Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups

Background: Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention). Methods: In CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care. Results: Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80 [95% CI, 0.67-0.95]; P=0.01), with consistent reductions in both the primary (HR, 0.68 [95% CI, 0.49-0.94]) and secondary (HR, 0.85 [95% CI, 0.69-1.06]) prevention groups (P for interaction=0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78 [95% CI, 0.61-1.00]), nonfatal myocardial infarction (HR, 0.81 [95% CI, 0.59-1.10]), and nonfatal stroke (HR, 0.80 [95% CI, 0.56-1.15]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction >0.5 for each outcome). Conclusions: Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease

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

Estudo observacional de afecções da superordem Xenarthra de vida livre e cativeiro no Brasil

Submitted by Alexandre Torres ([email protected]) on 2019-11-04T23:12:17Z No. of bitstreams: 1 Estudo observacional de afecções da superordem Xenarthra de vida livre e cativeiro no Brasil.pdf: 2862561 bytes, checksum: dc3b846f4ba2e0c08683923c90d7bcfc (MD5)Rejected by Eliane Andrade ([email protected]), reason: Prezado Alexandre, Conforme as “Diretrizes para Normalização de Trabalhos Acadêmicos da UFMG” detectamos que em seu trabalho não constam: Capa, Ficha Catalográfica, Ata de Defesa ou folha de aprovação assinada pelos membros da banca. Considerando a visibilidade nacional e internacional do RI/UFMG, os trabalhos disponibilizados devem seguir padrões e protocolos de integração qualificados e normalizados. Diante disso, gentileza executar as inserções devidas acessando o link abaixo. Tão logo o arquivo correto esteja inserido no Repositório, o atestado de entrega será emitido. Atenciosamente RI/UFMG on 2019-11-07T10:05:10Z (GMT)Submitted by Alexandre Torres ([email protected]) on 2019-11-10T15:25:54Z No. of bitstreams: 1 Estudo observacional de afecções da superordem Xenarthra de vida livre e cativeiro no Brasil.pdf: 15041563 bytes, checksum: cbcd856d4ad62060eb145254300fb0aa (MD5)Approved for entry into archive by Eliane Andrade ([email protected]) on 2019-11-18T14:58:16Z (GMT) No. of bitstreams: 1 Estudo observacional de afecções da superordem Xenarthra de vida livre e cativeiro no Brasil.pdf: 15041563 bytes, checksum: cbcd856d4ad62060eb145254300fb0aa (MD5)Made available in DSpace on 2019-12-13T16:29:38Z (GMT). No. of bitstreams: 1 Estudo observacional de afecções da superordem Xenarthra de vida livre e cativeiro no Brasil.pdf: 15041563 bytes, checksum: cbcd856d4ad62060eb145254300fb0aa (MD5) Previous issue date: 2019-02-27FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas GeraisA superordem Xenarthra é formada por duas ordens, Cingulata (tatus) e Pilosa (preguiças e tamanduás). Existe pouca informação sobre anatomia patológica destes animais na literatura, portanto este trabalho teve o objetivo de descrever a patologia da superordem Xenarthra de vida livre e cativeiro no Brasil, por meio de um estudo observacional. Foram utilizados 141 animais de cinco estados (São Paulo, Minas Gerais, Bahia, Mato Grosso do Sul e Amazonas), de diferentes procedências, contendo 32 animais de cativeiro e 109 de vida livre. 44 animais foram mortos por atropelamentos e 10 por queimaduras. Outras doenças e alterações significativas estão relacionadas com distúrbios metabólicos (acúmulo de ferro, mineralização e deficiência de taurina), parasitas protozoários e metazoários, doenças infecciosas como candidíase, esporotricose, clostridiose e uma suspeita de cinomose e distúrbios proliferativos incluindo três casos de carcinoma de células escamosas. Uma quantidade significativa destes achados não haviam ainda sido descritos em Xenarthra. Concluindo, as lesões aqui descritas podem ter serventia como fonte de conhecimento e de contribuição para a melhoria de trabalhos de conservação destas espécies.The Xenarthra superorder is composed by two orders, Cingulata (armadillos) and Pilosa (sloths and anteater). There is little information concerning anatomic pathology of these animals in the literature, thus this work aimed to describe the pathology of Xenarthra from wildlife and captivity in Brazil, through an observational study. We used 141 animals from five states (São Paulo, Minas Gerais, Bahia, Mato Grosso do Sul and Amazonas) from different sources, containing 32 captive and 109 free living animals. 44 animals were killed by runovers and 10 by burns. Other diseases and significant changes are related to metabolic disorders (iron storage, mineralization and taurine deficiency), protozoan and metazoan parasites, infectious diseases such as candidiasis, sporotrichosis, clostridiosis and a suspected distemper, and proliferative disorders including three cases of squamous cell carcinoma. A significant amount of these findings have not yet been described in Xenarthra. Concluding, lesions described herein may serve as reference for wildlife forensics; and as a contribution to the improvement of conservation efforts of these species

