The Pathophysiology and Treatment of Hypertension in Patients With Cushing's Syndrome

When hypertension, a pathology that is frequently found in the general population, presents in a young patient, secondary causes such as Cushing's syndrome (CS), a rare disease characterized by long-term elevated cortisol levels, should be considered. Present in ~80% of CS patients independently of their age and sex, hypertension is one of the pathology's most prevalent, alarming features. Its severity is principally associated with the duration and intensity of elevated cortisol levels. Prompt diagnosis and rapid initiation of treatment are important for reducing/delaying the consequences of hypercortisolism. Glucocorticoid excess leads to hypertension via a variety of mechanisms including mineralocorticoid mimetic activity, alterations in peripheral and renovascular resistance, and vascular remodeling. As hypertension in CS patients is caused by cortisol excess, treating the underlying pathology generally contributes to reducing blood pressure (BP) levels, although hypertension tends to persist in approximately 30% of cured patients. Surgical removal of the pituitary tumor remains the first-line treatment for both adrenocorticotropin hormone (ACTH) dependent and independent forms of the syndrome. In light of the fact that surgery is not always successful in curing the underlying disease, it is essential that other treatments be considered and prescribed as needed. This article discusses the mechanisms involved in the pathogenesis of CS and the pros and the cons of the various antihypertensive agents that are presently available to treat these patients

The effect of habitat change on nutrient removal in the Atchafalaya River Basin, Louisiana

The Mississippi and Atchafalaya rivers are the major sources of freshwater and nutrients to the Gulf of Mexico. Increased nutrient loads from these rivers exacerbate eutrophication in coastal receiving waters and contribute to the large area of hypoxia that develops seasonally in the Gulf. Levees along the Mississippi River have reduced contact between the river and the historic floodplain; this limits the ability of floodplain wetlands to naturally mitigate excess nutrients. However, the Atchafalaya River diverges from the Mississippi 217 km from the Gulf and enters a large river floodplain with a widely spaced levee system. This enhances the ability of the Atchafalaya River Basin to remove and sequester nutrients, potentially reducing downstream eutrophication. Overbank flow spreads river-water and sediment across the floodplain. Over time, sedimentation has filled in many of the open water areas on the floodplain, such that lakes are transitioning to baldcypress swamps and bottomland hardwood forests. These habitats differ in their available nutrient reservoirs and the rates at which they transform and store nutrients. This dissertation investigated the major retention and removal mechanisms for carbon, nitrogen, and phosphorus within bottomland hardwood forests, baldcypress swamps, and lakes of the Atchafalaya River Basin. These reservoirs include denitrification, sedimentation, and assimilation by aboveground biomass. Results estimate that nutrient retention and removal within bottomland hardwood forests ranges from 1,177,605—1,561,805 t C yr-1, 46,049—47,603 t N yr-1 and 20,040—20,175 t P yr-1. Within baldcypress swamps, rates range from 493,953—600,180 t C yr-1, 21,821—22,364t N yr-1 and 2,168—2,202 t P yr-1. Rates in the lakes were 57,490 t C yr-1, 5,140—5,390 t N yr-1 and 2,550 t P yr-1. Total retention and removal for the entire basin is on the order of 1,177,605—1,561,805 t C yr-1, 46,049—47,603 t N yr-1, and 20,040—20,175 t P yr-1. Rates varied by habitat, highlighting the need to consider habitat change when developing management strategies to improve water quality. Data from this dissertation can be used to parameterize nutrient models for the Atchafalaya River Basin, as well as for river diversions and floodplains with similar habitat types

Diabetes mellitus secondary to Cushing's disease

Associated with important comorbidities that significantly reduce patients’ overall wellbeing and life expectancy, Cushing’s disease (CD) is the most common cause of endogenous hypercortisolism. Glucocorticoid excess can lead to diabetes, and although its prevalence is probably underestimated, up to 50% of patients with CD have varying degrees of altered glucose metabolism. Fasting glycemia may nevertheless be normal in some patients in whom glucocorticoid excess leads primarily to higher postprandial glucose levels. An oral glucose tolerance test should thus be performed in all CD patients to identify glucose metabolism abnormalities. Since diabetes mellitus (DM) is a consequence of cortisol excess, treating CD also serves to alleviate impaired glucose metabolism. Although transsphenoidal pituitary surgery remains the first-line treatment for CD, it is not always effective and other treatment strategies may be necessary. This work examines the main features of DM secondary to CD and focuses on antidiabetic drugs and how cortisol-lowering medication affects glucose metabolism

