Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important?

Background

Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored.

Methods

We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (<80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization.

Results

The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011).

Conclusions

Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients.

Event-free survival cumulative curves.

Funding Acknowledgement

Type of funding source: None

Psychosocial and clinical factors associated with poor self-care in patients with chronic heart failure

Background

Self care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease.

Beyond heart failure related factors, the role of psychosocial determinants and its interaction with clinical aspects has not been fully explored.

Aims

The aim of the study was to analyze both clinical and psychosocial factors associated with poor self care in patients with chronic HF.

Methods

Self care was evaluated at baseline with the 9 item European HFR Self Care Behaviour Scale (9 item ESCBS).

Scores were standardized and reversed from 0 (worst self care) to 100 (better self care). This study we analysed the associations between poor self care (defined as scores in the lower tertile of the 9 item ESCBS) with demographic, HF-related (clinical) and psychosocial factors in all patients at baseline.

Results

We included 1123 patients: mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40%) were in NYHA class III or IV. Mean score of the 9-item ESCBS was 69±28. In the clinical multivariate analyses HF-related factors associated with poor self-care were serum albumins level, ckd level and previous admission due to heart failure. In the psychosocial multivariate analyses poor social support, depressive symptoms and needing a caregiver were independently associated with poor self care. In combined models, only psychosocial factors were independently associated with poor self care whereas no clinical factors remain in the model.

Conclusion

Our study showed that psychosocial conditions are the main factors independently associated with poor self-care in patients with chronic heart failure

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital del Bellvitge

Association between self-care and prognosis in 1123 patients with chronic heart failure

Background

Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF.

Aims and methods

The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF.

We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline.

Results

We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour.

Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception.

Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028]

Conclusion

Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure.

These results highlight the importance of assessing self-care and provide measures to improve them.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

Identifying environmental barriers to participation: Usability of a health-literacy informed problem-identification approach for parents of young children with developmental disabilities

BACKGROUND

Parents of very young children recently diagnosed with developmental disabilities (DD) need to identify environmental barriers to their children's participation and adopt an adaptive orientation to solving these problems. Given the health service disparities for diverse families, parents may benefit from easy to use problem-identification approaches that address environmental barriers stemming from community and policy contexts. This feasibility study evaluated the usability of a health literacy-informed, structured, environment-focused problem-identification approach for parents of young children with DD.

METHODS

We used purposeful, convenience sampling to enrol 9 mothers of children ages 1-3 with DD (4 racial/ethnic minorities, 3 high school education, 4 annual household income <$20,000). We developed a structured problem-identification approach guided by a social ecological model featuring home, community, and policy contexts. The approach was applied to 3 short stories during a narrative elicitation interview. Two researchers independently coded parent responses for the type of barrier and solution identified with and without the approach.

RESULTS

Parents identified 121 environmental barriers without the approach. When using the approach and prompted to consider home, community, and policy barriers, parents identified an additional 222 environmental barriers; the greatest number of barriers were aligned with International Classification of Functioning, Disability, and Health-Children and Youth environment Chapter 5 "Services, systems, and policies." Using the approach, parents with a postgraduate education and annual household income >$80,000 identified the most environmental barriers, and parents reporting the lowest annual household incomes identified the fewest environmental barriers. When parents attributed participation challenges to an environmental barrier, ~57% of solutions required parents to interact with individuals at the community or policy level.

CONCLUSIONS

This study suggests that parents with a range of background characteristics can use a structured, environment-focused problem-identification approach. With the approach, parents are more likely to attribute participation challenges to environmental barriers and adopt a problem-solving orientation focused on changes to the community and policy context.

A flexible control system designed for lab-scale simulations and optimization of composting processes

Understanding and optimization of composting processes can benefit from the use of controlled simulators of various scales. The Agricultural Research Organization Composting Simulator (ARO-CS) was recently built and it is flexibly automated by means of a programmable logic controller (PLC). Temperature, carbon dioxide, oxygen and airflow are monitored and controlled in seven 9-l reactors that are mounted into separate 80-l water baths. The PLC program includes three basic heating modes (pre-determined temperature profile, temperature-feedback ("self-heating"), and carbon dioxide-dependent temperature), three basic aeration modes (airflow dependence on temperature, carbon dioxide, or oxygen) and enables all possible combinations among them. This unique high flexibility provides a robust and valuable research tool to explore a wide range of research questions related to the science and engineering of composting. In this article the logic and flexibility of the control system is presented and demonstrated and its potential applications are discussed.

Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort

BACKGROUND

Cow's milk allergy (CMA) is one of the most commonly reported childhood food problems. Community-based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria.

METHODS

Children from the EuroPrevall birth cohort in 9 European countries with symptoms possibly related to CMA were invited for clinical evaluation including cows' milk-specific IgE antibodies (IgE), skin prick test (SPT) reactivity and double-blind, placebo-controlled food challenge.

RESULTS

Across Europe, 12 049 children were enrolled, and 9336 (77.5%) were followed up to 2 years of age. CMA was suspected in 358 children and confirmed in 55 resulting in an overall incidence of challenge-proven CMA of 0.54% (95% CI 0.41-0.70). National incidences ranged from 1% (in the Netherlands and UK) to <0.3% (in Lithuania, Germany and Greece). Of all children with CMA, 23.6% had no cow's milk-specific IgE in serum, especially those from UK, the Netherlands, Poland and Italy. Of children with CMA who were re-evaluated one year after diagnosis, 69% (22/32) tolerated cow's milk, including all children with non-IgE-associated CMA and 57% of those children with IgE-associated CMA.

CONCLUSIONS

This unique pan-European birth cohort study using the gold standard diagnostic procedure for food allergies confirmed challenge-proven CMA in <1% of children up to age 2. Affected infants without detectable specific antibodies to cow's milk were very likely to tolerate cow's milk one year after diagnosis, whereas only half of those with specific antibodies in serum 'outgrew' their disease so soon.

