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Introduction: Metabolic Syndrome (MS) is a pathologic condition characterized by Type 2 diabetes mellitus (T2DM), insulin resistance, abdominal obesity, hypertension, and hyperlipidemia. Until now, specific drugs such as metformin (MET) have been used to address its individual components; however, according to the recommendation of WHO, various plant extracts might be used as alternative medicines due to the side effects of pharmacologic agents. Policaptil Gel Retard® (PGR), a macromolecule complex based on polysaccharides which slows down the absorption rates of carbohydrates and fats, proved effective against glucose abnormalities. Our study aimed to verify the short-term efficacy and safety of PGR under real-life conditions. Methods: We evaluated both the 6-month changes in metabolic parameters in Italian patients with MS and T2DM, and the 10-year CV risk score (10-y-CV-RS) from the CUORE equation, competitively randomized to Policaptil Gel Retard (2172 mg before each main meal); Group A, n = 75, or Metformin (1500–2000 mg/day equally divided between the two main meals), and Group B, n = 75. Results: Fasting plasma glucose and HbA1c decreased significantly and similarly (p < 0.001) in the two groups. A significant decrease in BMI (−20% in the PGR group (p < 0.01), −14.3% in the MET group (p < 0.05)), % visceral fat, and UA levels was also apparent in both groups (p < 0.01). The opposite occurred for lipid profile, which improved significantly in the PGR group but remained unchanged in the MET group. Consequently, only the PGR group experienced a significant decrease in the 10-y-CV-RS (31.4 ± 8.0 vs. 19.7 ± 5.2, p < 0.0001), whereas this remained unchanged in the MET group (32.2 ± 3.3 vs. 30.5 ± 8.7; p n.s.). Conclusions: PGR could represent a suitable alternative to MET as a first-line treatment option, especially now that an ever-increasing number of people prefer natural products based on plant extracts. This is particularly pertinent given that, besides trying to avoid gastrointestinal side-effects as much as possible, patients might be sensitive to ecotoxicology-related problems involving plants and animals caused by the worldwide spread of environmental MET metabolites.

Type 2 diabetes (T2DM) is known to be associated with increased cardiovascular (CV) morbidity and mortality. Over time, the CV Risk of patients with T2DM has been assessed according to various methods, often borrowed from different populations. Nevertheless, never have been evaluated changes in insulin absorption due to improper injection technique and responsible for further, well recognized CV-R factors as high glycemic variability, frequent hypoglycemia, and unsatisfactory glycemic control. Aim of the study was to intensify diabetes and its own comorbidities treatment, and in addition reduce the impact of injection technique of insulin to evaluate possible improvement in the CV-R score and NHYA score in 4499 insulin-treated T2DM subjects with (LH+) and without lipohypertrophy (LH-) due to improper injection habit. The educational training and the treatment intensification significantly reduced glycemic control, hypoglycemia rate and the mean amplitude of glycemic variability, expecially in LH+ subjects, adding new knowledge to a global intervention addressed to reduce the devastating impact to the increased cardiovascular risk of diabetic people, inclusive of the risk due to LHs

L’indagine nel sito architettonico-archeologico che fu antico teatro romano sul mare poi trasformatoin ninfeo - erroneamente denominato Tomba di Agrippina - intende affidare alla dimensioneastratta e conoscitiva della rappresentazione la restituzione dei significati del manufatto come‘presenza preziosa’ nel paesaggio urbano di Bacoli. L’approccio di indagine, avvicinandosialla insita dimensione metaprogettuale del rilievo, si propone di suggerire linee di indirizzo permirate strategie di rigenerazione del patrimonio culturale flegreo, laddove l’espansione urbana nonpianificata ci restituisce una mappa territoriale priva di segni di connessione tra le attuali zoneurbanizzate e i resti dei pregevoli manufatti antichi. Diffusamente, e in particolare nel caso inesame, i ritrovamenti archeologici rivelano problematiche compenetrazioni con l’edilizia moderna.I preziosi reperti, spesso ancora parzialmente interrati o inagibili, esigono decisioni e interventidi integrazione che facciano riferimento alle peculiarità territoriali e che, confermandone le azionidi tutela, consentano nuove forme di accessibilità ai siti, attivabili attraverso operazioni dirappresentazione digitale del patrimonio che implementino livelli di fruizione alternativi allavisita diretta.Muovendo da questa esigenza, l’orientamento metodologico della ricerca è inteso ad assumerela digitalizzazione dei processi in ogni fase di lavoro. Obiettivo prioritario è rendere disponibilimodelli tridimensionali del sito, sezionabili ed interrogabili secondo diversi livelli semantici,sia durante la prima fase di acquisizione dei dati (SAPR, TLS), sia in quelle successive dimodellazione (modello virtuale e ABIM) e di consultazione-interrogazione dei simulacri che siprestano a rappresentare in maniera efficace e propositiva il sistema spaziale complessivo e gliapparati figurativi puntualmente esaminati.

