Récits de croisade et digression : la conquête de Constantinople de Robert de Clari

Partant de la réputation naïve, colorée et digressive de La Conquête de Constantinople de Robert de Clari, ce mémoire propose une analyse méthodique de ce récit en prose vernaculaire de la quatrième croisade de façon à en circonscrire les moments de continuité et de rupture. En fonction de plusieurs facteurs, dont leurs formules d’introduction et de clôture, leur rapport au temps de la croisade, leur longueur relative ainsi que leur positionnement dans l’économie globale du texte, les épisodes divergents sont identifiés puis analysés en travaillant lestement avec trois caractéristiques fondamentales de la digression plutôt qu’avec une définition nucléaire du concept, ce qui permet de discerner des degrés de digressif et d’offrir un panorama nuancé de l’oeuvre. Afin d’adopter un regard plus large sur le phénomène de la digression, quatre autres récits de croisade sont étudiés, et tous, qu’ils soient écrits en prose ou en vers, en français ou en latin, sont à leur façon coupables de s’être laissés emporter par leur sujet dans des excursus qui trahissent la personnalité et les convictions de leur auteur. Tout comme Clari, Villehardouin, l’auteur de l’Estoire de la guerre sainte, Eudes de Deuil et Albert d’Aix laissent entrevoir leur propre histoire lorsque celle qu’ils mettent à l’écrit s’égare de la droite voie de sa narration. Les digressions contenues dans les récits de croisade constituent ainsi une fenêtre privilégiée sur l’histoire des mentalités du Moyen Âge central, une mine d’informations qui ne peut être adéquatement exploitée que par les efforts conjoints de l’histoire et de la littérature.

Overweight/obesity and HIV disease progression in HIV+ adults in Botswana

Studies indicate that overweight and obesity protect against HIV-disease progression in antiretroviral therapy (ART)-naïve patients. We examined retrospectively the relationship of overweight/obesity with HIV-disease progression in ART-naïve HIV+ adults in Botswana in a case-control study with 18-month follow-up, which included 217 participants, 139 with BMI 18.0-24.9 kg/m 2 and 78 with BMI ≥25 kg/m2. Archived plasma samples were used to determine inflammatory markers: leptin and bacterial endotoxin lipopolysaccharide (LPS), and genotype single nucleotide polymorphisms (SNPs) of the Fat Mass and Obesity Associated Gene (FTO). ^ At baseline, BMI was inversely associated with risk for AIDS-defining conditions (HR=0.218; 95%CI=0.068, 0.701, P=0.011), and higher fat mass was associated with reduced risk of the combined outcome of CD4+cell count ≤250/µL and AIDS-defining conditions, whichever occurred earlier (HR=0.918; 95%CI=0.847, 0.994, P=0.036) over 18 months, adjusting for age, gender, marriage, children, and baseline CD4+cell count and HIV-viral load. ^ FTO-SNP rs17817449 was associated with BMI (OR=1.082; 95%CI=1.001, 1.169; P=0.047). Fat mass was associated with the risk alleles of rs1121980 (OR=1.065; 95%CI=1.009, 1.125, P=0.021), rs8050136 (OR=1.078; 95%CI=1.021, 1.140; P=0.007), and rs17817449 (OR=1.086; 95%CI=1.031, 1.145; P=0.002), controlling for age, gender, tribe, total energy intake, and activity. There were no associations of SNPs with markers of disease progression. ^ Leptin levels were positively associated with BMI (β=1.764; 95%CI=0.788, 2.739; P=0.022) and fat mass (β=0.112; 95%CI=0.090, 0.135; P<0.001), but inversely with viral load (β=-0.305; 95%CI=-0.579, -.031; P=0.030). LPS levels were inversely associated with BMI (OR=0.790, 95%CI=0.630, 0.990; P=0.041), and fat mass (OR=0.852, 95%CI=0.757, 0.958; P=0.007) and directly with viral load (OR=2.608, 95%CI=1.111, 6.124; P=0.028), adjusting for age, gender, smoking and %fat mass. ^ In this cohort, overweight/obesity predicted slower HIV-disease progression. Obesity may confer an advantage in maintaining fat stores to support the overactive immune system. FTO-SNPs may contribute to the variation in fat mass; however, they were not associated with HIV-disease progression. Our findings suggest that the obesity paradox may be explained by the association of increased LPS with lower BMI and higher viral load; while viral load decreased with increasing leptin levels. Studies in African populations are needed to clarify whether genetic variation and inflammation mediate the obesity paradox in HIV-disease progression.^

