de valor y toma de posición. La mundaneidad constituyente de la narrativa de Milton Hatoum, demanda una revisión de los elementos que conforman el tejido de su narrativa. Leer la ficción del escritor desde esta perspectiva significa entender la realidad brasileña contemporánea intrínsecamente unida a la historia más remota y también a la más reciente. Esta realidad está, para el autor, estrechamente vinculada con las políticas, instituciones, ideologías, sociedad y familia, de la cual su ficción da cuenta. La conjunción de las nociones destacadas y su dinamicidad dialéctica entre dispositivo y texto, aseguran la constitución de un referencial teórico que pretende instalar en el aparato crítico sobre la ficción del autor brasileño, un dispositivo conceptual a partir del cual dialogar con su ideología.

Associação entre peso de nascimento e fatores de risco cardiovascular em adolescentes

FUNDAMENTO: Peso ao nascer (PN) é um determinante de risco a médio e longo prazo de fatores de risco cardiovascular. OBJETIVO: Estudar a associação entre peso ao nascer e fatores de risco cardiovascular em adolescentes de Salvador. MÉTODOS: Estudo de corte transversal com grupos de comparação por PN. Amostra composta de 250 adolescentes, classificados segundo IMC: normal alto (>p50 e PN < 2.500g), peso normal (2.500g<PN<4.000g) e alto peso (PN > 4.000g). RESULTADOS: Cento e cinquenta e três (61,2%) meninas, idade 13,74 ± 2,03 anos, PN normal 80,8%, baixo PN 8,0% e alto PN 11,2%. Observou-se maior frequência de obesidade (42,9%, p=0,005), PAS e PAD elevadas (42,9%, p=0,000 e 35,7%, p=0,007, respectivamente) e síndrome metabólica (46,4%,p =0,002) no grupo com PN alto em relação ao PN normal. Indivíduos de alto PN apresentaram RP para PAS elevada 3,3(I.C. 95%, 1,7-6,4) e para obesidade 2,6 (I.C. 95%, 1,3-5,2) em relação aos com PN normal. A CA foi 83,3 ± 10,1 [p=0,038] nos adolescentes com alto PN. O perfil lipídico não mostrou diferenças estatisticamente significantes. CONCLUSÃO: Os dados sugerem que obesidade, PAS e PAD elevadas e síndrome metabólica na adolescência têm chance significativa de associar-se a alto peso no nascimento.

Intramolekulare Determinanten des Membran-assoziierten Guanylatkinase-Homologen DLG (Discs Large) für die subzelluläre Lokalisation in larvalen Körperwandmuskeln von Drosophila melanogaster

Drosophila melanogaster, synapse, neuromuscular junction, MAGuK

Untersuchungen zum Dotieren von Silicium aus einer Oberflächenbelegung mit Phosphor in einem Kurzzeitprozess

Silicon, shallow junction, rapid thermal doping, vapour phase doping, atomic-layer doping, phosphorus diffusion, phosphine adsorption, sheet resistance, four-point probe, native oxidation

