bluuebunny/crossref_metadata_2025 huggingface dataset:
The neglected season: Warmer autumns counteract harsher winters and promote population growth in Arctic reindeer
Authors: Loe Leif Egil , Liston Glen E. , Pigeon Gabriel , Barker Kristin , Horvitz Nir , Stien Audun , Forchhammer Mads , Getz Wayne Marcus , Irvine Robert Justin , Lee Aline , Movik Lars K. , Mysterud Atle , Pedersen Åshild Ø. , Reinking Adele K. , Ropstad Erik , Trondrud Liv Monica , Tveraa Torkild , Veiberg Vebjørn , Hansen Brage B. , Albon Steve D.
Published: November 2020

Arctic ungulates are experiencing the most rapid climate warming on Earth. While concerns have been raised that more frequent icing events may cause die‐offs, and earlier springs may generate a trophic mismatch in phenology, the effects of warming autumns have been largely neglected. We used 25 years of individual‐based data from a growing population of wild Svalbard reindeer, to test how warmer autumns enhance population growth. Delayed plant senescence had no effect, but a six‐week delay in snow‐onset (the observed data range) was estimated to increase late winter body mass by 10%. Because average late winter body mass explains 90% of the variation in population growth rates, such a delay in winter‐onset would enable a population growth of r = 0.20, sufficient to counteract all but the most extreme icing events. This study provides novel mechanistic insights into the consequences of climate change for Arctic herbivores, highlighting the positive impact of warming autumns on population viability, offsetting the impacts of harsher winters. Thus, the future for Arctic herbivores facing climate change may be brighter than the prevailing view.
The burden of root caries: Updated perspectives and advances on management strategies
Authors: AlQranei Mohammed S. , Balhaddad Abdulrahman A. , Melo Mary A.S.
Published: November 2020

Background

Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries.

Objective

This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries.

Materials and Methods

MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries.

Results

Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in‐office and home remineralisation tools. The use of non‐invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin‐based restorations can be placed.

Conclusion

The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries–affected patients.
Impact of Chinese market segmentation on regional collaborative governance of environmental pollution: A new approach to complex system theory
Authors: Bian Yuanchao , Song Kaiyi , Bai Junhong
Published: November 2020

The market segmentation among local governments under decentralization of China not only directly triggered the “fragmentation” of regional development, but also hindered collaborative actions in environmental governance. This study adopts a new method to calculate regional environmental collaborative governance using a synergy degree model of a complex system, and then it empirically analyzes the impact of Chinese market segmentation. We find that the regional environmental collaborative governance in China shows a growing trend during the period of investigation, but the level is still low. Market segmentation has significantly inhibited the regional collaborative governance of environmental pollution among local governments of China. The effect of market segmentation on the order of personnel input and capital input is significantly negative, while the effect on the order of policy input and organizational input is not significant. In the areas where the air pollution and water pollution are serious, the effect of market segmentation is also significantly negative. The conclusions are helpful to understanding the institutional factors that hinder regional environmental collaborative governance in China more comprehensively, and provide insights for improving the performance of environmental governance.
Trigeminal neuralgia in children and adolescents: Experience of a tertiary pediatric headache clinic
Authors: Brameli Anna , Kachko Ludmyla , Eidlitz‐Markus Tal
Published: November 2020

Objectives

To describe the characteristics and treatment of trigeminal neuralgia in children attending a dedicated pediatric headache clinic.

Background

Data on trigeminal neuralgia as a cause of headache are largely derived from adult studies. Little is known about the etiology, symptoms, treatment, and outcome of the disorder in children and adolescents.

Methods

A case series study was undertaken. The database of a headache clinic within a tertiary, university‐affiliated, pediatric medical center was searched for all patients aged 3–18 years presenting with clinical and epidemiological features of trigeminal neuralgia or trigeminal neuropathy from January 2015 to December 2019. The diagnosis was revised for the present study according to the criteria of the International Classification of Headache Disorders, third edition. Data on demographic parameters, clinical symptoms, treatment, and outcome were collected from the medical files.

Results

Of the 1040 patients who presented to our clinic during the study period, five (0.5%) were diagnosed with trigeminal neuralgia. Mean patient age was 15.1 ± 3.0 years (range 9.5–17.5; 95% CI 10.8–18.9). All had idiopathic type: purely paroxysmal in one and with concomitant continuous pain in four. Findings on herpes serology in all five and magnetic resonance imaging were normal in four patients. In the fifth, a vascular ring was noted from the superior cerebellar artery around the right trigeminal nerve without radiologic evidence of vascular nerve compression. All patients were initially treated with carbamazepine: one reported partial relief, two did not respond, and two had severe adverse effects. Three patients were switched to gabapentin but only one responded well. Three patients were treated with nerve block.

