A Record of Atmospheric Co2 During the Last 40,000 Years from the Siple Dome, Antarctica Ice Core

We have measured the CO2 concentration of air occluded during the last 40,000 years in the deep Siple Dome A ( hereafter Siple Dome) ice core, Antarctica. The general trend of CO2 concentration from Siple Dome ice follows the temperature inferred from the isotopic composition of the ice and is mostly in agreement with other Antarctic ice core CO2 records. CO2 rose initially at similar to 17.5 kyr B. P. ( thousand years before 1950), decreased slowly during the Antarctic Cold Reversal, rose during the Younger Dryas, fell to a local minimum at around 8 kyr B. P., and rose continuously since then. The CO2 concentration never reached steady state during the Holocene, as also found in the Taylor Dome and EPICA Dome C ( hereafter Dome C) records. During the last glacial termination, a lag of CO2 versus Siple Dome isotopic temperature is probable. The Siple Dome CO2 concentrations during the last glacial termination and in the Holocene are at certain times greater than in other Antarctic ice cores by up to 20 ppm (mumol CO2/mol air). While in situ production of CO2 is one possible cause of the sporadic elevated levels, the mechanism leading to the enrichment is not yet clear

A record of atmospheric CO₂ during the last 40,000 years from the Siple Dome, Antarctica ice core

We have measured the CO₂ concentration of air occluded during the last 40,000 years in the deep Siple Dome A (hereafter Siple Dome) ice core, Antarctica. The general trend of CO₂ concentration from Siple Dome ice follows the temperature inferred from the isotopic composition of the ice and is mostly in agreement with other Antarctic ice core CO₂ records. CO₂ rose initially at ~17.5 kyr B.P. (thousand years before 1950), decreased slowly during the Antarctic Cold Reversal, rose during the Younger Dryas, fell to a local minimum at around 8 kyr B.P., and rose continuously since then. The CO₂ concentration never reached steady state during the Holocene, as also found in the Taylor Dome and EPICA Dome C (hereafter Dome C) records. During the last glacial termination, a lag of CO₂ versus Siple Dome isotopic temperature is probable. The Siple Dome CO₂ concentrations during the last glacial termination and in the Holocene are at certain times greater than in other Antarctic ice cores by up to 20 ppm (μmol CO₂/mol air). While in situ production of CO₂ is one possible cause of the sporadic elevated levels, the mechanism leading to the enrichment is not yet clear.Keywords: Siple Dome, paleoclimate, CO

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

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 &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;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 &lt;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&lt;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&lt;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