On the occasion of the centennial of the Nobel Prize in Physiology or Medicine, 1923: Nicolae C. Paulescu—between scientific creativity and political fanatism

IF 3.1 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Alberto de Leiva-Hidalgo, Alejandra de Leiva-Pérez
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However, the initiative was cancelled in August 2003, when the European Center of the Simon Wiesenthal Foundation (SWC) accused Paulescu of being antisemitic. The authors of this manuscript have decided to approach \"the Paulescu case\" from its double aspect, scientific and sociopolitical, to analyze the circumstances surrounding the discovery of the antidiabetic hormone, and Paulescu's alleged antisemitic past in the historical context of the Romanian nation in the interwar period.</p><h3>Methods</h3><p>We contacted the SWC and people related to the 2003 events in Paris. We performed a comparative review of the documents published by the Toronto group and by Paulescu and analyzed the correspondence and articles generated by international experts from the scientific community interested in the controversy. We carried out an exhaustive bibliographic search through several online catalogs (INDEXCAT, NLM Gateway, EUREKA, MEDHIST). We travelled to Bucharest, where we visited Paulescu's house-museum, interviewed a former student of the Romanian professor, and a prominent medical historian who was knowledgeable about Paulescu's scientific and political biography. Dan Angelescu†, son of Dr. Constantin Angelescu (1904–1990), Paulescu's nephew and collaborator, provided us with a copy of all the available documentation from Paulescu's personal archive. It constitutes an essential source for understanding Paulescu's personal, political and academic biography. <i>Archives consulted:</i> Românǎ Academy (Bucharest). Personal Archive of Paulescu, House -Museum (Bucharest)*. Romanian Jewish Heritage (Bucharest). http://romanianjewish.org/ **. Simon Wiesenthal Center (Los Angeles, CA) http://www.wiesenthal.com **. Romanian Patent Office. Oficiul de Stat pentru Invenții şi Mǎrci (OSIM) (Bucharest)***. Nobel Archives (Stockholm) https://www.nobelprize.org. Internet Archive (San Francisco, CA) https://archive.org **. Wellcome Library (London) https://wellcomelibrary.org **. The European Library https://www.theeuropeanlibrary.org/ **. US National Library of Medicine, NLM historical collections http://www.nlm.nih.gov/hmd/index.html **. US. Holocaust Memorial Museum http://www.ushmm.org/ (*: archive consulted on site; **: material found in the online catalog of the archive; ***: archivists sent us digitized copies of archival material). <i>Books consulted for information on the history of Romania and antisemitism:</i> “Nationalist ideology and antisemitism. The case of Romanian intellectuals in the 1930s”, by Leon Volovici; “The mystique of ultranationalism: History of the Iron Guard, Romania, 1919–1941” by Francisco Vega; “Romania 1866–1947”, by Keith Hitchins; “History of Romania. Compendium”, by Ioan-Aurel Pop and Joan Bolovan; “The Holocaust in Romania. The destruction of Jews and Gypsies under the Antonescu regime, 1940–1944”, by Radu Ioanid; “The Jews of East Central Europe between the World Wars”, by Ezra Mendelson; “Cultural Politics in Greater Romania. Regionalism, Nation Building and Ethnic Struggle, 1918–1930”, by Irina Livezeanu, and “Judeophobia. How and when it is born, where and why it survives”, by Gustavo Daniel Perednik. Articles are referenced in the bibliography section at the end of the manuscript.