Conclusion

Trigeminal neuralgia accounted for only a small proportion of patients seeking treatment for headache in pediatric headache clinic over a 5‐year period. Unlike findings in adults, vascular compression was not the underlying mechanism in any of our patients. The response to pharmacologic treatment was poor. Nerve block may serve as an alternative when pharmacologic treatment fails.
Comparison of therapeutic outcomes of sorafenib and lenvatinib as primary treatments for hepatocellular carcinoma with a focus on molecular‐targeted agent sequential therapy: A propensity score‐matched analysis
Authors: Tomonari Tetsu , Sato Yasushi , Tani Joji , Hirose Akira , Ogawa Chikara , Morishita Akihiro , Tanaka Hironori , Tanaka Takahiro , Taniguchi Tatsuya , Okamoto Koichi , Sogabe Masahiro , Miyamoto Hiroshi , Muguruma Naoki , Uchida Kazushige , Masaki Tsutomu , Takayama Tetsuji
Published: November 2020

Aim

The optimal choice between sorafenib (SOR) or lenvatinib (LEN) as the first‐line treatment for unresectable hepatocellular carcinoma (u‐HCC) remains debatable. Using propensity score matching, this study compares the outcomes of SOR and LEN in the molecular‐targeted agent (MTA) sequential treatment of u‐HCC patients.

Methods

This retrospective, multicenter, observational study recruited 137 u‐HCC patients who underwent primary treatment with LEN (n = 52) or SOR (n = 85) between June 2017 and June 2020 after regorafenib was approved as the secondary treatment for u‐HCC. Propensity score matching was used to reduce confounding, resulting in the selection of 104 patients (n = 52 for the SOR and LEN cohorts).

Results

The median overall survival was 21.8 months for LEN and 20.4 months for SOR. LEN exhibited significantly greater therapeutic efficacy as compared to SOR (objective response rate: 3.8% [SOR] vs. 42.3% [LEN], p < 0.01; progression‐free survival: 10 months [LEN] vs. 5.1 months [SOR], p < 0.01). No significant intergroup differences were noted in the rate of transition to secondary MTA treatments (SOR: 58.7%; LEN: 48.4%), adverse events (SOR: 86%; LEN: 95%), and maintenance of the Child–Pugh (CP) score during treatment. Compared to non‐MTA treatments, secondary MTA treatment achieved a greater improvement in survival (4.3  vs. 2.8 months, p = 0.0047). Multivariate analysis demonstrated that the CP score (p < 0.01) and alpha‐fetoprotein level (p < 0.01) were independent prognostic factors.

Conclusions

Both SOR and LEN treatments showed a clinically comparable therapeutic efficacy as the first‐line treatments for u‐HCC patients in an MTA sequential therapy.
Effect of hydroxypropyl‐β‐cyclodextrin in fluid and semi‐solid submicron emulsions on physiological skin parameters during regular in vivo application
Authors: Pany Astrid , Wohlgenannt Marie , Klopprogge Safoura , Wolzt Michael , Heuser Thomas , Kotisch Harald , Valenta Claudia , Klang Victoria
Published: November 2020

Objective

The aim of the present study was to evaluate the effect of hydroxypropyl‐β‐cyclodextrin (HP‐β‐CD) in cosmetic submicron emulsions and submicron emulsion gels on physiological skin parameters during regular application in a clinical set‐up.

Methods

Formulation morphology was investigated using cryo‐transmission electron microscopy. Stability of the employed formulations was determined by photon correlation spectroscopy, measurement of pH and rheological properties. Effect on physiological skin parameters was evaluated during regular application over four weeks in a parallel group study (n = 15, healthy forearm skin) with a Corneometer, Sebumeter, skin‐pH‐Meter, Aquaflux and an Epsilon sensor. Confocal Raman spectroscopy was employed to monitor urea and NMF levels.

Results

Both submicron emulsions and gels showed satisfying storage stability irrespective of cyclodextrin incorporation. No statistically significant effects on skin barrier function and any of the observed parameters were obtained, indicating good skin tolerability of all tested formulations.

Conclusion

Results suggest good skin tolerability of the developed cosmetic submicron emulsions and gels with HP‐β‐CD.
Impact of financial debt on borrower’s health based on gender
Authors: Chen Gengxuan , Jia Qinmin , Maskara Pankaj K. , Williams Albert
Published: November 2020

This study investigated whether self‐reported impact of financial debt on health is different for women as compared with men. We found that female respondents are more likely to report that debt has affected their health. The results persisted when the analysis was performed on subsamples of employed individuals, married households and those with underwater mortgage (i.e., outstanding balance on mortgage is higher than the current value of the home). Prior studies have found that for a given level of debt, females are more likely to perceive higher levels of stress. When we controlled for stress perception, the health impact of debt was not higher for females. Some types of debt like credit card debt, student debt and loans from friends and family are known to result in higher levels of stress. Our findings persisted when we limited our sample to top users of credit card debt, to those with student debt or to those with loan(s) from friends and family. Prior studies have shown that mortgage debt is associated with lower levels of stress as compared with other types of debt. We found that in households with underwater mortgage, health impact of debt was higher for females even after we accounted for gender differential in stress perception. Our findings suggest that women’s tendency to experience higher levels of stress for a given level of debt mediates the increased likelihood of women reporting that debt has affected their health. However, there exists a possibility that some types of debt in some situations impact health of women more than men for reasons other than debt‐related stress.
Higher coagulation activity in hip fracture patients: A case‐control study using rotational thromboelastometry
Authors: Tsantes Andreas G. , Trikoupis Ioannis G. , Papadopoulos Dimitrios V. , Tsante Konstantina A. , Mavrogenis Andreas F. , Koulouvaris Panagiotis , Savvidou Olga D. , Kontogeorgakos Vasilios A. , Piovani Daniele , Kriebardis Anastasios G. , Bonovas Stefanos , Papagelopoulos Panayiotis J. , Tsantes Argirios E.
Published: November 2020

