bluuebunny/crossref_metadata_2025 huggingface dataset:
Class categories and the subjective dimension of class: the case of Denmark
Authors: Harrits Gitte Sommer , Pedersen Helene Helboe
Published: September 2017

Class relations have been proven to affect various aspects of social life, even in modern individualized societies. However, following claims on individualization and the so‐called ‘death of class’ thesis, studying the subjective dimension of class – that is, the way individuals perceive of class relations and their own position within them – has gone out of style. We argue that even in equalized societies, subjective class perceptions may still influence attitudes and behaviour as they evolve to fit modern class relations. To explore the existence as well as structure and content of perceived social classes, this article investigates how people describe society and social groups in focus group discussions. We find that groups in different positions in terms of education and economy all tend to apply hierarchical class categories to describe Danish society, which is normally seen as one of the most equal societies and political systems in the world. In addition, we find that economic resources serve as a baseline for the hierarchical ordering, often supplemented with notions of education, lifestyle and/or occupational profile. Even though people are somewhat uncomfortable with the notion of class, their descriptions of Danish society and classes are surprisingly similar within and across groups. We conclude that not only do class relations matter; people are also highly aware of the existing classes and able to position themselves and others according to their notion of classes.
Are you Ready2Help? Conceptualizing the management of online and onsite volunteer convergence
Authors: Schmidt Arjen , Wolbers Jeroen , Ferguson Julie , Boersma Kees
Published: September 2017

Citizens have often been found to converge on disaster sites. Such personal convergence is increasingly supported by online informational convergence. The adoption of online platforms represents an opportunity for response organizations to manage these two different manifestations of citizen convergence. We analyse one such platform, “Ready2Help”, developed by the Red Cross in The Netherlands. Our research demonstrates that by utilizing platforms, response organizations are able to transcend the boundaries between different types of organized behaviour during disaster. We extend the original conceptualization of organized behaviour, as previously described by the Disaster Research Center, explaining how the development of new platforms channels convergence of citizens and information. As such, platforms provide an interface between established, expanding, extending, and emergent forms of organized behaviour. These developments change the landscape of organized behaviour in times of disaster.
Enhancing the Ability of a Soil Moisture‐based Index for Agricultural Drought Monitoring by Incorporating Root Distribution
Authors: Zhou Hongkui , Wu Jianjun , Geng Guangpo , Li Xiaohan , Wang Qianfeng , Lei Tianjie , Mo Xinyu , Liu Leizhen
Published: September 2017

Agricultural drought differs from meteorological, hydrological, and socioeconomic drought, being closely related to soil water availability in the root zone, specifically for crop and crop growth stage. In previous studies, several soil moisture indices (e.g., the soil moisture index, soil water deficit index) based on soil water availability have been developed for agricultural drought monitoring. However, when developing these indices, it was generally assumed that soil water availability to crops was equal throughout the root zone, and the effects of root distribution and crop growth stage on soil water uptake were ignored. This article aims to incorporate root distribution into a soil moisture‐based index and to evaluate the performance of the improved soil moisture index for agricultural drought monitoring. The Huang‐Huai‐Hai Plain of China was used as the study area. Overall, soil moisture indices were significantly correlated with the crop moisture index (CMI), and the improved root‐weighted soil moisture index (RSMI) was more closely related to the CMI than averaged soil moisture indices. The RSMI correctly identified most of the observed drought events and performed well in the detection of drought levels. Furthermore, the RSMI had a better performance than averaged soil moisture indices when compared to crop yield. In conclusion, soil moisture indices could improve agricultural drought monitoring by incorporating root distribution.
Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta‐analysis
Authors: Kirkham K. R. , Grape S. , Martin R. , Albrecht E.
Published: September 2017

Many published reports consider blockade of the femoral nerve distribution the best available analgesic treatment after anterior cruciate ligament reconstruction. However, some argue that an alternative approach of infiltrating local anaesthetic into the surgical site has similar efficacy. The objectives of this meta‐analysis were to compare the analgesic and functional outcomes of both treatments following anterior ligament reconstruction. The primary outcomes were pain scores at rest (analogue scale, 0–10) in the early (0–2 postoperative hours), intermediate (3–12 hours) and late postoperative periods (13–24 hours). Secondary outcomes included range of motion, quadriceps muscle strength and complication rates (neurological problems, cardiovascular events, falls and knee infections). Eleven trials, including 628 patients, were identified. Pain scores in the early, intermediate and late postoperative periods were significantly lower in patients who received a femoral nerve block, with mean differences (95%CI) of 1.6 (0.2–2.9), p = 0.02; 1.2 (0.4–1.5), p = 0.002; and 0.7 (0.1–1.4), p = 0.03 respectively. The quality of evidence for our primary outcomes was moderate to high. Regarding functional outcomes, only one trial reported a similar range of motion between groups at 48 postoperative hours. No trial sought to record complications. In conclusion, femoral nerve block provides superior postoperative analgesia after anterior cruciate ligament reconstruction to local infiltration analgesia. The impact of improved analgesia on function remains unclear due to the lack of reporting of functional outcomes in the existing literature.
Testosterone therapy preserves muscle strength and power in aging men with type 2 diabetes—a randomized controlled trial
Authors: Magnussen L. V. , Hvid L. G. , Hermann A. P. , Hougaard D. M. , Gram B. , Caserotti P. , Andersen M. S.
Published: September 2017

