Fat loss in response to exercise training varies between individuals, even when differences in compliance to the exercise program are accounted for. The purpose of this study was to investigate whether individual variation in change in fasting respiratory quotient (RQ) after exercise training contributes to this interindividual variability. Fifty-five premenopausal women participated in a 7-week endurance-type exercise training program; and fitness, body composition, and resting substrate utilization and metabolic rate in the fasted state were assessed at baseline and postintervention. Total net energy expenditure of the exercise intervention (exEE) was determined from heart rate obtained in all exercise sessions and individualized calibration of the heart rate vs oxygen uptake relationship. Dietary intake and physical activity (by constant heart rate monitoring) were assessed at baseline and during the final week of the intervention. Mean change in fat mass for the group was −0.97 kg (range, +2.1 to −5.3 kg). The strongest correlate of change in fat mass was exEE (r = 0.60, P < .0005). Change in fasting RQ correlated significantly (r = −0.26, P = .05) with the residual for change in fat mass after adjusting for the effects of both exEE and change in energy intake, explaining 7% of the variance. In multiple regression analysis, exEE (P < .0005) and change in fasting RQ (P = .02) were the only statistically significant independent predictors of change in fat mass, together explaining 40.2% of the variance. Thus, fat loss in response to exercise training depends not only on exercise energy expenditure but also on exercise training–induced changes in RQ at rest. This suggests that development of strategies to maximize the change in resting fat oxidation in response to an exercise training program may help individuals to maximize exercise-induced fat loss.

Diabetes Foot Action GroupThis update on antimicrobial recommendations for diabetic foot ulcer treatment is a consensus statement based on clinical trial evidence, review of international guidelines and expert opinion.In the context of individual treatment decisions, local microbiology results and advice should be paramount in informing responsible clinicians. However, the spectrum of infecting pathogens causing foot infection is consistent and supports the consideration of empirical antibiotic advice. These recommendations are suggested to support clinicians and in conjunction with regional pathogen variations and antibiotic susceptibilities, provide a basis for local guideline development.

Aims/hypothesis Sedentary offspring of patients with type 2 diabetes are often more insulin-resistant than persons with no family history of diabetes, but when active or fit offspring of type 2 diabetic patients are compared with non-diabetic persons, differences in insulin resistance are less evident. This study aimed to determine the effects of an exercise training intervention on insulin sensitivity in both groups. Methods Women offspring (n=34) of type 2 diabetic patients (offspring age 35.6±7.0 years, BMI 28.1±5.1 kg/m 2 ) and 36 matched female controls (age 33.6±6.1 years, BMI 27.3± 4.7 kg/m 2 ) participated. Body composition, fitness and metabolic measurements were made at baseline and after a controlled 7 week exercise intervention.Results At baseline, insulin sensitivity index (ISI) was 22% lower in offspring than controls (p<0.05), despite similar body fat and maximal oxygen uptake :V O 2 max Þ À values in the two groups. ISI increased by 23% (p<0.05) in offspring following the exercise intervention, compared with 7% (NS) in the controls. Increases in :V O 2 max were similar in both groups (controls 12%, offspring 15%, p<0.05 for both). Plasma leptin concentrations decreased significantly in the offspring (−24%, p<0.01) but not in controls (0%, NS). Change in ISI correlated significantly with baseline ISI (r=−0.47, p<0.0005) and change in leptin (r=−0.43, p< 0.0005). The latter relationship was not attenuated by adjustment for changes in body fat. Conclusions/interpretation Offspring, but not controls, significantly increased ISI in response to an exercise intervention, indicating that insulin sensitivity is more highly modulated by physical activity in daughters of patients with type 2 diabetes than in women with no family history of the disease.