Introduction

Trauma‐induced coagulopathy has been extensively investigated in the multitrauma setting, but only sparsely following moderate orthopedic trauma. The purpose of this study was to evaluate changes in the hemostatic profile of patients with hip fractures, using rotational thromboelastometry (ROTEM).

Methods

198 patients with hip fractures who underwent surgery were included in the study. A matched group of 52 healthy individuals was also enrolled. Demographics, conventional laboratory assays, and ROTEM parameters were recorded and compared between patients and healthy adults. The preoperative and postoperative ROTEM values of fractured patients were also compared.

Results

The conventional coagulation assays were similar for the 2 groups. However, several ROTEM parameters including EXTEM MCF (P < .001), EXTEM alpha angle (P < .001), INTEM MCF (P < .001), INTEM A10 (P < .001), and INTEM alpha angle (P < .001) significantly differed between the 2 groups indicating a higher coagulation potential following hip fractures. Also, fractured patients had significantly lower INTEM and EXTEM CT values (P = .008 and P = .012, respectively) and significantly lower INTEM and EXTEM CFT values (P < .001). Adjusted analysis for confounders further confirmed the direct relationship between hip fracture and higher coagulation activity. Last, INTEM CT and CFT significantly decreased (P = .008 and P < .001, respectively), while INTEM MCF, A10, and alpha angle significantly increased (P < .001) postoperatively, indicating that surgery further increases the coagulation potential.

Conclusion

A higher coagulation activity following hip fractures and surgical treatment can be detected by ROTEM shortly after the injury, even when this is undetectable by conventional coagulation assays.
Negative pressure wound therapy in spinal fusion patients
Authors: Akhter Asad S. , McGahan Benjamin G. , Close Liesl , Dornbos David , Toop Nathaniel , Thomas Nicholas R. , Christ Elizabeth , Dahdaleh Nader S. , Grossbach Andrew J.
Published: November 2020

Post‐operative wound complications are some of the most common acute complications following spine surgery. These surgical site infections (SSI) contribute to increased healthcare related costs. Negative pressure wound therapy (NPWT) has long been used for treatment of soft tissue injury or defects. NPWT may reduce the incident of SSI following spinal fusion procedures; however, its potential applications need further clarification. Thus, we conducted a retrospective analysis of two cohorts to compare NPWT to traditional sterile dressings following spinal fusions in regards to post‐operative outcomes. Following institutional review board approval, 42 patients who had a NPWT were matched by type of surgery to 42 patients who had traditional dressings. A retrospective chart‐review was completed. Outcome measures, particularly SSI and need for reoperation, were analyzed using one‐way ANOVA for both univariate and multivariate analysis. When controlled for sex and body‐mass index, the use of a NPWT was independently correlated with decreased SSI (P = .035). Superficial dehiscence, seroma, need for additional outpatient care, and need for operative revision were all found to occur at higher rates in the traditional dressing cohort. Closed incisional negative pressure wound therapy provides a cost‐effective method of decreasing surgical site infection for posterior elective spine surgeries.
COMBINED CHLORAMBUCIL AND PREDNISOLONE TREATMENT OF FIVE PATIENTS WITH WEGENER'S GRANULOMATOSIS
Authors: Berglund G. , Hansson L. , Persson B. , Vikgren P.
Published: November 2020

Five patients with Wegener's granulomatosis have been treated with chlorambucil and prednisolone. Three patients are in good general condition 48, 14 and 8 months after commencement of this therapy and with improved of stable renal function. Two patients died. For one of the latter, therapy was started late in the course In the disease and could not prevent the fatal outcome. In the other fatal case chlorambucil could not be maintained at an adequate dosage because of complicating hemorrhagic diathesis. On the basis of the experience gained from our own and earlier reported results, a rational treatment of the disease is proposed.
GLUCOSE TOLERANCE, PLASMA INSULIN AND LIPIDS IN RELATION TO ADIPOSE TISSUE CELLULARITY IN MEN AFTER MYOCARDIAL INFARCTION
Authors: Berchtold Peter , Björntorp Per , Gustafson Anders , Lindholm Björn , Tibblin Gösta , Wilhelmsen Lars
Published: November 2020