The purpose of the study was to evaluate whether testosterone replacement therapy improves muscle mechanical and physical function in addition to increasing lean leg mass and total lean body mass in aging men with type 2 diabetes and lowered bio‐available testosterone (BioT) levels. Thirty‐nine men aged 50–70 years with type 2 diabetes and BioT levels <7.3 nmol/L were included from an academic tertiary‐care medical center. Patients were randomized to testosterone gel (testosterone replacement therapy, n = 20) or placebo (n = 19) for 24 weeks, applying a double‐blinded design. Muscle mechanical function was assessed by Nottingham Leg Rig (leg extension power) and isokinetic dynamometry (knee extensor maximal isometric contraction, rate of force development (RFD100), maximal dynamic contraction (Dyn180)). Physical function was assessed by gait speed. Body composition was assessed by whole body dual‐energy X‐ray absorptiometry (total lean body mass, lean leg mass, total fat mass, leg fat mass). Levels of total testosterone (TotalT), BioT, free testosterone (FreeT), and sex hormone‐binding globulin were measured from fasting blood samples. Coefficients (b) represent the placebo‐controlled mean effect of intervention. Maximal isometric contraction (b = 18.4 Nm, p = 0.039), RFD100 (b = 195.0 Nm/s, p = 0.017) and Dyn180 (b = 10.2 Nm, p = 0.019) increased during testosterone replacement therapy compared with placebo. No changes were observed in leg power or gait speed. Total lean body mass (b = 1.9 kg, p = 0.001) and lean leg mass (b = 0.5 kg, p < 0.001) increased, while total fat mass (b = −1.3 kg, p = 0.009) and leg fat mass (b = −0.7 kg, p = 0.025) decreased during testosterone replacement therapy compared with placebo. Total T (b = 14.5 nmol/L, p = 0.056), BioT (b = 7.6 nmol/L, p = 0.046), and FreeT (b = 0.32 nmol/L, p = 0.046) increased during testosterone replacement therapy compared with placebo, while sex hormone‐binding globulin (n = −2 nmol/L, p = 0.030) decreased. Knee extensor muscle mechanical function was preserved, and body composition improved substantially during testosterone replacement therapy for 24 weeks compared with placebo, whereas physical function (gait speed) was unchanged in aging men with type 2 diabetes and lowered BioT levels.
Andrology of male‐to‐female transsexuals: influence of cross‐sex hormone therapy on testicular function
Authors: Schneider F. , Kliesch S. , Schlatt S. , Neuhaus N.
Published: September 2017

Patients with gender dysphoria are offered cross‐sex hormone therapy and sex reassignment surgery to achieve the transition between the sex assigned at birth and gender identity. According to international guidelines, cross‐sex hormone therapy in trans‐women should lead to a psychologically and physiologically healthy body with feminized serum hormone levels, resulting in suppression of spermatogenesis. However, in a recently published multi‐center study, we discovered a high proportion of patients with male serum hormone levels and qualitatively intact spermatogenesis on the day of sex reassignment surgery. The objective of this study was to review the content of 11 publications that focus on the influence of cross‐sex hormone therapy on testicular morphology. These publications were identified based on a PubMed search for the key words transgender/transsexual/gender dysphoria in male‐to‐female persons, cross‐sex hormone therapy, and testicular tissues. Whereas three publications described a marked reduction of the spermatogenic level in all patients examined, eight publications reported inconsistent results. Histological analyses showed highly variable outcomes from qualitatively normal spermatogenesis and undisturbed Leydig/Sertoli cell morphology to full testicular regression with severe cellular damage and hyalinization. Explanations for these heterogeneous findings include insufficient cross‐sex hormone therapy regarding dosage or duration. As complete spermatogenesis is associated with virilized serum hormone levels, these patients may face challenges especially after sex reassignment surgery in adjusting to the abruptly established hypogonadal state following removal of the testes. These findings also suggest that contraception should be discussed, and fertility preservation should be offered during/prior to cross‐sex hormone therapy. There is a need for more individualized and better‐controlled cross‐sex hormone therapy and post‐treatment regimens. Evidence‐based guidelines for attending clinicians need to be established in order to deliver the most appropriate care.
Significance of histone methyltransferase SETDB1 expression in colon adenocarcinoma
Authors: Ho Yi‐Jung , Lin Yueh‐Min , Huang Yen‐Chi , Chang Jungshan , Yeh Kun‐Tu , Lin Liang‐In , Gong Zhiyuan , Tzeng Tsai‐Yu , Lu Jeng‐Wei
Published: September 2017

