987 resultados para Functional limit concept


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Dextran-based polymers are versatile hydrophilic materials, which can provide functionalized surfaces in various areas including biological and medical applications. Functional, responsive, dextran based hydrogels are crosslinked, dextran based polymers allowing the modulation of response towards external stimuli. The controlled modulation of hydrogel properties towards specific applications and the detailed characterization of the optical, mechanical, and chemical properties are of strong interest in science and further applications. Especially, the structural characteristics of swollen hydrogel matrices and the characterization of their variations upon environmental changes are challenging. Depending on their properties hydrogels are applied as actuators, biosensors, in drug delivery, tissue engineering, or for medical coatings. However, the field of possible applications still shows potential to be expanded. rnSurface attached hydrogel films with a thickness of several micrometers can serve as waveguiding matrix for leaky optical waveguide modes. On the basis of highly swelling and waveguiding dextran based hydrogel films an optical biosensor concept was developed. The synthesis of a dextran based hydrogel matrix, its functionalization to modulate its response towards external stimuli, and the characterization of the swollen hydrogel films were main interests within this biosensor project. A second focus was the optimization of the hydrogel characteristics for cell growth with the aim of creating scaffolds for bone regeneration. Matrix modification towards successful cell growth experiments with endothelial cells and osteoblasts was achieved.rnA photo crosslinkable, carboxymethylated dextran based hydrogel (PCMD) was synthesized and characterized in terms of swelling behaviour and structural properties. Further functionalization was carried out before and after crosslinking. This functionalization aimed towards external manipulation of the swelling degree and the charge of the hydrogel matrix important for biosensor experiments as well as for cell adhesion. The modulation of functionalized PCMD hydrogel responses to pH, ion concentration, electrochemical switching, or a magnetic force was investigated. rnThe PCMD hydrogel films were optically characterized by combining surface plasmon resonance (SPR) and optical waveguide mode spectroscopy (OWS). This technique allows a detailed analysis of the refractive index profile perpendicular to the substrate surface by applying the Wentzel Kramers Brillouin (WKB) approximation. rnIn order to perform biosensor experiments, analyte capturing units such as proteins or antibodies were covalently coupled to the crosslinked hydrogel backbone by applying active ester chemistry. Consequently, target analytes could be located inside the waveguiding matrix. By using labeled analytes, fluorescence enhancement was achieved by fluorescence excitation with the electromagnetic field in the center of the optical waveguide modes. The fluorescence excited by the evanescent electromagnetic field of the surface plasmon was 2 3 orders of magnitude lower. Furthermore, the signal to noise ratio was improved by the fluorescence excitation with leaky optical waveguide modes.rnThe applicability of the PCMD hydrogel sensor matrix for clinically relevant samples was proofed in a cooperation project for the detection of PSA in serum with long range surface plasmon spectroscopy (LRSP) and fluorescence excitation by LRSP (LR SPFS). rn

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In Chapter 1 I will present a brief introduction on the state of art of nanotechnologies, nanofabrication techniques and unconventional lithography as a technique to fabricate the novel electronic device as resistive switch so-called memristor is shown. In Chapter 2 a detailed description of the main fabrication and characterization techniques employed in this work is reported. Chapter 3 parallel local oxidation lithography (pLOx) describes as a main technique to obtain accurate patterning process. All the effective parameters has been studied and the optimized condition observed to highly reproducible with excellent patterned nanostructures. The effect of negative bias, calls local reduction (LR) studied. Moreover, the use of AC bias shows faster patterning process respect to DC bias. In Chapter 4 (metal/ e-SiO2/ Si nanojunction) it is shown how the electrochemical oxide nanostructures by using pLOx can be used in the fabrication of novel devices call memristor. We demonstrate a new concept, based on conventional materials, where the lifetime problem is resolved by introducing a “regeneration” step, which restores the nano-memristor to its pristine condition by applying an appropriate voltage cycle. In Chapter 5 (Graphene/ e-SiO2/ Si), Graphene as a building block material is used as an electrode to selectively oxidize the silicon substrate by pLOx set up for the fabrication of novel resistive switch device. In Chapter 6 (surface architecture) I will show another application of pLOx in biotechnology is shown. So the surface functionalization combine with nano-patterning by pLOx used to design a new surface to accurately bind biomolecules with the possibility of studying those properties and more application in nano-bio device fabrication. So, in order to obtain biochips, electronic and optical/photonics devices Nano patterning of DNA used as scaffolds to fabricate small functional nano-components.

