Journal articles on the topic 'De Benedetti, Carlo'

Introduzione Sergio Di Benedetto e Luca Gallarini “La solitudine del rumore”: città rimosse e memorie campestri nelle prose di Giovanni Pascoli Laura Crippa lI concetto di ‘ruralità’ (e le sue traduzioni) nel Cristo si è fermato a Eboli di Carlo Levi Sara Sermini 1941: Guareschi scopre Milano Luca Gallarini “In città sarei come un capriolo allo zoo”: la città in Mario Rigoni Stern Sergio Di Benedetto Gender, Housework, and Urban Space in Armanda Guiducci’s Due donne da buttare Viviana Pezzullo

Background:Spondyloarthritis (SpA) is the most frequent extra-intestinal manifestation in inflammatory bowel diseases (IBD), since it may occur in up to 25% of patients. The early referral to a Rheumatology Unit may lead to proper treatment and better outcomes for patients with suspect SpA. Recently, we have developed and preliminarily validated a self-administered screening questionnaire, called DETection of Arthritis in Inflammatory boweL diseases (DETAIL)1.Objectives:To validate the DETAIL questionnaire in a multicenter cohort of IBD patients enrolled at ten Gastroenterology and Rheumatology Units in Italy.Methods:The DETAIL instrument is a 6-item questionnaire developed through a Delphi method1. From October 2018 to March 2019, consecutive adult patients with IBD, Crohn’s disease (CD) or ulcerative colitis (UC), filled out independently the DETAIL in the outpatient waiting room. Thereafter, within 2 weeks a blinded rheumatologist assessed all the patients, irrespectively of the DETAIL results, and classified them to be affected or not by SpA according to ASAS criteria. The performance of the DETAIL was evaluated trough Bayesian analysis, defining for each item of the questionnaire the sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios.Results:Overall, 418 IBD patients filled out the DETAIL questionnaire. Upon rheumatological evaluation, 102 (24.4%) patients received a diagnosis of SpA. Of the six questions, the best performances were found in item 6 (LR+ 3.77), reporting inflammatory back pain at night, and in item 3 (LR+ 3.31), exploring Achilles enthesitis. The presence of back pain lasting more than three months (LR+ 2.91), of back pain with inflammatory features (LR+ 2.55) and a history of dactylitis (LR+ 2.55), showed also a fairly good performance, whereas a history of peripheral synovitis was slightly worse (LR+ 2.16). The combination of at least three items answered affirmatively yielded a post-test probability of SpA of 75% or more. The presence of alternative diagnoses, such as osteoarthritis and fibromyalgia, represented a minor confounder.Conclusion:The DETAIL questionnaire is the first screening tool for the early detection of SpA/IBD that has been validated by a multicenter study group.References:[1]Di Carlo M, Luchetti MM, Benfaremo D, Di Donato E, Mosca P, Maltoni S, Benedetti A, Gabrielli A, Grassi W, Salaffi F. The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis. Clin Rheumatol. 2018 Apr;37(4):1037-1044.Acknowledgments:We are grateful to all the members of the GRADES-IBD study group for their outstanding help in the enrollment of patients.We also would like to acknowledge the “Società Italiana di Gastro-Reumatologia” (SIGR) for its help and assistance in the constitution of the multidisciplinary network.Disclosure of Interests:None declared

reproducción de la carta de temática viquiana de Marcelino Menéndez Pelayo, emitida desde santander el 12 de agosto de 1903, a benedetto Croce respondiendo a la tarjeta enviada a su amigo por el filósofo italiano desde Nápoles una semana antes solicitando al polígrafo cántabro información sobre la recepción de Vico en España. PALAbrAs CLAVE: g. Vico, M. Menéndez Pelayo, b. Croce, hispanismo.

Rosalba Galvagno (a cura di), Vincenzo Consolo, Leonardo Sciascia, Essere o no scrittore. Lettere 1963-1988, Archinto, Milano 2019Luigi Sanfilippo, Fede e scienza nella Sicilia dell'Ottocento. Il benedettino Giacomo Maggiore (1812-1884), Edizioni Efesto, Roma 2020Rosalba Galvagno, Mitografie di Carlo Levi, Sinestesie, Avellino 2021Rosalia Francesca Margiotta, Beni mobili. Patrimonio artistico e committenti in Sicilia dalle fonti d'archivio tra XVI e XIX secolo, Palermo, OADI Digitalia, Palermo University Press, 2020Rosalba Galvagno, La litania del potere e altre illusioni. Leggere Federico De Roberto, Marsilio, Venezia, 2017

A entrevista cedida por Zygmunt Bauman ao jornalista italiano Benedetto Vecchi por meio de correio eletrônico, em 2004 e publicada pela Zahar no ano seguinte em livro de 110 páginas com tradução de Carlos Alberto Medeiros, nos apresenta uma abordagem sobre a ideia de identidade a partir de diversas perspectivas (histórica, política, sociocultural e psicossocial), entre as quais o autor pontuará o desenvolvimento de tal noção desde sua projeção sólida pelos estados-nacionais na era pré-moderna até o seu formato líquido-moderno atual, volúvel e instável...

Soon after the canonization of St. Carlo Borromeo, Cardinal Benedetto Giustiniani commissioned Lorenzo Garbieri to create three paintings for one of the chapels in the newly-erected Barnabite church of San Paolo Maggiore in the center of Bologna, with scenes taken from the new saint’s life. This was the first chapel to be decorated in the church. Here, as will be argued below, one may find the seeds of what eventually became common in representations of the saint: Barnabite propaganda meant to accentuate not only the saint himself and his important altruistic deeds, but also the order’s part in those deeds, as well as the connections between the saint and the Barnabites. An emphasis is given to the Barnabites’ participation in the very deeds that became associated with the saint and through which he became known during his lifetime as a living saint.

«Prólogo» de unamuno a la versión en español de la Estética de Croce, traducida por José sánchez Rojas, publicada en madrid en 1912. aunque directamente cita a Vico solo dos veces, es un texto plagado de viquismo que unamuno ha bebido de su colega y amigo italiano

Ante esta cuestión: ¿Cómo cambiar los marcos, los relatos, las estructuras del museo actual, para que podamos identificarnos con él, para reconocernos en sus imágenes y en sus narraciones? planteo referencias que tramadas podrían atisbar el principio de un nuevo debate. El título se va desgranando a lo largo del artículo. Para «El peligro de ablandarse» trabajo con el legado de las salonnières y la obra de Benedetta Craveri y Roger Chartier. Para «Hermandad», me apoyo en Carla Hesse y su descubrimiento de la historiadora dieciochesca francesa Louise-Félicité Guynement de Kéralio-Robert (1758-1822). En el tercer apartado, «Igualdad», trabajo desde los variados acercamientos al feminismo en los años 70, reviso a Linda Nochlin y reivindico a Mierle Laderman Ukeles. Y finalmente «Solidaridad», me apoyo en Angela Davis y su redescubrimiento de las blues ladies, así como en mi propio trabajo en el que reivindico la importancia para la historia del feminismo español de las cupletistas. AbstractFaced with this question: How to change the frameworks, the stories, the structures of the current museum, to identify them with it, to recognize us in its images and in its narrations? The title is unraveling throughout the article. For «The peril of tenderice» I work with the legacy of the salonnières and the work of Benedetta Craveri and Roger Chartier. For «Sisterhood» , I rely on Carla Hesse and her discovery of the French eighteenth-century historian Louise-Félicité Guynement de Kéralio-Robert (1758-1822). In the third section, «Equality», I work from the various approaches to feminism in the 70s, I review Linda Nochlin and I claim Mierle Laderman Ukeles. And finally «Solidaridad», I rely on Angela Davis and her rediscovery of the blues ladies, as well as my own work in which I claim the importance for the history of Spanish feminism of the cupletistas.

IL V EARL DI EXETER COME GRAN TURISTA E COLLEZIONISTACon questo articolo si analizzano e documentano i viaggi italiani e la collezione di quadri di John Cecil di Burghley House (1648–1700), che, dopo aver ottenuto il titolo di V Earl di Exeter nel 1678, fece una serie di grandi viaggi in Italia nel 1679–81, 1683–4 e 1699–1700, prima di morire vicino Parigi nel 1700 sulla via del ritorno a casa. Durante questi viaggi, che si estesero lungo l'intera penisola italiana, da Torino a Napoli, egli sviluppò un notevole desiderio, senza paragoni per i suoi tempi, di acquisire pitture contemporanee barocche, come estensione del suo progetto di rinnovare Burghley House, originariamente costruita tra il 1555 e il 1587. Il gusto artistico di Exeter, che abbracciò artisti come Carlo Dolci e Benedetto Gennari, così pure Calandrucci, Chiari, Gaulli, Giordano, Maratti, Preti, Recco, Ruoppolo e Trevisani, riflette per molti versi quello della corte di re Carlo II. Per la decorazione delle stanze reali a Burghley, compresa la Heaven Room e la Hell Staircase egli impiegò anche Antonio Verrio, che aveva lavorato per re Carlo a Windsor. Rimase leale alla causa Stuart per tutta la sua vita, votò contro il trasferimento del potere a William e Mary in tutte le divisioni parlamentari, e si rifiutò di presenziare come Hereditary Grand Almoner alla loro incoronazione; e avendo anche rifiutato di fare il Giuramento di Fedeltà non mise più piede nella House of Lords dopo il 13 febbraio del 1689. La disaffezione nei confronti del regime protestante ha avuto certamente un ruolo nell'ultima visita degli Exeter a Roma con i loro due figli più giovani, in occasione del Giubileo del Papa del 1699–1700.

Benedetto Croce’s description of fascism as ‘a moral illness of our time’ provides a useful starting point for thinking about the phenomenon of cine-revisionismo storiografico and the representation of Fascism and fascists in Italian cinema. In many films from the post-war period and beyond, the metaphor of moral illness is literalised in portrayals of fascist characters who are shown as mentally or physically sick or disabled (often confusing the two), in contrast to the otherwise healthy and wholesome body of Italians. Addressing the conflation of physical and moral impairment in three 1960 films that grapple with the memory of Italy’s Fascist past – Roberto Rossellini’s Era notte a Roma (Escape by Night), Carlo Lizzani’s Il gobbo (The Hunchback of Rome), and Florestano Vancini’s La lunga notte del ’43 (It Happened in ’43) – this article argues that in these films, bodies that do not conform to an able-bodied male norm function as lieux de mémoire that permit both the expression and containment of painful memories of the Fascist period.

