Stimulation of renal prostaglandin synthesis by the pressor activity of vasopressin

Renal prostaglandin E2 (PGE2) synthesis is enhanced by exogenous vasopressin (AVP). To determine whether the pressor or the antidiuretic activities of AVP are related to its effect on PGE2 synthesis, AVP and the nonpressor analog, 1-deamino-8-D-arginine vasopressin (dD'AVP), were administered to the isolated perfused rabbit kidney, PGE2 was measured in the renal venous effluent by RIA and validated by bioassay. AVP in doses of 20, 200, and 2,000 ng progressively increased perfusion pressore by 12.1 +/- 2.4, 62.0 +/- 7.9, and 74.3 +/- 13.5 mm Hg, respectively, and increased PGE2 by 28 +/- 7, 80 +/- 3, and 129 +/- 57 ng/50 ml effluent, respectively. Bradykinin and angiotensin II induced a similar dose response on PGE2 release. However, dD'AVP in doses up to 20,000 ng minimally enhanced PGE2 release (20 +/- 16 ng/50 ml) and did not alter perfusion pressure. Simultaneous administration of AVP (200 ng) with the specific AVP pressor antagonist, d-cyclo-O-methyl-tyrosine-AVP, in a 1:10 (agonist to antagonist) weight ratio blunted the increase in perfusion pressure by 59 +/- 9% and blunted the increase in PGE2 release by 59 +/- 10% (P < 0.05). In a 1:100 weight ratio, the pressure antagonist reduced the AVP pressure response by 86 +/- 6% and reduced PGE2 by 84 +/- 7% (P < 0.01). These data suggest that the AVP stimulation of renal PGE2 synthesis is related primarily to its pressor and not to its antidiuretic activity in this in vitro kidney model. (Endocrinology 108: 495, 1981)     

Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass?

Although iron, vltamm B₁₂, and folate deficiency have been well documented after gastric bypass operations performed for morbid obesity, there is surprisingly little information on either the natural course or the treatment of these deficiencies in Roux-en-Y gastric bypass (RYGB) patients Durmg a l0-year period, a complete blood count and serum levels of iron, total iron-binding capacity, vltamin B₁₂, and folate were obtained in 348 patients preoperatively and postoperatively at 6-month intervals for the first 2 years, then annually thereafter The principal objectives of this study were to determine how readily patients who developed metabolic deficiencies after Roux-en-Y gastric bypass responded to postoperative supplements of the deficient micronutrient and to learn whether the risk of developmg these deficiencies decreases over time Hemoglobin and hematocrit levels were slgnificantly decreased at all postoperative intervals in comparison to preoperative values Moreover, at each successive interval through 5 years, hemoglobin and hematocrit were decreased signifiantly compared to the preceding interval Folate levels were significantly increased compared to preoperative levels at all time intervals Iron and vltamin B₁₂ levels were lower than preoperative measurements and remained relatively stable postoperatively Half of the low hemoglobin levels were not associated with iron deficiency Taking multivltamin supplements resulted in a lower incidence of folate deficiency but did not prevent iron or vitamin B₁₂ deficiency Oral supplementation of iron and vitamin B₁₂ corrected defiaencies in 43% and 81% of cases, respectively Folate deficiency was almost always corrected with multivitamins alone No patient had symptoms that could be attributed to either vitamin B₁₂ or folate deficiency Conversely, many patients had symptoms of iron deficiency and anenua Lack of symptoms of vitamin B₁₂ and folate deficiency suggests that these deficiencies are not clinically important after RYGB Conversely, iron deficiency and anemia are potentially serious problems after RYGB, particularly in younger women Hence we recommend prophylactic oral iron supplements to premenopausal women who undergo RYGB     

Safety of drotrecogin alfa (activated) in severe sepsis: Data from adult clinical trials and observational studies

Drotrecogin alfa (activated) (DrotAA), or recombinant human activated protein C, represents the only Food and Drug Administration-approved therapy for mortality reduction in adult patients with severe sepsis. Drotrecogin alfa (activated) has properties that address microvascular injury in severe sepsis through its direct effects on endothelial cells and leukocytes while also having antithrombotic and indirect profibrinolytic properties. Sepsis bundle and guideline implementation has been associated with improved survival and includes DrotAA administration in appropriate patients. Several DrotAA postapproval clinical studies have yielded additional outcome and safety data, better defining its benefit/risk profile. Bleeding is more common in DrotAA-treated patients; therefore, a careful assessment of bleeding risk and an understanding of the safety profile is required. This summary provides a detailed review of safety data and outcomes of patients treated with DrotAA in recent clinical studies enrolling more than 7000 adult patients.     

Increasing Dietary Protein Requirements in Elderly People for Optimal Muscle and Bone Health

Osteoporosis and sarcopenia are degenerative diseases frequently associated with aging. The loss of bone and muscle results in significant morbidity, so preventing or attenuating osteoporosis and sarcopenia is an important public health goal. Dietary protein is crucial for development of bone and muscle, and recent evidence suggests that increasing dietary protein above the current Recommended Dietary Allowance (RDA) may help maintain bone and muscle mass in older individuals. Several epidemiological and clinical studies point to a salutary effect of protein intakes above the current RDA (0.8 g/kg per day) for adults aged 19 and older. There is evidence that the anabolic response of muscle to dietary protein is attenuated in elderly people, and as a result, the amount of protein needed to achieve anabolism is greater. Dietary protein also increases circulating insulin-like growth factor, which has anabolic effects on muscle and bone. Furthermore, increasing dietary protein increases calcium absorption, which could be anabolic for bone. Available evidence supports a beneficial effect of short-term protein intakes up to 1.6 to 1.8 g/kg per day, although long-term studies are needed to show safety and efficacy. Future studies should employ functional measures indicative of protein adequacy, as well as measures of muscle protein synthesis and maintenance of muscle and bone tissue, to determine the optimal level of dietary protein. Given the available data, increasing the RDA for older individuals to 1.0 to 1.2 g/kg per day would maintain normal calcium metabolism and nitrogen balance without affecting renal function and may represent a compromise while longer-term protein supplement trials are pending. J Am Geriatr Soc 57:1073–1079, 2009 .