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In this thesis, anodic aluminum oxide (AAO) membranes, which provide well-aligned uniform mesoscopic pores with adjustable pore parameters, were fabricated and successfully utilized as templates for the fabrication of functional organic nanowires, nanorods and the respective well-ordered arrays. The template-assisted patterning technique was successfully applied for the realization of different objectives:rnHigh-density and well-ordered arrays of hole-conducting nanorods composed of cross-linked triphenylamine (TPA) and tetraphenylbenzidine (TPD) derivatives on conductive substrates like ITO/glass have been successfully fabricated. By applying a freeze-drying technique to remove the aqueous medium after the wet-chemical etching of the template, aggregation and collapsing of the rods was prevented and macroscopic areas of perfectly freestanding nanorods were feasible. Based on the hole-conducting nanorod arrays and their subsequent embedding into an electron-conducting polymer matrix via spin-coating, a novel routine concept for the fabrication of well-ordered all-organic bulk heterojunction for organic photovoltaic applications was successfully demonstrated. The increased donor/acceptor interface of the fabricated devices resulted in a remarkable increase of the photoluminescence quenching compared to a planar bilayer morphology. Further, the fundamental working principle of the templating approach for the solution-based all-organic photovoltaic device was demonstrated for the first time.rnFurthermore, in order to broaden the applicability of patterned surfaces, which are feasible via the template-based patterning of functional materials, AAO with hierarchically branched pores were fabricated and utilized as templates. By pursuing the common templating process hierarchically polymeric replicas, which show remarkable similarities with interesting biostructures, like the surface of the lotus leaf and the feet of a gecko, were successfully prepared.rnIn contrast to the direct infiltration of organic functional materials, a novel route for the fabrication of functional nanowires via post-modification of reactive nanowires was established. Therefore, reactive nanowires based on cross-linked pentafluorophenylesters were fabricated by utilizing AAO templates. The post-modification with fluorescent dyes was demonstrated. Furthermore, reactive wires were converted into well-dispersed poly(N-isopropylacrylamide) (PNIPAM) hydrogels, which exhibit a thermal-responsive reversible phase transition. The reversible thermal-responsible swelling of the PNIPAM nanowires exhibited a more than 50 % extended length than in the collapsed PNIPAM state. rnLast but not least, the shape-anisotropic pores of AAO were utilized to uniformly align the mesogens of a nematic liquid crystalline elastomer. Liquid crystalline nanowires with a narrow size distribution and uniform orientation of the liquid crystalline material were fabricated. It was shown that during the transition from the nematic to the isotropic phase the rod’s length shortened by roughly 40 percent. As such these liquid crystalline elastomeric nanowires may find application, as wire-shaped nanoactuators in various fields of research, like lab-on-chip systems, micro fluidics and biomimetics.rn

