bluuebunny/crossref_metadata_2025 huggingface dataset:
Young care leavers' expectations of their future: A question of time horizon
Authors: Bengtsson Mattias , Sjöblom Yvonne , Öberg Peter
Published: September 2017

This paper investigates young care leavers' expectations of their future after discharge from care. The results are based on qualitative longitudinal data where 16‐ to 21‐year‐old care leavers (n = 15) were interviewed twice, first when still in care but planning for their discharge (T1) and the second time 6–9 months later (T2). The analysis using a general inductive approach showed that their expectations were dependent on the time horizon and that there was an obvious difference between the young informants' short‐ and long‐term expectations. Their short‐term expectations consisted of worries connected to their approaching discharge (at T1) and how to cope with challenges of everyday life after discharge from care (at T2). These results seem to echo negative outcomes shown in previous quantitative research. However, the informants' long‐term expectations provide a different picture, being mainly positive in both interviews (T1 and T2). The results are discussed from a life course perspective, where the informants' visions of their future are framed and understood in terms of the different stages of their transition process.
Management of Leigh syndrome: Current status and new insights
Authors: Chen L. , Cui Y. , Jiang D. , Ma C.Y. , Tse H.‐F. , Hwu W.‐L. , Lian Q.
Published: September 2017

Leigh syndrome (LS) is an inherited mitochondrial encephalopathy associated with gene mutations of oxidative phosphorylation pathway that result in early disability and death in affected young children. Currently, LS is incurable and unresponsive to many treatments, although some case reports indicate that supplements can improve the condition. Many novel therapies are being continuously tested in pre‐clinical studies. In this review, we summarize the genetic basis of LS, current treatment, pre‐clinical studies in animal models and the management of other mitochondrial diseases. Future therapeutical strategies and challenges are also discussed.
Uniformization and Density Adaptation for Point Cloud Data Via Graph Laplacian
Authors: Luo Chuanjiang , Ge Xiaoyin , Wang Yusu
Published: September 2017

Point cloud data is one of the most common types of input for geometric processing applications. In this paper, we study the point cloud density adaptation problem that underlies many pre‐processing tasks of points data. Specifically, given a (sparse) set of points Q sampling an unknown surface and a target density function, the goal is to adapt Q to match the target distribution. We propose a simple and robust framework that is effective at achieving both local uniformity and precise global density distribution control. Our approach relies on the Gaussian‐weighted graph Laplacian and works purely in the points setting. While it is well known that graph Laplacian is related to mean‐curvature flow and thus has denoising ability, our algorithm uses certain information encoded in the graph Laplacian that is orthogonal to the mean‐curvature flow. Furthermore, by leveraging the natural scale parameter contained in the Gaussian kernel and combining it with a simulated annealing idea, our algorithm moves points in a multi‐scale manner. The resulting algorithm relies much less on the input points to have a good initial distribution (neither uniform nor close to the target density distribution) than many previous refinement‐based methods. We demonstrate the simplicity and effectiveness of our algorithm with point clouds sampled from different underlying surfaces with various geometric and topological properties.
The prognostic significance of tricuspid valve regurgitation in pulmonary arterial hypertension
Authors: Chen Libo , Larsen Carolyn M. , Le Rachel J. , Connolly Heidi M. , Pislaru Sorin V. , Murphy Joseph G. , McGoon Michael D. , Frantz Robert P. , Kane Garvan C.
Published: September 2017

Introduction

Tricuspid valve regurgitation (TR) is a frequent finding in patients with pulmonary arterial hypertension (PAH). However, its prognostic significance and relation to PAH, while suspected, are poorly understood. We assessed 727 consecutive patients with newly diagnosed PAH who underwent transthoracic echocardiographic evaluation of tricuspid valve function.

Objectives

The study objective was to determine the association of TR presence and severity with patient characteristics, pulmonary artery hemodynamics and outcome.

Methods

Consecutive patients with newly diagnosed PAH (N = 727 with group 1 pulmonary hypertension) underwent transthoracic echocardiographic evaluation of tricuspid valve function at diagnosis. The primary study end point was all‐cause mortality or lung transplantation.

Results

In this population, 702 patients (96.5%) had TR; in 165 patients (23%), TR was severe. Compared with those with no or mild TR by echocardiography criteria, patients with severe TR had shorter mean (SD) 6‐minute walk distances (285 [125] m vs 360 [121] m; P = .02) and higher levels of B‐type natriuretic peptide (695 [672] pg/dL vs 328 [300] pg/dL; P < .05). Severe TR was associated with greater right atrial dilatation (91% vs 47%; P = .004) and right ventricular (RV) dilatation (92% vs 51%; P = .008), greater right atrial pressure (mean [SD] 15 [7] mm Hg vs 10 [6] mm Hg; P < .001) and lower cardiac index (mean [SD], 2.2 [0.7] L/min/m2 vs 2.8 [0.9] L/min/m2; P < .001). Severe TR was strongly predictive of greater 5‐year mortality risk after adjustment for age, sex, functional class, 6‐minute walk distance, diffusing capacity, RV size and pulmonary vascular resistance index (adjusted hazard ratio, 1.83; 95% CI, 1.38‐2.41; P < .001).

