Obestatin regulates adipocyte function and protects against diet-induced insulin resistance and inflammation.

The metabolic actions of the ghrelin gene-derived peptide obestatin are still unclear. We investigated obestatin effects in vitro, on adipocyte function, and in vivo, on insulin resistance and inflammation in mice fed a high-fat diet (HFD). Obestatin effects on apoptosis, differentiation, lipolysis, and glucose uptake were determined in vitro in mouse 3T3-L1 and in human subcutaneous (hSC) and omental (hOM) adipocytes. In vivo, the influence of obestatin on glucose metabolism was assessed in mice fed an HFD for 8 wk. 3T3-L1, hSC, and hOM preadipocytes and adipocytes secreted obestatin and showed specific binding for the hormone. Obestatin prevented apoptosis in 3T3-L1 preadipocytes by increasing phosphoinositide 3-kinase (PI3K)/Akt and extracellular signal-regulated kinase (ERK)1/2 signaling. In both mice and human adipocytes, obestatin inhibited isoproterenol-induced lipolysis, promoted AMP-activated protein kinase phosphorylation, induced adiponectin, and reduced leptin secretion. Obestatin also enhanced glucose uptake in either the absence or presence of insulin, promoted GLUT4 translocation, and increased Akt phosphorylation and sirtuin 1 (SIRT1) protein expression. Inhibition of SIRT1 by small interfering RNA reduced obestatin-induced glucose uptake. In HFD-fed mice, obestatin reduced insulin resistance, increased insulin secretion from pancreatic islets, and reduced adipocyte apoptosis and inflammation in metabolic tissues. These results provide evidence of a novel role for obestatin in adipocyte function and glucose metabolism and suggest potential therapeutic perspectives in insulin resistance and metabolic dysfunctions.

Combination of two long-pedicled myocutaneous flaps for closure of a complex contralateral dorsal defect.

A large and deep oncological defect has been filled up using a very long-pedicled latissimus dorsi myocutaneous flap, together with a trapezius myocutaneous flap, both harvested contralaterally to the lesion. Despite the distance of the defect from the area from which the flaps have been harvested, use of long-pedicled flaps warranted a better flap rotation with less tension and greater availability of bulky tissues. Both flaps were viable, and the recipient site healed uneventfully. The two donor sites were closed directly and healed rapidly. Therefore, a challenging complex thoracic defect was covered immediately after oncological resection through a combination of two myocutaneous flaps contralaterally harvested, which seemed safe and reliable.

Selective breast reduction: a personal approach with a central-superior pedicle.

BACKGROUND: Breast reduction shows a greater risk of complications in peculiar cases such as those with gigantomastia, a high degree of ptosis, obesity, smoking, cardiovascular diseases, or metabolic disorders. The authors feel that a reduction in the complication rate can be achieved by safeguarding the vascular and nervous structures of the breast as much as possible. METHODS: The authors propose a breast reduction method based on a double central-superior pedicle that was used in 91 patients with a more or less elevated degree of obesity. This technique aims to remove excess tissue, preserving the noble structures of the breast. Beginning from preoperative drawings similar to the ones of Lejour, deepithelialization and wide medial and lateral skin undermining are performed. Next, the excess tissue is removed from the caudal, medial, and lateral portions of the breast and from the deep cranial portion, sparing the horizontal septum that supplies vessels and nerves to the nipple. A "handle" composed of the superior and central pedicles is obtained. After fixing the central pedicle to the thoracic wall, redundant skin is removed, and a vertical or J-shaped suture is made. RESULTS: The authors obtained good breast shape, short scars, and optimal viability of the nipple-areola complex. The results are stable and durable, and the complication rate seems to be very low. CONCLUSIONS: The authors believe that this technique may be a valid alternative to traditional methods, especially in vast tissue resections and in cases of considerable nipple-areola complex lift. It is mainly indicated in obese and partial weight loss patients.

Reconstruction of the retroauricular fold by 'nonpedicled' superficial mastoid fascia: details of anatomy and surgical technique.

During ear reconstruction, it is often difficult to achieve a good projection of the new ear. This is due to the retraction of retroauricular tissues, and the use of a cartilage wedge and superficial temporal fascia is frequently needed to elevate the ear framework. The aim of this article is to identify, by cadaver dissection, the anatomical structures of the retroauricular and mastoid regions and also to demonstrate the possibility of increasing the size of the superficial mastoid fascia by defibrating and cutting up its structure. The cartilage wedge is then inserted into a three-dimensional fascial environment. This allows reconstruction of the retroauricular fold with 'nonpedicled' fascia and to have a firm, stable ear elevation without sacrificing the temporal fascia. Nine ear reconstructions were performed using this technique and no major complications occurred; however, one procedure was complicated by a limited necrosis of the skin graft. In all cases we obtained a good and persistent elevation of the ear, as well as a well-defined fold, with the possibility of wearing glasses. Symmetry was satisfactory and aesthetic results were pleasant for all treated patients. This simple procedure allows one to obtain a good projection of the ear without involving the use of the superficial temporal fascia, which in addition is very useful in case of eventual complications such as cartilage extrusion.

Abdominoplasty after weight loss in morbidly obese patients: a 4-year clinical experience.

BACKGROUND: Morbid obesity is associated with various co-morbidities. With the significant weight loss, new dysfunctions arise, and prior body contour disorders start to severely affect the patient's quality of life. The abdominal apron is generally the greater and the first disturbance faced by the post-bariatric patient. METHODS: The authors retrospectively reviewed their clinical experience in the treatment of those disorders through abdominoplasty. The benefits in terms of relief of said disorders and drawbacks in terms of surgical complications are described. RESULTS: 117 abdominoplasties were performed from January 2002 to December 2005 on patients who had lost significant weight. The tissue removed ranged from 400 g to 10,500 g of adipose-cutaneous tissue (mean 2,276.5 g). Mean duration of the procedure was 4 hours and 25 minutes, with a maximum of 7 and a minimum of 2 and 40. Complication rate was 50.43%. CONCLUSION: Abdominoplasty in the post-obese patient is an apparently simple procedure, which in fact causes a high rate of surgical complications. The complication rate is higher than that of cosmetic abdominoplasties. Nevertheless, the improvement in quality of life following such a procedure renders it a fundamental step in the rehabilitation of the formerly obese patient.

The plastic surgeon in the treatment of obesity.

Obesity is an increasingly common disease, whose complex treatment often terminates with the patient's discontinuation of therapies. The authors suggest how to improve a multidisciplinary approach to the obese, to increase compliance with therapy. A characterization of obesity is a helpful initial step. It consists of an accurate anatomic definition of fat distribution, which can more accurately be performed by imaging (U/S, CT, MRI). The patient's obesity should also be identified based on the physical characteristics that we propose. The plastic surgeon's intervention is often required and beneficial in every type of obesity. Many body areas are appropriate for contouring. Apart from providing a gain in esthetic appearance, plastic surgery also results in several benefits for the patient's general health.