Introduction Studies on the durability of an intensive, structured education protocol on best insulin injection practice are missing for people with type 2 diabetes mellitus (T2DM). The aim of this study was to assess the durability of an intensive, structured education-based rehabilitation protocol on best insulin injection practice in well-trained subjects from our previous intensive, multimedia intervention study registered as the ISTERP-1 study. A total of 158 subjects with T2DM from the well-trained group of the 6-month-long ISTERP-1 study, all of whom had successfully attained lower glucose levels compared to baseline levels with lower daily insulin doses and with less frequent and severe hypoglycemic episodes, participated in the present investigation involving an additional 6-month follow-up period, called the ISTERP-2 study. Methods Participants were randomized into an intervention group and a control group, depending on whether they were provided or not provided with further education refresher courses for 6 months. At the end of the 6 months, the two groups were compared in terms of injection habits, daily insulin dose requirement, number of severe or symptomatic hypoglycemic events, and glycated hemoglobin (HbA1c) levels. Results Despite being virtually superimposable at baseline, the two groups behaved quite differently during the follow-up. The within-group analysis of observed parameters showed that the subjects in the intervention group maintained and even improved the good behavioral results learned during the ISTERP-1 study by further reducing both the rate of injection technique errors (p

Introduction It is essential to use the correct injection technique (IT) to avoid skin complications such as lipohypertrophy (LH), local inflammation, bruising, and consequent repeated unexplained hypoglycemia episodes (hypos) as well as high HbA1c (glycated hemoglobin) levels, glycemic variability (GV), and insulin doses. Structured education plays a prominent role in injection technique improvement. The aim was to assess the ability of structured education to reduce (i) GV and hypos, (ii) HbA1c levels, (iii) insulin daily doses, and (iv) overall healthcare-related costs in outpatients with T2DM who were erroneously injecting insulin into LH. Methods 318 patients aged 19–75 years who had been diagnosed with T2DM for at least 5 years, were being treated with insulin, were routinely followed by a private network of healthcare centers, and who had easily seen and palpable LH nodules were included in the study. At the beginning of the 6-month run-in period (T−6), all patients were trained to perform structured self-monitoring of blood glucose and to monitor symptomatic and severe hypos (SyHs and SeHs, respectively). After that (at T0), the patients were randomly and equally divided into an intervention group who received appropriate IT education (IG) and a control group (CG), and were followed up for six months (until T+6). Healthcare cost calculations (including resource utilization, loss of productivity, and more) were carried out based on the average NHS reimbursement price list. Results Baseline characteristics were the same for both groups. During follow-up, the intra-LH injection rate for the CG progressively decreased to 59.9% (p

Introduction Despite the availability of sophisticated devices and suitable recommendations on how to best perform insulin injections, lipohypertrophy (LH) and bruising (BR) frequently occur as a consequence of improper injection technique. Aim The purpose of this nationwide survey was to check literature-reported LH risk factors or consequences for any association with BR Method This was a cross-sectional, observational, multicenter study based on the identification of skin lesions at all patient-reported insulin injection sites in 790 subjects with diabetes. General and injection habit-related elements were investigated as possible BR risk factors. Results While confirming the close relationship existing between LH and a full series of factors including missed injection site rotation, needle reuse, long-standing insulin treatment, frequent hypoglycemic events (hypos), and great glycemic variability (GV), the observed data could find no such association with BR, which anyhow came with high HbA1c levels, missed injection site rotation, and long-standing insulin treatment. Conclusion BR most likely depends on the patient’s habit of pressing the injection pen hard onto the skin. Despite being worrisome and affecting quality of life, BR seems to represent a preliminary stage of LH but does not affect the rate of hypos and GV. Trial Registration 207/19.09.2017

Background Frail populations burdened with chronic diseases can get more severe forms of coronavirus disease-2019 (COVID-19) and have a higher mortality rate. Aim To test the efficacy of a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) containment protocol in patients with endstage renal disease (ESRD) diabetes mellitus (DM) requiring dialysis, who are a typical example of the above category. Methods The protocol included: (i) daily telephone COVID-19 related triage for patients and their general practitioners (GPs); (ii) social distancing; (iii) environment sanitization, including ambulances, transfer vans, medical equipment, patient/health personnel clothing, and individual protection devices; (iv) adoption of quota systems for patients allowed to the dialysis room, and increased time lags among dialysis shifts. Eight hundred twenty-five (825) patients on dialysis (315 with and 510 without DM), and 381 healthcare providers (HCPs) were monitored continuously from the start of the pandemic until the end of the lockdown. Results No HCPs were infected, while only two patients on dialysis were positive for SARS-CoV-2: one with DM, who died in intensive care, and one without DM, who recovered at home. The adopted contagion containment protocol proved to be effective for both HCPs and patients. Conclusion Therefore, we propose it as a useful model for any internal medicine or ESRD specialized units dealing with patients on dialysisoriented with or without DM.

