The Titanosaur Sauropods from the late Campanian–early Maastrichtian Allen Formation of Salitral Moreno, Río Negro, Argentina

The dinosaur record of the Salitral Moreno locality (Río Negro Province, Argentina) is characterized by a high diversity of herbivore taxa, among them hadrosaurs, ankylosaurs, and titanosaur sauropods, but carnivores are rare, consisting of only a few fragmentary bones of small forms. Titanosaurs are represented by Rocasaurus muniozi and Aeolosaurus sp., and at least four other taxa, represented by fragmentary material. The elements preserved include a cervical, dorsal and caudal vertebrae, chevron, humerii, ulnae, radii, metacarpal, femora, tibiae, metatarsal, ischia, pubis, and ilium. The Allen Formation is thought to be correlated with the Marília Formation in Brazil, and their faunas have certain elements in common such as aeolosaurines, but saltasaurines and hadrosaurs, are known exclusively from the Allen Formation. These ab− sences, and particularly that of the saltasaurines, may be because those sauropods originated late in the Cretaceous, probably in southern South America (Northern Patagonia?), and they did not have time to disperse to northern South America.Fil: Garcia, Rodolfo Andres. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salgado, Leonardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Rio Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiologia y Geologia; Argentin

Dentition of titanosaurs (Dinosauria, Sauropoda) from the Upper Cretaceous of Río Negro province, Argentina: morphology, implantation and replacement

Se describe la anatomía observada en un fragmento de dentario de titanosaurio saurópodo de la Formación Anacleto (Cretácico Superior de la provincia de Río Negro), compuesto por siete alvéolos. Dentro de los alvéolos se hallan dientes funcionales así como dientes de reemplazo en sucesivos estadio de desarrollo. Al menos en la porción preservada del dentario es posible advertir un patrón de reemplazo alternante de los dientes. La histología de este ejemplar, permite observar la naturaleza de los tejidos involucrados en la inserción dentaria (hueso alveolar, cemento y ligamento periodontal). De esta misma formación y de la suprayacente Formación Allen, se describen morfológicamente numerosos dientes aislados. A partir de los dientes analizados, se propone una clasificación para los diferentes tipos de facetas de desgaste: 1) Dientes con una única facetas: - sobre el lado labial - sobre el lado lingual centrada o lateral. 2) Con dos facetas: - la mayor sobre el lado labial y la menor lingual - la mayor sobre el lado lingual y la menor labial - la mayor sobre el lado lingual y la menor mesial o distal. 3) Con tres facetas: - una sobre la cara lingual, otra mesial y otra distal - una sobre la cara lingual, otra labial y otra mesial o distal - una faceta labial, otra mesial y distal. 4) Con cuatro facetas: - una menor labial, otra mayor lingual y dos laterales, mesial y distal. Finalmente se propone una hipótesis de cómo se habrían originado mencionadas facetas de desgaste.A fragment of dentary of a titanosaur sauropod from the Anacleto Formation (Upper Cretaceous of the Río Negro Province) is described. Inside the alveoli, functional and replacement teeth in successive “premature” stages are observed. At least in the preserved portion, an alternate teeth replacement pattern is observed. The histological analysis of this specimen allowed identifying the attachment dental tissues (alveolar bone, cementum and periodontal ligament). Numerous isolated teeth from the same unit and from the overlying Allen Formation are described. Based on these, a classification of the wear facets is proposed: 1) Teeth with only one facet: on the labial side, on the lingual side, or on the lateral side. 2) Teeth with two facets: the bigger on the labial side and the smaller on the lingual side; the bigger on the lingual side and the smaller on the labial side; the bigger on the lingual side and the smaller on the mesial or distal edge. 3) Teeth with three facets: one on the lingual side, the others on the mesial and distal edges; one on the lingual side, the others on the labial and mesial or distal edges; one on the labial side, the others on the mesial and distal edges. 4) Teeth with four facets: the smaller on the labial side, the bigger on the lingual side, and two lateral facets, one on the mesial and the other on the distal edges. Finally, we propose a hypothesis about the origin of the wear facets.Fil: Garcia, Rodolfo Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Patagonia Norte. Instituto de Investigación en Biodiversidad y Medioambiente; Argentina. Universidad Nacional del Comahue. Museo de Geologia y Paleontologia; ArgentinaFil: Cerda, Ignacio Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Patagonia Norte. Instituto de Investigación en Biodiversidad y Medioambiente; Argentina. Universidad Nacional del Comahue. Museo de Geologia y Paleontologia; Argentin

