"Congo" red: out of Africa?

CONTEXT: Congo red is the essential histologic stain for demonstrating the presence of amyloidosis in fixed tissues. To the best of my knowledge, nothing has been written about why the stain is named "Congo." OBJECTIVE: To understand the etymology and history of the Congo red histologic stain. DESIGN: Primary sources were consulted extensively, including 19th-century corporate documents, newspapers, legal briefs, patents, memoirs, and scientific papers. SETTING: Sources were obtained from multiple university libraries and German corporate archives. RESULTS: To Europeans in 1885, the word Congo evoked exotic images of far-off central Africa known as The Dark Continent. The African Congo was also a political flashpoint during the Age of Colonialism. "Congo" red was introduced in Berlin in 1885 as the first of the economically lucrative direct textile dyes. A patent on Congo red was filed by the AGFA Corporation of Berlin 3 weeks after the conclusion of the well-publicized Berlin West Africa Conference. During these important diplomatic talks, German Chancellor Otto von Bismarck presided over a discussion of free trade issues in the Congo River basin. A challenge to AGFA's Congo red patent led to a precedent-setting decision in intellectual property law. CONCLUSIONS: The Congo red stain was named "Congo" for marketing purposes by a German textile dyestuff company in 1885, reflecting geopolitical current events of that time.     

"Altered-self" or "near-self" in the positive selection of lymphocyte repertoires?

Positive selection of lymphocyte repertoires is now recognized as applying to both B and T cells. However, much of the early literature on positive selection focussed on cell-mediated immunity (T cells), which biased consideration of its general biological role. The term “altered-self,” which initially captured the idea of self (i.e. MHC) altered by the addition of what was later found to be a peptide fragment, has not proven robust and may now be clouding our understanding. It is recommended that the term “near-self” be reintroduced since it captures the essence of the probable underlying adaptive process—sub-threshold self-reactivity to countermand rapid pathogen mutation.     

Vascular consequences of passive Aβ immunization for Alzheimer's disease. Is avoidance of "malactivation" of microglia enough?

The role of inflammation in Alzheimer's disease (AD) has been controversial since its first consideration. As with most instances of neuroinflammation, the possibility must be considered that activation of glia and cytokine networks in AD arises merely as a reaction to neurodegeneration. Active, healthy neurons produce signals that suppress inflammatory events, and dying neurons activate phagocytic responses in microglia at the very least. But simultaneous with the arrival of a more complex view of microglia, evidence that inflammation plays a causal or exacerbating role in AD etiology has been boosted by genetic, physiological, and epidemiological studies. In the end, it may be that the semantics of "inflammation" and glial "activation" must be regarded as too simplistic for the advancement of our understanding in this regard. It is clear that elaboration of the entire repertoire of activated microglia – a phenomenon that may be termed "malactivation" – must be prevented for healthy brain structure and function. Nevertheless, recent studies have suggested that phagocytosis of Aβ by microglia plays an important role in clearance of amyloid plaques, a process boosted by immunization paradigms. To the extent that this clearance might produce clinical improvements (still an open question), this relationship thus obligates a more nuanced consideration of the factors that indicate and control the various activities of microglia and other components of neuroinflammation.     

"Laughing" rats and the evolutionary antecedents of human joy?

Paul MacLean's concept of epistemics-the neuroscientific study of subjective experience-requires animal brain research that can be related to predictions concerning the internal experiences of humans. Especially robust relationships come from studies of the emotional/affective processes that arise from subcortical brain systems shared by all mammals. Recent affective neuroscience research has yielded the discovery of play- and tickle-induced ultrasonic vocalization patterns ( approximately 50-kHz chirps) in rats may have more than a passing resemblance to primitive human laughter. In this paper, we summarize a dozen reasons for the working hypothesis that such rat vocalizations reflect a type of positive affect that may have evolutionary relations to the joyfulness of human childhood laughter commonly accompanying social play. The neurobiological nature of human laughter is discussed, and the relevance of such ludic processes for understanding clinical disorders such as attention deficit hyperactivity disorders (ADHD), addictive urges and mood imbalances are discussed.     

Psychosomatic plasticity: An "emergent property" of personality research?

