Liraglutide Improves Cardiovascular Risk as an Add-on to Metformin and Not to Insulin Secretagogues in Type 2 Diabetic Patients: A Real-life 48-Month Retrospective Study.

INTRODUCTION: Although liraglutide is widely recognized to have glycemic and extra-glycemic effects, few studies have compared these effects in relation to hypoglycemic treatment starting from the diagnosis of diabetes. We evaluated the effectiveness of liraglutide in reducing the Framingham risk score (FRS) and visceral adiposity index (VAI) in relation to first-line hypoglycemic treatment from diagnosis of type 2 diabetes, continued without any changes. METHODS: We selected 105 diabetic outpatients who were treated with liraglutide for at least 48 months as an add-on therapy to metformin alone (group A, n = 52) or insulin secretagogues (group B, n = 53) from diagnosis time. RESULTS: Although both groups showed a reduction in BMI, waist circumference, blood pressure, HbA1c and triglycerides, only group A showed a significant reduction in FRS (p < 0.001) and VAI (p = 0.012) after 48 months. No significant intergroup difference was found for any parameters at either baseline or 48 months, with the exception of FRS at 48 months, lower in group A (p = 0.002), regardless of duration of disease, improvement in glycemic control and VAI. CONCLUSION: Our data show that during a 48-month follow-up liraglutide was more efficacious in reducing cardiovascular risk than when it was used as add-on therapy to the first-line therapy from diagnosis with metformin and not with insulin secretagogues

No phenotypic differences for polycystic ovary syndrome (PCOS) between women with and without type 1 diabetes mellitus.

CONTEXT: Women with type 1 diabetes mellitus (DM1) have a higher prevalence of polycystic ovary syndrome (PCOS) than the general population. OBJECTIVE: The aim of this study was to clarify, in DM1 women with PCOS (PCOS-DM1), the influence of insulin therapy and glycemic control and evaluate the hormonal and phenotypic differences with age-matched and body mass index (BMI)-matched women with PCOS without diabetes. DESIGN, SETTING, AND PATIENTS: We evaluated 103 DM1 women with and without PCOS treated with intensive insulin therapy; 38 age-matched and BMI-matched women with PCOS without diabetes were compared in a cross-sectional study. OUTCOME MEASUREMENTS: Clinical, anthropometric, and metabolic parameters were evaluated. Hormonal evaluation and ovary ultrasound were performed during the follicular phase of the menstrual cycle. RESULTS: Applying the diagnostic criteria of the Androgen Excess Society, 38 (36.89%) women with DM1 showed PCOS. The 38 PCOS-DM1 women showed no differences in treatment and glycemic control compared with DM1 women without PCOS. The only difference was a higher visceral adiposity index in PCOS-DM1 (1.21±0.70 vs 0.90±0.32; P=.002). PCOS-DM1 showed no phenotypic differences with age-matched and BMI-matched PCOS without diabetes. The hormonal pattern was similar except that higher levels of Δ4androstenedione were found in PCOS-DM1 (12.89±3.49 vs 2.79±1.75 nmol/L; P=.010). CONCLUSIONS: The women with PCOS-DM1 do not exhibit particular phenotypic characteristics compared with nondiabetic women with PCOS. However, this pathological disorder must not be underestimated because it could be an additional cardiovascular risk factor in women with DM1

Durability of a recombination catalyst-based membrane-electrode assembly for electrolysis operation at high current density

Hydrogen production through polymer electrolyte membrane water electrolysis was investigated at high current density (4 A cm-2). A PtCo recombination catalyst-based membrane-electrode assembly (MEA) was assessed in terms of performance, efficiency and durability. The electrolysis cell consisted of a thin (50 µm) perfluorosulfonic acid membrane and low platinum group metals (PGM) catalyst loadings (0.6 mgMEA PGM cm-2). An unsupported PtCo catalyst was successfully integrated in the anode. A composite catalytic layer made of IrRuOx and PtCo assisted both oxygen evolution and oxidation of hydrogen permeated through the membrane. The cell voltage for the recombination catalyst-based MEA was about 30 mV lower than the bare MEA during a 3500 h durability test. The modified MEA showed low performance losses during 3500 hours operation at high current density (4 A cm-2) with low catalyst loadings. A decay rate of 9 µV/h was observed in the last 1000 hours. These results are promising for decreasing the capital costs of polymer electrolyte membrane electrolysers. Moreover, the stable voltage efficiency of about 80% vs. the high heating value (HHV) of hydrogen at 4 A cm-2, here achieved, appears very promising to decrease operating expenditures

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

Simulation of the Out-of-Plane Behaviour of URM Walls by Means of Discrete Macro-Element Method

The seismic response of masonry structures without box-type behaviour is given by a complex interaction between in-plane and out-of-plane behaviours. Previous earthquakes demonstrated that out-of-plane failure mechanisms represent the main cause of structural collapses of UnReinforced Masonry (URM) and historical structures. Previous experimental and analytical studies, investigating the out-of-plane behaviour of URM structures, mostly considered the effects of one-way bending moment. In this regard, recent experimental campaigns and numerical simulations have been conducted in order to investigate the out-ofplane behaviour of masonry walls subjected to two-way bending. These investigations have demonstrated the complexity of this mechanism and stressed the need for accurate numerical tools capable of providing reliable predictions in terms of ultimate strength and failure mechanisms. This paper focuses on the assessment of the dynamic behaviour of a U-shape URM prototype, subjected to shaking table tests, by means of a simplified computational strategy denoted as Discrete Macro-Element Method (DMEM). In this investigation, a comparison between experimental and numerical results was conducted in order to validate the capabilities of the proposed modelling approach. Subsequently, a parametric analysis was carried aiming at determining the influence that masonry mechanical properties, and additional model parameters, have on the out-of-plane nonlinear dynamic response of URM masonry structures

