Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

The Colorado river delta (Mexico): ecological importance and management - DOI: 10.4025/actascibiolsci.v30i4.5867

The Colorado river delta is a unique coastal system in the world, as it combines two important systems: the Colorado river and the Gulf of California. Consequently, the delta is dominated by bilateral interests, and influenced by administrative, political and natural processes, which involve the countries of the United States and Mexico. Located in the northern part of the Gulf of California, under a condition of natural isolation, a series of environmental attributes have been developed (biotic and abiotic) that are only observed in is region. In this work, the development of the bilateral political relations and the most important ecological characteristics are presented, as well as the management instruments that have been developed for over 80 years. From these issues, the possible scenario for the region is defined, and the development of methodologies for monitoring the effects of these possible tendencies on the natural components of the delta is proposed.The Colorado river delta is a unique coastal system in the world, as it combines two important systems: the Colorado river and the Gulf of California. Consequently, the delta is dominated by bilateral interests, and influenced by administrative, political and natural processes, which involve the countries of the United States and Mexico. Located in the northern part of the Gulf of California, under a condition of natural isolation, a series of environmental attributes have been developed (biotic and abiotic) that are only observed in is region. In this work, the development of the bilateral political relations and the most important ecological characteristics are presented, as well as the management instruments that have been developed for over 80 years. From these issues, the possible scenario for the region is defined, and the development of methodologies for monitoring the effects of these possible tendencies on the natural components of the delta is proposed

POSEIDO. 2014;2(3) ISAIAS FAST scores in European and Korean universities 179 ISSN 2307-5295, Published by the POSEIDO Organization &amp; Foundation under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License T

Abstract Background and objectives. Internationalization is a major evolution in implant dentistry and biomaterial higher education and research. The aim of the present 3-part study was to apply the ISAIAS method (Intercultural Sensitivity Academic Index &amp; Advanced Standards) in this highly specialized dental field, and to evaluate the impact of leaders of internationalization. In this first part, the ISAIAS method was applied to the general campus of 3 universities, to validate the method itself and to assess the internationalization efforts of the participant universities through the development of intercultural competences, particularly in the Asian and European contexts. Materials and Methods. In each campus, a group of 20 Professors and 100 undergraduate students from 3 different Universities (respectively University of Granada, Spain; ParisSorbonne University, France; and Chonnam National University, South Korea) were observed through the ISAIAS FAST (Fast Assessment Screening Test) questionnaire and through intensive field study (mixed methodology, i.e. combination of qualitative and quantitative methods). A final ISAIAS FAST score (mean value) was calculated for each group, including the mean scores in the 4 dimensions of intercultural competences, and scores were integrated with field observation for interpretation. Results. The scores observed in the 3 universities presented different patterns, but relatively mild scores (always between 2 and 3), what appeared typical from Universities with moderate internationalization policies, i.e. a wish for internationalization which may not be fully fulfilled because of the organizational culture of the institution. Discussion and conclusions. The scores appeared coherent with the field observations in all aspects. The ISAIAS mixed methodology appeared as an easy and useful method to evaluate the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the internationalization efforts of these universities through the evaluation of the development of intercultural competences of the students and researchers/professors, but it requires to combine the FAST scores with an in-depth field study

Avis de l'Anses relatif à la présence de parasites Toxocara spp. dans les viandes de sanglier sauvage

Citation suggérée : Anses. (2023). Avis relatif à la présence de parasites Toxocara spp. dans les viandes de sanglier sauvage (saisine 2023-SA-0055). Maisons-Alfort : Anses, 20 p.Des analyses sur les carcasses de sangliers sauvages inspectées dans les établissements français de traitement de gibiers sauvages ont révélé depuis deux ans la présence régulière de larves de Toxocara spp. Ce constat a conduit les services vétérinaires d'inspection à saisir ces carcasses, conformément à l'article 45 du règlement d'exécution (UE) n°2019/627 de la Commission du 15 mars 2019 qui prévoit que les viandes présentant une infestation parasitaire sont déclarées impropres à la consommation humaine. La problématique pour le gestionnaire est double. Le premier enjeu est lié au risque de toxocarose pour les consommateurs de viandes de sanglier et des recommandations relatives à la conservation et la cuisson des viandes à adresser aux chasseurs. Le second enjeu est relatif à la gestion des lots de sangliers détectés positifs.Les demandes instruites dans le cadre de cette expertise sont les suivantes :Demande 1 : Établir un profil de risque pour Toxocara spp. dans les viandes de sanglier sauvage.Demande 2 : Évaluer l’efficacité de traitements assainissants de la carcasse sur la viabilité duparasite Toxocara spp., plus particulièrement la congélation et la cuisson, dans le cas où cestraitements sont réalisés, soit par les établissements du secteur alimentaire, soit directementpar les consommateurs