Conclusions

Severe TR was a significant predictor of long‐term mortality rate in PAH, and TR severity correlated with PAH severity.
Financing the 450 Year Road: Land Expropriation and Politics ‘All the Way Down’ in Vientiane, Laos
Authors: Pathammavong Bounnhong , Kenney‐Lazar Miles , Sayaraj Ek Vinay
Published: September 2017

Over the past decade, the Lao government has developed the policy of ‘Turning Land into Capital’ (TLIC), a strategy for generating revenue and economic value from ‘state land’. The 450 Year Road Project built along the periphery of the Laotian capital, Vientiane, linking the national highway with the Thai border, was financed using a TLIC model. Additional land to the side of the road was acquired to be resold at rates significantly higher than the compensation provided to landowners. Prior to construction, however, most of the land had already been purchased by external buyers, who impeded the project's development by refusing to concede their newly purchased plots. This article contributes to the literature on political reactions ‘from below’ to land grabbing by arguing that in order to understand the operational success or failure of land development projects, it is imperative to analyse the politics that pervade such investments ‘all the way down’ — the interrelated roles, interests and relations of involved actors and groups in all positions of power within society. The 450 Year Road project stalled due to its failure to take into account the interests and politics of seemingly compliant actors, particularly landowning farm households and speculative land buyers.
Plant species, mycorrhiza, and aphid age influence the performance and behaviour of a generalist
Authors: TOMCZAK VIKTORIA V. , MÜLLER CAROLINE
Published: September 2017

1. Life‐history traits of herbivores are shaped by the combination of various extrinsic and intrinsic variables. However, studies investigating the impact of both variables on insect behavioural phenotypes are rare, and research including the modulation of host plant quality by arbuscular mycorrhiza (AM) (extrinsic variable) and the herbivore developmental stage (intrinsic variable) on aphid behaviour is lacking.

2. To study the influences of extrinsic and intrinsic variables on aphid performance and behaviour, individuals of the generalist aphid pest Myzus persicae (Sulzer) were reared on Plantago lanceolata and Poa annua plants that were either non‐mycorrhized (NM) or mycorrhized (AM). Aphid performance was monitored over 2 weeks. Behavioural traits of nymphs were recorded twice during development after removing individuals from their feeding sites and placing them in an unknown environment (‘open field’), causing disturbance. Plant quality was determined by measuring the water content and leaf mass per area (LMA).

3. Differences in body mass of nymphs at day 6 dependent on plant species and treatment were compensated by the individuals within 4 days. Behavioural traits, considered as activity and exploration, were affected by the interaction between extrinsic and intrinsic variables (activity and exploration) and changed over ontogeny (activity). Independent of AM, a lower water content and LMA were recorded in P. annua leaves.

4. Overall, this study demonstrates that extrinsic and intrinsic variables need to be considered in combination and behavioural traits should be studied repeatedly during insect ontogeny to understand the complexity of microbe‐modulated plant–herbivore interactions.
Cost‐effective screening of DNMT3A coding sequence identifies somatic mutation in pediatric T‐cell acute lymphoblastic leukemia
Authors: Szarzyńska‐Zawadzka Bronisława , Kosmalska Maria , Sędek Łukasz , Sonsala Alicja , Twardoch Magdalena , Kowalczyk Jerzy R. , Szczepański Tomasz , Witt Michał , Dawidowska Małgorzata
Published: September 2017

Background and objectives

In pediatric T‐cell acute lymphoblastic leukemia (T‐ALL), risk assignment schemes preclude reliable prediction of outcome, and thus, new prognostic factors are needed. Mutations in DNMT3A are candidate prognostic and classification markers in adults with acute myeloid leukemia (AML) and T‐ALL and thus were considered as candidates prognostic markers in pediatric T‐ALL.

Patients and methods

DNMT3A mutational status was investigated in 74 pediatric T‐ALL samples collected at diagnosis. We applied high‐resolution melt (HRM) analysis and Sanger sequencing to study the hotspot position (R882) within catalytic MTase domain and exons coding for other functional domains of the protein, known to be mutated in the wide spectrum of hematological malignancies.

Results

We demonstrate a low frequency of mutations in DNMT3A coding sequence in pediatric T‐ALL (1.4%, n = 1/74). We identified missense mutation, p.Ala644Thr, which has not been described previously in pediatric T‐ALL, but is recurrent in adults with T‐ALL and AML.

Conclusions

Low frequency of DNMT3A mutations in pediatric T‐ALL is in striking contrast to adult T‐ALL and renders the necessity for the search of other candidate prognostic markers. Combined Sanger sequencing‐HRM approach offers a cost‐effective option for genotyping DNMT3A coding sequence, with potential clinical application in other hematological malignancies.
Is essential tremor a single entity?
Authors: Hopfner F. , Deuschl G.
Published: September 2017

Essential tremor (ET) is a frequent movement disorder. The new tremor classification has subdivided ET into the classical form with bilateral action tremor of the hands with or without involvement of further tremor locations and without any other explaining signs or symptoms for the tremor and into ‘ET plus’ which comes additionally with further neurological signs of unknown origin. This will provide a better foundation for subclassifying the condition. The immediate cause of ET is a preformed oscillating network within the central nervous system as revealed with electrophysiological methods. The reason why this network is getting into the tremor mode is unclear. Pathology has so far not convincingly proved neurodegeneration for the condition but possibly adaptive changes of the brain particularly in the cerebellum are likely. Genetics have not yet provided insight into the molecular causes of the condition but several genetic diseases presenting with an ET syndrome have been uncovered. Treatment options cover medication (propranolol, primidone, topiramate) and surgical interventions with deep brain stimulation, gamma‐knife surgery and the recently introduced magnetic resonance imaging guided focused ultrasound lesioning. Further progress is awaited from the better integration of large prospective cohort assessment and basic science studies on the possible etiologies. In particular, aging‐related tremor may explain a large number of the patients seen in clinical practice. Currently ET is considered a clinically relatively uniform condition with presumably various underlying etiologies.
Prevalence, correlates and impact of pain and cramps in anti‐MAG neuropathy: a multicentre European study
Authors: Rajabally Y. A. , Delmont E. , Hiew F. L. , Aubé‐Nathier A.‐C. , Grapperon A.‐M. , Cassereau J. , Attarian S.
Published: September 2017