The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries

It is unclear why some children develop food allergy. The EuroPrevall birth cohort was established to examine regional differences in the prevalence and risk factors of food allergy in European children using gold-standard diagnostic criteria. The aim of this report was to describe pre-, post-natal and environmental characteristics among the participating countries. In nine countries across four major European climatic regions, mothers and their newborns were enrolled from October 2005 through February 2010. Using standardized questionnaires, we assessed allergic diseases and self-reported food hypersensitivity of parents and siblings, nutrition during pregnancy, nutritional supplements, medications, mode of delivery, socio-demographic data and home environmental exposures. A total of 12,049 babies and their families were recruited. Self-reported adverse reactions to food ever were considerably more common in mothers from Germany (30%), Iceland, United Kingdom, and the Netherlands (all 20-22%) compared with those from Italy (11%), Lithuania, Greece, Poland, and Spain (all 5-8%). Prevalence estimates of parental asthma, allergic rhinitis and eczema were highest in north-west (Iceland, UK), followed by west (Germany, the Netherlands), south (Greece, Italy, Spain) and lowest in central and east Europe (Poland, Lithuania). Over 17% of Spanish and Greek children were exposed to tobacco smoke in utero compared with only 8-11% in other countries. Caesarean section rate was highest in Greece (44%) and lowest in Spain (<3%). We found country-specific differences in antibiotic use, pet ownership, type of flooring and baby's mattress. In the EuroPrevall birth cohort study, the largest study using gold-standard diagnostic criteria for food allergy in children worldwide, we found considerable country-specific baseline differences regarding a wide range of factors that are hypothesized to play a role in the development of food allergy including allergic family history, obstetrical practices, pre- and post-natal environmental exposures.

Shape change, engulfment, and breakup of partially engulfed compound drops undergoing thermocapillary migration

Compound drops comprise two or more immiscible phases, one of which entirely or partially engulfs the others. In this work we consider the thermocapillary-induced motion of partially engulfed compound drops, composed of two phases, in an immiscible fluid. If the capillary number is negligibly small, Ca << 1, the partially engulfed compound drop is composed of three spherical surface segments, intersecting at contact angles that are determined by the three interfacial tensions associated with the three fluid phases that make up the compound drop and the ambient medium. Corrections to the shapes of the undeformable case at Ca = 0 are expected to be of the order Ca. However, as the drop propagates through the nonisothermal fluid, the temperature at the three-phase contact line and, hence, the contact angles, may considerably change, resulting in a dramatic change of the compound drop shape. Moreover, the changes in the interfacial tensions may be so significant that the partially engulfed configuration may become impossible and either two immiscible parts of the compound drop separate or one of them becomes completely engulfed by the other.

Retention of acoustic conditioning in St Peter's fish Sarotherodon galilaeus

Groups of St Peter's fish Sarotherodon galilaeus were trained during 28 days of classical conditioning to respond to an acoustic signal by approaching a feeder. Their ability to retain the acoustically conditioned behaviour was tested after eight different intervals ranging from 12 to 188 days from termination of training. Retention tests comprised 7 consecutive days of retraining and the fish response was compared with that of naive fish. Fish response drastically diminished with time. After 55 days, there was no apparent expression of memory on the first test day but fish response was restored on subsequent retraining days, indicating the existence of latent memory. Six months from the end of training, there was no indication of behavioural retention and the response completely vanished. The study was conducted in the context of sea ranching, with classical conditioning used to gain control over fish location. In light of the present results, it is suggested that periodic reinforcement of the acoustically conditioned behaviour should be used.

Interfacial Shear Strength of Thin Polymeric Coatings on Glass

The interfacial adhesive shear strengths of epoxy and acrylate coatings on glass substrates were measured by the indentation and lap shear tests. The lap shear strengths were about an order of magnitude less and exhibited considerably more variability than those measured by indentation. It is believed that the lap shear strength is controlled by large processing flaws (pores in this study); whereas, the indentation test measures the “intrinsic” strength of the coating.

Written notification of test results: meanings, comprehension and implication on patients' health behavior

OBJECTIVE

Mailing test results are frequently used to provide patients with information about their medical condition and enhancing their participation in subsequent management. This study explores patients' experiences of the written notification process and its implications.

METHODS

Telephone interviews were conducted with 128 patients who had undergone endoscopic examinations in two gastroenterology clinics after the received of their mailed biopsies results. The interviews (open and closed questions) focused on patients' perceptions and emotions while waiting, and after reading the reports.

RESULTS

The findings are divided to emotions experienced, comprehension and behavioral implications. The reports arrived 6-33 days later than promised. Many patients were dissatisfied but most did nothing to hasten the process. Over half of them were unable to understand the information in the letters and the future steps needed to be taken. Explanatory covering letters, sent by the hospital clinic, enhanced comprehension and diminished confusion.

CONCLUSIONS

Mailed biopsy reports frequently failed to enhance patient understanding and participation in decisions. Incomprehensibility of written information, and unmet expectations, evoked negative emotional responses.

PRACTICE IMPLICATIONS

Improving readability with simple, non-technical information; and verification of understanding and fulfillment of recommendations using a follow-up call are critical for accomplishing the goals of mailed biopsy reports.

Ifetroban sodium: an effective TxA2/PGH2 receptor antagonist

This review presents a comprehensive discussion on the chemistry, pharmacokinetics, and pharmacodynamics of ifetroban sodium, a new thomboxane A2/prostaglandin H2 receptor antagonist. Thromboxane A2 is an arachidonic acid product, formed by the enzyme cyclooxygenase. In contrast to other cyclooxygenase products, thromboxane A2 has been shown to be involved in vascular contraction and has been implicated in platelet activation. In general, results of clinical studies and animal experiments indicate that hypertension is associated with hyperaggregability of platelets and increased thomboxane A2 levels in blood, urine, and tissues. The precursors to thromboxane A2, prostaglandin G2, and prostaglandin H2, also bind and activate the same receptors. Thus, a receptor antagonist was thought to be an improved strategy for reversing the actions of thromboxane A2/prostaglandin H2, rather than a thromboxane synthesis inhibitor. This review describes new methods for the synthesis and analysis of ifetroban, its tissue distribution, and its actions in a variety of animal models and disease states. We describe studies on the mechanisms of how ifetroban relaxes experimentally contracted isolated vascular tissue, and on the effects of ifetroban on myocardial ischemia, hypertension, stroke, thrombosis, and its effects on platelets. These experiments were conducted on several animal models, including dog, ferret, and rat, as well as on humans. Clinical studies are also described. These investigations show that ifetroban sodium is effective at reversing the effects of thromboxane A2- and prostaglandin H2-mediated processes.

