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Unlike other groups in Breslov, Nanachs focus more on publishing actual works of Rebbe Nachman and not personal compilations. In our previous study we suggested that a high VAI score is associated with cardiovascular and cerebrovascular events, well identifying patients with cardiometabolic risk [ 10 ].

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Nevertheless, WC alone does not help in distinguishing between subcutaneous and visceral both omental and mesenteric fat mass [ 4 ]. This is particularly significant given that differences in insulin-sensitivity, lipolytic activity and adipocytokines production play a fundamental role in the genesis of cardiovascular sequelae [ 5 - 7 ].

Since these two methods are extremely expensive and complicated to perform, they cannot be recommended in routinely clinical practice. Furthermore, in order to predict VAT-associated cardiometabolic risk, it would be highly desirable to perform routine evaluation of "visceral adipose dysfunction" VAD by adipocytokine assessment.

This approach, however, is also unfeasible because of the complexity of the 'adipose endocrine organ' function [ 9 ], and again for the high costs involved. This index, which could be considered a simple surrogate marker of VAD, showed a strong association with both the rate of peripheral glucose utilization M value during the Euglycemic-hyperinsulinemic Clamp and with visceral adipose tissue VAT measured with MRI.

Furthermore, it showed a strong independent association with both cardiovascular and cerebrovascular events [ 10 ] and showed better predictive power for incident diabetes events than its individual components WC, BMI, TG and HDL [ 11 ]. Moreover, this index has been studied in specific populations of patients: Since data from the 13, Primary Care patients PC patients were recorded anonymously, no individual informed consent was needed.

The study was approved by the Institutional Review Board of the Faculty of Medicine, University of Palermo, given that the identity of the participants remained anonymous during database analysis. Data have been recorded by PCPs since using the Millewin computed medical chart v. For 1, of the 13, PC patients, complete information was available on the following aspects: This group males and 1, females; mean age With regard to the clinical and biochemical parameters analyzed, we used the mean value of data recorded in the last six months of follow-up.

WC was measured at the midpoint between the lower rib and the iliac crest. Blood chemistry analyses were performed in accredited laboratories of the National Health Service in Alcamo. LDL cholesterol was calculated using the Friedwald equation. Normality of distribution for quantitative data was assessed by the Kolmogorov-Smirnov test.

Because HbA1c did not present normal distribution, it was therefore log-transformed. Multiple logistic regression models were performed to explore possible determinants of cardio- and cerebrovascular events using two predictive models for dichotomic variables: In the first model the following independent variables were included: In the second model the following independent variables were included: The 1, PC patients males and 1, females; mean age Optimal VAI cut-off points were: Specificity ; SE Standard Error.

In our previous study we suggested that a high VAI score is associated with cardiovascular and cerebrovascular events, well identifying patients with cardiometabolic risk [ 10 ].

However, given the lack of a prospective longitudinal study, it was not possible to define irrefutably a high VAI score as a cardiovascular risk factor. In fact, the cross-sectional nature of the study has not made it possible to find causal inferences regarding the relationship between VAI and cardio- and cerebrovascular events.

In this study we identified in a Caucasian Sicilian population the age-stratified cut-off points of VAI which proved to be strongly associated with MetS. PC patients with VAI scores greater than these cut-off points were arbitrarily defined as having mild, moderate or severe visceral adipose dysfunction VAD.

Since visceral fat is universally claimed to be more strongly associated with cardiometabolic risk than subcutaneous fat, we believe that emphasis should be given to the new model represented by VAD, since it is widely reported that visceral fat is more strongly associated with cardiometabolic risk compared with subcutaneous fat [ 18 , 19 ] and that VAT remains confirmed as an important correlate of metabolic risk factors after accounting for BMI [ 18 , 20 ].

Furthermore, over the last decade there has been increasing evidence regarding the endocrine function of adipose tissue: PC patients with VAD ranging from mild to severe, showed a significant trend of increased prevalence of all components of the MetS and of cardio- and cerebrovascular events. A possible explanation might lie in the fact that the 5 variables proposed in the ATP III criteria are not used as quantitative continuous variables, but rather as dichotomous variables.

Indeed, the 'presence' or the 'absence' of an abnormality may be too crude to identify the individual risk profile. Lastly, with current Mets diagnosis criteria, tools are considered as a homogeneous entity, which is very unlikely, especially as regards diabetes and high blood pressure [ 24 , 25 ]. For VAI, which represents a global calculator of non-glycemic and non-hemodynamic components of the MetS, while on one hand the variables are treated as continuous variables, on the other two important aspects are taken into consideration, i.

