Homocisteína en el paciente con diabetes mellitus

Association between homocysteine level and length of stay in patients with lower extremity atherosclerotic disease: a retrospective cohort study

OBJECTIVES

Homocysteine (Hcy) level has been widely identified as a risk factor associated with adverse outcomes in patients with lower extremity atherosclerotic disease (LEAD). However, there are still some knowledge gaps in research on the association between Hcy level and downstream adverse outcomes, such as length of stay (LOS). This study aims to explore whether and to what extent Hcy level is associated with LOS in patients with LEAD.

DESIGN

Retrospective cohort study.

SETTING

China.

PARTICIPANTS, PRIMARY AND SECONDARY OUTCOMES

We conducted a retrospective cohort study of 748 patients from inpatients with LEAD between January 2014 and November 2021 at the First Hospital of China Medical University in China. We used a slew of generalised linear models to evaluate the association between Hcy level and LOS.

RESULTS

The patients' median age was 68 years and 631 (84.36%) were males. A dose-response curve with an inflection point at 22.63 µmol/L was observed between Hcy level and LOS after the adjustment of potential confounders. LOS increased before Hcy level reached the inflection point (β: 0.36; 95% CI: 0.18 to 0.55; p<0.001).ConclusionOur results show that an Hcy level <22.63 µmol/L is associated with increased LOS in patients with LEAD, which was independent of some other risk factors. This might shed light on how Hcy can be used as a key marker in the comprehensive management of patients with LEAD during hospitalisation.

VSMC-Specific Deletion of FAM3A Attenuated Ang II-Promoted Hypertension and Cardiovascular Hypertrophy

RATIONALE

Dysregulated purinergic signaling transduction plays important roles in the pathogenesis of cardiovascular diseases. However, the role and mechanism of vascular smooth muscle cell (VSMC)-released ATP in the regulation of blood pressure, and the pathogenesis of hypertension remain unknown. FAM3A (family with sequence similarity 3 member A) is a new mitochondrial protein that enhances ATP production and release. High expression of FAM3A in VSMC suggests it may play a role in regulating vascular constriction and blood pressure.

OBJECTIVE

To determine the role and mechanism of FAM3A-ATP signaling pathway in VSMCs in the regulation of blood pressure and the pathogenesis of hypertension.

METHODS AND RESULTS

In the media layer of hypertensive rat and mouse arteries, and the internal mammary artery of hypertensive patients, FAM3A expression was increased. VSMC-specific deletion of FAM3A reduced vessel contractility and blood pressure levels in mice. Moreover, deletion of FAM3A in VSMC attenuated Ang II (angiotensin II)-induced vascular constriction and remodeling, hypertension, and cardiac hypertrophy in mice. In cultured VSMCs, Ang II activated HSF1 (heat shock factor 1) to stimulate FAM3A expression, activating ATP-P2 receptor pathway to promote the change of VSMCs from contractile phenotype to proliferative phenotype. In the VSMC layer of spontaneously hypertensive rat arteries, Ang II-induced hypertensive mouse arteries and the internal mammary artery of hypertensive patients, HSF1 expression was increased. Treatment with HSF1 inhibitor reduced artery contractility and ameliorated hypertension of spontaneously hypertensive rats.

CONCLUSIONS

FAM3A is an important regulator of vascular constriction and blood pressure. Overactivation of HSF1-FAM3A-ATP signaling cascade in VSMCs plays important roles in Ang II-induced hypertension and cardiovascular diseases. Inhibitors of HSF1 could be potentially used to treat hypertension.

N-acetylcysteine has neuroprotective effects against oxaliplatin-based adjuvant chemotherapy in colon cancer patients: preliminary data

Although adding oxaliplatin to fluorouracil and leucovorin in adjuvant chemotherapy for colon cancer may improve disease-free survival, grade 3-4 sensory neuropathy also increases. To determine whether oral N-acetylcysteine is neuroprotective against oxaliplatin-induced neuropathy, we did a pilot study. Fourteen stage III colon cancer patients with 4 or more regional lymph nodes metastasis (N2 disease) receiving adjuvant biweekly oxaliplatin (85 mg/m(2)) plus weekly fluorouracil boluses and low-dose leucovorin were randomized to oral N-acetylcysteine (1,200 mg) (arm A) or placebo (arm B). Clinical neurological and electrophysiological evaluations were performed at baseline and after 4, 8, and 12 treatment cycles. Treatment-related toxicity was evaluated based on National Cancer Institute (NCI) Criteria. After four cycles of chemotherapy, seven of nine patients in arm B and two of five in arm A experienced grade 1 sensory neuropathy. After eight cycles, five experienced sensory neuropathy (grade 2-4 toxicity) in arm B; none in arm A (p<0.05). After 12 cycles, grade 2-4 sensory neuropathy was observed in eight patients in arm B, one in arm A (p<0.05). There were no significant electrophysiological changes in arm A after 4, 8, or 12 cycles of chemotherapy. We concluded that oral N-acetylcysteine reduces the incidence of oxaliplatin-induced neuropathy in colon cancer patients receiving oxaliplatin-based adjuvant chemotherapy.