[Complicated polycystic liver disease with intracystic hemorrhage and obstructive jaundice]

Polycystic liver disease, which is generally part of the autosomal dominant polycystic kidney disease, is often asymptomatic. We report a case of obstructive jaundice caused by compression of the biliary tract by a large haemorrhagic liver cyst. The patient was a man with sporadic polycystic liver disease without polycystic kidney disease and with normal renal function for his age. Ultrasound combined with cholangio-MRI provided non-invasive confirmation of intracystic bleeding and intrahepatic biliary dilatation. Obstructive jaundice was confirmed by cyst puncture-aspiration which resolved symptoms and normalized biology. The initial treatment of haemorrhagic liver cyst complicating polycystic liver disease must be medical with cyst aspiration-drainage and sclerotherapy to avoid surgery in these fragile patients.

The chemical work of Alexander and Jane Marcet

Alexander Marcet was an authority on urinary calculi and their analysis when few medical practitioners appreciated the usefulness of chemistry in the explanation and treatment of disease. In An Essay on The Chemical History and Medical Treatment of Calculous Disorders, he described the discovery of an xanthine stone. He drew line illustrations of simple chemical apparatus useful for bedside analysis. His microtechnique used drops of solution and pinhead pieces of calculi; reagents were acids and alkalies and the blowpipe in conjunction with a small alcohol lamp. He reported the earliest description of a disorder later named "alcaptonuria". Marcet's work and that of a few others, on the chemical composition of urine and calculi, laid the foundations of our present knowledge. Between 1807 and 1820, his lectures to the medical students at Guy's Hospital were illustrated by experiments. Jane Haldimand Marcet wrote the very popular CONVERSATIONS: on Chemistry (16 editions in Great Britain). Her book dominated elementary chemical instruction during the first half of the 19th century. She followed Lavoisier's scheme of classification and explained chemical reactions in terms of affinity, aggregation, gravitation, and repulsion. Her advocacy that experimentation accompany lecture was new. The availability of serious scientific education in the new women's academies set the stage for increasing women's involvement in science. She also published a series of CONVERSATIONS: The topics were Political Economy, Natural Philosophy, and Vegetable Physiology.

A golden age of clinical chemistry: 1948-1960

This segment of history aims to inform the new, and remind the not-so-new, members of the profession about the relatively recent period that initiated the dominant role played by technological innovation in the modern investigation of disease. The 12 years from 1948 to 1960 were notable for introduction of the Vacutainer tube, electrophoresis, radioimmunoassay, and the AutoAnalyzer. Also appearing during this interval were new organizations, publications, programs, and services that established a firm foundation for the professional status of clinical chemists. It was a golden age.

Thomas Hodgkin: social activist

Thomas Hodgkin's discovery of a lymph gland disorder is merely one event in a life of unusually varied public activities in the social reform and humanitarian movements of the mid-19th century. He wrote pamphlets on medical care for the working-class poor, public health, housing, sanitation, and the relief of cold, hunger, and unemployment. Hodgkin wrote about the problems arising from urban renewal and suburban development. His contributions to geographic explorations, anthropology, ethnology, and foreign affairs are virtually unknown today. Hodgkin's opposition to slavery and the slave trade involved him in the development of settlements in Africa for freed slaves and disputes with the abolitionists in America. He fought for social justice and human rights for native populations being oppressed by British foreign policy in South Africa and New Zealand. His criticism of the exploitation of Indians by the Hudson's Bay Company's fur trade contributed to a professional conflict in the highly politicized environment of Guy's Hospital and blocked advancement of his medical career. Closer to home he advocated reform of medical education and practice and sponsored adult education programs. As a member of its Senate, he helped in establishing London University, the first nonsectarian institution of higher learning in England. He lectured to working people on the means of preserving and promoting health and advocated prepaid medical care for the working poor. Concerned about unequal distribution of medical care, he opposed medical contracts to the lowest bidder and price-determined government plans for health care. He consistently maintained that the basic problems of the poor were not medical but socioeconomic. Since charity leaves nothing behind in exchange, Hodgkin was certain that greater benefits would result if charitable money was used to provide jobs. He denounced the evils of tobacco, practices of trade unions, and barbarous prize fights. On a trip to Jerusalem with Sir Moses Montefiore in 1866, Hodgkin contracted dysentery and died. He is buried in a protestant cemetery in Jaffa. His epitaph is fitting: "Nothing human was alien to him."

Specificity of glycosaminoglycan suppression of endothelin-1 production by human umbilical vein endothelial cells

Endothelin-1 (ET-1) is the most potent vasoconstrictor peptide found in nature. Its production is stimulated by thrombin. By inhibiting thrombin we have previously shown that heparin, a highly negatively-charged glycosaminoglycan (GAG), suppresses the production of ET-1 by cultured human umbilical vein endothelial cells (HUVEC). The purpose of our study is to determine the effect of other GAGs and related compounds on ET-1 production. The GAGs and related compounds used in the study were: chondroitin sulfate A, chondroitin sulfate B, chondroitin sulfate C, fucoidin, low molecular weight dextran sulfate, high molecular weight dextran sulfate, and hyaluronan. HUVEC were incubated for 48 hr with media containing these GAGs and related compounds and with media without GAG as control. ET-1 levels were measured by radioimmunoassay. GAGs and related molecules with higher sulfate content, heparin, chondroitin sulfate B, low and high molecular weight dextran sulfates significantly suppressed ET-1 production by HUVEC. Fucoidin also suppressed ET-1 production despite its lower sulfate content, probably because of its structural similarity to heparin. These compounds may be useful for future in vivo studies.

