Pan-tropical Sentinel-2 cloud-free annual composite datasets.

Sentinel-2 MSI is one of the core missions of the Copernicus Earth Observation programme of the European Union. This mission shows great potential to map the regional high-resolution spatio-temporal dynamics of land use and land cover. In tropical regions, despite the high revisiting time of 5 days including both Sentinel-2A and 2B satellites, the frequent presence of clouds, cloud-shadows, haze and other atmospheric contaminants are precluding the visibility of the Earth surface up to several months. In this paper we present four annual pan-tropical cloud-free composites computed and exported from Google Earth Engine (GEE) by making use of available Sentinel-2 L1C collection for the period spanning from 2015 to 2020. We furthermore propose empirical approaches to reduce the BRDF effect over tropical forest areas by showing pros and cons of image-based versus swath-based methodologies. Additionally, we provide a dedicated web-platform offering a fast and intuitive way to browse and explore the proposed annual composites as well as layers of potential annual changes as a ready-to-use means to visually identify and verify degradation and deforestation activities as well as other land cover changes.

Clusterization of multi-channel electromyograms into muscle-specific activations to drive a subject-specific musculoskeletal model: towards fast and accurate clinical decision-making.

Current clinical decision-making is based on rapid and subjective functional tests such as 10 m walking. Moreover, greater accuracy can be achieved at the expense of rapidity and costs. In biomechanical laboratories, advanced technologies and musculoskeletal modeling can quantitatively describe the biomechanical reasons underlying gait disorders. Our work aims to blend clinical rapidity and biomechanical accuracy through multi-channel (MC) electromyography (EMG) clustering and real-time neuro-musculoskeletal (NMS) modeling techniques integrated into a sensorized wearable garment that is quick to set up. Here we present a unique pipeline that goes from MC EMG signals to ankle torque estimation following two steps: (1) non-negative matrix factorization (NNMF)-based EMG clustering for the extraction of muscle-specific activations and (2) subject-specific EMG-driven NMS modeling. The results show the potential of NNMF as an electrode clustering tool, as well as the ability to predict joint torque during movements that were not used for the EMG clustering.

Long-term (1990-2019) monitoring of forest cover changes in the humid tropics.

Accurate characterization of tropical moist forest changes is needed to support conservation policies and to quantify their contribution to global carbon fluxes more effectively. We document, at pantropical scale, the extent and changes (degradation, deforestation, and recovery) of these forests over the past three decades. We estimate that 17% of tropical moist forests have disappeared since 1990 with a remaining area of 1071 million hectares in 2019, from which 10% are degraded. Our study underlines the importance of the degradation process in these ecosystems, in particular, as a precursor of deforestation, and in the recent increase in tropical moist forest disturbances (natural and anthropogenic degradation or deforestation). Without a reduction of the present disturbance rates, undisturbed forests will disappear entirely in large tropical humid regions by 2050. Our study suggests that reinforcing actions are needed to prevent the initial degradation that leads to forest clearance in 45% of the cases.

A global cloud free pixel- based image composite from Sentinel-2 data.

Large-scale land cover classification from satellite imagery is still a challenge due to the big volume of data to be processed, to persistent cloud-cover in cloud-prone areas as well as seasonal artefacts that affect spatial homogeneity. Sentinel-2 times series from Copernicus Earth Observation program offer a great potential for fine scale land cover mapping thanks to high spatial and temporal resolutions, with a decametric resolution and five-day repeat time. However, the selection of best available scenes, their download together with the requirements in terms of storage and computing resources pose restrictions for large-scale land cover mapping. The dataset presented in this paper corresponds to global cloud-free pixel based composite created from the Sentinel-2 data archive (Level L1C) available in Google Earth Engine for the period January 2017- December 2018. The methodology used for generating the image composite is described and the metadata associated with the 10 m resolution dataset is presented. The data with a total volume of 15 TB is stored on the Big Data platform of the Joint Research Centre. It can be downloaded per UTM grid zone, loaded into GIS clients and displayed easily thanks to pre-computed overviews.

Modeling ethanol decomposition on transition metals: a combined application of scaling and Brønsted-Evans-Polanyi relations.

