Diabetic foot ulcers: Retrospective comparative analysis from Sicily between two eras

Aim: The aim of this study was to analyze changes in the incidence, management and mortality of DFU in Sicilian Type 2 diabetic patients hospitalized between two eras, i.e. 2008-2013 and 2014-2019. Methods: We compared the two eras, era1: 2008-13, era2: 2014-19. In era 1, n = 149, and in era 2, n = 181 patients were retrospectively enrolled. Results: In the population hospitalized for DFU in 2008-2013, 59.1% of males and 40.9% of females died, whilst in 2014-2019 65.9% of males and 34.1% of females died. Moderate chronic kidney disease (CKD) was significantly higher in patients that had died than in ones that were alive (33% vs. 43%, p < 0.001), just as CKD was severe (14.5% vs. 4%, p < 0.001). Considering all together the risk factors associated with mortality, at Cox regression multivariate analysis only moderate-severe CKD (OR 1.61, 95% CI 1.07-2.42, p 0.021), age of onset greater than 69 years (OR 2.01, 95% CI 1.37-2.95, p <0.001) and eGFR less than 92 ml/min (OR 2.84, 95% CI 1.51-5.34, p 0.001) were independently associated with risk of death. Conclusions: Patients with DFU have high mortality and reduced life expectancy. Age at onset of diabetic foot ulcer, eGFR values and CKD are the principal risk factors for mortality

Wall-to-horizontal diaphragm connections in historical buildings: A state-of-the-art review

Wall-to-horizontal diaphragm connections play a crucial role in the global stability of historical buildings under seismic actions. When these links are ineffective or absent, engineered measures should be considered to enhance the earthquake-resistant box-type behavior. Besides the great variety on the construction systems and materials, common damages were observed in recent seismic events showing the high vulnerability of local mechanisms promoted by the lack of structural integrity. Although the acknowledged importance of connections, this topic has been practically neglected over time among the research community and practitioners and only few of them focused on the influence of diaphragm-to-wall connections on the dynamic behavior of the building as a whole.This paper presents a literature review of the traditional wall-to-floor or wall-to-roof connections in unreinforced masonry buildings and summarizes typical and innovative strengthening solutions, taking into account the indications provided by the few design codes addressing this topic. Experimental laboratory researches are investigated, including shaking table tests on global and local scale, and cyclic or monotonic tests to characterize anchoring systems. An overview of the typical vulnerability assessment approaches and modelling techniques is given, considering present standards that account for connections.This work was partly financed by FEDER funds through the Operational Programme Competitiveness Factors (COMPETE) and by national funds through the Foundation for Science and Technology (FCT) within the scope of project POCI-01-0145-FEDER-007633. The financial support of FCT to the first author, through the PhD grant SFRH/BD/131652/2017, is also acknowledged

Constructive Analysis and Modelling of a Single Nave Church: a Proposal for S. Sebastiano (EN, Italy)

The seismic events occurred in Italy in the last decay (L’Aquila 2009, Emilia 2012, Central Italy Earthquakes 2016/2017) have caused the collapse of numerous historical buildings and monuments with loss of life and irreversible damages to the cultural heritage. An effective seismic prevention would avoid, or delay, the most frequent collapse mechanisms. However, it requires a correct interpretation of the structural mechanical behavior. With regard to the traditional masonry buildings, this issue presents a high level of complexity due to the uncertainties related to the materials and the constructive techniques. Furthermore, historic buildings are often the result of several modifications that induce significant structural irregularities. A possible analysis strategy is provided by a discrete macro-element modelling (DMEM) approach which is able to simulate the global behavior of traditional fabrics, if supported by an adequate level of historic, geometrical, constructive and structural knowledge. In this paper a multidisciplinary procedure is applied to the church of S. Sebastiano in Regalbuto (Italy), considered as case study. This procedure is composed of three steps: the knowledge phase in which the constructive apparatus and the static schemes are identified, the modelling phase and the assessment phase in which the current safety level of the building and possible interventions that would be compatible with its cultural instance, are individuated. According to the followed procedure, different scenarios of intervention, characterized by increasing levels of benefit and invasiveness, are considered. For each scenario, non-linear static push-over analyses are performed, to evaluate the benefits and identify the structural critical issues, useful to individuate the next scenario. The obtained results are presented and discussed both in terms of capacity curves and failure mechanisms