</p><h3>Results</h3><p>A-Nicolae Paulescu developed an intense long-term research activity, which included complete pancreatectomy and preparation of a pancreatic extract (PE) containing the antidiabetic hormone he called pancreina. Parenteral administration of the PE achieved excellent results in the treatment of experimental diabetes in dogs and induction of hypoglycemia in the healthy animal. This work was initiated before 1916 and published at least eight months antedating the publication of the first article by Banting and Best (February 1922), who were acquainted with Paulescu's results, but misinterpreted them. The pancreatic extract of the two Canadian researchers, -iletin/insulin-, only achieved similar results to that of the Romanian scientist once they abandoned the use of the \"degenerated pancreas\" extract (ligation of the ductal system), replacing it with the pancreas of adult or fetal bovine. Pancreina and insulin were very similar. The award of the Nobel Prize in Physiology or Medicine to FG Banting and JJR Macleod in October 1923 honored the successful clinical use of insulin in patients with diabetes mellitus. Paulescu's achievements were ignored. B-Nicolae Paulescu publicly manifested his Judeophobic ideology on multiple occasions in academic and political interventions and in publications and participated with other figures from the Romanian intellectual sphere in the founding of the Uniunea Național Crestinǎ (UNC, National Christian Union) in 1922 and of the Liga Apǎrǎrii Național Cresține (LANC, League for Christian National Defense) in 1923, antisemitic far-right political parties, associated with an irrational Christian orthodoxy and hatred of Jews. Paulescu played a pivotal role in the spread of antisemitism.</p><h3>Conclusions</h3><p>A-The Romanian scientist NC Paulescu started an intense research program aimed at the isolation of the antidiabetic hormone before 1916, including an original procedure of pancreatectomy in the dog and the elaboration of a pancreatic extract that achieved excellent results in the treatment of experimental diabetes, demonstrating its beneficial effects on the metabolism of carbohydrates, proteins and fats and reducing both glycosuria and glycemia and the urinary excretion of ketone bodies of depancreatized dogs toward normality. The results of these investigations were published in 1920 and 1921, predating the first report published by FG ​​Banting and CH Best in February 1922. It has been sufficiently demonstrated that Canadian researchers were aware of Paulescu's excellent results, mentioning them only in passing, albeit erroneously misrepresenting key results of the Romanian scientist's publication in the aforementioned seminal Canadian article. Expert historians and international scientists have recognized that the pancreatic extract that Paulescu called pancreina and that obtained by Banting and Best, insulin, were very similar. The October 1923 award of the Nobel Prize in Physiology or Medicine to FG Banting and JJR Macleod ignored Paulescu's scientific achievements in the treatment of experimental diabetes and rewarded the extraordinary advance of insulin treatment in human diabetes. B-At the end of August 2003, a few days before the date of the celebration at the Hôtel Dieu in Paris of the scheduled program of tribute to the scientific merits of NC Paulescu and his important contribution to the discovery of the antidiabetic hormone, convened by the Romanian Academy and the International Diabetes Federation, the Wiesenthal Foundation publicly accused the Romanian scientist of being an antisemite, an act that determined the cancellation of the announced events. The exhaustive investigation of the personal convictions and antisemitic behavior of Nicolae C. Paulescu has undoubtedly documented the Judeophobic ideology of the Romanian scientist, linked to his orthodox religious radicalism, manifested in multiple documents (mostly pamphlets) and interventions in collaboration with other relevant personalities of the Romanian intelligentsia of his time. Furthermore, Paulescu participated in the creation of political organizations of the most radical extreme right that played a fundamental role in the spread of antisemitism amongst the Romanian population and the university community.</p></div>","PeriodicalId":6921,"journal":{"name":"Acta Diabetologica","volume":"60 11","pages":"1513 - 1530"},"PeriodicalIF":3.1000,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00592-023-02136-6.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Diabetologica","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s00592-023-02136-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0

