Exercise and ectopic fat in type 2 diabetes: A systematic review and meta-analysis.

Ectopic adipose tissue surrounding the intra-abdominal organs (visceral fat) and located in the liver, heart, pancreas and muscle, is linked to cardio-metabolic complications commonly experienced in type 2 diabetes. A systematic review and meta-analysis was performed to determine the effect of exercise on ectopic fat in adults with type 2 diabetes. Relevant databases were searched to February 2016. Included were randomised controlled studies, which implemented≥4 weeks of aerobic and/or resistance exercise and quantified ectopic fat via magnetic resonance imaging, computed tomography, proton magnetic resonance spectroscopy or muscle biopsy before and after intervention. Risk of bias and study quality was assessed using Egger's funnel plot test and modified Downs and Black checklist, respectively. Of the 10,750 studies retrieved, 24 were included involving 1383 participants. No studies were found assessing the interaction between exercise and cardiac or pancreas fat. One study assessed the effect of exercise on intramyocellular triglyceride concentration. There was a significant pooled effect size for the meta-analysis comparing exercise vs. control on visceral adiposity (ES=-0.21, 95% CI: -0.37 to -0.05; P=0.010) and a near-significant pooled effect size for liver steatosis reduction with exercise (ES=-0.28, 95% CI: -0.57 to 0.01; P=0.054). Aerobic exercise (ES=-0.23, 95% CI: -0.44 to -0.03; P=0.025) but not resistance training exercise (ES=-0.13, 95% CI: -0.37 to 0.12; P=0.307) was effective for reducing visceral fat in overweight/obese adults with type 2 diabetes. These data suggest that exercise effectively reduces visceral and perhaps liver adipose tissue and that aerobic exercise should be a key feature of exercise programs aimed at reducing visceral fat in obesity-related type 2 diabetes. Further studies are required to assess the relative efficacy of exercise modality on liver fat reduction and the effect of exercise on pancreas, heart, and intramyocellular fat in type 2 diabetes and to clarify the effect of exercise on ectopic fat independent of weight loss.

Increased frequencies of the killer immunoglobulin-like receptor genes KIR2DL2 and KIR2DS2 are associated with neuroblastoma.

Neuroblastoma is the most common extra-cranial solid tumour in children. Natural killer (NK) cells are innate lymphocytes that are known to mediate the direct cytotoxicity of neuroblastoma tumour cells. Natural variation in the highly polymorphic killer immunoglobulin-like receptors (KIR) and their cognate human leukocyte antigen (HLA) class I ligands results in considerable diversity in NK cell function. As the early onset of neuroblastoma suggests the contribution of genetic factors, we investigated if individual KIR genes, combined KIR gene haplotypes or compound KIR-HLA ligand genotypes could influence susceptibility to neuroblastoma. Genotype analysis of the KIR genes as well as their three major HLA class I ligand groups, HLA-C1, HLA-C2 and HLA-Bw4, was carried out in a cohort of 201 neuroblastoma patients compared with 240 healthy control subjects using polymerase chain reaction with sequence-specific primers. We found a significant increase in the frequency of KIR2DL2 (P = 0.019) as well as KIR2DS2 (P = 0.008) in patients with neuroblastoma compared with the healthy control group. While the incidence of the least inhibitory compound KIR-HLA-C genotype, KIR2DL3 in the presence of HLA-C1 was slightly reduced in neuroblastoma patients, this did not reach statistical significance (P = 0.069). In summary, while KIR-HLA compound genotypes have previously been implicated in predicting treatment outcomes in neuroblastoma, here we show that the presence of the individual KIR genes, KIR2DL2 and KIR2DS2, irrespective of HLA-C genotype is associated with the onset of this embryonal malignancy.

Osteomyelitis of the foot in diabetic patients: evaluation with magnetic resonance imaging.

Magnetic resonance (MR) imaging examination was performed with a 1.5-Tesla superconducting magnet on a diabetic patient's right foot that had extensive deformities due to previous surgery, infection, and neuropathy. The purpose of the examination was to help identify areas of active infection in preparation for surgical debridement. This manuscript reviews current concepts on the use of radionucleotide scanning and computed tomography (CT) as compared to MR imaging when used to assist in the diagnosis of osteomyelitis in the diabetic foot. MR imaging was found to be useful in identifying areas of active bone infection in the presence of underlying osseous pathology when radiographic images and radionucleotide scans were unreliable.

Ancrod (Arvin) as an alternative to heparin anticoagulation for cardiopulmonary bypass.

