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 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 m 2), 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

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Diagnostic des pathologies héréditaires de la membrane du globule rouge (comparaison du pink test et de la résistance globulaire)

MONTPELLIER-BU Pharmacie (341722105) / SudocSudocFranceF

Counter-stereotypes and images : an exploratory research and some questions. Social Psychology of Education, 20(1), 1-13.

The dynamics of the construction and perpetuation of gender stereotypes are classic research subjects in social psychology and in the field of educational guidelines in France. The most recent government decree aims to counter stereotypes in schools, by exposing pupils to counter-stereotypes. This study examines the effects of activating counter-stereotypes, versus stereotypes and gender neutral input, on the test performance of female and male fourth-grade students in a mathematical task in a ?real-life&apos; classroom setting. Theoretical implications of social mechanisms to combat gender stereotypes are discussed

SPIE Opto-Ireland 2005

A contra-propagation set up is implemented and dynamic pump probe studies of a InGaAsP/InP SOA in the gain regime are undertaken using pulses of 2ps duration. The time resolved amplified probe signal is measured separately for the TE and TM modes of the semiconductor optical amplifier. Different behaviours are observed both in the gain compression and the timescales of the effect, with the TM mode displaying a faster component and a higher gain compression

Unravelling student evaluations of courses and teachers

There is debate over the functional basis of student evaluations of academics, and fresh potential for looking at the data in new ways. Student evaluation data was collated over a three year period (Semester 2 2015 to Semester 1 2018). We used a General Linear Model to estimate the variation in course scores explained by a number of coordinator and course attributes. Three significant factors collectively explain 49% of the School’s variation in course scores—individual coordinator, student evaluation response rate, and mode of delivery. Next, we used hierarchical clustering to explore the inter-relationships among the eight course and teaching evaluation questions. Learning appears to be related to stimulation, whereas overall satisfaction appears to be related to quality of learning materials and course structure (i.e. aspects of course organisation). Student evaluation response rate is positively correlated to all eight course questions, but most positively to a question relating to receiving adequate feedback. This perhaps implies some reciprocity in the flow of information between student and coordinator. The overall teaching rating awarded to academics clusters most with approachability and encouragement of student input—aspects of temperament and style—and not with explanatory skill or organisational ability

Circulating exosomes from metabolic syndrome patients induce insulin resistance in human hepatocytes but not in human endothelial cells.

International audienc

West Nile Virus, Guadeloupe

International audienceTo determine whether West Nile virus (WNV) had reached the archipelago of Guadeloupe, a serologic study in horses and birds was conducted in 2002. Immunoglobulin (Ig) G, IgM, enzyme-linked immunosorbent assay, and seroneutralization tests identified WNV infection in horses and chickens. Six months later, a high rate of seroconversion was observed in horses

Circulating exosomes from metabolic syndrome patients induce insulin resistance in human hepatocytes but not in human endothelial cells.

International audienc

An alternative scheme for the multiplexed acquisition of 1D and 2D NMR spectra

Spin system selective 1D 1H, 2D DQF-COSY and 2D HSQC NMR spectra were recorded in order to fully assign the 1H and 13C 1D NMR spectra of an asymmetrical β-cyclodextrin derivative. Instead of individually accessing the seven sugar anomeric protons by means of long multiplet selective pulses, only short region selective pulses were used. The simultaneously selected anomeric protons were differentiated by allowing their magnetization to evolve under the sole effect of the chemical shift interaction. In each experiment, the seven recorded spectra were linear combinations of the seven desired ones. The combination coefficients were measured and used to obtain almost perfectly separated sugar unit sub-spectra. This multiplexed acquisition scheme resulted in a time gain factor of about 2