This study investigated the clinical implications of SETDB1 (also known as KMT1E) in human colon adenocarcinoma. Expression levels of SETDB1 proteins were analyzed by immunohistochemistry staining, and tissue microarrays were used to examine expression profiles in human patients. Our results revealed that SETDB1 protein expression was significantly higher in tumor tissue than in normal tissue for the breast, colon, liver, and lung (p < 0.05). Moreover, an analysis with SurvExpress software suggested that elevated expression of SETDB1 mRNA was significantly associated with the overall survival of colon adenocarcinoma patients (p < 0.05); and additional analysis involving 90 paired samples of colon adenocarcinoma tissue and normal tissue revealed that SETDB1 protein expression was 82% higher in cancerous cells (p < 0.001). High SETDB1 expression was also found to be significantly correlated with histological grade (p = 0.005), TNM stage (p = 0.003), T‐class/primary tumor (p = 0.001), and N‐class/regional lymph nodes (p = 0.017); and Kaplan–Meier survival curves indicated that SETDB1 protein expression was significantly associated with poor survival. Finally, univariate analysis demonstrated that SETDB1 protein expression was related to TNM stage (p = 0.004) and SETDB1 score (p = 0.001), whereas multivariate analysis showed that the influence of SETDB1 on overall colon adenocarcinoma survival was independent from other risk factors. Taken together, our results suggest that the SETDB1 protein could serve as a clinical prognostic indicator for colon adenocarcinoma.
Risk factors for thiopurine‐induced myelosuppression and infections in inflammatory bowel disease patients with a normal TPMT genotype
Authors: Broekman M. M. T. J. , Coenen M. J. H. , Wanten G. J. , van Marrewijk C. J. , Klungel O. H. , Verbeek A. L. M. , Hooymans P. M. , Guchelaar H.‐J. , Scheffer H. , Derijks L. J. J. , Wong D. R. , de Jong D. J.
Published: September 2017

Background

Leucopenia is a common side effect in patients treated with thiopurines. Variants in the thiopurine S‐methyltransferase (TPMT) gene are the best‐known risk factor, but only explain up to 25% of leucopenia cases.

Aim

To identify the clinical risk factors for thiopurine‐induced leucopenia in patients without a common TPMT variant, and explore if these patients are at increased risk for infections.

Methods

Post hoc analysis of the Thiopurine response Optimisation by Pharmacogenetic testing in Inflammatory bowel disease Clinics (TOPIC) trial. For this analysis, patients without a variant in TPMT (*2, *3A or*3C) were included. Uni‐ and multivariate Cox‐proportional hazard models were used to identify risk factors for leucopenia and infections. Leucopenia was defined as a white blood cell (WBC) count <3.0 × 109/L and infections were classified according to the Common Terminology Criteria for Adverse Events.

Results

Sixty hundred and ninety‐five patients (90.6%) included in the TOPIC‐trial had no variant in TPMT, of which 45 (6.5%) developed leucopenia. Median time to leucopenia was 56 (29‐112) days. Multivariate analysis showed that use of mercaptopurine compared to azathioprine was associated with leucopenia (hazard ratio [HR] 2.61 [95% CIs, 1.39‐4.88; P < .01]) and a higher baseline WBC count was protective (HR 0.80 [95% CIs, 0.71‐0.89; P < .01]). Risk factors for infections were older age (per 10 year; HR 2.07 [95% CIs, 1.18‐3.63; P = .01]) and concomitant use of biologic drugs (HR 2.15 [95% CIs, 1.14‐4.07; P = .02]).

Conclusions

Low baseline WBC count and mercaptopurine, due to a relatively higher dose, were risk factors for thiopurine‐induced leucopenia in patients without a TPMT variant.
WASH overexpression enhances cancer stem cell properties and correlates with poor prognosis of esophageal carcinoma
Authors: Huang Lan , Lian Jingyao , Chen Xinfeng , Qin Guohui , Zheng Yujia , Zhang Yi
Published: September 2017

There is increasing evidence that cytoskeleton remodeling is involved in cancer progression. Wiskott‐Aldrich syndrome protein (WASP) family represents a key regulator of actin cytoskeleton remodeling. However, the underlying mechanism of the WASP family in cancer progression remains elusive. Here, we studied the role of WASP and SCAR Homolog (WASH), a recently identified WASP family member, in human esophageal squamous cell carcinoma (ESCC). Using three human ESCC cell lines, we found that WASH expression was significantly elevated in cancer stem‐like cells enriched by sphere formation assay. WASH knockdown decreased the sphere‐forming capacity of esophageal cancer cells whereas WASH over‐expression exhibited the opposite effect. Mechanistically, we identified interleukin‐8 (IL‐8) as a key downstream target of WASH. IL‐8 knockdown completely attenuated tumor sphere formation induced by WASH overexpression. WASH knockdown also delayed the growth of human ESCC xenografts in BALB/c nude mice. Importantly, high WASH levels were associated with poor clinical prognosis in a total of 145 human ESCC tissues. Collectively, our results suggest an essential role of the WASH/IL‐8 pathway in human ESCC by maintaining the stemness of cancer cells. Hence, targeting this pathway might represent a promising strategy to control human esophageal carcinoma.
Changes in frontal and posterior cortical activity underlie the early emergence of executive function
Authors: Buss Aaron T. , Spencer John P.
Published: September 2017

Executive function (EF) is a key cognitive process that emerges in early childhood and facilitates children's ability to control their own behavior. Individual differences in EF skills early in life are predictive of quality‐of‐life outcomes 30 years later (Moffitt et al., 2011). What changes in the brain give rise to this critical cognitive ability? Traditionally, frontal cortex growth is thought to underlie changes in cognitive control (Bunge & Zelazo, 2006; Moriguchi & Hiraki, 2009). However, more recent data highlight the importance of long‐range cortical interactions between frontal and posterior brain regions. Here, we test the hypothesis that developmental changes in EF skills reflect changes in how posterior and frontal brain regions work together. Results show that children who fail a “hard” version of an EF task and who are thought to have an immature frontal cortex, show robust frontal activity in an “easy” version of the task. We show how this effect can arise via posterior brain regions that provide on‐the‐job training for the frontal cortex, effectively teaching the frontal cortex adaptive patterns of brain activity on “easy” EF tasks. In this case, frontal cortex activation can be seen as both the cause and the consequence of rule switching. Results also show that older children have differential posterior cortical activation on “easy” and “hard” tasks that reflects continued refinement of brain networks even in skilled children. These data set the stage for new training programs to foster the development of EF skills in at‐risk children.
The discourse of security in development policies: A genealogical approach to “Security Sector Reform”
Authors: Larzillière Pénélope
Published: September 2017

