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

Climate seasonality limits leaf carbon assimilation and wood productivity in tropical forests

The seasonal climate drivers of the carbon cycle in tropical forests remain poorly known, although these forests account for more carbon assimilation and storage than any other terrestrial ecosystem. Based on a unique combination of seasonal pan-tropical data sets from 89 experimental sites (68 include aboveground wood productivity measurements and 35 litter productivity measurements), their associated canopy photosynthetic capacity (enhanced vegetation index, EVI) and climate, we ask how carbon assimilation and aboveground allocation are related to climate seasonality in tropical forests and how they interact in the seasonal carbon cycle. We found that canopy photosynthetic capacity seasonality responds positively to precipitation when rainfall is  < 2000 mm yr⁻¹ (water-limited forests) and to radiation otherwise (light-limited forests). On the other hand, independent of climate limitations, wood productivity and litterfall are driven by seasonal variation in precipitation and evapotranspiration, respectively. Consequently, light-limited forests present an asynchronism between canopy photosynthetic capacity and wood productivity. First-order control by precipitation likely indicates a decrease in tropical forest productivity in a drier climate in water-limited forest, and in current light-limited forest with future rainfall  < 2000 mm yr⁻¹

Genótipos melhorados de mamão (Carica papaya L.): avaliação sensorial e físico-química dos frutos

O presente trabalho teve por objetivo avaliar genótipos promissores através da avaliação sensorial e físico-química de frutos de doze genótipos melhorados de mamão (CMF008, CMF012, CMF018, CMF019, CMF020, CMF021, CMF022, CMF023, CMF030, CMF031, CMF036, CMF047), provenientes do Banco Ativo de Germoplasma da EMBRAPA Mandioca e Fruticultura, Cruz das Almas, Bahia, em dois anos consecutivos (1999 e 2000). As amostras dos doze genótipos foram submetidas à avaliação sensorial para os atributos aparência, cor, aroma, sabor e textura, através de testes afetivos utilizando-se escala hedônica estruturada de nove pontos. Realizou-se determinações de pH, acidez total titulável, sólidos solúveis (ºBrix), "ratio" e ácido ascórbico. Nas duas épocas de estudo, verificou-se que as maiores médias de aceitação para o atributo cor foram obtidas pelos frutos dos genótipos CMF008, CMF020, CMF021, CMF022, CMF023, CMF030, CMF031 e CMF036 que apresentaram coloração vermelho-alaranjada e os frutos dos genótipos CMF012, CMF022, CMF023, CMF031 e CMF047 obtiveram maior aceitação dos provadores alcançando médias elevadas para o atributo sabor. Constatou-se que as texturas mais firmes da polpa de mamão foram as mais aceitas, atingindo médias elevadas os frutos dos genótipos CMF008, CMF012, CMF022, CMF023, CMF030, CMF031, CMF036 e CMF047. Constatou-se, também, que os frutos dos genótipos CMF012, CMF020, CMF031 e CMF047 apresentaram os mais elevados valores de sólidos solúveis (12 a 14ºBrix) e os frutos dos genótipos CMF020 e CMF031 revelaram quantidades elevadas de ácido ascórbico, ao redor de 100mg%. O genótipo CMF031 foi o mais aceito pela equipe de provadores e apresentou os maiores valores de sólidos solúveis (ºBrix) e ácido ascórbico, podendo, então, ser considerado o mais promissor e com bom potencial para o mercado de fruta fresca e para industrialização

Processamento, estabilidade e aceitabilidade de marinado de vongole (Anomalocardia brasiliana) Processing, stability and acceptability of marinade of vongole (Anomalocardia brasiliana)