Background and purpose

The frequency of pain and cramps is uncertain in anti‐myelin associated glycoprotein antibody (anti‐MAG) neuropathy. Whether these symptoms may affect function/quality of life is unknown.

Methods

A cross‐sectional study of the prevalence, correlates and impact of pain, pain subtypes and cramps, their severity, frequency and anatomical distribution was performed for 55 clinically stable patients with anti‐MAG neuropathy.

Results

Pain of any type was reported by 80% of subjects. The most common subtype was paraesthesiae and dysaesthesiae (70%). Cramps were reported by >60% of patients, with lower limb cramps in all and upper limb cramps in about 20%. Cramps affected daily activities in >30% of these subjects, sleep in 60%, ability to exercise in >30%. Total pain score correlated with several Short Form 36 health‐related quality of life (SF‐36 HR‐QoL) measures (P < 0.05), with Inflammatory Rasch‐built Overall Disability Scale (I‐RODS) (P = 0.006) and 10‐m timed walk (P = 0.019). An independent association was ascertained with I‐RODS (P = 0.002). Different pain subtypes showed multiple associations with SF‐36 HR‐QoL measures and/or functional scales. Upper limb cramps had multiple SF‐36 HR‐QoL functional correlates, with an independent association with the Overall Neuropathy Limitation Score (ONLS) (P = 0.004). Cramp severity correlated with ONLS (P = 0.04) and I‐RODS (P = 0.028) and inversely with level of physiotherapy input (P = 0.009). Cramp frequency was associated with tremor score (P = 0.004) and multiple SF‐36 HR‐QoL subsections.

Conclusions

Neuropathic pain and cramps may affect function and quality of life in anti‐MAG neuropathy. Optimizing treatments of these symptoms, including by adequate levels of physiotherapy, may be beneficial in affected patients and requires further research.
Is there a benefit of mechanical thrombectomy in patients with large stroke (DWI‐ASPECTS ≤ 5)?
Authors: Manceau P. ‐F. , Soize S. , Gawlitza M. , Fabre G. , Bakchine S. , Durot C. , Serre I. , Metaxas G. ‐E. , Pierot L.
Published: September 2017

Background and purpose

Whether to withhold mechanical thrombectomy when the diffusion‐weighted imaging (DWI) lesion exceeds a given volume is undetermined. Our aim was to identify markers that will help to select patients with large DWI lesions [DWI−Alberta Stroke Program Early Computed Tomography Score (DWI‐ASPECTS) ≤ 5] that may benefit from thrombectomy.

Methods

From May 2010 to November 2016, 82 acute ischaemic stroke patients with DWI‐ASPECTS ≤5 (43 men, 64.6 ± 14.4 years, National Institutes of Health Stroke Scale 18.4 ± 5.4) treated with state‐of‐the‐art mechanical thrombectomy were studied. Thrombectomy alone was performed in 28 (34%) and bridging therapy in 54 (66%) patients. Recanalization was defined as a thrombolysis in cerebral infarction score 2B‐3 and significant hemorrhagic transformation as parenchymal haematoma type 2 (European Cooperative Acute Stroke Study 3 classification). Pretreatment variables were compared between patients with a good (modified Rankin Scale 0−2) and a poor (modified Rankin Scale 3−6) neurological outcome at 3 months.

Results

Overall, 28 patients (34%) achieved good neurological outcome at 3 months. Recanalizers were significantly more likely to achieve good outcome (61% vs. 7.3%, P < 0.0001), had lower mortality (24% vs. 49%, P = 0.03) and similar rates of parenchymal haematoma type 2 (9.8% vs. 7.3%, P = 1) compared to non‐recanalizers. Regression modelling identified DWI‐ASPECTS >2 [odds ratio (OR) 6.93; 95% confidence interval (CI) 1.05–45.76, P = 0.04), glycaemia ≤6.8 mmol/l (OR 4.05; 95% CI 1.09–15.0, P = 0.03) and thrombolysis (OR 3.67; 95% CI 1.04–12.9, P = 0.04) as independent predictors of good neurological outcome.

Conclusions

In patients with DWI‐ASPECTS ≤5, two‐thirds of patients experienced good neurological outcome when recanalized by state‐of‐the‐art thrombectomy, whilst only one in 14 non‐recanalizers achieved similar outcomes. Pretreatment markers of good neurological outcomes were DWI‐ASPECTS >2, intravenous thrombolysis and glycaemia ≤6.8 mmol/l.
Resilience to heat waves in the aquatic snail Lymnaea stagnalis: Additive and interactive effects with micropollutants
Authors: Salo Tiina , Stamm Christian , Burdon Francis J. , Räsänen Katja , Seppälä Otto
Published: September 2017

Multiple anthropogenic changes, such as climate change and chemical pollution, threaten the persistence of natural populations. Yet, their potential additive and interactive effects on organismal performance and fitness are poorly understood, thus limiting our ability to predict the effects of the global change.

