Reduced small-scale structural complexity on sponge-dominated areas of Indo-Pacific coral reefs

Corals provide a complex 3D framework that offers habitat to diverse coral reef fauna. However, future reefs are likely to experience reduced coral abundance. Sponges have been proposed as one potential winner on future coral reefs, but little is known of how they contribute to reef 3D structure. Given the ecological importance of structural complexity, it is critical to understand how changes in the abundance of structure-building organisms will affect the three-dimensional properties of coral reefs. To investigate the potentially important functional role of coral reef sponges as providers of structural complexity, we compared the structural complexity of coral- and sponge-dominated areas of an Indonesian coral reef, using 3D photogrammetry at a 4 m2 spatial scale. Structural complexity of 31 4 m2 quadrats was expressed as rugosity indicating reef contour complexity (R), vector dispersion indicating heterogeneity of angles between reef surfaces (1/k), and fractal dimension indicating geometrical complexity at five different spatial scales between 1 and 120 cm (D1-5). Quadrats were identified as high- or low-complexity using hierarchical clustering based on the complexity metrics. At high structural complexity, coral- and sponge-dominated quadrats were similar in terms of R and 1/k. However, smallest-scale refuge spaces (1-5 cm) were more abundant in coral-dominated quadrats, whereas larger scale refuge spaces (30-60 cm) were more abundant in sponge-dominated quadrats. Branching and massive corals contributed the most to structural complexity in coral-dominated quadrats, and barrel sponges in sponge-dominated quadrats. We show that smaller-scale refugia (1-5 cm) are reduced on sponge-dominated reefs at the spatial scale considered here (4 m2), with potential negative implications for smaller reef fauna.

Pengaruh Kepuasan Kerja dan Positive Self-Talk Terhadap Stres Kerja Pada Pemasar Kartu Kredit Debit

Penelitian ini bertujuan untuk mengetahui seberapa besar pengaruh kepuasan kerja dan positive self-talk terhadap stres kerja pada pemasar kartu kredit bank. Subjek dalam penelitian ini adalah Pemasar Kartu Kredit Bank yang berada di Kota Medan Sumatera Utara dengan jumlah total 100 sampel. Penelitian ini menggunakan metode penelitian kuantitatif, kemudian teknik yang digunakan dalam pengempulan data pada penelitian ini adalah menggunakan pengisian kuesioner, yang disusun melalui skala likert. Teknik yang digunakan dalam pengambilan sampel adalah teknik probability sampling, kemudian untuk menganalisis data, peneliti menggunakan teknik uji regresi linier berganda. Hasil penelitian ini menunjukkan bahwa kepuasan kerja berpengaruh terhadap stres kerja dengan nilai koefisien korelasi rx1y sebesar -0.691 dengan p < 0.05, kemudian hasil penelitian juga menunjukkan bahwa positive self- talk juga mempengaruhi stres kerja dengan nilai koefisien korelasi sebesar rx2y -0.378 dengan p < 0.05. hasil penelitian juga menunjukkan bahwa kepuasan kerja dan positive self-talk secara bersama-sama berpengaruh terhadap stress kerja karyawan, kontribusi keduanya dalam memunculkan stres kerja adalah sebesar 48.2%. dengan demikian dapat diatik kesimpulan bahwa kepuasan kerja dan positive self- talk memiliki pengaruh terhadap stres kerja pada adalah Pemasar Kartu Kredit Bank yang berada di Kota Medan Sumatera Utara.

Ferrate synthesis using NaOCl and its application for dye removal

Ferrate salt is a powerful oxidant for dye degradation. This work demonstrates a new method for degrading dyes containing Fe(vi) by synthesizing NaOCl from the electrolysis of table salt. NaOCl is then reacted with Fe(OH)3 in an alkaline condition to form ferrate. Electrolysis of table salt was successfully carried out using platinum as an anode and zinc as a cathode. The obtained ferrate was characterized by using Fourier transform infrared, UV-Vis, and X-ray diffraction spectroscopy. The ferrate solution has a maximum wavelength of 505 nm with a characteristic purple color. Furthermore, the ferrate produced was utilized to remove methylene blue (MB), remazol black blue (RBB), and methyl orange (MO) dyes with varying contact times. The degraded dyes were then analyzed using LC/MS. The results showed that ferrate was effective to remove dyes with an optimum contact time of 60 min that follows an order one reaction. In this study, MB showed a percent degradation close to 100% with the fastest decolorization rate compared with MO and RBB. This research provides new insights into the benefits of table salt as a base material for NaOCl through electrolysis for synthesizing ferrate, used in dye removal applications.

