Resting beta-cells - A functional reserve?

Pancreatic beta-cells play a pivotal role to synthesize and secrete insulin, as the solo source of the body. Physical as well as functional loss of beta-cells over a certain threshold result in diabetes. While the mechanisms underlying beta-cell loss in various types of diabetes have been extensively studied, less is known about residual beta-cells, found even in autoimmune type 1 diabetes and type 2 diabetes with a substantial amount. Why have these beta-cells been spared? Some patients with neonatal diabetes have demonstrated the life-changing restoration of functional beta-cells that were inactive for decades but awakened in several weeks following specific treatment. The recent striking outcomes of bariatric surgery in many obese diabetic patients indicate that their beta-cells are likely "preserved" rather than irreversibly lost even in the multifactorial polygenic state that is type 2 diabetes. Collectively, the preservation of residual beta-cells in various diabetic conditions challenges us regarding our understanding of beta-cell death and survival, where their sustenance may stem from the existence of resting beta-cells under physiological conditions. We posit that beta-cells rest and that studies of this normal feature of beta-cells could lead to new approaches for potentially reactivating and preserving beta-cell mass in order to treat diabetes.

Presentation and treatment of anterior cervical hyperostosis.

We report a case of severe anterior cervical hyperostosis presenting with dysphagia.

Lessons learned from cervical pseudoarthrosis in ankylosing spondylitis.

This case report illustrates three learning points about cervical fractures in ankylosing spondylitis, and it highlights the need to manage these patients with the neck initially stabilised in flexion. We describe a case of cervical pseudoarthrosis that is a rare occurrence after fracture of the cervical spine with ankylosing spondylitis. This went undetected until the development of myelopathic symptoms many months later. The neck was initially stabilised in flexion using tongs, and then slowly extended before anterior and posterior fixation was performed. The myelopathic symptoms resolved, and the patient had a good result at 18 months. We conclude that any increased movement of the spine after trauma in ankylosing spondylitis must be considered suspect and fully investigated.

Traumatic dislocation of trapezium: case report and review of the literature.

A complete dislocation of the trapezium from its fossa is rare. We present a case of a 36-year-old man with a complete ulnar and volar dislocation of the trapezium. The trapezium was reduced with manual manipulation and was held in anatomic position by using multiple Kirschner wires. The patient's clinical course is reviewed and similar cases from the literature are discussed.

Attendance and outcome in a work site weight control program: processes and stages of change as process and predictor variables.

This naturalistic study assessed client changes during treatment and identified salient predictors of therapy attendance and outcome. Subjects were assessed on processes and stages of change, self-efficacy, social support, weight history (including expectations, goals, and reasons for losing weight), and demographics at the beginning, middle, and end of a 10-week, behaviorally oriented work site program for weight control. Significant shifts from contemplation to action occurred for clients remaining in treatment. There were also significant modifications in the use of change processes as a result of treatment: counterconditioning, contingency management, stimulus control, interpersonal control, and social liberation increased while medication use, wishful thinking, and minimizing threats decreased. Change processes employed during the early portion of the group treatment were the best predictors of treatment attendance and outcome, superior to self-efficacy, social support, weight history, and demographic variables. The results supported a transtheoretical model that emphasizes dynamic processes and stages as core dimensions for understanding how people change.

Osteochondritis dissecans of the lunate.

Osteochondritis dissecans of the lunate appears to be extremely rare. A case is reported with no predisposing abnormality and with no history of previous trauma. The problem was successfully managed by arthroscopic surgery.

A review of fractures of the atlas vertebra.

From 48 consecutive cases of atlas fractures presenting over a 12.5-year period, two groups are apparent that differ in age, presentation, mechanism of injury, and treatment given. Jefferson fractures were, on average, 42 years of age. Displaced Jefferson fractures were treated by traction. At final review, those that had been reduced and those that were initially undisplaced did better than the displaced group. Inadequate reduction was often obtained due to insufficient traction. Patients sustaining a posterior arch fracture were generally more elderly and were, on average, 17 years older than those with a Jefferson fracture. Patients with a posterior arch fracture had marked degenerative changes in the mid- to distal cervical spine and almost invariably had another cervical spine fracture. Treatment was usually directed to the other cervical spine injury. Injury in the elderly usually followed low velocity trauma.

Experience with the Exeter total hip replacement since 1970.

The satisfactory long-term radiographic appearances with the use of the collarless, smooth, polished, tapered stem encourage its continued use. With the same stem geometry shortly to become available with interchangeable heads, the capacity for the surgeon to change the bearings when polythene wear starts to become marked should address what certainly will emerge as one of the major long-term problems of total hip arthroplasty.

Participant characteristics as predictors of attrition in worksite weight loss.

Attrition is a significant problem in worksite weight loss interventions, and differences in participants' motivational levels have been hypothesized to account for this high attrition rate. The present study examined characteristics of participants who completed a worksite weight loss program compared to those who dropped out, using a step-wise discriminant function analysis. The results indicate that a combination of motivational characteristics, expectations, and change in weight just prior to treatment significantly discriminated drop-outs from completers. The results of this investigation are discussed with respect to implications for developing cost-effective worksite treatment protocols and directions for future research.

Cancer mortality in oil refinery workers.

The cancer mortality experience from 1964 to 1973 of employees of the Imperial Oil Limited was examined in a cohort study. Employees in jobs which exposed them on a daily basis to crude petroleum or its products, compared with nonexposed employees, were found to have more than three times the risk of esophageal and stomach cancer and about twice the risk of lung cancer. In the exposed group, increasing risks of both cancers occurred with increasing duration of employment. In the absence of more complete information on the similarity of the exposed and nonexposed employees, these results cannot be ascribed with certainty to a carcinogenic effect of petroleum. However, there was no other clear explanation for the results, and further study is required. When refinery workers were compared with nonrefinery workers without consideration of exposure to petroleum in either group, the refinery workers were found to have twice the risk of cancer of the intestines (including rectum) and other digestive organs. No relationship with duration of employment was evident. Although the increased intestinal cancer mortality in the refinery workers was not consistent, bias was not an obvious explanation for the observed relationship. Therefore, the presence on a refinery site of a carcinogen other than petroleum has not been ruled out, and further study is urged.