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

Enrichments of the mantle sources beneath the Southern Volcanic Zone (Andes) by fluids and melts derived from abraded upper continental crust

Mafic basaltic-andesitic volcanic rocks from the Andean Southern Volcanic Zone (SVZ) exhibit a northward increase in crustal components in primitive arc magmas from the Central through the Transitional and Northern SVZ segments. New elemental and Sr-Nd-high-precision Pb isotope data from the Quaternary arc volcanic centres of Maipo (NSVZ) and Infernillo and Laguna del Maule (TSVZ) are argued to reflect mainly their mantle source and its melting. For the C-T-NSVZ, we identify two types of source enrichment: one, represented by Antuco in CSVZ, but also present northward along the arc, was dominated by fluids which enriched a pre-metasomatic South Atlantic depleted MORB mantle type asthenosphere. The second enrichment was by melts having the characteristics of upper continental crust (UCC), distinctly different from Chile trench sediments. We suggest that granitic rocks entered the source mantle by means of subduction erosion in response to the northward increasingly strong coupling of the converging plates. Both types of enrichment had the same Pb isotope composition in the TSVZ with no significant component derived from the subducting oceanic crust. Pb-Sr-Nd isotopes indicate a major crustal compositional change at the southern end of the NSVZ. Modelling suggests addition of around 2 % UCC for Infernillo and 5 % for Maip

Biologically relevant mono- and di-nuclear manganese II/III/IV complexes of mononegative pentadentate ligands.

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