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The extracellular vesicles (EVs) have emerged as key players in metabolic disorders rising as an alternative way of paracrine/endocrine communication. In particular, in relation to adipose tissue (AT) secreted EVs, the current knowledge about its composition and function is still very limited. Nevertheless, those vesicles have been lately suggested as key players in AT communication at local level, and also with other metabolic peripheral and central organs participating in physiological homoeostasis, and also contributing to the metabolic deregulation related to obesity, diabetes, and associated comorbidities. The aim of this review is to summarize the most relevant data around the EVs secreted by adipose tissue, and especially in the context of obesity, focusing in its protein cargo. The description of the most frequent proteins identified in EVs shed by AT and its components, including their changes under pathological status, will give the reader a whole picture about the membrane/antigens, and intracellular proteins known so far, in an attempt to elucidate functional roles, and also suggesting biomarkers and new paths of therapeutic action.

Brown adipose tissue (BAT) is a key target for the development of new therapies against obesity due to its role in promoting energy expenditure; BAT secretory capacity is emerging as an important contributor to systemic effects, in which BAT extracellular vesicles (EVs) (i.e., batosomes) might be protagonists. EVs have emerged as a relevant cellular communication system and carriers of disease biomarkers. Therefore, characterization of the protein cargo of batosomes might reveal their potential as biomarkers of the metabolic activity of BAT. In this study, we are the first to isolate batosomes from lean and obese Sprague–Dawley rats, and to establish reference proteome maps. An LC-SWATH/MS analysis was also performed for comparisons with EVs secreted by white adipose tissue (subcutaneous and visceral WAT), and it showed that 60% of proteins were exclusive to BAT EVs. Precisely, batosomes of lean animals contain proteins associated with mitochondria, lipid metabolism, the electron transport chain, and the beta-oxidation pathway, and their protein cargo profile is dramatically affected by high fat diet (HFD) intervention. Thus, in obesity, batosomes are enriched with proteins involved in signal transduction, cell communication, the immune response, inflammation, thermogenesis, and potential obesity biomarkers including UCP1, Glut1, MIF, and ceruloplasmin. In conclusion, the protein cargo of BAT EVs is affected by the metabolic status and contains potential biomarkers of thermogenesis activity.

Extracellular vesicles (EVs) have recently emerged as a relevant way of cell to cell communication, and its analysis has become an indirect approach to assess the cell/tissue of origin status. However, the knowledge about their nature and role on metabolic diseases is still very scarce. We have established an insulin resistant (IR) and two lipid (palmitic/oleic) hypertrophied adipocyte cell models to isolate EVs to perform a protein cargo qualitative and quantitative Sequential Window Acquisition of All Theoretical Mass Spectra (SWATH) analysis by mass spectrometry. Our results show a high proportion of obesity and IR-related proteins in pathological EVs; thus, we propose a panel of potential obese adipose tissue EV-biomarkers. Among those, lipid hypertrophied vesicles are characterized by ceruloplasmin, mimecan, and perilipin 1 adipokines, and those from the IR by the striking presence of the adiposity and IR related transforming growth factor-beta-induced protein ig-h3 (TFGBI). Interestingly, functional assays show that IR and hypertrophied adipocytes induce differentiation/hypertrophy and IR in healthy adipocytes through secreted EVs. Finally, we demonstrate that lipid atrophied adipocytes shed EVs promote macrophage inflammation by stimulating IL-6 and TNFα expression. Thus, we conclude that pathological adipocytes release vesicles containing representative protein cargo of the cell of origin that are able to induce metabolic alterations on healthy cells probably exacerbating the disease once established.

BackgroundBreast reconstruction with implants has proven serious complications, mostly in patients who have undergone radiotherapy. In these cases, autologous reconstruction is the technique of choice.ObjectivesTo study if breast reconstruction using latissimus dorsi and immediate fat grafting (LIFG) is a widely applicable technique for those cases in which an autologous reconstruction is desirable, but the use of microsurgical perforator flaps is not available.MethodsData of 95 consecutive breast reconstructions from May 2014 to December 2018 were prospectively collected. All patients included in the study had a minimum follow-up of one year after completion of the reconstructive process.ResultsThe mean age of the patients was 48.57 years with an average follow-up of 20.65 months. The mean number of surgeries per patient was 1.61. In 47.4% of the cases, only LIFG surgery was required to accomplish the reconstructive process. The mean volume of fat graft used was 416.00 ± 145.79 cc. Relevant statistically significant differences in the volume of graft were found regarding the use of previous radiotherapy and the timing of reconstruction. Radiological fat necrosis nodes were the main complication (15.8%). However, their presence was significantly lower if no additional fat grafting sessions were necessary, though, unexpectedly, no relation was found in relation to the total amount of fat graft needed.ConclusionsLIFG has proved to be a safe and reliable method for total autologous breast reconstruction. Even when a medium to large size is required, a large volume of fat graft is accepted; thus, excellent results can be obtained. It is an interesting alternative for breast reconstruction, in addition to abdominal perforator flaps.Level of evidence IVThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Breast Surgery.