Background After the official coronavirus (severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)) pandemic declaration by the World Health Organization (WHO), Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our National Health Service (NHS) again. Aim To assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium dialysis centers (DCs) as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors. Methods 381 HCP members underwent regular monitoring on April 1 and November 13, 2020. Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean±SD:853±30 per month; range 825 to 873) vs (11.8% in April, and 14.8% in November vs. a pre-coronavirus disease-2019 (COVID-19) 12.0% rate in January). Results More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic’s two periods showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD). Conclusion The previously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The author, discuss possible reasons and put forward further suggestions for the best handling of any future infection waves.

Background The number of older adults with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. Errors in the insulin injection technique can lead to skin lipohypertrophy (LH), which is the accumulation of fat cells and fibrin in the subcutaneous tissue. While lipohypertrophic lesions/nodules (LHs) due to incorrect insulin injection techniques are very common, they are often flat and hardly visible and thus require thorough deep palpation examination and ultrasonography (US) for detection. Detection is crucial because such lesions may eventually result in poor diabetes control due to their association with unpredictable insulin release patterns. Skin undergoes fundamental structural changes with aging, possibly increasing the risk for LH. We have therefore investigated the effect of age on the prevalence of LHs and on factors potentially associated with such lesions. Methods A total of 1227 insulin-treated outpatients with type 2 DM (T2DM) referred to our diabetes centers were consecutively enrolled in the study. These patients underwent a thorough clinical and US evaluation of the skin at injection sites, as previously described, with up to 95% concordance betweenthe clinical and US screening techniques. Of these 1227 patients, 718 (59%) had LH (LH+) and 509 (41%) were LH-free (LH−). These patients were then assigned to two age class groups (≤ 65 years and > 65 years), and several clinical features, diabetes complication rates, and injection habits were investigated. Results Comparison of the two age subgroups revealed that 396 (48%) and 322 (79%) patients in the younger and older groups, respectively, had LHs (p

Introduction Lipohypertrophies (LHs) due to incorrect insulin injection techniques have been described in the literature for decades. Their rate averages 38%, but this is still controversial because of the vast range reported by different publications, most of which fail to describe the selected detection protocol and therefore are not entirely reliable. We still need to identify the real LH rate, and only consistently using a standardized method in a large cohort of insulin-treated (IT) patients make this possible. Methods Our group performed thorough clinical skin examinations on patients suffering from type 2 diabetes mellitus (T2DM): 1247 IT T2DM outpatients were examined according to a standardized protocol, previously published elsewhere, as well as an ultrasound scan of the same skin areas to assess the degree of concordance between the two methods and to evaluate the demographic, clinical, and behavioral risk factors (RF) as well as metabolic consequences of identified LHs. Results The concordance between the two methods was 99%. Identified risk factors for LHs were needle reuse, failure to rotate injection sites, and ice-cold insulin injections. High HbA1c values, wide glycemic variability, and longstanding proneness to hypoglycemia with a high rate of ongoing hypoglycemic events proved to be significantly associated with LHs, too; the same applied to cardiovascular and renal complications as well as to living alone and being retired. Conclusions Based on a strict well-structured methodology, our data confirmed what has already been reported in the literature on factors leading to, or associated with, LHs and, for the first time in adults, indicated cryotrauma from ice-cold insulin injections and specific social conditions as factors facilitating LH occurrence. HCPs should therefore plan a yearly clinical examination of all injection sites to improve patient quality of life through better glucose control and a reduced rate of hypoglycemic events. Trial Registration Trial registration no. 127-11.01.2019, approved by the Scientific and Ethics Committee of Campania University “Luigi Vanvitelli,” Naples, Italy.

The history of insulin-induced skin lipohypertrophy (LH) runs parallel to that of insulin's 100 years, and an average of 47% of insulin-treated patients still suffer from it today. The metabolic and economic effects of LH are significant, with hypoglycemia being the most striking. The objective of the study was to perform a 52-week follow-up of 713 insulin-treated patients with type 2 diabetes (T2DM) and LH to detect any differences in the occurrence of hypoglycemic events (HYPOs) and related healthcare costs as well as in LH rates and injection habits between an intensive education intervention group (IG) and control group (CG) provided with a single educational session at the starting point.All participants were trained in accurately self-monitoring blood glucose and recording all HYPOs for 6 months, which allowed baseline recordings before they were randomized into the IG, comprising 395 insulin-treated subjects undergoing repeated, structured multimodal education on correct injection techniques as a longstanding behavioral rehabilitation strategy, and the CG, comprising 318 subjects receiving the same structured, multimodal educational session, but only initially.Changes in LH rate and size and in performance were large in the IG and only slight and transient in the CG. A striking difference in the rate of decrease of HYPOs was also apparent between groups. Indeed, estimated costs of health interventions for severe and symptomatic HYPOs, which were on the order of €70,000 and €9300, respectively, in the two groups at baseline decreased by 5.9 times and 13.7 times, respectively, at the end of follow-up in the IG and by only approximately half in the CG. Full details of the changes occurring as a result of intensive education are provided in the text.The effect of only initial education in the CG was not significant, thus providing evidence of the virtual worthlessness of a single training session on injection techniques, typical of worldwide daily clinical practice, and easily explaining the extremely high prevalence of LH in insulin-treated patients. Conversely, highly positive effects on LH prevalence and size as well as costs expected from decreased HYPO rate were obtained in the IG. To our knowledge, ours is the first 18-month randomized trial in the field. If our experimental model were to be used as an effective, longstanding behavioral rehabilitation strategy and therefore adapted to real-world settings universally, LH prevalence and costs related to their clinical consequences would be drastically reduced. However, only with a strong, relentless commitment of universities, scientific societies, and patient associations can we achieve this ambitious goal, which would provide great institutional savings and improved quality of life for people with diabetes.

