Chronic wounds have traditionally been classified based on their etiology (venous ulcers, diabetic ulcers, pressure ulcers, etc.), reinforcing a reductionist perspective of the problem. However, this fragmented model has undermined understanding of their common pathophysiology and standardizing management approaches. From a medical epistemology standpoint, the evolution of pathological concepts has demonstrated that many syndromes were initially considered heterogeneous disorders until their underlying commonality became evident (e.g., metabolic syndrome, systemic inflammatory response syndrome). This review discusses and supports the proposition that chronic wounds should be conceptualized within a syndromic framework, wherein a shared set of pathophysiological processes underlies their diverse clinical manifestations, prompting a move beyond etiological reductionism. This proposition is supported by three epistemological arguments: biological, clinical, and practical. Through an analysis of fundamental syndromic principles, relevant examples illustrate this novel perspective. Ultimately, this proposition aims to advance a comprehensive and multi-level approach to chronic wound care, emphasizing multidimensional therapies that facilitate optimal, timely, and cost-effective outcomes. Such a conceptual shift would enable the integration of therapeutic strategies, the development of cross-cutting biomarkers, improved prediction of treatment responses, and greater consensus in research.

The endothelial nitric oxide synthase (eNOS) gene plays an important role in several biological functions. Polymorphisms of the eNOS gene have been associated with cancer. It has been suggested that the VNTR 4 a/b polymorphism may affect the expression of eNOS and contributes to tumor promotion in the mammary gland. We examined the role of the eNOS4 a/b polymorphism by comparing the genotypes of 281 healthy Mexican women with the genotypes of 429 Mexican women with breast cancer (BC). The observed genotype frequencies for control and BC patients were 0.6% and 0.7% for a/a (polymorphic); 87% and 77% for a/a (wild type); and 12% and 22% for a/b respectively. We found that the odds ratio (OR) was 1.9, with a 95% confidence interval (95%CI) of 1.29-2.95, P = 0.001 for genotypes a/a-a/b, b/c. The association was also evident when comparing the distribution of the a/a-a/b genotypes in patients with high levels of glutamate-oxaloacetate transaminase (SGOT) (OR, 1.93; 95% CI, 1.14-3.28; P = 0.015); undergoing menopause with high levels of SGOT (OR, 2.0; 95% CI, 1.1-3.84); and with high levels of glutamic-pyruvic transaminase (SGPT) (OR, 3.5; 95% CI, 1.56-8.22). The genotypes a/a-a/b are associated with BC susceptibility in the analyzed samples from the Mexican population.
Adult ; Alanine Transaminase/*blood ; Aspartate Aminotransferases/*blood ; Breast Neoplasms/*blood/*genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Mexico ; Middle Aged ; Nitric Oxide/biosynthesis/metabolism ; Nitric Oxide Synthase Type III/*genetics ; Polymorphism, Single Nucleotide

Previous evidence supports the important role that oxidative stress (OxS) plays in metabolic syndrome (MetS)-related manifestations. We determined the relationship between the number of MetS components and the degree of OxS in MetS patients. In this comparative cross-sectional study from the LIPGENE cohort, a total of 91 MetS patients (43 men and 48 women; aged between 45 and 68 years) were divided into four groups based on the number of MetS components: subjects with 2, 3, 4 and 5 MetS components (n=20, 31, 28 and 12, respectively). We measured ischemic reactive hyperemia (IRH), plasma levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), total nitrite, lipid peroxidation products (LPO), hydrogen peroxide (H2O2), superoxide dismutase (SOD) and glutathione peroxidase (GPx) plasma activities. sVCAM-1, H2O2 and LPO levels were lower in subjects with 2 or 3 MetS components than subjects with 4 or 5 MetS components. IRH and total nitrite levels were higher in subjects with 2 or 3 MetS components than subjects with 4 or 5 MetS components. SOD and GPx activities were lower in subjects with 2 MetS components than subjects with 4 or 5 MetS components. Waist circumference, weight, age, homeostatic model assessment-beta, triglycerides (TGs), high-density lipoprotein and sVCAM-1 levels were significantly correlated with SOD activity. MetS subjects with more MetS components may have a higher OxS level. Furthermore, association between SOD activity and MetS components may indicate that this variable could be the most relevant OxS biomarker in patients suffering from MetS and could be used as a predictive tool to determine the degree of the underlying OxS in MetS.
Aged ; Anthropometry ; Antioxidants/metabolism ; Biological Markers/metabolism ; Blood Pressure ; Endothelium, Vascular/pathology/physiopathology ; Female ; Glutathione Peroxidase/blood ; Humans ; Hydrogen Peroxide/metabolism ; Hyperemia/blood/physiopathology ; Male ; Metabolic Syndrome X/blood/enzymology/*pathology/physiopathology ; Middle Aged ; Nitrites/blood ; *Oxidative Stress ; Regression Analysis ; Superoxide Dismutase/blood ; Vascular Cell Adhesion Molecule-1/metabolism