Análise da variação qualitativa em amostras pequenas

Na aplicação do X2-teste devemos distinguir dois casos : Á) Quando as classes de variáveis são caracterizadas por freqüências esperadas entre p = 0,1 e p = 0,9, podemos aplicar o X2-teste praticamente sem restrição. É talvez aconselhável, mas não absolutamente necessário limitar o teste aos casos nos quais a freqüência esperada é pelo menos igual a 5. e porisso incluimos na Táboa II os limites da variação de dois binômios ( 1/2 + 1/2)n ( 1/4 + 3/4)n para valo r es pequenos de N e nos três limites convencionais de precisão : ,5%, 1% e 0,1%. Neste caso, os valores dos X2 Índividuais têm apenas valor limitado e devemos sempre tomar em consideração principalmente o X2 total. O valor para cada X2 individual pode ser calculado porqualquer das expressôe seguintes: x2 = (f obs - f esp)²> f. esp = ( f obs - pn)2 pn = ( f obs% - p)2.N p% (100 - p%) O delta-teste dá o mesmo resultado estatístico como o X2-teste com duas classes, sendo o valor do X2-total algébricamente igual ao quadrado do valor de delta. Assim pode ser mais fácil às vezes calcular o X2 total como quadrado do desvio relativo da. variação alternativa : x² = ( f obs -pn)² p. (1-p)N = ( f obs - p %)2.N p% (100 - p%) B) Quando há classes com freqüência esperada menor do que p = 0,1, podemos analisar os seus valores individuais de X2, e desprezar o valor X2 para as classes com p maior do que 0,9. O X2-teste, todavia, pode agora ser aplicado apenas, quando a freqüência esperada for pelo menos igual ou maior do que 5 ou melhor ainda, igual ou maior do que 10. Quando a freqüência esperada for menor do que 5, a variação das freqüências observadas segue uma distribuição de Poisson, não sendo possível a sua substituição pela aproximação Gausseana. A táboa I dá os limites da variação da série de Poisson para freqüências esperadas (em números) desde 0,001 até 15. A vantagem do emprego da nova táboa I para a comparação, classe por classe, entre distribuições esperadas e observadas é explicada num exemplo concreto. Por meio desta táboa obtemos informações muito mais detablhadas do que pelo X2-teste devido ao fato que neste último temos que reunir as classes nas extremidades das distribuições até que a freqüência esperada atinja pelo menos o valor 5. Incluimos como complemento uma táboa dos limites X2, pára 1 até 30 graus de liberdade, tirada de um outro trabalho recente (BRIEGER, 1946). Para valores maiores de graus da liberdade, podemos calcular os limites por dois processos: Podemos usar uma solução dada por Fischer: √ 2 X² -√ 2 nf = delta Devem ser aplicados os limites unilaterais da distribuição de Gauss : 5%:1, 64; 1%:2,32; 0,1%:3,09: Uma outra solução podemos obter segundo BRIEGER (1946) calculando o valor: √ x² / nf = teta X nf = teta e procurando os limites nas táboas para limites unilaterais de distribuições de Fischer, com nl = nf(X2); n2 = inf; (BRIEGER, 1946).

Double-Exponential Model of a Photovoltaic Cell with Temperature Dependence

The purpose of the research is the creation of mathematical models in MATLAB based on the double exponential model of the photovoltaic cell. The developed model allows for different physical and environmental parameters. An equivalent circuit of the model includes a photocurrent source, two diodes, and a series and parallel resistance. The paper presents the simulation results for each parameter. The simulation data are displayed graphically and numerical results are saved in a file.