O objetivo deste estudo é efetivar uma revisão de literatura a partir dos pertencimentos identitários, sobretudo das características relacionadas a etnia e gênero e suas intersecções com a saúde mental. Fundamenta-se na concepção de identidade de Antonio Carlos Ciampa e nas variáveis sombra enfatizadas por Benedeto Saraceno. Promove-se um balanço do estado da arte a partir de levantamento no SciELO, Medline e LILACS. Conclui-se que a maioria dos estudos volta-se para temáticas relacionadas à mulher. A violência contra a mulher ganha proeminência nas suas repercussões negativas sobre a saúde emocional, sendo destacada a sua condição de vítima.

L'immagine letteraria di Napoli, "Capitale del Sud", che vede periodiche alternanze di crisi e splendore nelle arti, è sicuramente dicotomica: da un lato il locus amoenus in cui fiorisce l'inventiva e diverse tradizioni culturali si intersecano e convivono; dall'altro, il luogo simbolico di immense disparità sociali, uno scoppio di epidemie e la culla di una mentalità rilassata e reazionaria. L'immagine usata da Benedetto Croce per definire la città, "un paradiso abitato dai diavoli", risale al Medioevo, e viene negata di volta in volta dagli autori che intendono costruire un mito positivo di napoletanità, ma già agli inizi 20° secolo, e quindi soprattutto nel periodo dal 1943 (ai giorni nostri), ci sono accenti sempre più critici nei confronti di questa immagine, che risultano - più che nell'odio o nel disprezzo per la città e i suoi abitanti - nella tendenza ad allontanarsi da Napoli, per abbandonare una realtà contraddittoria che non risolve i suoi problemi, ma come una foresta vergine ricresce distruggendo ogni elemento del progresso. Gli autori esaminati nell'articolo sono: Carlo Bernari, Anna Maria Ortese, Raffaele La Capria, Fabrizia Ramondino, Ermanno Rea, Giuseppe Montesano, Elena Ferrante.

Autorka, przyjmując za punkt wyjścia nauczanie papieża Franciszka w czasie pandemii COVID-19 na temat doświadczenia choroby, cierpienia i śmierci oraz zachętę, by w tym trudnym czasie czerpać wzory do naśladowania z przykładów świętych i błogosławionych, postawiała tezę: czy w prowadzonych aktualnie przez Kongregację Spraw Kanonizacyjnych procesach kanonizacyjnych odnajdziemy postaci, które mogą inspirować osoby dotknięte chorobą i cierpieniem? Czy Kongregacja prowadzi jakieś procesy kanonizacyjne lekarzy, pielęgniarek i personelu medycznego? Spośród ponad 3,5 tysiąca męczenników i wyznawców dokonała wyboru kilkudziesięciu postaci czasowo najbliższych współczesnemu człowiekowi (z XX i XXI w.), aby ukazać walor eklezjalny (momentum ecclesiale) ich spraw. Posługując się metodą dogmatyczno-prawną oraz teologiczno-prawną, Autorka wykazała, że w orzecznictwie Kongregacji wzory do naśladowania odnajdą ludzie w każdym wieku i stanie, dotknięci nieuleczalną chorobą (jak bł. Carlo Acutis, Alexia González-Barros, czy bł. Nuncjusz Sulprizio), niepełnosprawnością (jak ks. Alojzy Schwartz), różnorakim cierpieniem (Benedetta Bianchi Porro). Wśród czcigodnych sług Bożych, świętych i błogosławionych są twórcy dzieł służących ochronie zdrowia (św. Matka Teresa z Kalkuty, św. Maria Teresa Chiramel Mankidiyan, bł. ks. Luigi Novarese, bł. Matka Róża Czacka, Urszula Mezzini, bł. bp Álvaro del Portillo), lekarze (np. Mariano Mullerat i Soldevila) i pielęgniarki różnych specjalizacji (Hanna Chrzanowska), położne, pielęgniarz Luigi Bordino, studenci medycyny (np. bł. Sandra Sabattini), ochotniczki Czerwonego Krzyża (María Pilar Gullón Yturriaga, Octavia Iglesias Blanco, Olga Pérez-Monteserín Núñez), profesorowie medycyny (bł. José Gregorio Hernández Cisneros, Jérôme Lejeune), pracujący w warunkach epidemii (bł. Irene Stefani, ks. Saturnino López Novoa i in.). Są to osoby bardzo nowoczesne, zasłużone dla współczesnej nauki, kandydaci do Pokojowej Nagrody Nobla (Alojzy Schwartz) oraz jej laureaci (Jan Paweł II, Matka Teresa z Kalkuty). Wszyscy wyróżniali się głęboką wiarą, praktyką cnót w stopniu heroicznym, zwłaszcza triadą nadziei, miłości i wiary. Z zapałem wychodzili na peryferie, by nieść ulgę cierpiącym. W ich osobach Kościół świętuje „kreatywność chrześcijańskiego miłosierdzia”.

Recently published by the Madrid publishing house Sequitur, La Escuela Universalista Española del siglo XVIII is an introductory work to a study of the so-called Universalist School. Its author, Pedro Aullón de Haro from the University of Alicante, Spain, and Head of the Research Group “Humanism-Europe” since 1994, has coordinated various volumes whose main objective is the historical reconstruction of the Late Spanish Enlightenment Period, which was truncated by Charles III of Spain’s expulsion of the Jesuits, affecting a great many of its members. This Enlightenment Period, in contrast to the victorious French Enlightenment, offered not a political, but a scientific and humanistic view of knowledge, taking a comparative and universalist approach, but, due to the aforementioned expulsion of the Jesuits, the authors dispersed, leaving their work unfinished; and it is only now, under the label of the Universalist School, coined by Prof. Aullón de Haro, that they have been gathered together furthering the possibility of recovering their meaning and systematic cohesion. This volume serves as an introduction to the publications that the author has announced for 2018, in which the detailed study of the main authors within this scientific community will be undertaken following an encyclopaedic structure, which will finally give recognition to the Universalist School movement, and whose stand out authors include: Juan Andrés, creator of the Universal History of the Humanities and Sciences; Lorenzo Hervás y Panduro, creator of Universal and Comparative Linguistics; and Antonio Eximeno, creator of a universal aesthetic concept of music as language and expression.The common thread of the School is precisely the "universalist ideation" that assumes the unity of knowledge in a harmonious integration of experimental sciences, fine arts and human sciences within a humanistic epistemological framework, and consequently, comparativism as a methodology of study, based on the unity of its object: the destiny of man, with his knowledge integrated into a unitary vision of the universe and the world. All this is ultimately based on the work of Dionysius of Halicarnassus, historically rooted in the process of Greco-Roman cultural parallels, and with the main figures of Macrobius, Scaliger and Morhof.Furthermore, 2017 is the second centenary of the death of Juan Andrés, commemorated by an international Congress held at the Complutense University of Madrid and featuring an important bibliographical exhibition in the History Library of this Madrid University, titled "Juan Andres y la Escuela Universalista Española" (2017).The great scientific and thematic scope of the School means that it is possible to discern several sectors or "sub-schools", although the authors often practice several disciplines: the linguistic sub-school (Hervás and his extensive circle of collaborators), bibliographical (Miguel de Casiri, Diosdado Caballero…), botanical-naturalist (Antonio José Cavanilles, Pedro Franco Dávila, Juan José Ruperto de Cuéllar, José Celestino Mutis, Eduardo Romeo…), musicological (Antonio Eximeno, Josef Pintado, Vicente Requeno, Buenaventura Prats, Joaquín Millás…), Americanist-Mexicanist (Francisco Javier Clavijero, Juan Bautista Muñoz, Miguel del Barco González, José Lino Fábregas, Juan Nuix y Perpiñá…), on the Philippines (Juan de la Concepción, Antonio de Tornos, Bernardo Bruno de la Fuente…), meteorology (Andrés, Viñes, Faura…), studies on translation (Carlos Andrés, Juan Bautista Colomés, Pedro Cantón…) etc.The work is divided into three sections: "Teoría general", "Textos de y sobre autores de la Escuela", and "Bibliografía fundamental y selecta".The first section begins with an introductory chapter in which the conceptual principles of the School are explained in relation to the particularity of the Hispanic cultural history, where both its antecedents and theoretical limits are determined. Next comes a description of the sequence of milestones, historical circumstances and accidents that resulted in the formation of the School, as well as an in-depth explanation of the concept of "universalist ideation". Finally, "La ideación del primer programa epistemológico", is a necessary exposition of the important and almost inaccessible Prospectus Philosophiae Universae, a work that was written and directed by Juan Andrés. It is a general and pluridisciplinary programmatic text published in 1773 in Ferrara, and access to it for consultation is hard to come by. That is, it is a kind of program that intends to carry out a radical overcoming of the culture and thought of the Baroque era, through the integration of empiricist science and philosophy with classical humanism and its evolution through a historically founded and revisable concept of progress. The fourth chapter, entitled "La Ilustración universalista: creación de la Comparatística moderna y Literatura Universal", lists the conceptual keys to understanding the particularity of this late Spanish age of Enlightenment of Hispanic-Italian roots, Christian, integrative, international, intercontinental, founded on a unitary vision of the universe and the world. The fifth chapter, "La clasificación de las ciencias, la universalidad tematológica y la estética de la expresión", analyses the variables of the Enlightenment Period, the various types of European illustrations and their internal conceptual sectors, in an attempt to bring to light the lack of historical and intellectual homogeneity of a process of great relevance, and analyses the universalistic classification of scientific disciplines by comparison with the classification of the French illustration, showing the flagrant reduction of the French classification, and also includes a revealing study on the concept of "expression" elaborated by Antonio Eximeno, which was later also recovered by Benedetto Croce, although without him acknowledging the precedence of Eximeno’s work.The second part, "Textos de y sobre autores de la Escuela", presents a series of documents as a critical support of the School and its authors. This is especially true of the textual references from the three main authors with respect to the other members of the School, which provides an account of the indisputable existence of a productive and active scientific community.The last part records essential bibliographical sources and information intended to enable a continuation of the study by the authors of this School, a bibliographic selection of the most important works of all the members of the School, and another selection of general and monographic studies on relevant theoretical, historical and cultural issues.In short, this work succeeds in refuting one of the most important historical and intellectual fallacies of our time: the absence of a Spanish Enlightenment Period, and consequently, proves the existence of an original and consistent modern Hispanic thought. In this way, it opens up a field of study that demands new research that will bring to light better-informed reinterpretations of both Spanish and Hispanic America pasts in general, which will lead to a search for unity, not in political and economic terms, as seems to be the objective of economic globalization, but on the basis of the concept of universality. For this purpose, the Research Group Humanismo-Europa has affiliated itself with the Instituto Juan Andrés de Comparatística y Globalización, as well created links to its online network Biblioteca HumanismoEuropa, where all the information about the authors of the School and their texts has been gathered and made available to the general public.

