Seeing the Whole Picture: Evaluating the Contribution of Whole Grains to Phosphorus Exposure in People With Kidney Failure Undergoing Dialysis Treatment.

Excessive dietary phosphorus is a concern among patients with kidney failure undergoing dialysis treatment because it may contribute to hyperparathyroidism and hyperphosphatemia. A long-standing but untested component of the low-phosphorus diet is the promotion of refined grains over whole grains. This paper reviews the scientific premise for restricting whole grains in the dialysis population and estimates phosphorus exposure from grain products based on three grain intake patterns modeled from reported intakes in the general US population, adjusting for the presence of phosphorus additives and phosphorus bioavailability: (1) standard grain intake, (2) 100% refined grain intake, and (3) mixed (50/50 whole and refined grain) intake. Although estimated phosphorus exposure from grains was higher with the mixed grain pattern (231 mg/day) compared to the 100% refined grain pattern (127 mg/day), the amount of additional phosphorus from grains was relatively low. Given the lack of strong evidence for restricting whole grains in people with CKD, as well as the potential health benefits of whole grains, clinical trials are warranted to address the efficacy and health impact of this practice.

Adaptive Nutrition Intervention Stabilizes Serum Phosphorus Levels in Hemodialysis Patients: A Multicenter Decentralized Clinical Trial Using Real-World Data.

OBJECTIVE: This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis (HD) in a routine care setting, using real-world data from electronic health records. METHODS: Decentralized clinical trial of seven HD facilities recruited patients who have been on HD for over 3 months (N = 153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and premade meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed. RESULTS: Meal intervention statistically significantly stabilized serum phosphorus level (ß = -0.81 mg/dL, 95% confidence interval = [-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (odds ratio = 1.21, 95% confidence interval = [1.04, 1.40]). Meal group showed better nutritional status (MIS = 3.65) than the education group (MIS = 5.10) at week 8 (adjusted p < .05). No significant changes were observed in serum potassium level, depression, and self-efficacy. CONCLUSION: It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on HD, without negative effect on depression levels or self-efficacy. More work is needed to develop an effective educational intervention.

Calcium-Phosphorus Product Is Associated with Adverse Prognosis in Hospitalized Patients with Heart Failure and Chronic Kidney Disease.

It has been reported that high levels of calcium-phosphorus (Ca-P) product are an indicator of coronary calcification and mortality risk in patients undergoing chronic hemodialysis. In the present study, we aimed to evaluate the significance of Ca-P product to predict the prognosis of patients with heart failure (HF) and chronic kidney disease (CKD). We conducted a prospective observational study of 793 patients with decompensated HF and CKD, and measured the value of Ca-P product. The cut-off value was obtained from the survival classification and regression tree (CART) analysis to predict post-discharge all-cause mortality and/or worsening HF, and the patients were divided into 2 groups: a high group (Ca-P product > 28, n = 594) and a low group (Ca-P product ≤ 28, n = 199). We compared the patient baseline characteristics and post-discharge prognosis between the 2 groups. The age as well as the prevalence of male sex, ischemic etiology, and anemia were significantly higher in the low group than in the high group. In contrast, there was no difference in echocardiographic parameters between the 2 groups. In the Kaplan-Meier analysis (mean follow-up 1089 days), all-cause mortality and/or worsening HF event rates were higher in the low group than in the high group (log-rank P = 0.001). In the multivariable Cox proportional hazard analysis, lower Ca-P product was found to be an independent predictor of all-cause mortality and/or worsening HF (hazard ratio 0.981, P = 0.031). Lower Ca-P product predicts adverse prognosis in patients with HF and CKD.

Screening of potential phosphate solubilizing bacteria inoculants should consider the contrast in phosphorus bio-solubilization rate along with plant growth promotion and phosphorus use efficiency.

