Paul Cololian (1869–1956) : membre de la Société Médico-Psychologique (1902) et fondateur de l’Union des Médecins Arméniens de Paris (1920) et de la Croix-Rouge Arménienne de Paris (1922) (Partie I)

Maksoud Boghos Cololian was born December 12, 1869 in Ortakeuy. It was a suburb of Constantinople. The young Maksoud Boghos was sent to the Armenian school of Berberian when he is expected to learn to read and write in. It was here he developed a taste for litterature and the knowledge of the French language thanks to a thorough instruction. When he completed his secondary schooling, he left Armenia for France. In September 1889, he registered at the faculty of medicine of Paris. Extern in 1891 then intern from the asylums of the Seine (1894), he was appointed doctor of medicine in 1898. Cololian acquired a deep knowledge of psychiatry under the direction of great specialists (Taguet, Briand, Magnan, Garnier). Member of the Société Médico-Psychologique in 1902, his happy memories of his non-residential internship in the department of Nicolas Augustin Gilbert (1858–1927) led him to practice general medicine. That is the speciality he dedicated to as a liberal, in Paris rue de Ponthieu, without forgetting his training in psychiatry. In the Rosenwald Book, his speciality was neuropsychiatry. Considering he was a former Ottoman subject and volunteer since the beginning of hostilities in 1914, Cololian became immediately naturalized French with the title of assistant major physician medical. He was appointed head physician of the physiotherapy centers of Versailles (VR 69 and 74), Grignon and the Officers’ Hospital at Versailles. Also, he named himself Paul. He took care of war-wounded and became a precursor in the field of mechano-therapeutic on one hand, and for the measurement of impotence and infirmities one the other hand. In 1918, Cololian was decorated with the Legion of Honor by Raymond Poincaré (1860–1934) himself. Several times laureate of the Academy of Medicine and the Institute, Cololian wrote articles or memories on semiology and psychiatric treatment. He was with P. Garnier the author of a treatise on therapeutics of mental and nervous diseases (1901). Author of chronic hunting in the newspaper “Le Figaro”, medical and scientific popularization in the review “Guérir” and “La Femme et l’Enfant” and too informal written in “Les Annales politiques et littéraires”, Cololian published various articles or analyzes on studies based on morbid psychological constitutions from characters in literature, plays, movies or politics (Emma Bovary, Marie Lafarge, Hitler…). In his psychiatric and psychoanalytic reading of Flaubert's Madame Bovary, Cololian asserted that the creator of Freudianism was Flaubert. Regarding psychoanalysis, he felt Freud's theory had been taken too far by the founder and mostly by his students.     

The Atherogenic Dyslipidemia Complex and Novel Approaches to Cardiovascular Disease Prevention in Diabetes

Despite the effectiveness of low-density lipoprotein (LDL)-lowering strategies for the treatment of diabetic dyslipidemia, significant residual risk of atherosclerotic cardiovascular disease remains. Residual risk might in part be explained by lipid abnormalities that go beyond LDL cholesterol elevation, collectively termed the “atherogenic dyslipidemia complex (ADC),” consisting of hypertriglyceridemia, elevated small dense LDL particles, reduced high-density lipoprotein cholesterol, and high-density lipoprotein particle numbers, increased remnant lipoproteins, and postprandial hyperlipidemia. In this review, we briefly discuss the pathophysiology of the typical dyslipidemia that occurs in insulin-resistant states including obesity, the metabolic syndrome, and type 2 diabetes. Lipid-modifying strategies including lifestyle modification, ezetimibe, statins, fibrates, niacin, and cholesteryl ester transfer protein inhibitors in treating ADC are discussed. With the advent of novel therapies involving antisense oligonucleotides and monoclonal antibodies, new targets can be specifically downregulated to potentially promote lipoprotein clearance or suppress production. We review novel approaches currently undergoing clinical testing and we speculate on their suitability for use in treating ADC for the prevention of atherosclerotic cardiovascular disease. In addition, future targets that might be considered for therapeutic development are discussed.     

Heart Failure With Preserved Ejection Fraction in Diabetes: Mechanisms and Management

Diabetes mellitus (DM) is a major cause of heart failure in the Western world, either secondary to coronary artery disease or from a distinct entity known as “diabetic cardiomyopathy.” Furthermore, heart failure with preserved ejection fraction (HFpEF) is emerging as a significant clinical problem for patients with DM. Current clinical data suggest that between 30% and 40% of patients with HFpEF suffer from DM. The typical structural phenotype of the HFpEF heart consists of endothelial dysfunction, increased interstitial and perivascular fibrosis, cardiomyocyte stiffness, and hypertrophy along with advanced glycation end products deposition. There is a myriad of mechanisms that result in the phenotypical HFpEF heart including impaired cardiac metabolism and substrate utilization, altered insulin signalling leading to protein kinase C activation, advanced glycated end products deposition, prosclerotic cytokine activation (eg, transforming growth factor-β activation), along with impaired nitric oxide production from the endothelium. Moreover, recent investigations have focused on the role of endothelial-myocyte interactions. Despite intense research, current therapeutic strategies have had little effect on improving morbidity and mortality in patients with DM and HFpEF. Possible explanations for this include a limited understanding of the role that direct cell-cell communication or indirect cell-cell paracrine signalling plays in the pathogenesis of DM and HFpEF. Additionally, integrins remain another important mediator of signals from the extracellular matrix to cells within the failing heart and might play a significant role in cell-cell cross-talk. In this review we discuss the characteristics and mechanisms of DM and HFpEF to stimulate potential future research for patients with this common, and morbid condition.