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The prologue of this thesis (Chapter 1.0) gives a general overview on lactone based poly(ester) chemistry with a focus on advanced synthetic strategies for ring-opening polymerization, including the emerging field of organo catalysis. This section is followed by a presentation of the state-of the art regarding the two central fields of the thesis: (i) polyfunctional and branched poly(ester)s in Chapter 1.1 as well as (ii) the development of new poly(ester) based block copolymers with functional methacrylates (Chapter 1.2). Chapter 2 deals with the synthesis of new, non-linear poly(ester) structures. In Chapter 2.1, the synthesis of poly(lactide)-based multiarm stars, prepared via a grafting-from method, is described. The hyperbranched poly(ether)-poly(ol) poly(glycerol) is employed as a hydrophilic core molecule. The resulting star block copolymers exhibit potential as phase transfer agents and can stabilize hydrophilic dyes in a hydrophobic environment. In Chapter 2.2, this approach is expanded to poly(glycolide) multiarm star polymers. The problem of the poor solubility of linear poly(glycolide)s in common organic solvents combined with an improvement of the thermal properties has been approached by the reduction of the total chain length. In Chapter 2.3, the first successful synthesis of hyperbranched poly(lactide)s is presented. The ring-opening, multibranching copolymerization of lactide with the “inimer” 5HDON (a hydroxyl-functional lactone monomer) was carefully examined. Besides a precise molecular characterization involving the determination of the degree of branching, we were able to put forward a reaction model for the formation of branching during polymerization. Several innovative approaches to amphiphilic poly(ester)/poly(methacrylate)-based block copolymers are presented in the third part of the thesis (Chapter 3). Block copolymer build-up especially relies on the combination of ring-opening and living radical polymerization. Atom transfer radical polymerization has been successfully combined with lactide ring-opening, using a “double headed” initiator. This strategy allowed for the realization of poly(lactide)-block-poly(2-hydroxyethyl methacrylate) copolymers, which represent promising materials for tissue engineering scaffolds with anti-fouling properties (Chapter 3.1). The two-step/one-pot approach forgoes the use of protecting groups for HEMA by a careful selection of the reaction conditions. A series of potentially biocompatible and partially biodegradable homo- and block copolymers is described in Chapter 3.2. In order to create a block copolymer with a comparably strong hydrophilic character, a new acetal-protected glycerol monomethacrylate monomer (cis-1,3- benzylidene glycerol methacrylate/BGMA) was designed. The hydrophobic poly(BGMA) could be readily transformed into the hydrophilic and water-soluble poly(iso-glycerol methacrylate) (PIGMA) by mild acidic hydrolysis. Block copolymers of PIGMA and poly(lactide) exhibited interesting spherical aggregates in aqueous environment which could be significantly influenced by variation of the poly(lactide)s stereo-structure. In Chapter 3.3, pH-sensitive poly(ethylene glycol)-b-PBGMA copolymers are described. At slightly acidic pH values (pH 4/37°C), they decompose due to a polarity change of the BGMA block caused by progressing acetal cleavage. This stimuli-responsive behavior renders the system highly attractive for the targeted delivery of anti-cancer drugs. In Chapter 3.4, which was realized in cooperation, the concept of biocompatible, amphiphilic poly(lactide) based polymer drug conjugates, was pursued. This was accomplished in the form of fluorescently labeled poly(HPMA)-b-poly(lactide) copolymers. Fluorescence correlation spectroscopy (FCS) of partially biodegradable block copolymer aggregates exhibited fast cellular uptake by human cervix adenocarcinoma cells without showing toxic effects in the examined concentration range (Chapter 4.1). The current state of further projects which will be pursued in future studies is addressed in Chapter 4. This covers the synthesis of biocompatible star block copolymers (Chapter 4.2) and the development of new methacrylate monomers for biomedical applications (Chapters 4.3 and 4.4). Finally, the further investigation of hydroxyl-functional lactones and carbonates which are promising candidates for the synthesis of new hydrophilic linear or hyperbranched biopolymers, is addressed in Chapter 4.5.

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Compared to Europe's mean immigrant contingent of 7.3 to 8.6 % Switzerland holds the highest contingent of foreign population with 23.5 %. Therefore it is of utmost importance that physicians have a knowledge of the specific characteristics of immigrant patients. The influence of personality factors (experience, behavior) is not independent from the influence of culturally-related environmental factors (regional differences in diet, pollutants, meanings, etc.). In addition, different cultural groups rate their quality of life differently. Psychological reasons for recurrent abdominal pain are stress (life events), effects of self-medication (laxatives, cocaine) and sexual abuse but also rare infectious diseases are more common among immigrants (e.g. tuberculosis, histoplasmosis, etc.). Migration-specific characteristics are mainly to find in the semiotics of the symptoms: not every abdominal pain is real pain in the abdomen. Finally, it is crucial to make the distinction between organic, functional and psychological-related pain. This can, however, usually only be accomplished in the context of the entire situation of a patient and, depending on the situation, with the support of a colleague from the appropriate cultural group or an experienced interpreter. In this review we limit ourselves to the presentation of the working population of the migrants, because these represent the largest group of all migrants. The specific situation of asylum seekers will also be refrained to where appropriate.