Security is one of the objectives that has become associated with development policies. This article offers a genealogical perspective on this shift, focusing on the introduction of “Security Sector Reform” (SSR) into development policy as an apparatus with a two‐fold normative process. The first point of note is the securitization of development policy. This pertains both to the discourse elements of the apparatus—here, the effects of the use of security semantics—and to its political technologies, with an SSR apparatus which can function as a new label for military co‐operation. This has led to new approaches in societies where this has taken place, with threat a key focus. There has also been a process of depoliticization in the wake of technical, standardized approaches. This has sidelined debate on the norms and political choices involved, albeit implicitly. Secondly, one can observe structural ambivalences in the field, chiefly on the issue of the state and the normative contradictions of a policy to strengthen “fragile states” that relies on external intervention in national politics. The case study of Lebanon complements this analysis, highlighting the structural tensions between the various aims of SSR, and how this affects local ownership: both the perception and reception of SSR are marked by power relationships which translate into hegemonic and counter‐hegemonic labelling.
Enological tannins affect acetaldehyde evolution, colour stability and tannin reactivity during forced oxidation of red wine
Authors: Picariello Luigi , Gambuti Angelita , Petracca Francesca , Rinaldi Alessandra , Moio Luigi
Published: September 2017

The addition of enological tannins is a practice admitted and widely used to improve wine phenolic compositions. Although wine ageing is an oxidative process involving phenolic compounds and acetaldehyde production and consumption, the effect of enological tannins on the acetaldehyde and chromatic and phenolic changes of a red wine during oxidation is still not known. In this study, three enological tannins preparations containing gallotannins GT, ellagitannins ET and condensed tannins CT were added to a young commercial Lambrusco red wine in order to obtain wines with three different phenolic compositions. Samples were then treated with hydrogen peroxide to trigger oxidation. All added tannins have determined a production of acetaldehyde greater than control. Acetaldehyde was then consumed in 30 days. The samples treated with CT and ET showed, after oxidation, an increase in colour intensity, determined as the sum of 420, 520 and 620 nm absorbances. A simultaneously increase in polymeric pigments was detected. No significant variation of the Saliva Precipitation Index (SPI), an index useful to give an indirect measure of wine astringency, was observed after 30 days of treatment of CT and ET samples. Results highlight that the addition of CT and ET can help to stabilise colour without affecting wine reactivity towards salivary proteins. A significant role of acetaldehyde has been even detected. These are the first data showing the effect of different enological tannins on the production and consumption of acetaldehyde formation during an oxidation process.
Inhibitory activities of kaempferol, galangin, carnosic acid and polydatin against glycation and α‐amylase and α‐glucosidase enzymes
Authors: Sheng Zhanwu , Ai Binling , Zheng Lili , Zheng Xiaoyan , Xu Zhimin , Shen Yixiao , Jin Zhiqiang
Published: September 2017

The activities of four natural phenolics, kaempferol, galangin, carnosic acid and polydatin in scavenging free radicals, inhibiting advanced glycation end‐product (AGE) formation, α‐amylase and α‐glucosidase and trapping methylglyoxal (MGO), were evaluated in this study. Carnosic acid and galangin had the highest activity in scavenging free radicals. Kaempferol and galangin had the greatest activity in preventing bovine serum albumin (BSA) against glycation and reducing glycated proteins. Polydatin had the greatest performance in trapping MGO to reduce glycation reaction. However, there was no significant difference for kaempferol, galangin and carnosic acid in inhibiting AGE formation by BSA‐MGO reaction. Kaempferol, galangin and carnosic acid were the competitive inhibitors for α‐amylase, while kaempferol and carnosic acid were noncompetitive inhibitors for α‐glucosidase. However, polydatin showed as a mixed noncompetitive inhibitor for both α‐amylase and α‐glucosidase. The results indicated that the four natural phenolics have potential in inhibiting AGE production and the digestive enzymatic activity with different mechanisms.
Addition of acid whey improves organic dry‐fermented sausage without nitrite production and its nutritional value
Authors: Karwowska Małgorzata , Kononiuk Anna
Published: September 2017

In this study, the effect of acid whey on the physicochemical properties and nutritional value of non‐nitrite organic fermented sausage made from beef and tallow was investigated. Fermented sausage was prepared in three formulations: C (cured), S (salted) and SAW (salted with liquid acid whey). Each sample was analysed during the ripening process: at 0, 7, 14 and 21 days of ripening in a temperature of 16 °C. The obtained results indicated that the addition of acid whey improves physicochemical properties of organic dry‐fermented sausage without nitrite and its nutritional value. The application of acid whey resulted in a significantly lower pH and a higher lactic acid bacteria content in organic fermented sausage without nitrite than in the sample with curing salt (respectively, by 0.12 units and 0.66 log CFU g−1). Acid whey successfully protected against haem iron loss in salted sausage during ripening. The salted sample with acid whey addition was characterised by a higher PUFA content (6.41%) at the end of ripening as compared to the cured sample (4.91%) and salted sample (5.58%). The addition of acid whey improves organic dry‐fermented sausage without nitrite production and its nutritional value.
Use of low‐voltage direct current electricity treatment to increase phenolics content of postharvest okra: effects of some treatment parameters
Authors: Saetung Thunyarat , Devahastin Sakamon , Chiewchan Naphaporn
Published: September 2017

