Cardiovascular and pulmonary interactions: why Galen’s misconceptions proved clinically useful for 1,300 years

Neder, J. Alberto

doi:10.1152/advan.00058.2020

Cited by 3 publications

(3 citation statements)

References 52 publications

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“…They found a significant correlation between this metric (mesenteric disease activity index) and the Crohn’s disease activity index and argued for inclusion of mesentery in ileocolic resection for Crohn’s disease. There is evidence for the involvement of adipose tissue in inflammation and immunomodulation (Mao et al, 2019)(Eder et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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Characterising COVID-19 as a Viral Clotting Fever: A Mixed Methods Scoping Review

Marley

2020

Preprint

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BackgroundThe COVID-19 pandemic has claimed over 1 million lives globally and results from the SARS-COV2 virus. COVID-19 is associated with a coagulopathy. In this mixed-methods PRISMA-compliant scoping review, we set out to determine if ARDS, sepsis and DIC could account for the coagulopathy and if there were any other features of the coagulopathy we could determine so as to inform future research. Methods: We used a search strategy to identify papers with clinically relevant thromboembolic events in COVID-19. We then developed a technique referred to as an Abridged Thematic Analysis (ATA) to quickly identify themes in the papers so as to increase the yield of clinically relevant information. We further developed Validated Abridged Thematic Analysis (VATA) to validate the resulting taxonomy of themes. Finally we developed a number of methods that can be used by other researchers to take forwards this work. Results: We identified 56 studies with 10,523 patients, 456 patients with COVID-19 and thromboembolic events (TBE’s) and 586 thrombembolic events. There were an average of 1.3 TBE’s per patient. There were five main arterial territories with corresponding clinical sequelae: Acute limb ischaemia, myocardial infarcts, strokes, mesenteric ischaemia and pulmonary embolism. We also identified DVT’s. There were two further groups: medical-device-related coagulopathy and dermal lesions. In a subgroup of 119 patients we found mortality ranged from 26% in DVT to 79% in acute limb ischaemia although there was evidence of selection bias in the latter group. All patients were hospitalised and the average age of survivors was 63 versus 73 for those who died. 91/150 patients with TE’s had fever. From the ATA, we identified 16 characteristics of the clotting pathology in COVID-19. From the VATA, we identified 34 mechanisms leading to coagulopathy and grouped them according to Virchow’s triad of vascular damage, stasis and hypercoagulability. Coagulopathy occurred with and without each of ARDS, Sepsis and DIC. We conclude that COVID-19 leads to the syndrome of a viral clotting fever in a subgroup of patients and that the presentation of coagulopathy and fever should raise the possibility of COVID-19 as a differential. We make recommendations for future research studies.

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Section: Discussionmentioning

confidence: 99%

“…Prior to Virchow there were different explanations for coagulation. Hippocrates advocated the model of the four humors (Yapijakis, 2009) which was further refined by Galen (Neder, 2020) and remained dominant for 1300 years. In this model, an imbalance in the four humors in the body accounted for disease.…”

Section: Virchow’s Triadmentioning

confidence: 99%

Characterising COVID-19 as a Viral Clotting Fever: A Mixed Methods Scoping Review

Marley

2020

Preprint

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“…Investigating inter-organ communication has garnered more attention in recent years. The mechanisms to control the body’s metabolic balance have been emphasized in a number of groundbreaking research, including the liver-intestine connection [ 9 ], kidney-lung connection [ 10 ] and heart-lung connection [ 11 ]. With the evolution of multicellular organisms, the interactions between peripheral organs and the central nervous system have diversified.…”

Section: Introductionmentioning

confidence: 99%

Study on the central neural pathway and the relationship between the heart and small intestine via a dual neural tracer

ZHANG

Hu³

et al. 2022

PLoS ONE

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Despite very different functions, studies increasingly report that there may be a potential central nervous anatomical connection between the heart and the small intestine. In this study, the central nervous anatomical relationship between the heart and small intestine was studied via a viral tracer. Pseudorabies virus (PRV) syngeneic strains with different fluorescent reporter genes (eGFP or mRFP) were microinjected into the heart walls and small intestinal walls of male C57BL/6J using glass microelectrode. The results showed that the co-labeled nuclei in the brain were lateral periaqueductal gray (LPAG) and ventrolateral periaqueductal gray (VLPAG) in the midbrain, mesencephalic trigeminal nucleus (Me5), and motor trigeminal nucleus anterior digastric Part (5Adi) in the pons. The co-labeled sites in the spinal cord were intermediolateral column (IML) in the second thoracic vertebra, IML and lamina 7 of the spinal gray (7SP) in the third thoracic vertebra, and IML in the fourth thoracic vertebra. Our data show that there is a neuroanatomical connection between the small intestine and the heart in the central nervous system (CNS). Neuroanatomical integration of the heart and small intestine may provide a basis for revealing the physiological and pathological interactions between the circulatory and digestive systems. The interactions may be mediated more effectively through sympathetic nerves.

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Cultural Explanations of Infectious Disease

2022

Historical and Epidemiological Analyses on the Impact of Infectious Disease on Society

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This chapter backs away from the big historical narration of the first chapter and engages critically with the range of explanations that have existed surrounding infectious disease. Exploring models for how humans have considered infectious disease is a way of delving into human-decision making in extremis—how humans make sense of catastrophes large and small without necessarily having immediate insight into their origins. Understandings motivate decisions, regardless of how far in advance of the moment of choice those understandings started to form, so this chapter places emphasis on philosophies of knowledge, biological understandings of knowledge, and the way belief relates to knowledge.

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Cardiovascular and pulmonary interactions: why Galen’s misconceptions proved clinically useful for 1,300 years

Cited by 3 publications

References 52 publications

Characterising COVID-19 as a Viral Clotting Fever: A Mixed Methods Scoping Review

Characterising COVID-19 as a Viral Clotting Fever: A Mixed Methods Scoping Review

Study on the central neural pathway and the relationship between the heart and small intestine via a dual neural tracer

Cultural Explanations of Infectious Disease

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