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

Infiltrative angiolipoma of the parotid salivary gland in a dog

Solitary benign angiolipoma and infiltrative angiolipoma are rare tumours in dogs. Angiolipomata can be distinguished histologically from lipomata by the large number of tightly packed blood vessels seen between the adipocytes with multiple fibrin thrombi occupying some of the vessels' lumens. The dog presented with a solitary slow-growing mass in the cervical region. Histopathology revealed multifocal to coalescing single or clusters of blood-filled vessels lined by flattened endothelial cells with narrow, elongated, basophilic nuclei. These regions were embedded in adipose tissue with multifocal areas of intervascular remnants of differentiated serous salivary glandular tissue with multifocal small ducts. Fibrin thrombi occupied a few of the vessel lumens. A histological diagnosis of infiltrative angiolipoma was made. On computed tomography, the mass was bibbed with a suspected primary component involving the right parotid gland which was grossly enlarged. The mass had a slightly hypoattenuating mottled to lobulated appearance with a few hyperattenuating mineralised specks throughout. Hounsfield units of the mass ranged between 40 and 45, which was less than the 60-65 of the contralateral salivary glands and cranial musculature. Post contrast images showed no contrast enhancement of 90 % of the mass with only a band of peripheral contrast uptake of the affected lateral lobe

Mobility of heavy metals in dredged harbor sediments

Solubility, mobility, and bioavailability of sediment-bound metals can be increased by four major facors: (1) Lowering of pH; (2) changing of redox conditions; (3) formation of organic complexes; and (4) increasing salinity. While the first two factors are particularly important for on-land deposition of dredged materials, the effect of salinity is particularly important for resuspended cadmium-rich sediments in estuaries. Chemical extraction studies, which were carried out under carefully controlled conditions on both fresh and freeze-dried samples, indicate that aeration of anoxic sediments (e.g., on-land disposal) may both increase and decrease the mobility of heavy metals. Transformation from sulfidic or carbonatic associations to oxidic phases will reduce mobility of manganese, wherease the respective changes from moderately reducible forms to carbonatic and easily reducible phases will enhance the reactivity of zinc during oxidation of dredged material