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The concept of chronic critical limb ischaemia (CLI) emerged late in the history of peripheral arterial occlusive disease (PAOD). The historical background and changing definitions of CLI over the last decades are important to know in order to understand why epidemiologic data are so difficult to compare between articles and over time. The prevalence of CLI is probably very high and largely underestimated, and significant differences exist between population studies and clinical series. The extremely high costs associated with management of these patients make CLI a real public health issue for the future. In the era of emerging vascular surgery in the 1950s, the initial classification of PAOD by Fontaine, with stages III and IV corresponding to CLI, was based only on clinical symptoms. Later, with increasing access to non-invasive haemodynamic measurements (ankle pressure, toe pressure), the need to prove a causal relationship between PAOD and clinical findings suggestive of CLI became a real concern, and the Rutherford classification published in 1986 included objective haemodynamic criteria. The first consensus document on CLI was published in 1991 and included clinical criteria associated with ankle and toe pressure and transcutaneous oxygen pressure (TcPO(2)) cut-off levels <50 mmHg, <30 mmHg and <10 mmHg respectively). This rigorous definition reflects an arterial insufficiency that is so severe as to cause microcirculatory changes and compromise tissue integrity, with a high rate of major amputation and mortality. The TASC I consensus document published in 2000 used less severe pressure cut-offs (≤ 50-70 mmHg, ≤ 30-50 mmHg and ≤ 30-50 mmHg respectively). The thresholds for toe pressure and especially TcPO(2) (which will be also included in TASC II consensus document) are however just below the lower limit of normality. It is therefore easy to infer that patients qualifying as CLI based on TASC criteria can suffer from far less severe disease than those qualifying as CLI in the initial 1991 consensus document. Furthermore, inclusion criteria of many recent interventional studies have even shifted further from the efforts of definition standardisation with objective criteria, by including patients as CLI based merely on Fontaine classification (stage III and IV) without haemodynamic criteria. The differences in the natural history of patients with CLI, including prognosis of the limb and the patient, are thus difficult to compare between studies in this context. Overall, CLI as defined by clinical and haemodynamic criteria remains a severe condition with poor prognosis, high medical costs and a major impact in terms of public health and patients' loss of functional capacity. The major progresses in best medical therapy of arterial disease and revascularisation procedures will certainly improve the outcome of CLI patients. In the future, an effort to apply a standardised definition with clinical and objective haemodynamic criteria will be needed to better demonstrate and compare the advances in management of these patients.

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Intestinal bacteria outnumber our own human cells in conditions of both health and disease. It has long been recognized that secretory antibody, particularly IgA, is produced in response to these microbes and hypothesized that this must play an important role in defining the relationship between a host and its intestinal microbes. However, the exact role of IgA and the mechanisms by which IgA can act are only beginning to be understood. In this review we attempt to unravel the complex interaction between so-called "natural," "primitive" (T-cell-independent), and "classical" IgA responses, the nature of the intestinal microbiota/intestinal pathogens and the highly flexible dynamic homeostasis of the mucosal immune system. Such an analysis reveals that low-affinity IgA is sufficient to protect the host from excess mucosal immune activation induced by harmless commensal microbes. However, affinity-maturation of "classical" IgA is essential to provide protection from more invasive commensal species such as segmented filamentous bacteria and from true pathogens such as Salmonellatyphimurium. Thus a correlation is revealed between "sophistication" of the IgA response and aggressiveness of the challenge. A second emerging theme is that more-invasive species take advantage of host inflammatory mechanisms to more successfully compete with the resident microbiota. In many cases, the function of IgA may be to limit such inflammatory responses, either directly by coagulating or inhibiting virulence of bacteria before they can interact with the host or by modulating immune signaling induced by host recognition. Therefore IgA appears to provide an added layer of robustness in the intestinal ecosystem, promoting "commensal-like" behavior of its residents.

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Despite the widespread popularity of linear models for correlated outcomes (e.g. linear mixed modesl and time series models), distribution diagnostic methodology remains relatively underdeveloped in this context. In this paper we present an easy-to-implement approach that lends itself to graphical displays of model fit. Our approach involves multiplying the estimated marginal residual vector by the Cholesky decomposition of the inverse of the estimated marginal variance matrix. Linear functions or the resulting "rotated" residuals are used to construct an empirical cumulative distribution function (ECDF), whose stochastic limit is characterized. We describe a resampling technique that serves as a computationally efficient parametric bootstrap for generating representatives of the stochastic limit of the ECDF. Through functionals, such representatives are used to construct global tests for the hypothesis of normal margional errors. In addition, we demonstrate that the ECDF of the predicted random effects, as described by Lange and Ryan (1989), can be formulated as a special case of our approach. Thus, our method supports both omnibus and directed tests. Our method works well in a variety of circumstances, including models having independent units of sampling (clustered data) and models for which all observations are correlated (e.g., a single time series).