Distribution of Light in the Human Retina under Natural Viewing Conditions

Age-related macular degeneration (AMD) is the leading cause of blindness inAmerica. The fact that AMD wreaks most of the damage in the center of the retina raises the question of whether light, integrated over long periods, is more concentrated in the macula. A method, based on eye-tracking, was developed to measure the distribution of light in the retina under natural viewing conditions. The hypothesis was that integrated over time, retinal illumination peaked in the macula. Additionally a possible relationship between age and retinal illumination was investigated. The eye tracker superimposed the subject’s gaze position on a video recorded by a scene camera. Five informed subjects were employed in feasibility tests, and 58 naïve subjects participated in 5 phases. In phase 1 the subjects viewed a gray-scale image. In phase 2, they observed a sequence of photographic images. In phase 3 they viewed a video. In phase 4, they worked on a computer; in phase 5, the subjects walked around freely. The informed subjects were instructed to gaze at bright objects in the field of view and then at dark objects. Naïve subjects were allowed to gaze freely for all phases. Using the subject’s gaze coordinates, and the video provided by the scene camera, the cumulative light distribution on the retina was calculated for ~15° around the fovea. As expected for control subjects, cumulative retinal light distributions peaked and dipped in the fovea when they gazed at bright or dark objects respectively. The light distribution maps obtained from the naïve subjects presented a tendency to peak in the macula for phases 1, 2, and 3, a consistent tendency in phase 4 and a variable tendency in phase 5. The feasibility of using an eye-tracker system to measure the distribution of light in the retina was demonstrated, thus helping to understand the role played by light exposure in the etiology of AMD. Results showed that a tendency for light to peak in the macula is a characteristic of some individuals and of certain tasks. In these situations, risk of AMD could be increased. No significant difference was observed based on age.

Récits de croisade et digression : la conquête de Constantinople de Robert de Clari

Partant de la réputation naïve, colorée et digressive de La Conquête de Constantinople de Robert de Clari, ce mémoire propose une analyse méthodique de ce récit en prose vernaculaire de la quatrième croisade de façon à en circonscrire les moments de continuité et de rupture. En fonction de plusieurs facteurs, dont leurs formules d’introduction et de clôture, leur rapport au temps de la croisade, leur longueur relative ainsi que leur positionnement dans l’économie globale du texte, les épisodes divergents sont identifiés puis analysés en travaillant lestement avec trois caractéristiques fondamentales de la digression plutôt qu’avec une définition nucléaire du concept, ce qui permet de discerner des degrés de digressif et d’offrir un panorama nuancé de l’oeuvre. Afin d’adopter un regard plus large sur le phénomène de la digression, quatre autres récits de croisade sont étudiés, et tous, qu’ils soient écrits en prose ou en vers, en français ou en latin, sont à leur façon coupables de s’être laissés emporter par leur sujet dans des excursus qui trahissent la personnalité et les convictions de leur auteur. Tout comme Clari, Villehardouin, l’auteur de l’Estoire de la guerre sainte, Eudes de Deuil et Albert d’Aix laissent entrevoir leur propre histoire lorsque celle qu’ils mettent à l’écrit s’égare de la droite voie de sa narration. Les digressions contenues dans les récits de croisade constituent ainsi une fenêtre privilégiée sur l’histoire des mentalités du Moyen Âge central, une mine d’informations qui ne peut être adéquatement exploitée que par les efforts conjoints de l’histoire et de la littérature.