AIMS: Although phosphate solubilizing bacteria (PSB) have been globally reported to improve soil phosphorus (P) availability and plant growth, technical gaps such as the lack of an ideal screening approach, is yet to be addressed. The potential of non-halo-forming PSB remains underestimated because of the currently adopted screening protocols that exclusively consider halo-forming and PSB with high phosphorus solubilization (PS) capacities. Yet, caution should be taken to properly assess PSB with contrasting PS rates regardless of the presence or absence of the solubilization halo. METHODS AND RESULTS: This study sought to examine the PS rate and plant growth promotion ability of 12 PSB categorized as high PSB (H-PSB), medium PSB (M-PSB), and low PSB (L-PSB) based on their PS rates of rock phosphate (RP). The non-halo-forming PSB Arthrobacter pascens was categorized as H-PSB, which might have been eliminated during the classical screening process. In addition, induction of organic acids and phosphatase activity in rhizosphere soils by H-, M-, and L-PSB was proportional to increased wheat P content by 143.22, 154.21, and 77.76 mg P g-1 compared to uninoculated plants (18.1 mg P g-1). CONCLUSIONS: Isolates considered as M- and L-PSB could positively influence wheat above-ground physiology and root traits as high as H-PSB. In addition, non-halo-forming PSB revealed significant PS rates along with positive effects on plant growth as high as halo-forming PSB.

Metal oxide modified biochars for fertile soil management: Effects on soil phosphorus transformation, enzyme activity, microbe community, and plant growth.

Metal oxide modified biochars are increasingly being used for intensive agricultural soil remediation, but there has been limited research on their effects on soil phosphorus transformation, soil enzyme activity, microbe community and plant growth. Two highly-performance metal oxides biochars (FeAl-biochar and MgAl-biochar) were investigated for their effects on soil phosphorus availability, fractions, enzyme activity, microbe community and plant growth in two typical intensive fertile agricultural soils. Adding raw biochar to acidic soil increased NH4Cl-P content, while metal oxide biochar reduced NH4Cl-P content by binding to phosphorus. Original biochar slightly reduced Al-P content in lateritic red soil, while metal oxide biochar increased it. LBC and FBC significantly reduced Ca2-P and Ca8-P properties while improving Al-P and Fe-P, respectively. Inorganic phosphorus-solubilizing bacteria increased in abundance with biochar amendment in both soil types, and biochar addition affected soil pH and phosphorus fractions, leading to changes in bacterial growth and community structure. Biochar's microporous structure allowed it to adsorb phosphorus and aluminum ions, making them more available for plants and reducing leaching. In calcareous soils, biochar additions may dominantly increase the Ca (hydro)oxides bounded P or soluble P instead of Fe-P or Al-P through biotic pathways, favoring plant growth. The recommendations for using metal oxides biochar for fertile soil management include using LBC biochar for optimal performance in both P leaching reduction and plant growth promotion, with the mechanisms differing depending on soil type. This research highlights the potential of metal oxide modified biochars for improving soil fertility and reducing phosphorus leaching, with specific recommendations for their use in different soil types.

Family-centered empowerment approach to optimize phosphate management among hemodialysis patients: an experimental study.

BACKGROUND: This study aimed to investigate the effect of a family-centered empowerment program on hyperphosphatemia management. METHOD: This experimental study was performed on 80 randomly selected eligible patients with hyperphosphatemia undergoing hemodialysis. Patients were assigned randomly to two groups of family-centered empowerment program (FCEPG) and control group (CG) by coin toss (40 people per group). Data collection tools were the researcher-made Phosphate Control Knowledge Scale, the researcher-made Adherence to Dietary Restriction of Phosphorus Intake Scale, the eight-item Morisky Medication Adherence Scale, and serum phosphorus measurements. Data were collected before the intervention, one month, and three months after the intervention. Patients in FCEPG participated in a family-centered empowerment program. The statistical significance level was considered to be 0.05. RESULTS: Inter-group comparisons showed no significant difference between FCEPG and CG in terms of the mean score of knowledge of phosphate control, adherence to dietary restriction of phosphorus intake, adherence to medication, and the mean serum phosphorus level before the empowerment program, but showed significant differences between them in these respects at one month after the program and three months after the program (p < 0.05). Intra-group comparisons showed a significant difference in FCEPG between the mean and standard deviation of all four variables before the empowerment program and the corresponding values one month and three months after the program (P < 0.05). CONCLUSION: The findings of this study can be used in various fields of healthcare in the hospital and community.

