Journal of Investigative Medicine

Mini-extracorporeal circulation (MECC) units were developed to reduce postoperative morbidity, transfusion requirements, and inflammation associated with conventional on-pump coronary artery bypass (ONCAB) surgery without the technical demands of the off-pump (OPCAB) technique. We compared perioperative outcomes and inflammatory mediation among OPCAB, MECC, and ONCAB techniques.

We prospectively enrolled 102 patients undergoing elective isolated coronary bypass grafting. Perfusion methods were OPCAB (n = 34), MECC (n = 34), and ONCAB (n = 34). Serial blood samples were collected to measure serum inflammatory markers.

There were no operative deaths or strokes. Total red blood cell (RBC) products used in OPCAB, MECC, and ONCAB patients were 0.676, 1.000, and 1.235 units, respectively. Adjusted (by splined Society of Thoracic Surgeons operative risk score) analysis showed no statistically significant differences in mean RBC product use among the different operative systems (OPCAB vs MECC, P = 0.580; OPCAB vs ONCAB, P = 0.311; MECC vs ONCAB, P = 0.633). Adjusted (by Society of Thoracic Surgeons risk score and baseline level) mean plasma level differences (24 hours postoperative - baseline) of C-reactive protein for OPCAB (117.89; 95% confidence interval [95% CI], 106.23–129.54) and for MECC (124.88; 95% CI, 113.45–136.32) were significantly higher than for ONCAB (98.82; 95% CI, 86.40–111.24). No significant adjusted differences (P = 0.304) in interleukin-6 level changes were observed.

Off-pump coronary artery bypass and MECC did not significantly reduce mean total RBC transfusion requirements. Off-pump coronary artery bypass and MECC were associated with greater C-reactive protein elevation than ONCAB, suggestive of an increased inflammatory response to each of these techniques.

Vitamin D may influence many diseases, including type 2 diabetes mellitus.

We studied serum levels of 25-hydroxyvitamin D (25(OH)D) and associated characteristics in type 2 diabetic outpatients with pharmacologic treatment attended in internal medicine offices in a first-level hospital from Extremadura (Southern Spain).

We included a total of 103 patients. Seventy-two patients (69.9%) had serum levels of 25(OH)D lower than 20 ng/mL. There was inverse correlation between serum levels of 25(OH)D and glycosylated hemoglobin (r = −0.74, P = 0.01). In 78 patients without insulin therapy, we found inverse correlation between serum levels of 25(OH)D and fasting serum insulin (r = −0.82, P = 0.001) and Homeostasis Model Assessment–Insulin Resistance (r = −0.51, P < 0.001).

Vitamin D deficiency is common in type 2 diabetic patients. There are inverse correlations between vitamin D and metabolic control and insulin resistance.

Hyperuricemia is an independent predictor of impaired fasting glucose and type 2 diabetes, but whether it has a causal role in insulin resistance remains controversial. Here we tested the hypothesis that lowering uric acid in hyperuricemic nondiabetic subjects might improve insulin resistance.

Subjects with asymptomatic hyperuricemia (n = 73) were prospectively placed on allopurinol (n = 40) or control (n = 33) for 3 months. An additional control group consisted of 48 normouricemic subjects. Serum uric acid, fasting glucose, fasting insulin, HOMA-IR (homeostatic model assessment of insulin resistance), and high-sensitivity C-reactive protein were measured at baseline and at 3 months.

Allopurinol-treated subjects showed a reduction in serum uric acid in association with improvement in fasting blood glucose, fasting insulin, and HOMA-IR index, as well as a reduction in serum high-sensitivity C-reactive protein. The number of subjects with impaired fasting glucose significantly decreased in the allopurinol group at 3 months compared with baseline (n = 8 [20%] vs n = 30 [75%], 3 months vs baseline, P < 0.001). In the hyperuricemic control group, only glucose decreased significantly and, in the normouricemic control, no end point changed.

Allopurinol lowers uric acid and improves insulin resistance and systemic inflammation in asymptomatic hyperuricemia. Larger clinical trials are recommended to determine if lowering uric acid can help prevent type 2 diabetes.

Contrast-induced nephropathy (CIN) is a common complication of diagnostic/therapeutic procedures. Serum creatinine levels are sensitive but often lead to diagnostic delays in acute kidney injury and potential misclassification of actual injury status. Kidney injury molecule (KIM-1) is a novel early marker of acute kidney injury. The aim of our study was to evaluate the KIM-1 levels in patients with CIN. We performed a single-center, nested case-control study.

Three thousand two hundred patients who had undergone coronary angiography were included in the study. Thirty-two patients were diagnosed with CIN. Twenty patients who had undergone coronary angiography but did not have CIN were evaluated as a control group (n = 20). The diagnosis of CIN was performed according to the KDIGO 2012 Acute Kidney Injury Guideline criteria. Urinary KIM-1 levels were measured by enzyme-linked immunosorbent assay before as well as on the 6th and 48th hours of contrast exposure. Serum creatinine levels were measured before as well as on the 24th and 48th hours after angiographic procedure.

We demonstrated that KIM-1 levels increased in the patients with CIN significantly on the sixth hour when compared with the baseline (P < 0.01; median levels, 0.27 and 0.70 mg/dL) but not in the controls (P = 0.107). The precontrast and 48th-hour KIM-1 levels were median ones and were also significantly different (P = 0.001, the median levels were 0.27 and 0.60 mg/dL, respectively).

Because creatinine is a sensitive but a late marker of CIN, KIM-1 may be used for early diagnosis and early initiation of treatment and may reduce risk for morbidity.

Guanidinoacetic acid (GAA), a natural precursor of creatine, is a new promising dietary supplement, yet its performance-enhancing effect, if any, has yet to be established. The purpose of this pilot study was to evaluate the effects of supplemental GAA on muscle strength, anaerobic performance, and aerobic performance in healthy men and women.

The study enrolled 48 young participants (age, 22.3 ± 1.5 years; height, 176.4 ± 10.0 cm; weight, 71.9 ± 14.3 kg), who received oral doses of GAA (1.2, 2.4, or 4.8 g/d) for 6 weeks in a randomized, double-blind, placebo-controlled trials.

Significant differences were observed between treatment groups for handgrip strength among participants receiving 1.2 g of GAA per day and 2.4 g of GAA per day, as compared with placebo (P < 0.05). In addition, muscle endurance expressed as the change from baseline in repetitions performed in the bench press exercise was significantly greater in the 1.2 g/d dose of GAA (P = 0.01) and the 4.8 g/d dose (P = 0.01) compared with placebo. No dose-response differences were found between trials.

Results from this preliminary study indicate that supplemental GAA ingested in young individuals can improve exercise performance, even at low doses (1.2 g/d).