Incision ante- et post-capture dans les vallées de l’Ornainet de la Saulx (Est du bassin de Paris)

Les travaux de cartographie montrent que les formations alluviales et les paléoformes fluviatiles des vallées de l’Ornain et de la Saulx permettent de reconstituer 11 stades de creusement plio-pléistocène regroupés en 4 épisodes : A, très ancien ; B, ancien ; C, récent ; D, actuel. Deux d’entre eux (A, B) sont antérieurs à la capture de l’Ornain et de la Saulx par la Marne et les deux autres (C, D) lui sont postérieurs. Les alluvions anté-capture, bien conservées, ont été rattachées au Quaternaire moyen d’après la faune et l’industrie préhistorique. Les taux d’incision de la Saulx et de l’Ornain ont brusquement varié suite à leur capture par la Marne, événement survenu il y a environ 250 ka BP. Estimées à environ  3 à 4 cm/ka sur tout le secteur (dans le Paléo-Perthois comme dans le Barrois) pour la période anté-capture, les vitesses d’incision sont nettement plus élevées pour la période post-capture. Maximales (12 à 20 cm/ka) sur le site de capture, elles se réduisent progressivement d’aval en amont (8 à 10 cm/ka à Stainville et4 à 6 cm/ka à Tréveray) et varient dans le détail en fonction des conditions liées à la nature du substratum, aux confluences et aux processus karstiques.Mapping shows that the alluvial formations and fluvial palaeoforms of the Ornain and Saulx valleys can be used to reconstruct 11 stages of Plio-Pleistocene incision subdivided in to 4 episodes : A, very old ;B, old ; C, recent ; D, present. Two of them (A, B) predate the capture of the Ornain and the Saulx by the Marne, and the two others (C, D) post-date it. The well-preserved pre-capture alluvial deposits were linked to the Mid-Quaternary by the fauna and prehistoric industry. The rates of incision of the Saulx and the Ornain varied abruptly following their capture by the Marne, an event which occurred about 250 ka BP. Estimated at about 3 to 4 cm/ka throughout the sector (in the Paleo-Perthois and the Barrois) for the pre-capture period, incision speed increased considerably during the post-capture period. Maximum rates (12 to 20 cm/ka) were recorded at the capture site and gradually decreased upstream (8 to 10 cm/ka at Stainville and 4 to 6 cm/ka at Tréveray), varying in detail according to conditions linked to the nature of the substrate, confluences and karstic processes.Auf der Grundlage der in diesem Rahmen vorgenommenen Kartografier­ arbeiten lassen sich in den alluvialen Formationen und fluviatilen Paläo-Formen der Täler des Ornain und der Saulx 11 Einschnittstadien des Plio-Pleistozäns rekonstituieren, die sich wiederum in vier Abschnitte : A, sehr alt ; B, alt ; C, jung ; D, gegenwärtig, unterteilen. Zwei von ihnen (A, B) sind vor der Anzapfung des Ornain und der Saulx durch die Marne und die beiden anderen (C, D) danach anzusiedeln. Die gut konservierten Ablagerungen aus der Zeit vor der Anzapfung wurden entsprechend der Fauna und der prähistorischen Industrie dem mittleren Quartär zugeordnet. Die Einschnittwerte der Saulx und des Ornain haben sich infolge ihrer Anzapfung durch die Marne, der vor etwa 250 ka BP erfolgte, erheblich geändert. Sie werden für die Periode vor der Anzapfung und für den gesamten Bereich (im Paläo-Perthois als auch im Barrois) auf 3-4 cm/ka geschätzt. In der Periode nach der Anzapfung sind die Einschnittswerte deutlich höher. Die Höchstwerte (12-20 cm/ka) am Ort der Anzapfung nehmen Richtung flussaufwärts ab (8-10 cm/ka in Stainville und 4-6 cm/ka in Tréveray) und variieren im einzelnen in Abhängigkeit von der Art des Untergrundes sowie der Zuflüsse und der Karsteinwirkungen

Clinical Study Comparison of a Bayesian Network with a Logistic Regression Model to Forecast IgA Nephropathy