Abstract

Aims

Since the Nobel Prize in Physiology or Medicine was awarded in 1923 to FG Banting and JJR Macleod, many voices have been raised against this decision. The bitterest protest was that of the Romanian scientist Nicolae C. Paulescu. In 2002, The Romanian Academy of Sciences, the European Association for the Study of Diabetes (EASD) and the International Diabetes Federation (IDF) planned to hold a series of academic events the following year in Paris to acknowledge Paulescu's scientific merits in the discovery of the antidiabetic hormone. However, the initiative was cancelled in August 2003, when the European Center of the Simon Wiesenthal Foundation (SWC) accused Paulescu of being antisemitic. The authors of this manuscript have decided to approach "the Paulescu case" from its double aspect, scientific and sociopolitical, to analyze the circumstances surrounding the discovery of the antidiabetic hormone, and Paulescu's alleged antisemitic past in the historical context of the Romanian nation in the interwar period.

Methods

We contacted the SWC and people related to the 2003 events in Paris. We performed a comparative review of the documents published by the Toronto group and by Paulescu and analyzed the correspondence and articles generated by international experts from the scientific community interested in the controversy. We carried out an exhaustive bibliographic search through several online catalogs (INDEXCAT, NLM Gateway, EUREKA, MEDHIST). We travelled to Bucharest, where we visited Paulescu's house-museum, interviewed a former student of the Romanian professor, and a prominent medical historian who was knowledgeable about Paulescu's scientific and political biography. Dan Angelescu†, son of Dr. Constantin Angelescu (1904–1990), Paulescu's nephew and collaborator, provided us with a copy of all the available documentation from Paulescu's personal archive. It constitutes an essential source for understanding Paulescu's personal, political and academic biography. Archives consulted: Românǎ Academy (Bucharest). Personal Archive of Paulescu, House -Museum (Bucharest)*. Romanian Jewish Heritage (Bucharest). http://romanianjewish.org/ **. Simon Wiesenthal Center (Los Angeles, CA) http://www.wiesenthal.com **. Romanian Patent Office. Oficiul de Stat pentru Invenții şi Mǎrci (OSIM) (Bucharest)***. Nobel Archives (Stockholm) https://www.nobelprize.org. Internet Archive (San Francisco, CA) https://archive.org **. Wellcome Library (London) https://wellcomelibrary.org **. The European Library https://www.theeuropeanlibrary.org/ **. US National Library of Medicine, NLM historical collections http://www.nlm.nih.gov/hmd/index.html **. US. Holocaust Memorial Museum http://www.ushmm.org/ (*: archive consulted on site; **: material found in the online catalog of the archive; ***: archivists sent us digitized copies of archival material). Books consulted for information on the history of Romania and antisemitism: “Nationalist ideology and antisemitism. The case of Romanian intellectuals in the 1930s”, by Leon Volovici; “The mystique of ultranationalism: History of the Iron Guard, Romania, 1919–1941” by Francisco Vega; “Romania 1866–1947”, by Keith Hitchins; “History of Romania. Compendium”, by Ioan-Aurel Pop and Joan Bolovan; “The Holocaust in Romania. The destruction of Jews and Gypsies under the Antonescu regime, 1940–1944”, by Radu Ioanid; “The Jews of East Central Europe between the World Wars”, by Ezra Mendelson; “Cultural Politics in Greater Romania. Regionalism, Nation Building and Ethnic Struggle, 1918–1930”, by Irina Livezeanu, and “Judeophobia. How and when it is born, where and why it survives”, by Gustavo Daniel Perednik. Articles are referenced in the bibliography section at the end of the manuscript.

Results

A-Nicolae Paulescu developed an intense long-term research activity, which included complete pancreatectomy and preparation of a pancreatic extract (PE) containing the antidiabetic hormone he called pancreina. Parenteral administration of the PE achieved excellent results in the treatment of experimental diabetes in dogs and induction of hypoglycemia in the healthy animal. This work was initiated before 1916 and published at least eight months antedating the publication of the first article by Banting and Best (February 1922), who were acquainted with Paulescu's results, but misinterpreted them. The pancreatic extract of the two Canadian researchers, -iletin/insulin-, only achieved similar results to that of the Romanian scientist once they abandoned the use of the "degenerated pancreas" extract (ligation of the ductal system), replacing it with the pancreas of adult or fetal bovine. Pancreina and insulin were very similar. The award of the Nobel Prize in Physiology or Medicine to FG Banting and JJR Macleod in October 1923 honored the successful clinical use of insulin in patients with diabetes mellitus. Paulescu's achievements were ignored. B-Nicolae Paulescu publicly manifested his Judeophobic ideology on multiple occasions in academic and political interventions and in publications and participated with other figures from the Romanian intellectual sphere in the founding of the Uniunea Național Crestinǎ (UNC, National Christian Union) in 1922 and of the Liga Apǎrǎrii Național Cresține (LANC, League for Christian National Defense) in 1923, antisemitic far-right political parties, associated with an irrational Christian orthodoxy and hatred of Jews. Paulescu played a pivotal role in the spread of antisemitism.