'Phos'tering a Clear Message: The Evolution of Dietary Phosphorus Management in Chronic Kidney Disease.

Phosphorus is a vital nutrient, but disturbances in phosphorus homeostasis are central to chronic kidney disease-mineral and bone disorder. To minimize disturbances, traditional dietary guidance focused on a numerical phosphorus target leading to the exclusion of many healthy foods and implementation challenges. Contemporary phosphorus guidance focuses on dietary source, avoiding additives, and emphasizing low-phosphorus bioaccessibility foods, leading to a more liberal approach. Additional work is needed to demonstrate the efficacy of these contemporary approaches and understand the influence of specific foods, processing, and cooking methods. Unfortunately, patient education using traditional and contemporary strategies may give mixed messages, particularly related to plant-based foods. Thus, greater clarity on the effects of specific foods and dietary patterns may improve phosphorus education. This review aims to discuss the evolution of dietary phosphorus management while highlighting areas for future research that can help move the field toward stronger evidence-based guidance to prevent and treat hyperphosphatemia.

Pollution source identification and abatement for water quality sections in Huangshui River basin, China.

Accurately obtaining the pollution sources and their contribution rates is the basis for refining watershed management. Although many source analysis methods have been proposed, a systematic framework for watershed management is still lacking, including the complete process of pollution source identification to control. We proposed a framework for identification and abatement of pollutants and applied in the Huangshui River Basin. A newer contaminant flux variation method based on a one-dimensional river water quality model was used to calculate the contribution of pollutants. The contributions of various factors to the over-standard parameters of water quality sections at different spatial and temporal scales were calculated. Based on the calculation results, corresponding pollution abatement projects were developed, and the effectiveness of the projects was evaluated through scenario simulation. Our results showed that the large scale livestock and poultry farms and sewage treatment plants were the largest sources of total nitrogen (TP) in Xiaoxia bridge section, with contribution rates of 46.02% and 36.74%, respectively. Additionally, the largest contribution sources of ammonia nitrogen (NH3-N) were sewage treatment plants (36.17%) and industrial sewage (26.33%). Three towns that contributed the most to TP were Lejiawan Town (14.4%), Ganhetan Town (7.3%) and Handong Hui Nationality town (6.6%), while NH3-N mainly from the Lejiawan Town (15.9%), Xinghai Road Sub-district (12.4%) and Mafang Sub-district (9.5%). Further analysis found that point sources in these towns were the main contributor to TP and NH3-N. Accordingly, we developed abatement projects for point sources. Scenario simulation indicated that the TP and NH3-N could be significantly improved by closing down and upgrading relevant sewage treatment plants and building facilities for large scale livestock and poultry farms. The framework adopted in this study can accurately identify pollution sources and evaluate the effectiveness of pollution abatement projects, which is conducive to the refined water environment management.

Remineralization Potential of a Novel Biomimetic Material (Self-assembling Peptide P11-4) on Early Enamel Caries: An In Vitro Study.