Introducción: La enfermedad renal crónica asociada a la obesidad (ERC-AO) es una enfermedad con aumento en la prevalencia en las últimas décadas. Se caracteriza por un exceso de desequilibrios hormonales adipocíticos (adipoquinas), desregulación del sistema de equilibrio energético y desequilibrios en la homeostasis metabólica. Propósito de la revisión: El objetivo de la revisión es delinear el papel de los diferentes mecanismos fisiopatológicos para el desarrollo de enfermedad renal funcional o anatómica en pacientes con obesidad. Buscamos reportes actualizados en donde se incluye los resultados de mejor supervivencia para los pacientes con ERC-AO. Recientes hallazgos: Actualmente sabemos la ERC-AO tiene un comportamiento pro inflamatorio crónico. La obesidad y sobrepeso se asocian alteraciones hemodinámicas, estructurales e histopatológicas en el riñón, así como alteraciones metabólicas y bioquímicas que predisponen a la enfermedad renal, aun cuando la función renal y las pruebas convencionales sean normales. Conclusiones: Clasificamos a la ERC-AO en Tipo 1: Obesidad y alteraciones funcionales potencialmente reversibles. Tipo 2: Obesidad y alteraciones estructurales histopatológicas potencialmente no reversibles (Incluye la Glomerulopatía asociada a obesidad y glomeruloesclerosis focal y segmentaria). Tipo 3: Obesidad en relacionada con enfermedades crónicas (Diabetes, Hipertensión, Hipertensión pulmonar. Insuficiencia Cardíaca). Tipo 4: Obesidad en el paciente con terapia sustitutiva de la función renal. Recibido: Agosto 03, 2022 Aceptado: Septiembre 30, 2022 Publicado: Septiembre 30, 2022 Editor: Dr. Franklin Mora Bravo. Introducción La obesidad es una enfermedad en crecimiento con un aumento en su prevalencia en las últimas décadas, asociándose a un elevada carga asistencial y económica para los sistemas sanitaros derivado de su relación con enfermedades cardiovasculares, endocrinas, psicológicas, renales entre otras [1, 2]. El incremento en las tasas de obesidad en distintos grupos etarios, desde niños hasta adultos jóvenes conlleva a asumir que en el futuro veremos más enfermedad renal relacionada con la obesidad (ERC-AO) en la población general, con implicaciones relevantes para los sistemas de atención [3]. Por ello el conocimiento y comprensión de esta interacción podría tener implicaciones en la prevención y tratamiento de las enfermedades renales. Dentro de la población general la obesidad se asocia a incremento en el riesgo de diversas condiciones patológicas, como la hipertensión arterial crónica (HTA), enfermedad renal crónica (ERC), artrosis, infecciones, síndrome de apnea hipopnea obstructiva del sueño (SAHOS) y diabetes mellitus (DM) entre otras [3]. No obstante, en el escenario de la ERC, la obesidad juega un rol dual y paralelo en el desarrollo de la enfermedad, tradicionalmente se ha denominado “paradoja de la obesidad”, donde por un lado actúa como un factor de riesgo modificable para el desarrollo de la enfermedad renal crónica (ERC) y por otro se ha asocia de manera consistente con mejores resultados de supervivencia en pacientes con enfermedad renal terminal [1]. Por lo anterior, en las próximas páginas describimos aspectos fisiopatológicos que involucran la obesidad en el desarrollo de la ERC. Definición y epidemiología La obesidad es una condición que se caracteriza por la acumulación anormal o excesiva de tejido adiposo con consecuencias patológicas adversas e incremento del riesgo cardiovascular [4]. Utilizando para su definición y diagnostico un indicador simple como es la relación entre el peso y la talla denominado índice de masa corporal (IMC), se calcula dividiendo el peso de una persona en kilos por el cuadrado de su talla en metros (kg/m2). Un IMC entre 18.5 y 25 kg/m2 es considerado por la Organización Mundial de la Salud (OMS) como peso normal, un IMC entre 25 y 30 kg/m2 como sobrepeso y un IMC > 30 kg/m2, como obesidad [5-7]. Además, la obesidad puede ser clasificada en tres niveles de severidad: clase I (IMC 30.0 – 34.9), clase II (IMC 35.0 – 39.9) y clase III (IMC > 40) [8]. Durante las últimas tres décadas, la prevalencia de adultos con sobrepeso y obesidad (IMC ≥ 25 kg/m2) en todo el mundo ha aumentado sustancialmente, convirtiendo a la obesidad en una epidemia y se prevé que su prevalencia crezca un 40% en la próxima década [6]. Actualmente, el problema de obesidad se ha visto en mayor aumento debido al incremento en la afectación en niños, lo que ocasiona una mayor prevalencia de patologías a edad temprana. En 2016, según las estimaciones de la OMS unos 41 millones de niños menores de cinco años tenían sobrepeso o eran obesos [7]. Esto afectando a todos los países, independiente de su nivel de ingresos [7]. La prevalencia del sobrepeso y la obesidad en niños y adolescentes (de 5 a 19 años) ha aumentado de forma espectacular, del 4% en 1975 a más del 18% en 2016. Este aumento ha sido similar en ambos sexos: un 18% de niñas y un 19% de niños con sobrepeso en 2016. Mientras que en 1975 había menos de un 1% de niños y adolescentes de 5 a 19 años con obesidad, en 2016 eran 124 millones (un 6% de las niñas y un 8% de los niños) [7]. La creciente prevalencia de la obesidad tiene implicaciones para las enfermedades cardiovasculares (ECV) y también para la ERC. Un IMC alto es uno de los factores de riesgo más fuertes para la ERC de nueva aparición [6]. Epidemiología de la enfermedad renal crónica asociada a obesidad (ERC-AO) La enfermedad renal crónica (ERC) es una condición de interés en salud pública, asociada a una elevada morbilidad y mortalidad a nivel mundial. Las guías KDIGO (Kidney Disease: Improving Global Outcomes), definen la ERC como la presencia de alteraciones en la estructura o función renal durante al menos tres meses y con implicaciones para la salud [9, 10]. Los principales elementos clasificatorios para definir la presencia de ERC son la tasa de filtración glomerular (TFG) estimada (G1 a G5) utilizando como umbral definitorio una TFG 60 ml/min/1,73m2 y la tasa de excreción de albúmina en orina (A1 a A3) según el cociente albúmina/creatinina en una muestra aislada de orina sea < 30, 30-300 o > 300 mg/g, respectivamente [9, 10]. Si bien inicialmente existía cierta controversia sobre el uso de la TFG para el diagnóstico de la ERC en fases iniciales, trabajos recientes han puesto en evidencia que tanto una TFG< 60 ml/min/1.73 m2 como un cociente albúmina/creatinina (CAC) ≥ 1.1 mg/mmol (10 mg/g) son predictores independientes del riesgo de mortalidad e insuficiencia renal terminal (IRT) en población general [11, 12]. En consecuencia, debido a estas categorías podemos determinar el pronóstico de cada paciente. Los datos globales sugieren que la prevalencia de la ERC se encuentra entre el 10 y el 16 %, pero la información sobre la prevalencia de la población por categoría de TFG y ACR es escasa [13]. La ERC es una afección asociada a una elevada carga de morbilidad, mortalidad y enfermedad cardiovascular (ECV). A medida que disminuye la función renal, surgen trastornos metabólicos y hemodinámicos que aumentan las tasas de hospitalización, ECV y muerte [4]. El conjunto de factores de riesgo conocidos para la progresión de la ERC es relativamente pequeño, y las terapias y estrategias efectivas para retrasar la progresión de la ERC son limitadas [14]. Por lo cual resulta necesario conocer y entender los diferentes factores de riesgo y su impacto en el daño renal, en aras de lograr minimizar la progresión del mismo, sobre todo en aquellos en los cuales se puede realizar intervenciones activas, evaluables, controlables y con seguimiento continuo como es la obesidad. A la fecha existe suficiente evidencia para asociar la obesidad con el desarrollo y progresión de la enfermedad renal crónica. Los datos granulares sobre la prevalencia de la obesidad en personas con ERC son limitados pero consistentes en todo el espectro de la enfermedad renal. En la Encuesta Nacional de Examen de Salud y Nutrición de 2011–2014, el 44.1 % de los pacientes con ERC en los Estados Unidos también tenían obesidad (21.9 % con obesidad de clase 1 y 11.1 % con clase 2 y obesidad clase 3, habiéndose incrementado el porcentaje global un 5% en los últimos 12 años [15]. La glomeruloesclerosis focal y segmentaria (GEFS) es el tipo de glomerulonefritis que se asocia con mayor frecuencia a la obesidad [16]. La enfermedad glomerular habitualmente asociada a la obesidad se denomina glomerulopatía relacionada con la obesidad (GRO). Esta condición suele presentarse con síndrome nefrótico y pérdida progresiva de la función renal. Con la epidemia mundial de obesidad, se produjo un aumento progresivo de la GRO del 0.2% entre 1986 y 1990 al 2% entre 1996 y 2000, y se ha convertido en un tema emergente en el ámbito de la nefrología [15]. Etiología y patogénesis de la ERC-AO La obesidad se caracteriza por un exceso de desequilibrios hormonales adipocíticos (adipoquinas), desregulación del sistema de equilibrio energético y desequilibrios en la homeostasis metabólica [12]. Hay dos tipos de tejido adiposo presentes en los humanos: tejido adiposo blanco (WAT) y tejido adiposo marrón (BAT) [17-19]. El depósito de grasa ectópica primariamente ocurre en lugares donde no se almacena fisiológicamente, como el hígado, el páncreas, el corazón y el músculo esquelético; secundariamente hay un cambio en la distribución del tejido adiposo visceral con almacenamiento de tejido adiposo en los espacios intraperitoneal y retroperitoneal; luego se presenta la desregulación inflamatoria y de adipoquinas; y por último la resistencia a la insulina [20]. Tejido adiposo blanco (WAT) El tejido adiposo blanco (WAT) se caracteriza por ser un tejido blanco o amarillo con menor vascularización e inervación que el tejido marrón. Las células grasas tienen un tamaño que oscila entre 20 y 200 µm y contienen una única vacuola lipídica (uniloculares). En dicha vacuola se almacenan lípidos para su uso cuando hay demanda energética. De la totalidad de los lípidos que abarca la vacuola lipídica del adipocito blanco, del 90 al 99% son triacilgliceroles. El tejido adiposo blanco genera una gran cantidad de adipocinas y lipocinas. Las adipocinas son péptidos que actúan como hormonas o mensajeros que regulan el metabolismo. El tejido adiposo blanco se localiza en el tejido omental, mesentérico, retroperitoneal, perirrenal, gonadal y pericárdico [19]. Este tejido al igual que el tejido adiposo de otros sitios, está compuesto por una variedad de células que incluyen macrófagos, neutrófilos, células T CD4 y CD8, células B, neutrófilos, mastocitos, células T reguladoras y células T asesinas naturales (NK) [21, 22]. El tejido adiposo es responsable de la secreción de muchas moléculas de señalización, incluidas adipocinas, hormonas, citocinas y factores de crecimiento, como leptina, adiponectina, resistina, factor de necrosis tumoral-α (TNF-α), interleucina 6 (IL-6), monocito, proteína quimioatrayente-1 (MCP-1), factor de crecimiento transformante-β (TGF-β) y angiotensina II [23]. Tejido adiposo marrón o pardo (BAT) La coloración marrón del tejido adiposo se debe a que está más vascularizado y tiene un alto contenido de mitocondrias, las células grasas que componen el tejido adiposo pardo son multiloculares o tienen varias vacuolas lipídicas. Estas células tienen forma poligonal y miden de 15 a 50 µm. A diferencia del tejido adiposo blanco, el tejido marrón no tiene la función de almacenar energía, sino que la disipa a través de la termogénesis. Para lograr la regulación de la temperatura corporal, el tejido adiposo pardo se localiza en sitios superficiales y profundos [18]. Clasificación de la ERC-AO Se ha establecido que la obesidad es una enfermedad con un comportamiento pro inflamatorio crónico con múltiples comorbilidades asociadas [19]. El tejido adiposo como se describió previamente funciona como un órgano con actividad endocrina y esta infiltrado por diferentes poblaciones celulares que incluyen macrófagos y otras células con actividad inmune como linfocitos T, B y células dendríticas [19]. La mayor parte de la grasa corporal total, se considera como un sistema de órganos endocrinos, la perturbación de este tejido tiene como resultado una respuesta patológica al balance calórico positivo en individuos susceptibles que directa e indirectamente contribuye a la enfermedad cardiovascular y metabólica, se tiene conocimiento de tres principales mecanismos de disfunción del tejido adiposo “adiposopatía” [20]. Estos mecanismos incluyen alteraciones hemodinámicas, metabólicas e inflamatorias, lo que es la base de la clasificación de la ERC-AO propuesta en esta revisión (Tabla 1). ERC-AO tipo 1 La obesidad produce un daño renal de forma directa a través de alteraciones hemodinámicas, inflamatorias, y desregulación de factores de crecimiento y adipocitoquinas, además de aumento de leptina y disminución de adiponectina, aun cuando la función renal y las pruebas convencionales sean normales [16]. La obesidad desencadena una serie de eventos, que incluyen resistencia a la insulina, intolerancia a la glucosa, hiperlipidemia, aterosclerosis e hipertensión, todos los cuales están asociados con un mayor riesgo cardiovascular [4, 16] (Figura 1). La obesidad conduce a un incremento en la reabsorción tubular de sodio, alterando la natriuresis y provocando una expansión de volumen extracelular debido a la activación del sistema nervioso simpático (SNS) y el sistema renina-angiotensina-aldosterona (SRAA)(16). El aumento en la reabsorción tubular de sodio y la consiguiente expansión de volumen extracelular es un evento central en el desarrollo de HTA en la obesidad [4, 16]. Algunos estudios sugieren que se produce un aumento de la reabsorción de sodio en algunos segmentos además del túbulo proximal, posiblemente en el asa de Henle. Además, hay un aumento del flujo sanguíneo renal, la tasa de filtración glomerular (TFG) y la fracción de filtración [16]. La hiperfiltración glomerular, asociada con el aumento de la presión arterial y otras alteraciones metabólicas como la resistencia a la insulina y la DM, finalmente resultan en daño renal y disminución del filtrado glomerular [16]. Por otro lado, la activación del SNS también contribuye a la hipertensión relacionada con la obesidad [4]. Hay evidencia de que la denervación renal reduce la retención de sodio y la hipertensión en la obesidad, lo que sugiere que la activación del SNS inducida por la obesidad aumenta la presión arterial principalmente debido al estímulo de retención de sodio, más que a la vasoconstricción [16]. Los mecanismos que conducen a la activación del SNS en la obesidad aún no se conocen por completo, pero se han propuesto varios factores como desencadenantes de este estímulo, entre ellos la hiperinsulinemia, la hiperleptinemia, el aumento de los niveles de ácidos grasos, los niveles de angiotensina II y las alteraciones del reflejo barorreceptor. El aumento de los niveles de leptina está asociado a la activación del SNS y su efecto sobre el aumento de los niveles de presión arterial incluye también la inhibición de la síntesis de óxido nítrico (potente vasodilatador) [16, 24, 25].También se ha descrito un aumento de la producción de endotelina-1 en sujetos obesos, lo que contribuye aún más a la elevación de los niveles de presión arterial y, en consecuencia, a la disfunción renal. Estudios recientes han demostrado que la endotelina-1 está aumentada en pacientes con hipertensión intradiálisis, lo que sugiere que esta sustancia juega un papel clave en la génesis de la hipertensión en pacientes con ERC y posiblemente esté asociada con la hipertensión en pacientes obesos [16, 25]. Por lo anterior, las alteraciones hemodinámicas en los pacientes con obesidad conllevan a progresión de la ERC e incremento del riesgo cardiovascular derivado del desarrollo de enfermedades adicionales como la HTA, potencialmente estos cambios son reversibles con el control de la obesidad. ERC-AO Tipo 2 Mantener el estado de obesidad más allá de los efectos renales funcionales produce cambios estructurales irreversibles a nivel glomerular [25]. El estudio de pacientes con ERC y obesidad ha permitido identificar la presencia de enfermedad glomerular asociada a la obesidad, denominada glomerulopatía relacionada con la obesidad (GRO). En esta condición la hipertrofia glomerular parece ser la lesión inicial que estimula el borramiento de los podocitos y desencadena la respuesta inflamatoria local [25, 26]. Es relevante mencionar que las señales profibrogénicas inducen la formación de depósitos en la matriz extracelular de las nefronas, que conduce al engrosamiento de la membrana basal glomeruloesclerosis y fibrosis tubulointersticial [26]. Dentro del curso patogénico de la enfermedad la expansión de la superficie glomerular conduce a que los podocitos sean incapaces de cubrirla, esto lleva a disfunción y borramiento de los mismos, generando ruptura de la barrera de filtración glomerular con sobrecarga de las células restantes, lo que finalmente conduce a hiperfiltración y proteinuria [25, 26]. No obstante, no todos los pacientes con obesidad o IMC aumentado desarrollan ERC, lo cual sugiere que el incremento del IMC por sí solo no genera aumento en la incidencia o progresión de la ERC, ameritando alteraciones metabólicas adicionales. En los siguientes apartados se describen algunas de estas vías fisiopatológicas comunes a todos los tipos de ERC-AO. ERC-AO Tipo 3 La obesidad produce daño renal de forma secundaria ya que aumenta el riesgo de diabetes mellitus, hipertensión y daño cardiovascular, estas patologías causan enfermedad renal diabética (ERD), nefroangioesclerosis, y glomerulopatía asociada a hipertensión pulmonar e insuficiencia cardíaca. La mortalidad no solo se ve afectada por la presencia de la obesidad sino