Models are increasingly used in clinical practice to improve the accuracy of diagnosis. The aim of our work was to compare a Bayesian network to logistic regression to forecast IgA nephropathy (IgAN) from simple clinical and biological criteria. Retrospectively, we pooled the results of all biopsies (n = 155) performed by nephrologists in a specialist clinical facility between 2002 and 2009. Two groups were constituted at random. The first subgroup was used to determine the parameters of the models adjusted to data by logistic regression or Bayesian network, and the second was used to compare the performances of the models using receiver operating characteristics (ROC) curves. IgAN was found (on pathology) in 44 patients. Areas under the ROC curves provided by both methods were highly significant but not different from each other. Based on the highest Youden indices, sensitivity reached (100% versus 67%) and specificity (73% versus 95%) using the Bayesian network and logistic regression, respectively. A Bayesian network is at least as efficient as logistic regression to estimate the probability of a patient suffering IgAN, using simple clinical and biological data obtained during consultation

Incision ante- et post-capture dans les vallées de l’Ornainet de la Saulx (Est du bassin de Paris)

Les travaux de cartographie montrent que les formations alluviales et les paléoformes fluviatiles des vallées de l’Ornain et de la Saulx permettent de reconstituer 11 stades de creusement plio-pléistocène regroupés en 4 épisodes : A, très ancien ; B, ancien ; C, récent ; D, actuel. Deux d’entre eux (A, B) sont antérieurs à la capture de l’Ornain et de la Saulx par la Marne et les deux autres (C, D) lui sont postérieurs. Les alluvions anté-capture, bien conservées, ont été rattachées au Quaternaire moyen d’après la faune et l’industrie préhistorique. Les taux d’incision de la Saulx et de l’Ornain ont brusquement varié suite à leur capture par la Marne, événement survenu il y a environ 250 ka BP. Estimées à environ  3 à 4 cm/ka sur tout le secteur (dans le Paléo-Perthois comme dans le Barrois) pour la période anté-capture, les vitesses d’incision sont nettement plus élevées pour la période post-capture. Maximales (12 à 20 cm/ka) sur le site de capture, elles se réduisent progressivement d’aval en amont (8 à 10 cm/ka à Stainville et4 à 6 cm/ka à Tréveray) et varient dans le détail en fonction des conditions liées à la nature du substratum, aux confluences et aux processus karstiques.Mapping shows that the alluvial formations and fluvial palaeoforms of the Ornain and Saulx valleys can be used to reconstruct 11 stages of Plio-Pleistocene incision subdivided in to 4 episodes : A, very old ;B, old ; C, recent ; D, present. Two of them (A, B) predate the capture of the Ornain and the Saulx by the Marne, and the two others (C, D) post-date it. The well-preserved pre-capture alluvial deposits were linked to the Mid-Quaternary by the fauna and prehistoric industry. The rates of incision of the Saulx and the Ornain varied abruptly following their capture by the Marne, an event which occurred about 250 ka BP. Estimated at about 3 to 4 cm/ka throughout the sector (in the Paleo-Perthois and the Barrois) for the pre-capture period, incision speed increased considerably during the post-capture period. Maximum rates (12 to 20 cm/ka) were recorded at the capture site and gradually decreased upstream (8 to 10 cm/ka at Stainville and 4 to 6 cm/ka at Tréveray), varying in detail according to conditions linked to the nature of the substrate, confluences and karstic processes.Auf der Grundlage der in diesem Rahmen vorgenommenen Kartografier­ arbeiten lassen sich in den alluvialen Formationen und fluviatilen Paläo-Formen der Täler des Ornain und der Saulx 11 Einschnittstadien des Plio-Pleistozäns rekonstituieren, die sich wiederum in vier Abschnitte : A, sehr alt ; B, alt ; C, jung ; D, gegenwärtig, unterteilen. Zwei von ihnen (A, B) sind vor der Anzapfung des Ornain und der Saulx durch die Marne und die beiden anderen (C, D) danach anzusiedeln. Die gut konservierten Ablagerungen aus der Zeit vor der Anzapfung wurden entsprechend der Fauna und der prähistorischen Industrie dem mittleren Quartär zugeordnet. Die Einschnittwerte der Saulx und des Ornain haben sich infolge ihrer Anzapfung durch die Marne, der vor etwa 250 ka BP erfolgte, erheblich geändert. Sie werden für die Periode vor der Anzapfung und für den gesamten Bereich (im Paläo-Perthois als auch im Barrois) auf 3-4 cm/ka geschätzt. In der Periode nach der Anzapfung sind die Einschnittswerte deutlich höher. Die Höchstwerte (12-20 cm/ka) am Ort der Anzapfung nehmen Richtung flussaufwärts ab (8-10 cm/ka in Stainville und 4-6 cm/ka in Tréveray) und variieren im einzelnen in Abhängigkeit von der Art des Untergrundes sowie der Zuflüsse und der Karsteinwirkungen

Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups

Background: Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention). Methods: In CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care. Results: Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80 [95% CI, 0.67-0.95]; P=0.01), with consistent reductions in both the primary (HR, 0.68 [95% CI, 0.49-0.94]) and secondary (HR, 0.85 [95% CI, 0.69-1.06]) prevention groups (P for interaction=0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78 [95% CI, 0.61-1.00]), nonfatal myocardial infarction (HR, 0.81 [95% CI, 0.59-1.10]), and nonfatal stroke (HR, 0.80 [95% CI, 0.56-1.15]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction >0.5 for each outcome). Conclusions: Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease

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

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

ECLAIRE: Effects of Climate Change on Air Pollution Impacts and Response Strategies for European Ecosystems. Project final report

The central goal of ECLAIRE is to assess how climate change will alter the extent to which air pollutants threaten terrestrial ecosystems. Particular attention has been given to nitrogen compounds, especially nitrogen oxides (NOx) and ammonia (NH3), as well as Biogenic Volatile Organic Compounds (BVOCs) in relation to tropospheric ozone (O3) formation, including their interactions with aerosol components. ECLAIRE has combined a broad program of field and laboratory experimentation and modelling of pollution fluxes and ecosystem impacts, advancing both mechanistic understanding and providing support to European policy makers. The central finding of ECLAIRE is that future climate change is expected to worsen the threat of air pollutants on Europe’s ecosystems. Firstly, climate warming is expected to increase the emissions of many trace gases, such as agricultural NH3, the soil component of NOx emissions and key BVOCs. Experimental data and numerical models show how these effects will tend to increase atmospheric N deposition in future. By contrast, the net effect on tropospheric O3 is less clear. This is because parallel increases in atmospheric CO2 concentrations will offset the temperature-driven increase for some BVOCs, such as isoprene. By contrast, there is currently insufficient evidence to be confident that CO2 will offset anticipated climate increases in monoterpene emissions. Secondly, climate warming is found to be likely to increase the vulnerability of ecosystems towards air pollutant exposure or atmospheric deposition. Such effects may occur as a consequence of combined perturbation, as well as through specific interactions, such as between drought, O3, N and aerosol exposure. These combined effects of climate change are expected to offset part of the benefit of current emissions control policies. Unless decisive mitigation actions are taken, it is anticipated that ongoing climate warming will increase agricultural and other biogenic emissions, posing a challenge for national emissions ceilings and air quality objectives related to nitrogen and ozone pollution. The O3 effects will be further worsened if progress is not made to curb increases in methane (CH4) emissions in the northern hemisphere. Other key findings of ECLAIRE are that: 1) N deposition and O3 have adverse synergistic effects. Exposure to ambient O3 concentrations was shown to reduce the Nitrogen Use Efficiency of plants, both decreasing agricultural production and posing an increased risk of other forms of nitrogen pollution, such as nitrate leaching (NO3-) and the greenhouse gas nitrous oxide (N2O); 2) within-canopy dynamics for volatile aerosol can increase dry deposition and shorten atmospheric lifetimes; 3) ambient aerosol levels reduce the ability of plants to conserve water under drought conditions; 4) low-resolution mapping studies tend to underestimate the extent of local critical loads exceedance; 5) new dose-response functions can be used to improve the assessment of costs, including estimation of the value of damage due to air pollution effects on ecosystems, 6) scenarios can be constructed that combine technical mitigation measures with dietary change options (reducing livestock products in food down to recommended levels for health criteria), with the balance between the two strategies being a matter for future societal discussion. ECLAIRE has supported the revision process for the National Emissions Ceilings Directive and will continue to deliver scientific underpinning into the future for the UNECE Convention on Long-range Transboundary Air Pollution

ECLAIRE third periodic report

The ÉCLAIRE project (Effects of Climate Change on Air Pollution Impacts and Response Strategies for European Ecosystems) is a four year (2011-2015) project funded by the EU's Seventh Framework Programme for Research and Technological Development (FP7)