The aim of the present research is to test an integrated framework between the data obtained from the Unmanned Aerial Vehicle (UAV), a handheld thermographic camera (Infrared thermography) and the Terrestrial Laser Scanner (TLS). Piscina Mirabilis, in the city of Naples, becomes the benchmark to generate a comprehensive database, including a clear geometrical definition of the thermal variations of the wall surfaces by texturing the IR images directly on the RGB mesh surfaces. To measure the performance of mapping, the present research compared the quality of information by using 3D processing algorithms to optimise final the result.

Resuming the cognitive process started in a previous study of integrated survey and interpretation of the remains of the Terme del Foro of Cumae in the Parco Archeologico dei Campi Flegrei, with this contribution, we intend to set up, a methodology to deepen the investigation already carried out on the current consistencies of the thermal system that, through the preparation of a suitable neural network managed by AI processes and structured for the systematic analysis of differences, is able to formulate reconstructive hypotheses with scientific authority. By integrating the possibilities of traditional methods of investigation on architectural and archaeological heritage, it will be possible not only to highlight what can be directly observed in situ, but also to enhance traces that are not immediately decodifiable and even latent, automatically emerging as the results of comparative investigations on large amounts of data whose logical structure will be clearly traceable along artificial neural ‘meshes’ similar to human cognitive processes.

Il libro si propone come contributo alla riflessione sui significati della trasparenza, assumendone la peculiarità del ‘vedere attraverso’ come atto interpretativo, rappresentativo del gradiente di libertà possibile nell’indagine sullo ‘spessore’ e l’ordinabilità del reale. Il termine, geneticamente instabile, risulta tanto consonante alla diffusa istanza di transitività di cui è permeata la cultura contemporanea da potersene ritenere una sorta di parola-chiave. La trasparenza, ampliata in una dimensione che non è più nella materia concreta ma piuttosto nello svelamento e nell’accompagnamento di un processo, si ri-presenta come luogo della sovrapposizione non rilevabile esclusivamente nell’oggettualità della situazione, ma piuttosto nella nostra esperienza percettiva, quale sistema per l’indagine e il disvelamento dei livelli interconnessi, dispositivo per la costituzione della differenza, strumento di ‘conoscenza-attraverso’. Contesto, comparazione, differenza, sono concetti centrali, e determinanti, per la comprensione delle composite fenomenologie della trasparenza, soprattutto quando dalle sue declinazioni più correnti e chiare si passa alle più enigmatiche e le infinite epifanie del reale, manifestandosi secondo connotati di gradualità differenziale, mutevolezza, imprendibilità, bellezza, convergono nel comune riferimento etimologico a quella accezione di ambiguità insita nel prefisso trans- e indicante mutamento, attraversamento. Il presente studio ha inteso percorrere i livelli di significato e di equivocità della trasparenza attinti dal linguaggio architettonico moderno e contemporaneo e, scandagliando l’instabilità dei confini tra quelle stesse espressioni di lucida complessità individuabili tra trasparenza fisica, percettiva, fenomenica, esemplificare, con l’architettura, le possibilità decodificative della natura evasiva del reale per ‘aumentare’ la conoscibilità dei complessi sistemi di relazioni che caratterizzano la nostra epoca. / The book proposes itself as a contribution to the reflection about the meanings of transparency, by taking on the peculiarity of ‘seeing through’ as an interpretative act, representative of the gradient of freedom possible in the investigation of the ‘thickness’ and the ordinability of reality. The term, genetically unstable, is so consonant with the widespread transitivity of contemporary culture that it can be considered a kind of key word. Transparency, widened in a dimension that is no longer in the concrete matter but rather in the unveiling and accompanying of a process, re-presents itself as a place of superimposition, not detectable exclusively in the objectivity of the situation, but rather in our perceptive experience, as a system for the investigation and unveiling of interconnected levels, a device for the constitution of difference, an instrument of ‘knowledge-through’. Context, comparison, difference, are central concepts, and determinants, for the understanding of the composite phenomenologies of transparency, especially when from its most current and clear declinations we pass to the most enigmatic and the infinite epiphanies of reality, manifesting themselves according to connotations of differential gradualness, mutability, entrepreneurship, beauty, converge in the common etymological reference to that meaning of ambiguity inherent in the prefix trans- and indicating change, crossing. The present study has aimed to cover the levels of meaning and ambiguity of transparency drawn from the modern and contemporary architectural language and, probing the instability of the boundaries between those same expressions of lucid complexity identifiable between physical, perceptive, phenomenal transparency, exemplifying, with architecture, the decoding possibilities of the evasive nature of reality in order to ‘increase’ the knowability of the complex systems of relationships that characterize our era.