Release of superoxide dismutase activity from human umbilical veins by heparin

OBJECTIVE

This study evaluated superoxide dismutase activity released from human umbilical veins incubated with different doses of heparin and examined at different time points.

STUDY DESIGN

Umbilical veins of fresh cords from full term babies were incubated with 175 or 1 U/ml of heparin at one end while the other end was incubated without heparin as control. Specimens were obtained at 10 minutes and 24 hours (high-dose) or at 10 minutes and 60 minutes (low-dose). Superoxide dismutase activity was measured by the cytochrome c method. Results were analyzed using Student's paired t test.

RESULTS

A time-dependent release of superoxide dismutase activity into the buffer was observed in both heparin specimens as well as in control specimens. The difference in release in the presence of heparin was of statistical significance, compared with the controls.

CONCLUSION

Because heparin is routinely used as an anticoagulant to maintain the patency of umbilical catheters, we conclude that this usage may alter a newborn's response to oxygen free radical damage by changes in superoxide dismutase activity.

Nitric oxide products degrade chondroitin sulfates

Nitric oxide (NO) is a potent endogenous vasodilator that is elevated in response to inflammation. Inflammation also produces high levels of superoxide, which combines with NO to produce peroxynitrite (PN). We have previously reported that NO degrades heparin and heparan sulfate under acidic conditions and that PN degrades hyaluronan (HA) at neutral pH. Heparin and HA are glycosaminoglycans (GAGs) widely distributed in the extracellular matrix of tissues. Disruption of intestinal GAGs, particularly the chondroitin sulfates, were linked to inflammatory bowel diseases. Chondroitin sulfate A (CSA), chondroitin sulfate B (CSB), and chondroitin sulfate C (CSC) are constituents of the basement membranes of many tissues, including the intestine. The purpose of this study is to determine whether the NO donor S-nitroso-N-acetylpenicillamine (SNAP) and PN can degrade chondroitin sulfates in vitro. The NO donor SNAP (2 mM, pH 4.0) or PN (5 mM, pH 7.4) was incubated for at least 1 week at 37 degrees C with CSA, CSB, or CSC. Breakdown of CSA, CSB, and CSC was assessed by gel filtration chromatography and compared with untreated controls. Percentage degradation was calculated based on the change in peak height compared to the control. SNAP treatment partially degraded CSB and CSC, whereas PN partially degraded all three chondroitin sulfates. Nitric oxide mediated degradation of GAGs, and particularly chondroitin sulfates, may be an important pathway of inflammatory tissue damage.

Endothelin-1 and CYP450 arachidonate metabolites interact to promote tissue injury in DOCA-salt hypertension

Inhibition of cytochrome P-450 (CYP450) enzymes with cobalt chloride (CoCl2) prevented hypertension, organ hypertrophy, and renal injury induced by DOCA and salt (1% NaCl) in uninephrectomized (UNx) rats. Systolic blood pressure (SBP) rose to 193 +/- 6 mmHg by day 21 from control levels of 150 +/- 7 mmHg in response to DOCA-salt treatment, a rise that was prevented by CoCl2 (24 mg. kg-1. 24 h-1). The effects of DOCA-salt treatment, which increased protein excretion to 88.3 +/- 6.9 mg/24 h on day 21 from 9.0 +/- 1.1 mg/24 h on day 3, were prevented by CoCl2. CoCl2 also attenuated the renal and left ventricular hypertrophy and the increase in media-to-lumen ratio in hypertensive rats. DOCA-salt treatment increased excretion of endothelin (ET)-1 from 81 +/- 17 to 277 +/- 104 pg. 100 g body wt-1. 24 h-1 associated with a fourfold increase in 20-hydroxyeicosatetraenoic acid (20-HETE) excretion from 3.0 +/- 1.1 to 12.2 +/- 1.9 ng. 100 g body wt-1. 24 h-1 (days 3 vs. 21). CoCl2 blunted these increases by 58 and 72%, respectively. In aortic rings pulsed with [3H]thymidine, ET-1 increased its incorporation. Dibromododec-11-enoic acid, an inhibitor of 20-HETE synthesis, attenuated ET-1-induced increases in [3H]thymidine incorporation. We distinguished effects of CoCl2 acting via CO generation vs. suppression of CYP450-arachidonic acid metabolism by treating UNx-salt-DOCA rats with 1-aminobenzotriazole (ABT), which suppresses CYP450 enzyme activity, and compared these results to those produced by CoCl2. ABT reduced hypertension, as did CoCl2. Unlike CoCl2, ABT did not prevent organ hypertrophy and proteinuria, suggesting that these effects were partially related to CO formation. Blockade of the ETA receptor with BMS-182874 reduced SBP, organ hypertrophy, and proteinuria, indicating the importance of ET-initiated abnormalities to the progression of lesions in UNx-salt-DOCA.

Structural requirements for glycosaminoglycan recognition by the Lyme disease spirochete, Borrelia burgdorferi

Borrelia burgdorferi, the Lyme disease agent, binds glycosaminoglycans (GAGs) such as heparin, heparan sulfate, and dermatan sulfate. Heparin or heparan sulfate fractions separated by size or charge were tested for their ability to inhibit attachment of B. burgdorferi to Vero cells. GAG chains of increasing length and/or charge showed increasing inhibitory potency, and detectable heparin inhibition of bacterial binding required a minimum of 16 residues. The ability of a given heparin fraction to inhibit binding to Vero cells was strongly predictive of its ability to inhibit hemagglutination, suggesting that hemagglutination reflects the capacity of B. burgdorferi to bind to GAGs.

