ABSTRACT
BACKGROUND: Many ca. survivors exhibit signs of IR, an important risk factor for the development of CAD. CAC scans offer a risk assessment of CV disease before cardiac damage has occurred. We investigated how IR affects CAC scores in cancer survivors. OBJECTIVES: The aim of this study was to show that CAC scores differ significantly between insulin-sensitive- and -resistant cancer survivors. METHODS: We enrolled 90 cancer survivors of a large community hospital from March 2021 to January 2022 into this pilot study. Patients were subdivided into three groups: insulin-sensitive (IS), insulin-resistant/prediabetic and insulin-resistant/diabetic. All patients received a CAC scan. RESULTS: 70% of asymptomatic survivors overall and 81% of asymptomatic IR patients show CAD on CAC scans. 17 CAC scans in the IS group, 6 CAC scans in the IR/prediabetic group and 5 CAC scans in the IR/diabetic group showed an Agatston score of 0. The p-value between the three groups was statistically significant (p = 0.005) whereas the IR/prediabetic- and the IR/diabetic group did not differ statistically from each other. The mean MESA 10-year CHD risk with CAC was 7.8. There was a highly significant difference between the 3 groups (p < 0.001). The two IR groups did not differ statistically (p = 0.076). CONCLUSIONS: Survivors with IR including prediabetes have less frequent zero CAC scores than insulin-sensitive survivors. Our study also showed that IR including prediabetes significantly increases the MESA 10-yr. CHD Risk with CAC in cancer survivors. This trial highlights the importance of screening survivors for IR and draws attention to the association of IR to CAC not only in diabetes but also in prediabetes. The high fraction of asymptomatic survivors with CAD is concerning and calls for further investigation. CAC scans are an inexpensive and efficient way of screening asymptomatic cancer survivors for CAD.
ABSTRACT
One of the hallmarks of human agglomeration is an increase in the division of labour, but the exact nature of this relationship has been debated among anthropologists, sociologists, economists, and historians and archaeologists. Over the last decade, researchers investigating contemporary urban systems have suggested a novel explanation for the links between the numbers of inhabitants in settlements and many of their most important characteristics, which is grounded in a view of settlements as social networks embedded in built environments. One of the remarkable aspects of this approach is that it is not based on the specific conditions of the modern world (such as capitalism or industrialization), which raises the issue of whether the relationships observed in contemporary urban systems can also be detected in pre-modern urban or even non-urban systems. Here, we present a general model for the relationship between the population and functional diversity of settlements, where the latter is viewed as an indicator of the division of labour. We then explore the applicability of this model to pre-modern contexts, focusing on cities in the Roman Empire, using estimates of their numbers of inhabitants, numbers of documented professional associations, and numbers of recorded inscriptions to develop an index of functional diversity. Our results are consistent with theoretical expectations, adding further support to the view that urban systems in both contemporary and pre-modern contexts reflect a common set of generative processes.