AIM: To assess the remineralizing potential of self-assembling peptide P11-4 and compare it to the remineralizing potential of fluoride varnish using DIAGNOdentTM, as well as the amount of mineral gain after application of fluoride varnish and self-assembling peptide P11-4. MATERIALS AND METHODS: This study included 20 premolars extracted during orthodontic therapy with all surfaces intact and free of hypoplastic regions, white spot lesions (WSL) and dental caries. The teeth sample for Curodont RepairTM (self-assembling P11-4) and Bifluorid 10® (fluoride varnish) was equally divided. On each tooth surface, a 2 × 2 mm window was created. The samples were immersed in a demineralizing solution for 96 hours before being subjected to DIAGNOdentTM pen reading, ICDAS-II scoring, and scanning electron microscopy-energy-dispersive X-ray (SEM-EDX) analysis on one half of the sample. The remineralizing agents were applied to the second half of the sample according to the manufacturer's instructions and placed in artificial saliva for 21 days, with the artificial salvia being replaced every 24 hours. After 21 days, the second half of the sample was subjected to DIAGNOdentTM pen reading, ICDAS-II score, and SEM-EDX analysis. RESULTS: Following remineralization, the DIAGNOdentTM pen and ICDAS-II score values differed statistically between the two groups, with the Bifluorid 10® group reporting higher mean values (p > 0.05) using t-test analysis. Energy-dispersive X-ray analysis using the t-test revealed a statistically significant result for remineralization (p < 0.05), with CurodontTM Repair group (55.150.84) reporting better mean values than Bifluorid 10® for phosphorus and calcium, but Bifluorid 10® reporting a higher result in remineralization (p < 0.05) than CurodontTM Repair for fluoride. CONCLUSION: CurodontTM Repair showed better remineralizing potential compared with Bifluorid 10® varnish. In terms of the mineral gain, CurodontTM Repair showed better results for calcium and phosphorus post-remineralization. Whereas Bifluorid 10® showed a higher gain in terms of fluoride. Self-assembling peptide P11-4 can be used as an alternative to fluoride varnish for remineralizing WSL. CLINICAL SIGNIFICANCE: Self-assembling polypeptide P11-4 is a novel remineralizing agent for initial enamel lesions, which is the least-invasive method of enamel remineralization.

Water Turbidity and Suspended Particulate Matter Concentration at Dredged Material Dumping Sites in the Southern Baltic.

Dredged material dumping is an activity that causes some of the greatest changes in coastal waters. It results in the need to regularly monitor the properties of seawater related to water quality. In this study, we present the first wide-ranging attempt to correlate seawater turbidity and suspended particulate matter (SPM) concentrations within dumping sites and adjacent waters on the basis of in situ measurements. In the years 2019-2020, we examined four dumping sites, namely Darlowo, Gdynia, Gdansk, and DCT, located in Polish coastal waters of the Baltic Sea, in the course of four measurement campaigns conducted in the spring, summer, autumn, and winter. The measurements were conducted using a turbidity sensor to determine the turbidity, in formazin turbidity units (FTU), a spectrophotometer to determine the concentrations of nutrients (total phosphorus (P-tot), phosphate phosphorus (P-PO4-3), total nitrogen (N-tot), ammonium nitrogen (N-NH4+), and nitrate nitrogen (N-NO3-)), as well as glass microfiber filters to determine the concentrations of SPM. The analysis of the relationship between the turbidity and SPM within the dumping sites in comparison to reference points showed that the dumping sites are very complex waters and that the issue must be approached locally. The highest turbidity values were registered in the spring, and they correlated linearly with the SPM concentrations (R2 = 0.69). Moreover, we performed a statistical cluster analysis to illustrate the similarities between sampling points in the four dumpsites based on nutrient concentrations. We conclude that the influence of the dumping sites on the local bio-optical and chemical properties significantly exceeds their borders and spreads to the adjacent waters. Nutrient concentrations in many cases exceeded the legal policy limits.

Use of a Phosphorus Points Education Program to Maintain Normal Serum Phosphorus in Pediatric Chronic Kidney Disease: A Case Report.

A 14-year-old male, with chronic kidney disease stage 4 (glomerular filtration rate 20 mL/min/1.73 m2) secondary to reflux nephropathy required dietary modification with evidence of renal osteodystrophy, presented with elevated serum phosphorus and parathyroid hormone. He was educated using a novel phosphorus point system where 1 point is equivalent to ∼50 mg of phosphorus. Dietary counseling was provided by a pediatric renal dietitian on phosphorus content of foods the patient typically consumed and converted to point system for daily tracking. The family reported limiting daily phosphorus points to less than 20 points daily for 15 months. The family completed a 3-day food record and provided points assigned to each food item. A Spearman's correlation of 0.7 (P < .001) was found between the family's and the dietitian's assignment of phosphorus points. The patient's recorded phosphorus intake remained below 1000 mg each day and met estimated calorie and protein needs. The patient also continued with age-appropriate weight gain and linear growth. Laboratory values showed phosphorus and intact parathyroid hormone remained within desired range. A phosphorus point system tool can be used to maintain normal serum phosphorus levels and subsequently prevent secondary hyperparathyroidism in patients with pediatric chronic kidney disease.