Contribution of endothelin to the acute pressor response of L-NAME in stroke-prone spontaneously hypertensive rats

In this study, we examined whether endothelin (ET) plays a role in the short-term increase in mean arterial pressure (MAP) after nitric oxide synthase (NOS) inhibition with N(omega)-nitro-L-arginine methyl ester (L-NAME) in stroke-prone spontaneously hypertensive rats (SHRSPs). Experiments were performed by using Inactin-anesthetized male SHRSPs that were pretreated with chlorisondamine to block reflex autonomic cardiovascular effects. Injection of L-NAME (10 mg/kg, i.v.), but not D-NAME, produced rapid and marked increases (74 +/- 3 mm Hg) in MAP that were sustained for >1 h. In SHRSPs that were treated with the ET(A/B) receptor antagonist, L-754,142 (15 mg/kg + 15 mg/kg/h), L-NAME increased MAP by 45 +/- 4 mm Hg (p < 0.0001 compared with L-NAME alone). L-754,142 blocked pressor responses to big ET-1 by >90% but was without effect on pressor responses to norepinephrine. Plasma levels of ET-1 averaged 5 +/- 1 pg/ml in animals given vehicle and were slightly increased in animals given either L-NAME alone (7 +/- 2 pg/ml) or L-754,142 alone (7 +/- 2 pg/ml) but increased markedly when L-NAME and L-754,142 were given together (114 +/- 18 pg/ml). This may relate to an effect of L-754,142 to block ET-receptor-mediated clearance of ET-1. We conclude that ET plays a role in the short-term pressor response after NOS inhibition in SHRSPs.

The nitric oxide donor S-nitroso-N-acetyl-D,L-penicillamine degrades heparan sulfate and heparin

Nitric oxide (NO) is a powerful vascular and neural regulator. One of the breakdown products of nitric oxide is nitrite which converts to nitrous acid, a reagent routinely used for the degradation of heparin and heparan sulfate. We have recently shown that nitric oxide gas degrades heparin and heparan sulfate through a nitrous acid mechanism (Vilar et al, 1997, Biochemical Journal, 324, 473-479). The purpose of the present study is to confirm these findings using the nitric oxide donor S-nitroso-N-acetyl-D,L-penicillamine (SNAP) under conditions that are close to those found in vivo. The results show that 2 mM SNAP releases a steady-state level of nitrite of over 200 microM. This level substantially degrades heparin and heparan sulfate at a pH of up to 5.0. This reaction may be important in breakdown of the glycosaminoglycan components of the extracellular matrix during normal and pathological conditions.

Nitric oxide degradation of heparin and heparan sulphate

NO is a bioactive free radical produced by NO synthase in various tissues including vascular endothelium. One of the degradation products of NO is HNO2, an agent known to degrade heparin and heparan sulphate. This report documents degradation of heparin by cultured endothelial-cell-derived as well as exogenous NO. An exogenous narrow molecular-mass preparation of heparin was recovered from the medium of cultured endothelial cells using strong-anion exchange. In addition, another narrow molecular-mass preparation of heparin was gassed with exogenous NO under argon. Degradation was evaluated by gel-filtration chromatography. Since HNO2 degrades heparin under acidic conditions, the reaction with NO gas was studied under various pH conditions. The results show that the degradation of exogenous heparin by endothelial cells is inhibited by NO synthase inhibitors. Exogenous NO gas at concentrations as low as 400 p.p.m. degrades heparin and heparan sulphate. Exogenous NO degrades heparin at neutral as well as acidic pH. Endothelial-cell-derived NO, as well as exogenous NO gas, did not degrade hyaluronan, an unrelated glycosaminoglycan that resists HNO2 degradation. Peroxynitrite, a metabolic product of the reaction of NO with superoxide, is an agent that degrades hyaluronan; however, peroxynitrite did not degrade heparin. Thus endothelial-cell-derived NO is capable of degrading heparin and heparan sulphate via HNO2 rather than peroxynitrite. These observations may be relevant to various pathophysiological processes in which extracellular matrix is degraded, such as bone development, apoptosis, tissue damage from inflammatory responses and possible release of growth factors and cytokines.

Degradation of hyaluronan by peroxynitrite

Treatment of high-molecular-weight hyaluronan (HA) with peroxynitrite at neutral pH (ONOO-/ONOOH) results in altered mobility on agarose gel electrophoresis, as well as reduced limiting viscosity number. Both effects are consistent with a reduction in HA molecular weight. HA is protected from peroxynitrite attack to varying extents by addition of alternate target molecules. Thiourea is extremely effective as a protective agent, dimethyl sulfoxide is moderately effective, while sodium benzoate and mannitol are slightly effective. A similar pattern of protection is observed when HA is degraded by hydroxyl radical generated by a metal ion/hydrogen peroxide system. On the basis of these observations, peroxynitrite is proposed to have hydroxyl radical-like activity in degrading HA.

Gastric tubes, meals, acid, and analysis: rise and decline

The stomach tube was first used to administer food and medication or to remove poisonous substances. Later, it served to aspirate the stomachs of patients with gastric retention. Chemical analysis of stomach contents after a meal was first suggested in 1871 and quickly became an important laboratory procedure as various test-meal stimuli and more flexible tubes were developed. Quantitative estimations of free and total acidity were made by titration with 0.01 mol/L sodium hydroxide and specific indicators. Pentagastrin has supplanted secretagogues such as histamine and betazole; meal stimulation, tubeless tests, and other tests of gastric secretion are no longer used clinically. Tests of gastric acid secretion have been used in the diagnosis of upper gastrointestinal lesions and to help select the type of surgical procedure for gastric and duodenal ulcers, but the tests have decreased in importance because of their limited diagnostic sensitivity and specificity. Today, fiberoptic endoscopy is replacing gastric analysis as well as radiologic examination.

Vitamine--vitamin. The early years of discovery

In 1905, Cornelius Adrianus Pekelharing found that animals fed purified proteins, carbohydrates, fats, inorganic salts, and water would thrive only if small amounts of milk were added to the diet. He concluded that the milk contained some unrecognized substance that in very small quantities was necessary for normal growth and maintenance. In 1911, Casimir Funk isolated a concentrate from rice polishings that cured polyneuritis in pigeons. He named the concentrate "vitamine" because it appeared to be vital to life and because it was probably an amine. Although the concentrate and other "accessory food substances" were not amines, the name stuck, but the final "e" was dropped. In 1913 two groups discovered a "fat-soluble" accessory food substance. Initially believed to be a single vitamin, two separate factors were involved. One, effective against xerophthalmia, was named vitamin A; the other, effective against rickets, was named vitamin D. The factor that prevented scurvy was isolated in 1928. Known as "water-soluble C," it was renamed ascorbic acid.