Background Diabetes mellitus (DM) is the leading cause of end-stage renal disease and 50% of dialysis patients are insulin-treated. Aim to search for unexplained hypoglycemia (HYPO). Methods identify a possible cause of HYPO due to altered insulin absorption. Results insulin injected into subcutaneous lipo-hypertrophy (LH) nodules leads to unpredictable HYPOS. Conclusion looking for LH systematically and training patients to the best injection technique are new challenges for nephrologists to reduce HYPO and emergency hospitalization rates, thus sparing healthcare resources and improving the quality of life of insulin-treated dialysis patients.

Introduction End-stage renal disease (ESRD) is associated with increased cardiovascular mortality (CVM) and diabetes mellitus (DM), which in many cases is treated with insulin. Skin lipohypertrophy (LH) very often occurs in insulin-treated (IT) patients as a consequence of inadequate injection technique and is one of the most prominent contributors to hypoglycemia (HYPO), glycemic variability (GV), and poor metabolic control (PMC). Method The aim of our multicenter observational study was to assess LH prevalence at self-injection sites and any possible factors predicting high LH/HYPO rates and GV in 296 dialyzed ITDM patients characterized by 64 ± 7 years of age, 7 ± 2 years disease duration, 2.6 ± 2.2 years dialysis duration, preferred pen utilization (80%), and basal-bolus regimen (87.4%) with self-injections (62.6%) largely surpassing caregiver-assisted ones (16.9%), and a mix of the two injection methods (20.5%). Results LH was detected in 57% of patients. Univariate analysis followed by backwards stepwise multivariate logistic regression function showed increased odds for developing LH in patients characterized by needle reuse, smaller injection areas, missed injection site rotation, higher HbA1c levels, and more prominent rates of HYPO and GV. Conclusion This was the first time such observation was made. It is now time for further studies aimed at providing evidence also in ESRD ITDM patients for the cause–effect relationship among wrong injection behavior, LH, and poor metabolic control and for the long-term preventative role of suitable educational countermeasures. Electronic supplementary material The online version of this article (10.1007/s13300-019-0650-2) contains supplementary material, which is available to authorized users.

The essay intends to begin a serious consideration about the ancient city of Poseidonia and its role in the landscape of Sele, intending to adopt a more correct relationship between innovative technologies and traditional theoretical and operational knowledge, and intending to research forms of interaction between the two possible approaches. Starting from these assumptions of reflection, both in the field survey operations and in the synthesis phases of the interpretation/ representation of the acquired data, the study intends to concentrate on the bond that condenses and perpetuates itself in the historical landscape of Paestum between the Templar architectures, the visible structures of the ancient city and the rich vegetation of the Mediterranean scrubland that contains and integrates them. To interpret this environmental unicum, in which the dialogue between the temples and the sea is modulated by the flora of the park, the dune oasis, the cultivated fields, the pine forest, scanned along a mythological path that reaches the beach of the ancient city of Poseidonia, a methodology is experimented which, synergistically making use of the accuracy of innovative instruments for the integrated survey - in particular of the complementarity between TLS and SAPR technologies - and of the peculiar comparative attitude of digital photomodelling methods, intends to engage profitably in the traditional and interpretative process to obtain the necessary knowledge for the formulation of hypotheses for the enhancement and regeneration of the entire context.

Nel 1841, a seguito del notevole sviluppo della navigazione, il governo borbonico fu costretto a promulgare il primo Codice Marittimo in Italia, disponendo anche l’installazione di una rete di fari che presidiasse la costa. A partire da Nisida, dove, nel 1841, fu collocato il primo faro lenticolare a luce costante, altri fari di questo tipo furono edificati su gran parte delle coste del regno, costituendo progressivamente il primo moderno sistema di impianti di segnalazione luminosa per la guida della navigazione notturna nella penisola. Oggetto del presente contributo è uno studio che ricostruisce la situazione dei fari in Campania prima dell’Unità d’Italia e un approfondimento sul Faro di Capo Miseno e del suo contesto, a partire da operazioni di rilievo integrate condotte in sinergia tra tecnologie SAPR e TLS. Gli esiti conoscitivi dei siti analizzati hanno consentito la formulazione di una ipotesi di riconversione dei manufatti che, contemplando la futura e prossima dismissione della funzionalità originaria dei fari, prevede la fattibilità per un sistema integrato del tipo ‘albergo diffuso’ prospettando la creazione di una ‘rete dei fari campani’.

