National Heart And Lung Institute Research Articles

Prioritising Patient Outcomes and Reducing Environmental Burden: How Both Are Achievable in Respiratory Care

Patient outcomes must take precedence when considering environmental legislation related to the availability of inhaler devices, which are essential for the care of patients with respiratory diseases. This article reviews presentations and abstracts from the European Respiratory Society (ERS) International Congress 2023, held in Milan, Italy, in September 2023. The sessions focused on healthcare inequality and patient outcomes, highlighting the need for stakeholders to make patient-centric decisions in order to ensure access to essential inhaled medicines are prioritised. This is especially important during a period when there is an increasing need to reduce the carbon footprint associated with respiratory care. During a satellite symposium, co-chairs John Hurst, Professor of Respiratory Medicine at University College London (UCL), UK, and Helen Reddel, Research Leader at the Woolcock Institute of Medical Research, Sydney, Australia, emphasised the necessity of addressing environmentally sustainable respiratory care while prioritising patient outcomes. Christine Jenkins, Clinical Professor of Respiratory Medicine at the University of New South Wales (UNSW), Sydney, Australia, discussed the association between health inequity and uncontrolled chronic obstructive pulmonary disease (COPD) and asthma, and how that relates to the carbon footprint of treatment. Alberto Papi, Full Professor of Respiratory Medicine at the University of Ferrara, Italy, examined how implementing evidence-based guidelines can improve patient outcomes and reduce the carbon footprint of respiratory care, and the progress being made in the transition to near-zero propellants in pressurised metered-dose inhaler (pMDI) devices. Omar Usmani, Professor of Respiratory Medicine at the National Heart and Lung Institute (NHLI), Imperial College London, UK, stressed that pMDIs contain essential medicines, and inhaler regimens should not be considered readily interchangeable. He urged the respiratory community to ensure that their voice is heard in decisions where it relates to the environment regarding COPD and asthma care. The symposium emphasised the opportunities to reduce the environmental impact of respiratory care whilst prioritising patient outcomes. By supporting the transition to climate-friendly propellants in pMDI devices, and implementing guidelines to improve patient outcomes, the overall carbon footprint of respiratory care can be reduced. However, this must be done without limiting access to essential medicines, or increasing adverse health outcomes. The symposium identified pathways towards achieving patient-centric, sustainable respiratory care by improving outcomes, harnessing innovation, and promoting multi-stakeholder collaboration.

Precision Medicine in Airway Diseases: What Can We Offer in the Clinic?

AN EXCITING session, delivered at the European Respiratory Society (ERS) International Congress 2023, held in Milan, Italy, saw field experts present recent research surrounding precision medicine in airway diseases. Chaired by Apostolos Bossios, Karolinska University Hospital, Stockholm, Sweden; Emer Kelly, St. Vincent’s University Hospital, Dublin, Ireland; and Omar Usmani, National Heart and Lung Institute (NHLI), Imperial College London, UK, presentations discussed the value of ‘omics’, cellular signatures, novel chronic obstructive pulmonary disease (COPD) classifications, and the identification of treatable traits in improving patient care.

What determines blood viscosity at the highest city in the world?

What determines blood viscosity at the highest city in the world?

Meet the First Authors.

Meet the First Authors.

Length doesn't matter-telomere damage triggers cellular senescence in the ageing heart.

Telomere shortening induces cellular senescence in proliferative cells. Yet, it is presently unclear how it is triggered in post‐mitotic cells such as cardiac myocytes. A new study by Anderson et al (2019) reports that during ageing of the heart, cellular senescence develops independently of telomere length, but is evoked by DNA damage, which preferentially accumulates at the telomere. Removal of senescent cells using senolytic drugs ameliorated cardiac hypertrophy and fibrosis and may inform novel approaches to improve the conditions for the ageing heart.

The Birth, and Evolution, of Percutaneous Coronary Interventions: A Conversation With Patrick Serruys, MD, PhD.