Estudos sobre thrombose cardiaca e endocardite parietal de origem não valvular

1.-Since the parietal endocarditis represents a chapter generally neglected, owing to the relative lack of cases, and somewhat confused because there various terms have been applied to a very same morbid condition, it justifies the work which previously we tried to accomplish, of nosographic classification. Taking into account the functional disturbances and the anatomical changes, all cases of parietal endocarditis referred to in the litterature were distributed by the following groups: A-Group-Valvulo-parietal endocarditis. 1st . type-Valvulo-parietal endocarditis per continuum. 2nd. type-Metastatic valvulo-parietal endocarditis. 3rd. type-Valvulo-parietal endocarditis of the mitral stenosis. B-Group-Genuine parietal endocarditis. a) with primary lesions in the myocardium. b) with primary lesions in the endocardium. 4th type-Fibrous chronic parietal endocarditis (B A Ü M L E R), « endocarditis parietalis simplex». 5th type-Septic acute parietal endocarditis (LESCHKE), «endocarditis parietalis septica». 6th type-Subacute parietal endocarditis (MAGARINOS TORRES), «endocarditis muralis lenta». 2.-Studying a group of 14 cases of fibrous endomyocarditis with formation of thrombi, and carrying together pathological and bacteriological examinations it has been found that some of such cases represent an infectious parietal endocarditis, sometimes post-puerperal, of subacute or slow course, the endocardic vegetations being contamined by pathogenic microörganisms of which the most frequent is the Diplococcus pneumoniae, in most cases of attenuated virulence. Along with the infectious parietal endocarditis, there occur arterial and venous thromboses (abdominal aorta, common illiac and femural arteries and external jugular veins). The case 5,120 is a typical one of this condition which we name subacute parietal endocarditis (endocarditis parietalis s. muralis lenta). 3.-The endocarditis muralis lenta encloses an affection reputed to be of rare occurrence, the «myocardite subaigüe primitive», of which JOSSERAND and GALLAVARDIN published in 1901 the first cases, and ROQUE and LEVY, another, in 1914. The «myocardite subaigüe primitive» was, wrongly, in our opinion, included by WALZER in the syndrome of myocardia of LAUBRY and WALZER, considering that, in the refered cases of JOSSERAND and GALLAVARDIN and in that of ROQUE and LEVY, there are described rather considerable inflammatory changes in the myocardium and endocardium. The designation «myocardia» was however especially created by LAUBRY and WALZER for the cases of heart failure in which the most careful aetiologic inquiries and the most minucious clinical examination were unable to explain, and in which, yet, the post-mortem examination did not reveal any anatomical change at all, it being forcible to admit, then, a primary functional change of the cardiac muscle fibre. This special cardiac condition is thoroughly exemplified in the observation that WALZER reproduces on pages 1 to 7 of his book. 4.-The clinical picture of the subacute parietal endocarditis is that of heart failure with oedemas, effusion in the serous cavities and passive chronic congestion of the lungs, liver, kideys and spleen associated, to that of an infectious disease of subacute course. The fever is rather transient oscillating around 99.5 F., being intersected with apyretic periods of irregular duration; it is not dependent on any evident extracardiac septic infection. In other cases the fever is slight, particularly in the final stage of the disease, when the heart failure is well established. The rule is to observe then, hypothermy. The cardiac-vascular signs consist of enlargement of the cardiac dullness, smoothing of the cardiac sounds, absence of organic murmurs and accentuated and persistent tachycardia up to a certain point independent of fever. The galloprhythm is present, in most cases. The signs of the pulmonary infarct are rather expressed by the aspect of the sputum, which is foamy and blood-streaked than by the classic signs. Cerebral embolism was a terminal accident on various cases. Yet, in some of them, along with the signs of septicemia and of cardiac insufficiency, occurred vascular, arterial (abdominal aorta, common illiac and femurals arteries) and venous (extern jugular veins) thromboses. 5. The autopsy revealed an inflammatory process located on the parietal endocardium, accompanied by abundant formation of ancient and recent thrombi, being the apex of the left ventricle, the junction of the anterior wall of the same ventricle, with the interventricular septum, and the right auricular appendage, the usual seats of the inflammatory changes. The region of the left branch of HIS’ bundle is spared. The other changes found consist of fibrosis of the myocardium (healed infarcts and circumscribed interstitial myocarditis), of recent visceral infarcts chiefly in lungs, spleen and brain, of recent or old infarcts in the kidneys (embolic nephrocirrhosis) and in the spleen, and of vascular thromboses (abdominal aorta, common illiacs and femurals arteries and external jugular veins), aside from hydrothorax, hydroperitoneum, cutaneous oedema, chronic passive congestion of the liver, lungs, spleen and kidneys and slight ictericia. 6. In the subacute parietal endocarditis the primary lesions sometimes locate themselves at the myocardium, depending on the ischemic necrosis associated to the arteriosclerosis of the coronariae arteries, or on an specific myocarditis. Other times, the absence of these conditions is suggestive of a primary attack to the parietal endocardium which is then the primary seat of the lesions. It matters little whatever may be the initial pathogenic mechanism; once injured the parietal endocardium and there being settled the infectious injury, the endocarditis develops with peculiar clinical and anatomical characters of remarkable uniformity, constituting an anatomo-clinical syndrome. 7.-The histologic sections show that recent lesions…

Estudo experimental de um "Schizotrypanum" do morcego "Hemiderma perspicillatum" da Venezuela