Reduction ventriculoplasty for the cardiomyopathic heart: a case report

A 44-year-old morbidly obese and hypertensive woman had been diagnosed with idiopathic cardiomyopathy seven years previously. She was referred for consideration for heart transplantation because of progression of symptoms to class IV. Massive obesity and pulmonary hypertension were strong relative contraindications to transplantation. During outpatient evaluation, the patient developed pulmonary edema, was hospitalized, and became intensive care unit-bound and immobile. Exercise radionuclide angiocardiography revealed left ventricular ejection fraction of 17%, and left ventricular end-diastolic volume of 408 mL. A reduction ventriculoplasty procedure was performed by resection of the lateral wall of the left ventricle. The patient did very well, and was discharged on postoperative day nine. Two weeks after the procedure, exercise radionuclide angiocardiography demonstrated left ventricular ejection fraction of 30% (76% increase) and left ventricular end-diastolic volume of 293 mL (28% decrease). The patient remains in stable New York Heart Association class II, now three months postprocedure. This initial positive experience in New England encourages-continued investigation of the reduction ventriculoplasty procedure, either as a bridge or as an alternative to heart transplantation in patients with dilated cardiomyopathy.

Initial single-center experience with an advanced third-generation investigational defibrillator

The CPI PRxII is a recently approved, multitiered implantable cardioverter defibrillator (ICD) that delivers high and low energy biphasic shocks, antitachycardia (ATP) and bradycardia pacing, and stores 2.5 minutes of electrograms from the widely spaced shocking electrodes. The PRxII was implanted in 58 patients at Yale-New Haven Hospital between December 1993 and January 1995. At implant, mean biphasic defibrillation threshold (DFT) in patients with testing to failure was 10 J (1-20). All 36 patients who were candidates for a new transvenous system underwent successful nonthoracotomy implantation. Based on noninvasive predischarge EPS results, 30 patients had > or = 1 VT zone: 21 patients had ATP, 9 others had first shock < or = 5 J. During follow-up, 13 patients had been treated for 379 events (range, 1-127). Of 340 events in a zone with ATP, 97% responded to ATP, 3% required shock. First programmed shock converted all events in a VF zone. Details, including RR intervals, were available for all events in 15 of 17 patients receiving appropriate or inappropriate therapy or diverted shocks. One hundred eleven of 148 available electrograms confirmed VT by morphology, rate, and/or presence of AV dissociation. In nine patients, electrogram data altered therapy through diagnosis of inappropriate or diverted therapy, guidance of detection enhancements, or diagnosis of previously unrecognized VTs. We conclude the PRxII achieves low DFTs that obviate the need for thoracotomy and effectively treats ventricular arrhythmias with ATP and shock, with programming guided by noninvasive electrophysiology. Multiple stored electrograms from widely spaced shocking electrodes greatly enhance diagnostic capabilities, facilitating effective treatment.

Suppression of endothelin-1 production in cultured human umbilical vein endothelial cells by heparin fractions separated by strong anion exchange chromatography

Heparin has been shown to lower the production/secretion of the vasoconstrictive peptide endothelin-1. Endothelin-1 production is stimulated by thrombin, and it has been proposed that heparin binds to the anion-binding exosite of thrombin, preventing it from stimulating endothelin-1 production. To further test this proposal, heparin was fractionated by strong anion exchange chromatography (QAE-Sephadex A-25) into four fractions. These fractions had anticoagulant activities that increased linearly with charge, as defined by the median salt concentration needed for elution from the column. The fractions also differed in the total number of sulfates per mole of heparin, which was dependent on the molecular mass of the fractions rather than charge density. The fractions were found to significantly differ fron each other in their ability to suppress endothelin-1 production. The fraction eluting from the ion exchange column at the highest salt concentration had the greatest suppressive effect. Addition of sodium or potassium chloride to the media interfered with the ET-1 suppressive effect of unfractionated heparin, whereas lithium chloride had no effect. These data show that charge interactions between heparin and thrombin may be important in regulating the production of endothelin-1 and in regulating other thrombin-dependent functions.

Specific heparin fractions suppress endothelin-1 production in cultured human umbilical vein endothelial cells

Vascular endothelial cells produce endothelin-1, a peptide with potent vasoconstrictor and mitogenic properties. Heparin suppresses thrombin-stimulated endothelin-1 production in endothelial cells; this is consistent with its reported effect of lowering blood pressure. Since heparin is a heterogeneous mixture of glycosaminoglycans, we examined the effects of different fractions of heparin in suppressing endothelin-1 production in cultured endothelial cells. Heparin fractions differing in size and in antithrombin III affinity were prepared. The results show that the suppressive effect of heparin is independent of these properties of size and antithrombin III affinity. Heparin sulfate suppressed endothelin-1 production to a similar level as heparin. These experiments were conducted in a complete culture medium in the absence of added thrombin. To assess the role of endogenous thrombin in the medium on this process, we tested the effects of hirudin, a specific thrombin inhibitor peptide, on suppression of endothelin-1. Hirudin, like heparin, binds to the anion-binding exosite of thrombin. Hirudin alone, and combined with heparin, suppressed endothelin levels to the same extent as heparin. These experiments demonstrate that the suppressive effect of heparin is the result of its binding to the traces of thrombin in the culture medium, preventing stimulation of endothelin-1 production. This study supports the hypothesis that the functional thrombin receptor may participate in the stimulation of endothelin-1 by thrombin.

Circadian variation of sustained ventricular tachycardia in patients with coronary artery disease and implantable cardioverter-defibrillators

BACKGROUND

While previous studies using epidemiological data and ambulatory ECG monitoring have shown peak occurrence of sudden death and nonsustained ventricular tachycardia in the morning, none have examined circadian variation of potentially life-threatening ventricular tachycardia (VT), nor has any study observed circadian behavior of any arrhythmias in individuals followed longitudinally. We used the event memory of multiprogrammable implantable cardioverter-defibrillators to evaluate the circadian pattern of sustained VT over time.