Comprehensive evaluation of manganese oxides and iron oxides as metal substrate materials for constructed wetlands from the perspective of water quality and greenhouse effect.

Manganese oxides and iron oxides have been widely introduced in constructed wetlands (CWs) for sewage treatment due to their extensiveness in nature and their ability to participate in various reactions, but their effects on greenhouse gas (GHG) emissions remain unclear. Here, a set of vertical subsurface-flow CWs (Control, Fe-VSSCWs, and Mn-VSSCWs) was established to comprehensively evaluate which are the better metal substrate materials for CWs, iron oxides or manganese oxides, through water quality and the global warming potential (GWP) of nitrous oxide (N2O), methane (CH4), and carbon dioxide (CO2). The results revealed that the removal efficiencies of chemical oxygen demand (COD), total nitrogen (TN), and total phosphorus (TP) in Mn-VSSCWs were all higher than that in Fe-VSSCWs, and manganese oxides could almost completely suppress the CH4 production and reduce GWP (from 8.15 CO2-eq/m2/h to 7.17 mg CO2-eq/m2/h), however, iron oxides promoted GWP (from 8.15 CO2-eq/m2/h to 10.84 mg CO2-eq/m2/h), so manganese oxides are the better CW substrate materials to achieve effective sewage treatment while reducing the greenhouse gas effect.

Dynamic sulfur-iron cycle promoted phosphorus mobilization in sediments driven by the algae decomposition.

Direct evidence of the algae bloom in eutrophic freshwater lakes on sulfur cycle and the subsequent iron oxide reduction and the iron oxides-bound phosphate (Fe-P) release in sediments is lacking. In this study, microcosms experiment was carried out to investigate the dynamic variations of S, Fe and P species in the water column and sediments as well as the sulfate reducing bacteria (SRB) abundance variation in the sediments during algae decomposition. The sulfate reduction was stimulated by the algae decomposition, which resulted in dramatic sulfate decline, sulfide increase and SRB growth. In addition, large amounts of acid volatile sulfide (AVS), pyrite sulfur (Pyrite-S) and elemental sulfur (S0) accumulated in the sediment. In particular, the contents of sedimentary Fe(II) and Pyrite-S in surface sediments continuously accumulated until the end of the experiment. Moreover, the terminal Fe-P content reduced by 35.4% compared with the initial concentration at high algae density group. These results suggested the irreversible reduction of iron oxides and revealed iron chemical reduction mediated by sulfide during algae decomposition. In addition, the connection of sulfur-iron cycle and the significant promotion of Fe-P mobilization in sediments was established, which should be paid more attention in the eutrophic freshwater ecosystems.

Effects of bentonite on the growth process of submerged macrophytes and sediment microenvironment.

The effects of clay mineral bentonite on the growth process of submerged macrophyte V. spiralis and sediment microenvironment were investigated in the study for the first time, aiming to determine whether it is suitable for application in the field of ecological restoration. The growth index, and physiological and biochemical index of V. spiralis in the experiments were measured once a month, and the changes of rhizosphere microorganisms and physicochemical properties of sediments were also studied at the same time. The results demonstrated that bentonite can effectively promote the growth of V. spiralis. The treatment groups of RB1/1 and MB1/5 (the mass ratios of bentonite to sediment were 1/1 and 1/5, respectively.) showed the best V. spiralis growth promotion rates which were 18.78%, and 11.79%, respectively. The highest microbial diversity and abundance existed in group of RB10 (the mass ratio of sediment to bentonite was 10/1), in which the OTUs, Shannon, Chao and Ace were 1521.0, 5.20, 1712.26, and 1686.31, respectively. Bentonite was conducive to the propagation of rhizosphere microorganisms, and further changed the physical and chemical properties of the sediment microenvironment. The nutrient elements dissolved from bentonite may be one of the main reasons that promoted the growth of V. spiralis. The purpose of this result is to prove that bentonite can be further applied as sediment improver and growing media in ecological restoration projects in eutrophic shallow lakes.

