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Aims: To evaluate erythropoietic response rates to oral iron over time in iron-deficient anemic patients with nondialysis-dependent chronic kidney disease (ND-CKD). Materials and methods: FIND-CKD was a 1-year, randomized, multicenter trial of iron therapy in patients with ND-CKD, anemia, and iron deficiency, without erythropoiesis-stimulating agent (ESA) therapy. Patients with active infection or C-reactive protein > 20 mg/L were excluded. In this post-hoc analysis, response was defined as >= 1 g/dL increase in hemoglobin (Hb) from baseline, before initiation of alternative anemia therapy (i.e., ESA, transfusion, or intravenous iron). Results: 308 patients received oral iron (200 mg elemental iron/day). Mean (SD) Hb at baseline was 10.4 (0.7) g/dL. At week 4, Hb data were available from 292 patients without alternative anemia therapy: 63/292 (21.6%) showed a response. Among the 229 nonresponders at week 4, 48.8% showed a cumulative response on >= 1 occasion by week 52 (11.1%, 19.9%, 25.9%, and 28.7% had a response at weeks 8, 12, 24, and 52, respectively), and 27.9% had received alternative iron therapy by week 52. Baseline levels of Hb, ferritin, and transferrin saturation were lower in responders than in nonresponders. Neither concomitant medication nor adherence (as assessed by medication count) was substantially different between early responders and nonresponders. Conclusion: Four weeks after starting oral iron therapy, only 21.6% of anemic patients with ND-CKD and iron deficiency showed an Hb increase of at least 1 g/dL. Among early nonresponders

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 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.)

PubMedID: 15643295 Familial Mediterranean fever (FMF) is an autosomal recessive disease that is prevalent among eastern Mediterranean populations, mainly non-Ashkenazi Jews, Armenians, Turks, and Arabs. Since a large proportion of all the FMF patients in the world live in Turkey, the Turkish FMF Study Group (FMF-TR) was founded to develop a patient registry database and analyze demographic, clinical, and genetic features. The cohort was composed of 2838 patients (mean age, 23.0 ± 13.33 yr; range, 2-87 yr), with a male:female ratio of 1.2:1. There was a mean period of 6.9 ± 7.65 years from disease onset to diagnosis; the period was about 2 years shorter for each decade since 1981. Ninety-four percent of patients were living in the central-western parts of the country; however, their familial origins (70% from the central-eastern and Black Sea regions) reflected not only the ongoing east to west migration, but also the historical roots of FMF in Turkey. Patients' clinical features included peritonitis (93.7%), fever (92.5%), arthritis (47.4%), pleuritis (31.2%), myalgia (39.6%), and erysipelas-like erythema (20.9%). Arthritis, arthralgia, myalgia, and erysipelas-like erythema were significantly more frequent (p < 0.001) among patients with disease onset before the age of 18 years. Genetic analysis of 1090 patients revealed that M694V was the most frequent mutation (51.4%), followed by M680I (14.4%) and V726A (8.6%). Patients with the M694V/M694V genotype were found to have an earlier age of onset and higher frequencies of arthritis and arthralgia compared with the other groups (both p < 0.001). In contrast to other reported studies, there was no correlation between amyloidosis and M694V homozygosity in this cohort. However, amyloidosis was still remarkably frequent in our patients (12.9%), and it was prevalent (27.8%) even among the 18 patients with a disease onset after age 40 years. Twenty-two patients (0.8%) had nonamyloid glomerular diseases. The high prevalence of vasculitides (0.9% for polyarteritis nodosa and 2.7% for Henoch-Schönlein purpura) and high frequency of pericarditis (1.4%) were striking findings in the cohort. Phenotype II cases (those patients with amyloidosis as the presenting or only manifestation of disease) were rare (0.3% or less). There was a high rate of a past diagnosis of acute rheumatic fever, which suggested a possible misdiagnosis in children with FMF presenting with recurrent arthritis. To our knowledge, this is the largest series of patients with FMF reported from 1 country. We describe the features of the disease in the Turkish population and show that amyloidosis is still a substantial problem.