METHODS AND RESULTS

Data were reviewed from 32 consecutive patients with coronary artery disease and sustained VT who had received the Ventak PRX (CPI, Inc) cardioverter-defibrillator between May 1991 and August 1993 and had experienced at least one episode of VT terminated by their device. Mean follow-up was 14 +/- 7 months. Among the 2558 episodes recorded by the device logs, VT occurrence peaked between 6 AM and noon (P = .007 by ANOVA among four 6-hour time periods). Harmonic regression revealed a morning peak at 9 AM (P < .01). This morning peak occurred in patients with both frequent and infrequent events. Among 21 patients who experienced more than four VT events, 8 (38%) had an AM peak of VT occurrence (> 35% of VT between 6 AM and noon). Neither age, ejection fraction, event frequency, presenting arrhythmia, nor drug therapy distinguished patients who displayed the AM VT peak.

CONCLUSIONS

In patients with coronary artery disease, sustained VT displays circadian variation with peak frequency in the morning, similar to that for sudden death. Individual patients who display specific patterns of circadian variation over time can be identified using defibrillator logs. Investigation of circadian variation of other phenomena to elucidate mechanisms of VT should focus on these patients.

Heparin enhances active site-dependent binding of tissue-type plasminogen activator to endothelial cells

Human umbilical vein endothelial cells (HUVEC) in culture express two classes of binding sites for tissue-type plasminogen activator (t-PA). The high-affinity binding site has been identified as PA inhibitor type 1 (PAI-1), which binds to the catalytic portion of the molecule, while the second site binds t-PA through an active-site independent domain. Because recombinant t-PA (rt-PA) is often administered concomitantly with heparin, we investigated the effects of heparin on rt-PA binding to HUVEC. Preincubation of HUVEC with heparin at 4 degrees C increased the binding of radiolabeled rt-PA in a time- and dose-dependent manner. One-half maximal increase in binding was observed within 10 minutes of heparin addition. When HUVEC were preincubated with optimal concentrations (5 U/mL) of heparin for 4 hours at 4 degrees C, a 2.5- +/- 0.2-fold increase in specific binding was observed (mean +/- SEM, n = 12, P less than .01). Other highly sulfated glycosaminoglycans and fucoidan (a sulfated polymer of fucose) stimulated rt-PA binding as well, whereas glycosaminoglycans with lower sulfate content than heparin did not. Several results suggested that heparin increased the binding of rt-PA to "cell-associated" PAI-1. First, only active-site-dependent binding was enhanced by heparin, whereas binding of active-site blocked rt-PA was not affected. Second, extracts from HUVEC preincubated with heparin contained increased amounts of rt-PA-PAI-1 complexes as shown by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Third, antibodies to PAI-1 blocked the increased binding entirely. HUVEC preincubated with heparin also bound increased amounts of enzymatically active radiolabeled urokinase-type PAs. However, HUVEC preincubated with heparin did not express increased amounts of immunoreactive PAI-1. Therefore, heparin, at therapeutic concentrations, may enhance or stabilize the association of PAs with endothelial cell-associated PAI-1.

Comparison of the separation of bovine heparin by strong anion exchange and by gel filtration chromatography

Heparin has been fractionated by strong anion exchange chromatography followed by elution of the pools on a gel filtration column. This resulted in the expected inverse relationship in the elution order for the pools run by the two methods. Also chromatography of heparin was performed in the reverse order: gel filtration first, followed by anion exchange of the pools. For this order of separation four of the five gel filtration pools of different molecular weights eluted at a similar LiCl concentration. The specific activities of different pools of heparin were evaluated using a colorimetric microwell kinetics assay using antithrombin and thrombin. For the pools separated by ion exchange first, there was an exponential increase of specific activity with increasing molecular weight for all pools. For the pools isolated by gel filtration first, the specific activities became level after an initial increase in relation to molecular weight. Thus, unique pools of heparin species are being isolated by different modes of chromatography.

Interaction of fibronectin with heparin in model extracellular matrices: role of arginine residues and sulfate groups

The interaction of heparin with the NH2-terminal domain of human plasma fibronectin was studied by using matrix-driven translocation, an assay for the adhesion of extracellular macromolecules with cell or particle surfaces within artificial collagen matrices. Partial desulfation of heparin rendered it ineffective in competitively inhibiting the interaction of the fibronectin NH2-terminal domain with heparin-coated particles, suggesting a role for sulfate groups of heparin in the interaction. Analysis of the fibronectin domain in terms of its primary structure, its proposed organization into "type I modules", and its hydrophilic and flexible segments led to the identification of several arginine-containing sites of potential interaction with the sulfate groups of heparin. Modification of increasing numbers of arginine side chains with 1,2-cyclohexanedione under mild conditions eventually led to decreases in translocation-promoting activity, and of heparin binding capacity as measured in a gel-shift assay, but the major portions of these functions were retained even when the four most accessible arginines (attributed to sites in and adjacent to the large loops of the type I modules) were modified. With the modification of additional arginines (attributed to sites in the small loops), both functions were lost. The peptide Gly-Arg-Gly, corresponding to a repeated determinant at the tips of two small loops, inhibited translocation, but arginine alone did not. Cleavage of the large loops by CNBr also led to loss of translocation-promoting activity. The correspondence between the molecular determinants of matrix-driven translocation and those previously found for mesenchymal morphogenesis indicates the utility of this system in the analysis of adhesive interactions of biological importance.

