Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Comportamento de baixas doses de herbicidas na cultura da soja (Glycine max (L.) Merril): I - efeitos sobre o controle das plantas daninhas e parâmetros de produção da cultura Behavior of low-rates of herbicides in the soybean (Glycine max (L .) Merril) crop: I - effects on weed control and crop yield parameters

Foi estudada a possibilidade de redução nas doses recomendadas de herbicidas, isolados ou em misturas, sem afetar a produção ou outras características desejáveis da planta, para o cultivar Santa Rosa em Solo Latossol Vermelho Escuro -fase arenosa. 0 experimento foi instalado em blocos ao acaso, com vinte tratamentos e três repetições, testando-se a dose total recomendada e reduções de 25% e 50% dela, para trifluralin, alachlor e metribuzin, isolados e em misturas. As doses recomendadas foram 0,86; 1,72 e 0,28 kg/ha de trifluralin, alachlor e metribuzin, respectivamente. As misturas com doses reduzidas, de tri-firalin + metribuzin (0,65 + 0,21 kg/ha) e alachlor + metribuzin (1,44 4 0,21 kg/ha), apresentaram controle geral das plantas daninhas acima de 90% até o 60.º dia após a semeadura, sem apresentar fitotoxicidade ou efeitos deletérios sobre a nodulação da soja. O controle das plantas daninhas obtido com a redução de 25% nas doses destas misturas, foi equivalente ao da testemunha capinada e proporcionou valores similares nos teores de proteína, extrato etéreo e cinzas, peso de 100 grãos, número de grãos por vagem, altura da planta e altura da inserção da vagem mais baixa. As maiores produções de soja, obtidas com as misturas na dose total recomendada, foram estatisticamente iguais às obtidas com estes mesmos herbicidas aplicados com dose padrão reduzida em 25%. Desta forma, de acordo com as conveniências econômicas e ecológicas, sugere-se que a recomendação atual destes tratamentos seja feito com as doses reduzidas em 25%, nas condições de desenvolvimento da presente pesquisa.<br>It was studied the feasibility of reducing there commended herbicide rate, single or in mixtures, without affecting the yield or other desirable plant features, for cultivar Santa Rosa in "Dark-Red Latossol -sandy phase". ' The trials was settled at randomized block design with treatments repplicated 3 times, testing the full recommended rate, 25% an d 50% reduction of full rate of trifluralin, alachlor and metribuzin alone and in mixtures. There - commended rates were 8, 06 ; 1, 72 and 0,28 kg/h a of trifluralin, alachlor and metribuzin, respectivelly. Mixtures with reduced rates of trigluralin metribuzin (0,6 5 + 0,21 kg/ha) and alachlor + metribuzin (1,44 - 0,21 kg/ha ) presented control rate higher than 90% up to 60th day after sowing without any phytotoxicity and deleterious effects on no dulation. Weed control achieved by 25% r eduction in herbicide rates was equivalent to hoeing and afforded similar levels of protein , et her -extract and ash content, weigh of 100 grains, number of grains per pod, plant heigh and height of inferior pod insertion. The highest soybean yield, achieved wi th full rates of the mixtures were statistically similar to yields provided with 25% reduction of the recommended rates of same herbicides. Therefore, in accordance to economic and ecologic conveniencies, it is suggested that the actual rate should be reduced 25%, under the conditions of this trial

Thresholds of freshwater biodiversity in response to riparian vegetation loss in the Neotropical region

Protecting riparian vegetation around streams is vital in reducing the detrimental effects of environmental change on freshwater ecosystems and in maintaining aquatic biodiversity. Thus, identifying ecological thresholds is useful for defining regulatory limits and for guiding the management of riparian zones towards the conservation of freshwater biota. Using nationwide data on fish and invertebrates occurring in small Brazilian streams, we estimated thresholds of native vegetation loss in which there are abrupt changes in the occurrence and abundance of freshwater bioindicators and tested whether there are congruent responses among different biomes, biological groups and riparian buffer sizes. Mean thresholds of native vegetation cover loss varied widely among biomes, buffer sizes and biological groups: ranging from 0.5% to 77.4% for fish, from 2.9% to 37.0% for aquatic invertebrates and from 3.8% to 43.2% for a subset of aquatic invertebrates. Confidence intervals for thresholds were wide, but the minimum values of these intervals were lower for the smaller riparian buffers (50 and 100 m) than larger ones (200 and 500 m), indicating that land use should be kept away from the streams. Also, thresholds occurred at a lower percentage of riparian vegetation loss in the smaller buffers, and were critically lower for invertebrates: reducing only 6.5% of native vegetation cover within a 50-m riparian buffer is enough to cross thresholds for invertebrates. Synthesis and applications. The high variability in biodiversity responses to loss of native riparian vegetation suggests caution in the use of a single riparian width for conservation actions or policy definitions nationwide. The most sensitive bioindicators can be used as early warning signals of abrupt changes in freshwater biodiversity. In practice, maintaining at least 50-m wide riparian reserves on each side of streams would be more effective to protect freshwater biodiversity in Brazil. However, incentives and conservation strategies to protect even wider riparian reserves (~100 m) and also taking into consideration the regional context will promote a greater benefit. This information should be used to set conservation goals and to create complementary mechanisms and policies to protect wider riparian reserves than those currently required by the federal law

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022