Mapping Trabecular Bone Fabric Tensor by in Vivo Magnetic Resonance Imaging

The mechanical competence of bone depends upon its quantity, structural arrangement, and chemical composition. Assessment of these factors is important for the evaluation of bone integrity, particularly as the skeleton remodels according to external (e.g. mechanical loading) and internal (e.g. hormonal changes) stimuli. Micro magnetic resonance imaging (µMRI) has emerged as a non-invasive and non-ionizing method well-suited for the repeated measurements necessary for monitoring changes in bone integrity. However, in vivo image-based directional dependence of trabecular bone (TB) has not been linked to mechanical competence or fracture risk despite the existence of convincing ex vivo evidence. The objective of this dissertation research was to develop a means of capturing the directional dependence of TB by assessing a fabric tensor on the basis of in vivo µMRI. To accomplish this objective, a novel approach for calculating the TB fabric tensor based on the spatial autocorrelation function was developed and evaluated in the presence of common limitations to in vivo µMRI. Comparisons were made to the standard technique of mean-intercept-length (MIL). Relative to MIL, ACF was identified as computationally faster by over an order of magnitude and more robust within the range of the resolutions and SNRs achievable in vivo. The potential for improved sensitivity afforded by isotropic resolution was also investigated in an improved µMR imaging protocol at 3T. Measures of reproducibility and reliability indicate the potential of images with isotropic resolution to provide enhanced sensitivity to orientation-dependent measures of TB, however overall reproducibility suffered from the sacrifice in SNR. Finally, the image-derived TB fabric tensor was validated through its relationship with TB mechanical competence in specimen and in vivo µMR images. The inclusion of trabecular bone fabric measures significantly improved the bone volume fraction-based prediction of elastic constants calculated by micro-finite element analysis. This research established a method for detecting TB fabric tensor in vivo and identified the directional dependence of TB as an important determinant of TB mechanical competence

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 <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >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 <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<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<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

Complejo educativo Fray Mamerto Esquiú : Tercer Premio en el Concurso Nacional de Anteproyectos de Arquitectura y Planeamiento otorgado por el Gobierno de la Provincia de Catamarca

Complejo educativo Fray Mamerto Esquiú (superficie 6.000 m2). Tercer Premio en el Concurso Nacional de Anteproyectos de Arquitectura y Planeamiento otorgado por el Gobierno de la Provincia de Catamarca. Otorgado por un jurado designado por la Federación Argentina de Sociedades de Arquitectos, Catamarca, Argentina.Facultad de Arquitectura y Urbanismo (FAU

Complejo educativo Fray Mamerto Esquiú : Tercer Premio en el Concurso Nacional de Anteproyectos de Arquitectura y Planeamiento otorgado por el Gobierno de la Provincia de Catamarca

Complejo educativo Fray Mamerto Esquiú (superficie 6.000 m2). Tercer Premio en el Concurso Nacional de Anteproyectos de Arquitectura y Planeamiento otorgado por el Gobierno de la Provincia de Catamarca. Otorgado por un jurado designado por la Federación Argentina de Sociedades de Arquitectos, Catamarca, Argentina.Facultad de Arquitectura y Urbanismo (FAU

Reciclaje en el Meridiano V

En la década 1920-30 la Estación se encontraba en pleno funcionamiento y como es habitual en este tipo de locaciones, en su entorno inmediato se generó un incipiente comercio que encontró en la calle 17 y el tranvía que por ella circulaba una importante vía de expansión. Había actividades terciarias y un notable movimiento de tráfico de pasajeros y cargas, a través del ferrocarril, especialmente por su vinculación con diferentes pueblos de la provincia.- Este esquema desapareció lentamente, con la paralización de los ferrocarriles en general, la centralización de funciones urbanas en detrimento de los barrios y particularmente el cierre definitivo de la Estación hacia 1974.- Dentro del concepto que tiene como principio el fortalecimiento de los vínculos barriales, afianzando su autonomía y desarropo en lo que a actividades propias se refiere , es de esencial importancia la presencia y vigencia de uso de aquellos elementos que le dieron origen con perfiles e identidad propia. El trabajo tiende a que la refuncionalización de un edificio y la inserción de nueva arquitectura en un medio urbano existente, favorezca y actúe como elemento generador de actividades urbanas hoy inexistentes.- No se trata de retrotraerse a situaciones coyunturales que un momento histórico determinado originó con el emplazamiento de la Estación. Se trata de un edificio de significativo valor histórico - testimonial, con nuevos usos y nuevas circunstancias que favorezcan la reactivación de un área urbana, hoy bastante deprimida.- El necesario crecimiento por la inclusión de nuevas actividades, y desarrollo de las existentes, plantea en la obra una dualidad de particular resolución.- Los beneficio de un criterio contextualiza que exalte la continuidad e integración , favorecerán la conformación de un paisaje urbano de valoree y experiencias propias, permitiendo la construcción de un hábitat personalizado y particularizadoFacultad de Arquitectura y Urbanism