On the relation between Seyfert 2 accretion rate and environment at z < 0.1

We analyse different properties of the small-scale environment of Seyfert 2 for two samples selected according to the accretion rate parameter, R, from the Sloan Digital Sky Survey, Data Release 7 survey. We compare the results with two control samples of non-active galaxies that cover the same redshift range, luminosity, colours, morphology, age and stellar mass content. Our study shows that both high and low accretion rate subsamples reside in bluer and lower density environments than the control samples. However, we find that this difference is at least two times stronger for the low accretion rate Seyferts. In the vicinity of Seyfert 2, red galaxies have systematically lower values of stellar mass as compared with corresponding control samples. The lower values of stellar mass for red neighbours is more significant at higher density environments and it is more evident for low accretion rate Seyfert. We also find that this effect is independent of the host's stellar mass. Our results are consistent with a scenario where active galactic nucleus occurrence is higher in lower/medium density environments with a higher merger rate and a lack of a dense intergalactic medium (that can strip gas from these systems) that provide suitable conditions for the central black hole feeding. We find this particularly evident for the low accretion rate Seyferts that could compensate through the intergalactic medium the lack of gas of their hosts.Fil: Coldwell Lloveras, Georgina Vanesa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan. Instituto de Ciencias Astronómicas, de la Tierra y del Espacio. Universidad Nacional de San Juan. Instituto de Ciencias Astronómicas, de la Tierra y del Espacio; Argentina. Universidad Nacional de San Juan; ArgentinaFil: Gurovich, Sebastian. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomía Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomía Teórica y Experimental; ArgentinaFil: Diaz Tello, Jorge Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomía Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomía Teórica y Experimental; ArgentinaFil: Söchting, Ilona K.. University of Oxford; Reino UnidoFil: Garcia Lambas, Diego Rodolfo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomía Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomía Teórica y Experimental; Argentin

(Z)-N-(2-Iodophenyl)-4-nitrobenzimidoyl cyanide

In the title molecule, C14H8IN3O2, the cyanide group is anti to the iodide substituent of the adjacent benzene ring. The central segment is essentially planar (r.m.s deviation = 0.0341 A ° ) and it is twisted away from the iodide- and nitro-substituted benzene rings by 69.02 (9) and 15.83 (16), respectively. In the crystal, molecules are linked by weak C—H N interactions, leading to C(8) chains along [010]

A large accumulation of avian eggs from the Late Cretaceous of Patagonia (Argentina) reveals a novel nesting strategy in Mesozoic birds

We report the first evidence for a nesting colony of Mesozoic birds on Gondwana: a fossil accumulation in Late Cretaceous rocks mapped and collected from within the campus of the National University of Comahue, Neuquén City, Patagonia (Argentina). Here, Cretaceous ornithothoracine birds, almost certainly Enanthiornithes, nested in an arid, shallow basinal environment among sand dunes close to an ephemeral water-course. We mapped and collected 65 complete, near-complete, and broken eggs across an area of more than 55 m2. These eggs were laid either singly, or occasionally in pairs, onto a sandy substrate. All eggs were found apparently in, or close to, their original nest site; they all occur within the same bedding plane and may represent the product of a single nesting season or a short series of nesting attempts. Although there is no evidence for nesting structures, all but one of the Comahue eggs were half-buried upright in the sand with their pointed end downwards, a position that would have exposed the pole containing the air cell and precluded egg turning. This egg position is not seen in living birds, with the exception of the basal galliform megapodes who place their eggs within mounds of vegetation or burrows. This accumulation reveals a novel nesting behaviour in Mesozoic Aves that was perhaps shared with the non-avian and phylogenetically more basal troodontid theropods.Fil: Fernández, Mariela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Patagonia Norte. Instituto de Investigación en Biodiversidad y Medioambiente; ArgentinaFil: Garcia, Rodolfo Andres. Universidad Nacional de Rio Negro. Sede Alto Valle. Instituto de Investigaciones En Paleobiologia y Geologia; ArgentinaFil: Fiorelli, Lucas Ernesto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Regional de Investigaciones Cientificas y Transferencia Tecnológica de Anillaco; ArgentinaFil: Scolaro, Jose Alejandro. Universidad Nacional de la Patagonia "san Juan Bosco"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Nacional Patagónico; ArgentinaFil: Salvador, Rodrigo B.. Universidade de Sao Paulo. Instituto Quã­mica de Sao Carlos; BrasilFil: Cotaro, Carlos N.. Comisión Nacional de Energía Atómica. Centro Atómico Bariloche; ArgentinaFil: Kaiser, Gary W.. Royal British Columbia Museum; CanadáFil: Dyke, Gareth J.. University Of Southampton; Reino Unid