Automatic Counting of Microglial Cells in Healthy and Glaucomatous Mouse Retinas

Proliferation of microglial cells has been considered a sign of glial activation and a hallmark of ongoing neurodegenerative diseases. Microglia activation is analyzed in animal models of different eye diseases. Numerous retinal samples are required for each of these studies to obtain relevant data of statistical significance. Because manual quantification of microglial cells is time consuming, the aim of this study was develop an algorithm for automatic identification of retinal microglia. Two groups of adult male Swiss mice were used: age-matched controls (naïve, n = 6) and mice subjected to unilateral laser-induced ocular hypertension (lasered; n = 9). In the latter group, both hypertensive eyes and contralateral untreated retinas were analyzed. Retinal whole mounts were immunostained with anti Iba-1 for detecting microglial cell populations. A new algorithm was developed in MATLAB for microglial quantification; it enabled the quantification of microglial cells in the inner and outer plexiform layers and evaluates the area of the retina occupied by Iba-1+ microglia in the nerve fiber-ganglion cell layer. The automatic method was applied to a set of 6,000 images. To validate the algorithm, mouse retinas were evaluated both manually and computationally; the program correctly assessed the number of cells (Pearson correlation R = 0.94 and R = 0.98 for the inner and outer plexiform layers respectively). Statistically significant differences in glial cell number were found between naïve, lasered eyes and contralateral eyes (P<0.05, naïve versus contralateral eyes; P<0.001, naïve versus lasered eyes and contralateral versus lasered eyes). The algorithm developed is a reliable and fast tool that can evaluate the number of microglial cells in naïve mouse retinas and in retinas exhibiting proliferation. The implementation of this new automatic method can enable faster quantification of microglial cells in retinal pathologies.

Occurrence of OsHV-1 in Crassostrea gigas cultured in Ireland during an exceptionally warm summer. Selection of less susceptible oysters

The occurrence of OsHV-1, a herpes virus causing mass mortality in the Pacific oyster Crassostrea gigas was investigated with the aim to select individuals with different susceptibility to the infection. Naïve spat transferred to infected areas and juveniles currently being grown at those sites were analyzed using molecular and histology approaches. The survey period distinguishes itself by very warm temperatures reaching up to 3.5°C above the average. The virus was not detected in the virus free area although a spread of the disease could be expected due to high temperatures. Overall mortality, prevalence of infection and viral load was higher in spat confirming the higher susceptibility in early life stages. OsHV-1 and oyster mortality were detected in naïve spat after 15 days of cohabitation with infected animals. Although, infection was associated with mortality in spat, the high seawater temperatures could also be the direct cause of mortality at the warmest site. One stock of juveniles suffered an event of abnormal mortality that was significantly associated with OsHV-1 infection. Those animals were infected with a previously undescribed microvariant whereas the other stocks were infected with OsHV-1 μVar. Cell lesions due to the infection were observed by histology and true infections were corroborated by in situ hybridization. Survivors from the natural outbreak were exposed to OsHV-1 μVar by intramuscular injection and were compared to naïve animals. The survival rate in previously exposed animals was significantly higher than in naïve oysters. Results derived from this study allowed the selection of animals that might possess interesting characteristics for future analysis on OsHV-1 resistance.

Synonymous co-variation across the E1/E2 gene junction of hepatitis C virus defines virion fitness

Hepatitis C virus is a positive-sense single-stranded RNA virus. The gene junction partitioning the viral glycoproteins E1 and E2 displays concurrent sequence evolution with the 3′-end of E1 highly conserved and the 5′-end of E2 highly heterogeneous. This gene junction is also believed to contain structured RNA elements, with a growing body of evidence suggesting that such structures can act as an additional level of viral replication and transcriptional control. We have previously used ultradeep pyrosequencing to analyze an amplicon library spanning the E1/E2 gene junction from a treatment naïve patient where samples were collected over 10 years of chronic HCV infection. During this timeframe maintenance of an in-frame insertion, recombination and humoral immune targeting of discrete virus sub-populations was reported. In the current study, we present evidence of epistatic evolution across the E1/E2 gene junction and observe the development of co-varying networks of codons set against a background of a complex virome with periodic shifts in population dominance. Overtime, the number of codons actively mutating decreases for all virus groupings. We identify strong synonymous co-variation between codon sites in a group of sequences harbouring a 3 bp in-frame insertion and propose that synonymous mutation acts to stabilize the RNA structural backbone.