Pervaporation Membranes for Seawater Desalination Based on Geo-rGO-TiO2 Nanocomposites: Part 2-Membranes Performances

This is part 2 of the research on pervaporation membranes for seawater desalination based on Geo-rGO-TiO₂ nanocomposite. The quality of the Geo-rGO-TiO₂ pervaporation membranes (PV), as well as the suitability of the built pervaporation system, is thoroughly discussed. The four membranes described in detail in the first article were tested for their capabilities using the parameters turbidity, salinity, total suspended solids (TSS), and electrical conductivity (EC). The membranes' flux permeate was measured as a function of temperature, and salt rejection was calculated using the electrical conductivity values of the feed and permeate. Fourier-transform infrared (FTIR) and X-ray diffraction (XRD) techniques were used to investigate changes in the chemical composition and internal structure of the membranes after use in pervaporation systems. The morphology of the membrane's surfaces was examined by means of scanning electron microscopy (SEM), and the elemental distribution was observed by using X-ray mapping and energy dispersive spectroscopy (EDS). The results showed that the pervaporation membrane of Geo-rGO-TiO₂ (1, 3) achieved a permeate flux as high as 2.29 kg/m²·h with a salt rejection of around 91%. The results of the FTIR and XRD measurements did not show any changes in the functional group and chemical compositions of the membrane after the pervaporation process took place. Long-term pressure and temperature feed cause significant cracking in geopolymer and Geo-TiO₂ (3) membranes. SEM results revealed that the surface of all membranes is leached out, and elemental distribution based on X-ray mapping and EDS observations revealed the addition of Na+ ions on the membrane surface. The study's findings pave the way for more research and development of geopolymers as the basic material for inorganic membranes, particularly with the addition of rGO-TiO₂ nanocomposites.

Environmental Health-based Educational Policies at Public Junior High School 1 Karanganyar, Central Java, Indonesia as an Independent Adiwiyata School

BACKGROUND: Adiwiyata is a program for Indonesian schools to encourage environmental-friendliness and ecological awareness. Public Junior High School 1 Karanganyar is a school in Central Java Province that won the Independent Adiwiyata School award. AIM: This research aims to describe: (1) The environmentally friendly policies, (2) the curriculum model of Islamic Religion Education subject that have ecologic orientation, (3) the participative-based school activities that color the construction of the Islamic Religion Education subject that have ecologic orientation, and (4) the management of facilities and infrastructure that support the construction of the Islamic Religion Education subject that have ecologic orientation in Public Junior High School 1 Karanganyar. METHODS: This study uses the method of constructivism paradigm. This descriptive research uses the qualitative approach. RESULT AND DISCUSSION: The environmentally-friendly school policies encompass the Curriculum of Educational Unit Level and the School Budget and Activity Plans, which contain efforts of environmental preservation. Results show that these policies are also contained in the vision of the Public Junior High School 1 Karanganyar, namely, “To create a generation that is religious, intelligent, have good character, and environmentally-friendly.” The curriculum model contains policies on environmental preservation. CONCLUSION: The participative-based school activities in PJHS 1 Karanganyar are supported by all school components, including in the form of partnerships. The management of the facilities and infrastructure that support ecologic orientation is quite good. Some educative slogans and posters contain ecologic messages put up in strategic places. There are green open spaces, a canteen that reduces plastic usage, and waste management facilities.

Empowering parents as a support group for children with special needs in Bima, Indonesia

Objective: To find how to empower parents as a support group to optimize the creativity of children with special needs in Bima, Indonesia. Methodology: This is Quasi-Experimental Design with pre-posttest without control group. Data were analized using wilcoxon to test the comparative hypothesis of two samples that were correlated. The limit of significance of p value 0.05 with a sample of 61 respondents. Results: Statistical test wilcoxon test with a Z value of 6.164 flower arranging and a Z value of making photo frames 6.856 with a p-value of 0.000 flower arrangement behavior and a p-value of 0.000 making photo frames. Conclusion: There is an effect of empowering the role of parents as a support group on optimizing the creativity of children with special needs in Bima Indonesia.

Effectiveness of Green Chemical Solvent-based on Triethylammonium Methanesulfonate Ion Liquid for the OPEFB Pretreatment Process

Many studies have explored the pretreatment of lignocellulosic biomass based on oil palm empty fruit bunch (OPEFB) which is categorized as potential biomass waste for bioethanol production. Before proceeding further to obtain bioethanol, several steps such as pretreatment to increase organic constituents are needed. The ionic liquids (ILs) were commonly investigated by many researchers for lignocellulosic pretreatment because it is easy solubilization property, non-toxic, and not harmful impacts on the environment. Therefore in this study, the hypothesis and main objective were to observe the effectiveness of triethylammonium methanesulfonate ion liquid (TMS IL) in the OPEFB lignocellulose pretreatment process. Three variations were studied to obtain optimization of the pretreatment process, such as times duration, IL composition, and temperature. Based on these results, we observed the effectiveness of the time duration for OPEFB pretreatment of 20 hours. Furthermore, it was applied to determine the optimization of IL composition and temperature showing that using 91% (1:1:10) at 120°C for 20 hours has provided good performance for the OPEFB lignocellulose pretreatment process. TMS IL has exhibited the ability to reduce hemicellulose and lignin contents to 7.35% and 17.80%, whereas cellulose was increased by 54.24%. This has the opportunity to be projected to a larger scale for bioethanol production based on OPEFB lignocellulose.