Low‐voltage direct current electricity was applied to increase phenolics content of postharvest okra (Abelmoschus esculentus L.) at different values of current (0.10–0.50 A) and application time (900–3600 s). Use of different electrolytes, namely tap water as well as 0.10‐ and 0.15‐mol L−1 brine, was also investigated. Calcium‐dependent protein kinase was quantified to indicate responses of okra to the treatment. Free and bound phenolics contents were measured and the results used to confirm whether the increased phenolics was due to the applied electricity; initial contents of total, bound and free phenolics were noted to be 6.19, 1.73 and 4.46 g kg−1, respectively. Total phenolics content (8.12–8.38 g kg−1) significantly increased when using a current of 0.30 A, application time of 900–3600 s, with brine as the electrolytes. Use of current of 0.30 A and 0.10‐mol L−1 brine for 900 s is suggested as the appropriate treatment condition.
Elderly living donor kidney transplantation allows worthwhile outcomes: The Japan Academic Consortium of Kidney Transplantation study
Authors: Okumi Masayoshi , Unagami Kohei , Kakuta Yoichi , Ochi Atsuhiko , Takagi Toshio , Ishida Hideki , Tanabe Kazunari ,   the Japan Academic Consortium of Kidney Transplantation (JACK)
Published: September 2017

Objective

To compare transplant outcomes among elderly (aged ≥60 years) and non‐elderly recipients, and to evaluate the acceptability of elderly living donor kidney transplantation in practice after consideration of living donor type.

Methods

We included 830 adult patients with living donor kidney transplantation between 2000 and 2011 in this retrospective cohort study. We compared death‐censored graft survival, patient survival, biopsy‐proven rejection, complications, and renal function in elderly (n = 119) and non‐elderly recipients (n = 278).

Results

There was no significant difference in 10‐year death‐censored graft survival (P = 0.980). Corresponding patient survival rates in the elderly and non‐elderly groups were 84.1% and 98.1%, respectively (hazard ratio 6.15, 95% confidence interval 2.12–17.82, P < 0.001). Elderly patients had more complications and chronic T‐cell‐mediated rejection. Factors associated with death in elderly recipients with functioning grafts were residual advanced recipient age (hazard ratio 1.39), decreased hemoglobin (hazard ratio 4.10), hepatitis B virus (hazard ratio 7.89), hepatitis C virus (hazard ratio 13.12) and elevated alanine aminotransferase (hazard ratio 1.13).

Conclusions

Elderly living donor kidney transplantation seems to provide adequate acceptable outcomes. However, physicians should be cautious when evaluating elderly patients with hepatitis, and further studies are required to improve long‐term outcomes.
PERSISTENT NEPHROTIC SYNDROME : A RENAL BIOPSY STUDY
Authors: MCGOVERN V. J.
Published: September 2017

A survey of renal biopsies of Si patients with the nephrotic syndrome not due to lupus erythematosus, renal amyloidosis, diabetic glomerulosclerosis or one of the congestive renal states shows that there are five main categories.

The first category is that of subsiding acute diffuse proliferative glomerulonephritis, which may follow streptococcal sore throat, and in which the prognosis is good. In the second category are patients who develop the nephrotic syndrome after acute diffuse proliferative glomerulonephritis, and who, on renal biopsy, are found to have progressive membrano‐proliferative glomerulonephritis in which there is a steady progression to diffuse glomerular sclerosis and renal failure. The third category is that in which, by light microscopy, there are only minimal glomerular changes. Some patients with continuous nephrotic syndrome in this category have been shown to have no alteration of glomerular structure in periods, between biopsies, of more than six years, while others have developed foci of hyaline sclerosis within a few months. This focal sclerosing glomerulonephritis seemed in most cases to be slowly progressive over a period of years, but in seven fatal cases the course of the disorder was accelerated by the complication of interstitial nephritis, so that renal insufficiency supervened much earlier than could be explained by the glomerular lesions alone. Nine patients whose renal biopsies were initially classified as illustrating the “ minimal lesion ”, subsequently developed focal glomerular sclerosis ; six of these have already died. The fourth category comprises seven other patients who already exhibited focal glomerular sclerosis when first subjected to biopsy ; of these, two have since died. The fifth category is that in which the nephrotic syndrome is due to diffuse membranous glomerulonephritis. None of the patients had an antecedent attack of acute diffuse proliferative glomerulonephritis, and no ætiological or precipitating agent could be incriminated. In no cases has the “ minimal lesion ” ever been demonstrated to have evolved into diffuse membranous glomerulonephritis.

Each category of glomerulonephritis has a recognizable pattern, but in many cases this pattern cannot be discerned without the aid of renal biopsy.
URINARY pH IN GOUT
Authors: PAK POY R. K.
Published: September 2017

Diurnal rhythm studies on 13 patients suffering from gout showed a loss of the normal rhythm for urinary pH. This disturbance is characterized by the excretion of a persistently acidic urine with pH values below 6 throughout the day. There is also a disturbance of rhythm for titratable acidity and ammonium. A possible explanation for these findings is presented. Some of the clinical implications of the results are discussed.
TRANSIENT ALTERATIONS IN EXCRETION OF UREA WITH DIURESIS IN MAN
Authors: HAAS L. F. , HOLDAWAY I. M. , ROBINSON J. R.
Published: September 2017

Rates of excretion of urea were determined in two young men during water diuresis and during osmotic diuresis with sodium chloride and with urea.

