Furosemide stimulation of parathormone in humans: role of the calcium-sensing receptor and the renin-angiotensin system.

Interactions between sodium and calcium regulating systems are poorly characterized but clinically important. Parathyroid hormone (PTH) levels are increased shortly after furosemide treatment by an unknown mechanism, and this effect is blunted by the previous administration of a calcimimetic in animal studies. Here, we explored further the possible underlying mechanisms of this observation in a randomized crossover placebo-controlled study performed in 18 human males. Volunteers took either cinacalcet (60 mg) or placebo and received a 20 mg furosemide injection 3 h later. Plasma samples were collected at 15-min intervals and analyzed for intact PTH, calcium, sodium, potassium, magnesium, phosphate, plasma renin activity (PRA), and aldosterone up to 6 h after furosemide injection. Urinary electrolyte excretion was also monitored. Subjects under placebo presented a sharp increase in PTH levels after furosemide injection. In the presence of cinacalcet, PTH levels were suppressed and marginal increase of PTH was observed. No significant changes in electrolytes and urinary excretion were identified that could explain the furosemide-induced increase in PTH levels. PRA and aldosterone were stimulated by furosemide injection but were not affected by previous cinacalcet ingestion. Expression of NKCC1, but not NKCC2, was found in parathyroid tissue. In conclusion, our results indicate that furosemide acutely stimulates PTH secretion in the absence of any detectable electrolyte changes in healthy adults. A possible direct effect of furosemide on parathyroid gland needs further studies

Effects of Commercial Harvest on Shovelnose Sturgeon Populations in the Upper Mississippi River

Shovelnose sturgeon Scaphirhynchus platorynchus have become an increasingly important commercial species in the upper Mississippi River (UMR) because of the collapse of foreign sturgeon (family Acipenseridae) populations and bans on imported caviar. In response to concerns about the sustainability of the commercial shovelnose sturgeon fishery in the UMR, we undertook this study to describe the demographics of the shovelnose sturgeon population and evaluate the influence of commercial harvest on shovelnose sturgeon populations in the UMR. A total of 1,682 shovelnose sturgeon were collected from eight study pools in 2006 and 2007 (Pools 4, 7, 9, 11, 13, 14, 16, and 18). Shovelnose sturgeon from upstream pools generally had greater lengths, weights, and ages than those from downstream pools. Additionally, mortality estimates were lower in upstream pools (Pools 4, 7, 9, and 11) than in downstream pools (Pools 13, 14, 16, and 18). Linear regression suggested that the slower growth of shovelnose sturgeon is a consequence of commercial harvest in the UMR. Modeling of potential management scenarios suggested that a 685-mm minimum length limit is necessary to prevent growth and recruitment overfishing of shovelnose sturgeon in the UMR

Clinical benefits of an adherence monitoring program in the management of secondary hyperparathyroidism with cinacalcet: results of a prospective randomized controlled study.

BACKGROUND/AIMS: One of the causes of uncontrolled secondary hyperparathyroidism (sHPT) is patient's poor drug adherence. We evaluated the clinical benefits of an integrated care approach on the control of sHPT by cinacalcet. METHODS: Prospective, randomized, controlled, multicenter, open-label study. Fifty hemodialysis patients on a stable dose of cinacalcet were randomized to an integrated care approach (IC) or usual care approach (UC). In the IC group, cinacalcet adherence was monitored using an electronic system. Results were discussed with the patients in motivational interviews, and drug prescription adapted accordingly. In the UC group, drug adherence was monitored, but results were not available. RESULTS: At six months, 84% of patients in the IC group achieved recommended iPTH targets versus 55% in the UC group (P = 0.04). The mean cinacalcet taking adherence improved by 10.8% in the IC group and declined by 5.3% in the UC group (P = 0.02). Concomitantly, the mean dose of cinacalcet was reduced by 7.2 mg/day in the IC group and increased by 6.4 mg/day in the UC group (P = 0.03). CONCLUSIONS: The use of a drug adherence monitoring program in the management of sHPT in hemodialysis patients receiving cinacalcet improves drug adherence and iPTH control and allows a reduction in the dose of cinacalcet

Instrumentation of the Säntis tower in Switzerland for lightning current measurements

This paper reports on the progress in a new project to instrument the Säntis telecommunications tower in the Saint Gallen region of Switzerland. The paper includes information on the Rogowski coils and magnetic loop sensors that will be used to measure the lightning current. In addition, information is given on the design of the control and monitoring system in the context of the particularly rough weather conditions of the site

Lightning measurement station on Mount Säntis in Switzerland

none7This paper reports on the progress in a new project to instrument the Säntis telecommunication tower in the Saint Gallen region of Switzerland. The paper includes information on the Rogowski coils and magnetic loop sensors that will be used to measure the lightning current. In addition, information is given on the design of the control and monitoring system in the context of the particular weather conditions of the site.mixedA. Rubinstein; C. Romero; M. Paolone; F. Rachidi; M. Rubinstein; P. Zweiacker; B. DaoutA. Rubinstein; C. Romero; M. Paolone; F. Rachidi; M. Rubinstein; P. Zweiacker; B. Daou

Dose-dependent acute and sustained renal effects of the endothelin receptor antagonist avosentan in healthy subjects.

The endothelin receptor antagonist avosentan may cause fluid overload at doses of 25 and 50 mg, but the actual mechanisms of this effect are unclear. We conducted a placebo-controlled study in 23 healthy subjects to assess the renal effects of avosentan and the dose dependency of these effects. Oral avosentan was administered once daily for 8 days at doses of 0.5, 1.5, 5, and 50 mg. The drug induced a dose-dependent median increase in body weight, most pronounced at 50 mg (0.8 kg on day 8). Avosentan did not affect renal hemodynamics or plasma electrolytes. A dose-dependent median reduction in the fractional renal excretion of sodium was found (up to 8.7% at avosentan 50 mg); this reduction was paralleled by a dose-related increase in proximal sodium reabsorption. It is suggested that avosentan dose-dependently induces sodium retention by the kidney, mainly through proximal tubular effects. The potential clinical benefits of avosentan should therefore be investigated at doses of <or= 5 mg