Approximately 100,000 hernia repairs are performed in the UK annually, the vast majority in hospital usually under general anaesthetic. 1 In the early 1990s, the waiting time in the UK for routine elective groin hernia repairs in the NHS had become unacceptably high () with NHS patients waiting times as long as 2 years for an operation. The prolonged wait had a marked effect on patient quality of life and increased the risk of urgent admission and emergency surgery 2,3 resulting in further pressure on operation lists and reducing the availability of in-patient beds for elective major operations. 4,5 In recent years, the pressure on hospital facilities, with increasing waiting times for non-emergency surgery for benign conditions has increased. Alternatives to in-patient and hospital-based surgery have been explored and the feasibility of performing hernia surgery in a general practice setting has already been shown. 6,7 It was in this context that the Probus Surgical Centre in Cornwall, UK was set up in 2005 in order to offer hernia repair to our patients, the main stimulus being to reduce prolonged waiting times. A secondary aim was to relieve the pressure on local hospital waiting lists for other surgical procedures. This article reviews our experience with ambulatory hernia repair in a primary care facility of more than 1000 cases over a period of 3 years. Patients and MethodsAll of the mesh hernia repairs were carried out by one of two general practitioners with a special interest (GPwSI) and tissue repairs by the associate surgeon. Patients were referred by their own GPs and were seen within 4 weeks. Surgical and anaesthetic options were discussed with the patient; if deemed suitable for local anaesthetic repair, they were given detailed written information about the procedure and postoperative management and offered a date for surgery. Age and co-morbidity were not regarded as contraindications as long as the patient had appropriate home support with a responsible adult. Exclusion criteria are listed in Table 1. There are no facilities for conversion to general anaesthesia and all procedures were performed using local anaesthetic only -with no sedation. A suitably PATIENTS AND METHODS A prospective analysis of 1164 patients who underwent abdominal wall hernia repair at Probus Surgical Centre during the study period. The operations were carried out by two GPs with a special interest (GPwSI) and one retired surgeon. The techniques used were a Lichtenstein mesh repair or modified Shouldice repair for inguinal hernias and a primary sutured repair for ventral hernias. All procedures were performed as day-cases under local anaesthesia without sedation. All patients were reviewed routinely at 6 weeks. The primary outcomes of the study were recurrence and patient satisfaction levels, and complications such as infection, haematoma and chronic pain. RESULTS No patient required conversion to general anaesthesia. There were three (0.3%) recurrences. Complication rates were low and similar to those...

Daughters of diabetes patients have lower insulin sensitivity than women with no diabetes family history, but increase insulin sensitivity to a greater extent with exercise training. This study aimed to determine whether differences in circulating concentrations of adiponectin and leptin, and adipose tissue expression of their genes and receptors played a role. Women offspring of patients with type 2 diabetes mellitus (n = 34; age, 35.6 ± 7.0 years; body mass index, 28.1 ± 5.1 kg/m2) and matched controls with no diabetes family history (n = 36; age, 33.6 ± 6.1 years; body mass index, 27.3 ± 4.7 kg/m2) participated. Blood and abdominal subcutaneous adipose tissue samples were obtained at baseline and after a controlled 7-week endurance-type exercise intervention (sessions were performed at 65%-80% of maximum heart rate). At baseline, no significant differences were observed between groups in circulating leptin or adiponectin concentrations, or expression of their genes or receptors. In response to exercise, plasma leptin decreased more in offspring than controls (−32.2% vs −7.3%, P = .005 for interaction); and the long isoform of the leptin receptor messenger RNA (mRNA) increased significantly only in the offspring (+39.4%, P = .026 vs +7.7%, P = .892). Leptin mRNA decreased similarly in both groups (−24.7% vs −25.0%, P < .05 for both). Furthermore, changes in plasma leptin (r = −0.432, P < .001) and leptin mRNA (r = −0.298, P = .019) correlated significantly with changes in insulin sensitivity. Plasma adiponectin decreased similarly in both groups (−12.1% vs −15.2%, P < .01 for both), but no significant changes were observed in adiponectin-related gene expression. This work shows that exercise training has differing effects on leptin-related variables between women with and without a diabetes family history and suggests that these molecular differences may contribute to the differential effects of exercise training on insulin sensitivity between these 2 groups.