Plasma osteoprotegerin is related to carotid and peripheral arterial disease, but not to myocardial ischemia in type 2 diabetes mellitus

<p>Abstract</p> <p>Background</p> <p>Cardiovascular disease (CVD) is frequent in type 2 diabetes mellitus patients due to accelerated atherosclerosis. Plasma osteoprotegerin (OPG) has evolved as a biomarker for CVD. We examined the relationship between plasma OPG levels and different CVD manifestations in type 2 diabetes.</p> <p>Methods</p> <p>Type 2 diabetes patients without known CVD referred consecutively to a diabetes clinic for the first time (n = 305, aged: 58.6 ± 11.3 years, diabetes duration: 4.5 ± 5.3 years) were screened for carotid arterial disease, peripheral arterial disease, and myocardial ischemia by means of carotid artery ultrasonography, peripheral ankle and toe systolic blood pressure measurements, and myocardial perfusion scintigraphy (MPS). In addition, plasma OPG concentrations and other CVD-related markers were measured.</p> <p>Results</p> <p>The prevalence of carotid arterial disease, peripheral arterial disease, and myocardial ischemia was 42%, 15%, and 30%, respectively. Plasma OPG was significantly increased in patients with carotid and peripheral arterial disease compared to patients without (p < 0.001, respectively), however, this was not the case for patients with myocardial ischemia versus those without (p = 0.71). When adjusted for age, HbA1c and U-albumin creatinine ratio in a multivariate logistic regression analysis, plasma OPG remained strongly associated with carotid arterial disease (adjusted OR: 2.12; 95% CI: 1.22-3.67; p = 0.008), but not with peripheral arterial disease or myocardial ischemia.</p> <p>Conclusions</p> <p>Increased plasma OPG concentration is associated with carotid and peripheral arterial disease in patients with type 2 diabetes, whereas no relation is observed with respect to myocardial ischemia on MPS. The reason for this discrepancy is unknown.</p> <p>Trial registration number</p> <p>at <url>http://www.clinicaltrial.gov</url>: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00298844">NCT00298844</a></p

A Place to Rest Your (Burnt) Bones? Mortuary Houses in Early Anglo-Saxon England

This is an Accepted Manuscript of an article published by Taylor & Francis in Archaeological Journal on 5th October 2017, available online: doi: 10.1080/00665983.2017.1366704This article presents a fresh interpretation of square and rectangular mortuary structures found in association with deposits of cremated material and cremation burials in a range of early Anglo-Saxon (fifth-/sixth-century AD) cemeteries across southern and eastern England. Responding to a recent argument that they could be traces of pyre structures, a range of ethnographic analogies are drawn upon, and the full-range of archaeological evidence is synthesized, to re-affirm and extend their interpretation as unburned mortuary structures. Three interleaving significances are proposed: (i) demarcating the burial place of specific individuals or groups from the rest of the cemetery population, (ii) operating as ‘columbaria’ for the above-ground storage of the cremated dead (i.e. not just to demarcate cremation burials), and (iii) providing key nodes of commemoration between funerals as the structures were built, used, repaired and eventually decayed within cemeteries. The article proposes that timber ‘mortuary houses’ reveal that groups in early Anglo-Saxon England perceived their cemeteries in relation to contemporary settlement architectures, with some groups constructing and maintaining miniaturized canopied buildings to store and display the cremated remains of the dead

Left atrial volume index:relation to long-term clinical outcome in type 2 diabetes

ObjectivesThe study sought to determine the prognostic importance of left atrial (LA) dilation in patients with type 2 diabetes mellitus (T2DM) and no history of cardiovascular disease (CVD).BackgroundT2DM is associated with the development of CVD, and morphological changes in the heart may appear before symptoms arise.MethodsA total of 305 T2DM patients without known CVD referred to a diabetes clinic were included consecutively (age 58.6 ± 11.3 years, diabetes duration 2.0 [interquartile range: 0 to 6.0] years). Each patient underwent a comprehensive echocardiogram and a myocardial perfusion scintigraphy (MPS) at inclusion. Patients were divided according to left atrial volume index (LAVi) ≥32 ml/m2. Patients were followed for median of 5.6 (interquartile range: 5.1 to 6.1) years for the occurrence of major cardiac events and death.ResultsLAVi ≥32 ml/m2 was found in 105 patients (34%). During follow-up, 60 patients (20%) experienced the composite endpoint, of whom 28 (9%) died. Patients with LAVi ≥32 ml/m2 had a significantly higher cardiac event rate and death rate (p < 0.001 and p = 0.002, respectively). Univariate predictors of the composite endpoint were age, hypertension, left ventricular diastolic function, E/e′septum-ratio and LAVi ≥32 ml/m2; however, myocardial ischemia on MPS was not a predictor. When adjusting for age and hypertension, only LAVi ≥32 ml/m2 was a predictor of the composite endpoint (hazard ratio: 1.82 [95% confidence interval: 1.08 to 3.07], p = 0.024).ConclusionsIncreased LAVi was an independent and incremental predictor of cardiovascular morbidity and mortality in T2DM patients with no history of CVD. (Presence of Macrovascular Disease in Type 2 Diabetes Mellitus; NCT00298844)

Does environmental archaeology need an ethical promise?

Environmental catastrophes represent profound challenges faced by societies today. Numerous scholars in the climate sciences and the humanities have argued for a greater ethical engagement with these pressing issues. At the same time, several disciplines concerned with hazards are moving towards formalized ethical codes or promises that not only guide the dissemination of data but oblige scientists to relate to fundamentally political issues. This article couples a survey of the recent environmental ethics literature with two case studies of how past natural hazards have affected vulnerable societies in Europe's prehistory. We ask whether cases of past calamities and their societal effects should play a greater role in public debates and whether archaeologists working with past environmental hazards should be more outspoken in their ethical considerations. We offer no firm answers, but suggest that archaeologists engage with debates in human-environment relations at this interface between politics, public affairs and science