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Objectives To determine the causes of death and risk factors in systemic sclerosis (SSc). Methods Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. Results We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was developed, which accurately predicted the 3-year mortality, with an area under the curve of 0.82. The 3-year survival of patients in the upper quartile was 53%, in contrast with 98% in the first quartile. Conclusion Combining two complementary and detailed databases enabled the collection of an unprecedented 3700 deaths, revealing the major contribution of the cardiopulmonary system to SSc mortality. We also developed a robust score to risk-stratify these patients and estimate their 3-year survival. With the emergence of new therapies, these important observations should help caregivers plan and refine the monitoring and management to prolong these patients' survival. ©Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Significant strides have been made using endovascular solutions for the treatment of patients with peripheral vascular disease (PAD) and for tissue loss. But the Trans-Atlantic Inter-Society Consensus (TASC) II classification states that surgery still remains the best solution for C and D lesions, though endovascular management of superficial femoral artery (SFA) can improve inflow for distal origin bypass grafts. Our aim was to evaluate the results of combining endovascular treatment of SFA with distal vein bypass in patients with critical limb ischemia (CLI) and great tissue loss or in the cases where the below-knee endoluminal techniques alone were unable to salvage limbs.A retrospective study of the combined interventions carried out from January 2006 and June 2013 was performed. Twenty-seven angioplasties or selective stentings of SFA combined with popliteal-distal bypass in 23 patients with stage 4, 5 or 6 Rutherford classification were performed. There were 14 men and 9 women, four were bilateral. Mean age was 71.5 years (55-91); 21 (91.3%) were diabetic, and in these, there was almost always deep debridement of necrotic or infected tissue. In 17 cases (62.9%) SFA angioplasty was performed alone, a self-expendable stent was released in the other 10 (37.1%). Distal bypass originated from distal SFA in 5 cases (18.5%), from above-knee popliteal artery in 8 (29.6%) and from below-knee popliteal artery in 14 (51.8%). Reversed saphenous vein was used for bypass in all cases. The target vessel was the posterior tibial artery in 6 cases, anterior tibial artery in 10 and dorsalis pedis in eleven. Follow-up ranged from 4 months to 6 years (with a mean of 37 months).There were no deaths, but two early graft failures and three major amputations during the perioperative period. Primary patency rate of both the endovascular SFA and the bypass was 81.6% (N.=22) and secondary patency was 88.8% (N.=24). Three years primary and secondary patency rate were, respectively, 74.1% (N.=20) and 81.6% (N.=22). One-year limb salvage rate was 88.8%, at three years was 86.1% and fifteen minor amputations were performed in 13 patients.The endovascular treatment of SFA associated with surgical distal vein bypass is a useful and effective strategy in patients with severe lower extremity arterial disease. This strategy allows a good inflow on SFA in selected patients with the opportunity to perform shorter bypass, use of limited autologous conduit and good expectation of patency.

We present an application implementing an original trafc ow simulation and forecast model for the road network of the Forl-Cesena province. We dened and calibrated a model, which makes use of trafc counts collected on some network arcs, of an origin/destination (OD) matrix of the province and of physical characteristics of networks arcs, and permits to identify trafc ows compatible with actual counts. This same model, after the calibration of its parameters for the province network, has also been utilized for forecasting new ows following structural variations of the network. The application also contains an OD matrix renement module which permits to update matrix entries as a function of the actual trafc counts.

Studies on tra±c °ows simulation and forecast have already lead to a signi¯cant theoretical corpus and to e®ective marketed packages. However, the current state of the art is not yet fully satisfactory for local government agencies, especially for medium sized ones, because of the operational constraints and of the inherent rigidity of currently available models and software. Greater importance has to be given to data re¯nement and to interactivity with the operator, which, in turn, constrains response times. We developed an original methodology for dealing with imprecise and not fully reliable input data by means of state of the art optimization techniques, leading to an e®ective tra±c simulation package. We pursued the two intertwined objectives of simulating/predicting tra±c °ows and of re¯ning origin/destination (OD) matrix input data. We worked at a regional level, corre- sponding to a province in the Italian context. We built upon a legacy GIS-based application, using a road network of about 10000 arcs, a superimposed region zoning decomposing the area of interest into about 60 zones, each of which corresponds to a row/column of an OD matrix, and 100 geocoded points, were actual tra±c counts were available. We de¯ned and calibrated a model, which makes use of the tra±c counts collected on the arcs, of the OD matrix of the province and of physical characteristics of networks arcs, and permits to identify tra±c °ows compatible with actual counts. This same model, after the calibration of its parameters for the province network, has also been utilized for forecasting new °ows following structural variations of the network. The application also contains an OD matrix re¯nement module which permits to update matrix entries as a function of the actual tra±c counts. We validated our model when supporting the de¯nition of the so-called Territorial Plan of Provincial Coordination" for the province of Forlµ³-Cesena, where we forecasted tra±c °ows following the infrastructural scenarios included in the plan for the next 20 years.