At the onset of water diuresis or of osmotic diuresis with sodium chloride, there was a large, but transient, increase in the rate of excretion of urea, which reached its peak about an hour before the peak of diuresis and then fell again while the urinary minute volume continued to increase. The transient increase in excretory rate suggested that urea previously stored in the kidney was washed out when the urinary concentration fell, but too much was washed out to have been contained in concentrated urine in the renal‐tract dead space. The greater part of this urea probably diffused out from an intrarenal store when the urinary concentration fell.

When urea was used as the diuretic, the concentration of urea in the urine did not fall, and the transient excretion of stored urea did not occur. The intrarenal store could have been accommodated in a volume of the same order as the subjects' medullary fluid.

Urea appears to be accumulated in the human kidney, as it has been found to be accumulated by a countercurrent mechanism in the kidneys of other mammals.
RENAL LESIONS IN EXPERIMENTAL PLUMBISM AND THEIR CLINICAL IMPLICATIONS
Authors: TANGE, D. , HAYWARD NANCY , BREMNER D. A.
Published: September 2017

Administration of lead acetate to rats for long periods is associated with changes in the cells of the convoluted tubules, especially those in the deeper portions of the renal cortex. These changes comprise dilatation of the affected tubules, degeneration, death and subsequently regeneration of individual cells, nuclear inclusions, and atypical mononuclear, giant tubule cells. Gross changes in renal architecture are not produced by administration of lead acetate alone. Administration of lead acetate followed by unilateral nephrectomy is associated with the appearance of foci of scarring in the remaining kidney in a proportion of animals. These foci may be widespread. In the present study the factors determining presence or absence of scarring could not be defined. Kidneys damaged by lead acetate are no more susceptible than normal kidneys to damage from intravenous injection of Escherichia coli. These experimental results may help to explain the frequency of chronic renal disease following lead poisoning in infancy and childhood and its rarity in industrial lead poisoning.
THE IMMUNOCYTOCHEMICAL LOCALIZATION OF CRYOMACRO‐GLOBULINS IN MALIGNANT LYMPHOMA
Authors: BAUMGARTEN A. , CURTAIN C. C. , WHITESIDE M. G.
Published: September 2017

By means of the fluorescent antibody technique, a cryomacroglobulin was localized in plasma cells in the bone marrow and spleen of a patient suffering from malignant lymphoma of an unspecified type. Cryomacroglobulin was also localized in plasma cells of the bone marrow of another patient suffering from lymphoma. In neither case was cryomacroglobulin detected in the small lymphocytes with scanty cytoplasm which were observed in relatively large numbers in bone marrow and splenic smears from the two patients, and whose presence supported the diagnosis of lymphoma. It is suggested that, although there is no evidence that these lymphocytes are direct precursors of the cryomacroglobulin‐containing plasma cells, there may be a transfer of information between the two cell lines analogous to that suggested in normal antibody production between macrophage and lymph‐node cell.
ELECTRON MICROSCOPIC DEMONSTRATION OF ORGANISMS IN THE INTESTINE AND MESENTERIC LYMPH NODES IN A CASE OF WHIPPLE'S DISEASE
Authors: PAPADIMITRIOU J. M.
Published: September 2017

A case is reported of Whipple's disease in which bodies resembling bacilli were demonstrated by electron micrography, not only in the intestinal mucosa, but also in the mesenteric lymph nodes. Their possible role in the causation of disease is discussed.
NEUTRALIZATION OF LONG‐ACTING THYROID STIMULATOR BY ANTIBODIES TO EUTHYROID HUMAN SERUM
Authors: ADAMS D. D. , SHARARD A.
Published: September 2017

Antiserum to unfractionated euthyroid human serum, prepared in the goat, neutralized the thyroidstimulating activity of a highly potent LATS preparation. Absorption tests with gamma globulin and with albumin showed that the neutralizing antibodies were anti‐gamma globulins. These findings, together with previous observations, make it probable that LATS is itself a gamma globulin.
THE RADIOSPLENOGRAM IN NORMAL SUBJECTS AND IN PATIENTS WITH SPLENOMEGALY
Authors: PRYOR D. S.
Published: September 2017

Autologous red cells labelled with 51Cr were injected intravenously into 10 normal subjects and 23 patients with splenomegaly due to various causes. The attainment of radioactive equilibrium in the spleen was measured with a scintillation detector over the organ connected to an automatic recording device. In the normal spleen equilibrium was established rapidly, this observation indicating that the red‐cell content is freely exchangeable with circulating erythrocytes. Delayed mixing was usual in splenomegaly, and was unrelated to the cause of the splenic enlargement or to the presence of excessive red cell destruction.

The enlarged spleen may contain a considerable mass of trapped red cells that are exchanged only slowly with circulating erythrocytes. The removal of such a trap may explain the beneficial effects of splenectomy in certain cases of anæmia in which there is no evidence of excessive red‐cell destruction by the spleen.
TRIGLYCERIDE TURNOVER AFTER DIETS RICH IN CARBOHYDRATE OR ANIMAL FAT
Authors: NESTEL P. , HIRSCH E. Z.
Published: September 2017

The influence on triglyceride turnover of diets rich in either carbohydrate or animal fat was studied in three normal men.

