International recommendations on the diagnosis and treatment of patients with acquired hemophilia A.

Acquired hemophilia A (AHA) is a rare bleeding disorder characterized by autoantibodies directed against circulating coagulation factor (F) VIII. Typically, patients with no prior history of a bleeding disorder present with spontaneous bleeding and an isolated prolonged aPTT. AHA may, however, present without any bleeding symptoms, therefore an isolated prolonged aPTT should always be investigated further irrespective of the clinical findings. Control of acute bleeding is the first priority, and we recommend first-line therapy with bypassing agents such as recombinant activated FVII or activated prothrombin complex concentrate. Once the diagnosis has been achieved, immediate autoantibody eradication to reduce subsequent bleeding risk should be performed. We recommend initial treatment with corticosteroids or combination therapy with corticosteroids and cyclophosphamide and suggest second-line therapy with rituximab if first-line therapy fails or is contraindicated. In contrast to congenital hemophilia, no comparative studies exist to support treatment recommendations for patients with AHA, therefore treatment guidance must rely on the expertise and clinical experience of specialists in the field. The aim of this document is to provide a set of international practice guidelines based on our collective clinical experience in treating patients with AHA and contribute to improved care for this patient group.

Economic structure and key sectors analysis of greenhouse gas emissions in Uruguay

This paper identifies the key sectors in greenhouse gas emissions of the Uruguayan economy through input-output analysis. This allows to precisely determine the role played by the different productive sectors and their relationship with other sectors in the relation between the Uruguayan productive structure and atmospheric pollution. In order to guide policy design for GHG reduction, we decompose sectors liability between the pollution generated through their own production processes and the pollution indirectly generated in the production processes of other sectors. The results show that all the key polluting sectors for the different contaminants considered are relevant because of their own emissions, except for the sector Motor vehicles and oil retail trade, which is relevant in CO2 emissions because of its pure, both backward and forward, linkages. Finally, the best policy channels for controlling and reducing GHGs emissions are identified, and compared with the National Climate Change Response Plan (NCCRP) lines of action.

Appanoose County, June 30, 2003

County Audit Report

Langage et cerveau : vingt ans d'imagerie fonctionnelle [Language and the brain: 20 years of functional imagery]

La masse considérable de travaux publiés dans le domaine de la neuroimagerie fonctionnelle concernant les fonctions ou modalités du langage (compréhension et expression de la parole, lecture) ou les différents processus linguistiques qui les sous-tendent (sémantique, phonologie, syntaxe) permet de dégager de grandes tendances en termes de substrats anatomiques. Si les « fondamentaux » issus des origines aphasiologiques du domaine n'ont pas été bouleversés, certaines spécificités non explorées par l'approche lésionnelle sont identifiables. Les méta-analyses, en regroupant les résultats de la littérature, nous procurent aujourd'hui une vision globale des substrats cérébraux du langage. Cependant la variabilité inter-individuelle reste importante en raison de multiples facteurs dont certains sont mal identifiés ; cartographier exhaustivement les fonctions du langage à l'échelle individuelle reste une gageure. La quête des images du langage est sans doute aussi inachevable que celle de l'étude du langage lui-même.

Recueil de commentaires exégétiques

F. 1r-40r : Abraham ben Isaac Tamakh, commentaire du Cantique des cantiques. F. 41r-55r : Benjamin ben Abraham Anaw, השערים. F. 55v-56v : miscellanées. F. 57r-67r : traité sur le calendier hébreu. F. 68r : Aharon de Lunel, liste chronologique d'événement survenus depuis la destruction du second temple de Jérusalem jsqu'en 1204. F. 70v-71r : miscellnées. F. 73r-102v : index des citations bibliques contenues dans le Moreh Nebuchim. F. 105r-111v : division des chapites de la bibles par les chrétiens. F. Colophon au f. 40r : ותשלם ... ע"י הצעיר ... בכמ"ר ... יצ"ו יו’ ג’ י’ אפרי’ רמ"א". שם המעתיק נמחק, ובסופו בכתיבה מאוחרת: "בסירמ’" Copié le 13 avril 5241 (1481) à Sermini (Italie)

Restoration of connexin 40 (cx40) in Renin-producing cells reduces the hypertension of cx40 null mice.