Molecularly imprinted membrane for transport of urea, creatinine, and vitamin B12 as a hemodialysis candidate membrane

High levels of urea and creatinine in the blood are a sign of decreased kidney function. To remove these substances from the blood, hemodialysis which utilizes membranes could be used. In this study, a molecularly imprinted membrane (MIM) was synthesized for the selective transport of urea. The synthesis is initiated with the polymerization of eugenol into polyeugenol and then into polyeugenoxy acetate (PA). The PA is then contacted with urea and then used as the functional polymer in the synthesis of MIM with polysulfone as the membrane base, and polyethylene glycol as the cross-linking agent. The result was later analyzed with FTIR and SEM-EDX. The membrane is then used in the transport of urea, creatinine, and vitamin B12 and then compared with the non-imprinted membrane (NIM) performance. By using UV-Vis spectrophotometry, the results showed that the membrane with 10 h heating variation is able to transport more urea and is more selective than NIM; this proves that the urea template on the MIM enables it to recognize urea molecules better than creatinine and vitamin B12. The order of transport from the best results is urea > creatinine > vitamin B12.

Bioeroding sponge species from the Wakatobi region of southeast Sulawesi, Indonesia

Sponges that excavate and inhabit calcareous substrate, predominantly of the Clionaidae, are widely distributed in marine habitats, but are particularly diverse and abundant on coral reefs. Unfortunately, their cryptic habit and difficult taxonomy mean respective taxa are poorly understood, and therefore they are rarely included in reef surveys. This is particularly true of the Southeast Asian Indo-Pacific, where a diverse faunistic record is contrasted with a very limited understanding of eco-physiological requirements of these sponges. In light of this, in situ surveys of the most common bioeroding sponges in the Wakatobi region of Southeast Sulawesi, Indonesia were conducted, followed by morphological and molecular analysis. The seven most common species in the Wakatobi included five species with a wide Indo-Pacific distribution and two new species. Four species, Cliona orientalis, Cliona aff. schmidtii, Spheciospongia cf. vagabunda trincomaliensis and Cliothosa hancocki have been previously reported from Indonesian waters, while Zyzzya criceta is a new record for Indonesia. Two brown sponges belonging to the Cliona viridis species complex, Cliona wakatobiensis sp. nov. and Cliona cribripora sp. nov., are here described as new to science. They were morphologically distinct from other species in the sample region and could not conclusively be allocated to any other known clionaid species. A maximum likelihood analysis of ITS1 rDNA revealed them to be phylogenetically closer to other Indo-Pacific species such as Cliona orientalis and Cliona thomasi than to other species within this taxon complex.

Potential of Nanoparticles Chitosan for Delivery pcDNA3.1-SB3-HBcAg

Hepatitis B virus (HBV) is a DNA virus that causes hepatitis in humans. This study aims to prepare a Hepatitis DNA vaccine. he optimized base sequence of the SB3-HBcAg gene was derived from the nucleotide base sequence of the Hepatitis B core antigen B3 HBcAg subgenotype, and then Cloning of the pcDNA3.1-SB3-HBcAg has been successfully performed on E. coli DH5α and confirmed by PCR, restriction analysis and sequencing. The propagated plasmids were prepared as DNA-chitosan complex and physiochemical characterized using Particle Size Analyzer. Complex with a 4:1 (wt/wt) ratio of DNA with 0.04% concentration and chitosan have a mean diameter of 231.7 nm and zeta potential +12.3 mV and the value of Cytotoxicity Assay 80-90% as compared to the untreated cells that used as negative control, so it can be concluded that nanoparticles chitosan has good potential as a carrier agent for pcDNA3.1-SB3-HBcAg.

Polysulfone Influence on Au Selective Adsorbent Imprinted Membrane Synthesis with Sulfonated Polyeugenol as Functional Polymer

An ionic imprinted membrane (IIM) was synthesized using sulfonated polyeugenol, derived from eugenol, as its functional polymer and polysulfone as its base membrane for the selective adsorption of Au(III). This study aims to determine the adsorption of Au(III) metal ions using IIM compared with the non-imprinted membrane (NIM) and to figure out the membrane selectivity towards Au(III) in mixed solutions of Au/Cd, Au/Cu, and Au/Fe. IIM has a pore size of 0.767 μm while the non-imprinted membrane (NIM) has a pore size of 0.853 μm. The best adsorption result was obtained in the variation of the membrane with the addition of 3.84 g of polysulfone that had pores according to the size of Au. The selectivity results of the Au/Cd mixture solution in NIM and IIM were 17.802 and 36.265. In the mixture of Au/Cu, the NIM and IIM selectivity was 2.386 and 6.886, and in the mixed solution of Au/Fe, the selectivity of NIM and IIM was 0 and 8.489. Thus, the selectivity of IIM towards Au is bigger than NIM.