Initiating sacubitril/valsartan (LCZ696) in heart failure: results of TITRATION, a double-blind, randomized comparison of two uptitration regimens

The aim is tassess the tolerability of initiating/uptitrating sacubitril/valsartan (LCZ696) from 50 to 200 mg twice daily (target dose) over 3 and 6 weeks in heart failure (HF) patients (ejection fraction ≤35%). A 5-day open-label run-in (sacubitril/valsartan 50 mg twice daily) preceded an 11-week, double-blind, randomization period [100 mg twice daily for 2 weeks followed by 200 mg twice daily (‘condensed’ regimen) vs. 50 mg twice daily for 2 weeks, 100 mg twice daily for 3 weeks, followed by 200 mg twice daily (‘conservative’ regimen)]. Patients were stratified by pre-study dose of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACEI/ARB; low-dose stratum included ACEI/ARB-naïve patients). Of 540 patients entering run-in, 498 (92%) were randomized and 429 (86.1% of randomized) completed the study. Pre-defined tolerability criteria were hypotension, renal dysfunction and hyperkalaemia; and adjudicated angioedema, which occurred in (‘condensed’ vs. ‘conservative’) 9.7% vs. 8.4% (P = 0.570), 7.3% vs. 7.6% (P = 0.990), 7.7% vs. 4.4% (P = 0.114), and 0.0% vs. 0.8% of patients, respectively. Corresponding proportions for pre-defined systolic blood pressure <95 mmHg, serum potassium >5.5 mmol/L, and serum creatinine >3.0 mg/dL were 8.9% vs. 5.2% (P = 0.102), 7.3% vs. 4.0% (P = 0.097), and 0.4% vs. 0%, respectively. In total, 378 (76%) patients achieved and maintained sacubitril/valsartan 200 mg twice daily without dose interruption/down-titration over 12 weeks (77.8% vs. 84.3% for ‘condensed’ vs. ‘conservative’; P = 0.078). Rates by ACEI/ARB pre-study dose stratification were 82.6% vs. 83.8% (P = 0.783) for high-dose/‘condensed’ vs. high-dose/‘conservative’ and 84.9% vs. 73.6% (P = 0.030) for low-dose/‘conservative’ vs. low-dose/‘condensed’. Initiation/uptitration of sacubitril/valsartan from 50 to 200 mg twice daily over 3 or 6 weeks had a tolerability profile in line with other HF treatments. More gradual initiation/uptitration maximized attainment of target dose in the low-dose ACEI/ARB group.

19th c. Coloured stuccos and plasters from Grilos' Church (Oporto, Portugal): Materials and techniques employed

The Oporto's St. Lourenço Church of the Jesuit College is locally known, since the St. Augustin Barefooted Eremites occupation (1779/80), as Grilos' Church. The Oporto's siege laid by D. Pedro and D. Miguel (1832/33) succeed in the college abandonment by Grilo's Friars. Throughout Augustin Friars presence period, the white plasters of the nave (end of 18th c.) were executed and it was constructed the Holly Sacrament Chapel (early 19th c.) with neoclassic coloured stuccos and plasters, influenced by Robert Adam, Luigi Chiari and Teixeira Barreto ornamental motifs. Pigments were added to the external layer to imitate the marble and to achieve the “base” colour of the panels. This study of the blue, rose and white stuccos and plasters of H.S. Chapel of Grilo's Church allows carrying out useful database on the original mortars composition by the use of different analytical techniques, important to select the most adequate solutions for restoration interventions. Optical microscopy, XRD, TG-DTA, SEM-EDS, XRF analysis results were considered to identify the composition of different layers and to provide mineralogical, microstructure and chemical characterization of the mortars components and to quantify the binder content in those mortars. These results were compared with collected information on compositions from other sources. This study allowed the identification of the decay causes of decorative stuccos and plaster, suggesting that water retention in the masonries and wooden laths structure of the dome of the chapel is the main factor.