Applying density functional theory (DFT) calculations to the rational design of catalysts for complex reaction networks has been an ongoing challenge, primarily because of the high computational cost of these calculations. Certain correlations can be used to reduce the number and complexity of DFT calculations necessary to describe trends in activity and selectivity across metal and alloy surfaces, thus extending the reach of DFT to more complex systems. In this work, the well-known family of Brønsted-Evans-Polanyi (BEP) correlations, connecting minima with maxima in the potential energy surface of elementary steps, in tandem with a scaling relation, connecting binding energies of complex adsorbates with those of simpler ones (e.g., C, O), is used to develop a potential-energy surface for ethanol decomposition on 10 transition metal surfaces. Using a simple kinetic model, the selectivity and activity on a subset of these surfaces are calculated. Experiments on supported catalysts verify that this simple model is reasonably accurate in describing reactivity trends across metals, suggesting that the combination of BEP and scaling relations may substantially reduce the cost of DFT calculations required for identifying reactivity descriptors of more complex reactions.

Multilineage potential of adult human mesenchymal stem cells.

Human mesenchymal stem cells are thought to be multipotent cells, which are present in adult marrow, that can replicate as undifferentiated cells and that have the potential to differentiate to lineages of mesenchymal tissues, including bone, cartilage, fat, tendon, muscle, and marrow stroma. Cells that have the characteristics of human mesenchymal stem cells were isolated from marrow aspirates of volunteer donors. These cells displayed a stable phenotype and remained as a monolayer in vitro. These adult stem cells could be induced to differentiate exclusively into the adipocytic, chondrocytic, or osteocytic lineages. Individual stem cells were identified that, when expanded to colonies, retained their multilineage potential.

Rapidly progressive periodontitis. Neutrophil chemotaxis inhibitory factors associated with the presence of Bacteroides gingivalis in crevicular fluid.

In the last few years several bacteriological and immunological studies have investigated the role of bacteria and immune defects in order to establish the etiopathogenesis of periodontal disease. With regard to the immune system, a defect in polymorphonuclear neutrophil (PMN) chemotaxis has been frequently reported in patients with rapidly progressive or juvenile periodontitis. The purpose of this study was to investigate in five patients with rapidly progressive periodontitis and normal chemotaxis of peripheral blood PMNs the presence of chemotaxis inhibitory activity in gingival fluid and to relate such activity to three types of bacteria, often involved in rapidly evolving periodontal lesions, that are able to inhibit in vitro PMN chemotaxis: Bacteroides gingivalis, Capnocytophaga sp., and Actinobacillus actinomycetemcomitans. We found strong inhibitory activity in three of these patients. This activity was consistently associated with the finding of B. gingivalis in gingival pockets. We cannot rule out, however, that other substances not of bacterial origin could be responsible for such inhibitory activity. The strict association with B. gingivalis, known to secrete blocking factors, is highly suggestive, although this data must be considered preliminary.

Adult mesenchymal stem cells: potential for muscle and tendon regeneration and use in gene therapy.

The expansion potential and plasticity of stem cells, adult or embryonic, offer great promise for their use in medical therapies. Recent provocative data suggest that the differentiation potential of adult stem cells may extend to lineages beyond those usually associated with the germ layer of origin. In this review, we describe recent developments related to adult stem cell research and in particular, in the arena of mesenchymal stem cell (MSC) research. Research demonstrates that transduced MSCs injected into skeletal muscle can persist and express secreted gene products. The ability of the MSC to differentiate into cardiomyocytes has been reported and their ability to engraft and modify the pathology in infarcted animal models is of great interest. Research using MSCs in tendon repair provides information on the effects of physical forces on phenotype and gene expression. In turn, MSCs produce changes in their matrix environment in response to those biomechanical forces. Recent data support the potential of MSCs to repair tendon, ligament, meniscus and other connective tissues. Therapeutic applications of adult stem cells are approaching clinical use in several fields, furthering the possibility to regenerate damaged and diseased tissue.

Effect of orthodontic therapy with fixed and removable appliances on oral microbiota: a six-month longitudinal study.