Editor,—We recently cared for a 27 year old man who died of multiple organ failure caused by systemic amyloidosis. Immunoperoxidase staining of a rectal biopsy specimen showed AA-type amyloid fibrils. He had been diagnosed at the age of 14 months as having X linked agammaglobulinaemia (XLA), presenting with a history of recurrent pneumonia and skin …

Steel curved girder bridges are largely used today in motorways and railways. They are often composed of thin-walled crosssections, entirely made of steel or with an upper concrete slab. The deck may have I-girders or box cross-sections: in any case curved girders are subjected to twisting moment, associated with bending, even for dead loads. Moreover, in thin-walled sections the influence of non-uniform torsion becomes sizable with respect to Saint Venant torsion, modifying the state of tangential stresses in the section and introducing axial stresses due to warping being prevented. Open sections of I-girder bridges are especially subject to these phenomena and warping can be significant not only for curved bridges but also for eccentrically applied traffic loads in straight ones. In this paper a method for the evaluation of the effects of non-uniform torsion, based on an energetic approach, is proposed; the method is simple and fast, with a reduced computational burden with respect to finite elements. The solution of curved girder bridges is performed by the Hamiltonian Structural Analysis method, which is implemented for straight and curved girders with thin-walled cross-sections. A parametric analysis is proposed for single and multi-span bridges, with variation in type of loads applied, crosssection parameters, geometric curvature of bridge deck and stiffness ratios of the cross-section. The parametric study is presented through dimensionless diagrams of internal forces for the evaluation of the global behaviour of curved girder bridges together with indications on the stress state of the cross-section. The interpretation of the results of the analyses performed can be useful to designers for the conceptual design stages and for optimization of the geometric and mechanical parameters of I-girder and box girder cross-sections.

Aims Diabetic cardiomyopathy is a multifactorial disease characterized by an early onset of diastolic dysfunction (DD) that precedes the development of systolic impairment. Mechanisms that can restore cardiac relaxation improving intracellular Ca2+ dynamics represent a promising therapeutic approach for cardiovascular diseases associated to DD. Istaroxime has the dual properties to accelerate Ca2+ uptake into sarcoplasmic reticulum (SR) through the SR Ca2+ pump (SERCA2a) stimulation and to inhibit Na+/K+ ATPase (NKA). This project aims to characterize istaroxime effects at a concentration (100 nmol/L) marginally affecting NKA, in order to highlight its effects dependent on the stimulation of SERCA2a in an animal model of mild diabetes. Methods and results Streptozotocin (STZ) treated diabetic rats were studied at 9 weeks after STZ injection in comparison to controls (CTR). Istaroxime effects were evaluated in vivo and in left ventricular (LV) preparations. STZ animals showed 1) marked DD not associated to cardiac fibrosis, 2) LV mass reduction associated to reduced LV cell dimension and T-tubules loss, 3) reduced LV SERCA2 protein level and activity and 4) slower SR Ca2+ uptake rate, 5) LV action potential (AP) prolongation and increased short-term variability (STV) of AP duration, 6) increased diastolic Ca2+, and 7) unaltered SR Ca2+ content and stability in intact cells. Acute istaroxime infusion (0.11 mg/kg/min for 15 min) reduced DD in STZ rats. Accordingly, in STZ myocytes istaroxime (100 nmol/L) stimulated SERCA2a activity and blunted STZ-induced abnormalities in LV Ca2+ dynamics. In CTR myocytes, istaroxime increased diastolic Ca2+ level due to NKA blockade albeit minimal, while its effects on SERCA2a were almost absent. Conclusions SERCA2a stimulation by istaroxime improved STZ-induced DD and intracellular Ca2+ handling anomalies. Thus, SERCA2a stimulation can be considered a promising therapeutic approach for DD treatment. Translational perspective Deficient sarcoplasmic reticulum (SR) Ca2+ uptake has been identified in cardiomyocytes from failing human hearts with impaired diastolic relaxation (e.g. diabetic hearts) and has been associated with a decreased SERCA2a expression and activity and/or with a higher SERCA2a inhibition by phospholamban. Thus, SERCA2a may represent a pharmacological target for interventions aimed at improving cytosolic Ca2+ compartmentalization into the SR to limit diastolic dysfunction pathologies. In this context, istaroxime is the first-in-class luso-inotropic agent targeting SERCA2a that has already demonstrated its efficacy in clinical trials and may be useful to clarify the relevance of SERCA2a stimulation in controlling cytosolic Ca2+ level.