Analysis of Pancreas Histological Images for Glucose Intolerance Identification using Wavelet Decomposition

Subtle structural differencescan be observed in the islets of Langer-hans region of microscopic image of pancreas cell of the rats having normal glucose tolerance and the rats having pre-diabetic(glucose intolerant)situa-tions. This paper proposes a way to automatically segment the islets of Langer-hans region fromthe histological image of rat's pancreas cell and on the basis of some morphological feature extracted from the segmented region the images are classified as normal and pre-diabetic.The experiment is done on a set of 134 images of which 56 are of normal type and the rests 78 are of pre-diabetictype. The work has two stages: primarily,segmentationof theregion of interest (roi)i.e. islets of Langerhansfrom the pancreatic cell and secondly, the extrac-tion of the morphological featuresfrom the region of interest for classification. Wavelet analysis and connected component analysis method have been used for automatic segmentationof the images. A few classifiers like OneRule, Naïve Bayes, MLP, J48 Tree, SVM etc.are used for evaluation among which MLP performed the best.

UN “ORDEN MUNDIAL” NO TAN “NUEVO”: BANDERAS DE CONVENIENCIA Y EL OECÚMENE GEOECONÓMICO

El rol de la geocconomía como una poderosa herramienta condicionante al interior de la organización de “lo global”, permanece sin la suficiente investigación en lo relativo a los trabajos sustentados en la tradición geopolítica. Las Banderas de Conveniencia (BDCs, en adelante) son destacadas como un ejemplo de la importancia que posee el enfrentamiento entre la geopolítica y la geoeconomía en la geoeconomía política, y las dificultades asociadas con el manejo de “lo global”. Banderas de Conveniencia es la expresión que define la utilización por parte de una empresa mercantil naviera de la bandera de un país que no es el suyo, con la finalidad de beneficiarse de la regulación menos estricta que rige en dicho país. El mecanismo a través del cual se realiza esta acción está constituido por el registro de la nave en el país que la va a beneficiar con su regulación. El presente artículo se preocupa de la geopolítica, de manera preferente, como de las interrelaciones de las naciones-estados (lo internacional). Por contraste, la geoeconomía sugiere una preocupación acerca de la fluidez de las transferencias y los flujos de capital y productos al interior y entre las empresas y los mercados, a una escala global. Los desarrollos en la geoeconomía durante la Guerra Fría han tenido como resultado la evolución de un oecúmene geoeconóm leo. Dicho oecúmenc se caracteriza por la flexibilidad del intercambio mundial, y la relativa facilidad de los movimientos y flujos transfronterizos. Estableciendo un enfrentamiento entre la geopolítica y la geocconomía, el concepto de una geoeconomía política globalizada se hace más difícil y las operaciones de las BDCS demuestran los problemas vinculados con el manejo y control en este nivel.Abstract:The role ofgeoeconomics in the organization of “the global” has received comparatively little attention comparcd with traditional geopolitics; in contrast to the inter-state focus of gcopolitics, geoeconomics focuses on the global transfers of capital and goods in and between firms and markets. In this paper, “Flags of Convenience” are used as examples of the merging of geopolitics and geocconomics within an evolving glohalised “geopolitical cconomy”; they also reveal the complex issues associated with thc control and management of globalised activities. Geoeconomic changes during the Coid War have given rise to increased intcrconncctcdness at the global level. These connections are characterized by flexibility, transfers, ease of movement and transboundary flows. By linking gcopolitics and geoeconomics within a concept of a globalised geopolitical economy, it may be possible to understand these changes better, also the ways in which their negative and positive impacts can be reduccd or enhanced respectively.