The present study evaluated microbiological and clinical changes occurring during the first six months of orthodontic therapy with fixed and removable appliances and the consequent risk for gingivitis and periodontal disease. This study was justified by the disagreement among different authors: only some of them reported gingivitis development and changes in dental plaque composition during orthodontic therapy with fixed appliances, others did not. Thirty, 7-to-15-year-old children, fifteen with fixed and fifteen with removable appliances, previously motivated to oral hygiene, completed the study. They were clinically examined by a dentist at baseline and at the end of the study. Three supra and subgingival microflora samples were collected from the first molars, when the appliances were inserted (T0), 6-8 weeks later (T1) and 6-7 months later (T2). Microflora was examined using dark-field and light microscopes and cultural methods. An indicator of healthy status (percentage of Gram positive cocci in total bacterial count) and some risk indicators for gingivitis (bacterial count evaluated with light microscope, percentage of Gram negative rods) and for periodontitis (motile rod and spirochete percentages, presumptive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis prevalence) were investigated. Patients with fixed appliances were clinically healthy at T2; yet they showed significantly increased counts, motile rods, subgingival spirochetes and a decrease of Gram positive cocci. At T2, patients with removable appliances were clinically healthy and the only significant microbiological changes were supragingival motile rods and subgingival spirochetes. These data suggest that in the oral hygiene motivated patients of the present study, gingivitis and periodontitis do not occur, during the first six months of treatment: the significant modification of oral microbiota, shown by subjects with fixed appliances, however, suggests that the risk for gingivitis in the following months of therapy is still high and the risk for periodontitis cannot be excluded.

The effect of levodopa on the habituation of the acoustic-palpebral reflex in Parkinson's disease.

The aim of the present study was to assess the habituation of the blink responses evoked by repetitive auditory stimuli in patients with Parkinson's disease in different clinical states. We studied 28 parkinsonian patients. Eighteen patients without motor fluctuations were studied off and on levodopa, on two different sessions, one week apart. The remaining 10 parkinsonians had the wearing off phenomenon and were studied while being off their medication and while ON and OFF, as determined clinically, after a single dose of levodopa. Twelve age-matched controls were also studied in a single session. Unilateral auditory 1 kHz, 105 dB stimuli were delivered at a frequency of 0.2 Hz. The number of responses (R) from the orbicularis oculi was registered. R values were significantly smaller in controls and in treated parkinsonians than in untreated patients. R was also significantly smaller when ON than at baseline and when OFF in parkinsonians with the wearing off phenomenon. These results suggest a failure of the inhibition of the acoustic-palpebral reflex in Parkinson's disease. The improvement with levodopa and the similarities between the clinical and the electrophysiological changes suggest a dopaminergic role in the inhibition of this brainstem reflex.

Motor activation time in Parkinson's disease.

Motor activation time (MAT), considered in the present work as the actual intracerebral processing delay during a reaction time (RT) task, was assessed in 17 patients with Parkinson's disease (PD) and in 7 age-matched healthy volunteers. MAT was calculated by subtracting from the premotor RT the afferent and efferent times obtained by sensory and motor evoked potentials. When compared with healthy volunteers, patients exhibited significantly (p < 0.02) prolonged MATs. In a smaller group of 9 PD patients MAT and the auditory P3 event related potential were assessed while on antiparkinsonian treatment and after a 12-hour withdrawal period. During the off medication condition patients showed a significant slowing (p < 0.01) of MAT values without any remarkable change in P3 latency or amplitude. These results suggest that MAT slowing indicates an abnormal function of the dopaminergic mechanism involved in the initiation of movement which is not related to changes in the arousal or cognitive state.

[A new device for the disinfection of handpieces and turbines]. / Su un nuovo apparecchio per la disinfezione di manipoli e turbine.