Thomas Hodgkin and Moses Montefiore; Europe, Asia, and Africa

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Characterization of human endothelial cell urokinase-type plasminogen activator receptor protein and messenger RNA

Human umbilical vein endothelial cells in culture (HUVEC) express receptors for urokinase-type plasminogen activators (u-PA). The immunochemical nature of this receptor and its relationship to u-PA receptors expressed by other cell types is unknown. Cross-linking active site-blocked u-PA to HUVEC lead to an increase in its apparent molecular mass by approximately 40 Kd. The predominant u-PA binding protein isolated from whole cell detergent extracts migrated with a molecular mass of approximately 36 Kd using affinity chromatography. In contrast, when only cell surface proteins were radiolabeled before extraction, the predominant labeled u-PA binding protein isolated migrated with a molecular mass of approximately 46 Kd. Several pieces of evidence suggested that the difference in molecular mass between these two u-PA binding proteins resulted from glycosylation of a single receptor protein. First, a polyclonal antibody against u-PA receptor isolated from phorbol myristate acetate (PMA) stimulated U-937 cells reacted with both the 36- and 46-Kd proteins on Western blotting. Second, the size of the unmodified receptor was estimated by amplifying a full-length cDNA for u-PA receptor from an endothelial cell cDNA library using the polymerase chain reaction (PCR) and oligonucleotide primers corresponding to the DNA sequence of the receptor cloned from transformed human fibroblasts (Roldan et al, EMBO J 9:467, 1990). The size of the cDNA (approximately 1,054 base pairs, bp) and the presence of a single 1.4-kilobase (Kb) mRNA transcript on Northern blot analysis predict an unglycosylated receptor protein of approximately 35 Kd. Third, synthesis of 35S-labeled 46-Kd cell surface receptor protein was inhibited when the cells were grown in the presence of tunicamycin, while the synthesis of the 36-Kd species was unaffected. Moreover, the apparent molecular mass of purified surface-labeled receptor (approximately 46 Kd) was reduced by N-glycanase. These studies suggest that the u-PA receptor on the surface of HUVEC is a glycoprotein derived from a protein of approximately 35 Kd which is similar immunologically to u-PA receptors on other cell types.

Interaction of single-chain urokinase-type plasminogen activator with human endothelial cells

The interaction of urokinase-type plasminogen activators with receptors on the surface of endothelial cells may play an important role in the regulation of fibrinolysis and cell migration. Therefore, we investigated whether human umbilical vein endothelial cells (HUVEC) express receptors for single-chain urokinase (scu-PA) on the cell surface and examined the effect of such binding on plasminogen activator activity. Binding of 125I-labeled scu-PA to HUVEC, performed at 4 degrees C, was saturable, reversible, and specific (k+1 4 +/- 1 X 10(6) min-1 M-1, k-1 6.2 +/- 1.4 X 10(-3) min-1, Kd 2.8 +/- 0.1 nM; Bmax 2.2 +/- 0.1 X 10(5) sites/cell; mean +/- S.E.). Binding of radiolabeled scu-PA was inhibited by both natural and recombinant wild-type scu-PA, high molecular weight two-chain u-PA (tcu-PA), catalytic site-inactivated tcu-PA, an amino-terminal fragment of u-PA (amino acids 1-143), and a smaller peptide (amino acids 4-42) corresponding primarily to the epidermal growth factor-like domain. Binding was not inhibited by low molecular weight urokinase or by a recombinant scu-PA missing amino acids 9-45. Cell-bound scu-PA migrated at its native molecular mass on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. In the presence of plasminogen, scu-PA bound to endothelial cells generated greater plasmin activity than did scu-PA in the absence of cells. In contrast, when tcu-PA was added directly to HUVEC, sodium dodecyl sulfate-stable complexes formed with cell or matrix-associated plasminogen activator inhibitors with a loss of plasminogen activator activity. These studies suggest that endothelial cells in culture express high affinity binding sites for the epidermal growth factor domain of scu-PA. Interaction of scu-PA with these receptors may permit plasminogen activator activity to be expressed at discrete sites on the endothelial cell membrane.

Lipoprotein analysis. Early methods in the diagnosis of atherosclerosis

Before 1950, there was no clear perception of the interrelationship of serum lipids, atherosclerosis, and coronary heart disease. Since then, research laboratories have made conflicting claims for the most useful measurement of the serum lipid levels in detecting and managing coronary heart disease. Emphasis has been placed in turn on the measurement of levels of serum cholesterol, lipoproteins, triglycerides, and, currently, cholesterol and lipoproteins again. Physical separation and characterization of serum lipoproteins by ultracentrifugation and electrophoresis resulted in two classification systems for lipoproteins based on hydrated density and electrophoretic mobility, respectively. Two operational by-products were the atherogenic index, an empirical formula supposed to correlate with coronary heart disease, and a phenotype system for classification of the lipoproteinemias. Current National Heart, Lung, and Blood Institute criteria for atherosclerosis risk implicate elevated levels of cholesterol and low-density lipoprotein cholesterol, and decreased levels of high-density lipoprotein cholesterol. Although triglycerides are closely associated with cholesterol in lipoprotein molecules and are positively associated with cardiovascular disease, there is no strong evidence of elevated levels of plasma triglycerides as an independent risk factor in coronary heart disease. Elevated levels of triglycerides can help identify persons with increased risk of cardiovascular disease from other causes, but screening for hypertriglyceridemia is not recommended. Apolipoproteins and lipoprotein Lp(a) are briefly discussed.

Martin Robison Delany (1812-1885): physician, black separatist, explorer, soldier

Martin Robison Delany's great contribution to American life and black history stems from his defiant blackness. He was America's first "Black Nationalist" and the intense embodiment of black pride. Ever changing in his career, he always identified with the black experience and its place in history. In an active life he was doctor, dentist, orator, editor, publisher, Harvard medical student, explorer, dabbler in Central American politics, army officer, and Reconstruction office seeker.

Hodgkin's disease: origin of an eponym--and one that got away

Hodgkin's disease, the syndrome of enlarged lymph nodes associated with enlarged spleen, was described in 1832 on the basis of the gross appearance of the affected parts. The eponym entered the medical literature after repeated attempts by Dr. Samuel Wilks to credit Thomas Hodgkin with the priority of discovery. Today, this malady, also known by many other names, is recognized by microscopic examination of histological features. Hodgkin also described retroversion of the aortic valves with insufficiency in 1827 but Dr. Dominic Corrigan, whose report appeared in 1832, was credited with the eponym, despite efforts again by Wilks on behalf of Hodgkin.