PENERAPAN MODEL DISCHARGE PLANNING TERSTRUKTUR DAN HOME CARE DALAM MENINGKATKAN SELF CARE PENDERITA TUBERKULOSIS PARU DI RUMAH SAKIT UMUM DAERAH BIMA NUSA TENGGARA BARAT

Latar Belakang: Penyakit TB merupakan masalah kesehatan masarakat di seluruh dunia dan menjadi penyebab kematian ketiga terbesar setelah penyakit kardiovaskuler dan penyakit saluran pernafasan, dan merupakan nomor satu terbesar dalam kelompok penyakit infeksi. Penerapan discharge planning terstruktur melalui 5 (lima) tahap langkah kegiatan dapat meningkatkan pengetahuan, kesadaran dan perilaku perawatan diri (self care) penderita TB paru selama menjalani pengobatan TB yang biasanya berlangsung sampai 6 bulan. Tujuan : Penelitian ini bertujuan untuk membuktikan pengaruh penerapan model discharge planning terstruktur dan home care dalam meningkatkan self care penderita tuberkulosis paru di Rumah Sakit Umum Daerah Bima. Metode: Menggunakan randomized control group pretest posttest design, penelitan ini melibatkan dua kelompok subjek yaitu kelompok perlakuan dan kelompok kontrol yang dilakukan randomisasi. Populasi dalam penelitan ini adalah semua penderita TB paru yang menjalani rawat inap di RSUD Bima selama tahun 2017 yang tersebar di dua ruangan yaitu ruangan penyakit dalam dan ruangan perawatan isolasi. Pengambilan sampel menggunakan tehnik non probability sampling yaitu purposive sampling. Analisis data menggunakan statistik non parametris  Wilcoxon sign rank test dan Mann-Whitney test, hipotesis alternatif diterima bila nilai p ≤ 0,05. Hasil: Self care demand dan self care agency penderita TB paru mengalami peningkatan, uji Wilcoxon Signed Rank Test dan uji Mann-Whitney Test menunjukan nilai p<0,05, yang berarti ada pengaruh penerapan model discharge planning terstruktur dan home care dalam meningkatkan self care penderita tuberkulosis. Kesimpulan: ada pengaruh penerapan model discharge planning terstruktur dan home care terhadap self care demand penderita TB paru di Rumah Sakit Umum Daerah Bima.

Photoacclimation to light-limitation in a clionaid sponge; implications for understanding sponge bioerosion on turbid reefs

Watershed-based pollution is a common form of coral reef degradation. Affected reefs are often highly turbid, where light-limitation confines the distribution of photosynthetic benthic taxa and the capacity for photoacclimation is important for survival. We investigated low light photoacclimation in a Symbiodinium-hosting bioeroding sponge using in situ PAM fluorometry. Cliona aff. viridis was artificially shaded (70 & 95% ambient light reduction) on a low turbidity Indonesian reef for 25 days, with a subsequent 14-day recovery period. Significant changes in rETR_max, and qP, and a non-significant but observable decline in E_k, demonstrated that C. aff. viridis is able to photoacclimate to conditions of extreme light reduction and recover within a relatively short period of time. The sponge is therefore unlikely to be light limited on even the most turbid reefs. However, other aspects of watershed-pollution such as sedimentation may still limit their distribution in affected coastal waters.

EFFECT OF LO'I KARANA ON PAIN LEVEL IN POSTPARTUM MOTHERS

Background: Lo'i Karana is one type of traditional therapies that has existed for more than one hundred years in the midst of society of Bima and Dompu to overcome the discomfort due to labor. However, lack of research has been conducted to examine its effect on pain in postpartum mothers.Objective: To examine the effect of Lo’I Karana on muscle pain in postpartum mothers.Methods: This was a quasy experimental study with posttest only control group design. Thirty mothers were selected using purposive sampling, which 10 assigned in 3 groups (standard-dose group, minimal-dose group, and maximal-dose group). Wong-Baker Faces Pain rating scale was used to measure pain on day 1 and day 3. Kruskal-Wallis Test and Mann Whitney test were used for data analysis. Results: There were significant effects of Lo’I karana in minimal, standard and maximal dosage on pain level in the first day (p=0.004) and the third day (p=0.009) in postpartum mothers. The results revealed that the higher doses used for the treatment, the less pain of the mothers will be. Conclusion: Lo’I Karana has a significant effect in reducing pain level in postpartum mothers. It is recommended that this intervention can be applied as a part of nursing intervention in caring postpartum mothers.