Laser scanner and digital photogrammetric systems (photo scanning) must be considered at present two of the main techniques used for archaeological and architectural surveying. The integration of both 3D scanning systems allowed us to improve the scienti?c knowledge, the management, the use and the safeguarding of Cultural Heritage. The aim of this article is to identify analogies and differences between the two surveying techniques applied to different archaeological contexts. Starting from a general introduction to the concept of measurement and the management of the data acquired from different techniques of surveying, the article focuses on the laser scanner applications with particular attention on the intrinsic properties of the instrument, the problems of measurement and the methodology used during the survey. The second part is focused on the digital photogrammetry applied on a particular archaeological context. Digital photogrammetry was developed and experimented in order to acquire territorial data quickly. The optimization of the working speed, while maintaining accuracy of data, means cost savings and an optimal use of funds. Our workgroup decided to transfer that methodology to the archaeological excavations of Rome Metro Line C in collaboration with some public institutions and private companies. The ?nal results have produced 2D and 3D graphic documentations of all the archaeological area up to highly-accurate ortho-recti ?ed images. Point clouds allowed us to simultaneously view a general 3D model of all open archaeological areas, providing an opportunity for observation and an analysis not possible by other means. Each area can be studied together with the others in a global view of the excavation. Every stratigraphic unit can be displayed in the same area and switched on in the same way as a layer.

The Italian Mission in Peru (MIPE) has been working on the archaeological site of Chan Chan from 2002 in collaboration with the Ministerio de Cultura of Peru. Although it is inscribed in the UNESCO World Heritage List, Chan Chan is suffering from a structural deterioration due to its building technique (mud brick or adobe), but also from an equally dangerous degradation due to the rapid urban growth of the nearby town of Trujillo and to migratory movements, still difficult to control. In an attempt to stop the degradation of the complex, the Peruvian government, pressed by UNESCO, in 2000 approved the Plan Maestro de conservación y manejo del Complejo Arqueologico Chan Chan, redact by Instituto Nacional de Cultura, (today Ministerio de Cultura). The Plan Maestro has a number of projects and sub-projects aimed to enhancing the complex and its territory with the purpose of helping the socio - economic development of the population. The MIPE intends to support the actions foreseen by the Plan Maestro participating to its revision and updating and following three main objectives: the planning of the Archaeological Park of Chan Chan, the restoration and the virtual visit of Palacio Rivero and other peculiar architectonic typologies and the baking of local handicraft and tourism by mean of training courses arranged also with the help of the international cooperation. In order to achieve these objectives, taking into account the impressive dimension of the site, it was very important to take advantage of the potentiality of new methodologies of investigation: the remote sensing techniques and the ICT processes to organize and archive the geodatabase; the modern acquisition techniques, such as laser scanner, to arrange a 3D surveying, to reconstruct in virtual way the emergencies and by means other multimedia solutions to spread the whole site by virtual visits. In the paper, after a first part devoted to the description of the site, we will illustrate the work of the MIPE in relation to the above-listed objectives, describing the results achieved and the future prospects of research and planning.

