Restoration of the Brigadier López’s House: Santa Fe, Argentina

En la acción intersectorial entre el estado provincial, la universidad pública y la empresa privada, se consolida un “triángulo virtuoso”, en el que se complementan las especificidades de cada una de las partes. El objetivo de esta unión, en lo referido al presente artículo, fue realizar el mejor y más cuidadoso restauro de una emblemática construcción de adobe. Durante el proceso, la universidad brindó sus conocimientos para determinar la salud de su estructura, el estado redactó un pliego de contratación que contempló tanto la consolidación estructural del bien como su puesta en valor, y luego, durante la obra y en diálogo con la empresa ejecutora, se analizó la mejor forma de operar en función de la verificación de la materialidad. Se realizaron ensayos de la tierra existente en la construcción y de la materia prima que se incorporó, y se corroboró que existiera una similitud entre la ejecución original y la nueva; atendiendo a las dosificaciones y resistencias adecuadas según la técnica utilizada. Dada la poca experiencia local documentada en intervenciones de este tipo, se tuvo como resultado un antecedente importante, del cual se puede ir acumulando experiencia para obras similares, y replicar de este modo los conocimientos generados.In the intersectoral action between the provincial state, the public university and the private company a “virtuous triangle” is consolidated, in which specificities of each of the parties are complemented. The purpose of this union, as referred in this article, is to perform the best and most careful restoration of an emblematic adobe construction. During said process, the university provided its knowledge to determine the structural integrity of the house, the state drew up a contract sheet which included both the structural consolidation of the building and its put in value, and then during the work -in dialogue with the executing company- the best way to operate was analysed based on the materials’ verification. Tests were carried out to the existent earth in the building and to the raw material being incorporated, and a corroboration of existing similarity between the original and new executions were made, attending to suitable dosages and resistances according to the used techniques. Given the little documented local experience in this type of interventions, an important antecedent was set, from which experience can be accumulated in order to replicate the generated knowledge in further works.Fil: Losa, Nicolás Rodolfo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Centro de Investigaciones en Métodos Computacionales. Universidad Nacional del Litoral. Centro de Investigaciones en Métodos Computacionales; ArgentinaFil: Spina, María Laura. Universidad Tecnológica Nacional. Facultad Regional Santa Fe. Departamento de Ingeniería Civil; ArgentinaFil: Cabrera, Santiago Pedro. Universidad Tecnológica Nacional. Facultad Regional Santa Fe. Departamento de Ingeniería Civil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk