PKN1 Kinase: A Key Player in Adipocyte Differentiation and Glucose Metabolism.

Adipocyte dysfunction is the driver of obesity and correlates with insulin resistance and the onset of type 2 diabetes. Protein kinase N1 (PKN1) is a serine/threonine kinase that has been shown to contribute to Glut4 translocation to the membrane and glucose transport. Here, we evaluated the role of PKN1 in glucose metabolism under insulin-resistant conditions in primary visceral adipose tissue (VAT) from 31 patients with obesity and in murine 3T3-L1 adipocytes. In addition, in vitro studies in human VAT samples and mouse adipocytes were conducted to investigate the role of PKN1 in the adipogenic maturation process and glucose homeostasis control. We show that insulin-resistant adipocytes present a decrease in PKN1 activation levels compared to nondiabetic control counterparts. We further show that PKN1 controls the adipogenesis process and glucose metabolism. PKN1-silenced adipocytes present a decrease in both differentiation process and glucose uptake, with a concomitant decrease in the expression levels of adipogenic markers, such as PPARγ, FABP4, adiponectin and CEBPα. Altogether, these results point to PKN1 as a regulator of key signaling pathways involved in adipocyte differentiation and as an emerging player of adipocyte insulin responsiveness. These findings may provide new therapeutic approaches for the management of insulin resistance in type 2 diabetes.

Adipose Tissue Protein Glycoxidation is Associated with Weight-Loss Potential.

OBJECTIVE: This study aimed to characterize the differences in protein oxidation biomarkers in adipose tissue (AT) as an indicator of AT metabolism and bariatric surgery weight-loss success. METHODS: A human model, in which sixty-five individuals with obesity underwent bariatric surgery, and a diet-induced obesity animal model, in which animals were treated for 2 months with normocaloric diets, were analyzed to determine the associations between AT protein oxidation and body weight loss. Protein oxidative biomarkers were determined by gas chromatography/mass spectrometry in AT from human volunteers before the surgery, as well as 2 months after a diet treatment in the animal model. RESULTS: The levels of carboxyethyl-lysine (CEL) and 2-succinocystein (2SC) in both visceral and subcutaneous AT before the surgery directly correlated with greater weight loss in both human and animal models. 2SC levels in subcutaneous AT greater than 4.7 × 106  µmol/mol lysine (95% CI: 3.4 × 106 to 6.0 × 106 ) may predict greater weight loss after bariatric surgery (receiver operating characteristic curve area = 0.8222; P = 0.0047). Additionally, it was observed that individuals with diabetes presented lower levels of CEL and 2SC in subcutaneous AT (P = 0.0266 and P = 0.0316, respectively) compared with individuals without diabetes. CONCLUSIONS: CEL and 2SC in AT are useful biomarkers of AT metabolism and predict the individual's ability to reduce body weight after bariatric surgery.

Estudio comparativo prospectivo aleatorizado entre apendicectomía laparoscópica por puerto único y apendicectomía laparoscópica convencional / Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy

INTRODUCCIÓN: La apendicectomía laparoscópica es probablemente en la actualidad la técnica de elección en las apendicitis agudas. La cirugía laparoscópica por puerto único (PU) ha intentado instalarse como técnica alternativa. El objetivo de este estudio es comparar la seguridad y eficacia del PU frente a la apendicectomía laparoscópica convencional (LC). MATERIAL Y MÉTODOS: De enero del 2011 a septiembre del 2012 se aleatorizó prospectivamente a 120 pacientes con apendicitis aguda (PU 60, LC 60). Se seleccionó a pacientes entre 15 y 65 años con inicio de síntomas < 48 h comparándose el IMC, tiempo operatorio, inicio de ingesta, estancia hospitalaria, dolor postoperatorio, anatomía patológica y costes. RESULTADOS: La edad media, IMC, sexo y tiempo de inicio de síntomas hasta el diagnóstico fueron similares. No se encontraron diferencias del tiempo operatorio, inicio de ingesta ni estancia hospitalaria. Se evidenciaron diferencias en el dolor postoperatorio siendo mayor en el PU (4 ± 1,3) que en la LC (3,3 ± 0,5) con una p = 0,004. La apendicitis flemonosa predominó para ambos grupos. Hubo 3 reingresos por absceso intraabdominal (PU 2, LC 1) que requirieron tratamiento antibiótico intravenoso. Un caso del PU requirió asistencia intraoperatoria de un trocar de 5 mm en FID por necesidad de drenaje. El coste fue mayor en el PU debido al dispositivo empleado. CONCLUSIÓN: La apendicectomía por PU es segura, eficaz con resultados similares a la LC en pacientes seleccionados y, aunque el coste es mayor, serán los resultados obtenidos a largo plazo los que determinen el futuro de esta técnica

INTRODUCTION: Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). MATERIAL AND METHODS: From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 and 65 years were selected, with onset of symptoms less than 48 h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology, and costs. Results The median age, BMI, sex, and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake, or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4 ± 1.3) than in LA (3.3 ± 0.5) with a P = .004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5 mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. CONCLUSION: SILS appendectomy is safe, effective, and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique

Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy.

INTRODUCTION: Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). MATERIAL AND METHODS: From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 to 65 years were selected, with onset of symptoms less than 48h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology and costs. RESULTS: The median age, BMI, sex and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4±1.3) than in LA (3.3±0.5) with a P=.004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. CONCLUSION: SILS appendectomy is safe, effective and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique.