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

Estimation of potential flash flood risk in a basin using morphometric parameters: A case study of Akcay Basin

In this study, the Akcay basin located in Western Black Sea Region was divided into sub basins and the geometrical parameters of those sub basins, the drainage network and the stream orders specified by the Strahler method were determined by using ArcGIS 10.1.Thus, the morphometric parameters of each sub basin were computed.Then, in order to be able to evaluate the sub basins in terms of flood potential, a prioritization method in the literature was adapted and with the usage of the morphometric parameters the sub basins were graded according to their flood potentials. According to the sub basin prioritization carried out, it was determined that the reservoir of the Yunuslar HEPP located in the Akcay basin enclosed the sub basin which had a high flood potential and constituted approximately half of the total drainage area of the basin. Furthermore, it was suggested that construction of a check dam in the sub basin which has the largest drainage area and a river bridge located at its outlet point would reduce the potential effect of the flash flood for both the river bridge and the whole basin. The flash flood potential of all sub basins was also investigated by using lesser number of morphometric parameters according to a graphical method in the literature and the flash flood potential of all sub basins was found to be moderate according to this method

Effect of watershed partitioning on hydrologic parameters and estimation of hydrograph of an ungauged basin: a case study in Gokirmak and Kocanaz, Turkey

The main goal of this study is to investigate the effect of the size of the subbasins of a watershed on the hydrologic parameters and their spatial variability in an estimation of the hydrologic parameters and hydrograph of a neighbouring ungauged basin. In this paper, Hydrologic Engineering Center-Hydrologic Modelling System (HEC-HMS), a semi-distributed hydrologic model, is used to calibrate and cross-validate two flood events occurred in 1998 and then validate four other flood events occurred in 1991, 1994, 2002, and 2009 in Gokirmak Basin in Western Black Sea Region, Turkey. The basin is divided into seven different subbasins to investigate the effect of watershed partitioning on calibrated hydrologic parameters of each subbasin using the peak-weighted root mean square error method as an objective function and the hydrograph at the outlet of the whole basin. It is found out that as the geometric magnitudes of the subbasins changed, the calibrated values of the hydrologic parameters of those subbasins changed as well. Then, a neighbouring basin, Kocanaz, is considered as an assumed neighbouring ungauged basin to investigate the effect of watershed partitioning of a gauged basin on the estimation of hydrograph of a neighbouring ungauged basin. Hydrologic parameters and direct runoff hydrograph of assumed ungauged neighbouring basin are estimated from the hydrologic parameters of the HEC-HMS calibration results of Gokirmak. Statistical indicators of the simulation results for each basin partitioning were graded with respect to the boundary values of the simulation outputs to find the best alternative. The grading results show that the simulation results with a single basin gave better representation among all other partitioning except two flood events

Effect of using multiple stream gauging stations on calibration of hydrologic parameters and estimation of hydrograph of ungauged neighboring basin

In this study, Hydrologic Engineering Center-Hydrologic Modeling System is used to simulate hydrologic processes in a watershed in Western Black Sea Region that frequently experiences flooding. The region is mountainous with steep hill slopes and receives high precipitation throughout the year. There are three stream gauging stations in the basin whose data are available for calibration and validation of hydrologic parameters. Simulations are performed for different scenarios to investigate the effect of using multiple stream gauging stations' data on catchment wide calibration and validation of hydrologic parameters. Furthermore, performance of using calibrated internal stream gauging stations' flow data in the estimation of hydrologic parameters in an assumed neighboring ungauged basin was assessed. It is found that using data of multiple stream gauging stations for calibration and validation gives satisfactory results for direct runoff hydrograph but the peak discharge predictions are not improved. The study results suggest that using data of internal stream gauging stations enables improved understanding of internal dynamics and transport in the basin and better predicted direct runoff hydrograph for the assumed neighboring ungauged basin