BackgroundHeart failure (HF) therapeutic toolkit would strongly benefit from the availability of ino-lusitropic agents with a favorable pharmacodynamics and safety profile. Istaroxime is a promising agent, which combines Na+/K+ pump inhibition with SERCA2a stimulation; however, it has a very short half-life and extensive metabolism to a molecule, named PST3093. The present work aims to investigate whether PST3093, still retains the pharmacodynamic and pharmacokinetic properties of its parent compound.MethodsWe studied PST3093 for its effects on SERCA2a and Na+/K+ ATPase activities, Ca2+ dynamics in isolated myocytes and hemodynamic effects in an in-vivo rat model of diabetic (streptozotocin (STZ)-induced) cardiomyopathy.ResultsIstaroxime infusion in HF patients led to accumulation of PST3093 in the plasma; clearance was substantially slower for PST3093 than for istaroxime. In cardiac rat preparations PST3093 did not inhibit the Na+/K+ ATPase activity, but retained SERCA2a stimulatory activity. In in-vivo echocardiographic assessment, PST3093 improved overall cardiac performance and reversed most STZ-induced abnormalities. PST3093 i.v. toxicity was considerably lower than that of istaroxime and it failed to significantly interact with 50 off-targets.ConclusionsOverall, PST3093 is a “selective” SERCA2a activator, the prototype of a novel pharmacodynamic category with a potential in the ino-lusitropic approach to HF with prevailing diastolic dysfunction. Its pharmacodynamics are peculiar and its pharmacokinetics are suitable to prolong the cardiac beneficial effect of istaroxime infusion.Graphical abstract

Neurocognitive disorders are frequent among chronic kidney disease (CKD) patients. Identifying and characterizing cognitive impairment (CI) can help to assess the ability of adherence to CKD risk reduction strategy, identify potentially reversible causes of cognitive decline, modify pharmacotherapy, educate the patient and caregiver and provide appropriate patient and caregiver support. Numerous factors are associated with the development and progression of CI in CKD patients and various conditions can influence the results of cognitive assessment in these patients. Here we review clinical warning signs that should lead to cognitive screening; conditions frequent in CKD at risk to interfere with cognitive testing or performance, including specificities of cognitive assessment in dialysis patients or after kidney transplantation; and available tests for screening and observed cognitive patterns in CKD patients., Graphical Abstract Graphical abstract

Neuropeptide Y (NPY) is a 36-amino-acid peptide member of a family also including peptide YY and pancreatic polypeptide, which are all ligands to Gi/Go coupled receptors. NPY regulates several fundamental biologic functions including appetite/satiety, sex and reproduction, learning and memory, cardiovascular and renal function and immune functions. The mesenteric circulation is a major source of NPY in the blood in man and this peptide is considered a key regulator of gut-brain cross talk. A progressive increase in circulating NPY accompanies the progression of chronic kidney disease (CKD) toward kidney failure and NPY robustly predicts cardiovascular events in this population. Furthermore, NPY is suspected as a possible player in accelerated cognitive function decline and dementia in patients with CKD and in dialysis patients. In theory, interfering with the NPY system has relevant potential for the treatment of diverse diseases from cardiovascular and renal diseases to diseases of the central nervous system. Pharmaceutical formulations for effective drug delivery and cost, as well as the complexity of diseases potentially addressable by NPY/NPY antagonists, have been a problem until now. This in part explains the slow progress of knowledge about the NPY system in the clinical arena. There is now renewed research interest in the NPY system in psychopharmacology and in pharmacology in general and new studies and a new breed of clinical trials may eventually bring the expected benefits in human health with drugs interfering with this system. Funding Agencies|COST Action CA19127-Cognitive Decline in Nephro-Neurology: European Cooperative Target (CONNECT)