Design of Chitosan Sterilization Agents by a Structure Combination Strategy and Their Potential Application in Crop Protection.

Chitosan is the only cationic polysaccharide in nature. It is a type of renewable resource and is abundant. It has good biocompatibility, biodegradability and biological activity. The amino and hydroxyl groups in its molecules can be modified, which enables chitosan to contain a variety of functional groups, giving it a variety of properties. In recent years, researchers have used different strategies to synthesize a variety of chitosan derivatives with novel structure and unique activity. Structure combination is one of the main strategies. Therefore, we will evaluate the synthesis and agricultural antimicrobial applications of the active chitosan derivatives structure combinations, which have not been well-summarized. In addition, the advantages, challenges and developmental prospects of agricultural antimicrobial chitosan derivatives will be discussed.

Promotion of Zinc Tolerance, Acquisition and Translocation of Phosphorus in Mimosa pudica L. Mediated by Arbuscular Mycorrhizal Fungi.

Heavy metal contamination of soil is of increasing concern because of its potential risk to human health. In this study, two AMFs (Rhizophagus intraradices and Funneliformis mosseae) substantially increased the biomass of bashfulgrass in Zn-contaminated soil, even at Zn levels of up to 600 mg kg-1. Zn uptake in R. intraradices- and F. mosseae-mycorrhizal bashfulgrass was increased by 40-fold and 7-fold, respectively, when plants grown in Zn-contaminated (400 mg kg-1) soil. Elemental analysis showed that neither AMF had an effect on Zn concentration in plant tissues, including the roots and shoots. However, a significant increase of phosphorus (P) concentration was observed, suggesting the increased is from the improved use efficiency of soil nutrients by AMFs. Comparing the two AMFs, better growth performance with more biomass occurred with R. intraradices-inoculated bashfulgrass in Zn-contaminated soil. This is consistent with R. intraradices being more tolerant to Zn than F. mosseae, indicated by a higher colonization percentage in bashfulgrass roots. Taken together, our data indicate that AMFs possibly improve acquisition and translocation of P to promote increased biomass. Moreover, mycorrhiza did not enhance Zn accumulation in shoots and roots of bashfulgrass at the same Zn level. In the future, developing AMF (especially R. intraradices) inoculation of plants might be a desirable means of safe production of ornamental plants in metal-polluted soil.

Response of community composition and biomass of submerged macrophytes to variation in underwater light, wind and trophic status in a large eutrophic shallow lake.

Light climate is of key importance for the growth, community composition of submerged macrophytes in lakes and, they, in turn, are affected by lake depth and the degree of eutrophication. To test the relationships between submerged macrophyte presence and the ratio of Secchi disk depth (SDD) to water depth, i.e. SDD/depth, nutrients and wind, we conducted an extensive sampling campaign in a macrophyte-dominated area of the eastern region (n = 36) in 2016 in Lake Taihu, China, and combined the data gathered with results from extensive physico-chemical monitoring data from the entire lake. We confirmed that SDD/Depth is the primary factor controlling the community composition of macrophytes and showed that plant abundance increased with increasing SDD/Depth ratio (p < 0.01), but that only SDD/Depth > 0.4 ensured growth of submerged macrophytes. Total phosphorus and total nitrogen also influenced the growth and community composition of macrophytes (p < 0.01), while Chla was an indirectly affecting factor by reducing underwater light penetration. Wave height significantly influenced plant abundance (p < 0.01), whereas it had little effect on the biomass (p > 0.05). The key to restore the macrophyte beds in the lake is to reduce the nutrient loading. A decrease of the water level may contribute as well in the shallow bays but will not bring plants back in the main part of the lake. As the tolerance of shade and nutrients varied among the species studied, this should be taken into account in the restoration of lakes by addition of plants.

Variations in transport of suspended sediment and associated elements induced by rainfall and agricultural cycle in a Mediterranean agroforestry catchment.