Psychosomatic plasticity, defined as an extreme capacity to turn suggestions into bodily realities, is as phenomenon well worth investigating because it challenges mainstream conceptions about the relationship between mind and body in health as well as illness. The field of psychoneuroimmunology (PNI) offers a framework within which to understand this phenomenon because PNI makes a compelling case for the biological unity of self. Hartmann's Boundaries concept is particularly applicable because it suggests that the minds of "thin-boundary" persons are relatively fluid and able to make numerous connections. Wilson and Barber's identification of the fantasy prone person and Thalbourne's transliminality concept are similarly relevant. Taking these explorations a step further, this author proposes that the flow of feeling within individuals represents the key to psychosomatic plasticity. Blushing, psoriasis, and immune reactions are offered as examples, as are more anomalous reports such as those provided by heart transplantation recipients and cases said to be indicative of reincarnation. In each instance, persons who are highly sensitive (ie, have a speedier and more direct flow of feeling) are more likely to evidence physical reactions. Psychosomatic plasticity represents an emerging area of interest in personality research, one that clearly merits further investigation.     

The historical roots of the "bipolar spectrum": did Aristotle anticipate Kraepelin's broad concept of manic-depression?

The construct of bipolar disorder, or bipolar spectrum disorders, has been a source of controversy in recent years. Some have argued that subtle variants within the putative bipolar spectrum are merely the creation of overzealous clinicians, perhaps encouraged by various special interest groups. In reality, the concept of a bipolar spectrum may be inferred from numerous classical sources, dating back to the 19th century and even into antiquity. The Greek philosopher Aristotle, usually considered the author of a work called Problemata, appears to have recognized some form of the bipolar spectrum, more than two millennia ago. This recognition continues throughout the 19th century, and into our own time. Such transcultural findings across many centuries have implications for the “objective" nature of psychiatric disease.     

Development of a computerized equipment management program at Children's Hospital "Bambino Gesù" of Rome, Italy

The main activities of the Clinical Engineering Service at the Children's Hospital "Bambino Gesù" of Rome, Italy and the computerized system developed in-house for electromedical equipment management are described here. The approach recently adopted and implemented for an objective cost/benefit evaluation of the equipment installed at the hospital is also described. The program outputs appear to be effective tools, both in evaluating maintenance costs and workload increases from new equipment installations and, more relevantly, in comparing similar equipment from different manufacturers during prepurchase evaluation.     

Predictive factors of restenosis: what changes with "active" stents?

For many years, restenosis was the major limiting factor of coronary angioplasty, even since the systematic use of stents. Numerous scientific publications have aimed to define the predictive factors of this phenomenon. Factors such as diabetes, the size of the treated artery, the use of stents or not, the length of the lesion, lesion located on the proximal left anterior descending artery, the degree of residual stenosis post-angioplasty (assessed by angiography or by intravascular ultrasound) have all been evoked as being classically related to restenosis. However, our perception of the restenosis phenomenon has been dramatically changed by the demonstration of the efficacy and security of active stents. Even in so-called "at risk" populations, the use of active stents is rarely followed by restenosis. In this way, the classic risk factors for restenosis have now become arguments in favour of the implantation of an active stent. As long as budgetary constraints limit the use of active stents to patients said to be "at risk of restenosis", this population, quite paradoxically, will have a more favourable outcome than so-called "low risk" patients, in whom "ordinary" non-active stents will continue to be used.     

"Constitutive" skin pigmentation: a marker of breast cancer risk?

There is much evidence to support a link between oestrogen and breast cancer. Both adult and foetal oestrogen may have this predisposing effect, and between-individual and between-population differences in oestrogen may account for much of the variation in risk for breast cancer. Here we suggest that "constitutive" skin colour in women is a marker for prenatal and adult oestrogen levels such that within ethnic groups light-skinned women have experienced higher in utero and adult oestrogen than dark-skinned women. Scores for 'constitutive' skin pigment may therefore be predictive of risk for breast cancer and low scores could be used to identify individuals at high risk.     

On establishing priority of ideas: revisiting the "pli cacheté" (deposition of a sealed envelope)

This article proposes that individuals should have the option to deposit with journals and editors ideas, hypotheses, theories and other research material in "sealed envelopes". This "pli cacheté" approach could allow to establish priority of thinking and doing a posteriori, i.e., when the envelope is opened. Such concept can be important in two ways: (i) it offers the opportunity to claim priority of sealed scientific rationale and data which may not be substantiated enough and might mislead when published too early or even erroneously; (ii) it could facilitate research in connection with patents because scientific information which is available in the public domain will not receive patent protection in most cases. Roots of the pli cacheté in the French Academie des Sciences in the 1700s, three empirical examples between 1798 and 1982 and recommendations as to how to handle sealed envelopes proceduraly today are provided.     

Does introduction of new "easy to use" inhalational devices improve medical personnel's knowledge of their proper use?

