ARGININE VASOPRESSIN (AVP) is the antidiuretic hormone which is synthesized in the magnocellular neurons in the supraoptic and paraventricular nuclei [1,2]. AVP is axonally transported to the posterior pituitary, released into the systemic circulation, and acts through V2 receptor in the kidney in order to promote reabsorption of free water [1,2]. The osmoregulation of AVP release is so precise that increases in plasma osmolality of only 1-2% lead to increases in plasma AVP [1,3,4]. As a result, plasma osmolality in most cases is controlled at levels of around 280 mOsm/kg, which is the threshold of AVP release [1,3,4].The deficiency of AVP causes a disorder called cen- Abstract. Central diabetes insipidus (CDI), which is characterized by polyuria and polydipsia, is caused by a deficiency of the antidiuretic hormone arginine vasopressin (AVP). While CDI is treated with desmopressin, an analogue of AVP, the intranasal formulation is inconvenient and CDI patients reportedly prefer the oral formulation to the intranasal one. In Japan, intranasal desmopressin had been the only formulation for the treatment of CDI until 2012, when the desmopressin orally disintegrating tablet (ODT) was approved for treatment. In this study we analyzed 26 patients with CDI in whom intranasal desmopressin was switched to desmopressin ODT. The mean daily dose of intranasal desmopressin was 10 ± 8 μg/day, and that of desmopressin ODT was 142 ± 59 μg/day. The mean serum sodium levels were 140 ± 5 mmol/L and 140 ± 3 mmol/L with intranasal desmopressin and desmopressin ODT, respectively, and there were no significant differences between these values. The frequency of hyponatremia (<135 mmol/L) with intranasal desmopressin was 11.7% and that with desmopressin ODT was 7.6%, while the frequency of hyponatremia (<130 mmol/L) with intranasal desmopressin was 4.2% and that with desmopressin ODT was 1.3%. Statistical analyses revealed that incidence of hyponatremia was significantly decreased after the switch to desmopressin ODT. Thus, it is suggested that water balance is better controlled with desmopressin ODT than with intranasal desmopressin in patients with CDI.Key words: Desmopressin, Central diabetes insipidus, Hyponatremia, Vasopressin tral diabetes insipidus (CDI), which is characterized by polyuria accompanied by thirst and polydipsia [5,6]. Patients with CDI are treated with desmopressin, an analogue of AVP, which is usually given twice or three times per day [7]. The concentration of desmopressin in blood reaches a peak soon after administration, and the antidiuretic action remains maximal for several hours [8][9][10][11]. Due to the pharmacokinetics/pharmacodynamics of desmopressin, its most frequent side effect in the treatment of CDI is hyponatremia [12,13].In Japan, intranasal desmopressin had been the only formulation for the treatment of CDI until 2012, when desmopressin orally disintegrating tablet (ODT) was approved for treatment. Because the efficiency and safety of desmopressin ODT have been demonstrated [13,14], and oral form...
There are several considerations when implementing a transaction processing system in cloud environments like Google App Engine (GAE). One of the most critical ones is the data integrity, since the cloud provides us with limited capability for it. Therefore we need to evaluate the applications and the cloud platform carefully from the data integrity viewpoint. This paper presents a model based data integrity evaluation method using the UPPAAL model checker. In order to make the model reusable, we built it as a set of application independent functional modules. On the other hand, the application unique functionalities are to be included in the model as UPPAAL functions written by the C-like UPPAAL language. The data integrity evaluation is performed in two different ways. One is a simulation based method in which the model is executed by the UPPAAL simulator to obtain the resultant variable values. The other is a verification based method in which the given integrity constraints are examined by the UPPAAL verifier using full state space search of the model.
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