Carotid artery angioplasty and stenting (CAS) has emerged as an alternative treatment for extra cranial carotid artery stenosis in stroke prevention. Nevertheless concerns are remaining about the long-term durability as hemodynamic in-stent restenosis (ISR) after CAS are increasing and usually treated again by endovascular approach. This preliminary study, instead, albeit in a limited series, reports our safe and successful experience of the surgical correction of carotid ISR after CAS.From January 2003 to June 2011 seven patients with severe hemodynamic carotid ISR (three symptomatic, four asymptomatic, mean age 76±2), were submitted to surgical operation to remove the carotid stent. The indications for CAS were primary in five cases, secondary to restenosis after carotid endarterectomy (CEA) in two patients. Standard CEA with complete removal of the stent and the entire atherosclerotic plaque was carried out easy and without technical difficulty in the five primary ISR. In the two patients of ISR in post-CEA restenosis, a common carotid to the distal internal carotid artery (ICA) bypass with polytetrafluoroethylene (PTFE) graft was carried out. Mean operation time was 88±26 min. All interventions were performed under general anesthesia with remifentanil preserved consciousness.No death or major complications occurred. Temporary vocal cord impairment by deficit of recurrent inferior laryngeal nerve in one patient with ISR after CAS performed to treat post-CEA restenosis was observed. Intimal hyperplasia was the predominant mechanism to ISR. The mean follow-up of 18 months (range, 4 to 36 months) showed a normal patency of the surgical correction without recurrent restenosis on color-coded duplex ultrasounds (US) examinations.The surgical management of carotid ISR appears feasible and effective leading to good long-term outcome.

The increasing use of carotid artery stenting (CAS) is justified in patients at high-risk for carotid endarterectomy (CEA). The aim of this study was to evaluate the hypothesis that the high-risk patients can be submitted to CEA without increased risk of stroke and death.A retrospective analysis of 625 consecutive CEA in 545 patients (M/F 386/159, age 75 ± 7) performed from January 2005 to December 2010 was carried out. Definite anatomical and pathophysiological high-risk cohort of patients (N.=173, 31.7%) was evaluated and compared to normal risk patients. Univariate, multivariate and Kaplan-Meier analysis were used as appropriate. Poisson regression (Pr) model was used to study all univariate criteria in combination. A P value0.05 was statistically significant.The overall 30-day stroke and death rate was 0.96%. No difference between high-risk vs. normal patient cohort regarding physiological and anatomical risk factors was detected. Univariate and multivariate analysis did not show statistical difference for 30-day outcome in any of the variables examined. No increase of risk in cases of presence of more risk factors resulted to the Pr analysis. The 24-month survival rate was worse in high-risk patients, especially when more physiologic risk as chronic renal failure, severe pulmonary and cardiac diseases and age over eighty were present.CEA is a safe procedure in patients at high-risk carotid artery disease. A better classification of high-risk patients may be necessary because trials criteria appear ineffective to define the patients at real high surgical risk. Long-term outcome was affected by the presence of severe comorbidities.

Carotid artery stenting (CAS) is the treatment of choice for recurrent stenosis after carotid endarterectomy (CEA). However a significative incidence of in-stent restenosis could be occurred. Despite classical CEA leads to good results, in selective cases bypass graft may be the best treatment of in-stent restenosis.We describe two cases of carotid bypass graft performed to treat a recurrent in-stent stenosis after CAS for post-CEA restenosis. No death and cardiac complication occurred and no cranial nerves impairment was detected.Prosthetic bypass graft is safe and effective in treatment of in-stent recurrent restenosis after CEA restenosis.

Purpose of the study was to assess how the introduction of endovascular treatment has affected mortality and morbidity of the traditional surgery for infrarenal abdominal aortic aneurysms (AAA).From January 2002 to December 2009 we treated 230 patients with AAA (mean age 71.6; 121 male 70.7%); 171 (74.4%) were treated with surgery, 59 (25.6%) underwent to endovascular exclusion .We divided the patients into two groups: Group A, before the beginning of our "endovascular"; Group B, after the beginning of our endovascular experience. A total of 171 patients were treated with traditional surgical intervention, 99 in Group A and 72 in Group B. We evaluated the morbidity and mortality between the two groups by statistical analysis (by Student t test and χ ² test) considering a significant p-value0.001.e 30-day mortality was 4% respectively in group A and 5.5% in group B (P = not significative, n.s.). The incidence of renal and ischemic peripheral complications was, respectively, 2% and 4% in group A, and 4.1% and 8.3% in group B showing statistical significance (P.001). There were no documented statistically significant differences between the two groups in terms of cardiac and respiratory complications (P = n.s.). CONCLUSIONS. The results of the traditional surgery for the infrarenal AAA not suitables for endovascular repair suffer from the difficult anatomy of aorto-iliac district. Although the incidence of complications of open surgery is increased, the mortality is similar to anatomical not complicated aneurysms.