Bamboo leaf-based carbon dots for efficient tumor imaging and therapy

In this study, carbon dots synthesized from bamboo leaf cellulose were used simultaneously as a staining agent and for doxorubicin delivery to target cancer cells.

Targeted energy transfer and modal energy redistribution in automotive drivetrains

The new generations of compact high output power-to-weight ratio internal combustion engines generate broadband torsional oscillations, transmitted to lightly damped drivetrain systems. A novel approach to mitigate these untoward vibrations can be the use of nonlinear absorbers. These act as Nonlinear Energy Sinks (NESs). The NES is coupled to the primary (drivetrain) structure, inducing passive irreversible targeted energy transfer (TET) from the drivetrain system to the NES. During this process, the vibration energy is directed from the lower-frequency modes of the structure to the higher ones. Thereafter, vibrations can be either dissipated through structural damping or consumed by the NES. This paper uses a lumped parameter model of an automotive driveline to simulate the effect of TET and the assumed modal energy redistribution. Significant redistribution of vibratory energy is observed through TET. Furthermore, the integrated optimization process highlights the most effective configuration and parametric evaluation for use of NES.

Resilience to disturbance despite limited dispersal and self-recruitment in tropical barrel sponges: implications for conservation and management

While estimates of connectivity are important for effective management, few such estimates are available for reef invertebrates other than for corals. Barrel sponges are one of the largest and most conspicuous members of the coral reef fauna across the Indo-Pacific and given their large size, longevity and ability to process large volumes of water, they have a major role in reef functioning. Here we used a panel of microsatellite markers to characterise the genetic structure of two barrel sponge species, Xestospongia testudinaria and a currently undescribed Xestospongia species. We sampled across seven populations in the Wakatobi Marine National Park, SE Sulawesi (Indonesia) spanning a spatial scale of approximately 2 to 70 km, and present the first estimates of demographic connectivity for coral reef sponges. Genetic analyses showed high levels of genetic differentiation between all populations for both species, but contrasting patterns of genetic structuring for the two species. Autocorrelation analyses showed the likely dispersal distances of both species to be in the order of 60 and 140 m for Xestopongia sp. and Xestospongia testudinaria, respectively, which was supported by assignment tests that showed high levels of self-recruitment (>80%). We also found consistently high inbreeding coefficients across all populations for both species. Our study highlights the potential susceptibility of barrel sponges to environmental perturbations because they are generally long-lived, slow growing, have small population sizes and are likely to be reliant on self-recruitment. Surprisingly, despite these features we actually found the highest abundance of both barrel sponge species (although they were generally smaller) at a site that has been severely impacted by humans over the last fifty years. This suggests that barrel sponges exhibit environmental adaptation to declining environmental quality and has important implications for the management and conservation of these important reef species.

PENGARUH ION LOGAM Cd(II) DAN pH LARUTAN TERHADAP EFEKTIVITAS FOTODEGRADASI ZAT WARNA REMAZOL BLACK B MENGGUNAKAN KATALIS TiO2

Telah dilakukan penelitian pengaruh ion logam Cd(II) dan pH larutan terhadap efektivitas fotodegradasi zat warnaRemazol Black B menggunakan katalis TiO2. Serbuk TiO2 yang digunakan dikarakterisasi dengan menggunakan XRD. Proses fotokatalisis dilakukan secara simultan menggunakan katalis TiO2 dalam suatu reaktor tertutup yang dilengkapi dengan lampu UV-C. Kosentrasi Remazol Black B dianalisis menggunakan spektrofotometer UV-Vis dan AAS. Hasil karakterisasi serbuk TiO2 menunjukkan bahwa TiO2 yang digunakan mempunyai struktur kristal anatase dengan harga d yaitu 3,5; 2,42; 2,37; 2,32; 1,9; 1,7 dan mempunyai ukuran kristal 46,696 nm. Hasil penelitian menunjukkan bahwa penambahan ion logam Cd(II) meningkatkan efektivitas fotodegradasi Remazol Black B dan secara simultan mereduksi ion logam Cd(II) menjadi Cd(s). Pada proses fotodegradasi Remazol Black B 40 ppm dengan TiO2 50 mg, penambahan ion logam Cd(II) paling optimum adalah pada konsentrasi 4,5 ppm yang menghasilkan fotodegradasi Remazol Black B sebesar 85,83% dengan fotoreduksi ion Cd(II) sebesar 97,78%. Proses fotodegradasi Remazol Black B dengan adanya penambahan ion logam Cd(II) paling efektif adalah pada pH 4, dengan efektivitas fotodegradasi sebesar 97,62%.

C1-inhibitor autoantibodies in SLE

The presence of anti-C1-inhibitor (anti-C1-INH) autoantibodies is a hallmark of acquired C1-inhibitor deficiency. However, only scarce data are available on their prevalence, diagnostic value, and/or significance in systemic lupus erythematosus (SLE). In a multicentre study, we determined the levels of autoantibodies to C1-inhibitor in sera from 202 patients with SLE and 134 healthy controls. Additional clinical and laboratory parameters, such as organ involvement, as well as anti-C1q, anti-double-stranded DNA antibody, erythrocyte sedimentation rate, C-reactive protein, C3 and C4 serum complement levels have been studied in patients. The level of anti-C1-INH IgG was significantly higher (p = 0.034) in SLE patients, than in the controls. A high anti-C1-INH level of ≥0.4 U/ml (mean of controls + 2 SD) was found in 17% of the patients, but in only 4% of the controls (p = 0.0003). The SLEDAI score was significantly higher (p = 0.048) and the duration of SLE was significantly longer (p = 0.0004) among patients with elevated anti-C1-INH levels compared with patients without this autoantibody (median disease duration 8 vs. 17 years, respectively). Anti-C1-INH level was not correlated with any other laboratory parameter or organ manifestation of the disease. These findings indicate that the anti-C1-INH level is higher in SLE patients than in healthy controls and furthermore, the anti-C1-INH level correlates with the duration and activity of the disease. Lupus (2010) 19, 634—638.

Reversal of adynamic bone disease by lowering of dialysate calcium

Adynamic bone disease (ABD) is increasingly recognized, especially in dialysis patients treated with oral calcium carbonate, vitamin D supplements, or supraphysiological dialysate calcium. We undertook this study to assess the effect of lowering dialysate calcium on episodes of hypercalcemia, serum parathyroid hormone (PTH) levels as well as bone turnover. Fifty-one patients treated with peritoneal dialysis and biopsy-proven ABD were randomized to treatment with control calcium, 1.62 mM, or low calcium, 1.0 mM, dialysate calcium over a 16-month period. In the low dialysate calcium group, 14 patients completed the study. This group experienced a decrease in serum total and ionized calcium levels, and an 89% reduction in episodes of hypercalcemia, resulting in a 300% increase in serum PTH values, from 6.0+/-1.6 to 24.9+/-3.6 pM (P<0.0001). Bone formation rates, all initially suppressed, at 18.1+/-5.6 microm2/mm2/day rose to 159+/-59.4 microm2/mm2/day (P<0.05), into the normal range (>108 microm2/mm2/day). In the control group, nine patients completed the study. Their PTH levels did not increase significantly, from 7.3+/-1.6 to 9.4+/-1.5 pM and bone formation rates did not change significantly either, from 13.3+/-7.1 to 40.9+/-11.9 microm2/mm2/day. Lowering of peritoneal dialysate calcium reduced serum calcium levels and hypercalcemic episodes, which resulted in increased PTH levels and normalization of bone turnover in patients with ABD.

[Hypophosphatemic oncogenic osteomalacia]

The first case of oncogen osteomalacia in Hungary is reported, to draw the attention of the medical profession to it and to present the new data about its pathomechanism. Pathological hip fracture caused by hypophosphataemic osteomalacia due to isolated renal phosphate wasting was found in a previously healthy 19 years old sportsman. In spite of daily 1.5 micrograms calcitriol treatment and phosphate supplementation, hypophosphataemia persisted for 13 years and he needed regular indometacin medication for his bone pain. During that time an 1.5 cm gingival tumour was found and radically removed. The serum phosphate level returned to normal in a few hours after the operation (preoperative 0.51, after 2, 4 and 8 hours 0.61, 0.68 and 0.79 mmol/l respectively), and remained normal without calcitriol. The histological examination showed epulis with fibroblast and vascular cell proliferation, which has never been previously reported in connection with oncogenic osteomalacia. The pain resolved after 3 months and the bone density became normal in one year. Oncogenic osteomalacia must be considered in every case presenting with atypical hypophosphataemic osteomalacia. Careful dental examination is needed also in the course of search for the underlying tumour. Every tumour-like growth, even the common epulis, has to be operated radically and serum phosphate monitored in the postoperative period in all such cases.

[Transtubular potassium gradient in the diagnosis of potassium metabolism disorders]

The transtubular potassium gradient (TTKG) is a simple physiologically based clinical test to study the renal excretion of potassium. This article reviews the most important physiological changes influencing TTKG, the hypokalaemia and hyperkalaemia, the effect of mineralocorticoids, alkalosis, action of diuretics among other drugs etc. The authors studied the abnormalities of TTKG occurring in clinical conditions (renal patients with nephrotic edema, "dry" patients with renal diseases, liver cirrhosis associated with ascites, and primary hyperaldosteronism) and compare them to the results obtained in healthy people. They consider the test to be useful in the recognition of conditions with hypoaldosteronism (including the various types of pseudohypoaldosteronisms and aldosterone resistance) and hyperaldosteronism as well as renal diseases, in accordance with the data published in the literature. On the basis of their own results, they found the method of determination of TTKG informative and helpful also when investigating the site of actions and the effect mechanisms of the diuretics.

[Hyperkalemias]

Hyperkalaemia is a frequent electrolyte disturbance connected with new knowledge and practical routine. It is developed by the disorders of the "external balance" (potassium [K] intake and output) as well as the "internal balance" (distribution of K in the extracellular and intracellular fluid compartments). Factors playing a role in it are: the upright posture, physical activity and hyperosmolality. In the hormonal regulation of K metabolism first of all beta adrenergic agents, insulin and aldosterone have significance; the first two mainly in the internal balance. Hyperkalaemia is occurring especially frequently in renal patients (in acute and chronic renal insufficiency, in dialyzed persons) in patients with diabetes, in adrenal insufficiency (Addison's disease, in selective hypoaldosteronisms and in pseudohypoaldosteronisms) in renal tubular acidosis as well as in response to various drugs (ACE inhibitors, angiotensin receptor antagonists, beta blocking agents, potassium sparing diuretics, NSAID's, anticoagulants etc.). Interactions between illness and drugs as well as between drugs and hormones may have outstanding importance in the development of hyperkalaemia. Physical activity carried out in the upright posture in the presence of hyperosmolality (water restriction together with salt or/and glucose loading) developing in pharmacological hypoaldosteronism accompanied with insulin deficiency, may be especially dangerous with respect to hyperkalaemia. To avoid life-threatening hyperkalaemia it is necessary 1. to stop cardiotoxicity with calcium; 2. to enhance K uptake by the cells by bicarbonate, insulin and beta adrenergic agents; and 3. to remove abnormal quantities of K from the body by enemas and/or ion exchange resins. The quickest and best way of treatment of hyperkalaemia is haemodialysis.

Patterns of potassium wasting in response to stepwise combinations of diuretics in nephrotic syndrome

OBJECTIVE

To study the urinary potassium wasting patterns when the decreasing effectiveness of diuretics during repeated administrations are counterbalanced by stepwise increases of doses and combinations of them.

PATIENTS

Eleven patients with renal edema. Seven patients suffered from advanced nephrotic syndrome and 4 patients were "forme fruste".

METHODS

Urinary excretions and serum levels of potassium, sodium, creatinine, osmoles were determined; specific renal functions, glomerular filtration rate (GFR) fractional excretion of potassium (FE(K)), transtubular potassium gradient (TTKG) and free water reabsorption (TcH2O) were calculated. Nine different intervention-induced changes were followed daily: furosemide (FSD) alone, FSD with chlorthalidone (CTN), "low dose" and "high dose" potassium sparing drugs (PSD), FSD with CTN and "low dose" or "high dose" PSD, and "no drug" as well as "postdiuretic" periods with or without PSD.

RESULTS

TTKG significantly decreased in response to FSD. It elevated during FSD with CTN, but remained lower than the baseline. The normal correlation between urinary potassium excretion (UKV) and TTKG became distorted under FSD. UKV and FE(K) were slightly increased by FSD and more markedly when given FSD together with CTN, probably because "distal volume flow" was elevated. In the "postdiuretic" periods TTKG increased, but this was reversed by PSD. In response to PSD, TTKG and UKV decreased, but both were elevated when combining with FSD + CTN.

CONCLUSIONS

FSD caused relatively small potassium loss, because the enhanced "distal volume flow" was counterbalanced by a decrease of TTKG. FSD may have had a potassium secretion inhibitory influence as well. Potassium loss and TTKG were enhanced during coadministration of CTN, and decreased by PSD. "Postdiuretic rebound" increase of TTKG was reversed by PSD.

Familial adult onset X-linked hypophosphataemic osteomalacia (report of a family; clinical and experimental studies)

From four patients (a great-grandmother, grandmother, her daughter and her grandson) suffering from a very severe form of familial X-linked hypophosphataemic osteomalacia (XLH), belonging to a 23-number-kindred of five generations, the youngest patient a 24-year-old man with an adult onset XLH was treated with phosphate and calcitriol for two years. Phosphate was given in increasing doses (500-6000 mg elemental phosphate) by mouth for a relatively short-term period and calcitriol in high doses per os combined with intermittent intravenous administration. Long-term treatment consisted of daily three grams of phosphate and 1.25 micrograms calcitriol by mouth combined with daily 2 micrograms calcitriol intravenously for one week every month. Dramatic clinical improvement occurred accompanied with definite radiological and scintigraphical changes. Serum phosphate increased from 0.525 +/- 0.478 mmol/l to 1.054 +/- 0.041 mmol/l (p < 0.001) in response to 3000 mg phosphate. A close correlation (r = 0.69) was found between serum phosphate and urinary phosphate excretions (p < 0.001) and an inverse correlation (r = -0.31) was found between serum phosphate and tubular reabsorption of phosphate (p < 0.01). Serum and urinary calcium values, parathormone as well as renal functions did not change. Administration of high doses of phosphate seemed to be an effective and probably safe form of treatment in XLH provided that development of hyperparathyroidism is prevented by the coadministration of high doses of calcitriol.