A twofold to fourfold rise in plasma triglyceride concentration was brought about by the 3000 Calorie, 70% carbohydrate diet, but not by the 3000 Calorie, 50% animal fat diet.

The turnover rate of palmitate in the triglycerides of very low density lipoproteins was greatly increased by the carbohydrate diet, but was not affected by the high fat diet. The carbohydrate‐induced rise in triglycerides was therefore associated with an increase in the synthesis of triglyceride. However, it was also found that diminished utilization contributed to the rise in triglyceride concentration.

Characteristic changes in triglyceride fatty acid composition were observed after the carbohydrate diet. There was an absolute increase in the concentrations of palmitate, palmitoleate and oleate. Although there was a fall in the percentage content of linoleate, there was no change in the absolute linoleate concentration.

The similarities in the findings obtained in this study and those described in hypertriglyceridæmic subjects with coronary heart disease suggest that excessive consumption of carbohydrate is responsible for the hypertriglyceridæmia of coronary heart disease.
THE SIGNIFICANCE OF AUTOIMMUNITY TO A CLINICIAN
Authors: BLACKBURN C. R. B.
Published: September 2017

Autoimmunity and autoimmune disease are described in terms of the types of immune hypersensitivity reactions which may arise from endogenous or exogenous stimuli. The presence of autoantibodies does not imply that they are having harmful effects or that they are causally related to the patient's diseases. The effects of exogenous agents, such as drugs, inducing immune responses in genetically susceptible persons may mimic autoimmune diseases. An autoimmune causation for most so‐called autoimmune diseases has not been proven, and strict criteria must be adopted if a diagnosis of an autoimmune cause for a patient's illness is made, especially before the administration of potentially lethal drugs. Immunosuppressive agents, such as prednisone and 6‐mercaptopurine, may effectively control symptoms by exerting anti‐inflammatory effects, and a response to them does not necessarily imply immune causation for the disease being treated.
RELATIONSHIP OF ANTIGEN TO THE FORMATION OF ANTIBODIES
Authors: ADA G. L.
Published: September 2017

It is difficult to compose a precise summary of the present state of knowledge about the role of antigen in inducing antibody formation. If one remembers that no theory has been proved or disproved, a reasonable statement would be as follows. The immune response to even a simple antigen depends upon a complex interplay of different cell types. Competent cells possess the necessary genetic information to manufacture specific antibody and they are stimulated to do this by antigen which has been modified by contact with a macrophage.
THE THYMUS: EXPERIMENTAL PHYSIOLOGY, AND PATHOLOGY IN MAN
Authors: MACKAY IAN R. , GOLDSTEIN GIDEON
Published: September 2017

The thymus is an integral part of the immunological system. It is a site of intense lymphopoiesis, especially in early life. Neonatal thymectomy in mice causes runting and death due to gross immunological deficiencies. These deficiencies are determined by lymphopenia, and by lack of a lymphotrophic hormone secreted by the epithelial cells of the medulla; this hormone confers on lymphocytes the capacity to respond to antigenic stimulation. The thymus may be the main source of lymphoid cells carrying new or primary patterns of immune reactivity; it is thus “first‐level” or “central” lymphoid tissue, which seeds cells to “second‐level” or “peripheral” lymphoid tissues in the lymph nodes and spleen.

Pathological lesions of the thymus in man include aplasia, hyperplasia, dysplasia and neoplasia. Gross aplasia characterizes the immunological deficiency diseases of infancy, including the lymphopenic type of congenital agammaglobulinæmia. Hyperplasia accompanies thyrotoxicosis. Dysplasia refers to the lymph follicle‐germinal centre development in myasthenia gravis, probably an autoimmune disease, and to the proliferation in the medulla of spindle‐epithelial cells in lupus erythematosus, an autoimmune disease. Neoplasia occurs as benign thymoma, which may be accompanied by extrathymic diseases which are possibly autoimmune in origin; these include myasthenia gravis, red cell aplasia, polymyositis, agammaglobulinæmia and lupus erythematosus. These diseases may in some way be caused by the thymoma; alternatively, the thymoma may represent the result of continuing hyperplasia of the thymus provoked by a primary autoimmune process.

The place of thymectomy in the treatment of autoimmune disease is discussed. It is an established procedure in myasthenia gravis, and has been successful in two cases of autoimmune hæmolytic anæmia in infancy. We review our experience with thymectomy for three patients with systemic lupus erythematosus.
PLATELET THROMBOPLASTIC FUNCTION IN POLYCYTHÆMIA AND THROMBOCYTHÆMIA
Authors: JELLETT L. B. , BONNIN J. A.
Published: September 2017

The platelet thromboplastic function levels in patients with primary disease of the bone marrow (polycythæmia vera and primary thrombocythæmia) were compared with the findings in patients whose polycythæmia or thrombocytosis was due to a definable underlying disorder.

Of the patients with untreated polycythæmia vera, irrespective of the platelet count, 71% showed reduced platelet thromboplastic function, compared with only 12% of patients with secondary polycythæmia which was uncomplicated by either renal or liver disease. Similarly, the platelet thromboplastic function level was reduced in 100% of patients with untreated primary thrombocythæmia, compared with 47% of patients with elevated platelet numbers secondary to other associated diseases. The platelet thromboplastic function test was therefore useful in differentiating between primary and secondary polycythæmia. Normal platelet thromboplastic function virtually excluded a myeloproliferative disease (thrombocythæmia) in patients with raised platelet counts, irrespective of other hæmatological changes.