To retrospectively evaluate and compare the safety and efficacy of general anesthesia with remifentanyl conscious sedation (RCS) vs local-regional anesthesia (LA) for carotid endarterectomy (CEA).From January 2004 to January 2008, 390 CEA performed in 325 patients (M/F 214/111, age 75 +/- 7) were collected in 2 groups: RCS group included 275 consecutive CEA in 230 patients carried out under remifentanyl conscious sedation with stopping of the remifentanyl infusion at the carotid clamping time to evaluate the clinical neurological status; LA group was composed of 115 consecutive CEA in 95 patients, performed under local-regional anesthesia. We evaluated complications, postoperative morbidity and mortality, need for shunt insertion and compared the results by means of Student's t-test and chi2 analysis. P value0.05 (T=2.28) was considered significant.The 30 days mortality was 0.35% in the RCS group and 0% for LA group (P=NS). The 30 days stroke rates were 0.3% and 0% respectively (P=NS). TIA/RIND rates were 0.3% for RCS group and 1.7% for LA group (P=0.47); shunt usage was 20% for RCS group and 17% for LA group (P=0.26). We found higher postoperative nausea/vomiting in the RCS group (3.9% vs 0.8%, P0.05).General anesthesia with remifentanyl conscious sedation seems to be a safe technique, allowing monitoring of the neurological status, cerebral protection during arterial clamping, better control of the airway and a good compliance to both the surgeon and the patient. A randomized control trial is needed to prove RCS to be effective as LA.

The persistence of hypoglossal artery is a rare malformation. Association of carotid stenosis with persistent hypoglossal artery can lead to cerebral posterior symptoms due to ischemia intolerance. The Authors report a case of unexpected intraoperative detection of this anomaly in a patient with high grade stenosis of the right internal carotid artery. Right carotid endarterectomy was performed, and no shunt was used. The postoperative course was normal. The literature was reviewed.

Petra and Beida are two adjacent archaeological sites in southern Jordan characterised by both a striking monumental heritage, and an imposing geomorphologic landscape. These sites, besides preserving important remainders of protohistorical cultures, contain the most important Nabatean vestiges of the entire Middle-East and have more recent, Roman, Crusade and Islamic, significant remains as well. On account of the importance of their archaeological and monumental heritage, the two sites are included in the UNESCO's World Heritage list and are the heart sites of a National Archaeologic Park. Less known, yet not less interesting, is the rich and striking geomorphologic heritage of the Petra-Beida area, characterised by tectonic troughs alternating with steep mountains riddled by canyons and passages to form a town of rocks. The intrinsic beauty and significance of landforms and landscapes could be the driving elements for touristic and educational aims, towards an integration of the geomorphologic heritage with the archaeological-monumental one. In this connection, both Nabatean water management systems and historical burials of monumental areas by flood events are primary links to an integrated approach, suitable for being exploited for tourism and cultural goals. Ongoing researches by means of GPS systems and laser scanning allowed us the detailed reconstruction of both parts of the Nabatean water systems and historical alluvial fills. The digital elaboration and modellisation, as well as computer simulations and reconstructions, besides their intrinsic scientific meaning, can be powerful tools for tourism improvement and educational work.

Aim of this paper is to evaluate the safety and the patency rate of the infrapopliteal bypass grafts performed with the great saphenous vein (GSV) with small (2.5 mm) or large calibre (5 mm).Between January 2003 and May 2007, 73 infra-genicular bypass with autologous saphenous vein were performed in patients affected by atherosclerotic femoropopliteal disease. In 8 cases a bypass grafts with small saphenous vein (diameter 2.2-2.5 mm) were performed, in 4 cases a bypass with segmental varicose saphenous vein (diameter 5.7-6.4 mm ) were carried out. In 64 cases the bypass was carried out with the reversed technique, in 9 cases with the in situ technique.Thirty day mortality was 3/82 (3.6%) and 30 day cumulative patency rate was 95.1% (78/82) with limb salvage of 96.3% (79/82). All the patients with small diameter vein showed a normal patency at the follow-up and at the duplex scan examination no complications occurred. The mean calibre of the arterialized vein increased to 2.6-3,4 mm at 1 week with maintenance during the follow-up. Patients with varicose vein implanted present a mean dilatation of 6.4-7.2 mm at 1 week and no dilatative complication were detected at the follow-up.The risk of stenosis, graft thrombosis or aneurysm degeneration doesn't seem to be higher respect normal GSV either for small or for large veins. Large series and longer follow up are mandatory for an extensive clinical application.