1) - Em Guarativana, Estado de Yaracuy, Venezuela, foi determinada a infecção natural de morcegos da espécie Hemiderma perspicillatum (L) por um hemoflagelado do gênero Schizotrypanum CHAGAS. 2) - As formas sanguícolas do parasito são morfologicamente muito semelhantes às do Trypanosoma phyllostomae CARTAYA, 1910, descrito em morcegos da mesma espécie, em Cuba. Sem por ora identificarmos a este parasito o que encontramos na Venezuela, continuaremos a referir-nos a este último como amostra phyllostomae (cf. DIAS, VTDJ). 3) - Os tripanosomas da amostra phyllostomae teem em média 20µ de comprimento total, possuem volumoso blefaroplasto subterminal, núcleo elíptico quese mediano, porem mais próvimo à extremidade anterior do corpo. As seguintes médias foram obtidas da medida de 100 tripanosomas: Extremidade posterior ao meio do núcleo 7,1µ; Meio do núcleo à extremidade anteior 5,0µ; Flagelo livre 7,8µ; Comprimento total 20,0µ; Posição do núcleo (índice PN/NA) 1,4. A amostra phyllostomae mostrou-se biometricamente diferençavel de todas as demais de Schizotupanum estudadas (DIAS & FREITAS). 4) - Formas de multiplicação com a morfologia de leishmania foram encontradas em coração e estômago de morcegos infectados. Tripanosomas em via de divisão nunca foram observados no sangue. 5) - Cobaia, cão e camondongo branco são sensiveis à amostra, sofrendo algumas vezes infecções intensas e mortais. Leishmanias intracelulares e lesões foram encontradas em diversos orgãos, principalmente no coração. 6) - O morcego Phyllostomae hastatus não é sensivel à amostra, apresentando apenas um parasitismo sanguíneo escasso e transitório quando inoculado e reinoculado repetidas vezes. O Molossus obscurus tambem é aparentemente insensivel, enquanto que os Molossus rufus parece receptivel ao parasito. 7) - Após numerosas passagens por animais de laboratório, a amostra Phyllostomae foi infesctante para dois exemplares de Hemiderma perspicillatum do Brasil. Os morcegos H. perpicillatum e H. perspicillatum aztecum são aparentemente resistentes á inoculação do Schizotrypanum cruzi (tipo humano). 8) - A amostra phyllostomae evoluiu facilmente em todos os artrópodes sugadores experimentados: Rhodnius prolixus, Eutriatoma nigromaculata, E. maculata, E. sordida, Panstrongylus megistus, P. geniculatus, Triatoma infestans,Psammolestes arthuri, Cimex hemipterus e Ornithodoros moubata. A evolução processa-se analogamente à do S. chuzi, terminando com a formação de tripanosomas metacíclicos no intestino posterior. 9) - Cultivos artificiais são facilmente conseguidos em meios apropriados. 10) - A amostra phyllostomae distingue-se biológica e morfologicamente de outros hemoflagelados de morcegos (amostras hastatus e vespertilionis). Biologicamente aproxima-se muito do Schizotrydanum cruzi humano, do qual é, entretanto, diferençavel por processos biométricos (DIAS, 1940, DIAS & FREITAS).

Sôbre alguns Phlebotomus e Brumptomyia da Colômbia (Diptera, Psychodidae)