O vongole (Anomalocardia brasiliana) tem importância socioeconômica para grande parte da população da região da Baía de Todos os Santos, na costa da Bahia, por fazer parte da dieta familiar e ser uma das principais fontes de renda. Para ampliar a comercialização deste molusco foi desenvolvido um processo de obtenção de marinado, envolvendo acidificação do produto com vinagre (pH<4,5) e tratamento térmico convencional (banho-maria) durante 30 minutos. O Índice de Aceitabilidade do marinado foi de 78-82%, em relação à aparência, cor, aroma, sabor e textura. Sob os pontos-de-vista microbiológico, físico-químico, químico e sensorial, o marinado de vongole manteve-se estável durante 240 dias de armazenamento, a temperatura ambiente. O processo proposto atende a possibilidade de um maior e melhor aproveitamento comercial do vongole.<br>The vongole has economic-social importance to the most of people in the "Todos os Santos" Bay, located in Bahia coast, Brazil; it is a product of the familiar diet and it is one of the principal rental source of this local people. In purpose to increase the mollusc sale was developed studies on the marinating of vongole, through acidification of the product with vinegar at a pH[4,5 and a boiling water treatment during 30 min.The product was stored at room temperature for 240 days and the shelf life study included microbiological, physico-chemical, chemical and sensory evaluation. The process was effective to stablish commercial sterility to the marinaded vongole. According to sensory analyses, the marinaded vongole reached acceptability index like 78-82% for the overall appearance, colour, odour, flavour and texture. The data showed that the marinade of vongole was stable during storage for 240 days at room temperature

Qualidade física, microbiológica e parasitológica de alfaces (Lactuca sativa) de diferentes sistemas de cultivo Physical, microbiological and parasitological quality of lettuce (Lactuca sativa) from different growing processes

A alface (Lactuca sativa) é a hortaliça folhosa mais comercializada no Brasil. Seu baixo valor calórico a qualifica para diversas dietas, o que favorece o seu consumo sob a forma crua, possibilitando a ocorrência de enfermidades intestinais. O objetivo deste trabalho foi realizar uma avaliação física, microbiológica e parasitológica de amostras de alfaces, variedade crespa, provenientes dos sistemas de cultivo orgânico, tradicional e hidropônico, comercializadas nos principais supermercados da cidade de Salvador (BA), no período de setembro de 2003 a junho de 2004. As amostras do cultivo hidropônico apresentaram o menor peso total e da parte bio-comestível, diferindo significativamente (p<0,05) das amostras de cultivo orgânico e tradicional; foram classificadas como Extra, de acordo com a legislação vigente, enquanto que as de cultivo orgânico e tradicional foram inseridas como hortaliças De Primeira e De Segunda classe, respectivamente. As amostras de alfaces, independente do sistema de cultivo, apresentaram baixos padrões higiênicos, indicados pela presença de formas parasitológicas de origem animal ou humana e alta concentração de coliformes fecais, sendo que foram observadas as maiores freqüências de contaminação nas amostras do cultivo orgânico, seguida das de cultivo tradicional e hidropônico. Considerando-se os resultados obtidos, ressalta-se a importância desta hortaliça na transmissão de enfermidades intestinais, assim como a necessidade de medidas que propiciem uma melhoria na sua qualidade higiênico-sanitária.<br>The lettuce (Lactuca sativa) has economic importance to the people in Brazil. The aim of this study was to carry out a physical, microbiological and parasitological evaluations in the lettuce samples - crisp variety, according to organic, traditional and hydroponics growing processes, commercialized at the supermarkets of the City of Salvador, Bahia, Brazil, collected from September/2003 until June/2004. The hydroponics lettuce samples showed the lowest total and edible part weight; they were inserted into Extra rate quality standard, according to the current legislation, whereas the organic and traditional lettuce samples were inserted into First and Second rate quality standard, respectively. The lettuce samples, independently of the growing process, showed low hygienic conditions, indicated by the presence of parasites of animal or human origin, and high concentration of fecal coliforms; the organic lettuce samples showed the highest frequencies of enteroparasities and fecal coliforms concentration, followed by the traditional and hydroponics lettuce samples. Considering the obtained results, the importance of this kind of food in the transmission of enteroparasities is stressed, as well as the need of actions which improve the sanitary conditions of these products