Cardiovasc Diabetol

Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthfull to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patients and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes

Ancient ruins of the future

The Herculea Telesina in the region of Campania is certainly not a fragment but an almost continuous defensive wall. The strong point of this particular project for siege defense being geometric criteria that have remained practically unchanged even when the weapons themselves evolved. The ruins offer a vast repertory of useful signs: the contemporary scholar can not only acquire the teachings of a culture that was much advanced compared to the Roman world, but by observing the angles and vectors can ponder the absence of any changes in the measurements that were subordinated to tactics and thus to human needs. Decisive factors that elevate the walls of Telesia to the level of a cultural testament still to be discovered

High strength modified nanofibrillated cellulose-polyvinyl alcohol films

In this study surface-modified nanofibrillated cellulose (NFC) was used at low levels (0.5 to1.5 wt%) as a reinforcement in a polyvinyl alcohol (PVA) matrix. The modified-NFC-PVA composite films prepared using the solution casting technique showed improved mechanical performance. Birch pulp cellulose was initially modified by allylation using a solvent-free, dry modification method followed by subsequent epoxidation of the allyl groups and finally grinding the pulp to yield epoxy-NFC. In order to obtain optimal mechanical performance, epoxy-NFC with different degrees of substitution was evaluated in the reinforcement of PVA. The addition of 1 wt% epoxy- NFC (degree of substitution, DS 0.07) enhanced the modulus, strength, and strain of pure PVA film by 307, 139 and 23 %, respectively, thus producing the best performing film. The results demonstrate the favourable effect of chemically functionalized NFC on the mechanical properties of polyvinyl alcohol compared to unmodified NFC as reinforcement. In order to improve industrial and economic feasibility, the manufacture of the composite was also done in situ by grinding cellulose directly in PVA to produce the new biocomposite in a one-step process