Glucose and insulin values in plasma after a peroral glucose tolerance test, triglycerides and cholesterol in plasma, body composition and adipose tissue fat cell diameter were determined in nonselected men surviving a myocardial infarction and were compared with the same variables in randomly selected men from the same region of equivalent age. The patients with myocardial infarction were characterized by a diminished glucose tolerance and elevated plasma lipids when compared with controls. The diminished glucose tolerance was more pronounced in patients with signs suggesting severe myocardial damage or complications to the myocardial infarction. Body fat, fat cell size or insulin values during glucose tolerance test were, however, not increased in patients with myocardial infarction. Fat cell size and fasting insulin or the sum of plasma insulin during the glucose tolerance test correlated positively in both groups of older men. Plasma triglycerides showed significant, positive correlations with the sum of insulin and glucose values during the glucose tolerance test. Patients with endogenous hypertriglyceridemia had higher insulin and blood glucose values and more body fat than patients without plasma lipid abnormalities. It was suggested that increased plasma triglycerides in patients with myocardial infarction are combined with decreased glucose tolerance and an increased insulin secretion associated with enlargement of adipose tissue fat cells.
ALPRENOLOL AS MAINTENANCE THERAPY FOR THE PROTECTION AGAINST ARRHYTHMIA RELAPSE IN PATIENTS WITH DC‐CONVERTED CHRONIC ATRIAL FIBRILLATION
Authors: Rydén L. , Nyberg G. , Saetre H. , Karlsson L. , Lindén L. , Sjöholm J. , Sundquist O.
Published: November 2020

There is a constant search for new drugs, free from side‐effects, to maintain sinus rhythm following DC‐conversion of atrial fibrillation. Adrenergicβ‐receptor blockers have been tried with rather disappointing results, possibly due to the relatively low dosage used. The present trial Was performed in order to evaluate the efficacy of a dose almost twice the one earlier used. By incrementing the dose, alprenolol 100 mg q.i.d. was given to 66 patients and 75 mg q.i.d. to two others. No patient converted spontaneously on alprenolol. After DC‐conversion 80% of the patients reverted to sinus rhythm. Further follow‐up showed a relapse rate of 17% after 24 hours, 65% after one month, 79% after three months, and 85% after six months. In comparison with previously reported studies, these figures are all higher than usual. Possible reasons for this are discussed. The incidence of post‐conversion arrhythmias remained low despite uninterrupted digitalis therapy. Sinus node depression following DC‐conversion, as has been reported in propranolol studies, did not occur, and in our experience it is not necessary to discontinue alprenolol prior to DC‐conversion. Ten patients who relapsed were subsequently treated with a combination of alprenolol and quinidine, but the results were disappointing. In a few cases treatment was stopped with the onset of bradycardia due to sinus node depression. Although generally, adrenergicβ‐receptor blockade appears ineffective in preventing relapse following DC‐conversion, it should be considered in selected cases where it may prove to be a valuable alternative, as illustrated by one of the treated patients.
ON THE METABOLISM OF FAT AND CARBOHYDRATE IN A PATIENT WITH REFRACTORY SIDEROBLASTIC ANAEMIA
Authors: Hagenfeldt Lars , Hellström Kjell , Rosenqvist Urban
Published: November 2020

A patient with an acquired refractory sideroblastic anaemia has been studied. The anaemia had many features in common with pernicious anaemia, but high level of vitamin B12and a normal urinary excretion of methylmalonate excluded vitamin B12deficiency. A decreased pyruvate utilization and an increased urinary ex‐creation of acetate were demonstrated. Studies in vitro with white blood cells indicated a decreased efficiency of tricarboxylic acid cycle oxidation due to a low citrate synthetase activity. All serum lipid fractions were low, and a decreased lipolytic response to exercise and isoprenaline infusion was observed. The pathogenesis of these changes is discussed.
DISSEMINATED INTRAVASCULAR COAGULATION, UREMIA AND LIVER DAMAGE AFTER INTRAVENOUS CRUDE OPIUM
Authors: Bernheim Jan L. , Cate Jan W. ten , van der Heide Roelof M.
Published: November 2020

A 21‐year‐old man is described who—after two intravenous injections of a self‐prepared suspension of crude opium—developed a syndrome of disseminated intravascular coagulation (DIC) with severe kidney and less severe liver injury. The condition could have been caused by transient endotoxinemia (though bacteriemia could not be demonstrated), and another pathogenic role may be ascribed to the particulate character of the drug suspension. The analogy with the generalized Sanarelli‐Shwartzman reaction is stressed.
COMPOSITION OF PERICARDIAL FLUID IN CHOLESTEROL PERICARDITIS
Authors: Eisalo Antti , Konttinen Aarne
Published: November 2020

Two cases of cholesterol pericarditis have been described. The cholesterol content of the pericardial fluid was in one case 798 and in the other 138 mg/100 ml, but the triglyceride content was very low. Lipid electrophoresis of the pericardial fluid, although it differed from that of the serum, gave inconsistent results. Protein electrophoresis gave similar results in the serum and the pericardial fluid, and the electrolytes were similar in pericardial fluid and serum. Of the enzymes studied, only the lactate dehydrogenase activity (LDH) showed elevated values in the pericardial fluid, with a preponderance of LDH5 isoenzyme.
LACTATE DEHYDROGENASE AND MECHANICAL TRAUMA OF ERYTHROCYTES
Authors: Dale Jon , Myhre Erik
Published: November 2020