Professor Patrick W. Serruys, MD, PhD, has been a Senior Interventional Cardiologist since 1977, Chief of Interventional Research since 1988, and Chief of Interventional Cardiology at the Thorax Center of Erasmus Medical Center, Rotterdam, Emeritus, since April 1, 2014. He was the first Chair of Interventional Cardiology created by the Royal Netherlands Academy of Arts and Sciences (KNAW). Currently, he is Professor of Cardiology in the Cardiovascular Science Division of the National Heart and Lung Institute (NHLI) of Imperial College London. Dr Serruys received his MD in 1972 from the Catholic University of Louvain, Belgium, and his PhD in 1986 from the Erasmus Medical Center in Rotterdam, The Netherlands. Dr Serruys replies: In 1975 at a meeting in Frankfurt, a key opinion leader at that time, Professor Paul Lichtlen, Chief of Cardiology at Hannover, was describing during a keynote lecture a significant coronary lesion with a thin fibrous cap and a large atheromatous core; today, we call this a vulnerable plaque. He mentioned somewhat sarcastically that Dr Andreas Gruentzig had developed a procedure he believed could dilate that type of lesion. There was of course a lot of skepticism whether the procedure could be performed without major distal embolization. I went to see Andreas Gruentzig and to look at his poster. He had tied a ligature with catgut around the coronary artery of a dog, and he was using his balloon to open this artificial narrowing. Honestly, I could not foresee the future of this therapeutic approach. At that time, the Department of Cardiology in Zurich (where Gruentzig worked) was headed by 2 cardiologists, Hans Peter Krayenbuhl and Wilhelm Rutishauser. Krayenbuhl was not in favor of attempting the procedure, but Rutishauser was more enthusiastic about it. The famous Chief of Cardiovascular Surgery, Dr Ake Senning, told the Board of the …

Majid Ezzati: a positive enthusiasm for global health

Among the books on the shelves of Majid Ezzati's office in the Imperial College Faculty of Medicine at St Mary's Hospital in London are three small black iron cooking stoves of the kind found by the million in huts and houses in low-income countries around the world. In most offices you might view the stoves as offbeat mementos of a conference somewhere, or a holiday. These are not. Their presence reflects a line of research that Ezzati has been pursing for two decades: the malign effects of the smoke they emit. “Throughout the fetal period people are exposed, and then from day one of childhood and until the end of life”, he says. He recalls long periods spent breathing their fumes himself when doing field research on these stoves in Kenya. “Your eyes are watery all the time. I was sick during much of the study.” When beginning his PhD on the effects of cooking smoke on childhood pneumonia, he wasn't the first person to have studied the topic. But he was able to take advantage of new technology that allowed him to make precise measurements in the field without the need for equipment more suited to a laboratory. His interest in the issue continues to this day. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participantsSince 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Full-Text PDF Open Access

Comparison of questionnaires: the BMRC and NHLI respiratory questionnaires and a new self-completion questionnaire.

Interviewer-administered National Heart and Lung Institute (NHLI) and British Medical Research Council (BMRC) respiratory questionnaires were compared with each other and with a self-administered questionnaire of our own design in 2,350 adults enrolled in a longitudinal community study. There was a basic 10% disagreement between responses to any 2 questionnaires for all questions that inquired about a perception of a complaint or a disease, but much less disagreement for more factual questions, such as those concerning smoking. Little effect was noted from minor variations in wording, order of questions, method of administration, inclusion of other questions, or time between questionnaires (as long as this interval was less than 1 month). For questions with similar wording, the BMRC and NHLI questionnaires yielded very similar results in terms of over-all prevalence of responses, relationships to answers on an independent questionnaire, and inter-relationships of positive responses. The new self-completion questionnaire used in this study detected more abnormalities and better delineated cough and phlegm "syndromes" than either the NHLI or the BMRC questionnaire, and we believe that self-administration was a very satisfactory technique in the type of population surveyed in this study.