The expressive values of light penetrate into materials, becoming intensely structuring factors, which have always been used in design processes, together with formal choices, to characterize the surfaces and spaces of architecture from a sensory point of view and to orient the perceptive experience. Currently, the widespread instability of the material substance is reversed in a growing interest in materials aimed at enhancing the sensory qualities within an expanded perceptual dimension that, confirming the most usual and established meanings of materials, reinvents additional, innovative and surprising ones. The level of aesthetic and functional affordance of the architectural space and of the elements that compose it is entrusted not so much to abstract forms, but rather to a sort of sensory extension of them, linked to the specific materiality of objects that Merleau Ponty has icastically formulated in his reflections on 'Feeling'. The realizations of many great contemporary architects, especially in the field of public architecture, paradigmatically exemplify the search for multidimensionality as a founding value of spatial genesis that, alongside the perceptive transience, place materials at the center of the project, as bearers of meanings, relationships, multisensory experiential modes. This general interest in the simultaneity of the various components of perception is projected, demultiplied, in the architecture dedicated to spaces for health where, re-evaluating the synergistic action of all five senses, the design criteria adopted for the creation of new and sensitive spaces call into question, next to the usual and dominant visual perception, other sensibilities and modes of perception such as proprioception, kinesthesia, synaesthesia.

Berberine, a quaternary isoquinoline alkaloid present in Berberis aristata, is well known in terms of its cholesterol-lowering, hypoglycemic, and insulinsensitizer effects. Because of its low oral bioavailability, it has been recently formulated along with silymarin (Silybum marianum) to improve intestinal absorption. The aim of our study was to evaluate, versus placebo treatment, the possible effect of its association with silymarin on abdominal fat in overweight/obese patients affected by type 2 diabetes mellitus. Using bioelectrical impedance at enrolment and after 6 months of treatment, we have evaluated the following clinical parameters: waist circumference, trunk fat, and visceral fat. Our results seem to indicate a clinically significant effect for the association berberine+silymarin.

Gli ordini non furono affrontati nel Rinascimento come un ritorno all’antico: si venne piuttosto delineando e rafforzando nel corso del Cinquecento l’esigenza di un metodo razionale per l’applicazione del linguaggio antico all’architettura del proprio tempo e la necessità di uno strumento di supporto nella progettazione e nell’uso pratico degli ordini che contenesse le modalità di trascrizione delle forme del passato e dell’articolato sistema proporzionale che in esse risultava non univocamente individuabile. Il canone degli ordini architettonici raggiunse la sua struttura definitiva solo nella seconda metà del Cinquecento, dando esito alle numerose ricerche condotte sugli antichi ordini fin dal secolo precedente quando, all’interno della cultura umanistica e in seguito alla riscoperta del trattato vitruviano, si accrebbe l’interesse per l’architettura classica e si avviò la trattatistica rinascimentale. Il metodo elaborato da Jacopo Barozzi da Vignola fu il primo a risolvere efficacemente questa frattura tra teoria e prassi presentandosi quale ‘regola generale’ per la progettazione degli ordini architettonici. La compresenza dei due termini ‘regola’ e ‘ordine’ rilevabile fin dal titolo Regola delli cinque ordini di Architettura, già contemporaneamente al Vignola, è stata spesso fraintesa imputando al binomio caratteri di inflessibilità, imposizione, freddezza. Tale giudizio è chiaramente scorretto. Le accuse mosse al Vignola di pedanteria, di eccessivo rigore e tediosità hanno certamente avuto anche origine dalla stessa posizione storica dell’architetto emiliano che non ha permesso una equilibrata valutazione della sua opera: rispetto al coevo ambito culturale del Rinascimento maturo e del Manierismo, Vignola è stato erroneamente giudicato come uomo della norma e del ripiegamento espressivo. In tempi più recenti è stato E, invero, a monte delle applicazioni della Regola delli cinque ordini, gli aspetti di flessibilità e creatività compositiva che Vignola dimostrò nelle sue opere costruite si riscontrano contenuti in vari punti del trattato. Jacopo Barozzi da Vignola rese congruenti, in un unico sistema coerente costituito dalla sua Regola delli cinque ordini d’Architettura i rapporti proporzionali che aveva individuato attraverso lo studio dei modelli classici, già riportati in maniera disgiunta nel Libro quarto del trattato L’Architettura di Sebastiano Serlio. L’opera teorica di Serlio si era posta alla stregua di un insieme di modelli atti a conformare i cinque ordini di colonne, apportando un’utilità limitata al lavoro degli architetti che si trovarono a dover applicare rapporti proporzionali tra le parti non dotati di univocità e in parte contraddittori. A fronte delle regole teoriche indicate nelle estese didascalie serliane, erano i disegni di rilievo delle antichità con le rispettive, divergenti, strutture proporzionali.