We conducted a laboratory experiment to study the singular and combined effects of experimental heat waves and micropollutants (i.e. low‐concentration toxicants; henceforth micropollutants [MPs]) on the freshwater snail, Lymnaea stagnalis. To comprehensively understand physiological and ecological consequences of stress, we studied a broad range of traits from respiration rate to feeding performance and growth. We also determined traits contributing to fitness and immune responses, as these are key traits in determining both organismal fitness and interspecific (e.g. host–parasite) interactions. We tested whether a constant exposure to MPs affects the ability of snails to tolerate heat waves (8 days of 23.5°C), and subsequently to recover from them, and whether the effects are immediate or delayed.

We found strong immediate additive effects of both stressors on reproduction, while they synergistically increased respiration and antagonistically decreased food consumption. Moreover, these effects were transient. Although the heat wave increased metabolic rates, individuals did not increase their resource uptake. This caused an apparent imbalance in resource levels—a probable cause for the observed trade‐off between immune function and reproductive traits (i.e. phenoloxidase‐like activity decreased, while reproductive output increased). In addition, exposure to MPs led to a temporarily reduced reproductive output.

Our results indicate that even short‐term heat waves and low concentrations of chemical pollution can have large, mainly additive impacts on organismal fitness (e.g. altering susceptibility to infections and reproductive output). This suggests that long‐term effects of existing stressors and heat waves need to be considered when assessing the resilience of natural populations.
Recovery of lake vegetation following reduced eutrophication and acidification
Authors: Baastrup‐Spohr Lars , Sand‐Jensen Kaj , Olesen Sissel C. H. , Bruun Hans Henrik
Published: September 2017

In recent decades, many aquatic ecosystems in Europe and North America have experienced reduced inputs of nutrients and acidifying substances because of improved sewage treatment and reduced emission of sulphur oxides. We evaluated the consequences of these efforts to changes in water chemistry, species richness and community composition of aquatic macrophytes in 56 lakes in Denmark around 1990 and again around 2010.

Reductions in lake water concentrations of phosphorus and nitrogen were strongest in eutrophic and hypertrophic lakes, for example, lakes which had been heavily affected by domestic sewage. These changes translated into decreased algal biomass in the most eutrophied lakes. Oligo‐ and mesotrophic lakes did not change significantly in terms of nutrients or algal biomass. Water clarity increased across all lakes but not significantly in specific trophic lake groups. Alkalinity and pH increased significantly (up to 2 pH‐units) in low‐alkaline lakes, while well‐buffered high‐alkaline lakes (>0.5 meq/L) did not show any change.

Macrophyte species richness per lake increased, on average, by 13% during the 20‐year study period. The increase was strongest in species preferring nutrient‐rich conditions and could be directly attributed to reductions in phytoplankton biomass in lakes of medium water clarity. The similarity among all lakes in terms of species composition increased over the study period. This development was closely related to higher average species richness and was mainly caused by recolonisation of lakes, recovering from past eutrophication, by relatively common species (e.g., Lemna trisulca, Sparganium emersum and Potamogeton berchtoldii). Higher pH in low‐alkaline lakes was accompanied by a shift from acid‐tolerant to more acid‐sensitive species.

Our results demonstrate that investment in pollution control has been successful in terms of markedly improving water quality of lakes and, with a time lag, macrophyte species richness. Although relatively common species have spread across lakes and resulted in homogenised macrophyte communities, continued efforts to reduce pollution could ensure the survival of rare specialist species and perhaps even increase their abundance in the future.
Assessment of ecosystem resilience to hydroclimatic disturbances in India
Authors: Sharma Ashutosh , Goyal Manish Kumar
Published: September 2017

Recent studies have shown an increasing trend in hydroclimatic disturbances like droughts, which are anticipated to become more frequent and intense under global warming and climate change. Droughts adversely affect the vegetation growth and crop yield, which enhances the risks to food security for a country like India with over 1.2 billion people to feed. Here, we compared the response of terrestrial net primary productivity (NPP) to hydroclimatic disturbances in India at different scales (i.e., at river basins, land covers, and climate types) to examine the ecosystems’ resilience to such adverse conditions. The ecosystem water use efficiency (WUEe: NPP/Evapotranspiration) is an effective indicator of ecosystem productivity, linking carbon (C) and water cycles. We found a significant difference (p < .05) in WUEe across India at different scales. The ecosystem resilience analysis indicated that most of the river basins were not resilient enough to hydroclimatic disturbances. Drastic reduction in WUEe under dry conditions was observed for some basins, which highlighted the cross‐biome incapability to withstand such conditions. The ecosystem resilience at land cover and climate type scale did not completely relate to the basin‐scale ecosystem resilience, which indicated that ecosystem resilience at basin scale is controlled by some other ecohydrological processes. Our results facilitate the identification of the most sensitive regions in the country for ecosystem management and climate policy making, and highlight the need for taking sufficient adaptation measures to ensure sustainability of ecosystems.
Neuromodulation and Devices in Trigeminal Neuralgia
Authors: Weber Kevin
Published: September 2017

Premise

Trigeminal neuralgia is a severe facial pain disorder that has been studied for decades. Classical trigeminal neuralgia (CTN) is either idiopathic or caused by neurovascular compression. The related painful trigeminal neuropathies are often secondary to other causes, such as multiple sclerosis or trauma.