In cantilever construction of long-span cable-stayed bridges the stressing sequence of stays is fundamental for establishing the final configuration of the bridge. The structural behaviour of these bridges is usually evaluated through a forward staged construction analysis, in which the values of the prestressing forces to be applied to stays are the main unknowns. A unified procedure for determining the initial cable forces and for analyzing the entire sequence is presented here, considering the geometric nonlinearity of stays through the Dischinger equivalent elastic modulus. The target is the simultaneous determination of the initial cable forces with the simulation of the construction stages in the forward analysis, taking into account the cable-sag effect, in order to achieve the required geometric configuration at the end of the sequence together with an advantageous state of stress for deck and pylon. Furthermore, a probabilistic approach is proposed for the evaluation of the effects that uncertainties of stay forces, occurring in the actual stressing sequences on site, have on the bridge behaviour. With this purpose probable errors during the real work operations on site are considered here in addition to the theoretical analysis of construction stages. Finally, the evaluation of the reliability of the proposed procedure is tested on a case-study of a long-span cable-stayed bridge, considering the influence of the deck typology on the stressing sequence.

Patients with severely decreased glomerular filtration rate (GFR) (i.e., chronic kidney disease [CKD] G4+) are at increased risk for kidney failure, cardiovascular disease (CVD) events (including heart failure), and death. However, little is known about the variability of outcomes and optimal therapeutic strategies, including initiation of kidney replacement therapy (KRT). Kidney Disease: Improving Global Outcomes (KDIGO) organized a Controversies Conference with an international expert group in December 2016 to address this gap in knowledge. In collaboration with the CKD Prognosis Consortium (CKD-PC) a global meta-analysis of cohort studies (n = 264,515 individuals with CKD G4+) was conducted to better understand the timing of clinical outcomes in patients with CKD G4+ and risk factors for different outcomes. The results confirmed the prognostic value of traditional CVD risk factors in individuals with severely decreased GFR, although the risk estimates vary for kidney and CVD outcomes. A 2- and 4-year model of the probability and timing of kidney failure requiring KRT was also developed. The implications of these findings for patient management were discussed in the context of published evidence under 4 key themes: management of CKD G4+, diagnostic and therapeutic challenges of heart failure, shared decision-making, and optimization of clinical trials in CKD G4+ patients. Participants concluded that variable prognosis of patients with advanced CKD mandates individualized, risk-based management, factoring in competing risks and patient preferences.

In box girder bridges, the quantity and distribution of reinforcement to be put in concrete elements of sections can be evaluated only by considering the deformation of the cross section in addition to the longitudinal analysis of the static scheme, establishing the entire state of stress of box sections. This leads to a need to evaluate the interaction between internal forces obtained by the global analysis and the ones obtained by the local analysis of the cross sections. The frame effect implies the elastic deformation of slabs and webs, whereas eccentrically applied loads lead to cross-section distortion with the loss of the box shape. Hence, the reinforcement is strongly influenced by a significant interaction between longitudinal shear and transverse bending moments, because the same reinforcement bars, although acting on different planes, face these two stress resultants. Moreover, the longitudinal reinforcement in the webs plays an important role in the failure model. In this paper, an analytical model of interaction between longitudinal shear and transverse bending is presented, based on the stress field theory and on the application of the static theorem of plasticity. The proposed model allows engineers to establish the effective quantity of transverse and longitudinal reinforcements of box girder elements, both for ordinary and prestressed concrete girders. In the model, the variation of stress field inclination between the limit state of first cracking (serviceability) and the ultimate limit state is considered, and the related consequences are discussed. Interaction domains of longitudinal shear and transverse bending are sketched and supplied through dimensionless graphs to be used by designers for actual cases of engineering practice. A case study of a prestressed girder bridge is presented to show the reliability of the proposed approach. The analytical model is validated through comparisons with experimental data; finally, the influences of prestressing, warping phenomena, and cross-section distortion are discussed.