Intravascular hemolysis develops in most patients after prosthetic heart valve replacement. The serum lactate dehydrogenase activity (LDH) is elevated in these patients; it has been shown that the enzyme level correlates fairly well with the degree of red blood cell destruction. The heme pigments and LDH content of erythrocytes have been determined in ten normals and ten patients with prosthetic heart valves by hemolysing blood diluted in plasma. The red blood cells from the same subject were exposed to a standardized mechanical trauma by rotating the blood in a cylindrical chamber. The LDH activity and heme pigment concentration were estimated in plasma before and after the rotation. The patients' red blood cells, subjected to the traumatic effect of the implanted valves, contained significantly less LDH than the normal erythrocytes. The in vitro experiments demonstrated that erythrocytes subjected to a mechanical trauma lost proportionally much more of their LDH activity than of their heme pigments. This indicates that when the pigment loss is due to cell lysis alone, the LDH is derived also from erythrocytes remaining in circulation.
RIGHT VENTRICULAR MONOPHASIC ACTION POTENTIALS DURING REGULAR RHYTHM
Authors: Olsson S. Bertil
Published: November 2020

Right ventricular monophasic action potential (MAP) has been recorded during spontaneous regular rhythm in 27 out of 28 patients investigated with MAP recording technique. In addition 14 recordings of right ventricular MAP were obtained in 12 of the patients during pacing‐induced tachycardia. There is a good agreement between duration of right ventricular MAP and QT time in the absence of conduction defects. A higher heart rate is associated with a shortening of the duration of the MAP, both in individual cases during pacing‐induced tachycardia and in a patient group. A decreased duration of MAP recorded during spontaneous rhythm is due to shortening of phases 1–2 and 3 as well as increased repolarization rates during these phases. The shortening of a MAP induced by atrial pacing is not accompanied by a general increase of repolarization rate of phase 3, possibly due to lack of increased sympathetic discharge. Acute digitalization is accompanied by a shortening of the duration of the MAP in spite of decreased heart rate.
LIVER CHANGES IN MEDICO‐LEGAL AUTOPSIES IN ADDIS/ABABA, ETHIOPIA
Authors: Hofvander Yngve , Olding Lars , Westermark Per
Published: November 2020

Liver specimens obtained at autopsy from 161 Ethiopians in the Addis Ababa region have been examined. The subjects belonged to two consecutive series of medico‐legal autopsies at the Department of Pathology at the Menelik Hospital. They represented 94% of all traumatic deaths examined at the hospital during the two periods; 91% of the subjects were males, 55% of the total series were between 20 and 39 years of age. Road accidents and criminal assaults accounted for 70% of the deaths. Cirrhosis was found in 3.7% and portal fibrosis in another 6.2%. In only 3 out of 16 cases was the portal fibrosis or cirrhosis accompanied by fatty changes, Schistosoma infestation, and haemosiderosis, respectively. The over‐all rate of fatty changes was 4.3%. Haemosiderosis was found in 4 cases (2.5%), and considering the high intake of iron in the Ethiopian food an even higher frequency might have been anticipated. Haemosiderosis was combined with fatty changes in three cases and with cirrhosis in one case. Granulomata were found in 15 cases (9.3%). One of them was probably caused by tuberculosis and two by Schistosoma infestation, while the etiology of the other 12 was unexplained.
CALIBRATED HYPOXEMIA TEST IN NORMAL SUBJECTS AND CORONARY PATIENTS
Authors: Broch Ole Jacob
Published: November 2020

In 13 patients with angina pectoris and 5 normal subjects hypoxemia tests have been carried out, with continual registration of the arterial O2 saturation and ECG. A gradual depression of the T wave was found during hypoxemia in most cases. There was no difference in the pattern found in normal subjects and coronary patients. The S‐T depression during hypoxemia was not found in the normal subjects. In 6 patients with angina pectoris the S‐T change occurred in the course of 3–4 min, at somewhat differing degrees of saturation, depending on the degree of angina pectoris. When the mask was removed, the arterial saturation rose rapidly in the course of approximately 30–40 sec. In most cases the ECG was normalized before saturation was complete. In a few cases the ECG changes persisted for some minutes before full saturation occurred. On repeated tests in the same patient the S‐T changes occurred within the same saturation range. The deviation was, on the average, 2.4%. On administration of nitroglycerine the tolerance of the myocardium to hypoxemia increased, the S‐T depression occurring only at considerably lower degrees of saturation and normalization occurring more rapidly. It therefore seems that a calibrated hypoxemia test with continuous O2 registration is capable of giving a standardized and reproducible registration of the degree of coronary insufficiency. This test will also permit the registration of the effect of medication on coronary insufficiency.
LACTIC ACIDOSIS IN PHENFORMIN‐TREATED DIABETICS
Authors: Bengtsson Kristina , Karlberg Bengt , Lindgren Sören
Published: November 2020