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

The Research Journey as a Challenge Towards New Trends

The academic community of the department of Risaralda, in its permanent interest in evidencing the results of the research processes that are carried out from the Higher Education Institutions and as a product of the VI meeting of researchers of the department of Risaralda held in November 2021 presents its work: “The journey of research as a challenge towards new trends”, which reflects the result of the latest research and advances in different lines of knowledge in Agricultural Sciences, Health Sciences, Social Sciences and Technology and Information Sciences, which seek to solve and meet the demands of the different sectors. This work would not have been possible without the help of each of the teachers, researchers and authors who presented their articles that make up each of the chapters of the book, to them our gratitude for their commitment, dedication and commitment, since their sole purpose is to contribute from the academy and science to scientific and technological development in the search for the solution of problems and thus contribute to transform the reality of our society and communities. We also wish to extend our gratitude to the institutions of the Network that made this publication possible: UTP, UCP, UNAD, UNIREMINGTON; UNISARC, CIAF, Universidad Libre, Uniclaretiana, Fundación Universitaria Comfamiliar and UNIMINUTO, institutions that in one way or another allowed this work to become a reality, which we hope will be of interest to you.Preface............................................................................................................................7 Chapter 1. Technologies and Engineering Towards a humanization in Engineering using soft skills in training in Engineers.............................................................................................................11 Omar Iván Trejos Buriticá1, Luis Eduardo Muñoz Guerrero Innovative materials in construction: review from a bibliometric analysis....................................................................................................................27 Cristian Osorio Gómez, Daniel Aristizábal Torres, Alejandro Alzate Buitrago, Cristhian Camilo Amariles López Bibliometric review of disaster risk management: progress, trends, and challenges.........................................................................................................51 Alejandro Alzate Buitrago, Gloria Milena Molina Vinasco. Incidence of land coverage and geology, in the unstability of lands of the micro-basin of the Combia creek, Pereira, Risaralda....................................73 Alejandro Alzate Buitrago, Daniel Aristizábal Torres. Chapter 2. Arts, Humanities, and Social Sciences Training experience with teachers teaching mathematics using the inquiry methodology ...............................................................................................95 Vivian Libeth Uzuriaga López, Héctor Gerardo Sánchez Bedoya. Interpretation of the multiple representations of the fears associated to the boarding of limited visual patients in the elective I students’ written productions and low vision ...................................................................................113 Eliana Bermúdez Cardona, Ana María Agudelo Guevara, Caterine Villamarín Acosta. The relevance of local knowledge in social sciences............................................131 Alberto Antonio Berón Ospina, Isabel Cristina Castillo Quintero. Basic education students’ conceptions of conflict a view from the peace for the education....................................................................................................143 Astrid Milena Calderón Cárdenas,Carolina Aguirre Arias, Carolina Franco Ossa, Martha Cecilia Gutiérrez Giraldo, Orfa Buitrago. Comprehensive risk prevention in educational settings: an interdisciplinary and socio-educational approach ............................................................................163 Olga María Henao Trujillo, Claudia María López Ortiz. Chapter 3. Natural and Agricultural Sciences Physicochemical characterization of three substrates used in the deep bedding system in swine .......................................................................................175 Juan Manuel Sánchez Rubio, Andrés Felipe Arias Roldan, Jesús Arturo Rincón Sanz, Jaime Andrés Betancourt Vásquez. Periodic solutions in AFM