Heparin is the anticoagulant used during cardiopulmonary bypass (CPB). Both the use of heparin and the reversal of its effect with protamine have well-documented complications. Ancrod is a defibrinogenating enzyme that has been used as an anticoagulant in humans, but its use as an anticoagulant for CPB has been limited to studies in animals. Twenty patients for elective aortocoronary bypass surgery were anticoagulated by means of an intravenous infusion of ancrod pre-operatively. Target plasma fibrinogen concentrations of 0.40-0.80 g/l were achieved within 13.3 +/- 2.5 h using an average dose of ancrod of 1.65 +/- 0.55 U/g. All perfusions were without incident. Postoperative blood loss (2286 +/- 1311 cc) was compared to that of 20 matched controls (1737 +/- 973 cc), as was blood product use; 4.1 +/- 2.1 U of packed cells versus 2.5 +/- 2.3 U (P less than 0.05) and 5.6 +/- 3.1 U of plasma versus 2.6 +/- 2.9 U (P less than 0.05) in the ancrod and heparin-treated groups, respectively. There were no differences in the postoperative courses or recovery periods of the ancrod-treated and control patients. This study confirms the efficacy and feasibility of ancrod as an alternative form of anticoagulation for CPB.

Reverse Austin osteotomy for correction of acquired static hallux adductus.

Hallux adductus, a horizontal plane deformity, often has an iatrogenic etiology especially as a complication of hallux abducto valgus surgery. A case at Sheridan Park Hospital is described in which the patient developed a steadily worsening static hallux adductus following foot surgery. She underwent further corrective procedures for the hallux adductus 11/2 years later. The authors conclude that if a mild static hallux adductus is observed in conjunction with bunionectomy or other surgery, it should be corrected at that time rather than some years later.

Prophylactic antibiotic usage in podiatric implant surgery of the first metatarsophalangeal joint.

All first metatarsophalangeal joint implants used at Sheridan Park Hospital from 1979 through 1984 were evaluated for postoperative infection and subsequent implant removal. Thirteen (1.3%) of 929 implants used were removed due to infection. Antibiotic prophylaxis was not determined to be necessary to avoid this complication. However, in all cases in which prophylaxis was used, no infection occurred.

Topical hemostatic agents to reduce bleeding from cancellous bone surfaces: a comparison of Gelfoam paste and bone wax.

This article reviews the history of topical bone hemostatic agents, listing advantages and disadvantages of the more commonly used agents. Gelfoam paste and bone wax were chosen to study the effects that bone hemostatic agents have on the occurrence and severity of postoperative edema and pain. The authors discovered 80% of the patients utilizing bone wax, and 91% of the patients receiving Gelfoam paste, had markedly decreased amounts of immediate postoperative edema. Furthermore, 90% of the patients treated with bone wax, and 75% of the patients treated with Gelfoam paste, reported less postoperative pain than anticipated with the surgical procedure performed.

Control of postoperative pain in foot surgery using a combination of anesthetic and steroid for local infiltration.

The authors examine a technique that is performed for control of postoperative pain. Sixty-eight patients were evaluated who had received a combination of Marcaine with no epinephrine, plus Hexadrol, at the surgical site immediately postoperatively. It was found that 65% did not require any form of analgesia within the first 4 hours postsurgically; 44% the first 8 hours, and 28% the first 12 hours. Sixteen percent of the patients required no form of analgesia during their entire hospital stay.

A new instrumentation for heel spur resection.

Numerous procedures are available for resecting an inferior calcaneal exostosis (heel spur) when conservative management of the condition fails. A study was conducted with Sheridan Park Hospital patients by using the Kazanjian nasal forceps for spur removal. This procedure minimizes soft tissue destruction, bone pain, and iatrogenic calcaneal fractures.

The use of naproxen in controlling postoperative pain in podiatric surgery.

The study was conducted with 110 patients admitted to Sheridan Park Hospital to determine the efficacy of the nonsteroidal anti-inflammatory drug, naproxen, in relieving postoperative pain. Aspirin, as well as compounds classified as nonsteroidal, anti-inflammatory drugs (NSAID), such as naproxen, are known to inhibit synthesis of certain prostaglandins that are involved in the inflammation process. This is the cause of a significant percentage of postoperative pain.

Tibial sesamoid planing procedure: an appraisal of 26 feet.

The authors present their findings upon evaluation of 26 feet that had undergone a tibial sesamoid planing procedure. A preoperative method of radiographic evaluation is also presented. The subjective success rate was determined to be 88.8%, whereas the objective success rate was 76.9%, and a successful procedure was performed on feet with a first metatarsal declination angle not exceeding 8 degrees. It was also determined that the apparent postoperative changes in the hallux abductus and intermetatarsal angles were 0.73 degrees and 0.6 degrees, respectively. The authors believe this procedure does not significantly alter the biomechanics of the first metatarsophalangeal joint postoperatively.

Bacteriology of diabetic foot ulcers.

Diabetic foot ulcerations exhibit a wide range of the bacterial spectrum. A long-standing question is whether any particular bacterium or class of bacteria is responsible for the more involved ulcers. A review of such cases at Sheridan Park Hospital reveals that there may be factors other than bacterial type that may account for the virulence of diabetic ulcers. Multifactorial causes host a vital role in this common, but potentially serious, podiatric problem.

Angioleiomyoma.

Angioleiomyoma is a benign tumor that occurs rarely, but it must be considered in the differential diagnosis in patients who have a painful subcutaneous nodule on the lower extremity. The treatment of choice in all cases is surgical excision.