In-plane Behaviour of an Iron-Framed Masonry Façade: Comparison between Different Modelling Strategies

The ‘baraccato’ system is a construction technique with genius earthquake resilient features, used for the reconstruction of the historical city centres in the South of Italy after the catastrophic events occurred in the 18th-19th centuries. A very interesting example of such a building typology is represented by the Church of Santa Maria Maddalena, located in the municipality of Casamicciola Terme of the Ischia Island and built in 1896, after the catastrophic earthquake of 1883. The church is characterized by a mixed ‘baraccato’ system mainly made of yellow tuff block masonry walls strengthened by iron profiles or wooden elements. The reduced damage suffered by the church after the seismic event of 21st August 2017 evidenced the good behaviour of such a mixed structural system, especially into avoiding out-of-plane mechanisms. The presence of the iron-framed system is even more challenging in the definition of the modelling strategies for the structural analysis of the church. Thus, the choice of an appropriate numerical strategy to be used for nonlinear simulation should be properly investigated since the interaction between the frame elements and the elements representing the masonry walls has to be considered. As a first step of the structural analysis of the whole church, the in-plane behaviour of the main façade of the Church of Santa Maria Maddalena is analysed in this paper, with the aim to evaluate the efficacy of different modelling strategies. In particular, the study considers different models according to Finite and Discrete Element strategies available within DIANA FEA [1] and 3DMacro [2] software, respectively. Non-linear static analyses are carried out by means of both software and the obtained results are compared and discussed with the aim of extending them to the study of the whole church

Predictors of microvascular complications in type 1 diabetic patients at onset: The role of metabolic memory

Background Several epidemiological studies showed a close association between metabolic control and microvascular complications in type 1 Diabetes Mellitus (T1DM). The aim of our longitudinal observational study was to evaluate the predictive role of the main clinical and biochemical parameters in determining microvascular complications. Methods 376 T1DM patients, hospitalized in our division from 1991 to 2005 (mean follow-up = 10.93 ± 4.26 years) were studied. Stepwise Cox regression analysis was used to identify the influence of residual ß-cell function, ß-cell autoimmunity, HbA1c levels and other clinical and laboratory parameters in the development of microalbuminuria and retinopathy. Results The probability of developing microalbuminuria was higher in males than in females (HR 1.82; 95% CI 1.01–3.28; p = 0.044), in patients with higher mean HbA1c values (HR 2.80; 95% CI 1.63–4.83; p < 0.001), longer duration of disease (HR 1.98; 95% CI 1.10–3.57; p = 0.022) and younger age of diabetes onset (HR 0.53; 95% CI 0.03–0.92; p = 0.026). An increased probability of developing retinopathy was found in patients with higher mean HbA1c levels during follow-up (HR 2.35; 95% CI 1.34–4.12, p = 0.003), as well as at onset (HR 1.85; 95% CI 1.06–3.24; p = 0.030). Conclusions Our study suggests that among the clinical, metabolic, immunological and biochemical factors evaluated at onset, only HbA1c is predictive for the microangiopathy development in T1DM

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

Discrete modelling of externally bonded composite layers on masonry structures

The safeguard of existing masonry structures requires the adoption of structural retrofitting strategies able to preserve the architectural of the construction. Numerous strengthening techniques are available for the rehabilitation of exitsting structures, including historic and monumental buildings, most of them based on the application of Externally Bonded Composite (EBC) layers on the masonry surfaces. Such a technique represents a low-invasive retrofitting strategy widely used in engineering practice. In this paper, within the framework of the Discrete Macro-Element Method (DMEM) already introduced by the authors, an original macro-element for modelling the interaction between masonry elements and EBC layers is presented. The proposed model is able to provide a reliable simulation of the EBC layer applications to masonry structures although maintaining a low computational burden. After a theoretical description of the EBC macro-element, the new macro-modelling approach is validated against experimental and numerical tests available in the literature

An Interdisciplinary Approach for the Geometric, Constructive, and Structural Assessment of Historical Masonry Domes with Application to the ‘Badia di Sant’Agata’ in Catania, Sicily

Masonry domes have always represented one of the most fascinating and daring architectural structures, with great symbolic relevance. However, their structural behaviour under environmental actions, such as earthquakes, has not yet been thoroughly investigated. This paper defines an interdisciplinary methodological approach, based on advanced digital survey techniques to evaluate constructive, geometrical, and structural aspects of historical domes. The applied procedure comprises the study of archival documents and diagnostic reports, in-situ analyses and advanced three-dimensional surveys, the development of simplified discrete-element-based structural models, and the performing of pushover analyses. The procedure is applied to a case study represented by the dome of the ‘Badia di Sant’Agata’ church in Catania, an earthquake-prone town located in Eastern Sicily. This church was built after the devastating 1693 earthquake and its dome represents one of the most significant examples among hundreds of masonry domes built in Sicily. The historical and constructive investigation showed that the dome was built without supporting formworks, by laying 21 concentric courses of limestone voussoirs on a peculiar springing ring made of mortared rubble stones. The numerical simulations highlighted that this peculiar ring affects the dome’s failure mechanism and limits its displacement capacity and the maximum shear transferred to the substructure