Analisi del comportamento di serbatoi di gas naturale liquefatto per applicazioni di propulsione navale in scenari di incendio

Il presente lavoro di tesi vuole focalizzare l’attenzione sull’impiego del GNL per la propulsione navale, analizzando aspetti legati alla sicurezza delle infrastrutture necessarie a tale scopo. Si sono considerati due diversi casi di studio: il primo riguarda un deposito costiero attrezzato per poter svolgere attività di rifornimento per imbarcazioni, mentre il secondo caso interessa una nave da trasporto passeggeri alimentata a GNL. È stata condotta un’analisi del rischio: l’identificazione dei pericoli ha seguito le linee guida proposte dalla metodologia MIMAH, oltre a sfruttare risultati di analisi HAZOP e HAZID. La stima delle frequenze di rilascio è stata effettuata con la tecnica della parts count, sulla base di valori ottenuti da database affidabilistici. La valutazione delle conseguenze è stata realizzata con il supporto del software DNV PHAST, utilizzando come riferimento i valori soglia proposti dal D.M. 9/5/2001. È stata infine impostata una modellazione fluidodinamica con lo scopo di valutare la possibilità di rottura catastrofica dei serbatoi di stoccaggio dovuta ad un’eccessiva pressurizzazione causata da una situazione di incendio esterno. Le simulazioni sono state condotte con il supporto del software CFD ANSYS® FLUENT® 17.2. Si è modellata una situazione di completo avvolgimento dalle fiamme considerando due geometrie di serbatoio diverse, nel caso di materiale isolante integro o danneggiato. I risultati ottenuti dall’analisi del rischio mostrano come i danni derivanti da un ipotetico scenario incidentale possano avere conseguenze anche significative, ma con valori di frequenze di accadimento tipici di situazioni rare. Lo studio fluidodinamico del comportamento di serbatoi di stoccaggio avvolti dalle fiamme ha evidenziato come questi siano capaci di resistere a condizioni gravose di incendio per tempi prolungati senza che si abbia una pressurizzazione tale da destare preoccupazione per l’integrità strutturale delle apparecchiature.

The role of CD8+CCR4+ T-cells in axial spondyloarthritis

Axial spondyloarthritis (AxSpA) is an inflammatory disease affecting the axial skeleton. The infiltrate of T-cells in the structural lesions has been found to contribute to bone remodeling, but consensus relating the functional contribution of different T-cell subsets to pathogenesis has not been reached yet. Aim of the project was to characterize circulating T-cells and their homing markers from axSpA patients in order to identify cellular populations that could migrate to inflamed tissues and be implicated in axSpA. We found an altered proportion of circulating naïve and memory T-cells in axSpA patients, and a skew in favor of CD8+ T-cells expressing the chemokine receptor CCR4. Since CCL17 and CCL22, the two ligands for CCR4, are found to be elevated in the sera of axSpA patients, we investigated in details the role of CD8+CCR4+ T cells in axSpA. Our data showed that circulating CD8+CCR4+ T-cells display an effector memory phenotype and express homing markers for tissues that are target of the disease. Noteworthy, CD8+CCR4+ T cells from axSpA patients were activated, expressed markers of proliferation and acquired a cytotoxic phenotype, as demonstrated by the increased production of granzyme and perforin. CD8+CCR4+ T cells from axSpA patients upregulate the transcription of genes involved in bone mineralization and downregulate genes involved in osteoclast differentiation, indicating their possible involvement in bone remodeling. Furthermore, CD8+CCR4+ T cells stimulated with PMA and ionomycin were able to produce and release TNF and IL-8, two cytokines involved in osteoclastogenesis, indicating that CD8+CCR4+ T-cells after stimulation would be able to promote osteoclasts differentiation and neutrophils recruitment. Taken together our data suggest that CD8+CCR4+ T cells might exert a pathogenic role in axSpA, by releasing mediators of tissue damage, bone remodeling and recruitment of other pro inflammatory cells.