por la presencia de diabetes tipo 2, hipertensión arterial, hipertensión pulmonar e insuficiencia cardíaca. Los peores resultados en supervivencia lo padecen los pacientes con falla cardíaca, obesidad e insuficiencia renal. ERC-AO Tipo 4 En pacientes en hemodiálisis los niveles más elevados de adiponectina se asocian paradójicamente con tres veces más riesgo de muerte [24]. La obesidad se asocia a niveles muy bajos adiponectina por lo que la obesidad en el grupo poblacional que se realiza hemodiálisis es un fuerte factor protector con mejores resultados de supervivencia a 3 años comparados con pacientes con índice de masa corporal normal o baja. Mecanismos fisiopatológicos comunes en la ERC-AO Lipotoxicidad derivada del tejido adiposo En pacientes obesos el exceso de energía conduce a un microambiente sometido a estrés crónico, lo cual resulta en hipertrofia del tejido adiposo hasta que los adipocitos alcanzan su límite de crecimiento [25]. En ese momento, el exceso de especies toxicas lipídicas se acumula ectópicamente en diferentes órganos, induciendo un efecto nocivo conocido como lipotoxicidad; especialmente a nivel renal [27]. La lipotoxicidad se asocia a cambios estructurales y funcionales de las células mesangiales, podocitos y células tubulares proximales [28]. En los podocitos, esto interferiría con la vía de la insulina, crítica para la supervivencia y el mantenimiento de la estructura de los podocitos, lo que conduciría a la apoptosis de los podocitos e induciría una respuesta hipertrófica compensatoria en los podocitos restantes [25]. En el riñón, los depósitos de lípidos ectópicos contribuyen tanto a la inflamación local como al estrés oxidativo [27]. En modelos de ERD, la dislipidemia puede favorecer la acumulación de lípidos ectópicos e intermediarios lipídicos, no solo en el riñón sino también en tejidos extrarrenales como hígado, páncreas y corazón [27]. La acumulación de lípidos en el parénquima renal, genera daño en varias poblaciones celulares, incluídos podocitos, células epiteliales tubulares proximales y el tejido tubulointersticial a través de distintos mecanismos descritos en las siguientes apartados, pudiendo general compromiso a largo plazo de la función renal [27]. El tejido adiposo es una fuente importante de producción de diferentes factores proteicos activos, conocidos como adipocitocinas, las cuales participan en diferentes procesos metabólicos. Alteraciones en la secreción y señalización de moléculas derivadas del tejido adiposo durante la obesidad en gran medida puede mediar en la patogenia de los trastornos metabólicos [25]. A continuaciones se describe el rol de las adipocinas en la patogenia de la ERC y obesidad. Adiponectina La adiponectina es una proteína secretada principalmente por los adipocitos WAT, las principales funciones biológicas de la adiponectina incluyen una mayor biosíntesis de ácidos grasos y la inhibición de la gluconeogénesis hepática [17]. Es probablemente la adipocina secretada más abundantemente, forma alrededor del 0.05 % de las proteínas séricas y mide de 3 a 30 mg/ml en humanos, para su activación utiliza dos isoformas del receptor (AdipoR1 y AdipoR2) son receptores de siete transmembranas y tienen una homología del 66.7 % en su estructura [17]. Sin embargo, AdipoR1 y AdipoR2 son estructural y funcionalmente distintos de los receptores acoplados a proteína G porque su terminal N es intracelular, mientras que el terminal C es extracelular [29, 30]. La señalización de adiponectina se basa principalmente en interacciones de tipo receptor-ligando, en las que la adiponectina se une a sus receptores afines e inicia la activación de varias cascadas de señalización intracelular a través de las vías AMPK, mTOR, NF-κB, STAT3 y JNK [17]. La adiponectina inicia la activación de la señalización de AMPK mediada por la proteína adaptadora APPL1, que se une al dominio intracelular de AdipoR. Eso produce la activación de la biosíntesis de moléculas, otras proteínas reguladoras e importantes factores de transcripción. AMPK es un regulador que participa principalmente en la proliferación celular [17]. Hay dos tipos de macrófagos, M1 participan en la estimulación de los factores pro inflamatorios e induce la resistencia a la insulina y M2 bloquean una respuesta inflamatoria y promueve el metabolismo oxidativo; En los macrófagos, la adiponectina promueve la diferenciación celular de monocitos a macrófagos M2 y suprime su diferenciación a macrófagos M1, lo que muestra efectos pro inflamatorios y antiinflamatorios. Además, también activa los factores antiinflamatorios IL-10 pero reduce las citoquinas pro inflamatorias como IFN-γ, IL-6 y TNF-α en los macrófagos humanos [17]. Los pacientes con ERC muestran niveles elevados de proteína C reactiva (PCR), IL-6 y TNF-α y tienen una activación aberrante de receptor tipo toll (TLR)-4 [25]; en un estudio realizado en el año 2005 en 29 pacientes con ERC no diabéticos en etapa 5 y 14 controles sanos, se identificó que los pacientes con ERC tenían una expresión elevada del gen y la proteína TLR4, la estimulación de TLR-4 in vitro indujo la activación de TNF-α y NF-κB en células C2C12. Esto sugiere indirectamente que la activación de TLR-4 podría promover la inflamación muscular de los pacientes con ERC [31]. Los niveles de adiponectina se consideran predictivos de ERC, dado que estos se encuentran aumentados en pacientes con etapa pre diálisis [17, 29, 32]. Adicionalmente, en un estudio prospectivo realizado en el año 2008 en pacientes con ERC primaria no diabética identificó niveles elevados de adiponectina como un predictor novedoso de progresión de la ERC en hombres [33]. En estudios realizados en animales (ratones) muestran que la deficiencia de adiponectina se relaciona con varias alteraciones histológicas, incluida la fusión segmentaria procesos podocitarios, albuminuria y aumento del estrés oxidativo en los riñones [34]. Por otro lado, en pacientes obesos la producción de adiponectina se encuentra disminuida por lo que se cree que puede generar una función protectora sobre el riñón [29]. No obstante, paradójicamente, algunos estudios muestran que los pacientes con ERC y enfermedad renal crónica en diálisis (ERCT) tienen altos niveles de adipocinas, las explicaciones a esta situación son controversiales, se ha planteado podrían corresponder a un mecanismo compensatorio, otras consideraciones sugieren una disminución de la sensibilidad a la adiponectina o una reducción en el aclaramiento de la misma [35]. Leptina En pacientes con ERC independiente de la presencia de obesidad o no, se asocian a niveles elevados de leptina sérica. La leptina es una proteína de 167 aminoácidos, con una masa molecular de aproximadamente 16 kDa que está codificada por el gen LEP [23] secretada principalmente por los adipocitos, es una adipocina pleiotrópica. La leptina circulante llega a los órganos diana, donde se une a receptores específicos (conocidos como ObR, LR o LEPR), se conocen cinco isoformas del receptor de leptina en humanos (ObRa, ObRb, ObRc, ObRd y ObRe), de estas solo la isoforma ObRb (isoforma larga) se considera un receptor completamente activo, ya que es capaz de transducir completamente una señal de activación en la célula. Esta isoforma se encuentra altamente expresada en el sistema nervioso central (SNC), especialmente en el hipotálamo, donde participa en la regulación de la actividad secretora de este órgano. Los efectos de la leptina están mediados por cinco vías principales de señalización. Estas vías incluyen las vías de señalización JAK-STAT, PI3K, MAPK, AMPK y mTOR [23]. Por esta razón la principal función fisiológica de la leptina es transmitir información al hipotálamo sobre la cantidad de energía almacenada, como la masa de tejido adiposo, e influir en el gasto de energía al reducir el apetito. Regula el metabolismo energético, tiene efecto sobre la ingesta de alimentos, procesos de coagulación, angiogénesis, funciones relacionadas con la insulina y la remodelación vascular, además funciona como un pro inflamatorio molecular [36]. La leptina tiene efectos sobre el apetito y se ha demostrado que la hiperleptinemia contribuye a la hipertensión asociada a la obesidad por sobre activación del sistema nervioso simpático [37]. En cuanto al curso de la ERC, la leptina puede modular diferentes vías de señalización en el riñón, debido a que las células endoteliales glomerulares y mesangiales expresan abundantes receptores de leptina [25]. La leptina inducirá un incremento en la expresión de genes profibróticos, como TGF-β1 y citocinas pro inflamatorias [25]. El aumento en la expresión de TGF-β1, también contribuirá al desarrollarlo de la fibrosis renal, al unirse a receptores específicos a nivel renal, estimulara la expresión de factores profibróticos en un ciclo de retroalimentación positiva. Además, TGF-β1 es un potente iniciador de proliferación de células mesangiales renales [25]. Debido a su tamaño relativamente pequeño, la leptina atraviesa libremente el filtro glomerular de los riñones y luego se reabsorbe en la parte proximal de los túbulos contorneados [23]. Por lo que el estado elevado de leptina puede indicar una función renal deficiente [36]. Promueve la inflamación y trastorno de los lípidos, que contribuyen al riesgo de ERC [36]; se considera como “toxina urémica”, estando implicada tanto en la progresión de la enfermedad renal a través de efectos pro-hipertensivos y profibróticos, como en el desarrollo de complicaciones relacionadas con la ERC (inflamación crónica, pérdida de proteínas) [38]. Como se mencionó previamente, la leptina estimula la proliferación de células endoteliales glomerulares renales y aumenta la expresión de TGF-β1, un mediador clave de la hidrogénesis en estas células, el aumento de los niveles de leptina también contribuye al aumento de la expresión de colágeno tipo IV en el riñón, induce la proliferación de células mesangiales glomerulares mediante la activación de la vía PI3K, la hipertrofia de las células mesangiales aumenta la cantidad de proteína filtrada y albúmina que llega a las células del túbulo proximal y, como resultado, activa las vías inflamatorias y la fibrosis [23]. Puede presentarse un aumento en la síntesis del receptor TGFβ-1 secretado por las células endoteliales, este actúa de manera parácrina sobre el mesangio uniéndose a su receptor y activando la síntesis de proteínas de la matriz extracelular (ECM), incluyendo colágeno, fibronectina, tenazina y proteoglicanos; consiguientemente, un aumento en el nivel de TGFβ-1 conduce a la acumulación de MEC y, en consecuencia, a fibrosis glomerular y glomeruloesclerosis. En los podocitos, la leptina contribuye a la disminución de la expresión de las proteínas responsables de la filtración glomerular adecuada, incluidas la podocina, la nefrina, la podoplanina y la podocalixina. En las células del túbulo contorneado proximal (PTC), la leptina reduce la actividad metabólica de las células al activar la vía de señalización de mTOR [23]. Por otro lado, la leptina inhibe el apetito y aumenta el gasto de energía conduciendo a anorexia y desnutrición en pacientes con ERC, particularmente en casos de hemodiálisis de mantenimiento [36]. Por ende, una elevación de la leptina no solo nos indicaría daño renal, sino que además nos indica mayor progresión de complicaciones secundarias [39]. La obesidad aumenta la carga sobre los riñones y es un factor de riesgo de lesión renal, además de contribuir en los trastornos metabólicos asociados. Por lo que, teniendo en cuenta los efectos inhibitorios de la leptina sobre la obesidad, se puede considerar que puede proteger contra la lesión renal [39, 40]. Un estudio experimental publicado en el año 2017 demostró que la leptina disminuyó la ingesta calórica y los niveles de glucosa en ratas diabéticas [41], ese mismo año se publicó un estudio retrospectivo donde demostraron que la metreleptina, una metionil leptina humana recombinante, reduce el peso corporal y la dosis diaria de insulina en la diabetes mellitus tipo 1 [42]. La metreleptina ejerce efectos terapéuticos en la lipodistrofia [43], lo que indica que es probable que la leptina se aplique en los trastornos metabólicos [36]. Otras adipocinas Las principales adipocinas corresponden a la adiponectina y leptina como se ha descrito previamente. Además de estas, se distinguen la actividad de la visfatina y resistina, las cuales muestran propiedades pro-inflamatorias y efectos aterogénicos [25]. La visfatina estimula la expresión de TGF-β1, inhibidor del activador del plasminógeno-1 (PAI-1) y colágeno tipo I, los cuales han demostrado un rol importante como agentes profibróticos. Por otro lado, la resistina estimula la producción de las moléculas de adhesión como la molécula de adhesión intracelular 1 (ICAM-1) y la proteína de adhesión celular vascular 1 (VCAM-1) y promueve la activación del sistema renal simpático. Los niveles de estas adipocinas están marcadamente elevados en la obesidad y ERC correlacionándose con parámetros proinflamatorios y disminución de la tasa de filtración glomerular (TFG) [25, 37]. Durante el curso de la obesidad se presenta una sobre activación del SRAA, el tejido adiposo también estaría involucrado en la producción o estimulación de algunos de los componentes del RAS. Por ello la sobre estimulación del SRAA en obesos, asociado a la glomerulomegalia y desregulación de la reabsorción de sodio/glucosa, generalmente conlleva a hipertensión glomerular e hiperfiltración [25]. Otra adipocina a considerar, es la actividad de la adipocina proinflamatoria lipocalina 2 (LCN2), también denominada lipocalina asociada con la gelatinasa de neutrófilo (NGAL), estudiada como biomarcador funcional tanto para la enfermedad renal aguda como ERC(25). LCN2 es conocido por su papel en la respuesta inmune innata a través de su unión a sideróforos derivados de una infección bacteriana. Sin embargo, LCN2 no es secretada únicamente por neutrófilos sino también por otros tejidos como hígado, pulmones y de interés para este artículo, a nivel renal [25]. Se han informado niveles elevados de LCN2 en suero y orina en la lesión renal, debido a una expresión aumentada de LCN2 en el túbulo distal renal y una reabsorción alterada en el túbulo proximal [44]. El tejido adiposo, también puede producir factores angiogénicos como el factor de crecimiento del endotelio vascular (VEGF). Este elemento podría inducir la formación de novo de capilares glomerulares en gran parte defectuosos dentro del riñón, lo que contribuye a la hipertrofia glomerular característica de GRO [25] (Figura 2). Conclusiones La obesidad y el sobrepeso se asocian a alteraciones hemodinámicas, estructurales e histopatológicas en el riñón, así como alteraciones metabólicas y bioquímicas que predisponen a la enfermedad renal, aun cuando la función renal y las pruebas convencionales sean normales. Por lo tanto, los efectos renales de la obesidad son estructurales y funcionales. Hay varios mecanismos actualmente descritos que involucran a la obesidad como generador de alteraciones renales. Teniendo en cuenta las bases fisiopatológicas, proponemos una clasificación de la ERC-AO basadas en 4 tipos. Abreviaturas ERC: enfermedad renal crónica. ERC-AO: enfermedad renal crónica-asociada a enfermedad. VEGF: factor de crecimiento del endotelio vascular. OR: Odds ratio. Información suplementaria Materiales suplementarios no han sido declarados. Agradecimientos No aplica. Contribuciones de los autores Jorge Rico-Fontalvo: Conceptualización, Curación de datos, Análisis formal, Adquisición de fondos, Investigación, Metodología, Administración de proyecto, Recursos, Software, Escritura – borrador original. Rodrigo Daza-Arnedo: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Tomás Rodríguez-Yanez: Metodología, validación, supervisión, redacción: Revisión y edición. Washington Osorio: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Beatriz Suarez-Romero: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Oscar Soto: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Juan Montejo-Hernandez: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. María Cardona-Blanco: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Juan Camilo Gutiérrez: Conceptualización, Supervisión, Validación, Visualización, Redacción: revisión y edición. Todos los autores leyeron y aprobaron la versión final del manuscrito. Financiamiento Los autores proveyeron los gastos de la investigación. Disponibilidad de datos o materiales Los conjuntos de datos generados y analizados durante el estudio actual no están disponibles públicamente debido a la confidencialidad de los participantes, pero están disponibles a través del autor correspondiente a pedido académico razonable. Declaraciones Aprobación del comité de ética y consentimiento para participar No aplica para revisiones narrativas. Consentimiento para publicación No aplica cuando no se publican imágenes o fotografías del examen físico o radiografías/tomografías/resonancias de pacientes. Conflictos de interés Los autores reportan no tener conflictos de interés. 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Este artigo discorre sobre a produção, a circulação e a repercussão na imprensa do longa-metragem de ficção A esposa do solteiro (Carlo Campogalliani, 1925), cujo título na Argentina foi La mujer de medianoche. Como não se conhece o paradeiro de alguma cópia integral do filme, foram utilizadas como fontes principais a imprensa cinematográfica e fotografias da película. Trata-se de uma produção realizada de forma pioneira entre Brasil e Argentina, envolvendo os profissionais de origem italiana Paulo Benedetti, Federico Valle, Carlo Campogalliani e Letizia Quaranta, o que aponta para formas de internacionalização mesmo em cinematografias ainda incipientes.