Interactive Haematology Imagebank with Self Assessment

Second Edition Barbara J. Bain Professor of Diagnostic Haematology, St Mary's Hospital Campus, Imperial College Faculty of Medicine, London, UK Wiley-Blackwell, May 2014 The difficulty of morphological disciplines lies in our need to be able to examine visual forms, identify them and know to which disease they correspond. Professionals are always on the lookout for richly illustrated teaching material to refresh what they have already learnt and reveal what they have yet to discover. The DVD by Barbara J. Bain responds magnificently to our every wish in the field of haematology teaching and reference. It makes it easy to pass from one topic to another and to deepen our knowledge on each topic through the hypertext links. All this is presented with constant reference to the image and in an eminently intuitive way that is elegant and effective. The DVD also includes reference data (full blood count, bone marrow differential count), a listing of CD numbers of haematological relevance, the different classifications (FAB, WHO, Ann Arbor) and the presentation of the cytochemical stains used in the diagnosis of acute leukaemia, and even video clips on practical procedures such as bone marrow aspiration. Importantly, all images in this bank can be used for teaching purposes on condition the source is acknowledged, and the material can be networked subject to permission. Lastly, this DVD is very reasonably priced (€284.40) for its wealth of content (images and text) and its accessibility. This tool has its place everywhere that haematology is practised. There is, however, one danger: it's addictive!

Heart Failure Therapy: drugs, Genes Or Stem cells?

Professor Sian Harding talks to Caroline Telfer, Assistant Commissioning Editor. Professor Sian Harding obtained her PhD in Pharmacology from King's College, London (UK) in 1981. She became Professor of Cardiac Pharmacology at the National Heart and Lung Institute, a division of the Imperial College Faculty of Medicine, in 2002. Her work has been funded by the British Heart Foundation, the Wellcome Trust, the Medical Research Council, the Biochemical and Biophysical Research Council, the The National Centre for the Replacement, Refinement and Reduction of Animals in Research, Pfizer, GlaxoSmithKline and SmithKline Beecham. Harding is former president of the European Section of the International Society for Heart Research and has organized international cardiovascular science meetings for this society, as well as for the European Society of Cardiology. She is the principal investigator for the first UK gene therapy trial aimed at improving cardiac contractility, organized jointly at Harefield and Papworth Hospitals. Harding is a member of the Nuffield Council on Bioethics and the Medical Research Coucil Regenerative Medicine Research Committee, and Director of a recently awarded British Heart Foundation Cardiovascular Regenerative Medicine Centre. She has been elected Fellow of the American Heart Association, European Society of Cardiology, International Society for Heart Research, Society of Biology and British Society of Pharmacology.

CrossTalk opposing view: The intermittent hypoxia attending severe obstructive sleep apnoea does not lead to alterations in brain structure and function

Ivana Rosenzweig, Steven C. Williams and Mary J. Morrell Department of Neuroimaging, Institute of Psychiatry, King’s College London, UK Danish Epilepsy Centre, Dianalund, Denmark Academic Unit of Sleep and Breathing, NationalHeart andLung Institute, Imperial College London, and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK

2009 versus 2010 comparison of influenza activity in southern hemisphere temperate countries

Global Influenza Programme, World HealthOrganization, Geneva, Switzerland.Correspondence: Maria D. Van Kerkhove, MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology,Imperial College Faculty of Medicine, St Mary’s Campus, Norfolk Place, London W2 1PG, UK. E-mail: m.vankerkhove@imperial.ac.ukAccepted 21 February 2011. Published Online 21 March 2011.

Experimental glucocorticoid induced osteoporosis: differences between mouse strains