Conclusions

A-The Romanian scientist NC Paulescu started an intense research program aimed at the isolation of the antidiabetic hormone before 1916, including an original procedure of pancreatectomy in the dog and the elaboration of a pancreatic extract that achieved excellent results in the treatment of experimental diabetes, demonstrating its beneficial effects on the metabolism of carbohydrates, proteins and fats and reducing both glycosuria and glycemia and the urinary excretion of ketone bodies of depancreatized dogs toward normality. The results of these investigations were published in 1920 and 1921, predating the first report published by FG ​​Banting and CH Best in February 1922. It has been sufficiently demonstrated that Canadian researchers were aware of Paulescu's excellent results, mentioning them only in passing, albeit erroneously misrepresenting key results of the Romanian scientist's publication in the aforementioned seminal Canadian article. Expert historians and international scientists have recognized that the pancreatic extract that Paulescu called pancreina and that obtained by Banting and Best, insulin, were very similar. The October 1923 award of the Nobel Prize in Physiology or Medicine to FG Banting and JJR Macleod ignored Paulescu's scientific achievements in the treatment of experimental diabetes and rewarded the extraordinary advance of insulin treatment in human diabetes. B-At the end of August 2003, a few days before the date of the celebration at the Hôtel Dieu in Paris of the scheduled program of tribute to the scientific merits of NC Paulescu and his important contribution to the discovery of the antidiabetic hormone, convened by the Romanian Academy and the International Diabetes Federation, the Wiesenthal Foundation publicly accused the Romanian scientist of being an antisemite, an act that determined the cancellation of the announced events. The exhaustive investigation of the personal convictions and antisemitic behavior of Nicolae C. Paulescu has undoubtedly documented the Judeophobic ideology of the Romanian scientist, linked to his orthodox religious radicalism, manifested in multiple documents (mostly pamphlets) and interventions in collaboration with other relevant personalities of the Romanian intelligentsia of his time. Furthermore, Paulescu participated in the creation of political organizations of the most radical extreme right that played a fundamental role in the spread of antisemitism amongst the Romanian population and the university community.

