096 Relationship between obesity and heart failure with left ventricular systolic dysfunction

ObjectiveAssessment of obese patients with heart failure by left ventricular systolic dysfunction (LVEF<40%).MethodsWe included in our study 293 patients with heart failure by left ventricular systolic dysfunction. We analyzed clinical factors (heart failure etiology, functional class, risk factors – hypertension,dyslipidemia, smoking,diabetes mellitus,BMI),electrocardiographic factors (LVH presence,conduction and rhythm disturbances),echocardiographic features (LVEF,diastolic function, LVH, systolic PAP) and laboratory data (Hb,serum creatinine,uric acid,WBC count,serum BNP). Obesity was defined as presence of a BMI>30 kg/m2.ResultsOf the 293 patients included there were 89 obese patients (30.9%)-73 males (82%) and 16 females(18%).Heart failure was ischemic at 163 patients (55.6%). At obese patients we observed a more frequent association with hypertension(78.6% of obese patients versus 55.4% nonobese patients;p=0.001); dyslipidemia (70.8% of obese patients versus 42.6%;p=0001); diabetes mellitus (43.8% vs. 14.7%;p=0,0001). Heart failure was more frequent of ischemic etiology at obese patients (66.3% vs. 50.9%; p=0.015). Likewise, EF was greater at obese patients (32.22 ±6.07% vs. 30.06±6.85%;p=0.011) and sinus rhythm was more frequent, too(78.6% vs. 67.15%; p = 0,047). There were no significant differences between BNP at obese and nonobese patients (860.04±803,97 pg/ml vs. 931.58±881,28 pg/ml;p=0,51,ns),neither between diastolic function,presence of LVH,QRS duration, enal dysfunction and other factors studied.ConclusionsA significant proportion of patients with heart failure by left ventricular systolic dysfunction are obese. At obese patients with heart failure by left ventricular systolic dysfunction there is a more frequent association with other risk factors (hypertension, dyslipidemia, diabetes mellitus) and ischemic etiology of heart failure. BNP values were not significantly different at obese patients with systolic heart failure versus nonobese patients

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Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways

It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melancholic (anhedonia), physio-somatic (fatigue, hyperalgesia, malaise), anxiety and neurocognitive symptoms. In clinical depression, however, a transition occurs to sensitization of immuno-inflammatory pathways, progressive damage by oxidative and nitrosative stress to lipids, proteins, and DNA, and autoimmune responses directed against self-epitopes. The latter mechanisms are the substrate of a neuroprogressive process, whereby multiple depressive episodes cause neural tissue damage and consequent functional and cognitive sequelae. Thus, shared immuno-inflammatory pathways underpin the physiology of sickness behavior and the pathophysiology of clinical depression explaining their partially overlapping phenomenology. Inflammation may provoke a Janus-faced response with a good, acute side, generating protective inflammation through sickness behavior and a bad, chronic side, for example, clinical depression, a lifelong disorder with positive feedback loops between (neuro)inflammation and (neuro)degenerative processes following less well defined triggers

Writing National Identity: Postmemory in Contemporary France

This dissertation considers the recent wave of memoir-style fiction by French Jewish authors of Ottoman and North African origin in light of current debates on immigration and French national identity. These authors were raised by immigrant parents who, eager to assimilate into French society, did not focus on transmitting their heritage to subsequent generations. However, their children later attempted to reclaim their lost heritage as adults through literature that revisited their parents' immigration stories, culture, and Judeo-Spanish language. Through the narrative reconstruction of the past, these authors explore how hybrid identity functions within contemporary French society and historiography as an alternative form of French identity. By writing the Judeo-French experience into French literature and history, they revise the nationalist view of French identity to allow for colonial and non-European influences. Through this case study, this project argues that France's new multicultural demographics break down the barrier between "French" and "Francophone" and redefine what it means to be a French national. This not only allows both immigrants in France and French speakers in other countries to claim French culture as their own, but also reconceptualizes French culture to include foreign linguistic, cultural, and national elements.The first two chapters analyze the experience of Mediterranean Jewish immigrants in Paris in the early- to mid-twentieth century. My archival research challenges assumptions about immigrant assimilation, arguing that some immigrants developed a hybrid identity that would allow them to integrate into French society without denying their heritage. Moreover, by writing their stories into French literature, they legitimized their claim to French's cultural capital. My analysis of this work thus urges the revaluation of the Francophone and Jewish literary canons.The following two chapters turn to second-generation Jewish immigrant authors who, though raised disconnected from their ancestral pasts, attempt to reconstruct their parents' immigration narratives in order to gain access to their lost heritages. I analyze this move by reconceptualizing Marianne Hirsch's theory of postmemory, a term that describes the relationship of the second generation to the previous generation's trauma. Through narrative techniques of temporal conflation and multilingualism, these authors rethink their previously monocultural French identities, allowing them to be in conversation with their foreign heritages even as they identify as French nationals. By producing linguistically and culturally bilingual texts, these authors are attempting to alter the current, monocultural conception of French national identity to include the cultural and linguistic traditions of France's postcolonial, post-immigration population. Working simultaneously in minor and major languages, they redefine French identity as multilingual and global, not just for immigrants but also for the dominant culture. The conclusion reconsiders the texts discussed in the dissertation through the lens of contemporary debates in France on immigration and national identity, analyzing the politics of France's controversial new immigration museum to show the relevance of these French-Sephardic literary voices to current issues of French identity and culture. While French national identity has long been based on the idea of a shared past, France's colonial legacy and diverse demographics prove that this past in fact encompasses multiple cultures, languages, and ancestral heritages. By redefining the parameters of French national identity, France's political and cultural policies can better reflect and address its diverse population

Conflict, Solidarity, Imagination: Affect in Appalachian Development

In my paper I consider how, as major resource extraction-based development projects proliferate across North America, new population sectors are being forced to confront how the global economy defines people, places, things, ideas and behaviors as either valuable or expendable. Since Appalachia, as in colonized spaces elsewhere, was and remains a central site for refining the production and enforcement of value and expendability, I ask, what are the social and political effects of new sectors in Appalachia seeing themselves made expendable? Expendability, as it is experienced by new sectors of the population, can offer different coordinates from which to imagine political possibility. Residents, scholars, and activists unfamiliar with such a condition ought to learn from and think with populations most familiar with expendability. In this paper I suggest that a materialist, feminist, and decolonial reading of affect –a term describing the precognitive forces exchanged among objects, bodies and landscapes– can contribute to this learning and rethinking. So conceived, affect can better strengthen multi-scalar and multi-sectoral coalitions through and across lines of economic, ecological, and socio-political difference by critically linking subjects and groups to both material systems of social reproduction, (ecological, geological, and economic) and socio-political systems of group formation and interaction. Such a reading of affect offers a new understanding of the formation of political power among residents and activists and sheds light on the limits and possibilities of an Appalachian renaissance