In fact, women have, on average, more subcutaneous fat and less visceral fat than men [ 26 ]. Although VAI cannot be claimed per se as a diagnostic tool for cardiovascular and cerebrovascular events, since it includes physical BMI and WC and metabolic TG and HDL parameters, it may, however, indirectly reflect other non-classical risk factors, i.

This condition, which we ourselves consider useful to define visceral fat dysfunction , when associated with physiological age-linked leptin resistance, leads to pancreatic lipotoxicity with subsequent beta-cell apoptosis and diabetes onset, muscle insulin resistance, liver insulin resistance and NAFLD, lipotoxic cardiomyopathy and generalized endothelial dysfunction [ 27 ].

In conclusion, given the simplicity of WC and BMI measurement and TG and HDL assessment, and the identification of reference cut-off points in a Caucasian population, we suggest that VAI would be an easy tool for the assessment of VAD, and might be useful in daily clinical practice and in population studies for the assessment of cardiometabolic risk associated with visceral obesity. All authors contributed to the intellectual development of this work, and approved the final manuscript.

MCA designed the study, performed the statistical analysis of data, searched the literature and wrote the draft paper; MP searched the literature; CG and AG coordinated the study, searched the literature and provided critical corrections to the manuscript. We are indebted to the AlkaMesy Study Group for their valuable assistance with data collection.

National Center for Biotechnology Information , U. Journal List Lipids Health Dis v. Published online Oct Author information Article notes Copyright and License information Disclaimer. Na Nach vans can contain a single Mafitz or as many as Most vans average a team of Mafitzim. Life on the Na Nach van can be rough, Mafitzim often work on very little food and sleep. Most Mafitzim spend hours dancing each day, sometimes for a few hours in a row.

Most Hafatza vans stay on the road for the bulk of the week, with the Mafitzim sleeping in the van itself or at designated Na Nach resting spots.

Besides dancing on busy streets, many Hafatza teams will visit events and weddings as well. It has already become a tradition amongst secular Israelis to invite Nanachs and bring joy to their weddings. Saba once said "whoever wants to be my friend should do bayit bayit", go house to house spreading Na Nach, the Petek and teachings of Rebbe Nachman.

Many Mafitizim practice this teaching and take off a few hours a week knocking door to door trying to spread the books of Rebbe Nachman.

Aside from the vans there are Na Nach stores located throughout Israel. Almost all the stores are run and operated by Keren Rebbe Yisroel Odesser. These stores are generally small, often nothing more then a booth. Amongst Na Nachs they are referred to as 'bastas'. Na Nach stores often sell non Nanach products as well to help cover the rent and raise money for additional printing of books. Meron hosts the largest operation.

There are a number of other store locations including Jerusalem, Hebron and Safed. In addition to the stores, Mafitizm will often set up makeshift tables at events expected to have a large turnout.

It has become practically impossible to walk around Israel and not come across Nanach Stickers. From street poles and traffic signs to store fronts and car bumpers, Na Nach stickers have made their mark all over the country. Popular even by non believers of the Petek, Na Nach sticker have infiltrated every group in Israeli society. Over time hundreds if not thousands of unique Nanach stickers have been printed using different designs, shapes and printing methods.

Some Na Nach stickers are small enough to fit the back of a cell phone and others can be couple of feet long. There is no particular group or person responsible for the stickers, practically every Na Nach will at some point in his career tried to print a Nanach sticker.

Most sticker designs only last a single printing run before they go extinct. Stickers are cheap to buy and are the most popular selling Na Nach product. This probably contributed to their widespread distribution.

Stickers stay in place for a while and may remain in the same location for years after being hung up. Aside from stickers there are a number of other Na Nach products being produced. These include Na Nach Kipas, scarves, baseball caps, hats, t-shirts, sweat shirts and key chains. Like many other groups the Na Nachs have developed their own music. There are many types of Na Nach music created by different artists.

Some Nanach artists have succeeded in having their music penetrate even traditional Orthodox Judaism. A common type of Na Nach music is Nanach Trance, where recorded statements of the Saba are dubbed against a background of techno music.

Nanach graffiti is a common site around Israel and is more then an act of juvenile delinquency. It is the mark of the Na Nach group trying to infuse their teachings upon the nation. Na Nach graffiti is very controversial and one of the main arguments people have against Na Nach. Not every Na Nach supports the use of graffiti to spread the Song of Redemption but many do.

Rabbi Odesser himself said that painting Na Nach can only be done with the owners permission. A debate rages amongst Na Nachs about what is permissible and what is not. All Na Nachs agree that it prohibited to spray paint private property, although occasionally an over enthusiastic newcomer might get caught up in his zeal and violate this rule.