From a fairly large clinical material of diabetics treated with the antidiabetic drug phenformin 21 patients showed clinical and laboratory evidence of lactic acidosis. The diagnosis was confirmed by direct and specific determinations of lactate (L) and pyruvate (P) in 15 of the patients. All of them showed raised L and P levels with a raised L/P ratio. All remaining six patients had severe metabolic acidosis with low pH values and increased so called “anion gap”. Predisposing factors in patients developing lactic acidosis on phenformin treatment seem to be impaired renal and liver function, in some cases also alcohol consumption and interaction with other drugs. The mortality rate is high despite intensive treatment, in the present material 33%. It is concluded that phenformin therapy is contraindicated in diabetics with impaired renal or liver function. The treatment dose also seems to be of importance. The prognosis depends on early diagnosis and intensive treatment with bicarbonate intravenously, probably also in combination with administration of insulin and glucose. The exact role of phenformin in causing lactic acidosis is not known, but probable mechanisms are discussed.
C‐CELLS IN NON‐MALIGNANT HUMAN GOITERS STUDIED IN FINE‐NEEDLE ASPIRATION BIOPSY SPECIMENS
Authors: Nilsson Göran
Published: November 2020

It was recently shown that in May–Grünwald–Giemsa stained smears obtained from thyroid medullary carcinomas by fine‐needle aspiration the malignant C‐cells have a very distinctive morphology with a bright red cytoplasmic granulation and rather characteristic nuclei as specific features. This enabled the author to detect corresponding cells in fine‐needle aspirates also from nonneoplastic goiters. These presumed C‐cells proved to be more common in toxic goiters than in cases of lymphoid thyroiditis and atoxic goiters without signs of malignancy or thyroiditis. In toxic goiters their occurrence showed a statistically significant positive correlation with the (125I) T3‐uptake. They also were found to be more scarce in older than younger age groups.
THE EFFECT OF METHYLDOPA ON RENAL FUNCTION IN PATIENTS WITH RENAL INSUFFICIENCY
Authors: Brodwall E. K. , Myhre E. , Stenbæk Ø. , Hansen T.
Published: November 2020

Renal function studies have been performed before and during treatment with methyldopa in ten patients with different degree of renal functional impairment. Effective renal plasma flow increased during treatment in patients both with slight and advanced renal failure. However, ever, the glomerular filtration rate decreased slightly in several cases despite increased renal plasma flow. The renal hemodynamic effects of methyldopa could not be related to the serum concentrations of unconjugated methyldopa. The present study suggests that methyldopa is a useful drug for treatment of hypertension also in patients with impaired renal function. In patients with advanced renal failure the treatment should be given with caution because a further decrease of the glomerular filtration rate might occur.
PROTECTION OF PHAGOCYTIZED BACTERIA AGAINST ANTIBIOTICS
Authors: Solberg Claus O.
Published: November 2020

Antibiotic‐sensitive Staphylococcus aureus phagocytized by human neutrophil granulocytes were exposed to a mixture of penicillin G and streptomycin in concentrations from 25 U (25 μg/ml) to 1 000 U (1 000 μg/ml). Phagocytized bacteria were effectively protected from the antibacterial effect of the antibiotics. Considerable numbers of intracellular bacteria remained viable after 20 h exposure to concentrations of antibiotics that killed more than 99% of extracellular bacteria in less than 30 min. Killing of phagocytized bacteria by granulocyte enzymes was effectively inhibited by phenylbutazone. A new method is described for the evaluation of the number of viable intracellular bacteria, using phenylbutazone for the inhibition of intracellular killing of bacteria and high concentrations of antibiotics for the control of extracellular organisms. This method facilitates an in vitro evaluation of the phagocytic and bactericidal activities of neutrophil granulocytes.
IRON–TETRACYCLINE INTERACTION: EFFECT OF TIME INTERVAL BETWEEN THE DRUGS
Authors: Gothoni G. , Neuvonen P. J. , Mattila M. , Hackman R.
Published: November 2020

Iron is known to interfere with the absorption of simultaneously taken tetracycline derivatives. The possibility to avoid this interaction, by observing a suitable time interval between the drugs, has been studied on human volunteers using ferrous sulphate and tetracycline. Three consecutive experiments were performed with 25, 20 and 15 volunteers from a pool of 38 healthy medical students. It was found that if iron was given not less than three hours before or two hours after tetracycline no significant interference occurred.
VASCULAR RESISTANCE IN HYPOTHERMICALLY PERFUSED KIDNEYS FOLLOWING ONE HOUR OF WARM ISCHAEMIA
Authors: Løkkegaard Hans , Bilde Torben
Published: November 2020

The vascular resistance in hypothermically perfused rabbit kidneys following one hour of warm ischaemia has been investigated in 45 experiments. As perfusate medium was used 5% low molecular weight dextran in balanced salt solution (TIS‐U‐SOL) to which 5 mg% papaverine was added. One hour of warm ischaemia following death (cardiac arrest) either by suffocation or bleeding, and with an agonal phase from 3 to 15 min, increased the vascular resistance about three times compared to a group with only a short period of warm ischaemia. Clamping of the renal artery for one hour revealed a similar increase in the vascular resistance, while simultaneous clamping of the renal artery and vein only increased the vascular resistance by about one‐third compared to the group with a short period of warm ischaemia. Heparinization of the animals before a one‐hour ischaemic period prevented a pronounced increase in the vascular resistance during the first 10 to 20 min of perfusion.
A STROKE REGISTER IN GÖTEBORG, SWEDEN
Authors: Harmsen Per , Tibblin Gösta
Published: November 2020