The effect of 32P in the two conditions due to primary disease of the bone marrow was to produce a rise towards normal platelet thromboplastic function.

It is considered that the platelet defect in primary thrombocythæmia is a qualitative one, and not, as has been reported by others, a quantitative anticoagulant effect of high in‐vitro platelet numbers.
A DUPLICATION OF THE ALIMENTARY CANAL
Authors: MIDDLETON G. , HIRSCHFELD MARY
Published: September 2017

A duplication adherent to the lesser curve of the stomach in a child, aged six months, is described. The duplication had a cyst lined with gastric mucosa, and pancreatic tissue was present in the lesser omentum adjacent to the cyst. In common with the other cases of duplications in this region, the main presenting symptom was vomiting. Suggested mechanisms of origin of alimentary canal duplications are discussed. It is concluded that no single hypothesis can explain all types. However, in individual cases there is frequently strong evidence for favouring one or other of the proposed mechanisms of development.
NORMAL HUMAN IRON STORAGE AND ITS RELATION TO ETHANOL CONSUMPTION
Authors: POWELL L. W.
Published: September 2017

Hepatic storage iron was estimated in 100 subjects who had suffered sudden unexpected death, and in whom post‐mortem examination revealed no abnormality other than cardio‐vascular or cerebro‐vascular disease. Information about previous alcohol consumption and past illnesses was obtained from close relatives who had lived with the subjects before death. There was a significant difference in hepatic iron concentration and total hepatic iron content between subjects with heavy alcohol consumption and subjects with light alcohol consumption. When those subjects with a heavy alcohol consumption were excluded, the range of hepatic iron concentration was reduced to 0·03 to 0·53 mg. per gramme wet weight of liver (mean 0·20±0·02 for males, and 0·14±0·02 for females). This corresponded to a mild degree of hæmosiderin deposition (Grades 0 and 1) in histological preparations stained for iron. It is concluded that the finding of stainable iron in the livers of relatives of patients with idiopathic hæmochromatosis cannot be regarded as positive evidence of the existence of the genetic abnormality unless the iron is present in increased amounts and unless alcoholism has been excluded.
NEUROLOGICAL PRESENTATIONS OF INSULIN SECRETING TUMOURS OF THE PANCREAS
Authors: SUTHERLAND J. M. , TYRER J. H. , EADIE M. J. , LEAMING DONALD B. , COURTICE B. , LEGGETT C. A. C.
Published: September 2017

Hypoglycæmia may produce a variety of disturbances of nervous system function. Neurological manifestations were the presenting features in all four patients here described as suffering from episodic hypoglycæmia due to insulin‐producing tumours of the pancreas. These manifestations included headache, paræsthesiæ, blurred vision, diplopia, staggering gait and speech disturbance, while each patient had experienced episodes of disturbed consciousness and other symptoms suggesting epilepsy. The patients' histories permitted a provisional clinical diagnosis of hypoglycæmia in two instances, but the passage of time and special investigations were required before the remaining cases were diagnosed. Unless the clinician keeps in mind the possibility of hypoglycæmia in such cases, he may omit the laboratory investigations necessary to establish the diagnosis. Even when a pancreatic tumour has been diagnosed clinically, identified at laparotomy and removed, a second insulin‐producing tumour may still be present.
STUDIES OF THE EFFECTS OF SALICYLATE IN HYPERTHYROIDISM
Authors: GOOD B. F. , HETZEL B. S. , HOFFMANN M. J. , WELLBY M. L. , BLACK M. L. , POTTER H. A. , BUTTFIELD I. H.
Published: September 2017

Previous studies in rats have shown that salicylate depresses thyroid function by causing a fall in TSH secretion from the pituitary. This fall in TSH secretion has been correlated with a rise in free thyroxine (T4) level due to displacement by salicylate from thyroxine‐binding proteins in the plasma. There is evidence of similar changes following administration of salicylate to man. In view of these findings, the effects of salicylate have now been studied in hyperthyroidism.

Consistent depression of the plasma P.B.I. level was noted in 12 hyperthyroid subjects given 6 grammes of salicylate per day for four days. However, there was no improvement in clinical status. A rise in metabolic rate was observed. There was also a rise in free T4 (demonstrated with the dialysis procedure of Christensen). This increase in free T4 was correlated with displacement of T4 from thyroxine‐binding prealbumin (TBPA). The isomer p‐hydroxybenzoate was without effect on free T4 and TBPA.

There was a significant depression of three‐hour uptake of radioiodine after salicylate administration (5 grammes per day for 48 hours), but no consistent effect on 24‐hour uptake. The depression in uptake occurred in the presence or absence of long‐acting thyroid stimulator (LATS).

A slowing of secretion rate was noted in three of nine hyperthyroid subjects studied after therapeutic doses of 131I. LATS was demonstrated in one of these three subjects.

The significance of these findings is discussed. The persistence of clinical hyperthyroidism has been shown to be correlated with a rise in free T4 level, in spite of a fall in the plasma P.B.I. (total T4) concentration. This finding indicates that the free T4 level determines the clinical state of the patient. The reason for the fall in uptake of radioiodine and slowing of secretion rate is uncertain. The possibility of salicylate affecting the action of LATS on the thyroid gland is suggested.