Opera de la Bastille : Concurso Internacional de Anteproyectos de Arquitectura y Planeamiento

Opera de la Bastille (superficie: 140.000 m2). Concurso Internacional de Anteproyectos de Arquitectura y Planeamiento. Comité de selección designado por la Unión Internacional de Arquitectos.Publicado en revista Summa no. 193. p. 61Facultad de Arquitectura y Urbanismo (FAU

Centro Internacional de Comunicaciones y Dos Ministerios en el barrio De la Dèfènse : Concurso Internacional de Anteproyectos de Arquitectura y Planeamiento

Centro Internacional de Comunicaciones y Dos Ministerios en el barrio De la Dèfènse. (Superficie 160.000 m2). Concurso Internacional de Anteproyectos de Arquitectura y Planeamiento. Otorgado por un Comité de selección designado por la Unión Internacional de Arquitectos, París, Francia.Publicado en Revista Summa no. 193. p. 60-61Universidad Nacional de La Plata (UNLP) - Facultad de Arquitectura y Urbanismo (FAU

Centro Internacional de Comunicaciones y Dos Ministerios en el barrio De la Dèfènse : Concurso Internacional de Anteproyectos de Arquitectura y Planeamiento

Centro Internacional de Comunicaciones y Dos Ministerios en el barrio De la Dèfènse. (Superficie 160.000 m2). Concurso Internacional de Anteproyectos de Arquitectura y Planeamiento. Otorgado por un Comité de selección designado por la Unión Internacional de Arquitectos, París, Francia.Publicado en Revista Summa no. 193. p. 60-61Universidad Nacional de La Plata (UNLP) - Facultad de Arquitectura y Urbanismo (FAU

Cardiorenal End Points in a Trial of Aliskiren for Type 2 Diabetes

BACKGROUND This study was undertaken to determine whether use of the direct renin inhibitor aliskiren would reduce cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease, cardiovascular disease, or both. METHODS In a double-blind fashion, we randomly assigned 8561 patients to aliskiren (300 mg daily) or placebo as an adjunct to an angiotensin-converting-enzyme inhibitor or an angiotensin-receptor blocker. The primary end point was a composite of the time to cardiovascular death or a first occurrence of cardiac arrest with resuscitation; nonfatal myocardial infarction; nonfatal stroke; unplanned hospitalization for heart failure; end-stage renal disease, death attributable to kidney failure, or the need for renal-replacement therapy with no dialysis or transplantation available or initiated; or doubling of the baseline serum creatinine level. RESULTS The trial was stopped prematurely after the second interim efficacy analysis. After a median follow-up of 32.9 months, the primary end point had occurred in 783 patients (18.3%) assigned to aliskiren as compared with 732 (17.1%) assigned to placebo (hazard ratio, 1.08; 95% confidence interval [CI], 0.98 to 1.20; P = 0.12). Effects on secondary renal end points were similar. Systolic and diastolic blood pressures were lower with aliskiren (between-group differences, 1.3 and 0.6 mm Hg, respectively) and the mean reduction in the urinary albumin-to-creatinine ratio was greater (between-group difference, 14 percentage points; 95% CI, 11 to 17). The proportion of patients with hyperkalemia (serum potassium level, = 6 mmol per liter) was significantly higher in the aliskiren group than in the placebo group (11.2% vs. 7.2%), as was the proportion with reported hypotension (12.1% vs. 8.3%) (P <0.001 for both comparisons). CONCLUSIONS The addition of aliskiren to standard therapy with renin-angiotensin system blockade in patients with type 2 diabetes who are at high risk for cardiovascular and renal events is not supported by these data and may even be harmful. (Funded by Novartis; ALTITUDE ClinicalTrials.gov number, NCT00549757.