Problem

Therapies for trigeminal neuralgia and neuropathy have often been pharmacologic or surgical. Pharmacologic therapies are not effective in some cases and often cause side effects, some substantial. Surgery can have comorbidity (such as anesthesia dolorosa, or painful differentiation of the affected nerve distribution) and also is not always effective. There is a desire, as in all chronic conditions, to find effective treatments with minimal morbidity and side effects.

Potential solutions

We review several devices including neuromodulation, ranging in invasiveness, for treatment of trigeminal neuralgia and neuropathy. We review existing data on sphenopalatine ganglion blocks, transcranial magnetic stimulation, transcortical direct stimulation, deep brain stimulation, spinal cord stimulation, peripheral nerve stimulation, and transcutaneous electrical stimulation for CTN and pain trigeminal neuropathies. We also offer hope for further research in this area with the goal of discovering a device that can provide treatment for many with few side effects and minimal morbidity.
Latent Tuberculosis Infection Screening Acceptability among Migrant Farmworkers
Authors: Osuchukwu Obiyo , Nuῆez Maria , Packard Samuel , Ehiri John , Rosales Cecilia , Hawkins Eric , Gerardo Avilés José Gabino , Gonzalez‐Salazar Francisco , Oren Eyal
Published: September 2017

Latent tuberculosis (TB) infection is routinely diagnosed using the tuberculin skin test (TST). New methods of detection more specific than TST such as QuantiFERON TB Gold In‐Tube (QFT‐GIT) have been developed but evidence remains limited on their acceptability among migrant farmworkers. This article examined the acceptability of screening tests among migrant farmworkers working on the Arizona‐Mexico border. We conducted a cross‐sectional survey of migrant farmworkers via questionnaire. Of 83 participants interviewed, 53 (63.9%) believed that TB was a serious disease that could result in death and 59 (71.1%) considered TB a health concern in their community. Sixty‐four participants (77.1%) rated QFT‐GIT test as performing better than TST. Our study demonstrates preference for QFT‐GIT results over TST, and highlights migrant farmworkers’ considering themselves at risk of TB and TB as a health concern. Policies that create easy access and culturally appropriate, affordable healthcare for this vulnerable population should be encouraged.
The Turks of Bulgaria: An Outlier Case of Forced Migration and Voluntary Return
Authors: Kutlay Muzaffer
Published: September 2017

The Turks of Bulgaria have a particular place in displacement scholarship. As the largest minority group in the country, they were subjected to ethnic cleansing in the 1980s. Anti‐Turkish sentiments culminated in state‐led systematic exclusion and more than 340,000 Turks were forcefully migrated to Turkey in 1989. After the collapse of Communism and the transition to democracy, almost 40 per cent of them voluntarily returned to Bulgaria, making it an outlier case in displacement literature. Drawing on 46 semi‐structured interviews, this study contributes to the literature by offering a grounded conceptual framework which explains the macro‐dynamics of voluntary and sustainable return through an in‐depth study of the Bulgarian case. The findings suggest that three‐factors account for the voluntary return: (i) the peaceful transition to inclusive democracy and power‐sharing; (ii) the dual moderation between majority and minority representatives; and (iii) the enabling role of international actors, primarily the EU‐anchor.
THE ÆTIOLOGY OF PITUITARY TUMOURS : THE ROLE OF HYPOGONADISM AND HYPOTHYROIDISM
Authors: CAUGHEY J. E.
Published: September 2017

In rodents partial or complete impairment of thyroid and also of gonadal function leads in time to the development of pituitary tumours.

There is evidence in the literature of the development of basophile tumours in humans who die of myxædema.

In no case presenting as a pituitary tumour in our series of 50 cases has previous hypothyroidism appeared to be significant.

In two cases quoted from Cushing's series, and in four personal cases in which pituitary tumours developed, there had been a complete or partial gonadal failure for many years preceding the signs and symptoms of tumours.

It is suggested that in humans, as in rodents, the formation of some pituitary tumours may follow overactivity of gonadotrophic cells secondary to hypogonadism.
A COMPARISON OF THE EARLY METABOLIC EFFECTS OF TRI‐IODOTHYRONINE AND HYDROCORTISONE IN MAN
Authors: HETZEL BASIL S. , WILLIAMS R. , LANDER H.
Published: September 2017

The early metabolic effects of intravenous triiodothyronine and hydrocortisone have been studied in five healthy male volunteers over a ten‐hour period.

Triiodothyronine (0.5 and 1.0 milligramme) produced a rise in metabolic rate with a fall in non‐protein respiratory quotient in three hours. This was associated with an increase in serum and urinary inorganic phosphate content but no increase in total nitrogen or electrolyte excretion.

Hydrocortisone (50 milligrammes) produced a rise in potassium excretion after two hours, followed by a retention of sodium. There was an initial retention followed by an increase in urinary excretion of phosphate associated with a rise in serum inorganic phosphate content. There was also a rise in serum cholesterol content.

These changes have been compared with those associated with stress in man. Though neither hormone reproduced the full stress pattern, each reproduces some of the changes, and hence they may both be involved in their mechanism.
THE SIGNIFICANCE OF PULMONARY VASCULAR CHANGES IN EMPHYSEMA
Authors: MCLEAN K. H.
Published: September 2017

Observations on the morphology of vascular changes in emphysema and related conditions are presented, with particular emphasis on those in the pulmonary and bronchial arteries.

