Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Addition of salmeterol versus doubling the dose of beclomethasone in children with asthma

Studies in adults revealed that addition of salmeterol to a moderate dose of inhaled corticosteroid resulted in better symptom control and higher PEF compared with doubling the dose of inhaled corticosteroid. The aim of this three group study was to compare the effects of a moderate dose of beclomethasone, the same dose of beclomethasone with salmeterol, and a doubling dose of beclomethasone on lung function and symptoms in children with moderate asthma. A total of 177 children already treated with inhaled corticosteroids, were randomized in a double-blind parallel study either to salmeterol 50 mu g twice daily (BDP400+salm), beclomethasone 200 mu g twice daily (BDP800), or placebo (BDP400) in addition to beclomethasone 200 mu g twice daily. No significant differences between groups were found in FEV1, PD20 methacholine, symptom scores, and exacerbation rates after 1 yr. Salmeterol resulted in slightly better PEF in the first months of treatment. FEV1, and PD,, methacholine significantly improved in all groups. After 1 yr mean changes in FEV,, percent predicted were 4.3% (95% CI 1.3; 7.2), 5.8% (95% CI 2.9; 8.7), and 4.3% (95% CI 2.1; 6.5) for BDP400+salm, BDP800, and BDP400, respectively. Changes in airway responsiveness were 0.60 (95% CI 0.05; 1.14), 1.30 (95% CI 0.73; 1.87), and 0.80 (95% CI 0.33; 1.27) doubling doses. Growth was significantly slower in the BDP800 group. We conclude that no additional benefit was found of adding either salmeterol or more beclomethasone to a daily dose of 400 mu g beclomethasone in this group of children with excellent compliance of medication

The stomach contents of post-hatchling green and loggerhead sea turtles in the southwest Pacific: an insight into habitat association

Dietary information obtained from stomach contents can provide a wealth of information on an animal's ecology. Where animals are cryptic, such as the post-hatchling life history stage of a sea turtle, the ecological insight that dietary analyses can provide, may be otherwise unobtainable. Investigations into post-hatchling turtle stomach contents have found planktonic organisms, dominated by pelagic molluscs and crustaceans, hydrozoans, Sargassum and fish eggs. The nature of these dietary organisms provides evidence for the widely accepted hypothesis that, with the exception of the flatback turtle (Natator depressus), the post-hatchling stage of a sea turtle's life history is pelagic and oceanic. As the majority of studies that have investigated the stomach contents of post-hatchling sea turtles have been conducted on loggerhead turtles (Caretta caretta) in the northern Atlantic and Pacific Oceans, insight derived from dietary investigations into post-hatchling ecology is biased. This study investigates the diet of post-hatchling green turtles (Chelonia mydas) and loggerhead turtles in the southwest Pacific Ocean. Stomach contents were obtained from 55 green and loggerhead post-hatchling turtles that had stranded or been consumed by Coryphaena hippurus. Our findings demonstrate that loggerhead and green post-hatchlings in the southwest Pacific share similar feeding ecology and feed on a variety of neustonic items that are indicative of an oceanic and pelagic existence. The dietary items consumed by both species investigated belong to similar taxonomic groups as those found in previous studies with species level distinctions occurring owing to the different geographical location