Connexin 40 (Cx40) is expressed by the renin-producing cells (RSCs) of the kidneys and the endothelial cells of blood vessels. Cx40 null mice (Cx40(-/-)) feature a much increased renin synthesis and secretion, which results in chronic hypertension, and also display an altered endothelium-dependent relaxation of the aorta because of reduced eNOS levels and nitric oxide production. To discriminate the effect of Cx40 in renin secretion and vascular signaling, we targeted Cx40 to either the RSCs or the endothelial cells of Cx40 null mice. When compared with Cx40(-/-) controls, the animals expressing Cx40 in RSCs were less hypertensive and featured reduced renin levels, still numerous RSCs outside the wall of the afferent arterioles. In contrast, mice expressing Cx40 in the endothelial cells were as hypertensive as Cx40(-/-) mice, in spite of control levels of Cx37 and eNOS. Our data show that blood pressure is improved by restoration of Cx40 expression in RSCs but not in endothelial cells, stressing the prominent role of renin in the mouse hypertension linked to loss of Cx40.

Locating emergency services with priority rules: The priority queuing covering location problem

One of the assumptions of the Capacitated Facility Location Problem (CFLP) is thatdemand is known and fixed. Most often, this is not the case when managers take somestrategic decisions such as locating facilities and assigning demand points to thosefacilities. In this paper we consider demand as stochastic and we model each of thefacilities as an independent queue. Stochastic models of manufacturing systems anddeterministic location models are put together in order to obtain a formula for thebacklogging probability at a potential facility location.Several solution techniques have been proposed to solve the CFLP. One of the mostrecently proposed heuristics, a Reactive Greedy Adaptive Search Procedure, isimplemented in order to solve the model formulated. We present some computationalexperiments in order to evaluate the heuristics performance and to illustrate the use ofthis new formulation for the CFLP. The paper finishes with a simple simulationexercise.

Agrarförbundets ordförande 1958 generaldirektör V. J. Sukselainen

Kirje

Situación de la población de merluza (Merluccius gayi peruanus) durante El Niño

Evalua los ultimos 10 años de pesca y las variaciones oceanográficas producidas y como estas han afectado el comportamiento de la especie.

Un témoin latin du Protévangile de Jacques: l'homélie Postulatis filiae Ierusalem en l'honneur de sainte Anne (BHL 483-485)

L'article s'inscrit dans une recherche sur la survie du Protévangile de Jacques en latin. Il contient l'édition critique et la traduction d'une homélie pour la fête de sainte Anne, qui combine le début du Protévangile (ch. 1-4) et le début du De Nativitate Mariae (ch. 1-5 ). L'homélie se compose de trois parties. (1) un préambule (<pilcrow> 1-6) ; (2) un récit sur Anne et Joachim, qui associe les deux sources précitées (<pilcrow> 7-29), (3) une péroraison (<pilcrow> 30-34 ). Les manuscrits l'ont conservée sous des formes plus ou moins complètes et remaniées. Certains la transmettent comme légende d'Anne au sein de la Legenda Aurea de Jacques de Voragine. La plupart son t des recueils liturgiques, contenant l'office et les lectures pour la fête d'Anne. Dans un cas, l'homélie a été transformée et fournit des leçons pour la fête de la Conception de la Vierge. L'auteur de l'homélie s'adresse à une communauté de moniales qui lui ont demandé de traduire en latin un « petit livre grec - qui n'est autre que le Protévangile. Le texte a dû être composé à Chartres ou dans les environs immédiats de cette ville, durant les premières années du XIIIe siècle Son origine est liée à l'institution dans l'église de Chartres d'une fête en l'honneur de sainte Anne. Cette innovation liturgique s'explique par la donation d'une relique- la tête de la sainte - acquise par Louis de Blois et provenant du butin enlevé à Constantinople lors de la conquête de la ville par les Latins (1204).

