The renin-angiotensin-aldosterone system, glucose metabolism and diabetes

In diabetes mellitus (DM), the circulating renin-angiotensin system (RAS) is suppressed, but the renal tissue RAS is activated. Hyperglycemia increases tissue angiotensin II (Ang II), which induces oxidative stress, endothelial damage and disease pathology including vasoconstriction, thrombosis, inflammation and vascular remodeling. In early DM, the type 1 Ang II (AT(1)) receptor is upregulated but the type 2 Ang II (AT(2)) receptor is downregulated. This imbalance can predispose the individual to tissue damage. Hyperglycemia also increases the production of aldosterone, which has an unknown contribution to tissue damage. The insulin resistance state is associated with upregulation of the AT(1) receptor and an increase in oxygen free radicals in endothelial tissue caused by activation of NAD(P)H oxidase. Treatment with an AT(1) receptor blocker normalizes oxidase activity and improves endothelial function. An understanding of the tissue renin-angiotensin-aldosterone system, which is a crucial factor in the progression of tissue damage in DM, is imperative for protection against tissue damage in this chronic disease

Lessons learned from Federated Identity Management experience in e-Government

Nowadays the management of digital identity involves every company and institution, not only in the Internet world. Among different models of identity management, the federated model (FIdM) is the only one able to ensure a strong protection in terms of trust and privacy. Organizations joining the federation can decide to trust each other about which information can be exchanged in the process of authentication and authorization, according to policies agreed upon trust relationship management. This process is going to quickly raise in the immediate future with the adoption of cloud computing by Public Administration (PA). In Europe, FIdM presents a heterogeneous scenario: not every country has already decided to adopt a federated approach, depending on political choices and local governments relations. With reference to cloud scenario in PA, we believe that is critical to strive the development of Cloud Identity as a Service model

Asymptomatic primary hyperparathyroidism: surgical and medical management

Primary hyperparathyroidism (PHPT) is a common endocrine disorder, frequently asymptomatic. Notwithstanding, mild PHPT may cause adverse skeletal effects that include high bone remodeling, reduced bone mineral density (BMD), and increased fracture risk. The definitive therapy for symptomatic and asymptomatic PHPT (aPHPT) is parathyroidectomy, which has been shown to increase BMD. In patients who choose not to be treated surgically or have contraindications for surgery, medical therapy should include drugs designed to protect the skeleton and/or to lower serum calcium, such as bisphosphonates, hormone replacement, and/or calcimimetic agents. However, there are currently no fracture data for any of these options. Obviously, there is the need for larger randomized controlled trials with fractures as end-points to evaluate the efficacy of medical treatment

Aldosterone as a key mediator of the cardiometabolic syndrome in primary aldosteronism: an observational study.

none7GIACCHETTI G; RONCONI V; TURCHI F; AGOSTINELLI L; MANTERO F; RILLI S; M. BOSCAROGiacchetti, G; Ronconi, V; Turchi, F; Agostinelli, L; Mantero, F; Rilli, S; Boscaro, Marc