Development of a Safety-Inspection Method for River Bridges in Turkey

In this paper, findings of a research project about river bridges in Turkey are shared and details of the developed safety-inspection method based on hydrological and hydraulic factors are presented. In the project, the Western Black Sea Basin was chosen as the pilot area, where the basin is mountainous with steep slopes and has a rainy climate with frequent flash floods. Many river bridges in the basin were inspected at different flow conditions throughout the project duration of three years. The developed safety-inspection method is composed of four main parts: evaluation of watershed hydrology and its flood potential, stream stability, bridge characteristics and a rapid scour assessment. A structural assessment is also included in the method. Five river bridges in the area were chosen for detailed inspection and application of the method. Results showed that the method was capable of identifying and ranking the bridges in regard to maintenance needs and forming a comprehensive inventory for bridge engineers

A Novel Mutation in Human Androgen Receptor Gene Causing Partial Androgen Insensitivity Syndrome in a Patient Presenting with Gynecomastia at Puberty

WOS: 000378169400018PubMed ID: 27087292Partial androgen insensitivity syndrome (PAIS) typically presents with micropenis, perineoscrotal hypospadias, and a bifid scrotum with descending or undescending testes and gynecomastia at puberty. It is an X-linked recessive disorder resulting from mutations in the androgen receptor (AR) gene. However, AR gene mutations are found in less than a third of PAIS cases. A 16-year-old boy was admitted with complaints of gynecomastia and sparse facial hair. Family history revealed male relatives from maternal side with similar clinical phenotype. His external genitalia were phenotypically male with pubic hair Tanner stage IV, penoscrotal hypospadias, and a bifid scrotum with bilateral atrophic testes. He had elevated gonadotropins with a normal testosterone level. Chromosome analysis revealed a 46,XY karyotype. Due to the family history suggesting a disorder of X-linked trait, PAIS was considered and molecular analysis of AR gene was performed. DNA sequence analysis revealed a novel hemizygous mutation p.T576I (c. 1727C>T) in the AR gene. The diagnosis of PAIS is based upon clinical phenotype and laboratory findings and can be confirmed by detection of a defect in the AR gene. An accurate approach including a detailed family history suggesting an X-linked trait is an important clue for a quick diagnosis

Efficacy And Safety Of Hepatectomy Performed With Intermittent Portal Triad Clamping With Low Central Venous Pressure

Background. This retrospective study was designed to investigate the efficacy and safety of intermittent portal triad clamping (PTC) with low central venous pressure (CVP) in liver resections. Methods. Between January 2007 and August 2013, 115 patients underwent liver resection with intermittent PTC. The patients' data were retrospectively analyzed. Results. There were 58 males and 57 females with a mean age of 55 years (±13.7). Cirrhosis was found in 23 patients. Resections were performed for malignant disease in 62.6% (n = 72) and for benign disease in 37.4% (n = 43). Major hepatectomy was performed in 26 patients (22.4%). Mean liver ischemia period was 27.1 min (±13.9). The mortality rate was 1.7% and the morbidity rate was 22.6%. Cumulative clamping time (t = 3.61, P < 0.001) and operation time (t = 2.38, P < 0.019) were significantly correlated with AST alterations (D-AST). Cumulative clamping time (t = 5.16, P < 0.001) was significantly correlated with D-ALT. Operation time (t = 5.81, P < 0.001) was significantly correlated with D-LDH. Conclusions. Intermittent PTC under low CVP was performed with low morbidity and mortality. Intermittent PTC can be safely applied up to 60 minutes in both normal and impaired livers.PubMedWoSScopu

Consensus Report on Patient Blood Management in Cardiac Surgery by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Cardiology (TSC), and Society of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care (SCTAIC)

Anemia, transfusion and bleeding independently increase the risk of complications and mortality in cardiac surgery. The main goals of patient blood management are to treat anemia, prevent bleeding, and optimize the use of blood products during the perioperative period. The benefit of this program has been confirmed in many studies and its utilization is strongly recommended by professional organizations. This consensus report has been prepared by the authors who are the task members appointed by the Turkish Society of Cardiovascular Surgery, Turkish Society of Cardiology (TSC), and Society of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care to raise the awareness of patient blood management. This report aims to summarize recommendations for all perioperative blood-conserving strategies in cardiac surgery