Propter adhorantium auctoritatem voluntate. Legittimazione, patronage e propaganda nelle Gesta Regum Anglorum di Guglielmo di Malmesbury

L’oggetto di ricerca della presente tesi di dottorato è costituito dall’analisi dell’opera Gesta Regum Anglorum, del monaco benedettino Guglielmo di Malmesbury, all’interno della quale sono stati esplorati e verificati i temi di legittimazione, di patronage e di propaganda. L’opera, infatti, rimane senza un manifesto committente, ad eccezione di una primissima versione. Il titolo della tesi rivela fin da subito questo aspetto, giacché estrae un passaggio del prologo al I libro: «propter adhorantium auctoritatem voluntate», traducibile con «per le autorevoli esortazioni che ricevetti». Dopo un’analisi delle lettere dedicatorie premesse all’opera, si è ipotizzata la volontà dell’autore di dedicare le Gesta Regum Anglorum, nella loro versione definitiva, a Roberto conte di Gloucester, approfondendo in tal senso l’aspetto legittimatorio dell’opera e la possibilità che essa potesse servire come strumento per ottenere un patronage dal conte nei confronti dell’abbazia di Malmesbury. La seconda parte della tesi è incentrata sulla comparazione tra le due principali redazioni dell’opera – quella conclusa intorno al 1126/27 e quella rivista tra 1135 e 1140 – per analizzarne le modifiche, ipotizzandone la funzione come volta mitigare aspetti relativi ai principali antenati di Roberto di Gloucester (Guglielmo I e Guglielmo II). La terza parte della tesi si è concentrata sull’aspetto propagandistico dell’opera in favore del monastero di appartenenza di Guglielmo (Malmesbury) e soprattutto in favore del clero regolare, nella dicotomia che caratterizzò questo e il clero secolare durante gli anni in cui l’autore viveva. Nell’ultima parte della tesi, è stato ripreso l’aspetto legittimatorio delle Gesta Regum, tentando di fornire un’analisi delle tre raffigurazioni dei sovrani normanni d’Inghilterra, che punteggiano i tre libri finali dell’opera.

Apnea e reflusso gastroesofageo nel neonato pretermine

Objective: To document the existence of a relationship between apnea of prematurity (AOP) and gastroesophageal reflux (GER) in preterm infants. Setting: One Neonatal Intensive Care Unit Patients: Twenty-six preterm infants (gestational age<32 weeks) with recurrent apneas. Intervention: Simultaneous and synchronized recording of polysomnography and pH-impedance monitoring (pH-MII). Polysomnography detects and characterizes apneas, by recording of breathing movement, nasal airflow, electrocardiogram, pulse oximeter saturation. pH-MII is the state-of-theart methodology for GER detection in preterm newborns. Main outcome measures: Relationship between AOP and GER, which were considered temporally related if both started within 30 seconds of each other. Results: One-hundred-fifty-four apneas out of 1136 were temporally related to GER. The frequency of apnea during the one-minute time around the onset of GER was significantly higher than the one detected in the GER-free period (p=0.03). Furthermore, the frequency of apnea in the 30 seconds after GER (GER-triggered apneas) was greater than that detected in the 30 seconds before (p=0.01). A great inter-individual variability was documented in the proportion of GERtriggered apneas. A strong correlation between total number of apneas and the difference between apneas detected 30 seconds after and before GER was found (p=0.034). Conclusions: Our data show that a variable rate of apneas can be triggered by GER in very preterm infant. Further studies are needed to recognise clinical features which identify those patients who are more susceptible to GER-triggered apneas.

Validazione e applicazioni cliniche della metodica NIRA (Near Infrared Reflectance Analysis) per la valutazione del contenuto nutrizionale del latte materno in terapia intensiva neonatale

Phase 1: To validate Near-Infrared Reflectance Analysis (NIRA) as a fast, reliable and suitable method for routine evaluation of human milk’s nitrogen and fat content. Phase 2: To determine whether fat content, protein content and osmolality of HM before and after fortification may affect gastroesophageal reflux (GER) in symptomatic preterm infants. Patients and Methods: Phase 1: 124 samples of expressed human milk (55 from preterm mothers and 69 from term mothers) were used to validate NIRA against traditional methods (Gerber method for fat and Kjeldhal method for nitrogen). Phase 2: GER was evaluated in 17 symptomatic preterm newborns fed naïve and fortified HM by combined pH/intraluminal-impedance monitoring (pH-MII). HM fat and protein content was analysed by a Near-Infrared-Reflectance-Analysis (NIRA). HM osmolality was tested before and after fortification. GER indexes measured before and after fortification were compared, and were also related with HM fat and protein content and osmolality before and after fortification. Results: Phase 1: · A strong agreement was found between traditional methods’ and NIRA’s results (expressed as g/100 g of milk), both for fat and nitrogen content in term (mean fat content: NIRA=2.76; Gerber=2.76; mean nitrogen content: NIRA=1.88; Kjeldhal =1.92) and preterm (mean fat content: NIRA=3.56; Kjeldhal=3.52; mean nitrogen content: NIRA=1.91; Kjeldhal =1.89) mother’s milk. · Nitrogen content of the milk samples, measured by NIRA, ranged from 1.18 to 2.71 g/100 g of milk in preterm milk and from 1.48 to 2.47 in term milk; fat content ranged from 1.27 to 6.23 g/100 g of milk in preterm milk and from 1.01 to 6.01 g/100 g of milk in term milk. Phase 2: · An inverse correlation was found between naïve HM protein content and acid reflux index (RIpH: p=0.041, rho=-0.501). · After fortification, osmolality often exceeded the values recommended for infant feeds; furthermore, a statistically significant (p<.05) increase in non acid reflux indexes was observed. Conclusions: NIRA can be used as a fast, reliable and suitable tool for routine monitoring of macronutrient content of human milk. Protein content of naïve HM may influence acid GER in preterm infants. A standard fortification of HM may worsen non acid GER indexes and, due to the extreme variability in HM composition, may overcome both recommended protein intake and HM osmolality. Thus, an individualized fortification, based on the analysis of the composition of naïve HM, could optimize both nutrient intake and feeding tolerance.