In January 1970 a Stroke Register was established in Göteborg, Sweden, covering all cases of acute cerebrovascular incidents occurring in inhabitants of the city born in 1904 and later. This was initiated by the success of the existing Myocardial Infarction Register and constitutes an autonomous but integral part of the Heart Control Programme of Göteborg that has been in progress since 1968 and is partly supported by the WHO. The method of registration and the results from the initial 6‐month period (Jan. 1st – June 30th, 1970) are presented. From all cases of stroke notified clinically through hospital contact (all acute disease manifestations are traditionally served centrally at the one major hospital of the city) and from cases additionally detected through autopsy recordings and death certificates, various information was collected. This consisted of a selection of personal data, previous medical history of cardiovascular diseases, clinical findings on admission, routine laboratory results, and findings at special neurological examinations. The results show a total number of 102 registered cases and a male/female ratio in these age groups of nearly 2 : 1. The rale of co‐existent cardiovascular diseases was found to be high when compared with prevalence data of two running population studies for men and women from Göteborg of similar ages. Other data obtained gave rise to several indications of association with various clinical factors, though the limited numbers of patients do not allow any conclusions so far. It is concluded that the establishment of a stroke register seems a prerequisite as a basic measurement tool in order further to describe the natural history of stroke in a community and to assess preventive, therapeutic and rehabilitation measures both for the present hospital‐oriented and for implementation of an eventual community stroke control programme.
PANCREATIC EXOCRINE FUNCTION AND D‐XYLOSE TEST IN PATIENTS WITH CHRONIC ALCOHOLISM
Authors: Carlsson Carl , Dehlin Ove
Published: November 2020

Pancreatic exocrine function has been assessed from determinations of trypsin concentration in duodenal aspirate after a standardized test meal in 18 patients with long‐standing and well documented chronic alcoholism. The results did not differ significantly from those obtained in 22 controls. The d‐xylose test, as an index of the absorptive capacity of the small bowel, was performed in 60 patients with chronic alcoholism and showed a significantly increased urinary excretion of d‐xylose in comparison to 28 healthy controls. The d‐xylose test was also performed in 9 patients with chronic alcoholism on admission and at discharge about 10 days later. No statistical difference was found between the results obtained on the two occasions.
A PILOT CLINICAL STUDY ON YERSINIOSES IN SOUTH‐EASTERN FINLAND
Authors: Hällström Kalevi , Sairanen Eero , Ohela Kyllikki
Published: November 2020

Yersinia agglutinins and—when suitable samples were available—also cultural and histological evidence of Yersinia infections have been searched for from 400 hospital patients during the period 1965–70 at Lappeenranta, Finland. In 31 of them immune responses compatible with infections caused by Yersinia pseudotuberculosis (YP) serotypes I, II, III or V or Yersinia enterocolitica (YE) serotypes 3 or 9 were found. In seven patients the diagnosis was confirmed by cultural or histological findings. YE serotype 9 was involved in 20 cases. Of the 31 patients 19 had disease states commonly regarded as immunological late effects of bacterial infections. Such states included erythema nodosum, temporary arthritides or arthralgias and also pulmonary changes resembling sarcoidosis. The joint symptoms met in children were indistinguishable from so‐called benign aseptic arthritis. One patient had a typical Löfgren's syndrome.
MYOCARDIAL INFARCTION IN MALMÖ 1960–1968
Authors: Johansson Bengt W.
Published: November 2020

Malmö is unusually well suited for studies on the frequency of a disease since the whole population of about a quarter of a million inhabitants is served by a single hospital. The case records from the Department of Medicine were perused and those with a definite diagnosis of acute myocardial infarction (AMI) were collected. The hospital material comprised 3 249 patients with a mean age at onset of 67 years (65 years for the 2 166 males and 72 for the 1 083 females). The incidence was found to increase with age, the rise being more pronounced in the higher than in the lower decades. There was an overrepresentation of patients with diabetes mellitus, and mortality was higher among these patients than in the whole hospital material. The hospital mortality for AMI was 33.1%, 30.4 for men and 38.5 for women, the latter higher figure being due to the higher mean age of the women. Rather pronounced yearly differences in mortality were observed, with a low of 27.9% in 1964 and a high of 38.9% in 1966. Thirty‐five per cent of the patients arrived at the hospital within 3 hours after onset of symptoms, but the mean delay was 31 hours. The mortality figure of 33.1% is misleadingly low because many patients die before they reach hospital. Including patients who died at home and were autopsied in the Department of Forensic Medicine, and those who were dead on arrival at the hospital, the mortality rose to 43%. The importance of preventive measures as a complement to the coronary care units is stressed.
THROMBOCYTOPENIA
Authors: Böttiger L. E. , Westerholm B.
Published: November 2020

