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CONTEXT: Despite being one of the major drivers of diabetes incidence, the degree of insulin resistance in patients with type 2 diabetes (T2D) is not usually evaluated in clinical practice or in large epidemiologic studies. OBJECTIVE: To identify a model of insulin sensitivity using widely available clinical and laboratory parameters in patients with T2D and evaluate its association with all-cause and cardiovascular mortality. METHODS: One hundred forty patients with T2D underwent a euglycemic hyperinsulinemic clamp to measure total body glucose disposal rate (mg kg-1 minute-1). We used demographic, clinical, and common laboratory parameters to estimate insulin sensitivity (IS) via stepwise linear regression on 85 patients (training cohort) and validated it in the remaining 55 (validation cohort). The identified equation was then applied to 3553 patients with T2D from the 1999-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to evaluate its association with all-cause and cardiovascular mortality up to December 2015. RESULTS: The best model included triglycerides, gamma glutamyl transpeptidase, albumin excretion rate, and body mass index. The identified IS score correlated well with the clamp-derived glucose disposal rate in both the training (r = 0.77, P < .001) and the validation (r = 0.74, P < .001) cohorts. In the NHANES cohort, after a median follow-up of 8.3 years, 1054 patients died, 265 of cardiovascular causes. In a multivariable Cox proportional hazard model adjusted for age, sex, race-ethnicity, education, cigarette smoke, total cholesterol, chronic kidney disease, blood pressure, prevalent cardiovascular disease, and alcohol consumption, a higher estimated IS was associated with a lower risk of both all-cause and cardiovascular mortality. CONCLUSION: We propose a new model of IS in patients with T2D based on readily available clinical and laboratory data. Its potential applications are in both diagnosis as well as prognos

Aim: To evaluate the long-term efficacy, up to 2 years, of an advanced hybrid closed-loop (AHCL) system and to assess predictors of best results of the therapy. Methods: We retrospectively evaluated 296 adults with type 1 diabetes mellitus [mean age 42.8 - 16.5 years, men 42.9%, duration of diabetes 22.5 - 12.8 years, body mass index 24.9 - 4.7 kg/m2, baseline glycated hemoglobin (HbA1c) 63.4 - 12.2 mmol/mol (8.0 - 1.1%) ] who used the MiniMed_ 780G system. Demographic and clinical data were recorded. Continuous glucose monitoring (CGM)-derived metrics and insulin requirement were analyzed from the 4 weeks before and from every quarter after the switch to the AHCL system. Results: In the first quarter of AHCL treatment, all CGM metrics improved. Time in range (TIR) increased from 58.1 - 17.5% to 70.3 - 9.5% (P < 0.0001). The improvement lasted for up to 2 years of observation regardless of previous insulin therapies. Throughout the period of observation, 53.4% of participants achieved mean TIR >70%, 92.6% mean time below range <4%, and 46% mean glucose management indicator [removed]70%. At multivariable analysis, lower HbA1c remained independently associated with a better glycemic control. However, mean TIR increased more in participants with a higher baseline HbA1c. Conclusions: Switching to an AHCL leads to a rapid improvement in glycemic control lasting for up to 24 months along with a low risk for hypoglycemia, confirming the safety of the system. Lower baseline HbA1c was the main predictor of better efficacy of therapy, although higher baseline HbA1c was associated with the greatest improvement in mean TIR.

Aims: Advanced hybrid closed-loop (AHCL) systems represent the latest introduction in the treatment of type 1 diabetes (T1DM). Randomized controlled trials and real-world evidence studies showed that AHCL systems are a safe and effective insulin management strategy. Aim of this retrospective, single-center, real-life study was to evaluate the effect on metabolic control, evaluated by continuous glucose monitoring (CGM) metrics, of the switch from four available insulin strategies to an AHCL system in adult patients with type 1 diabetes. Methods: A total of 102 patients with T1DM (mean age 42.1 ± 16.3 years, males/females 47/55, duration of diabetes 21.4 ± 13.3 years, BMI 24.4 ± 4.5 kg/m2, HbA1c 59.9 ± 9.6 mmol/mol or 7.6 ± 0.9%), treated with four different insulin therapies [multiple daily insulin (MDI) therapy, continuous subcutaneous insulin infusion (CSII), sensor-augmented pump (SAP) with predictive low-glucose suspend (PLGS), and hybrid closed loop (HCL) system] were evaluated before hand, two months and six months after switching to an AHCL (MinimedTM 780G system, Medtronic, Northridge, CA) system. Results: Two months after the switch, mean GCM metrics improved in all four treatment groups. Six months after the switch, the participants of all four groups achieved a mean GMI < 53 mmol/mol, TIR > 70%, TBR < 4%, and CV < 36%, which is recommended by the ADA Standard of Medical Care in Diabetes 2022, including the MDI group with worse baseline glycemic control. Conclusions: Switching to an AHCL leads to a rapid improvement in glycemic control lasting for up to six months independently of previous insulin treatment and baseline conditions.

This paper attempts to retrace the reasons for the choice of the container gathering the burnt remains after the practice of incineration. Indeed, the voluntary destruction of the body is an ancient and highly symbolic practice, which has not been sufficiently investigated so far in a broad perspective (even from a chronological point of view) and with a multidisciplinary approach. The starting point for the exposed remarks is the excavation with related recent publication of a Hellenistic necropolis in Epirus (Phoinike). From this privileged observatory, supported by detailed anthropological investigations, a fascinating itinerary will be attempted, moving across the Greek world, up to the threshold of the Roman times, between myths and rites connected to fire. &nbsp, Il contributo tenta di ripercorrere i motivi della scelta del contenitore entro cui deporre i resti combusti dopo la pratica dell’incinerazione: quella della distruzione volontaria del corpo, infatti, è una pratica antica e altamente simbolica, che non è stata finora sufficientemente indagata in una prospettiva ampia (anche dal punto di vista cronologico) e multidisciplinare. Il punto di partenza è lo scavo e la recente pubblicazione di una necropoli ellenistica in Epiro (Phoinike): da questo osservatorio privilegiato (anche grazie alle precise indagini antropologiche ivi condotte), si tenterà di spaziare all’interno del mondo greco, fino alle soglie della romanità, tra miti e riti collegati al fuoco.

Nell’attuale panorama di studi sugli spazi e gli edifici pubblici nelle realtà cittadine sorte in Epiro in età tardo-classica ed ellenistica manca ancora uno studio di contesto che analizzi l’architettura pubblica civile nella sua totalità, in relazione ai singoli complessi, al tessuto urbano di cui essi fanno parte e al suo sviluppo su scala regionale. Questa ricerca affronta l’argomento attraverso un approccio contestuale agli spazi e agli edifici pubblici con funzioni di gestione della vita politica, amministrativa ed economica di otto città situate nel territorio delle attuali Albania meridionale e Grecia nord-occidentale. Obiettivi principali sono da un lato individuare le forme e le funzioni degli spazi pubblici delle città e ricostruire la loro evoluzione dalla genesi della cultura urbana, avvenuta nel corso del IV sec. a.C., fino alla fine del I sec. a.C., in relazione ai modelli architettonici e urbanistici, con le loro trasformazioni, adottati nei centri greci del Mediterraneo; dall’altro definire meglio il profilo istituzionale ed amministrativo dei centri urbani e il ruolo che essi hanno svolto all’interno delle compagini etnico-tribali e dello stato federale epirota. Lo studio interpretativo si basa sull’analisi incrociata del dato archeologico, che le fruttuose ricerche archeologiche continuano a mettere in luce, e delle informazioni desunte dalle molteplici categorie di fonti disponibili (letterarie, epigrafiche e numismatiche)., Nowadays, within the studies devoted to the public spaces and buildings in the urban centres of Late Classical and Hellenistic Epirus, a contribution thoroughly investigating the architecture of political and civil character in both its singularity and in its connections to the urban and regional context is still lacking. The aim of the present research is to fill this gap through a contextual approach focusing on the buildings fulfilling an administrative, political, or economic function in eight major cities of nowadays southern Albania and north-western Greece. In order to achieve this goal, two main topics have been developed: first, the issue of the function and architectural form of the buildings and their typological evolution from the genesis of Epirote urban culture during the 4th century to the end of the 1st century BC, with reference to the architectural and urban models spread in the Mediterranean basin from the end of the Classical period; second, a better definition of the institutional and administrative frame of the urban centres of the region on the one hand, and of their role within the ethnic and tribal groups and the Epirote federal state on the other. From a methodological point of view, the archaeological data provided by the excavations have been compared with the information derived from the literary, epigraphic, and numismatic sources.

I corsi d’acqua costituiscono un elemento molto importante del paesaggio antico. Separano territori e i popoli che li abitano ma al tempo stesso favoriscono i transiti di persone, merci e idee, consentendo di esercitare forme di controllo. Nella presente ricerca si prendono in considerazione le valli dei fiumi Sele ed Ofanto dal punto di vista dell’evidenza funeraria. Questi due importanti corsi d’acqua collegano la costa Tirrenica a quella Adriatica costituendo un’agevole via di transito interna. Tra VI e IV sec. a.C., l’Italia meridionale è caratterizzata dalla presenza di vaste necropoli il cui rito principale è l’inumazione. I forti caratteri di identità e gli oggetti di corredo all’interno delle tombe, insieme alle differenze tra la tipologia delle sepolture, la posizione del corpo del defunto e le rare informazioni ricavabili dalle fonti scritte, consentono di tracciare dei confini culturali e politici tra le diverse aree. In particolare le forme e le decorazioni dei vasi prodotti localmente permettono di istituire una relazione tra i diversi stili regionali e l’identità culturale dei gruppi umani che li producevano, li utilizzavano e li ostentavano tra gli oggetti di corredo dei loro defunti. In questo lavoro vengono esaminate le scelte operate nei costumi funerari, in età arcaica e classica, ed i possibili significati che si celano dietro tali scelte., The waterways are an important element of the ancient landscape. They separate territories and peoples who inhabit them but, at the same time, favoring the transit of people, goods and ideas, allowing to have control on them. In this research, I consider the Sele and the Ofanto rivers valleys in terms of funerary evidence. These two waterways connecting the Tyrrhenian coast to the Adriatic constituting an easy way of internal transit. Between the VI and IV centuries BC, Southern Italy is characterized by the presence of large necropolis where inhumation burial rite is predominant. The identity’s markers and the grave goods, along with the differences between the types of burials, the body position of the deceased and rare information obtained from written sources, allow to trace the cultural and political borders between different areas. Especially the shapes and decorations of locally produced pottery allow to establish a relationship between the different regional styles and the cultural identity of human groups that produced, used and show them among the ceremony performed at the burial. This paper examines the burial customs choices, during the Archaic and Classical Period, and the possible meanings that lie behind these choices.