The first case of Kala-azar in Colombia was discovered in Soledad, S. Vicente do Chucuri, Dept. Santander, by Gast-Galvis who viscerotomized a three year old girl deceased in December, 1943. In 1944, fifty-three Phlebotominae were collected in the chicken pen of the girl's house, two new species included. Mangabeira helped by A. Gast Galvis, Juan Antonio Montoya and E. Osorno Mesa, collected some Phlebotomus in that country. The geographical distribution of the species of Phlebotomus collected in Colombia (P. abonnenci, P. camposi, P. columbianus, P. dubitans, P. gasti, P. montoyai, P. saulensis, P. serranus, P. triramulus) and two species of Brumptomyia (B. beaupertuyi and b mesari), are included. our description of the male P. columbianus is based on some specimens found in association with females. However, doubts exist about such association of sexes. There is no correspondence between the length of the spicules and the ducts of spermathecae. Besides, the specimens were not obtained by raising. The following new species are described and compared with previously known ones: a) Phlebotomus gasti sp. n. differs from the other species by a protruding tubercle in the gubernaculum. It has also fewer setae in the tuft of the basistyle, a different length of the inferior gonapophyses, and a differently shaped clasper. b) Phlebotomus dubitans sp. n. differs from P. walkeri and P. deanei (according to personal information from O. Theodor, who examined the types, they are identical to P. williamsi and P. sericeus respectively), mainly because these species have the inferior gonapophyses larger than the basistyle and fewer setae in the basistyle. P. evandroi is separated by the shape of the claspers and by the tuft of setae of the basistyle. P. marajoensis is the closest relative to P. dubitans. There is a possibility of their being synonymous. On the other hand, they can be differentiated by the existence of three extra distal spines in P. marajoensis. There is also a difference in their palpal indexes: for marajoensis I - II - IV - III - V, and for dubitans I - IV (III - II) - V. We notice, too, that the inferior gonapophyses in P. marajoensis is a little shorter. P. marajoensis has a long seta in the basistyle (clearly shown in the original drawing), not found in the new species. c) Phlebotomus montoyai sp. n.: The closest relatives are P. noguchii, P. peruensis, P. pescei, P. quinquifer and P. rickardi. They differ from the new species by the number and length of the setae of the basistyle tuft which are more numerous and longer in the new species. The shapes of their claspers are also different. Other differences are: the basal portion of the basistyle in P. noguchii is very wide (in montoyai it is narrower); the intermediate spine of the dististyle is located on a protruding tubercle ( in the new species there is hardly a tubercle); the spicules are long, and the inferior gonapophyses is longer than the basistyle. P. quinquifer and P. rickardi have a shorter dististyle and narrower wings, with different venation. The main difference, however lies, in the M4, which ends almost at the level of the junction of M1 with M2 (in P. montoyai the M4 ends far behind). In P. peruensis and P. pescei the intermediary spine of the dististyle is closer to the distal spine than to the basal one, whereas in the new species it is situated between the two pairs. Their inferior gonapophyses is longer than the basistyle. d) Brumptomyia mesai sp. n. - Closest relatives are: B. hamatus, B. pentacanthus, B. beaupertuyi which are easily separated from the new species because the tufts of their basistyle have thin and differently shaped hairs. Also their claspers are shaped differently. B. avellari is also easily recognized on account of the twisted aspect of its clasper and because the basal tuft of the basistyle has few setae, B. brumpti tuft of setae arise directly from the basistyle; these setae are stronger than those of the new species. It has 8 blade-like setae located on the inner surface of the distal half, whereas the new species has only six setae. In B. brumpti, there are three median and two terminal spines in the dististyle; in the new species, there are two median and two terminal spines and one between them, which is closer to the two median spines. The comparison with B. galindoi is based in a specimen determined by Fairchild and deposited in the entomological collection of the "Faculdade de Higiene e Saúde Pública da Universidade de S. Paulo". The genitalia of the new species is much shorter, in galindoi the inferior gonapophyses is 0,8 mm long whereas in B. mesai it hardly reaches 0,6 mm. The shape of the clasper and the distribution of its setae are different. The sub-median lamellae, besides being longer in B. galindoi are also longer in comparison with the other parts of the genitalia. The gubernaculum of the new species is longer, thinner, and more pointed; in B. galindoi it is shorter and triangular. In the drawing published by Fairchild and Hertig 91947), the basistyle shows 8 blade-like setae on the distal half, whereas in the new species only six are found.

Physa Marmorata Guilding, 1828 (Pulmonata: Physidae)

A description of Physa marmorata Guilding, 1828, based on material collected at its type-locality, the Caribbean island of Saint Vincent, is presented. The shell is thin, horn-colored, surface very glossy, diaphanous. Spire acute, elevated; protoconch distinct, rounded-conical, reddish-brown; five not shouldered, broadly convex whorls with subobsolete spiral lines and thin growth lines. Aperture elongated, 1.4-2.0 times as long as the remaining shell length, narrow obovate-lunate; upper half acute-angled,lower half oval,narrowly rounded at the base, outer lip sharp, inner lip completely closing the umbilical region; a very distinct callus on the parietal wall; columellar lip with a low ridge gradually merging into the callus. ratios: shell width/shell length = 0.44 - 0.52 (mean 0.47); spire length /shell lenght = 0.33-0.41 (mean 0.39); aperture length/shell lenght = 0.59-0.67 (mean 0.62). Oral lappets laterally mucronate, foot spatulate with deeply pigmented acuminate tail. Mantle reflection with 6-10 short triangular dentations covering nearly half the right surface of the body whorl, and 4-6 covering a part of the ventral wall. Body surface with tiny dots of greenish-yellow pigment besides melanin. Renal tube tightly folded in toa zigzag course. Ovotestis diverticula acinous, laterally pressed against each other around a collecting canal. Ovispermiduct with well-developed seminal vesicle. oviduct highly convoluted, merging into a less convoluted nidamental gland which narrows to a funnel-shaped uterus and a short vagina. Spermathecal body oblong, more or less constricted in the middle and somewhat curved; spermathecal duct uniformly narrow, a little longer than be body. About 20 prostatic diverticula, simple, bifurcate or divided into a few short branches, distalmost ones assembled into a cluster. Penis long, nearly uniformly narrow; penial canal with lateral opening about the junction of its middle and lower thirds. Penial sheath with a bulbous terminal expasion the tip of which isinserted into the caudal end of the prepuce. Prepuce shouldered, much wider than the narrow portion of the penial sheath. Penial sheath/prepuce ratio about 2.08 (1.45-2.75). The main extrinsic muscles of the penial complex are a retractor, with a branch attached to the bulb, and another to the caudal end of the penial sheath; and a protractor, with a branch attached to the shoulder of the prepuce and adjoining area of the penial sheath, and another to the caudal end of the penial sheath. Egg capsule C-shaped, with 10-30 elliptical eggs (snails 10mm long) measuring about 1.10 mm (0.90-1.32) through the long axis and surrounded by an inner and an outer lamellate membranes. Jaw a simple obtusely V-shaped plate. radula will be described separately.