An analysis has been made of 359 patients with thrombocytopenia—from a health service region in Sweden—in respect of sex, age, cause and course. The incidence of thrombocytopenia is 4.5 male and 7.4 female cases per 100 000 inhabitants and annum. In contradistinction to earlier reports, a large number of cases occur at high ages, probably due in particular to an increase in the number of drug‐induced cases. Drugs have caused 18% of all cases, but the main group (47%) must still, in the absence of an established cause, be denoted as idiopathic.
3D Nanotomography of calcium silicate hydrates by transmission electron microscopy
Authors: Viseshchitra Panod , Ercius Peter , Monteiro Paulo J. M. , Scott Mary , Ushizima Daniela , Li Jiaqi , Xu Ke , Wenk Hans‐Rudolf
Published: November 2020

Calcium silicate hydrate (C‐S‐H), is the principal hydration product of Portland cement that mainly contributes to the physical and mechanical properties of concrete. This paper aims to investigate the three‐dimensional structure of C‐S‐H with Ca/Si ratios of 1.0 and 1.6 at the nanoscale using electron tomography. The 3D reconstructions and selected region of interest analysis confirm that the morphology of both C‐S‐H materials are foil‐like structures. The difference between the two materials is the density of elongated structures. C‐S‐H with Ca/Si ratio 1.6 is clearly composed of denser particles compared to the other C‐S‐H material due to overlapping of the foil‐like structure. Pore analysis shows that C‐S‐H 1.0 and C‐S‐H 1.6 have porosities 69.2% and 49.8% respectively. Pore size distribution also reveals that C‐S‐H 1.0 has pore size range between 0‐250 nm and C‐S‐H 1.6 between 0‐100 nm. The pore network's size of C‐S‐H 1.0 is significantly larger than 1.6. This study illustrates the capability of using electron tomography to determine the 3D nanoscale structure of cementitious products and to distinguish between C‐S‐H 1.0 and 1.6.
Community lifespan, niche expansion and the evolution of interspecific cooperation
Authors: Rodrigues António M. M. , Estrela Sylvie , Brown Sam P.
Published: November 2020

Microbes live in dense and diverse communities where they deploy many traits that promote the growth and survival of neighbouring species, all the while also competing for shared resources. Because microbial communities are highly dynamic, the costs and benefits of species interactions change over the growth cycle of a community. How mutualistic interactions evolve under such demographic and ecological conditions is still poorly understood. Here, we develop an eco‐evolutionary model to explore how different forms of helping with distinct fitness effects (rate‐enhancing and yield‐enhancing) affect the multiple phases of community growth, and its consequences for the evolution of mutualisms. We specifically focus on a form of yield‐enhancing trait in which cooperation augments the common pool of resources, termed niche expansion. We show that although mutualisms in which cooperation increases partners growth rate are generally favoured at early stages of community growth, niche expansion can evolve at later stages where densities are high. Further, we find that niche expansion can promote the evolution of reproductive restraint, in which a focal species adaptively reduces its own growth rate to increase the density of partner species. Our findings suggest that yield‐enhancing mutualisms are more prevalent in stable habitats with a constant supply of resources, and where populations typically live at high densities. In general, our findings highlight the need to integrate different components of population growth in the analysis of mutualisms to understand the composition and function of microbial communities.
Filibuster Change and Judicial Appointments
Authors: Nash Jonathan Remy , Shepherd Joanna
Published: November 2020

In this article, we consider the effects of filibuster change on judicial appointments, judicial voting, and opinion drafting. The filibuster effectively empowers a minority of 41 senators by requiring 60 votes to break off debate on a nomination. We develop a game‐theoretic model that explains that the elimination of the filibuster changed the relevant “pivotal senator,” whose support was necessary to secure a nomination. Freed of the power of the minority of senators, presidents ought to exercise freer rein in naming judicial nominees closer to their preferred ideology. Moreover, sitting judges who seek elevation to a higher court ought to alter their “signal” that they would be good candidates to match the preferences of the newly relevant pivotal senator. To test our hypotheses empirically, we use the 2013 elimination of the filibuster in the U.S. Senate for lower federal court judicial nominations as an exogenous shock. We explore how the change in the filibuster rule affected the characteristics of judges President Obama nominated to the federal courts. We find statistically significant shifts in the background characteristics of judges confirmed to the federal courts of appeals after the elimination of the filibuster. Compared to the earlier Obama appointees, these judges were more likely to be female, slightly younger, and to have previously clerked for a liberal judges, but less likely to be nonwhite. In addition, we find that there was a statistically significant increase in the confirmation of judges with liberal ideologies, as measured by their common space campaign finance scores. These liberal ideologies mapped onto actual votes in politically charged cases. Compared to Obama judges confirmed before the rule change, these judges were more likely to cast pro‐choice votes in abortion cases and anti‐death penalty votes in death penalty cases. We also find evidence that the elimination of the filibuster had a polarizing effect on sitting federal district judges, especially those with a greater chance of promotion to the courts of appeals. Using computational content analysis, we find that after the change in the filibuster rule, Democratic judges were more likely to use politically charged words signaling their very liberal ideological positions in abortion opinions and Republican judges were more likely to use words signaling their conservative views. These findings are useful in assessing the desirability of restoring the judicial filibuster, as well in assessing the debate over the retention of the legislative filibuster.