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1923年诺贝尔生理学或医学奖百年之际:尼古拉·保莱斯库——科学创造力与政治狂热之间
自从1923年诺贝尔生理学或医学奖授予FG Banting和JJR Macleod以来,许多人反对这一决定。最激烈的抗议是罗马尼亚科学家尼古拉·保莱斯库的抗议。2002年,罗马尼亚科学院、欧洲糖尿病研究协会(EASD)和国际糖尿病联合会(IDF)计划于次年在巴黎举行一系列学术活动,以表彰Paulescu在发现抗糖尿病激素方面的科学优势。然而,该倡议在2003年8月被取消,当时西蒙·维森塔尔基金会欧洲中心指责Paulescu反犹太主义。这份手稿的作者决定从科学和社会政治的双重层面来处理“Paulescu案”,以分析抗糖尿病激素发现的环境,以及Paulescu在两次世界大战期间罗马尼亚民族的历史背景下所谓的反犹太主义过去。方法我们联系了SWC和2003年巴黎事件的相关人员。我们对多伦多小组和Paulescu发表的文件进行了比较审查,并分析了对争议感兴趣的科学界国际专家的信件和文章。我们对几个在线目录(INDEXCAT、NLM Gateway、EUREKA、MEDHIST)进行了详尽的书目搜索。我们前往布加勒斯特,在那里我们参观了Paulescu的故居博物馆,采访了这位罗马尼亚教授的一名前学生,以及一位了解Paulescu科学和政治传记的著名医学历史学家。Dan Angelescu†是Paulescu的侄子兼合作者Constantin Angelescu博士(1904–1990)的儿子,他向我们提供了Paulescu个人档案中所有可用文件的副本。它是理解Paulescu个人、政治和学术传记的重要来源。查阅档案:罗马学院(布加勒斯特)。Paulescu个人档案馆,House-Museum(布加勒斯特)*。罗马尼亚犹太遗产(布加勒斯特)。http://romanianjewish.org/**。Simon Wiesenthal中心(加利福尼亚州洛杉矶)http://www.wiesenthal.com**。罗马尼亚专利局。国家统计局局长(OSIM)(布加勒斯特)***。诺贝尔档案馆(斯德哥尔摩)https://www.nobelprize.org.互联网档案馆(加利福尼亚州旧金山)https://archive.org**。惠康图书馆(伦敦)https://wellcomelibrary.org**。欧洲图书馆https://www.theeuropeanlibrary.org/**。美国国家医学图书馆,NLM历史藏品http://www.nlm.nih.gov/hmd/index.html**。美国大屠杀纪念博物馆http://www.ushmm.org/(*:现场查阅的档案;**:档案在线目录中的材料;***:档案管理员向我们发送了档案材料的数字化副本)。查阅关于罗马尼亚和反犹太主义历史的书籍:莱昂·沃洛维奇的《民族主义意识形态和反犹太主义:20世纪30年代罗马尼亚知识分子的案例》;弗朗西斯科·维加的《极端民族主义的神秘性:铁卫队的历史,罗马尼亚,1919–1941》;基思·希钦斯的《罗马尼亚1866-1947》;《罗马尼亚历史简编》,作者:伊安·奥雷尔·波普和琼·波洛万;“罗马尼亚大屠杀。1940年至1944年安东尼斯库政权对犹太人和吉普赛人的毁灭”,拉杜·伊阿尼德著;“世界大战期间的中东欧犹太人”,埃兹拉·门德尔松著;Irina Livezeanu的《大罗马尼亚的文化政治。区域主义、国家建设和民族斗争,1918-1930》和Gustavo Daniel Perednik的《犹太恐惧症。它是如何、何时出生的,在哪里以及为什么生存》。文章引用在手稿末尾的参考书目部分。结果Nicolae Paulescu开展了深入的长期研究活动,包括完整的胰腺切除术和含有抗糖尿病激素的胰腺提取物(PE)的制备,他称之为胰腺癌。PE的肠外给药在治疗犬实验性糖尿病和诱导健康动物低血糖方面取得了良好的效果。这项工作始于1916年之前,在Banting和Best(1922年2月)发表第一篇文章之前至少八个月发表,他们熟悉Paulescu的结果,但误解了这些结果。这两位加拿大研究人员的胰腺提取物——回肠蛋白/胰岛素——只有在他们放弃使用“退化胰腺”提取物(导管系统结扎),用成年或胎牛的胰腺代替后,才获得了与罗马尼亚科学家相似的结果。胰腺癌和胰岛素非常相似。1923年10月,FG Banting和JJR Macleod获得了诺贝尔生理学或医学奖,以表彰胰岛素在糖尿病患者中的成功临床应用。Paulescu的成就被忽视了。 B-Nicolae Paulescu在学术和政治干预以及出版物中多次公开展示了他的犹太恐惧思想,并与罗马尼亚知识界的其他人物一起于1922年成立了全国基督教联盟(UNC,National Christian Union)和全国基督教联盟1923年,反犹太主义的极右翼政党,与非理性的基督教正统观念和对犹太人的仇恨联系在一起。Paulescu在反犹太主义的传播中发挥了关键作用。结论a罗马尼亚科学家NC Paulescu在1916年之前开始了一项旨在分离抗糖尿病激素的深入研究计划,包括对狗进行胰腺切除术的原始程序和胰腺提取物的精制,该提取物在治疗实验性糖尿病方面取得了优异的效果,证明了其对碳水化合物代谢的有益作用,蛋白质和脂肪,减少糖尿病和血糖,并使脱胰狗的酮体尿液排泄正常。这些调查的结果发表于1920年和1921年,早于FG发表的第一份报告​​Banting和CH Best于1922年2月。已经充分证明,加拿大研究人员知道Paulescu的优秀成果,只是顺便提及,尽管在上述加拿大开创性文章中错误地歪曲了这位罗马尼亚科学家发表的关键成果。