Vincenzo Tullo, Fabio Valguarnera, Piero Barbanti, Pietro Cortelli, Giuliano Sette, Gianni Allais, Florindo d’Onofrio, Marcella Curone, Dario Zava, Deborha Pezzola, Chiara Benedetto, Fabio Frediani and Gennaro Bussone. Comparison of frovatriptan plus dexketoprofen (25 mg or 37.5 mg) with frovatriptan alone in the treatment of migraine attacks with or without aura: A randomized study. Cephalalgia 2014; 34: 434–445. DOI: 10.1177/0333102413515342 . In the published version of this article, the author names and affiliations were represented as below: Vincenzo Tullo1, Fabio Valguarnera2, Piero Barbanti3, Pietro Cortelli4, Giuliano Sette5, Gianni Allais6, Florindo d’Onofrio7, Marcella Curone1, Dario Zava8, Deborha Pezzola8, Chiara Benedetto6, Fabio Frediani9 and Gennaro Bussone1 1Department of Clinical Neuroscience, National Neurological Institute Carlo Besta, Italy 2Sestri Ponente Hospital “Padre Antero Micone”, Italy 3Unit for treatment and research of headaches and pain, IRCCS San Raffaele Pisana, Italy 4Neurological Clinic, Department of Neurological Science, University of Bologna, Italy 5Sant’Andrea Hospital, Italy 6Department of Gynecology and Obstetrics, Women’s Headache Center, University of Turin, Italy 7San Giuseppe Moscati Hospital, Italy 8Istituto Luso Farmaco d’Italia, Peschiera Borromeo, Italy 9Ospedale S. Carlo Borromeo, Italy However, the affiliation for Pietro Cortelli4 should have been written correctly as follows: 4Neurological Clinic, Department of Biomedical and Neuromotor Science, University of Bologna, Italy and IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy The authors apologize for this mistake.