Event Abstract Back to Event Experimental glucocorticoid induced osteoporosis: differences between mouse strains Y Vattakuzhi1*, AR Clark1 and NJ Horwood1 1 Imperial College Faculty of Medicine, Kennedy Institute of Rheumatology, United Kingdom Glucocorticoids (GCs) are frequently used in inflammatory diseases like rheumatoid arthritis, asthma and inflammatory bowel disease. Long term use of GCs, however, can lead to the development of GC induced osteoporosis (GIO). GIO is characterised by increased osteoclast (OCL) activity and decreased osteoblast activity leading to bone loss; paradoxically, GCs are also reported to inhibit p38 MAPK activity and to directly inhibit OCL function. Experimental models of GIO are well established in the outbred Swiss Webster mice and show loss of bone volume and trabecular connectivity. However, most genetically modified mice are on C57BL/6 background and the aim of this study was to induce GIO in this strain. {BR}CD1 mice were used instead of Swiss Webster mice in these experiments; they are an outbred strain similarly derived from the original Swiss mice. Bone marrow cells of C57BL/6 and CD1 mice were used to investigate the effect of GCs on OCL formation and activity in vitro and to assess p38 activity. To determine the in vivo effects of GCs in the two mouse strains, slow release pellets containing the GC prednisolone were implanted subcutaneously into C57BL/6 and CD1 mice to induce GIO. 3.2mg/kg/day of prednisolone was released over a 58 day period. Lumbar vertebrae and tibiae were then analysed by bone histomorphometry and micro CT analysis. Bone marrow cells were harvested for colony forming assays to determine differences in the progenitor cell populations after GC treatment as well as for in vitro OCL assays.{BR}GCs inhibited p38 activity after RANKL stimulation in C57BL/6 mice; however, in vitro OCL formation and activity was not affected. Long term treatment with prednisolone did not reduce trabaecular volume and bone mineral density compared to placebo in C57BL/6 mice in contrast to CD1 mice. In addition no differences were observed in progenitor cell populations in C57BL/6 mice.{BR}Experimental models of GIO are therefore dependent on the genetic background of the mice with CD1 mice being more susceptible than C57BL/6 mice to glucocorticoid induced bone loss. Keywords: Bones, Bone Research Conference: 2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society, Cambridge, United Kingdom, 27 Jun - 29 Jun, 2011. Presentation Type: Poster Topic: Abstracts Citation: Vattakuzhi Y, Clark A and Horwood N (2011). Experimental glucocorticoid induced osteoporosis: differences between mouse strains. Front. Endocrinol. Conference Abstract: 2011 joint meeting of the Bone Research Society & the British Orthopaedic Research Society. doi: 10.3389/conf.fendo.2011.02.00070 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Sep 2011; Published Online: 30 Sep 2011. * Correspondence: Prof. Y Vattakuzhi, Imperial College Faculty of Medicine, Kennedy Institute of Rheumatology, London, W6 8LH, United Kingdom, yv07@ic.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Y Vattakuzhi AR Clark NJ Horwood Google Y Vattakuzhi AR Clark NJ Horwood Google Scholar Y Vattakuzhi AR Clark NJ Horwood PubMed Y Vattakuzhi AR Clark NJ Horwood Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Is oil red-O staining and digital image analysis the gold standard for quantifying steatosis in the liver?