models........................................................................187 Daniel Cortés Zapata, Alexander Gutiérrez Gutiérrez. Phenology in flower and fruit of Rubus glaucus benth. Cv. Thornless in Risaralda: elements for phytosanitary management .........................................199 Shirley Palacios Castro, Andrés Alfonso Patiño Martínez, James Montoya Lerma, Ricardo Flórez, Harry Josué Pérez. Socio-economic and technical characterization of the cultivation of avocado (Persea americana) in Risaralda..............................................................217 Andrés Alfonso Patiño Martínez, Kelly Saudith Castañez Poveda, Eliana Gómez Correa. Biosecurity management in backyard systems in Santa Rosa de Cabal, Risaralda................................................................................................................227 Julia Victoria Arredondo Botero, Jaiver Estiben Ocampo Jaramillo, Juan Sebastián Mera Vallejo, Álvaro de Jesús Aranzazu Hernández. CONTENTS Physical-chemical diagnosis of soils in hillside areas with predominance of Lulo CV. La Selva production system in the department of Risaralda.............241 Adriana Patricia Restrepo Gallón, María Paula Landinez Montes, Jimena Tobón López. Digestibility of three concentrates used in canine feeding....................................271 María Fernanda Mejía Silva, Valentina Noreña Sánchez, Gastón Adolfo Castaño Jiménez. Chapter 4. Economic, Administrative, and Accounting Sciences Financial inclusion in households from socioeconomic strata 1 and 2 in the city of Pereira ..................................................................................................285 Lindy Neth Perea Mosquera, Marlen Isabel Redondo Ramírez, Angélica Viviana Morales. Internal marketing strategies as a competitive advantage for the company Mobilautos SAS de Dosquebradas........................................................................303 Inés Montoya Sánchez, Sandra Patricia Viana Bolaños, Ana María Barrera Rodríguez. Uses of tourist marketing in the tourist sector of the municipality of Belén de Umbría, Risaralda.............................................................................................319 Ana María Barrera Rodríguez, Paola Andrea Echeverri Gutiérrez, María Camila Parra Buitrago, Paola Andrea Martín Muñoz, Angy Paola Ángel Vélez, Luisa Natalia Trejos Ospina. Territorial prospective of Risaralda department (Colombia), based on the SDGS...............................................................................................................333 Juan Guillermo Gil García, Samanta Londoño Velásquez. Chapter 5. Health and Sports Sciences Performance evaluation in times of pandemic. What do medical students think?.......................................................................................................353 Samuel Eduardo Trujillo Henao, Rodolfo A. Cabrales Vega, Germán Alberto Moreno Gómez. The relevance of the therapist’s self and self-reference in the training of psychologists.....................................................................................................371 Maria Paula Marmolejo Lozano, Mireya Ospina Botero. Habits related to oral health which influence lifestyle of elder people in a wellness center for the elderly in Pereira 2020. .............................................387 Isadora Blanco Pérez, Olga Patricia Ramírez Rodríguez, Ángela María Rincón Hurtado. Analysis of the suicide trend in the Coffee Region in Colombia during the years 2012-2018 ..............................................................................................405 Germán Alberto Moreno Gómez, Jennifer Nessim Salazar, Jairo Franco Londoño, Juan Carlos Medina Osorio. Hind limb long bone fractures in canines and felines...........................................419 María Camila Cruz Vélez, Valentina Herrera Morales, Alba Nydia Restrepo Jiménez, Lina Marcela Palomino, Gabriel Rodolfo Izquierdo Bravo. Prevalence of overweight and obesity in children in the rural and urban area of Risaralda....................................................................................................439 Angela María Álvarez López, Angela Liceth Pérez Rendón, Alejandro Gómez Rodas, Luis Enrique Isaza Velásquez. Chapter 6. Architecture, Design and Advertising The artisan crafts of Risaralda, characteristics, importance, and risks within the Colombian Coffee Cultural Landscape, CCCL....................................457 Yaffa Nahir Ivette Gómez Barrera, Javier Alfonso López Morales