The article presents the results of the GPS and photographic surveys conducted on the archaeological site of Villa Magna (Anagni, Lazio). The archaeological complex, identified as the imperial residence of Antoninus Pius, occupies an area of about 22 hectares. Presently, the visible remains are divided into two principal nuclei: the northern one, near the church of S. Pietro, and the southern one, occupied by a farmhouse. The aim of the survey was the reconstruction of the morphology of the terrain in order to produce a Digital Terrain Model and to highlight the relationship between natural elements and ancient structures. In order to speed up the work, a new procedure was used. It consists of a Differential GPS used in a kinematic way by mounting the rover antenna on a jeep. In this article the experimental method's advantages and the problems of acquisition are analysed. Moreover, low altitude photographs of the archaeological excavations were taken using an aerostatic balloon. The photographic system was anchored to the balloon with a radio-controlled device called Picavet. Georeferenced photos can be very useful not only for documenting but also for presenting and exploiting the site.

This paper relates the specific experience for the collaboration between the Institute for Technologies Applied to Cultural Heritage and the University of Tuscia in managing archaeological excavations on a GIS platform. The basic idea was the reproduce on a graphic level the exact situation we find in the field. We therefore organised our objects according to an overall composite plan representing all the excavated layers, as well as the necessary landscape features, related only spatial terms; detailed alphanumerical data and interpreted information were derived from the DBMS using specific identifiers.

A series of topographical surveys carried out during the past years in the Salto Valley (Rieti - Lazio), have provided much interesting data regarding local archaeological sites, particularly along the southern slopes of the Breccioso Hills which rise between the Corvaro and Spedino plain. An interesting site has recently come to our attention at Colle Breccioso. However, the nature of the site was not clear and its structure is hazy, a consequence of the deterioration of the surrounding ground and increased vegetation coverage. The situation at the site suggested that a detailed survey of the southern incline and the plateau associated with the site would be valuable. The objective of the survey was to highlight topographic variation and to bring to light any traces of human construction or manipulation. The survey was carried out using a DGPS Leica SR 510, and a total station. The integration of these two instruments (which had both, differing and complementary capacities) produced satisfactory and innovative results. The processing of the Digital Terrain Model (DTM) of the area highlighted several characteristics of the site and the consequent production of thematic maps from this data could be used to guide future excavations at the site.

In general, a territory can be considered as the centre which contains all information related to different historical ages. The study of a portion of a given territory characterised by the presence of archaeological sites must be aimed at the complete and accurate acquisition of environmental data (e.g. topography, geo-morphology, litho-stratigraphy, land use, etc.), which will be used for an overall study of the site, the reconstruction of the man-environment interaction, and the evaluation of possible applications of geophysical prospecting methods. By interpreting different sets of remote-sensing data, studying existing geological and geo-morphological information and through systematic field work (e.g. archaeological survey, geophysical investigations, etc.), a wide spectrum of environmental data can be collected. The methodology of a complete analysis of the territory can be summarised as follows: analysis of remote-sensing data sets and their geo-referencing; DTM of the selected study area; morphological and geological definition of the selected study area; identification, location and geo-referencing of all archaeological sites in the territory; high-resolution integrated geophysical prospecting methods, to delineate the extension of the site and to locate the archaeological structures; a complete description of the site in its environmental context; definition of an integrated analysis method, based on the spatial correlation of the different data sets; study and design of a GIS for the management of all data sets which have been collected, elaborated and interpreted; definition of a model for the knowledge and protection of the historical and environmental aspects of the territory.

Recently, an interesting debate has developed in the context of historic archaeological disciplines concerning the employment of typical technical scientific methodologies and instruments utilized in research. The aim of this article is to contribute to this debate by showing how it is possible to conjointly utilize information technology techniques and statistical methods in archaeological research for both descriptive and interpretative purposes. The objective was successfully achieved by integrating several common spatial-statistical methods (Ripley's K-function) with the potential offered by GIS. In fact, the collection of files and graphical data representation was followed up by statistical data processing which, with the identification of several important parameters, has enabled GIS files to be improved with further information for subsequent processing.

The relative reactivity of isopropyl, ethyl and methyl groups in the gas-phase side-chain deprotonation of alkylaromatic radical cations by some pyridines has been determined by using Fourier transform mass spectrometry.