These observations indicate that the sclerosis of the small arteries in emphysema results from organization of thrombi, this thrombosis being precipitated by the cause of the inflammation of the adjoining air passages producing some degree of damage to the arterial wall. In early generalized emphysema pulmonary arterial sclerosis is found predominantly in the small arteries adjoining terminal and respiratory bronchioles; in these early lesions inflammatory damage is largely confined to these bronchioles.

It is emphasized that sclerosis of the smaller pulmonary arteries is not directly proportional to the degree of inflammatory damage to bronchioles. The relation between the two, particularly in early or mild cases, varies within wide limits.

It is pointed out that the significance of pulmonary arterial sclerosis as one factor in the genesis of pulmonary hypertension has not yet been accurately assessed, since morphological studies of this subject have been limited and the widespread complete arterial obliteration that occurs in chronic inflammatory disease of the lungs has not been adequately recognized.

Observations on the bronchial arteries in emphysema and on the development of anastomoses between these vessels and pulmonary arteries indicate that these last develop from the minute vessels in organizing tissue in inflammatory areas. Where a “demand” for nutriment continues, the vessels enlarge. Such vessels are bronchial in origin; and where the wall of a pulmonary vessel has been involved, an anastomosis arises.

The vascular changes observed in emphysema are not of great ætiological importance but are the incidental concomitant of earlier general connective tissue changes in the region. As happens in all parts of the body, the vessels are necessarily involved in any connective tissue disturbance. At the same time sclerosis and particularly obliteration will limit the nutrition of tissues depending on them.

The vascular phenomena therefore are important in that, by their presence, they support the hypothesis propounded, as the result of observations of the bronchioles and related structures, that emphysema is intimately related to and develops as the result of previous damage to and chronic inflammatory changes in the bronchioles and proximate pulmonary tissues.
FLUORESCEIN‐GLOBULIN AFFINITIES FOR RED CELLS IN HIEMOLYTIC ANÆMIA
Authors: HUGHES P. E.
Published: September 2017

Red corpuscles, which normally are not affected, were found to become stained by fluorescein‐globulin in a small number of cases of lymphatic leukæmia. These cases were complicated by a hæmolytic anaemia associated with a positive Coombs reaction.

Cases of congenital hæmolytic anæmia failed to show positive staining. Among other forms of acquired hæmolytic anæmia, positive staining was sometimes encountered in the presence of a positive Coombs reaction. This was demonstrated to be of a non‐specific type except in one case, complicating lupus erythematosus, in which it appeared to have an immunological mechanism.

A faint staining and fluorescence was found in association with erythroblastosis fœtalis. Here the prior application of unconjugated anti‐human‐gamma‐globulin globulin to blood films resulted in enhancement rather than inhibition of staining.

The non‐specific type of staining appears to be a physico‐chemical protein‐protein interaction which is independent of any immunological reaction.
THE PARTIAL ABSORPTION TEST : A NEW TECHNIQUE FOR TITRATING RH ANTIBODIES OF PATHOLOGICAL SIGNIFICANCE
Authors: VOS G. H.
Published: September 2017

A new test is described which enables the quantity of Rh antibody free in the fœtal serum to be estimated by titrations carried out on the maternal serum. Equal volumes of a hæmolysed 25% suspension of Rh‐positive red cells and a 1 : 4 dilution of the maternal anti‐Rh sera are incubated at room temperature for 15 minutes. The Rh antibody remaining free at the end of this time is titrated by the indirect antiglobulin method. The titre value obtained is referred to as the partial absorption (P.A.) titre.

The P.A. titre is closely related to the titre of free Rh antibody in the cord serum of the infant at birth. The P.A. titre also is highly correlated with the blocking titre, but shows no relationship with the conglutination or albumin titres. The P.A. test, however, is more sensitive than the blocking test in detecting Rh antibodies of pathological significance, and is likely to be therefore of greater prognostic value.
CATION STUDIES DURING EXPERIMENTAL HYPOTHERMIA
Authors: HERCUS VICTOR , BOWMAN SHEILAH
Published: September 2017

Experimental hypothermia in sheep was produced by immersing them in an iced water bath, the body temperature being lowered to 28°–30° C. The animal was anaesthetized with sodium pentobarbitone given intravenously and mechanically ventilated with oxygen during the procedure.

There was a significant fall in the serum potassium level and a rise in the hæmatocrit as a result of this cooling. Examination of specimens of skeletal muscle showed that water and sodium had entered the muscle fibre, with a consequent dilution of its potassium. The sulphate space of skeletal muscle was reduced.

The changes in muscle suggest either an anoxic effect possibly resulting from the hæmodynamic changes (lowered cardiac output, increased blood viscosity, lowered blood pressure, lowered heart rate and peripheral vasoconstriction) produced by hypothermia, or a direct depression of cell metabolism reducing the energy production necessary to maintain an effective “sodium pump”.

All the changes observed were reversed after of the animals were rewarmed.
WHIPPLE'S DISEASE
Authors: TAFT L. I. , LIDDELOW A. G. , RALSTON MARY
Published: September 2017

The clinical course and autopsy findings in three cases of Whipple's disease are described.

