RESUMEN
The effect of oleic acid (OA) on the regulation of the circadian rhythm present in human visceral (VAT) and subcutaneous (SAT) adipose tissue from patients with morbid obesity has not been analyzed yet. VAT and SAT explants from patients with morbid obesity were incubated with OA to analyze the circadian regulation of clock and other genes related to lipid metabolism (SREBP-1c, FAS, LPL and CPT1), and their association with baseline variables and the improvement of these patients after bariatric surgery. There were significant differences in amplitude and acrophase in VAT with respect to SAT. In VAT, body weight negatively correlated with BMAL1 and CRY1 amplitude, and REVERBα acrophase; body mass index (BMI) negatively correlated with REVERBα acrophase; and waist circumference negatively correlated with PER3 acrophase. In SAT, BMI negatively correlated with CLOCK amplitude, and CLOCK, REVERBα and CRY2 MESOR; and waist circumference negatively correlated with PER3 amplitude and acrophase. A greater short-term improvement of body weight, BMI and waist circumference in patients with morbid obesity after bariatric surgery was associated with a lower CRY1 and CRY2 amplitude and an earlier PER1 and PER3 acrophase in SAT. OA produced a more relevant circadian rhythm and increased the amplitude of most clock genes and lipid metabolism-related genes. OA regulated the acrophase of most clock genes in VAT and SAT, placing CLOCK/BMAL1 in antiphase with regard to the other genes. OA increased the circadian rhythmicity, although with slight differences between adipose tissues. These differences could determine its different behavior in obesity.
Asunto(s)
Ritmo Circadiano , Grasa Intraabdominal , Obesidad Mórbida , Ácido Oléico , Grasa Subcutánea , Humanos , Factores de Transcripción ARNTL/genética , Factores de Transcripción ARNTL/metabolismo , Ritmo Circadiano/efectos de los fármacos , Obesidad Mórbida/fisiopatología , Ácido Oléico/farmacología , Grasa Subcutánea/efectos de los fármacos , Grasa Subcutánea/fisiología , Grasa Intraabdominal/efectos de los fármacos , Grasa Intraabdominal/fisiologíaRESUMEN
OBJECTIVES: We report the case of a female patient with adrenal carcinoma who had undergone surgery and presented with local-regional and distant recurrences, emphasizing the importance of the aggressive surgical treatment to achieve long-term survival which is unexpected sometimes. Currently, it represents the gold standard and all cases should be reported to stimulate other groups to work in this line. METHODS/RESULTS: We report the case of a 29-year-old female patient who consulted for left flank pain, being diagnosed of an adrenal tumor by radiological tests; she underwent surgical excision of a left adrenal carcinoma (stage II). Later on she presented with local-regional recurrences (2 times) and distant metastases (liver) undergoing excision in three procedures. Currently, the patient is alive and free of disease 7 years after diagnosis. CONCLUSIONS: Adrenal cancer recurrences have been considered lethal in the short-term. Nevertheless, an aggressive surgical approach of local recurrences and metastasic disease may significantly prolong patient's survival and, sometimes, leave the patient disease free several years after the diagnosis of the primary tumor.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/cirugía , Carcinoma/cirugía , Neoplasias de las Glándulas Suprarrenales/mortalidad , Adulto , Carcinoma/mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Reoperación , Factores de TiempoRESUMEN
OBJETIVO: Comunicamos el caso de unapaciente con un cáncer suprarrenal intervenido que presentóposteriormente recidivas locorregional y a distancia,enfatizando la importancia del tratamiento quirúrgicoagresivo para lograr supervivencias a veces noesperadas a largo plazo. En la actualidad, representael gold standard y todos los casos deben comunicarsepara estimular a los distintos grupos a trabajar enesta línea.MÉTODO/RESULTADOS: se presenta el caso de unapaciente de 29 años que consultó por dolor en flancoizquierdo, diagnosticándose en los estudios de imagenun tumor suprarrenal; fue intervenida, realizándoseresección de un carcinoma suprarrenal izquierdo(Estadio II). Posteriormente presentó recidiva locorregional(en dos ocasiones) y a distancia (en hígado), siendoresecada la enfermedad en las tres ocasiones en sutotalidad. En el momento actual, 7 años después deldiagnóstico, está viva y libre de enfermedad.CONCLUSIÓN: la recidiva del cáncer suprarrenal seha considerado letal a corto plazo desde el punto devista pronóstico. Sin embargo, un abordaje quirúrgicoagresivo de la enfermedad recurrente y metastásicapuede prolongar de forma significativa la supervivenciadel paciente y lograr, en ocasiones, status de libre deenfermedad varios años después del diagnóstico deltumor primario
OBJECTIVES: We report the case of afemale patient with adrenal carcinoma who had undergonesurgery and presented with local-regional and distantrecurrences, emphasizing the importance of theaggressive surgical treatment to achieve long-term survivalwhich is unexpected sometimes. Currently, it representsthe gold standard and all cases should be reported tostimulate other groups to work in this line.METHODS/RESULTS: We report the case of a 29-yearoldfemale patient who consulted for left flank pain,being diagnosed of an adrenal tumor by radiologicaltests; she underwent surgical excision of a left adrenalcarcinoma (stage II). Later on she presented with localregionalrecurrences (2 times) and distant metastases(liver) undergoing excision in three procedures.Currently, the patient is alive and free of disease 7 yearsafter diagnosis.CONCLUSIONS: Adrenal cancer recurrences havebeen considered lethal in the short-term. Nevertheless,an aggressive surgical approach of local recurrencesand metastasic disease may significantly prolongpatients survival and, sometimes, leave the patient diseasefree several years after the diagnosis of the primarytumor