The Authors examine some elements of the work of the great cartographer Benedetto Marzolla (1801-1858) who, together with Carlo Afàn de Rivera, represents the best among the intellectuals and technicians that the Kingdom of Two Sicilies yielded before the Italian unification. This contrasts with the commonplace outlined be the Savoyard-Risorgimental propaganda which describes Naples and the Kingdom as a country inhabited by incapables, depraved and lazy persons. The Authors resume the theme of the Map of Nourishing Products, an excellent work not only because it describes the terrestrial and marine nourishing productions, but also for the connection with many agrarian landscapes and relative trades. Moreover, the Authors present the Map of Excise Duty (1830) another work of Marzolla together with Valentino, never known or considered by cartography scholars. This map does not seem to be cited inside the catalogues or inventories about Marzolla’s production, compiled by Valerio or by others authors in the frame of the analysis of the Royal Topographical Office of Naples (ROT), especially along the second half of the XIX century. The “modernity” of Marzolla manifests not only in consideration of anti-historical comparisons with actual excellent or “organic” food products, but for the analogies with the original proposals of Brunet, Ferras and other academics of the Maison de la Géographie. Unfortunately, Italian geographers have devoted little attention to this field of study.

I’m not calling today about the competition we are holding for Reinventing Cities here in Lambrate - I am calling to ask you if you would like it if we had a dialogue together on the Heteronomy of Architecture. Benedetta Tagliabue: Hello Matteo! Don’t even talk about it, everything is so sad. You know just how important it is for me to travel and meet people all the time... in person. Dialogue? Absolutely! But... what is this “heteronomy”? You don’t mean it’s something that excludes someone? You know I don’t like it... M.R. Come on, we’ve known each other for years! Look, it’s exactly the opposite. A very interesting concept which Giancarlo De Carlo summed up well in a sentence I am going to read to you. «As you can tell as you listen, one cannot help but think of your way of knowing, investigating and reading the places and cities in which you design. It is also impossible not to think of how you live together with others, and how this has always been the way you live architecture on a daily basis, and how you know how to transmit it and build it together with all the people you meet: collaborators, citizens, users, clients, politicians, artists, producers of materials, craftsmen, friends, etc. [...]». B.T. Oh well... I was actually joking a bit, you know it amuses me. I remembered this idea of Giancarlo’s from when I was studying at the Faculty of Architecture in Venice, and I was struck by his strength and energy in knowing how to interpret it at its best and translate it into splendid practice on many occasions. Thank you also for your kind words, it was so kind of you to have thought of me. It certainly is an interesting theme to delve into in a monographic issue of a magazine, and I would like to congratulate those who thought of it. So... Yes, I like it: let’s dialogue! You already know that we’ll have to talk again a few times. M.R. Of course I know... it’s always a great pleasure!