Miglioramento clinico e metabolico in pazienti affetti da diabete mellito tipo 1 associato ad altre endocrinopatie (APS) dopo shift della terapia insulinica basale con glargine a degludec

Background L’utilizzo di insulina degludec, rispetto ad altre insuline basali, sembra associato ad una ridotta incidenza di episodi ipoglicemici e di conseguenza ad una maggiore stabilità glicemica con miglioramento del compenso glicometabolico. Materiali e Metodi Abbiamo analizzato i parametri clinico-metabolici e i profili glicemici di 51 consecutivi pazienti affetti da diabete tipo 1 associato ad altre endocrinopatie (APS) in stabile terapia basale con glargine (in baseline) e suddivisi in 2 gruppi: gruppo A (n.21) a cui è stata confermata la terapia con glargine e gruppo B (n.30) a cui è stata sostituita glargine con degludec per un periodo di 6 mesi. A tutti i pazienti è stato chiesto di effettuare un monitoraggio glicemico domiciliare intensivo compilando un diario mensile riportante almeno 10 valori glicemici per ogni fascia oraria (pre-colazione, post-colazione, pre-pranzo, post-pranzo, pre-cena, post-cena, notturno). Da questi dati abbiamo calcolato la media glicemica per ogni fascia oraria e la media delle deviazioni standard (DS), che è stata considerata indice di variabilità glicemica. Risultati In baseline, i due gruppi sono risultati appaiati per età (37 ± 15 vs. 38 ± 13 aa; p=0.818), durata di malattia (11 ± 8 vs. 15 ± 9 aa; p=0.086), BMI (25 ± 5 vs. 23.6 ± 4 kg/m2; p=0.289), HbA1c (9.4 ± 1.9 vs. 9 ± 1.4%; p=0.395), I.R totale (0.5 ± 0.4 vs. 0.7 ± 0.1 U/kg/die; p=0.073) e I.R. di insulina basale (0.3 ± 0.1 vs. 0.3 ± 0.1 U/kg/die; p=0.701). Il gruppo B, che al baseline presentava una maggiore variabilità glicemica nella fascia pre-cena (73.9 ± 28.4 vs. 26 ± 21 DS; p=0.025) e dopo cena (50.1 ± 29.9 vs. 10.1 ± 7.7 DS; p=0.020), senza differenze significative negli altri orari, dopo 6 mesi di terapia ha mostrato una significativa riduzione di BMI (22.8 ± 4.3 vs. 23.6 ± 4 kg/m2; p=0.001), Hba1c (7.9 ± 1 vs. 9 ± 1.4%; p<0.001) e I.R.totale (0.6 ± 0.1 vs. 0.7 ± 0.1 U/kg/die; p=0.005) e i suddetti parametri a 6 mesi sono risultati significativamente inferiori nel gruppo B rispetto al gruppo A. Inoltre, a 6 mesi non si è più evidenziata alcuna differenza nella variabilità glicemica tra i due gruppi in nessuna fascia oraria. Conclusioni Lo shift da glargine a degludec migliora significativamente i parametri clinico-metabolici e riduce l’I.R. in pazienti affetti da APS che presentano una maggiore variabilità glicemica in corso di terapia con glargine

Retrofitting of Slender Masonry Arch Bridges

There is a large stock of masonry arch bridges built more than 100 years ago that are still in use in the world roadway and railway network. The restoration and conservation of this type of structures has become one of the main challenges of bridge engineering. As a first step, any intervention strategy requires an early stage consisting in the assessment of the structural safety (in the actual condition) of the masonry bridge. Only after that stage is performed, it is possible to design, if required, optimal repair interventions to bring the bridge to adequate safety level. In the first part of this paper, the seismic vulnerability assessment of a slender multi-span masonry arch bridge is presented. Results show that it is required to increase the flexural capacity of the structure. In the second part, an innovative intervention technique intended to increase the capacity of masonry arches is discussed. The proposed intervention technique consists on applying a layer of steel fiber reinforced mortar (SFRM) on the arch intrados. The behavior of a masonry arch strengthened with this technique is discussed by means of experimental and analytical results