The basic abnormality is considered to be a proliferation of mucoprotein‐producing reticulo‐endothelial cells, maximally concentrated in the small intestinal lymphatic system, but occurring at other sites including peripheral lymph nodes where, in the earliest stages, these cells can be seen arising in the germ centres. Transitions demonstrable between RNA‐containing cells and cells containing mucoprotein are considered to indicate synthesis of the mucoprotein, rather than its phagocytosis by the proliferating reticulo‐endothelial cells. Collagenization of lymph nodes and lymphatics is believed to be a result of the activity of these cells and responsible for the observed obstructive phenomena.

The stimulus responsible for the proliferation of the mucoprotein‐synthesizing cells is unknown. It may represent a highly differentiated neoplastic process. Again, it may be the outcome of some cellular defect—e.g., enzymatic—whereby there is an abnormal accumulation of a normally synthesized mucoprotein.

Response to steroid therapy in this condition is compatible with the known reticulo‐endothelial suppressive action of adrenal cortical steroids. However, this response is not sustained.
PLASMA 17‐HYDROXYCORTICOSTEROIDS (STEROIDAL DIHYDROXY‐ACETONES) IN ADDISON'S DISEASE AND HYPOPITUITARISM
Authors: STEINBECK A. W.
Published: September 2017

In Addison's disease, the plasma concentrations of 17‐hydroxycorticosteroids may be within the lower normal range of values, zero, or not significantly different from zero; they do not increase after the intravenous administration of corticotrophin. Brief reference is made to the clinical features of three cases of Addison's disease with normal plasma steroid values, partial Addison's disease.

In hypopituitarism, the plasma concentrations of 17‐hydroxycorticosteroids may be within the normal range of values, zero, or essentially zero. The lowest values are found in panhypopituitarism, and they may either not increase or increase less than normally after the intravenous administration of corticotrophin, according to the degree of adrenocortical hypo‐responsiveness from atrophy. In addition, some evidence is presented in favour of a possible adrenocortical over‐responsiveness under certain conditions of hypopituitarism.

The diagnostic significance of the results with respect to Addison's disease and some reservations regarding the intravenous use of corticotrophin in hypocorticism are noted.
PLASMA CREATININE LEVEL AND CREATININE CLEARANCE AS TESTS OF RENAL FUNCTION
Authors: EDWARDS K. D. G. , WHYTE H. M.
Published: September 2017

In hospital patients with no evidence of renal disease, the mean value (and standard deviation) for plasma creatinine concentration was 0.93±0.14 milligramme per 100 millilitres in 14 males, and 0.73±0.14 milligramme per roo millilitres in 18 females. The corresponding endogenous creatinine clearances were 108±16 and 104±14 millilitres per minute respectively. Reasons are advanced for considering this clearance to be equivalent to the glomerular filtration rate (G.F.R.).

Blood urea nitrogen content, urea clearance and plasma creatinine content were compared as measures of the G.F.R. in 50 hospital patients referred for investigation of renal function. There was a highly significant correlation between urea clearance and G.F.R., and the latter could be predicted from urea clearance with some precision (standard deviation of estimate, 18.7 millilitres per minute). With the blood urea nitrogen content alone a less significant correlation was obtained, and the G.F.R. could be predicted less precisely (standard deviation of estimate, 24.7 millilitres per minute). The plasma creatinine content showed a highly significant correlation with the G.F.R., and was at least as good as urea clearance for estimating the G.F.R., particularly if males and females were separated.

Comparison of the plasma creatinine content with the G.F.R. in a larger group on 136 occasions showed a highly significant correlation, and the G.F.R. could be estimated from the plasma creatinine content with a standard deviation of 13.6 millilitres per minute. The G.F.R. for males was best expressed by
and for females by

It was concluded that the measurement of true plasma creatinine content provides a better indication of renal function than tests in common use based on measurements of urea.
HEALED DISSECTING ANEURYSM OF THE AORTA
Authors: COLLINS A. G.
Published: September 2017

Three cases of healed dissecting aneurysm diagnosed during life are presented. Two had several points in common—an onset during mild exertion, external leakage into the pleural cavity and a similar site of intimal tear. The third was characterized by involvement of the aortic valve ring with aortic incompetence, dissection of the great vessels with unequal peripheral pulsations, and occlusion of the left renal artery causing infarction and atrophy of the kidney. In each case there was endothelialization of the false sac, with formation of atheroma‐like plaques in one instance. Histologically, the striking features throughout the media were loss of elastic tissue and scattered areas devoid of nuclei.

The so‐called healed dissecting aneurysm is a temporary state, and further fatal complications are probable.
HUMORAL FACTORS IN LIVER REGENERATION
Authors: HUGHES P. E.
Published: September 2017

The mechanism by which control of growth in multi‐cellular organisms is exercised is ill understood. Previously, it was thought that this was due to some “work” factor. However, it has been shown that injection of a rat with serum taken from a partially hepatectomized rat results in an increased mitotic rate in the liver of the recipient rat. When serum taken from partially hepatectomized rats is subjected to Cohn‐type fractionation, the active agent(s) has been found to be associated with the alpha‐globulin and albumin fractions.
GASTRIC ULCER : AGE, SEX, AND A CURIOUS RETROGRESSION
Authors: BILLINGTON B. P.
Published: September 2017

The incidence of chronic gastric ulcer increases with age in both sexes.