The Shape of Pulverized Bituminous Vitrinite Coal Particles

The shape of pulverized bituminous coal particles (vitrinites) was determined by optical and laser light scattering. Vitrain samples were collected from obvious tree remains located in the ceilings of two Appalachian coal mines. Wet sieving produced narrow size cuts. The particles were determined to be oblong or blocky in shape, with average length-to-width ratio of 1.7 and sphericity of 0.78. They were analogous in shape to a square ended, rectangular house brick . The two bituminous coals and different size cuts of each coal had essentially the same shape parameters. Characteristic heating times and terminal velocities were higher by 22 and 20%, respectively compared to spherical particles

O mercado de dados no Brasil : fundamentos e diretrizes

O presente estudo tem, por objetivo, estabelecer diretrizes aptas a equilibrarem o fluxo e a proteção dos dados no mercado de dados pessoais, especificamente no âmbito do Direito Privado. Por meio do método dedutivo de abordagem, e pela pesquisa bibliográfica como método de procedimento, as duas hipóteses levantadas são, por um lado, a impossibilidade de existência de um mercado de dados, uma vez que os princípios e as normas de proteção de dados vedam essa prática e, por outro, a possibilidade, desde que observadas determinadas diretrizes desenvolvidas a partir do ordenamento jurídico já existente. Para responder à questão, optou-se pela divisão em dois capítulos, divididos em dois subcapítulos. O primeiro subcapítulo da primeira parte aborda a ascensão dos dados enquanto principal ativo da sociedade da informação e seus impactos no Direito, dialogando com autores que buscam explicar essa nova organização, além de definir o que seja o mercado de dados pessoais. O segundo subcapítulo versa especificamente da maneira pela qual este assunto deve ser tratado pelo Direito, debatendo a natureza jurídica dos dados pessoais, as implicações desta caracterização a partir do Código Civil, além da crise do consentimento e o consequente impacto da utilização das demais bases legais na autodeterminação informativa. O segundo capítulo conceitua mercado de dados econômica e juridicamente, buscando alcançar o que denominamos de fluxo protetivo de dados pessoais. No primeiro subcapítulo desta parte, trata-se do problema da gestão de risco na seara da proteção de dados. Ao defendermos uma abordagem à LGPD baseada no risco, identificamos os fundamentos a esta sustentar esta posição. No segundo subcapítulo, explora se os fundamentos legais a sustentar um mercado de dados no Brasil, demonstrando o papel das bases legais na licitude do tratamento em um mercado de dados, com a legitimidade do estabelecimento da vantagem econômica como finalidade a informar o tratamento de dados. Ainda, aplica-se a ideia de atos de autodeterminação também às relações jurídicas envolvendo dados pessoais. Ao final, concluiu-se pela hipótese da possibilidade de existência de um mercado de dados nos termos da LGPD, sendo lícito, ao controlador, estabelecer a vantagem econômica como finalidade no tratamento de dados pessoais.This study aims to establish guidelines able to balance the flow and protection of data in the personal data market, specifically within the scope of Private Law. Through the deductive method of approach, and through bibliographical research as a method of procedure, the two hypotheses raised are, on the one hand, the impossibility of the existence of a data market, since the principles and norms of data protection prohibit this practice and, on the other hand, the possibility, as long as certain guidelines developed from the existing legal system are observed. To answer the question, it was decided to divide it into two chapters, divided into two subchapters. The first subchapter of the first part addresses the rise of data as the main asset of the information society and its impacts on Law, dialoguing with authors who seek to explain this new organization, in addition to defining what the personal data market is. The second subchapter deals specifically with the way in which this matter should be dealt with by the Law, debating the legal nature of personal data, the implications of this characterization from the Civil Code, in addition to the crisis of consent and the consequent impact of the use of other legal bases. in informative self-determination. The second chapter conceptualizes the economic and legal data market, seeking to achieve what we call the protective flow of personal data. In the first subchapter of this part, the issue of risk management in the area of data protection is addressed. By advocating a risk-based approach to the LGPD, we identify the rationale behind this position. In the second subchapter, the legal foundations supporting a data market in Brazil are explored, demonstrating the role of legal bases in the lawfulness of the treatment in a data market, with the legitimacy of establishing the economic advantage as a purpose to inform the treatment of data. data. Still, the idea of acts of self-determination also applies to legal relationships involving personal data. In the end, it was concluded by the hypothesis of the possibility of the existence of a data market under the terms of the LGPD, being lawful, for the controller, to establish the economic advantage as a purpose in the processing of personal data

Gauging Residential Knowledge and Behavior to Inform Stormwater Outreach Efforts across South Carolina