Soil erosion and fine particle exports are two of the major concerns of soil nutrient loss and water quality decrease nowadays. In Mediterranean mountainous environments, agricultural practices during different cropland stages likely increase sediment supplies and the export of fertilisers and pesticides out into the drainage system. In this study, we attempt to evaluate the soil response to different agricultural practices implemented during the agricultural cycle by monitoring the bare soil cropland area through the use of remote sensing and applying the sediment fingerprinting technique together with the newly consensus-based tracer selection method. To this purpose, 128 source samples were distributed over the four main land use/land covers and geomorphic elements existing in the study area. To analyse the spatio-temporal variability of source contributions, three sampling stations were established along the catchment and collected during two hydrological years. The consensus method was used to show the individual messages of each tracer, revealing non-conservative and dissenting tracers, followed by a discriminant function analysis (DFA) to select the best set of tracers for each mixture. Overall, the unmixing model outputs displayed channel bank and agriculture as the main contributing sources for all the seasonal campaigns. Nevertheless, the agricultural contribution was higher during the periods when the soil surface in croplands had no plant cover protection. Certain elements such as As, Co, Li, Mn, Zn and 238U were above source ranges in the sediment mixtures. The enriched elements showed higher content in the sediment mixtures during sowing and after harvest periods. Besides, an enrichment of phosphorous during both agricultural practices periods points out to agricultural activities as the main cause of sediment and elements export to streams. Thus, in the subcatchment with less bare soil cropland area, the agriculture source contributed with the lowest percentages. Our results support the protection of croplands, especially in periods of vegetation cover absence to prevent the loss of fertile soil and the export of potential pollutants to downstream water bodies.

Impact of Prophylaxis on Bone Mineral Metabolism in Children With Hemophilia.

In this study, we aimed to investigate changes in calcium (Ca) metabolism in hemophilia patients (PWH). We also aimed to investigate the importance of diagnosis and treatment of factors impairing calcium metabolism and the significance of early diagnosis and prophylaxis with respect to these subjects. For all patients, serum calcium, phosphorus, alkaline phosphatase, 25 hydroxy vitamin D (25-OHD), parathormone (PTH), and calcitonin levels were evaluated. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry. Low BMD scores and 25-OHD deficiency were observed in 29 (74.4%) and 34 (87.2%) patients, respectively. Prophylaxis of PWH did not differ significantly in terms of 25-OHD levels and BMD scores. Patients in the prophylaxis group had significantly higher PTH levels (P=0.042). A negative correlation was found between PTH measurements and Z-score (P=0.008). In summary, our findings, with a small number of PWH in our study group, suggest that biochemical markers of bone turnover may be used to detect bone loss. Follow-up through annual BMD measurements coupled with appropriate exercise programs could be recommended.

Pharmacodynamics of evocalcet for secondary hyperparathyroidism in Japanese hemodialysis patients.

BACKGROUND: This study investigated the pharmacokinetics, pharmacodynamics, and safety of multiple doses of evocalcet in Japanese secondary hyperparathyroidism (SHPT) patients receiving hemodialysis. METHODS: In this multicenter, open-label study, conducted between August 2013 and March 2014, 27 patients received multiple doses of 1 and 4 mg evocalcet for 14 days, followed by an extension period of multiple doses of 8 and 12 mg evocalcet for 7 days using an intra-patient dose escalation protocol. Pharmacodynamic parameters consisted of measurement of intact parathyroid hormone (PTH), serum-corrected calcium, serum phosphorus and intact fibroblast growth factor 23 concentrations. Safety was assessed by analysis of adverse events. RESULTS: Plasma evocalcet levels reached steady state 3 days after the first day of administration. Pharmacodynamic analyses showed that evocalcet effectively reduced intact PTH and serum-corrected calcium levels. Adverse events (AEs) occurred in 29.6 and 62.5% of patients receiving multiple doses of 1 or 4 mg, respectively. The AE 'blood calcium decreased' occurred in eight patients (33.0%) after multiple doses of 4 mg. All events were mild, except for one patient with a moderate AE (abnormal liver function) and one patient with a severe adverse drug reaction (blood calcium decreased). CONCLUSION: Multiple doses of evocalcet reduced intact PTH levels with a concomitant decrease in serum calcium levels. Evocalcet was well tolerated in SHPT patients receiving hemodialysis.