High-dose phosphate treatment leads to hypokalemia in hypophosphatemic osteomalacia

The mechanism of the decrease in plasma potassium induced by phosphate treatment was investigated in a 24-year-old hypertensive patient with hypophosphatemic osteomalacia, who was the youngest of four patients, belonging to a 23 number kindred of five generations. Parameters of potassium, sodium, calcium, and phosphate metabolism as well as specific renal functions have been studied in the basal state and during administration of graded doses of phosphate (500-6000 mg). Progressive hypokalemia developed during phosphate treatment. An inverse correlation was found between plasma potassium and doses of phosphate (plasma potassium = -0.2 g phosphate + 3.9 r = -0.49; p < 0.05; N = 21). A renal route of potassium loss was suspected, but could not be confirmed as potassium excretion did not increase although sodium excretion was augmented [basal sodium output: 56.7 mmol/24 h; phosphate treatment: 153 mmol/24 h (p < 0.05)]. Transtubular potassium gradient (TTKG) also decreased and an inverse correlation was found between TTKG and doses of phosphate (r = -0.37; p < 0.02; N = 38). Decrease of TTKG was possibly the result of suppressed K+ secretion. It was concluded that potassium loss occurred by a non-renal (intestinal) route in phosphate-induced hypokalemia. Although major hazards of treatment of hypophosphatemic osteomalacia with phosphate and calcitriol are secondary hyperparathyroidism and vitamin D intoxication, potassium loss also should be kept in mind.

[Hyponatremia]

Hyponatremia is the most frequent electrolyte disorder. Two forms of it, the "true"--and "pseudo"--hyponatremia are known. The normal osmoregulation is an accurate operation which ensures the steadiness of serum sodium level by regulating vasopressin (ADH) release and water intake. Hyponatremia usually indicates water excess in the body, however, it may be complicated by sodium loss as well. It has hypovolemic, hypervolemic and normovolemic forms; the syndrome of inappropriate antidiuretic hormone (SIADH) is associated mostly with the normovolemic states. Nowadays the pathomechanism, criteria, diagnosis and etiologic factors of SIADH (water intoxication) are fairly well known, but the number of drugs capable of inducing this syndrome is increasing day by day. According to the newest knowledge, SIADH may exist not only in the acute but chronic form as well, which should be born in mind when treating water intoxicated patients. The basic principle is that in cases with mild clinical disturbances aggressive treatment should be avoided. For mild hyponatremia water restriction is usually sufficient, but in serious cases hypertonic saline infusion should be administered. Its speed has to be determined and adjusted carefully according to the needs of the patient, and it can be combined with the administration of furosemide, when necessary. Vasopressin antagonists are under clinical investigation, their therapeutic value has not yet been determined. Water intoxication is not rare-if one keeps it in mind. The syndrome's simple treatment can be life saving for the patient and provides an easy problem solution for the physician.

[Role of aldosterone in potassium secretion in chronic renal failure associated with hypertension (transtubular potassium gradient)]

Aldosterone protects against hyperkalemia in disorders with reduced number of over-working nephrons. It is not clear however, whether diminished aldosterone production or aldosterone resistance is responsible for the hyperkalemia in chronic renal failure. The importance of this question is underlined by the fact that antihypertensive drugs often reduce aldosterone level. Therefore we investigated the distal tubular potassium "driving force" (transtubular potassium gradient) in 9 patients with chronic renal failure accompanied by hypertension and compared it to the results obtained in 10 healthy persons. Glomerular filtration rate was 15.77 +/- 4.88 ml/min in the chronic renal patients. Serum potassium was normal in 3 of 9 patients, the average 4.88 +/- 0.16 mmol/l, higher than in healthy persons 4.27 +/- 0.09 mmol/l (p < 0.001). Nevertheless the transtubular potassium gradient was lower in patients (3.52 +/- 0.32) comparing to healthy persons (7.25 +/- 0.57, p < 0.001). The patients' plasma aldosterone was much higher than normal. The reduced tubular potassium secretion-decreased "driving force" --suggested to aldosterone resistance. We conclude that the renal tubules' aldosterone resistance is not an exceptional but rather frequent feature in chronic renal failure which should be considered when administering antihypertensive drugs.