Public outreach and education are important components of local stormwater management efforts aimed at protecting water quality and reducing pollutants of concern. Increasingly, educators recognize that creating effective outreach material depends on an understanding of the target audience, their current behavior, and their barriers and motivations to adopting pro-environmental behaviors. Clemson Extension’s Carolina Clear program partners with 39 communities across South Carolina to provide compliance-based stormwater education and outreach. On behalf of these community partners, Carolina Clear conducted the third iteration of a telephone survey to gauge local knowledge, perceptions, and behaviors of residents related to stormwater and watershed health. Results presented here will highlight key knowledge gaps (e.g., the misconception that stormwater runoff is treated) and behaviors (e.g., dumping down storm drains) that could potentially be targeted through education and removal of barriers (e.g., storm drain markings). Survey results showed ongoing misperceptions about the major sources of stormwater pollution, whether stormwater is treated, and what behaviors generate pollution. However, results also show a high level of concern about water quality, as well as a desire to practice pro-environmental behavior. Highlighting the connection between potential sources of pollution, such as pet waste and septic systems, and impacts, such as shellfish bed closures and swimming restrictions, could provide stronger awareness and motivation, particularly among the large number of residents who enjoy visiting beaches and who swim, fish, and boat in local waterways. Ultimately, the survey results can be used by a variety of educators and practitioners statewide to better understand and identify target audiences and to guide the development of stormwater programming that addresses these knowledge gaps. Conducting focus groups with subpopulations of residents is recommended as a next step to further identify specific motivations within subpopulations of residents. Combining the survey results with focus-group data can help educators remove barriers to taking action and further motivate behavior change

A mercadoria é você: o uso secundário de dados pessoais

O presente estudo tem, por objetivo, verificar se há compatibilidade entre a proteção de dados e o uso de dados para uma finalidade distinta daquela originalmente autorizada, especificamente no Direito Civil. Por meio do método dedutivo de abordagem, e pela pesquisa bibliográfica como método de procedimento, as duas hipóteses levantadas são, por um lado, que não há compatibilidade porque são situações mutuamente excludentes e, por outro, que a compatibilidade é possível desde que observados alguns critérios. Para responder à questão, optou-se pela divisão em dois capítulos, divididos em dois subcapítulos. O primeiro aborda a datificação da sociedade e seus impactos no Direito, fazendo um diálogo entre os autores que procuram explicar como nos organizamos socialmente a partir das informações pessoais, além de definir o que seja uso secundário de dados pessoais e analisar os princípios aplicáveis das legislações de proteção de dados pessoais. O segundo capítulo versa especificamente da maneira pela qual este assunto é tratado pelo Direito, debatendo os limites do consentimento e a necessidade de uma tutela coletiva de dados pessoais, que diminua o ônus protetivo do indivíduo. Ao final, concluiu-se pela hipótese da compatibilidade entre a proteção de dados e uso secundário de dados pessoais, estabelecendo-se critérios tanto para a proteção individual, quanto para a proteção coletiva, com especial relevo a esta última. Assim, se torna possível a conciliação entre os dois fundamentos da Lei Geral de Proteção de Dados: o desenvolvimento econômico e a proteção da privacidade.This study aims to verify if there is compatibility between data protection and the use of data for a purpose other than the one originally agreed, specifically in Civil Law. Through the deductive method, and thorough bibliographic research as procedure method, two hypotheses are raised: that there is no compatibility because the situations are mutually excluding, or that the compatibility is possible since some criteria are observed. To answer this question, this study was divided in two chapters, both divided in two subchapters. The first one addresses societies datification and its impacts in law, dialoging between authors trying to explain how we socially organize in the context of personal information, besides defining what secondary use of data is and analyzing the principles being applied by the data protection laws. The second chapter addresses how do law deals with this subject, debating the limits of consenting and the necessity of a collective guardianship of personal data, that reduces the individual’s protective burden. In the end, it is concluded by the hypothesis of compatibility between the use for a purpose other than the one originally agreed and personal data protection, establishing some criteria, both for individual and collective protection. Therefore, the conciliation between two of the fundaments of General Data Protection Law becomes possible: the economic development and the privacy protection

Role of Estrogen and Estrogen Receptor in GH-Secreting Adenomas

Acromegaly is a rare disease with several systemic complications that may lead to increased overall morbidity and mortality. Despite several available treatments, ranging from transsphenoidal resection of GH-producing adenomas to different medical therapies, complete hormonal control is not achieved in some cases. Some decades ago, estrogens were first used to treat acromegaly, resulting in a significant decrease in IGF1 levels. However, due to the consequent side effects of the high dose utilized, this treatment was later abandoned. The evidence that estrogens are able to blunt GH activity also derives from the evidence that women with GH deficiency taking oral estro-progestins pills need higher doses of GH replacement therapy. In recent years, the role of estrogens and Selective Estrogens Receptor Modulators (SERMs) in acromegaly treatment has been re-evaluated, especially considering poor control of the disease under first- and second-line medical treatment. In this review, we analyze the state of the art concerning the impact of estrogen and SERMs on the GH/IGF1 axis, focusing on molecular pathways and the possible implications for acromegaly treatment