The effects of time-dependent phenomena on concrete prestressed girder bridges are investigated. The study concerns the case of bridges built directly in their final configuration and that of bridges built by a sequence of stages in which geometry, restraints, and loads vary until the final configuration is achieved. An analytical approach based on the principles of aging linear viscoelasticity and the age-adjusted effective modulus method is followed. The paper has two aims: the first is to provide an efficient and simplified tool for the evaluation of the structural response in the early stages of design; the second is to compare the results of the analyses on actual cases of bridges when different shrinkage and creep prediction models are used. Numerical applications show that the influence of stress redistribution on bending moments, attributable to the change in static schemes, is reduced by the load-balancing effect of the dead load and prestressing and that bending moment diagrams for bridges in service do not change significantly with the different prediction models. Opposite results are found on deflections, which differ significantly in reference to the model used. Differences between predictions models are underlined, suggesting that designers should manage them with prudence to predict the long-term performance of concrete. Finally, Eurocode predictions always underestimate final deflections and stress redistribution because of the static scheme variation.

The structural behaviour of incrementally launched bridges in the construction stages depends on different parameters involving deck, nose, supports and guide devices, because static schemes vary continuously with the advance of the deck above the piers. For this reason temporary stresses in the deck, during launching, are rather different from those occurring in service life. Horizontally curved launched bridges also present the effects of torsion induced by geometric curvature. A parametric study is presented in order to analyse the influence of design parameters on the construction of these bridges. Analyses were carried out by extending to curved beams a procedure based on the Transfer Matrix Method, already known for straight continuous decks. Effects of curvature, nose–deck ratios of length and load, bending and torsional stiffness ratio were taken into account. The results show that maximum torsion values increase with the decrease in the curvature radius R and with the decrease in the ratio between bending and torsional stiffness. Moreover, with variation in the nose length ratio, the value ln/l = 0.60 with respect to the span length, is confirmed as the optimal value, as happens for straight bridges. With variation in the nose weight, a significant increase in bending moment and torsion can only be appreciated in the cantilever stages of launching. Dimensionless diagrams and related expressions are given for numerical evaluation of the maximum values of bending moment and torsion in the construction stages, with variation in the stiffness ratio and the radius of curvature.

A cable-stayed bridge is built by following a construction sequence of different subsequent stages that imply changes of the geometric configuration, restraints and consequently stress and strain patterns. A study is presented about stay stressing sequences in cable-stayed bridges with composite deck for the case of construction made by the cantilever method. Initial cable forces are found through partial elastic schemes of construction stages. Different stay stressing procedures are implemented and a comparison between them is proposed in order to evaluate the differences in terms of deformed shape and internal force distribution of the deck and the pylon. Results can be useful to give practical suggestions to designers, when they have to deal with stay stressing sequences of composite cable-stayed bridges.

The evaluation of the safety degree in service life for a segmental prestressed concrete bridge built by the cantilever method presents different aspects related to strength, deformability, durability and to effects of time-dependent phenomena as creep and shrinkage. The case-study of a prestressed concrete frame bridge with inclined piers is presented, built by cantilevering, with precast segments. By considering the fundamental items of design and construction stages, the implications due to the arch effect in this static scheme are investigated, with respect to an equivalent bridge with a final scheme of continuous girder on vertical piers. The birth of a significant value of axial force in the main span is considered and the stress redistribution in time due to the effects of creep on the static scheme change during construction is analysed. The main parameters involved are underlined and results in terms of serviceability and ultimate limit state are obtained. Finally, aspects related to durability are considered and analysed in the presented case-study.

In this paper, a study about stay stressing procedures of concrete arch bridges built by cantilevering with temporary stays is presented. Particularly, the partial elastic scheme method is proposed to find the initial cable forces, and a forward procedure is implemented to follow the actual sequence of construction by extending a procedure already applied to concrete cable–stayed bridges. The theoretical treatment is followed by a numerical application on a case study of a concrete arch bridge, and a comparison between initial cable forces found by the partial elastic scheme method and classical backward analysis is presented here. Results show the effectiveness of the proposed procedure to achieve the requested design geometry of the arch and for limiting the variation of bending moments and stay forces in construction stages.