O presente artigo tem como objetivo apresentar uma análise da reportagem “Os cinco mandamentos do professor da EJA” publicada em 28 de março de 2019 no site da Revista Gestão Escolar da Nova Escola. Para desenvolvermos a análise, utilizamos como referencial teórico-metodológico a Teoria das Representações Sociais de Moscovici (2009), Jodelet (2011) e da Semântica da Enunciação, especificamente, Dias (2013) e Guimarães (2017, 2018) do qual adotamos e utilizamos a noção/conceito de locutor e enunciador. Também utilizamos o conceito de cultura proposto por Carmo (2014), de identidade propostos por Hall (2011), Coracini (2003) e Bauman (2005) e de diversidade cultural proposto por Cox (1993), com o intuito de identificar e analisar as representações sociais e as identidades que permeiam os discursos na reportagem. Percebemos que as representações de professor da EJA traçam o modo como o aluno deve ser considerado, para além dos conteúdos e habilidades a serem cobradas. BAUMAN, Zygmunt. Identidade: entrevista a Benedetto Vecchi. Rio de Janeiro: Zahar, 2005. BRASIL. Lei 13632 – março 2018. Lei de Diretrizes e Bases da Educação Nacional. Brasília: Ministério da Educação, artigos 37 e 38, 2018. CARMO, Cláudio Márcio do. O lugar da cultura nas teorias de base linguística sistêmico funcional: multimodalidade e produção de sentido na dança-ritual de Oxóssi. Curitiba: Appris, 2014. CORACINI, Maria José. A celebração do outro. In: CORACINI, Maria José. (Org.). Identidade & discurso: (des)construindo subjetividades. Campinas, SP: Editora da UNICAMP; Chapecó: Argos, 2003. p. 197-221. COX, Taylor. Cultural Diversity in Organizations: theory, research & practice. San Francisco: Berrett-Koehlerpublishers,p. 6, 1993. DIAS, Luiz Francisco. Formações nominais designativas da língua do Brasil: uma abordagem enunciativa. Letras, Santa Maria, v. 23, n. 46, p. 11-22, jan./jun. 2013. GUIMARÃES, Eduardo. Ler um texto uma perspectiva enunciativa. Revista da ABRALIN, v.12, n.2, p. 189- 205, jul./dez. 2013. GUIMARÃES, Eduardo. (2002). Semântica do acontecimento. Campinas: Pontes, 4. ed., 2017. GUIMARÃES, Eduardo. Semântica enunciação e sentido. Campinas: Pontes, 2018. HALL, Stuart. A identidade cultural na pós-modernidade. 11. ed. Rio de Janeiro: DP&A, 2011. JODELET, Denise. Representações Sociais: um domínio em expansão. In: JODELET, D. (Org.). As representações sociais. Rio de Janeiro: UERJ, 2011. MOSCOVICI, Serge. Representações sociais: investigações em psicologia social. 6. ed. Petrópolis, RJ: Vozes, 2009. SILVEIRA, Edna Cristina. A nomeação de programas sociais: um olhar semântico enunciativo. UFSJ, Dissertação de mestrado, 2019.

AbstractQuasi-elastic neutron scattering (QENS)—based on the seminal work of Nobel Laureate Brockhouse—has been one of the major methods for studying pico-second to nano-second diffusive dynamics over the past 70 years. This is regarded as an “inelastic” method for dynamics. In contrast, we recently proposed a new neutron-scattering method for dynamics, which uses the elastic line of the scattering to access system dynamics directly in the time domain (Benedetto and Kearley in Sci Rep 9:11284, 2019). This new method has been denoted “vHI” that stands for “van Hove Integral”. The reason is that, under certain conditions, the measured elastic intensity corresponds to the running-time integral of the intermediate scattering function, $$I\left( {Q,t} \right)$$ I Q , t , up to a time that is inversely proportional to the energy band-width incident on the sample. As a result, $$I\left( {Q,t} \right)$$ I Q , t is accessed from the time derivative of the measured vHI profile. vHI has been supported by numerical and Monte-Carlo simulations, but has been difficult to validate experimentally due to the lack of a suitable instrument. Here we show that vHI works in practice, which we achieved by using a simple modification to the standard QENS backscattering spectrometer methodology. Basically, we varied the neutron-energy band-widths incident at the sample via a step-wise variation of the frequency of the monochromator Doppler-drive. This provides a measurement of the vHI profile at the detectors. The same instrument and sample were also used in standard QENS mode for comparison. The intermediate scattering functions, $$I\left( {Q,t} \right)$$ I Q , t , obtained by the two methods—vHI and QENS—are strikingly similar providing a direct experimental validation of the vHI method. Perhaps surprisingly, the counting statistics of the two methods are comparable even though the instrument used was expressly designed for QENS. This shows that the methodology modification adopted here can be used in practice to access vHI profiles at many of the backscattering spectrometers worldwide. We also show that partial integrations of the measured QENS spectrum cannot provide the vHI profile, which clarifies a common misconception. At the same time, we show a novel approach which does access $$I\left( {Q,t} \right)$$ I Q , t from QENS spectra.

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Introduction Curation-related discourses have become widespread. The growing public profile of curators, the emergence of new curation-related discourses and their proliferation beyond the confines of museums, particularly on social media, have led some to conclude that we now live in an age of curation (Buskirk cited in Synder). Curation is commonly understood in instrumentalist terms as the evaluation, selection and presentation of artefacts around a central theme or motif (see O’Neill; Synder). However, there is a growing academic interest in what underlies the shifting discourses and practices. Many are asking what do these changes mean (Martinon) now that “the curatorial turn” has positioned curation as a legitimate object of academic study (O’Neill). This article locates an exploration of the curatorial turn in journalism studies since 2010 within the shifting meanings of curation from antiquity to the digital age. It argues that the industry is facing a Foucauldian moment where the changing political economy of news and the proliferation of user-generated content on social media have disrupted the monopolies traditional news media held over the circulation of knowledge of current affairs and the power this gave them to shape public debate. The disruptions are profound, prompting a rethinking of journalism (Peters and Broersma; Schudson). However, debates have polarised between those who view news curation as symptomatic of the demise of journalism and others who see it as part of a wider revival of the profession, freed from monopolistic institutions to circulate a wider array of knowledge and viewpoints (see Picard). This article eschews such polarisations and instead draws on Robert Picard’s argument that journalism is in transition and that journalism, as a set of professional practices, is adapting to the age of curation but that those traditional news providers that fail to adapt will most likely decline. However, Picard’s approach does not address the definitional problem as to what distinguishes news curating from other journalistic practices when the commonly used instrumental definition can apply to editing. This article aims to negotiate this problem by addressing some of the conceptual ambiguities that arise from wholly instrumental notions of news curation. From “Cura” to the Curatorial Turn and the Age of Curation Modern instrumentalist definitions are necessary but not sufficient for an exploration of the curatorial turn in journalism. Tracing the meanings of curation over time facilitates an expansion of the instrumental to include metaphoric conceptualisations. The term originated in a Latin allegory about a mythological figure, personified as the “cura”, translated literally as care or concern, and who created human beings from the clay of the earth. Having created the human, the cura was charged by the gods with the lifelong care of the human (Reich) and at the same time became a symbol of curiosity and creativity (see Nowotny). “Curators” first emerged in Imperial Rome to denote a public officer charged with maintaining order and the emperor’s finances (Nowotny) but by the fourteenth century the meaning had shifted to that of religious officer charged with the care of souls (Gaskill). At this point the metaphorical associations of creativity and curiosity subsided. Six hundred years later souls had been replaced by artefacts valorised because of their contribution to human knowledge or as a testament to exceptional human creativity (Nowotny). Objects of curiosity and originality, as well as their creators, were reified and curation became the specialist practice of an expert custodian charged with the care and preservation of artefacts but relegated to the background to collect, evaluate and archive artefacts entrusted to the care of museums and to be preserved for future generations. Instrumentalist meanings thus dominated. From the 1960s discourses shifted again from the privileging of a “producer who actually creates the object in its materiality” to an entire set of actors (Bourdieu 261). These shifts were part of the changing political economy of museums, the growing prevalence of exhibitions and the emergence of mega-exhibitions hosted in global cities and capable of attracting massive audiences (see O’Neill). The curator was no longer seen merely as a custodian but able to add cultural value to artefacts when drawing individual items together into a collection, interpreting their relevance to a theme then re-presenting them through a story or visuals (see O’Neill). The verb “to curate”, which had first entered the English lexicon in the early 1900s but was used sporadically (Synder), proliferated from the 1960s in museum studies (Farquharson cited in O’Neill) as mega-exhibitions attracted publicity and the higher profile of curators attracted the attention of intellectuals prompting a curatorial turn in museum studies. The curatorial turn in museum studies from the 1980s marks the emergence of curation as a legitimate object of academic enquiry. O’Neill identified a “Foucauldian moment” in museum studies where shifting discourses signified challenges to, and disruptions of, traditional forms of knowledge-based power. Curation was no longer seen as a neutral activity of preservation, but one located within a contested political economy and invested with contradictions and complexities. Philosophers such as Martinon and Nowotny have highlighted the impossibility of separating the oversight of valuable artefacts from the processes by which these are selected, valorised and signified and what, at times, has been the controversial appropriation of creative outputs. Thus, a new critical approach emerged. Recently, curating-related discourses have expanded beyond the “rarefied” world of museum studies (Synder). Social media platforms have facilitated the proliferation of user-generated content offering a vast array of new artefacts. Information circulates widely and new discourses can challenge traditional bases of knowledge. Audiences now actively search for new material driven in part by curiosity and a growing distrust of the professions and establishments (see Holmberg). The boundaries between professionals and lay people are blurring and, some argue, knowledge is being democratized (see Ibrahim; Holmberg). However, as new information becomes voluminous, alternative truths, misinformation and false information compete for attention and there is a growing demand for the verification, selection and presentation of artefacts, that is online curation (Picard; Bakker). Thus, the appropriation of social media is disrupting traditional power relations but also offering new opportunities for new information-related practices. Journalism is facing its own Foucauldian moment. A Foucauldian Moment in Journalism Studies Journalism has been traditionally understood as capturing today’s happenings, verifying the facts of an event, then presenting these as a narrative that reporters update as news unfolds. News has been seen as the preserve of professionals trained to interview eyewitnesses or experts, to verify facts and to compile what they found into a compelling narrative (Hallin and Mancini). News-gathering was typically the work of an individual tasked with collecting stand-alone stories then passing them onto editors to evaluate, select, prioritise and collate these into a collection that formed a newspaper or news programme . This understanding of journalism emerged from the 1830s along with a type of news that was accessible, that large numbers of people wanted to read and that, consequently, attracted advertising making news profitable (Park). The idea that presumed trained journalists were best placed to produce news appeared first in the UK and USA then spread worldwide (Hallin and Mancini). At the same time as there was growing demand for news, space constraints restricted how much could be published and the high costs of production served as a barrier to entry first in print then later in broadcast media (Picard; Curran and Seaton). The large news organisations that employed these professionals were thus able to control the circulation of information and knowledge they generated and the editors that selected content were able, in part, to shape public debates (Picard; Habermas). Social media challenge the control traditional media have had over the production and dissemination of news since the mid-1800s. Practically every major global news story in 2010 and 2011 from natural disasters to uprisings was broken by ordinary people on social media (Bruns and Highfield). Twitter facilitates a steady stream of updates at an almost real-time speed that 24-hour news channels cannot match. Facebook, Instagram and blogs add commentary, context, visuals and personal stories to breaking news. Experts and official sources routinely post announcements on social media platforms enabling anyone to access much of the same source material that previously was the preserve of reporters. Investigations by bloggers have exposed abuses of power by companies and governments that journalists on traditional media have failed to (Wischnowski). Audiences and advertisers are migrating away from traditional newspapers to a range of different online platforms. News consumers now actively use search engines to find available information of interest and look for efficient ways of sifting through the proliferation of the useful and the dubious, the revelatory and the misleading or inaccurate (see Picard). That is, news organisations and the professional journalists they employ are increasingly operating in a hyper-competitive (see Picard) and hyper-sceptical environment. This paper posits that cumulatively these are disrupting the control news organisations have and journalism is facing a Foucauldian moment when shifting discourses signify a disturbance of the intellectual rules that shape who and what knowledge of news is produced and hence the power relations they sustain. Social media not only challenge the core news business of reporting, they also present new opportunities. Some traditional organisations have responded by adding new activities to their repertoire of practices. In 2011, the Guardian uploaded its entire database of the expense claims of British MPs onto its Website and invited readers to select, evaluate and comment on entries, a form of crowd-sourced curating. Andy Carvin, while at National Public Radio (NPR) built an international reputation from his curation of breaking news, opinion and commentary on Twitter as Syria became too dangerous for foreign correspondents to enter. New types of press agencies such as Storyful have emerged around a curatorial business model that aggregates information culled from social media and uses journalists to evaluate and repackage them as news stories that are sold onto traditional news media around the world (Guerrini). Research into the growing market for such skills in the Netherlands found more advertisements for “news curators” than for “traditional reporters” (Bakker). At the same time, organic and spontaneous curation can emerge out of Twitter and Facebook communities that is capable of challenging news reporting by traditional media (Lewis and Westlund). Curation has become a common refrain attracting the attention of academics. A Curatorial Turn in Journalism The curatorial turn in journalism studies is manifest in the growing academic attention to curation-related discourses and practices. A review of four academic journals in the field, Journalism, Journalism Studies, Journalism Practice, and Digital Journalism found the first mention of journalism and curation emerged in 2010 with references in nearly 40 articles by July 2015. The meta-analysis that follows draws on this corpus. The consensus is that traditional business models based on mass circulation and advertising are failing partly because of the proliferation of alternative sources of information and the migration of readers in search of it. While some of this alternative content is credible, much is dubious and the sheer volume of information makes it difficult to discern what to believe. It is unsurprising, then, that there is a growing demand for “new types and practices of curation and information vetting” that attest to “the veracity and accuracy of content” particularly of news (Picard 280). However, academics disagree on whether new information practices such as curation are replacing or supplementing traditional newsgathering. Some look for evidence of displacement in the expansion of job advertisements for news curators relative to those for traditional reporters (Bakker). Others look at how new and traditional practices co-exist in organisations like the BBC, Guardian and NPR, sometimes clashing and sometimes collaborating in the co-creation of content (McQuail cited in Fahy and Nisbet; Hermida and Thurman). The debate has polarised between whether these changes signify the “twilight years of journalism or a new dawn” (Picard). Optimists view the proliferation of alternative sources of information as breaking the control traditional organisations held over news production, exposing their ideological biases and disrupting their traditional knowledge-based power and practices (see Hermida; Siapera, Papadopoulou, and Archontakis; Compton and Benedetti). Others have focused on the loss of “traditional” permanent journalistic jobs (see Schwalbe, Silcock, and Candello; Spaulding) with the implication that traditional forms of professional practice are in demise. Picard rejects this polarisation, counter-arguing that much analysis implicitly conflates journalism as a practice with the news organisations that have traditionally hosted it. Journalists may or may not be located within a traditional media organisation and social media is offering numerous opportunities for them to operate independently and for new types of hybrid practices and organisations such as Storyful to emerge outside of traditional operations. Picard argues that making the most of the opportunities social media presents is revitalising the profession offering a new dawn but that those traditional organisations that fail to adapt to the new media landscape and new practices are in their twilight years and likely to decline. These divergences, he argues, highlight a profession and industry in transition from an old order to a new one (Picard). This notion of journalism in transition usefully negotiates confusion over what curation in the social media age means for news providers but it does not address the uncertainty as to where it sits in relation to journalism. Futuristic accounts predict that journalists will become “managers of content rather than simply sourcing one story next to another” and that roles will shift from reporting to curation (Montgomery cited in Bakker; see Fahy and Nisbet). Others insist curators are not journalists but “information workers” or “gatecheckers” (McQuail 2013 cited in Bakker; Schwalbe, Silcock, and Candello) thereby differentiating the professional from the manual worker and reinforcing the historic elitism of the professions by implying curation is a lesser practice. However, such demarcation is problematic in that arguably both journalist and news curator can be seen as information workers and the instrumental definition outlined at the beginning of this article is as relevant to curation as it is to news editing. It is therefore necessary to revisit commonly used definitions (see Bakker; Guerrini; Synder). The literature broadly defines content creation, including news reporting, as the generation of original content that is distinguishable from aggregation and curation, both of which entail working with existing material. News aggregation is the automated use of computer algorithms to find and collect existing content relevant to a specified subject followed by the generation of a list or image gallery (Bakker; Synder). While aggregators may help with the collection component of news curation, the practices differ in their relation to technology. Apart from the upfront human design of the original algorithm, aggregation is wholly machine-driven while modern news curation adds human intervention to the technological processes of aggregation (Bakker). This intervention is conscious rather than automated, active rather than passive. It brings to bear human knowledge, expertise and interpretation to verify and evaluate content, filter and select artefacts based on their perceived quality and relevance for a particular topic or theme then re-present them in an accessible form as a narrative or infographics or both. While it does not involve the generation of original news content in the way news reporting does, curation is more than the collation of information. It can also involve the re-presenting of it in imaginative ways, the re-formulating of existing content in new configurations. In this sense, curation can constitute a form of creativity increasingly common in the social media age, that of re-mixing and re-imagining of existing material to create something novel (Navas and Gallagher). The distinction, therefore, between content creation and content curation lies primarily in the relation to original material and not the assumed presence or otherwise of creativity. In addition, curation outputs need not stand apart from news reports. They can serve to contextualize news in ways that short reports cannot while the latter provides original content to sit alongside curated materials. Thus the two types of news-related practices can complement rather than compete with each other. While this addresses the relation between reporting and curation, it does not clarify the relation between curating and editing. Bakker eludes to this when he argues curating also involves “editing … enriching or combining content from different sources” (599). But teasing out the distinctions is tricky because editing encompasses a wide range of sub-specialisations and divergent duties. Broadly speaking, editors are “newsrooms professionals … with decision-making authority over content and structure” who evaluate, verify and select information so are “quality controllers” in newsrooms (Stepp). This conceptualization overlaps with the instrumentalist definition of curation and while the broad type of skills and tasks involved are similar, the two are not synonymous. Editors tends to be relatively experienced professionals who have worked up the newsroom ranks whereas news curators are often new entrants ultimately answerable to editors. Furthermore, curation in the social media age involves voluminous material that curators sift through as part of first level content collection and it involves ever more complex verification processes as digital technologies make it increasingly easy to alter and falsify information and images. The quality control role of curators may also involve in-house specialists or junior staff working with external experts in a particular region or specialisation (Fahy and Nisbett). Some of job advertisements suggest a growing demand for specialist curatorial skills and position these alongside other newsroom professionals (Bakker). Whether this means they are journalists is still open to question. Conclusion This article has presented a more expansive conceptualisation of news curation than is commonly used in journalism studies, by including both the instrumental and the symbolic dimensions of a proliferating practice. It also sought to avoid confining this wider conceptualisation within unhelpful polarisations as to whether news curation is symbolic of a wider demise or revival of journalism by distinguishing the profession from the organisation in which it operates. The article was then free to negotiate the conceptual ambiguity surrounding the often taken-for-granted instrumental meanings of curation. It argues that what distinguishes news curation from traditional newsgathering is the relationship to original content. While the reporter generates the journalistic equivalent of original content in the form of news, the imaginative curator re-mixes and re-presents existing content in potentially novel ways. This has faint echoes of the mythological cura creating something new from the existing clay. The other conceptual ambiguity negotiated was in the definitional overlaps between curating and editing. On the one hand, this questions the appropriateness of reducing the news curator to the status of an “information worker”, a manual labourer rather than a professional. On the other hand, it positions news curators as one of many types of newsroom professionals. 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