Lipohypertophy (LH) is the most common skin complication of incorrect injection technique which does not only represent an aesthetic defect but also severely disrupts insulin pharmacokinetics/pharmacodynamics. As a consequence of that, hormone release is delayed and unexplained/unpredictable hypoglycemia occurs, both deteriorating metabolic control while negatively affecting adherence to treatment and quality of life. The economic burden due to unwanted intra-LH injections is accounted for by inappropriately high insulin requirements, increased emergency-related hospitalizations, and loss of work days. Greater attention has to be paid by diabetes care teams to education programs with periodic refreshers to achieve better metabolic control and reduce the economic burden of diabetes.

L'identità plurale di Napoli e le sue profonde contraddizioni si condensano in prossimità della linea di costa, dove la simultaneità delle opposte nature del mare e della terra, e la stessa condizione di confine, come entità che contemporaneamente separa e unisce, innescano e rappresentano un complesso sistema di relazioni, sovrapposizioni e interferenze tra periodi storici, culture, parti e componenti urbane, che ha costruito il significato fondamentale della città come stratificazione. Le aree prossime al porto monumentale sono particolarmente permeate da questa caratteristica: hanno la più alta densità di tracce di insediamenti di antica origine vicino al mare e costituiscono il luogo ancestrale delle reciproche influenze tra culture ed etnie, dove il confronto diventa necessariamente una parola chiave, ma sono anche una delle zone della città dove, più fortemente, le parti urbane originarie sono state interessate dai mutamenti della loro struttura connettiva, e hanno perso la loro identità primitiva, trasformandosi in meri ‘pezzi’ di città in un sistema di connessioni interrotte o inesistenti. Partendo da un modello dinamico del territorio, ci si propone di scandagliare i tratti distintivi di questa discontinuità relazionale, attraverso letture comparate dei tessuti e degli edifici, operate nelle zone limite o in quelle di transizione, dove le caratteristiche delle parti urbane tendono a variare e le varie problematiche si sovrappongono. In questi luoghi ‘molteplici’ dove la simultaneità delle componenti, e non la loro mera sequenza, consente di intercettare contraddizioni e problematiche urbane ‘per comparatione’, la congerie dei dati tende a sgretolarsi in livelli ordinabili, suggerendo potenzialità per la gestione urbana. Il lavoro individua una serie di coppie contrapposte di problematiche urbane che leggono i dislivelli lungo tratti trasversali eseguiti da terra a mare, evidenziando la comparabilità dei risultati nelle specifiche aree di discontinuità.

The research activities conducted in the territory of the ancient Ager Nolanus saw the thicken of a large number of ruins of many settlement marks, all referabled, by origin, to the so-called urban phenomenon of incastellamento and, by the present situation, to a diffused oblivion condition that relegate these emblematic testimonies of medieval architectural heritage in a persistent state of neglect and decay. The surviving structures of the eighteen census fortified systems, almost always in ruin state and at risk of protection, after they lost them original matrix, certainly military, but economic and social also, show the important issues of conservation of artistic and environmental heritage and recall attention to the issues of regeneration of urban centers that require interventions of integration between memory and modernity. The tricky question of regeneration of urban centersre quires the convergence of various areas of expertise and different research lines, placing in the foreground the choices of method and the definition of the working tools and imposing the need to build appropriate knowledge struc‐ tures capable of reading, represent and simulate, through the complexity of spatial and temporal consistencies of sites and specific architectures, the value of the potential relationships between the ancient pre-existing and current urban centers, suggesting a hierarchy of protection and enhancement actions for our heritage cultural. In order to start a critical knowledge system of our object of interest, we predisposed a documentary investigation that studied and compared the settle‐ ment’s morphologies in the area of interest, analyzing each case, the original nature in the various sites and reading them in relation to the layers and the used transformations connected to the architectural and planning local event. The deepening of the comparative study identified the relative position between the current urban center and the specific fortified origin system, the greater parameter of reference in relation with the abandonment of architectures. The case of Avella’s fortified citadel, despite being paradigmatic of those medieval settlements which were isolated from the next urban development, if on the one hand basically performs in a state of ruin and devoid of a true reutili‐ zation of its surviving structures, it is not abandoned by all action of protection, and is, therefore, still, on the whole ‘recoverable’ as a unified architectural-urban system with the full identity of cultural heritage and significant regenerative potential. To that complex was dedicated a further stage of the study proposed here in order to show that, if the physical distance from the current location of the ancient to the center of the city clearly cannot be healed, the opportunity to increase their knowledge of the site through effective representation that accurately communi‐ cate consistencies and, together, the specific interpretive potential for the construction of the place’s significance, can certainly reduce the distance between the Avella’s community and this significant example of our architectural and cultural heritage. In the context of the integrated survey method adopted and restitution, the availability of the points cloud, which assembled the numerous predisposed laser scans in a special plane of survey, was an invaluable tool in particular to read the layers of the castle, and locate, with good clarity, remains and traces needed to orient the virtual reconstruction that was necessary to study and formulate to meet not only the requirements for reinstatement in the context, but especially those of the appropriate and urgent monitoring on the ruins of the fortified citadel.