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OBJECTIVES: To demonstrate the safety and feasibility of a new concept for CTO recanalization using a controlled antegrade and retrograde subintimal tracking technique (CART technique). BACKGROUND: A successful percutaneous recanalization of chronic coronary occlusions results in improved survival, as well as enhanced left ventricular function, reduction in angina, and improved exercise tolerance. However, successful recanalization of CTOs is still not optimal, and needs further improvements. METHODS: Ten patients with a CTO underwent the CART procedure. This technique combines the simultaneous use of the antegrade and retrograde approaches. A subintimal dissection is created antegradely and retrogradely, which allows the operator to limit the extension of the subintimal dissection in the CTO portion. A retrograde approach means that the occlusion site is approached in a retrograde fashion through the best collateral channel from any other patent coronary artery. RESULTS: The occlusion site was located in the RCA in 9 patients, and in the LAD in 1 patient. CTO duration varied from 7 to 84 months. Vessel recanalization was achieved in all patients. In all cases, the subintimal dissection was limited to the CTO region. No complications occurred in the collateral channel used for the retrograde approach. There were no in-hospital major adverse cardiac events. CONCLUSIONS: The CART technique is feasible, safe, and has a high success rate.

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INTRODUCTION: Functional dyspepsia and non-erosive reflux disease (NERD) are prevalent gastrointestinal conditions with accumulating evidence regarding an overlap between the two. Still, patients with NERD represent a very heterogeneous group and limited data on dyspeptic symptoms in various subgroups of NERD are available. AIM: To evaluate the prevalence of dyspeptic symptoms in patients with NERD subclassified by using 24 h impedance-pH monitoring (MII-pH). METHODS: Patients with typical reflux symptoms and normal endoscopy underwent impedance-pH monitoring off proton pump inhibitor treatment. Oesophageal acid exposure time (AET), type of acid and non-acid reflux episodes, and symptom association probability (SAP) were calculated. A validated dyspepsia questionnaire was used to quantify dyspeptic symptoms prior to reflux monitoring. RESULTS: Of 200 patients with NERD (105 female; median age, 48 years), 81 (41%) had an abnormal oesophageal AET (NERD pH-POS), 65 (32%) had normal oesophageal AET and positive SAP for acid and/or non-acid reflux (hypersensitive oesophagus), and 54 (27%) had normal oesophageal AET and negative SAP (functional heartburn). Patients with functional heartburn had more frequent (p<0.01) postprandial fullness, bloating, early satiety and nausea compared to patients with NERD pH-POS and hypersensitive oesophagus. CONCLUSION: The increased prevalence of dyspeptic symptoms in patients with functional heartburn reinforces the concept that functional gastrointestinal disorders extend beyond the boundaries suggested by the anatomical location of symptoms. This should be regarded as a further argument to test patients with symptoms of gastro-oesophageal reflux disease in order to separate patients with functional heartburn from patients with NERD in whom symptoms are associated with gastro-oesophageal reflux.

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Cancer is caused by a complex pattern of molecular perturbations. To understand the biology of cancer, it is thus important to look at the activation state of key proteins and signaling networks. The limited amount of available sample material from patients and the complexity of protein expression patterns make the use of traditional protein analysis methods particularly difficult. In addition, the only approach that is currently available for performing functional studies is the use of serial biopsies, which is limited by ethical constraints and patient acceptance. The goal of this work was to establish a 3-D ex vivo culture technique in combination with reverse-phase protein microarrays (RPPM) as a novel experimental tool for use in cancer research. The RPPM platform allows the parallel profiling of large numbers of protein analytes to determine their relative abundance and activation level. Cancer tissue and the respective corresponding normal tissue controls from patients with colorectal cancer were cultured ex vivo. At various time points, the cultured samples were processed into lysates and analyzed on RPPM to assess the expression of carcinoembryonic antigen (CEA) and 24 proteins involved in the regulation of apoptosis. The methodology displayed good robustness and low system noise. As a proof of concept, CEA expression was significantly higher in tumor compared with normal tissue (p<0.0001). The caspase 9 expression signal was lower in tumor tissue than in normal tissue (p<0.001). Cleaved Caspase 8 (p=0.014), Bad (p=0.007), Bim (p=0.007), p73 (p=0.005), PARP (p<0.001), and cleaved PARP (p=0.007) were differentially expressed in normal liver and normal colon tissue. We demonstrate here the feasibility of using RPPM technology with 3-D ex vivo cultured samples. This approach is useful for investigating complex patterns of protein expression and modification over time. It should allow functional proteomics in patient samples with various applications such as pharmacodynamic analyses in drug development.