City of Hitchcock Comprehensive Plan 2020-2040

Hitchcock is a small town located in Galveston County (Figure 1.1), nestled up on the Texas Gulf Coast. It lies about 40 miles south-east of Houston. The boundaries of the city encloses an area of land of 60.46 sq. miles, an area of water of 31.64 sq. miles at an elevation just 16 feet above sea level. Hitchcock has more undeveloped land (~90% of total area) than the county combined. Its strategic location gives it a driving force of opportunities in the Houston-Galveston Region.The guiding principles for this planning process were Hitchcock’s vision statement and its corresponding goals, which were crafted by the task force. The goals focus on factors of growth and development including public participation, development considerations, transportation, community facilities, economic development, parks, and housing and social vulnerabilityTexas Target Communitie

Una mirada prospectiva de la industria Risaraldense camino a la industria 4.0 : plan tecnológico 2020–2030 Centro de Diseño e Innovación Tecnológico Industrial

Se presenta el plan tecnológico del Centro de Diseño e Innovación Tecnológico Industrial del SENA para la vigencia 2002 - 2030. Comprende el análisis y diagnóstico de la industria risaraldense, sus necesidades y tendencias, con enfoque a la industria 4.0. Se provee información para: identificar tecnologías y ocupaciones emergentes que permitan anticipar la definición de perfiles de instructores, determinar requerimientos de modernización de infraestructura física y tecnológica del Centro de formación, actualizar, crear o eliminar programas de formación, establecer el tipo de formación, servicios tecnológicos e innovación que el centro de formación ofrecerá en un horizonte de 10 años e identificar los proyectos y actores estratégicos para el centro de formación.The technological plan of the SENA Industrial Technological Design and Innovation Center for the period 2002-2030 is presented. It includes the analysis and diagnosis of the Risaralda industry, its needs and trends, with a focus on industry 4.0. Information is provided to: identify emerging technologies and occupations that allow anticipating the definition of instructor profiles, determine modernization requirements of the physical and technological infrastructure of the Training Center, update, create or eliminate training programs, establish the type of training, services technology and innovation that the training center will offer over a 10-year horizon and identify projects and strategic actors for the training center.Fase I: análisis y diagnóstico estratégico -- Análisis externo del centro de formación -- Análisis interno del centro de formación -- Seguimiento al plan tecnológico inmediatamente anterior -- Cruce DOFA -- Vigilancia científico -tecnológica y competitiva especialidad energía eléctrica -- Vigilancia científico -tecnológica y competitiva especialidad electrónica y automatización -- Vigilancia científico -tecnológica y competitiva especialidad Mecánica Industrial -- Vigilancia científico -tecnológica y competitiva especialidad Informática, diseño y desarrollo de software -- Vigilancia científico -tecnológica y competitiva especialidad materiales para la industria -- Vigilancia científico -tecnológica y competitiva especialidad Automotor -- Vigilancia científico -tecnológica y competitiva especialidad Textil, confección y diseño -- Vigilancia científico -tecnológica y competitiva especialidad construcción e infraestructura -- Vigilancia científico -tecnológica y competitiva servicios tecnológicos -- Fase II: formulación estratégica -- Mapa de trayectoria tecnológica -- Validación con expertos -- Construcción de escenarios -- Formulación estratégica -- Métodos prospectivos utilizados -- Formulación estratégica -- Fase III: recomendaciones estratégicas -- Recomendaciones estratégicas especialidad energía eléctrica -- Recomendaciones estratégicas especialidad electrónica y automatización -- Recomendaciones estratégicas especialidad mecánica industrial -- Recomendaciones estratégicas especialidad Informática, diseño y desarrollo de software -- Recomendaciones estratégicas especialidad materiales para la industria -- Recomendaciones estratégicas especialidad Automotor -- Recomendaciones estratégicas especialidad Textil, confección y diseño -- Recomendaciones estratégicas especialidad construcción e infraestructura -- Recomendaciones estratégicas Sennova -- Servicios tecnológicos -- Introducción e información general -- Planteamiento de la necesidad u oportunidad -- Objetivos -- Desarrollo de la vigilancia científico-tecnológica -- Resultados de vigilancia tecnológica con base en análisis de patentes -- Identificación de tecnologías y sublíneas tecnológicas -- Comportamiento de los aceros -- Vigilancia normativa y regulatoria -- Vigilancia tecnológica -- Vigilancia competitiva -- Vigilancia comercial -- Resultados -- Conclusiones y recomendacionesna556 página

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years