O papel da controladoria como business partner

A tradicional visão e os estereótipos da controladoria como bean-counter (contador de feijão), book keeper (guardador de livros), watchdog (cão de guarda), number crunching (triturador de números) e scorekeeping (registro de informações), que muitas vezes tinha uma orientação exclusiva para análises financeiras do passado, tem gradualmente sido substituídas por uma função de maior proximidade dos parceiros de negócios, dando lugar a novos termos como, o de business oriented (orientação para o negócio), change agent (agente de mudança), internal consultant (consultor interno), co-pilot (copiloto) e business partner (parceiro de negócios). Na BASF, este papel de business partnering (parceria de negócio) na controladoria, iniciou-se em 2006 com a implementação do conceito Controller Mission (Missão do Controller), consolidando-se em 2009 com a iniciativa Business Partnering. O objetivo geral deste trabalho, atendendo as demandas e necessidades da BASF, consistiu em avaliar o nível de business partnering da controladoria junto a seus clientes internos. Com os objetivos específicos de verificar: a) a diferença na avaliação do nível de business partnering entre a área de controladoria e seus clientes internos; b) a diferença na avaliação do nível de business partnering entre as diferentes localidades; e c) a diferença na avaliação do nível de business partnering de acordo com as diferentes áreas de atuação dos clientes internos da controladoria. Foi feita uma pesquisa do tipo survey com os colaboradores da área de controladoria e com os gestores da BASF na América do Sul. A pesquisa utilizou uma escala métrica de quatro pontos para avaliar a frequência de atuação da controladoria como business partner, de acordo com as 36 características previstas pela própria BASF, dentro de três perspectivas chaves: requerimentos pessoais, habilidades de interação e atitude comercial. Os resultados da pesquisa mostraram que, de um modo geral, há uma avaliação positiva quanto ao papel de business partnering da controladoria da BASF. Dentre os respondentes, 82% avaliaram positivamente o papel de business partnering da controladoria, sendo que 31% e 51% avaliaram que “Sempre” e “Frequentemente”, a controladoria atua como business partner respectivamente. A minoria (2%) avaliou que a controladoria “Nunca” atua como business partner e 15% dos respondentes avaliou que a controladoria “Raramente” atua como business partner. Dentre as características mais bem avaliadas estão: a atuação da controladoria em conformidade com as políticas e normas estabelecidas; abordagem aberta e leal com as pessoas; e construção ou proativa manutenção das relações e redes de confiança. Por outro lado, as características menos bem avaliadas pelos respondentes estão: a comparação do desempenho da BASF com o dos concorrentes; antecipação de externalidades como novas oportunidades e riscos; síntese do status do negócio em um minuto; referir-se regularmente à estratégia da BASF; e traduzir temas complexos em uma linguagem simples. Foi constatado que a área de controladoria tem uma auto-avaliação mais positiva quanto a sua atuação de business partner, em relação a avaliação realizada pelos seus clientes internos, evidenciando-se um gap entre a avaliação dos dois grupos. Além disso, verificou-se uma avaliação menos positiva dentre os respondentes no Brasil, em comparação com a avaliação realizada pelos respondentes em outros países da América do Sul. No entanto, conforme as questões ou características avaliadas apresentaram similaridades entre as localidades, entende-se que as ações de melhorias do business partnering tomadas pela empresa, possam se dar de forma regional. Finalmente, os resultados confirmaram que há diferença entre o nível de avaliação do business partnering da controladoria segundo as áreas de atuação dos seus clientes internos, embora, de um modo geral, os pontos de melhorias e pontos fortes, concentraram-se nas mesmas questões e características levantadas.The traditional view and the stereotype of controlling as bean-counter, book keeper, watchdog, number crunching and scorekeeping, which often had an exclusive focus on financial analysis of the past, have gradually been replaced by a closer business partnering role, leading to new terms such as the business oriented, change agent, internal consultant, co-pilot and business partner. At BASF, the role as business partner in controlling, started in 2006 with the implementation of the Controller Mission concept, consolidating its position in 2009 with the Business Partnering Initiative. The overall objective of this research, attending the demands and needs of BASF, was to evaluate the business partnering level in controlling with its internal customers. The specific objectives aimed to verify the difference in the evaluation of controlling business partnering level: 1) between controlling group and its internal customers; 2) between the different locations; 3) according to the different internal controlling customers areas. A survey was conducted with controlling employees and with BASF managers in South America. A metric scale of four point was used to assess the frequency of controlling acting as business partners, according to the 36 skills provided by BASF in three major perspectives personal requirements, interaction skills and commercial attitude. The survey results showed that, in general, there is a positive evaluation of the controlling business partnering role in BASF. Among the respondents, 82% positively evaluated the controlling business partnering role, with 31% and 51% said that “Always” and “Often”, controlling is business partner respectively. The minority (2%) assessed that controlling "Never" acts as a business partner and 15% of the respondents assessed that controlling "Seldom" acts as a business partner. Among the characteristics best evaluated: controlling act in compliance with established policies / standards; controlling is open and a loyal approach to the people; controlling build or actively maintain trustful relationships / networks. On the other hand, the characteristic with low evaluation by the respondents: comparison of BASF's performance with competitors; anticipation of externalities as new opportunities and risks; business status overview in a minute; refer regularly to the BASF strategy; and translating complex issues into simple language. It was found that controlling area has a more positive self-assessment as its business partner performance, in comparison to assessment by its internal customers, showing a gap between the assessments of the two groups. In addition, there was a less positive assessment from the respondents in Brazil, compared with the assessment made by the respondents in other countries in South America. However, as the evaluated characteristics were similar between the locations, it is possible to implement regional measures to improve business partnering level. Finally, the results confirmed that there is a difference between the business partnering level according to the different areas of its internal customers, although, in general, the points of improvements and strengths, were concentrated on the same characteristics raised