A curious retrogression has occurred in Australia since 1945, involving a sudden exacerbation of chronic gastric ulcer in young women. At the present time women up to the age of 40 years are more likely to die from gastric ulcer than men of the same age. No similar change is yet apparent in other countries. It is probable that an alteration in the environment has been responsible.
THE “Q” WAVE AND HIGH CHEST LEADS : AN ANALYSIS OF 425 CASES
Authors: FREEMAN ZELMAN
Published: September 2017

Normal Q waves indistinguishable from abnormal Q waves may be recorded from leads on the chest wall. They differ only in site, but not in form or duration.

The mechanism of production of Q waves is discussed, and the findings at two fixed points on the upper part of the anterior chest wall are analysed in 425 cases.

It is clear that the normal Q zone rarely extends to the second intercostal space above the V2 position, or the middle of the sternum at the level of the third intercostal space. Only two instances of Q waves were seen at this level in 149 normal subjects.

In none of 32 cases of posterior infarction were Q waves found in these leads, whereas in 85% of cases of recent anterior infarction Q waves are found at these sites.

The presence of a Q wave in these leads is highly unlikely to be normal if bundle branch block, ventricular hypertrophy, gross clock‐wise rotation and right ventricular dilatation are excluded.
CHRONIC PYELONEPHRITIS AND HYPERTENSION
Authors: GWYNNE J. F.
Published: September 2017

The autopsy incidence of chronic pyelonephritis has been investigated in a series of zoo hypertensive patients. Evidence of the disease was found in 51.5%, the condition being unilateral in 4.5%. The findings indicate that “essential” hypertension is rare in young patients. Malignant hypertension and uræmia should suggest the presence of primary renal disease. Only 10% of the cases were diagnosed clinically, and the condition is often overlooked or misdiagnosed pathologically.

The suggestion is put forward that full urine examination, X‐ray investigation of the abdomen and intravenous pyelography should be used more often and with greater care, in order that the clinical recognition of the disease may be improved.
“ Q ” FEVER : CLINICAL FEATURES IN 72 CASES
Authors: POWELL OWEN
Published: September 2017

In 72 consecutive cases of “ Q ” fever, with no death, the commonest symptoms were headache and anorexia. Myalgia, sore eyes, cough, chills and sweats were also frequent. The commonest signs were a relative bradycardia, hepatomegaly and splenomegaly. Minor chest signs were frequently found. The total duration of fever was 10 days or less in the majority of cases. The longest duration of continuous fever was 24 days, and of intermittent fever 34 days.

Common laboratory findings included an increased erythrocyte sedimentation rate, the presence of atypical mononuclear cells during the acute illness and an absolute lymphocytosis during convalescence. Only three patients had radiologically demonstrable pneumonic changes. However, respiratory infection of a lower severity was frequent, and this suggests that local strains of Coxiella burneti may be less virulent than overseas strains. Subclinical involvement of the liver was common, and in seven cases there was electrocardiographic evidence of transient myocardopathy.

About 70% of patients returned to work within six weeks from the onset, but the convalescence of the remainder was protracted. The duration of convalescence was prolonged with increasing age. Infection with C. burneti may become chronic.

Cases are described in which “ Q ” fever was complicated by pneumonia, pleural effusion, thrombocytopenia, encephalitis and endocarditis, and in which the problem of chronicity is illustrated.
SOME OBSERVATIONS ON EJECTION SOUNDS
Authors: WAGNER G. R.
Published: September 2017

The properties of ejection sounds are described as they were found in a limited number of proven cases of simple pulmonary stenosis, pulmonary hypertension, congenital aortic stenosis and coarctation of the aorta.

Pulmonary ejection sounds are commonly found in pulmonary stenosis, even in severe cases. They tend to occur earlier in systole in cases of severe stenosis than in cases of mild or moderate stenosis. They vary in intensity with respiration.

In pulmonary hypertension, ejection sounds are also frequently present. They occur later in systole than in pulmonary stenosis and show little variation in intensity with respiration.

Aortic ejection sounds are commonly found in congenital aortic stenosis and in coarctation of the aorta. They occur later in systole in coarctation than in aortic stenosis, and in the former they are often less sharp and less click‐like to the ear and rather broad and “split‐up” phonocardiographically.

Ejection sounds are an additional physical sign in the conditions described, and they may at times be helpful in diagnosis.
NEUTROPHIL ALKALINE PHOSPHATASE
Authors: WYLLIE R. G.
Published: September 2017

Neutrophil alkaline phosphatase (N.A.P.) levels were studied in 665 patients. In 511 patients, 24 hours after the onset of acute inflammation, the N.A.P. level was proportional to the extent and severity of the lesion. In 20 patients unexplained weak N.A.P. responses were observed. In 132 patients with a wide variety of non‐inflammatory diseases (excluding infarction, liver disease and blood dyscrasias), N.A.P. levels were normal. In two patients, raised N.A.P. levels occurred without demonstrable cause. It is concluded that N.A.P. levels reflect the progress of acute inflammation and can be of value in diagnosis.
IN‐VIVO ABSORPTION OF IRON FROM TREATED BLOOD AND LIVER
Authors: SANFORD RONA
Published: September 2017

Rats were injected with iron‐59 to obtain blood and liver labelled with this element. These materials were cooked and then some of the cooked blood and cooked liver were subjected to peptic digestion in vitro, with the production of supernatant fluids and residues.

Different groups of rats were then fed each of these several substances.

It was found that the rats absorbed the same amount of iron from the supernatant fluids as they did from the cooked blood or cooked liver, but very little iron was absorbed from the residues.