Connexin-36 contributes to control function of insulin-producing cells.

Connexin-36 (Cx36) is a gap junction protein expressed by the insulin-producing beta-cells. We investigated the contribution of this protein in normal beta-cell function by using a viral gene transfer approach to alter Cx36 content in the insulin-producing line of INS-1E cells and rat pancreatic islets. Transcripts for Cx43, Cx45, and Cx36 were detected by reverse transcriptase-PCR in freshly isolated pancreatic islets, whereas only a transcript for Cx36 was detected in INS-1E cells. After infection with a sense viral vector, which induced de novo Cx36 expression in the Cx-defective HeLa cells we used to control the transgene expression, Western blot, immunofluorescence, and freeze-fracture analysis showed a large increase of Cx36 within INS-1E cell membranes. In contrast, after infection with an antisense vector, Cx36 content was decreased by 80%. Glucose-induced insulin release and insulin content were decreased, whether infected INS-1E cells expressed Cx36 levels that were largely higher or lower than those observed in wild-type control cells. In both cases, basal insulin secretion was unaffected. Comparable observations on basal secretion and insulin content were made in freshly isolated rat pancreatic islets. The data indicate that large changes in Cx36 alter insulin content and, at least in INS-1E cells, also affect glucose-induced insulin release.

Sclérodermie et risques oncologiques [Systemic sclerosis and cancer]

The combination of skin induration with clinical features such as dyspnea, facial telangiectasia, digital infarctions and/or dysphagia supports the diagnosis of systemic sclerosis. The oesophageal dysmotility is associated with symptoms which may delay the diagnosis of gastro-oesophageal cancer. Herein we report a case of long standing systemic sclerosis with heartburn and dysphagia symptoms which were monitored closely. Unfortunately, these symptoms delayed the diagnosis of gastric adenocarcinoma. This case prompted us to review the evidence of the association of cancer and systemic sclerosis and if any oncologic evaluation is required during the follow-up of patients affected with systemic sclerosis.

Development and current use of parenteral nutrition in critical care - an opinion paper.

Critically ill patients depend on artificial nutrition for the maintenance of their metabolic functions and lean body mass, as well as for limiting underfeeding-related complications. Current guidelines recommend enteral nutrition (EN), possibly within the first 48 hours, as the best way to provide the nutrients and prevent infections. EN may be difficult to realize or may be contraindicated in some patients, such as those presenting anatomic intestinal continuity problems or splanchnic ischemia. A series of contradictory trials regarding the best route and timing for feeding have left the medical community with great uncertainty regarding the place of parenteral nutrition (PN) in critically ill patients. Many of the deleterious effects attributed to PN result from inadequate indications, or from overfeeding. The latter is due firstly to the easier delivery of nutrients by PN compared with EN increasing the risk of overfeeding, and secondly to the use of approximate energy targets, generally based on predictive equations: these equations are static and inaccurate in about 70% of patients. Such high uncertainty about requirements compromises attempts at conducting nutrition trials without indirect calorimetry support because the results cannot be trusted; indeed, both underfeeding and overfeeding are equally deleterious. An individualized therapy is required. A pragmatic approach to feeding is proposed: at first to attempt EN whenever and as early as possible, then to use indirect calorimetry if available, and to monitor delivery and response to feeding, and finally to consider the option of combining EN with PN in case of insufficient EN from day 4 onwards.

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.