BACKGROUND: Lack of basic inhaler skills by medical personnel has been documented by numerous studies. Consequently, training of patients in correct inhalational technique suffers. Newer dry powder inhalers such as Turbuhaler (budesonide, Astra USA, Westborough, MA) and Diskus (salmeterol, GlaxoSmithKline, Research Triangle Park, NC) have some advantages over conventional metereddose inhalers (MDIs) including easier technique of usage. They have been recently marketed with the hope of overcoming this problem. OBJECTIVE: To determine whether introduction of newer "easy to use" dry powder inhalers such as budesonide (Turbuhaler) and salmeterol (Diskus) would result in improvement in medical personnel's knowledge of their proper use. METHODS: In and around a community-based teaching hospital, interviews were conducted in March 2000 of 50 assorted randomly selected medical personnel. They included 10 respiratory therapists, 10 registered nurses, 10 medical residents, 10 primary care physicians, and 10 pharmacists. Objective evaluation was made of their skills demonstration and knowledge scores for usage of MDIs, budesonide, and salmeterol. RESULTS: Mean percentage demonstration scores of different medical personnel for all three devices taken together: respiratory therapist (81.6%), primary care physicians (77.7%), pharmacists (57.7%), registered nurses (54.4%), and medical residents (53.8%). Mean percentage demonstration scores of different inhalers for all medical personnel taken together: MDI (80.9%), salmeterol (64.2%), budesonide (49.9%). Mean percentage knowledge score of all three inhalational devices taken together for respiratory therapist was the best at 76.6%. Registered nurses performed the worst with a score of 52.0%. Mean percentage knowledge scores: MDI (78%), salmeterol (63.2%), and budesonide (52.4%). A repeated measures two-way analysis of variance demonstrated that differences in both demonstration and knowledge scores between inhaler types and between medical personnel were all highly statistically significant (P < 0.0001). CONCLUSIONS: Demonstration skills and knowledge scores for use of both budedsonide and salmeterol were substantially lower than that for MDI for all medical personnel. Medical personnel responsible for teaching the correct use of inhalational devices are lacking in basic knowledge and user skills. This likely contributes to patient's poor technique when using these devices.     

Clinical research: protection of the "vulnerable"?

In this age of evidence-based medicine, clinical research is critical for developing new therapeutics and determining the best way to use these therapies. To perform appropriate clinical research, researchers must adhere to ethical standards. These standards have developed in large part as a response to egregious violations of ethically appropriate behavior. In this respect certain populations have been identified as at risk of being treated inappropriately in medical research. Current ethical guidelines prohibit or severely limit what types of research can be performed involving these "vulnerable" populations. Although this might protect these populations, the lack of research on them might actually do harm in limiting their access to life-saving therapies. We explore the historical underpinnings of protecting the vulnerable populations and whether a newer ethical paradigm that would allow for protected research on these populations should be adopted by society.     

Functional adaptation: the key to plasticity of cardiovascular "stem" cells?

There is increasing evidence that cells of disparate phenotypes displaying various degrees of proliferative capacity engraft and function heterotopically in adult organisms. Efforts were made to reconcile these findings with the embryologic notions of pluripotent stem or progenitor cell, although the nature of the 'stemness' remained elusive. This topic is particularly important for the cardiovascular system, in which cytotrophoblasts, certain tumor cells, monocytes/macrophages, peritoneal mesothelial cells, and others acquire endothelial properties and/or perform endothelial functions. Here we suggest that this pluripotency reflects a fundamental characteristic of cellular diversity, which is manifested as the adaptive response to a functional pressure exerted by the cell's biochemical and biophysical microenvironments that would drive their differentiation. In this model, differentiation is a dynamic, reversible, and open-ended process where the cells would maintain the flexibility to respond to changing environmental clues with a fine tuning of their structure, a property that was previously called cellular plasticity. Pluripotent adult stem cells that display this property in culture, and, perhaps upon in vivo administration, were described. Therefore, we also suggest that differentiation of stem cells is a form of cellular plasticity within the larger context of functional adaptation, whereas their stemness remains associated with self-renewal.     

"Tree-barking" of the ascending aorta. Syphilis or systemic lupus erythematosus?

A case of unsuspected classical aortitis with "tree-barking" of the ascending aorta in a young woman with systemic lupus erythematosus and inconclusive syphilitic serologic results is presented. At autopsy, no definite diagnostic clues as to syphilitic or lupic aortitis could be obtained. Although infrequent today, the possibility of complicated cardiovascular syphilis still should be considered. Involvement of the ascending aorta by other systemic diseases is well known and can imitate syphilitic aortitis. Although the possibility of two concomitant diseases cannot be ruled out, the young age of the patient, the weak syphilitic serologic result, and active systemic lupus erythematosus demonstrated in other organs favor a diagnosis of lupic aortitis of the ascending aorta.