We read with great interest the randomized placebo-controlled trial by Abdelmalek et al.,1 in which the effects of betaine were studied in nonalcoholic fatty liver disease (NAFLD). The authors used the widely employed NAFLD activity score (NAS)2 as part of the inclusion criteria to their study and as the “gold-standard” endpoint to define treatment response. One of the major outcomes identified in the trial was change in the steatosis grade. The NAS is a well-validated, pragmatic, semiquantitative scoring system for determining the severity of NAFLD.3 The degree of steatosis contributes up to 3 of the 8 points to this score, and hepatocyte ballooning (which may be confused with small-droplet steatosis) contributes a further 2 points. Given the large contribution of steatosis to the overall score, it is important to correctly identify steatosis in a liver biopsy. During the study of both human tissue and tissue from mouse models of NAFLD, we have found that accurately determining the amount of steatosis on hematoxylin and eosin (H&E) staining, especially when the fat droplets are small, is extremely challenging. Consequently, we have explored an alternative approach adopting Oil red-O (ORO) as the “gold standard” histochemical stain for specifically identifying lipids.4 Using steatotic murine liver tissue from C57BL/6 mice, we compared the assessment of steatosis in H&E-stained sections by two expert liver pathologists with digital image analysis (DIA) quantification of ORO-stained sections. Hepatic triglyceride levels were quantified in the same tissues (triglyceride quantification kit, ab65336; Abcam Inc., Cambridge, MA). We found that, although ORO DIA assessment correlates well with the total liver triglyceride concentration and is therefore an accurate reflection of liver steatosis (Pearson correlation R = 0.706, P = 0.001), assessment by the expert pathologists showed poor correlation (R = −0.422). In samples with macrovesicular steatosis, we found that liver pathologists overestimated the amount of steatosis present on H&E stain as compared with ORO DIA (71.8% versus 46.7%, P < 0.01). In 67% of cases, the NAS steatosis score decreased from 3 to 2 when using ORO DIA. We conclude that the ORO DIA technique provides a more accurate quantification of microvesicular and macrovesicular steatosis. The NAS score is a useful and pragmatic tool in clinical practice and for patient selection for trial entry, but when the score is used as an outcome measure in a clinical trial setting, its performance is less robust. When, as Abdelmalek et al.1 report, steatosis changes are the major study outcome, it is therefore difficult to know whether inaccurate scoring of H&E-stained sections by expert pathologists confounds these observations. ORO DIA is the most reliable way to accurately assess and quantify histological liver steatosis. We accept that ORO staining is not practical for everyday use. It is optimally performed on frozen tissue because processing removes the lipids, hence the stain is not routinely performed on liver biopsies. However, its use may be of merit in clinical trials. Indeed, we have been able to successfully perform ORO staining on frozen sections of formalin-fixed human liver biopsies prior to processing, making wider adoption of this technique viable. Adam P. Levene MBChB Hons*, Hiromi Kudo MSc*, Mark R. Thursz M.D, FRCP , Quentin M. Anstee Ph.D., FRCP , Robert D. Goldin M.D., FRCPATH*, * Department of Histopathology, Imperial College Faculty of Medicine at St Mary's Hospital, London, UK, Department of Gastroenterology and Hepatology, Imperial College Faculty of Medicine at St Mary's Hospital, London, UK.

In memoriam: Professor Brian Maurice John Foxwell, 1956 to 2008

In memoriam: Professor Brian Maurice John Foxwell, 1956 to 2008

Thematic review series: The Pathogenesis of Atherosclerosis. An interpretive history of the cholesterol controversy, part IV: The 1984 Coronary Primary Prevention Trial ends it—almost

As of the early 1980s, despite the wealth of evidence from experimental animal models, the extensive epidemiologic evidence, the powerful genetic evidence, and the strongly suggestive clinical intervention trial results, most clinicians still remained unpersuaded regarding the relevance of the lipid hypothesis. What was needed was a well-designed, large-scale, long-term, double-blind study demonstrating a statistically significant impact of treatment on coronary heart disease events. The National Institutes of Health (NIH) had laid the groundwork for such a study as early as 1970, but the study was not completed and the results published until 1984. This study, the Coronary Primary Prevention Trial, showed that treatment with a bile acid binding resin reduced major coronary events in hypercholesterolemic men by 19%, with a P value of 0.05. The NIH followed this up with a national Consensus Development Conference on Lowering Blood Cholesterol to Prevent Heart Disease. For the first time, the NIH now went on record advocating screening for hypercholesterolemia and urging aggressive treatment for those at high risk. The Institute initiated a national cooperative program to that end, the National Cholesterol Education Program. For the first time, preventing coronary heart disease became a national public health goal.

MSc in Medical Ultrasound Full-time/Part-time (specialising in echocardiography, general ultrasound, obstetric and gynaecological ultrasound physics or vascular ultrasound) Imperial College Faculty of Medicine, Hammersmith Campus, London

MSc in Medical Ultrasound Full-time/Part-time (specialising in echocardiography, general ultrasound, obstetric and gynaecological ultrasound physics or vascular ultrasound) Imperial College Faculty of Medicine, Hammersmith Campus, London

Magnetic brain stimulation can improve clinical outcome in incomplete spinal cord injured patients.