Dimensionamento de lotes e programação do forno numa fundição automatizada de porte médio

Este trabalho consiste no estudo de um problema prático que ocorre numa fundição que tem apenas um forno em operação por período, consistindo no gargalo do processo produtivo, e várias máquinas de moldagem que produzem diferentes tipos de itens com demandas conhecidas que devem ser feitos com diferentes ligas. Em cada período, a programação da produção envolve dois níveis importantes de decisão que estão inter-relacionados: 1) qual liga deve ser produzida no forno; 2) a quantidade de cada item a ser produzida em cada máquina de moldagem. Num estudo anterior, foi proposto um modelo de dimensionamento de lotes monoestágio, com restrições de capacidade, máquinas paralelas e múltiplos itens. Neste trabalho foram realizadas extensões do modelo e do método de solução, considerando-se custos de preparação e admitindo-se atrasos na data de entrega. Esta abordagem fornece ao decisor possíveis rearranjos na demanda, caso não seja possível o atendimento sem atraso

Macroscopic and Microscopic findings in a set of congenital anomalies in two calves produced through in Vitro production

In vitro production and somatic cell nuclear transfer are biotechnologies widely used for breeding cattle, although may result in congenital anomalies. This paper aims to report a set of congenital anomalies in two Nelore calves, a male and a female, produced through in vitro fertilization. The major anomalies revealed at necropsy were hypospadias, bifid scrotum, atresia ani and rectum ending in blind pouch in the male calf. In the female calf accessory spleen, atresia ani, underdevelopment of extern genitalia and urethral orifice, and rectum ending in blind pouch forming a uterus-rectum fistula were observed

Cytopathology in the diagnosis of oral trichomoniasis in a rock pigeon (columba livia)

A Rock Pigeon (Columba livia) submitted for necropsy had an oral white-yellow mass with a friable surface and putrid odor. Impression smears were performed and tissue samples were collected for histopathology. Cytopathological analysis revealed numerous pyriform protozoa, compatible with Trichomonas gallinae. Protozoans were not evident within the lesions by histopathology after staining the samples with Hematoxylin and Eosin or Gomori methenamine silver (GMS) stain. We conclude that impression smears from avian oral trichomoniasis suspects, even during post-mortem evaluation, can be a useful technique for the diagnosis of this disease