L'articolo interpreta i caratteri ambientali del sito di S. Maria di Pietraspaccata in Marano di Napoli attraverso gli esiti di un rilievo già condotto che permettono di rappresentare, attraverso il disegno, la complessità del luogo. Le antichissime cavità rupestri configurano l'ipotesi di un originario insediamento eremitico dislocato su tre principali livelli e costituito 'in negativo' nella parete tufacea (due grotte eremitiche e un ambiente cultuale absidato al livello di accesso, un ambiente con funzione di colatoio orizzontale per la mummificazione dei morti al secondo livello, una grotta per la sistemazione dei corpi al terzo livello) cui si innestarono, in periodo rinascimentale, le strutture murarie destinate a romitorio. Il luogo, diventato successivamente sede di accoglienza per i pellegrini transitanti lungo l'antico tratturo di origine osca che collegò l'entroterra napoletano alla piana flegrea, la cui capacità di rappresentare il tempo emerge dalla contestualità delle due principali fasi generative (quella di scavo e 'sottrazione' materica e quella costruttiva di 'addizione'), accresce la propria dimensione enigmatica nelle numerose e più minute testimonianze stratificate e particolarissimi rinvenimenti, ispessendo i propri strati di memoria e ponendosi come esempio di architettura dimenticata da recuperare all'interno dei processi contemporanei per la rigenerazione territoriale.

I centri storici rappresentano uno dei beni più diffusi e caratterizzanti del nostro Paese; tuttavia, il riconoscimento e la salvaguardia delle qualità peculiari di ciascun sito necessita di complesse riflessioni riguardanti sia le finalità che le metodologie della salvaguardia. Il ricco patrimonio storico dei piccoli centri rischia, infatti, di scomparire per incuria o perché snaturato da interventi di recupero poco attenti alla affermazione delle identità culturali locali. È evidente che il solo intervento di recupero dell’edilizia storica o il restauro di singole architetture, anche se ineccepibilmente condotto, non è di per sé sufficiente se non dettato da una profonda consapevolezza dell’originario rapporto di necessità tra il manufatto e il contesto, nell’accezione più ampia di tessuto urbano ma anche di territorio e paesaggio. Si assiste frequentemente all’introduzione nei centri storici di elementi estranei alla cultura del luogo, in evidente contrasto con l’architettura tradizionale e con l’ambiente circostante, con il quale l’insediamento urbano intrattiene necessariamente forti legami. Nei piccoli centri questa sofferenza è maggiormente sentita perché più profondo è tale rapporto, sebbene tenda sempre più a scomparire in nome di una globalizzazione, che finisce per sopprimere quegli aspetti di architettura spontanea che sono la vera e propria ricchezza dei paesi. Le tradizioni artigiane e i modi costruttivi, diversi per ogni zona del territorio e particolarmente identitari nei piccoli centri, esprimono una struttura edilizia che si basa sul legame tra la vita dell’uomo e l’ambiente naturale. La configurazione del territorio, infatti, caratterizza la tipologia edilizia e la forma dell’agglomerato urbano, determinando il disegno complessivo dell’intreccio viario, le articolate sinuosità delle strade, la presenza di improvvisi slarghi. La conoscenza di questo patrimonio edilizio fatto di cultura e tradizioni locali diventa così essenziale per un recupero sostenibile dei piccoli centri; si tratta di tutelare non opere d’arte isolate ma interi tessuti edilizi, che sono testimonianza di una antica vita collettiva, oggi in via di trasformazione per adeguare il patrimonio edilizio alle nuove esigenze del vivere contemporaneo. A tal fine è indispensabile una lettura attenta della morfologia dei luoghi, sperimentando metodologie di analisi e di rappresentazione flessibili e articolate, che possano essere espressione della complessità che caratterizza un insediamento urbano storicamente stratificato, affinché le operazioni conoscitive non si trasformino in passive e acritiche catalogazioni di tipologie edilizie. La rappresentazione deve necessariamente confrontarsi con l’articolata varietà di un ambiente urbano per poter descrivere e testimoniare l’esperienza sensibile di quegli spazi, fatta di scorci visuali, prospettive inattese, connessioni di forme, relazioni tra architettura e paesaggio, materiali, luci e colori, luogo di fruizione di antichi valori, talvolta anche immateriali.

The current demand of retraining of the historical town, and especially of that town part consolidated in the process of his time stratifications, pays the attention on the renewal potentialities implied in the town, on his interconnection structures, in his capacity of interaction not only at architectural and urban level, but also at social and economic level. The retraining operation, in the ampleness of the effects derivable from it, can certainly guide the town transformation, if a scientific ground of reference is supposed, which could define the program of the activities to be made.