There is also a general agreement amongst Nanachs that it is acceptable to spray paint on abandoned property such as a ruin. Na Nachs claim that each time a person sees the graffiti and is reminded of Na Nach, it is the biggest favor that can be done for him and far outweighs any negative elements involved. A sticky part of the debate revolves around the issue of 'national property'. Many Na Nachs claim that this is forbidden and doing so might even violate Halacha.

A minority argue that since Rebbe Nachman is the King of Israel, all 'national property' belongs to him. These Nanachs feel justified spray painting his name on what they believe to be Rebbe Nachman's property. There is no official dress code in Nanach but a large percentage of its members wear a Na Nach Kipa and every last one dons a Kemea. Na Nachs generally have an untrimmed beard and long payos.

Many Na Nachs prefer to wear their payos all out and wild, there are others that keep them curled in a more traditional Hasidic fashion. Based on the opinion of the Kabbalah almost all Nanachs have large untrimmed beards. Na Nachs tend to dress loosely sometimes mimicking hippy styles. On Shabbos some Na Nachs wear a shtreimel with Yerushalmi yellow blue striped caftans. Others wear white as is customary according to the Kabbalah and practiced by Rebbe Nachman himself.

It is an ancient Kablistic custom to wear a white Yarmulke and Rebbe Nachman's personal Kipa somewhat resembles the modern Nanach Kipa. Nanach Kipas can be purchased for a few dollars and have become a very popular Purim costume in the Charadi world.

Traditional Nanach Kipas are white with black letters, they have also been produced in a number of other colors. Following instructions of the Sabba the Na Nachs have created a 'Kemea' or protective amulet.

A Kemea is generally worn around the neck and contains the phrase Na Nach Nachma Nachman Muman written on parchment alongside a small copy of the petek. Inside the Kemea there is a double wrapping to make its entry into the bathroom permissible. Many designs of the Kemea have been manufactured using a variety of materials including leather, plastic and wood. More expensive silver Kemeas are also available and are generally given as a gift for large donations. Amongst the Nanachs there is strong belief in the power of the Kemea and many have supernatural tales to tell over regarding its effects.

Some Na Nachs wear two Kemeas, following a teaching of the Saba that two is better then one. Leadership is a position frowned upon by the Na Nachs. Since the death of Rabbi Yisroel Ber Odesser in there has not been any leader the movement answers up to. There are a number of sub groups within Nanach, although for the most part they share similar outlooks. Na Nachs tend to have an individualist personality and value personal independence.

Many Na Nachs will not conform to any group and live as interests them at that moment. Due to the strong emphasis Na Nachs place on Hafatza most groups contain a publishing arm dedicated to the printing of Breslev books.

Aside from the main Nanach publishers, many books and pamphlets are printed by individual Nanachs. Unlike other groups in Breslov, Nanachs focus more on publishing actual works of Rebbe Nachman and not personal compilations. Keren Rebbe Yisroel Odesser is the largest publisher of Breslov Books in the world, having distributed and sold millions of copies.

After he passed away Saba left a will stating that his grandson Amram Horowitz be placed in charge of the Keren. Many Na Nachs took the will as a direct command from the Saba that all Hafatza was supposed to go directly through Amram.

Others argued that there was room for other Hafatza to take place. Amram Horowitz passed away in and left his two sons Shmuel and Nachman in charge of the Keren. Shmuel and Nachman Horowitz were also mentioned in the original will of the Saba as two of the three caretakers of the Keren. Over time the Keren has become more then just a book publisher. Keren Rebbe Yisroel currently runs a number of schools, stores and Hafatza operations.

Although not all Mafitzim subjugate themselves to the Keren, the bulk will work alongside them and distribute their books. After a bitter disagreement with the Keren regarding the printing of the Petek and Na Nach on published books, a number of French devotees separated and began their own Hafatza activities.

French Mafitizm tend to emphasis the spreading of Saba over the teachings of Rebbe Nachman. Their publishing company is currently called 'Nekuda Tova'. A large public annual party in Jerusalem during the Hillulah of the Saba, is also run by French Nanachs. Recent years have shown an active growth of Na Nach amongst Americans. Occasionally American Nanachs do Hafatza activities on their own.

There is at least one Nanach van that is completely American. Internet based Hafatza is largely dominated by American Nanachs. Benzonson became a devote of the Saba during the last week of Rabbi Odesser's life. Shir Chadash is based in Tel Aviv and aims to make secular Israelis religious by spreading Na Nach teachings on an intellectual level. Shir Chadash publishes a number of books compiled by Yitzchok Benzonson. To fully understand the mind of a Na Nach one has to first understand the teachings of Rebbe Nachman of Breslov.

Na Nachs are very devoted followers of Rebbe Nachman and try to integrate his teachings and advice deep into their lives. Na Nach is not a new form of Judaism and it does nothing to change Halacha.

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