ABC transporters of the A subfamily: potential prognostic markers and candidates for antibody selection from phage-display libraries for therapeutic use in Ewing sarcoma

The prognostic value of ABC transporters in Ewing sarcoma is still poorly explored and controversial. We described for the first time the impact of various ABCs on Ewing sarcoma prognosis by assessment of their gene expression in two independent cohorts of patients. Unexpected associations with favourable outcomes were observed for two ABCs of the A-subfamily, ABCA6 and ABCA7, whereas no associations with the canonical multidrug ABC transporters were identified. The ABCs of the A-subfamily are involved in cholesterol/phospholipids transportation and efflux from cells. Our clinical data support the drug-efflux independent contribution to cancer progression of the ABCAs, which has been confirmed in PDX-derived cell lines. The impact of these ABCA transporters on tumor progression seems to be mediated by lowering intracellular cholesterol, supporting the role of these proteins in lipid transport. In addition, the gene expression of ABCA6 and ABCA7 is regulated by transcription factors which control lipid metabolism: ABCA6 was induced by the binding of FoxO1/FoxO3a to its promoter and repressed by IGF1R/Akt signaling, whereas the expression of ABCA7 was regulated by p53. The data point to ABCA6 and ABCA7 as potential prognostic markers in Ewing sarcoma and suggest the IGF1/ABCA/lipid axis as an intriguing therapeutic target. Agonist monoclonal antibodies towards ABCA6/7 or inhibitors of cholesterol biosynthesis, such as statins or aminobiphoshonates, may be investigated as therapeutic options in combination with chemotherapy. Considering that no monoclonal antibodies selectively targeting extracellular domains of ABCA6/7 are available, the second part of the project has been dedicated to the generation of human antibody phage-display libraries as tools for selecting monoclonal antibodies. A novel synthetic human antibody phage-display library has been designed, cloned and characterized. The library takes advantages of the high variability of a designed naïve repertoire to be a useful tool for isolating antibodies towards all potential antigens, including the ABCAs.

Strategia terapeutica nei pazienti con ipertensione arteriosa polmonare a rischio intermedio

Le attuali linee guida stratificano il rischio dei pazienti con ipertensione arteriosa polmonare (IAP) in basso, intermedio e alto (rispettivamente con mortalità a 1 anno <5%, 5-10% e >10%). La maggior parte dei pazienti è però classificata nella categoria intermedia. Per stratificare ulteriormente questi pazienti, abbiamo valutato il ruolo prognostico dello stroke volume index (SVI) misurato al cateterismo cardiaco destro (CCDx) in 725 pazienti naïve da terapia con IAP idiopatica/ereditaria, associata a malattie del tessuto connettivo o cardiopatie congenite. I pazienti sono stati valutati al basale e 3-4 mesi dopo l'inizio della terapia (1° F-UP) con CCDx, livelli plasmatici di peptide natriuretico cerebrale (BNP), test dei 6 minuti (T6M) e classe funzionale OMS. Abbiamo applicato una tabella di rischio semplificata utilizzando i criteri: classe funzionale OMS, T6M, pressione atriale destra o livelli plasmatici di BNP e indice cardiaco (IC) o saturazione di ossigeno venoso misto (SvO2). Le classi di rischio sono state definite come: basso= almeno 3 criteri a basso rischio e nessun criterio ad alto rischio; alto= almeno 2 criteri ad alto rischio inclusi IC o SvO2; intermedio= tutti gli altri casi. Lo SVI, mediante la regressione di Cox, stratifica la prognosi dei pazienti a rischio intermedio al 1° F-UP [p=0.008] ma non al basale [p=0.085]. Considerandone l’ottimale cut-off predittivo (38 ml/m2) i pazienti a rischio intermedio sono ulteriormente classificabili in intermedio-basso e intermedio-alto. Considerando l'effetto dei 3 principali farmaci che agiscono sulla via della prostaciclina in aggiunta alla duplice terapia di combinazione con inibitori della fosfodiesterasi-5 e antagonisti dell'endotelina, i pazienti trattati con epoprostenolo e.v. hanno ottenuto un maggiore miglioramento rispetto ai pazienti trattati con selexipag; col treprostinil s.c. vi è stata una risposta intermedia. Abbiamo quindi proposto un algoritmo di terapia con selexipag in pazienti a rischio intermedio-basso e con prostanoidi parenterali in pazienti a rischio intermedio-alto.