专家历史学家和国际科学家已经认识到,Paulescu称之为pancreina的胰腺提取物与Banting和Best获得的胰岛素非常相似。1923年10月,FG Banting和JJR Macleod被授予诺贝尔生理学或医学奖,这忽略了Paulescu在治疗实验性糖尿病方面的科学成就,并奖励了胰岛素治疗人类糖尿病的非凡进展。B-2003年8月底,在巴黎迪厄酒店举行庆祝活动的前几天,罗马尼亚科学院和国际糖尿病联合会召集了一个预定的项目,以表彰保列斯库的科学功绩及其对发现抗糖尿病激素的重要贡献,维森塔尔基金会公开指责这位罗马尼亚科学家是反犹太主义者,这一行为决定了宣布的活动的取消。对Nicolae C.Paulescu的个人信念和反犹太主义行为的详尽调查无疑记录了这位罗马尼亚科学家的犹太恐惧意识形态,这与他的正统宗教激进主义有关,表现在多份文件(主要是小册子)中,并与他那个时代的罗马尼亚知识界其他相关人士合作进行干预。此外,Paulescu参与创建了最激进的极右翼政治组织,这些组织在罗马尼亚人口和大学社区中反犹太主义的传播中发挥了根本作用。 B-Nicolae Paulescu在学术和政治干预以及出版物中多次公开展示了他的犹太恐惧思想,并与罗马尼亚知识界的其他人物一起于1922年成立了全国基督教联盟(UNC,National Christian Union)和全国基督教联盟1923年,反犹太主义的极右翼政党,与非理性的基督教正统观念和对犹太人的仇恨联系在一起。Paulescu在反犹太主义的传播中发挥了关键作用。结论a罗马尼亚科学家NC Paulescu在1916年之前开始了一项旨在分离抗糖尿病激素的深入研究计划,包括对狗进行胰腺切除术的原始程序和胰腺提取物的精制,该提取物在治疗实验性糖尿病方面取得了优异的效果,证明了其对碳水化合物代谢的有益作用,蛋白质和脂肪,减少糖尿病和血糖,并使脱胰狗的酮体尿液排泄正常。这些调查的结果发表于1920年和1921年,早于FG发表的第一份报告​​Banting和CH Best于1922年2月。已经充分证明,加拿大研究人员知道Paulescu的优秀成果,只是顺便提及,尽管在上述加拿大开创性文章中错误地歪曲了这位罗马尼亚科学家发表的关键成果。专家历史学家和国际科学家已经认识到,Paulescu称之为pancreina的胰腺提取物与Banting和Best获得的胰岛素非常相似。1923年10月,FG Banting和JJR Macleod被授予诺贝尔生理学或医学奖,这忽略了Paulescu在治疗实验性糖尿病方面的科学成就,并奖励了胰岛素治疗人类糖尿病的非凡进展。B-2003年8月底,在巴黎迪厄酒店举行庆祝活动的前几天,罗马尼亚科学院和国际糖尿病联合会召集了一个预定的项目,以表彰保列斯库的科学功绩及其对发现抗糖尿病激素的重要贡献,维森塔尔基金会公开指责这位罗马尼亚科学家是反犹太主义者,这一行为决定了宣布的活动的取消。对Nicolae C.Paulescu的个人信念和反犹太主义行为的详尽调查无疑记录了这位罗马尼亚科学家的犹太恐惧意识形态,这与他的正统宗教激进主义有关,表现在多份文件(主要是小册子)中,并与他那个时代的罗马尼亚知识界其他相关人士合作进行干预。此外,Paulescu参与创建了最激进的极右翼政治组织,这些组织在罗马尼亚人口和大学社区中反犹太主义的传播中发挥了根本作用。
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来源期刊
Acta Diabetologica
Acta Diabetologica 医学-内分泌学与代谢
CiteScore
7.30
自引率
2.60%
发文量
180
审稿时长
2 months
期刊介绍: Acta Diabetologica is a journal that publishes reports of experimental and clinical research on diabetes mellitus and related metabolic diseases. Original contributions on biochemical, physiological, pathophysiological and clinical aspects of research on diabetes and metabolic diseases are welcome. Reports are published in the form of original articles, short communications and letters to the editor. Invited reviews and editorials are also published. A Methodology forum, which publishes contributions on methodological aspects of diabetes in vivo and in vitro, is also available. The Editor-in-chief will be pleased to consider articles describing new techniques (e.g., new transplantation methods, metabolic models), of innovative importance in the field of diabetes/metabolism. Finally, workshop reports are also welcome in Acta Diabetologica.
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