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This article develops the concept of “Functional Regulatory Space” (FRS) in order to analyze the new forms of State action addressing (super) wicked problems. A FRS simultaneously spans several policy sectors, institutional territories and levels of government. It suggests integrating previous policy theories that focused on “boundary-spanning regime,” “territorial institutionalism” or multi-level governance. The FRS concept is envisaged as a Weberian “ideal-type” of State action and is applied to the empirical study of two European cases of potential FRS: the integrated management of water basins and the regulation of the European sky through functional airspace blocks. It will be concluded that the current airspace regulation does match the ideal-type of FRS any better than the water resource regulation does. The next research step consists in analyzing the genesis and institutionalization of potential FRS addressing other (super) wicked problems such as climate change and economic, security, health and immigration issues in different institutional contexts as well as at various levels of governance.

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Children with nonorganic voice disorders (NVDs) are treated mainly using direct voice therapy techniques such as the accent method or glottal attack changes and indirect methods such as vocal hygiene and voice education. However, both approaches tackle only the symptoms and not etiological factors in the family dynamics and therefore often enjoy little success. The aim of the "Bernese Brief Dynamic Intervention" (BBDI) for children with NVD was to extend the effectiveness of pediatric voice therapies with a psychosomatic concept combining short-term play therapy with the child and family dynamic counseling of the parents. This study compares the therapeutic changes in three groups where different procedures were used, before intervention and 1 year afterward: counseling of parents (one to two consultations; n = 24), Brief Dynamic Intervention on the lines of the BBDI (three to five play therapy sessions with the child plus two to four sessions with the parents; n = 20), and traditional voice therapy (n = 22). A Voice Questionnaire for Parents developed by us with 59 questions to be answered on a four-point Likert scale was used to measure the change. According to the parents' assessment, a significant improvement in voice quality was achieved in all three methods. Counseling of parents (A) appears to have led parents to give their child more latitude, for example, they stopped nagging the child or demanding that he/she should behave strictly by the rules. After BBDI (B), the mothers were more responsive to their children's wishes and the children were more relaxed and their speech became livelier. At home, they called out to them less often at a distance, which probably improved parent-child dialog. Traditional voice therapy (C) seems to have had a positive effect on the children's social competence. BBDI seems to have the deepest, widest, and therefore probably the most enduring therapeutic effect on children with NVD.

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The attentional blink (AB) represents a fundamental limit of information processing. About 5-10 % of all subjects, however, do not show the AB. Because of the low base rate of these so-called non-blinkers, studies on mechanisms underlying non-blinkers' absent AB are extremely scant. The few existent studies found non-blinkers to be faster and more efficient in information processing compared to blinkers. A personality trait that has been linked previously to speed and efficiency of information processing as well as to the magnitude of the AB is impulsivity. Therefore, the present study investigated whether 15 non-blinkers and 15 blinkers differed from each other in functional and/or dysfunctional impulsivity. To obtain a better understanding of the underlying processing mechanisms, the P300 component in the event-related potential was recorded during performance on the AB task. Our results indicated higher functional impulsivity in non-blinkers compared to blinkers but no differences between the two groups in dysfunctional impulsivity. As indicated by shorter P300 latency, non-blinkers processed information faster than blinkers after the AB period but slower during the AB period. These speed effects, however, were not associated with functional impulsivity. Thus, impulsivity and speed of information processing appear to represent two rather independent sources for non-blinkers' absent AB

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OBJECTIVE: The study of HIV-1 rapid progressors has been limited to specific case reports. Nevertheless, identification and characterization of the viral and host factors involved in rapid progression are crucial when attempting to uncover the correlates of rapid disease outcome. DESIGN: We carried out comparative functional analyses in rapid progressors (n = 46) and standard progressors (n = 46) early after HIV-1 seroconversion (≤1 year). The viral traits tested were viral replicative capacity, co-receptor usage, and genomic variation. Host CD8 T-cell responses, humoral activity, and HLA immunogenetic markers were also determined. RESULTS: Our data demonstrate an unusual convergence of highly pathogenic HIV-1 strains in rapid progressors. Compared with standard progressors, rapid progressor viral strains show higher in-vitro replicative capacity (81.5 vs. 67.9%; P = 0.025) and greater X4/DM co-receptor usage (26.3 vs. 2.8%; P = 0.006) in early infection. Limited or absent functional HIV-1 CD8 T-cell responses and neutralizing activity were measured in rapid progressors. Moreover, the increase in common HLA allele-restricted CD8 T-cell escape mutations in rapid progressors acts as a signature of uncontrolled HIV-1 replication and early impairment of adaptive cellular responses. CONCLUSION: Our data support a dominant role for viral factors in rapid progressors. Robust HIV-1 replication and intrinsic viral properties limit host adaptive immune responses, thus driving rapid disease progression.