Preliminary longitudinal clinical trial. To test the efficacy of repetitive transcranial magnetic stimulation (rTMS) in modulating corticospinal inhibition and improving recovery in stable incomplete spinal cord injury (iSCI). National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, UK and Division of Neuroscience, Imperial College Faculty of Medicine, Charing Cross Hospital, London, UK. Four stable iSCI patients were treated with rTMS over the occipital cortex (sham treatment) and then over the motor cortex (real treatment). Patients were assessed using electrophysiological, clinical and functional measures before treatment, during sham treatment, during the therapeutic treatment and during a 3-week follow-up period. Cortical inhibition was reduced during the treatment week. Perceptual threshold to electrical stimulation of the skin, ASIA clinical measures of motor and sensory function and time to complete a peg-board improved and remained improved into the follow-up period. In this preliminary trial, rTMS has been shown to alter cortical inhibition in iSCI and improve the clinical and functional outcome. This work was supported by the International Spinal Research Trust.

The role of inflammation in airway disease: remodeling.

Department of Pediatrics, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands; University Department of Child Health, Leicester Royal Infirmary, Leicester, United Kingdom; and Paediatric Respirology, Imperial School of Medicine at the National Heartand Lung Institute, Royal Brompton Hospital, London, United Kingdom

NHLBI: fifty years of achievement in pulmonary biology and medicine.

On June 16, 1948, the National Heart Act (P.L. 80-655) authorized the formation of the National Heart Institute (NHI) to “improve the health of the people of the United States through the conduct of researches, investigations, experiments, and demonstrations relating to the cause, prevention, and method of diagnosis and treatment of diseases of the heart and circulation; assist and foster such researches and other activities by public and private agencies, and promote the coordination of all such researches and activities and the useful application of their results; provide training in matters related to heart diseases, including refresher courses for physicians; and develop, and assist states and other agencies in use of the most effective methods of prevention, diagnosis and treatment of heart diseases.” Although the NHI focused its efforts mainly on heart disease, its programs from the beginning included many projects on cardiopulmonary physiology. Research on topics such as fluid balance, muscle biology, control of breathing, high-altitude physiology, and hyperbaric medicine were part of the grant portfolio. These investigations paved the way for formal recognition of a long-standing need for a national program committed to diseases of the lung when the Secretary of the Department of Health, Education, and Welfare announced in November 1969 an expansion of the NHI to the National Heart and Lung Institute (NHLI). * At that time, the National Institutes of Health (NIH) was providing $11.0 million for support of research and training in respiratory diseases, but these activities were dispersed among various institutes, with little integration and no mechanism for coordination. Shortly after issuance of the new charter, several administrative actions were taken: ( 1 ) the NIH Guidelines for Referral were modified to reflect the expanded role of the NHLI; ( 2 ) the National Heart and Lung Advisory Council was increased from 12 to 16 members (Table 1); ( 3 ) an Office of Lung Programs was established in the NHLI; and ( 4 ) an intramural pulmonary program was initiated with establishment of a Pulmonary Function Laboratory in March 1971 and, shortly thereafter, a Pulmonary Branch for Intramural Research. In September 1972 Congress enlarged the authority of the Institute through the National Heart, Blood Vessel, Lung, and Blood Act (P.L. 92-423), which provided for expanded, intensified, and coordinated Institute activities in lung disease research and training. This action launched the formation of the Division of Lung Diseases and the beginning of intense research efforts in all aspects of pulmonary biology and medicine (with the exception of lung cancer, which remained in the National Cancer Institute, and infectious lung diseases, which remained the responsibility of the National Institute of Allergy and Infectious Diseases). In this report, we highlight some of the administrative steps that were taken and acknowledge the contributions of some individuals and groups that played an important role in guiding the implementation and evaluation of the national pulmonary research effort. As we mark the 50th anniversary of the NHLBI, it is clear that throughout the history of the Institute, a close and valuable collaboration in cardiopulmonary medicine must be recognized as contributing to a vast knowledge base that served as the foundation for many important discoveries made in this last half-century.