Some plants of the genus Alyssum are able to accumulate nickel(II). It has been observed that increase in nickel content is accompanied by an increase in the level of malonic and malic acids in the leaves [1]. Indeed crude extracts obtained from the leaves showed the presence of the nickel salts of the above mentioned acids. However, it has been shown these plants also contain a considerable amount of free amino acids, which in principle should also act as ligands of the nickel(II) ion [2]. R. J. P. Williams has suggested that only the presence of ligands containing nitrogen donors can explain the selective uptake for example of nickel(II) over cobalt(II) [3]. We decided therefore to study the mechanism of uptake, transport and accumulation of metal ions by these plants, using the copper(II) ion as a probe. This is because the copper(II) ion can be studied trough ESR, a technique which can be applied directly to whole samples (roots, leaves, plants etc.) thus avoiding the formation of artefacts. When the cut roots of the plant are introduced for 1′ into a 10−4M CuSO4 solution and washed with distilled water the spectrum 1a is observed (Fig. 1). This spectrum can be interpreted as the superimposition of the isotropic spectrum of freely rotating aqueous copper(II) with an anisotropic spectrum typical of immobilized copper(II) [4]. This spectrum does not change with time even if the roots are kept in water. If however the roots of an entire plant are immersed in distilled water after the treatment with CuSO4, the spectrum 1a changes with time (1b, 1c, 1d) showing the progressive formation of a copper(II) complex with low molecular weight. The spectrum 1d is also found in the leaves indicating that this is the medium through which copper(II) is transported across the plant. The giso = 2.13 and Aiso = 80 × 10−4 cm−1 values are consistent with the presence of nitrogen atoms among the donors. This complex is fairly stable as it is also found in crude extracts of the plant and this might provide a possible way for its isolation. Preliminary experiments indicated that this complex does not migrate under electrophoresis. This complex could represent a 1:2 copper(II) amino acid complex. Studies are in progress in order to isolate and characterize this species (or mixture of species). We also studied the absorption of other metal ions by these plants and we found that the uptake follows the order Cu Zn Ni Co Mn Cr. All these metals behave competitively toward Ni(II) indicating a common uptake pathway at least at the level of the roots (Fig. 2).

Cytomegalovirus (CMV) infection is a major complication in immunocompromised patients, including those with autoimmune diseases. Here, we describe the first case of granulomatosis with polyangiitis treated with steroids and cyclophosphamide, complicated by a multid-rug-resistant (MDR) CMV infection in presence of weak antiviral cellular immunity. Since reports regarding CMV infection in rheumatological patients are rarely described and no guidelines on its management exist, the described case contributes to identify potential strategies to predict the risk of CMV disease and developing of MDR-CMV in these patients, through virological and immunological surveillance.

Human papillomavirus (HPV) persistent infections are associated with cervical cancer and other HPV-related diseases and tumors. Thus, the characterization of long lasting immunity to currently available HPV vaccines is important. A total of 149 female subjects vaccinated with Cervarix or Gardasil participated to the study and they were stratified according to age (10&ndash, 12-year-old and 16&ndash, 20-year-old). Humoral immune responses (IgG and neutralizing antibody titers, antibody avidity) and circulating memory B cells were analyzed after an average of 4&ndash, 6 years from the third immunization. The humoral responses against HPV-16 and HPV-18 (and HPV-6 and HPV-11 for Gardasil) were high in both age groups and vaccines up to six years from the third dose. However, Cervarix induced significantly higher and more persistent antibody responses, while the two vaccines were rather equivalent in inducing memory B cells against HPV-16 and HPV-18. Moreover, the percentage of subjects with vaccine-specific memory B cells was even superior among Gardasil vaccinees and, conversely, Cervarix vaccinated individuals with circulating antibodies, but undetectable memory B cells were found. Finally, a higher proportion of Cervarix-vaccinated subjects displayed cross-neutralizing responses against non-vaccine types HPV-31 and HPV-45. Gardasil and Cervarix may, thus, differently affect long-lasting humoral immunity from both the quantitative and qualitative point of view.

An established research line in ACO systems supports the intuition that ant algorithms are particularly fit for dynamic optimization problems because of their ability to construct an internal representation of the essential elements of the problem to solve, a representation which needs to be updated and not reconstructed when the instance changes.