In this paper a study on prestressed concrete slab bridges is presented. A design philosophy based on the concept of load balancing through prestressing is proposed in order to minimize the effects of delayed deformations due to creep. Aspects related to the stress redistribution inside these bridges for time-dependent phenomena are analyzed and discussed, by applying the principles of aging linear visco-elasticity. Prestressing is seen as an equivalent external load which counterbalances the permanent loads applied to the bridge, nullifying the elastic deflections due to sustained loads, and thus avoiding the related delayed deformations. An optimization of the structural behavior through the use of one-way prestressing is achieved. The determination of a convenient variable depth of slab bridges and the correspondent layout of tendons is considered as a useful means for applying the load balancing concept in actual cases of structures like long cantilevers or bridge decks. A case-study related to the slab bridges built 30 years ago at Jeddah in Saudi Arabia is presented and discussed, in order to show the effectiveness of the proposed approach to the conceptual design of prestressed concrete bridges.

Construction stages of a cable-stayed bridge are characterized by a sequence in which geometric configuration, restraints and consequently stress and strain patterns vary many times till the final arrangement is achieved. When construction of concrete bridges is made by cantilever method the influence of time-dependent phenomena becomes significant. In this study an evaluation of stay stressing procedures is given by taking into account creep and shrinkage in cantilever construction of concrete cable-stayed bridges. A methodology of stay stressing is proposed with the final target of reaching the desired geometric configuration. Comparison with classical analyses performed by backward methodology is reported. A case-study is presented and discussed by performing analyses with different international creep models. Practical suggestions are given to designers, in order to minimize time-dependent effects on deck and stay internal forces and to reach an optimal final configuration.

Box girder, due to its high torsional stiffness, is very appropriate for railway and highway long- medium span bridges. This type of cross section, subjected to transversely non-uniform loads, present warping and distortion phenomena. Accurate but time-consuming numerical procedures are available for determination of further strains and stresses caused by cross-section deformation. In this paper warping and distortion of box girders is evaluated through BEF analogy, by writing a 4th order differential equation. The problem is solved for practical cases of box girders by considering internal diaphragms stiffness. Graphs are supplied to designers and main design parameters affecting cross section deformation are underlined. The proposed methodology is shown through the use of graphs by developing numerical examples on actual bridge girders.

In this paper a study about concrete arch bridges built by lattice cantilevers is presented. Lattice cantilevers are partial structures composed of deck, arch, piers and provisional steel diagonals, organized as reticular cantilever girders, in order to build arch bridges without the use of centrings, supports or temporary towers. Characteristics of this construction methodology with its variants are explained together with their implications in the erection sequence. Partial elastic scheme method is implemented in order to find initial forces of temporary cables and a forward analysis is carried out to follow the actual sequence of construction, by extending a procedure already applied to concrete cable–stayed bridges and to arches built by the classical suspended cantilever method. A numerical application on a case–study of a concrete arch bridge is performed together with a comparison between different methodologies followed for its construction sequence. Differences between erection by lattice cantilevers and cable-stayed cantilevers, are discussed. Results can be useful for designers in conceptual design of concrete arch bridges.

A solution of space curved bars with generalized Winkler soil found by means of Transfer Matrix Method is presented. Distributed, concentrated loads and imposed strains are applied to the beam as well as rigid or elastic boundaries are considered at the ends. The proposed approach gives the analytical and numerical exact solution for circular beams and rings, loaded in the plane or perpendicular to it. A well-approximated solution can be found for general space curved bars with complex geometry. Elastic foundation is characterized by six parameters of stiffness in different directions: three for rectilinear springs and three for rotational springs. The beam has axial, shear, bending and torsional stiffness. Numerical examples are given in order to solve practical cases of straight and curved foundations. The presented method can be applied to a wide range of problems, including the study of tanks, shells and complex foundation systems. The particular case of box girder distortion can also be studied through the beam on elastic foundation (BEF) analogy.