Dental handpieces are often difficult to disinfect. This is one of the main reasons for the considerable risk of cross-infections in dental offices. The aim of the present study was the evaluation of the disinfectant property of a recent, commercially available, automatic instrument, described as capable to clean, disinfect and lubricate dental handpieces. The following experimental evaluations were made: 1) antimicrobial activity of the disinfectant (glyoxalaldehyde) used. The method described by the European Committee for Standardization was followed. Test microorganisms were Pseudomonas aeruginosa and Staphylococcus aureus. 2) disinfection of dental handpieces (69 contra-angles and 97 turbines of different marks). They were naturally infected using them on patients for 30 minutes at least. 3) disinfection of dental handpieces infected with bacterial suspensions of Staphylococcus aureus, Streptococcus pyogenes (beta-haemolyticus, group A), Candida albicans and Pseudomonas aeruginosa. The results of the first experiment showed a strong bactericidal power of the disinfectant with both the tested strains, after a contact time of only 1 minute. A great proportion of the dental handpieces tested during the second experiment were found disinfected: from 84% through 89% out of the various models of turbine handpieces; from 89% through 100% out of the models of contra-angle handpieces. Even though bacterial contamination level was low (about 10(3) microorganisms per handpiece), a satisfactory disinfectant ability in natural conditions was found. The results of the third experiment were unclear. The tested instrument reduced 10(5)-10(8) times the original bacterial count when the gram positive microorganisms (Staphylococcus aureus, Streptococcus pyogenes) were used. On the other hand, when Pseudomonas aeruginosa and Candida albicans were used, the results were different: the bacterial count was reduced 10(6)-10(7) times in some cases, and only 10(2) times in other cases. This difference was found in the tests made using the same attachment and in those made using various attachments. In conclusion, the tested instrument showed, in most cases, a good disinfectant property, but the presence of unclear results suggests that some technical modifications are required.

[Use of a microwave device for dental instrument sterilization: possibilities and limitations]. / L'impiego di un apparecchio a microonde nella sterilizzazione di strumentario odontoiatrico: possibilità e limiti.

BACKGROUND: The aim of the present study was the evaluation of the effectiveness as sterilizer of a modified version of a microwave device, which was previously tested by the same authors and found unsatisfactory. MATERIALS AND METHODS: Dental mirrors were contaminated by 10(4)-10(9) microorganisms of Stapbylococcus aureus and spores of Bacillus subtilis and Bacillus stearothermophilus. The inocula used were both wet and dry. The duration of the treatment was 4 minutes. Three series of tests were made: 1) microwaves and "adjuvant" solution (as suggested by the producer of the device); 2) microwaves only (in place of the "adjuvant" solution, a Na Cl 0.9% was used); 3) "adjuvant" solution only (into an oven at 25 degrees C). RESULTS: In the 1st and 3rd series of tests all the microorganisms and the spores were killed. In the 2nd series of tests a bactericidal effect against some, not all, microorganisms of the S. aureus species and against spores of B. subtilis and B. stearothermophilus was found. CONCLUSIONS: The results of this study suggest that the device tested has a sterilizing activity, which, however, is not due to the activity of microwaves only; but to the combined activity of microwaves, "adjuvant" solution and temperature (since inside the device, at the end of the treatment the temperature on the mirrors was 94 degrees C).

[3 different methods for evaluating Streptococcus mutans in the saliva]. / Su tre differenti metodiche di valutazione dello Streptococcus mutans nella saliva.

Three different methods for detection and count of Streptococcus mutans in saliva have been compared with a microbiological method in order to estimate their efficacy and practicality. The study has been carried out on fifty children of six-eleven years old. The first method (stamp method) derives from that of Kohler and Bratthall, improved on the sampling, without saliva stimulation and, hence, more rapid. Furthermore, using a tongue depressor with a shovel-like extremity, we can either restrict the area where the grown colonies must be counted, avoiding any mistake, and stamp the spatula in the centre of the plate, not in the border, as the original method described, pressing it with the same force in every part, so that almost all the saliva collected can be plated on the Streptococcus mutans selective medium. As stated by this method, a tongue depressor is pressed first on the subject's tongue, then on a plate containing the medium. After incubation, the Streptococcus mutans colonies are counted on the plate's area limited by the stamp of the extremity of the spatula. According to Emilson we can also discriminate Streptococcus mutans and Streptococcus sobrinus colonies. The second method is a "strip mutans test" (Dentocult): saliva is stimulated making the subject chew a piece of paraffin and then it is collected passing a plastic spatula for ten times on the child's tongue. The spatula is introduced into a tube containing a liquid medium selective for Streptococcus mutans and then incubated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Current and future prospects concerning the prevention of dental caries]. / Attualita' e prospettive in tema di prevenzione della carie dentale.