Background Madelung’s disease (MD) is an uncommon pathology characterized by the presence of multiple masses of unencapsulated adipose tissue that is symmetrically distributed. The aim of this study was to investigate clinical and epidemiological features of patients diagnosed with MD in our department. Associated diseases and evolution after treatment were also investigated. Methods We reviewed the clinical histories of 22 patients diagnosed with MD from 1990 to 2010 and obtained their epidemiological and clinical characteristics. Results We found 21 patients with MD type 1 and one patient with MD type 2 according to Enzi’s classification. All patients were male, 95.5% with high alcohol intake, and 59.1% with some hepatic disease. No family antecedents were significant; 40.9% had dyslipidemia, 22.7% arterial hypertension, 22.7% chronic obstructive pulmonary disease (COPD), 13.6% hyperuricemia, 9.1% hypothyroidism, 4.5% diabetes mellitus type 2, and 4.5% carbohydrate intolerance; 40.9% had a body mass index >30, and 27.3% presented gynecomastia/lipomastia. The region most frequently affected by fatty deposits was the neck. Conclusions Madelung’s disease affects mainly alcoholic males in their fourth decade of life. Hepatic diseases appear in most patients. Also associated with MD are high lipid blood levels, arterial hypertension, COPD, hyperuricemia, and obesity. MD type 1 is the most frequent phenotype and the neck the most common location for fatty masses. Recurrence after surgery, in the same location or different locations, is a frequent event, even in patients who later abstain from alcohol intake. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .

Squamous cell carcinoma of the palm is a very infrequent malignancy. Its unusual presentation can produce a delay in the final diagnosis with serious consequences as far as morbidity and mortality are concerned. This article summarises the case of a patient who was referred to our department presenting a squamous cell carcinoma on his left palm and a clinically positive axillar lymphadenopathy. He had previously been wrongly diagnosed on several occasions.

El objetivo de esta investigación es medir los factores que inciden en la intención de realizar compras por internet. Los usuarios del internet, ya sea utilizando las computadoras, tabletas o dispositivos móviles, llevan a cabo compras mediante el uso del comercio electrónico. Tomando en consideración las frecuencias de dichas compras, este investigador pregunta si dichos usuarios tienen en consideración la protección de la información personal al llevar a cabo dichas compras. Para contestar estas preguntas se diseñó un cuestionario, se aplicó 246 usuarios activos en el proceso de realizar compras por internet. A través de este estudio se pretende probar las distintas hipótesis formuladas, así como las preguntas que han sido planteadas.Los resultados obtenidos son:Las variables fundamentales que permitieron predecir la adopción del comercio electrónico fueron: fácil uso percibido, utilidad percibida, influencia social, privacidad, actitud de comportamiento, control de comportamiento, y riesgo percibido. Se logró validar el modelo de adopción del comercio electrónico. Esto, estableciendo que la gran influencia de las variables lo fueron utilidad percibida, control de comportamiento y riesgo percibido.Los factores relevantes que fueron identificados y que influyen en la adopción del comercio electrónico fueron el fácil uso percibido, la utilidad percibida, la actitud de comportamiento y el riesgo percibido.Del análisis de los datos obtenidos de los 246 encuestados se concluyó que algunos factores no determinaban la adopción del comercio electrónico. En cuanto a la privacidad, esta es un factor determinante para no adoptar el comercio electrónico. Son los individuos precavidos que protegen su información personal los que quizás prefieran ir al comercio a comprar en vez de usar los métodos electrónicos de comercio (Barone, Crocco, & Mongelli, 2013).

Dupuytren's disease is a palmar fascia pathology characterised by flexion contracture of the involved fingers in late stages. It has been described a higher prevalence in northern populations, especially in men in the fifth or sixth decade of life.1 Alcohol consumption, liver disease, diabetes mellitus, epilepsy and some of its treatments, tobacco smokers or hand workers are only a example of the different aetiologies proposed. There are a group of patients presenting with more aggressive clinical manifestation named Dupuytren's diathesis. This subtype could frequently present a positive family history, ectopic fibromatosis and bilateral hand affectation.The authors present a 24-year-old woman referred to the Plastic Surgery Department because severe fingers contracture with an associated aggressive plantar fibromatosis. She referred familial history in her first degree relatives (mother and three of seven brothers and sisters). The first clinical manifestations in her hand began when she was 7 years old.