Extraits de chroniques du LIMOUSIN.

Contient : « Chronica monasterii Sancti Marcialis Lemovicensis, usque ad annum MCCCX, ex ms. exemplari Joannis Cordesii, Lemovicensis ecclesie canonici » (ms. lat. 11019, p. 1-45) ; « Chronicon aliud ex eodem codice, ab anno MXVIII ad annum MCCLXVIII » (ibid., p. 101-191) ; « Ex chronico Lemovicensi Sancti Martialis ms. » 1204-1320 (ibid., p. 228-266) ; « Breve chronicon ex eodem codice S. Martialis (ibid., p. 257 et 267-278 ; cf. Duplès-Agier, Chroniques de Saint Martial, p. 130) ; Notes historiques (1272-1275), tirées d'un ms. de Saint-Martial ; Notes sur les saints du Limousin, d'après un ms. de la même abbaye ; « Ex sermone de sanctis Lemovicensibus. » ; « Incipiunt miracula de translatione sancti Martialis apostoli. » ; Extrait de la « Commemoratio abbatum S. Martialis » (Cf. Duplès-Agier, op. cit., p. 1) ; Notes sur les abbayes du Limousin, tirées d'un ms. de Saint-Martin ; Catalogue des évêques de Limoges et notes historiques diverses, tirées d'un ms. de dom Ribier (ms. lat. 5425) ; Liste des abbés de Saint-Augustin de Limoges ; « Fundatio ordinis Artigiae. » ; Histoire de l'Ordre de Grandmont, précédée d'une vie de saint Etienne de Muret (Cf. Labbe, Nova Bibliotheca mss., t. II, p. 674) et continuée jusqu'à 1585 ; Catalogue des prieurés de l'Ordre de Grandmont

Indications à la coronarographie en urgence. Partie II: syndromes coronariens aigus sans élévation du segment ST [Indications for urgent coronary angiography. Part II: Acute coronary syndromes without ST-segment elevation]

The optimal treatment strategy for patients presenting with an acute coronary syndrome without ST elevation is controversial and different therapeutic approaches are recognized. Currently, given the literature available, it is not possible to recommend a universal systematic invasive approach. It is essential to individually risk stratify patients in order to identify those high risk patients that have been shown to benefit from an invasive strategy. Compared to conservative medical treatment, patients at low risk have not been shown to benefit from an invasive strategy. Urgent coronary angiography remains recommended for those patients with persistent or recurrent ischemic symptoms under optimal medical treatment.

T helper 1 (Th1) and Th2 characteristics start to develop during T cell priming and are associated with an immediate ability to induce immunoglobulin class switching.

The respective production of specific immunoglobulin (Ig)G2a or IgG1 within 5 d of primary immunization with Swiss type mouse mammary tumor virus [MMTV(SW)] or haptenated protein provides a model for the development of T helper 1 (Th1) and Th2 responses. The antibody-producing cells arise from cognate T cell B cell interaction, revealed by the respective induction of Cgamma2a and Cgamma1 switch transcript production, on the third day after immunization. T cell proliferation and upregulation of mRNA for interferon gamma in response to MMTV(SW) and interleukin 4 in response to haptenated protein also starts during this day. It follows that there is minimal delay in these responses between T cell priming and the onset of cognate interaction between T and B cells leading to class switching and exponential growth. The Th1 or Th2 profile is at least partially established at the time of the first cognate T cell interaction with B cells in the T zone. The addition of killed Bordetella pertussis to the hapten-protein induces nonhapten-specific IgG2a and IgG1 plasma cells, whereas the anti-hapten response continues to be IgG1 dominated. This indicates that a Th2 response to hapten-protein can proceed in a node where there is substantial Th1 activity.