Caries is a disease which on the basis of numerous epidemiological data it should be possible to control. The preventive interventions which have proved to have the greatest effect on the diffusion of this disease are essentially: fluoroprophylaxis, oral hygiene, food hygiene and periodic dental examination. The common denominator, which has the greatest effect on success, is a good level of health education of the populations affected by the programme, with specific reference to the teeth. The importance of the diet as a possible element predisposing to caries is an ascertained fact by now, and in fact it is well known that the greatest cariogenic effect is achieved after eating foods containing large quantities of fermentable sugars at irregular intervals throughout the day, especially in the form of products of high density and viscosity. The proposal to replace sugar with substitutive sweeteners such as: xilitol, sorbitol, licasin, talin, palatinit and, more recently, aspartame does not completely solve the problem; and apart from this the clearcut reduction of caries achieved in different European and non-European countries does not appear to be directly connected with a drop in sugar consumption, while more and more importance is ascribed to individual food choices. Oral hygiene procedures aim not only at the cleaning of teeth but also, to some extent, controlling the bacterial plaque. For this reason these are sometimes included among anticaries interventions; however opinions differ in this regard, with a clear prevalence of negative views. The question changes radically if we combine with mechanical procedures alone the use of fluoride-based toothpastes, which are recognised, in combination with other interventions, as playing a fundamental role in the rapid decline of caries in industralised countries. Toothpaste is considered as an excellent vehicle for the topical application of fluoride since it comes into contact with the teeth is slight concentrations only (of about 20 p.p.m.) but at high frequency, the latter constituting a decisive factor for the success of prevention. Furthermore, especially in the case of small children, it acts not only topically but also at systemic level, since in fact part of the toothpaste is swallowed, with consequent passing of the fluoride into the circulation. Undoubtedly the most valid anticaries prophylaxis is fluoroprophylaxis which may be achieved following different methods. Fluoration of water is the most widespread form of administration of fluoride systemically and also the most appropriate since it supplies small but continuous doses of fluoride.(ABSTRACT TRUNCATED AT 400 WORDS)

[Nutritional hygiene in the prevention of dental decay: thoughts about weight gain in children in elementary schools]. / L'igiene alimentare nella prevenzione della carie dentale: riflessi sull'accrescimento ponderale in alunni della scuola elementare.

Hereafter the results of an investigation carried out in two elementary schools, centred on a health education programme divided into oral hygiene and nutritional hygiene interventions, having the aim above all of assessing the effectiveness of otherwise of such interventions for purposes of checking up on dental caries. Parallel to this main aim we also wished to verify the validity of a working hypothesis which, departing from a strictly odontological aspect, also aimed at pointing out the influence or otherwise of such food education interventions on a more harmonious growth in weight of the children concerned in the programme. This was because most of the principles underlying food education interventions in the strictly auxological field coincide with the basic principles of interventions aimed at the prevention of caries. The programme was prolonged for three school years in two elementary school of Rome coming under the same Local Health Service. This note concerns the second point on the programme, namely study of the body growth pattern. The results may be summarised as follows: At the beginning of the experiment the control group showed a maximum concentration of children in the "normal weight" class (38.9%) and a progressive decrease towards the extreme classes. Whereas in the experimental sample the spread was less regular, with a smaller percentage of children in the "normal weight" (22.9%) a maximum concentration in the "slightly overweight" class (30%) and a distribution of pupils progressively decreasing towards the extremes, but with a slight preponderance towards the Overweights. At the end of the experiment the control group showed a clear reduction in the "normal weight" class (from 38.9% to 30.6%) and at the same time an increase in all the adjacent classes (with the "slightly overweights" rising from 19,45% to 22,21%, and the "seriously overweights" from 9,72% to 13,9%, the "slightly underweights" from 18,06% to 23,62% to 23,62%; while a fall in the "very seriously underweights" was recorded (from 5,56% to 2.78%), with the "seriously overweights" remaining practically unchanged). Whereas in the experimental group we found a better redistribution by classes, with the greatest concentration of pupils in the "normal weight" class (from 22.86% to 41.43%), the only significant increase (p less than 0.01), and considerable falls in the "slightly overweight" class (from 30.0% to 21.44%) and in the "slightly underweight" class (from 20.0% to 12.86%); while the "seriously overweights" continued to gather a large percentage of children (from 18.58% to 20.00%).(ABSTRACT TRUNCATED AT 400 WORDS)

[Epidemiologic approaches, in school health education programs with particular attention to dentistry]. / Approccio epidemiologico per interventi di educazione sanitaria nella scuola con particolare attenzione al campo odontoiatrico.

At the request of the Cultural Union of the Upper Aniene Valley, the social-health workers dealing with school medicine of the Teaching District of Affile (Rome) have tried to define the programming lines for a health education intervention in the elementary schools of the district. The basic requisites of the intervention were pinpointed as: effectiveness, in terms of improvement of health conditions; short-term results; cognitive-transformative methodology having a spiral progression (cognitive, decision-making, implementative and of verification). The departure point of the intervention was the cognitive study on the social-health situation of the school population based on an analysis of the individual data contained in the medical files compiled by the school doctor, standardised and filled out with the pupils' social and family data. Out of 257 children, 212 were examined, namely 82.4% of the school population. The first social-anamnestic data on pupils' families was in respect of parents' level of education, giving the following results: 65% with elementary schooling only, 11% semi-illiterate and 10.5% diploma- or degree-holders. In respect of parents' working activities, on the other hand, a clear difference emerged: compared with 50.4% of worker or artisan fathers and about 33.3% engaged in the tertiary sector, almost all the mothers were still home-based (90.9% housewives). Another interesting fact emerged from the cards, namely that only 69% of the boys and girls have undergone the full cycle of antidiphtheria-antitetanus vaccinations, and only 80% of antipolio vaccinations. As regards pupils pathological anamnesis, cases of hospitalisation were for the following causes: 5.7% fractures and/or burns, followed by intestinal infections (4.5%). Whereas, as regards current pathology the high incidence of a cariogenic pathology emerged, with such high values as to indicate, in the field of prevention and health education, oral hygiene as the priority intervention to be undertaken in respect of the pupils included in the teaching district. The stages of the planned intervention were fixed as follows: -campaign to make teachers and families, considered as the primary educators, aware of this health problem; -meetings with pupils for the purpose of informing them in a simple way of the problem of caries and of discussing together behaviours liable to ensure greater dental hygiene; -involvement of the school and local administrative authorities for the implementation of any measures aimed at favouring the improvement of the behavioural and eating habits of the boys and girls (access for all to school canteens, free dental examinations, etc.).(ABSTRACT TRUNCATED AT 400 WORDS)

[Health-related behaviour and HCV prevalence among elderly and younger adults in an isolated community close to Rome (Italy)]. / Abitudini comportamentali e prevalenza di HCV in anziani e giovani di una comunità del frusinate.

The aim of this study has been to investigate the differences in the health-related behaviour by means of a questionnaire in a sample of elderly (>54 years, 1st generation) and younger adults (<54 years, 2nd generation, all of them sons/daughters of HCV positive subjects), given the high difference in HCV positive prevalence among the two groups (19.4% vs. 2.1%). Most (53.4% vs. 0.0%) of the 1st generation subjects used glass syringes while all the 2nd generation subjects used disposable syringes. Among the elderly, the frequency of hospitalisation (70% vs. 50%), transfusions (11.8% vs. 2.9%) and dental therapy by false dentists (52% vs. 0%) were higher. These results show that the use of non recyclable syringes is the main responsible for the drastic reduction of HCV circulation in the present community, and the consequent decrease in the risk for infection in younger subjects. Moreover, dental therapy was not related to an increased risk for infection, providing that the treatment has been made by a "true" dentist. Finally, the intrafamiliar transmission was not supported by the present data.

Management of ischemic diabetic foot.

Diabetic foot pathology represent the more disabling complication of diabetes. More the 1 million of diabetes patients undergo a lower limb amputation per year; 85% of these amputation are preceded by un ulcer that can be avoided by a prevention program. Critical limb ischemia (CLI), the only independent cause of major amputation in diabetic population, can be correctly treated when an early diagnosis is made. Both endoluminal and surgical revascularization procedures can be applied in diabetes with high rate of success when performed by skilled operator. Infection of diabetic foot, in particular in patients suffering from peripheral artery disease (PVD), may rapidly evolves in severe local or systemic infection putting the patient at high risk of major amputation or death. Together with an early diagnosis of infection and ischemia it is mandatory to apply a correct medical and surgical treatment protocol with the aim to control infection and to improve blood perfusion to the foot. In case of infection surgical procedure should be applied first while revascularization procedure will follow soonest. Antibiotic therapy should be chosen considering different local biological pattern and different type of infection. Reconstructive surgery, the last step in treatment of any diabetic foot lesion, must obtain a functional residual foot or a stump that will allow the patient to go back walking soonest with residual good walking capacity.