MethodsAtrial natriuretic factor (ANF), a recently sequenced cardiac peptide, has been shown to have potent natriuretic, diuretic, and vasodilating effects in several species. We have developed a radioimmunoassay to measure the levels of immunoreactive ANF in human plasma. Plasma levels of ANF in healthy volunteers on a low sodium diet were 9.8±1.4 pmol/liter and increased to 21.9±3.0 on a high sodium diet. The levels of atrial natriuretic factor correlated directly with urinary sodium and inversely with plasma renin activity and plasma aldosterone levels. Patients with marked edema due to congestive heart failure had plasma levels of atrial natriuretic factor five times higher than normal (P < 0.05), whereas patients with cirrhosis and edema had levels that were not different from normal. These results suggest that atrial natriuretic factor plays an important role in the adaptation to increased sodium intake.

To evaluate the relationship between plasma levels of immunoreactive atrial natriuretic hormone (IR-ANH) and different hemodynamic parameters in man, we studied 34 patients undergoing right heart catheterization. Plasma levels of IR-ANH in blood samples withdrawn from the femoral vein (n = 28), right ventricle (n = 27), and left ventricle (n = 17) were determined by radioimmunoassay. Right atrial pressure, pulmonary arterial wedge pressure, heart rate, and mean arterial pressure were found to be independent and significant predictors of IR-ANH plasma levels. The closest correlations were between right atrial pressure and either right ventricular IR-ANH levels ( evidence of congestive heart failure.14 The purpose of this investigation was to establish the relationship between different hemodynamic parameters and plasma IR-ANH levels in man. MethodsStudy population. Thirty-four patients (33 men and one woman) undergoing right heart catheterization for clinically indicated purposes were studied after informed consent was obtained. Left heart catheterization was also performed in 21 of these patients. Ages ranged from 39 to 74 years (59 + 2). Longterm medications included diuretics in 19, nitrates in 18, X3-blockers in 14, calcium-channel blockers in 10, digitalis in 10, and vasodilators in five patients. Eighteen had left ventricular ejection fractions calculated from contrast ventriculograms, whereas ejection fractions were obtained in 13 from radionuclide ventriculograms. Heart rate, arterial blood pressure, and cardiac output by the thermodilution method were measured, as were pressures in the right atrial, pulmonary arterial, and pulmonary arterial wedge positions. Cardiac index, mean pulmonary arterial pressure, mean systemic arterial pressure, pulmonary vascular resistance, and systemic vascular resistance were calculated from standard fornulas. Before administration of contrast medium and after each patient had been supine for at least 15 min, 7 ml blood samples were withdrawn from the femoral vein (28 patients), right ventricle (27 patients

Objective To compare glycemic outcomes in hospitalized patients with or without type 2 diabetes mellitus receiving neutral protamine Hagedorn insulin (NPH) vs glargine as basal insulin for management of glucocorticoid-associated hyperglycemia. Methods We conducted a retrospective review of electronic medical records in prednisone-treated adult patients with hyperglycemia in a university hospital. Consecutive patients were selected in both the NPH and glargine cohorts using inclusion and exclusion criteria. Baseline characteristics were assessed in each cohort. Glycemic outcomes were analyzed by comparing fasting blood glucose, mean daily blood glucose concentration, median daily blood glucose concentration, and the number of hypoglycemic episodes on a prespecified index day. Results One hundred twenty patients were included: 60 patients in the NPH cohort and 60 patients in the glargine cohort. The weight-based insulin requirement was lower in the NPH cohort than in the glargine cohort (0.27 ± 0.2 units/kg vs 0.34 ± 0.2 units/kg [P = .04] for basal insulin and 0.26 ± 0.2 units/kg vs 0.36 ± 0.2 units/kg [P = .03] for bolus insulin). NPH and glargine cohorts were similar regarding age, sex, race, body mass index, hemoglobin A1c, serum creatinine, and prednisone dosage. Glycemic outcomes in the NPH cohort compared with outcomes in the glargine cohort were similar regarding mean fasting blood glucose concentration (134 ± 49 mg/dL vs 139 ± 54 mg/dL [P = .63]), mean daily blood glucose (167 ± 46 mg/dL vs 165 ± 52 mg/dL [P = .79]), median blood glucose (160 ± 49 mg/dL vs 159 ± 57 mg/dL [P = .90]), and number of hypoglycemic episodes per day (0.12 ± 0.3 vs 0.10 ± 0.3 [P = .77]). Conclusions NPH and glargine appear to be equally effective as basal insulin in the management of hyperglycemia in hospitalized patients receiving prednisone. However, the total daily insulin doses used were lower in the NPH cohort.

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Objective The study aim was to measure change in total energy expenditure (TEE) and body composition during exenatide administration and by deduction the relative contributions of energy expenditure and energy intake to exenatide-induced weight loss. Research Design and Methods Forty-five obese (BMI 30–40 kg/m2) subjects were identified. After exclusion criteria application, 28 subjects entered into and 18 subjects completed the study which consisted of 6 visits over 14 weeks. Respiratory gas analysis and doubly-labeled water measurements were performed before initiation of exenatide and near the end of approximately 3 months of exenatide administration. Results Eighteen adult obese nondiabetic subjects (12 female, 6 male) completed the study injecting exenatide for an average of 84 ± 5 days. The average weight loss from the beginning of injection period to the end of the study in completed subjects was 2.0 ± 2.8 kg (P =0.01). Fat mass declined by 1.3 ± 1.8 kg (P =0.01) while the weak trend to decrease in fat-free mass was not significant (0.8 ± 2.2 kg, P =0.14). There was no change in weight-adjusted TEE (P=0.20), resting metabolic rate (P= 0.51), or physical activity energy expenditure (P =0.38) and no change in the unadjusted thermic effect of a meal (P =0.37). The significant weight loss due to exenatide administration was thus the result of decreasing energy intake over the study period Conclusion In obese nondiabetic subjects, exenatide administration did not increase TEE and by deduction the significant weight loss and loss of fat mass was due to decreased energy intake.