Obesity is the major contributing factor for the increased prevalence of type 2 diabetes (T2D) in recent years. Sustained positive influx of lipids is considered to be a precipitating factor for beta cell dysfunction and serves as a connection between obesity and T2D. Importantly, fatty acids (FA), a key building block of lipids, are a double‐edged sword for beta cells. FA acutely increase glucose‐stimulated insulin secretion through cell‐surface receptor and intracellular pathways. However, chronic exposure to FA, combined with elevated glucose, impair the viability and function of beta cells in vitro and in animal models of obesity (glucolipotoxicity), providing an experimental basis for the propensity of beta cell demise under obesity in humans. To better understand the two‐sided relationship between lipids and beta cells, we present a current view of acute and chronic handling of lipids by beta cells and implications for beta cell function and health. We also discuss an emerging role for lipid droplets (LD) in the dynamic regulation of lipid metabolism in beta cells and insulin secretion, along with a potential role for LD under nutritional stress in beta cells, and incorporate recent advancement in the field of lipid droplet biology.

Neurogenic thoracic outlet syndrome (nTOS) develops secondary to repetitive motion of the upper extremity. Competitive athletes (CAs) performing repetitive motion in their respective activities are at risk for nTOS. First rib resection and scalenectomy (FRRS) may be required for symptomatic relief and return to competition. This vulnerable population has not been previously studied for the results of FRRS.Methods: Demographic, historical, procedural, and follow-up data for every patient treated (by the senior author) for nTOS from July 2009 to May 2014 were entered into a dedicated data base. These patients were contacted to complete a nine-question survey to assess the effect FRRS on pain medication use, postoperative physical therapy duration, patient satisfaction (willingness to do the surgery again), symptom relief, effect on activities of daily living, athletic performance, time to return of athletic performance, and need for other surgeries (of the neck, shoulder or arm). A multivariate analyses of the following risk factors: age, pectoralis minor release, preoperative narcotic use, athletic shutdown, and involvement in a throwing sport were performed.Results: During the study period, 564 patients had FRRS for nTOS. There were 221 competitive athletes and 67 (35 male, 32 female) with an average (range) age of 19 (14-48) years responded to the survey. The breakdown consisted of 48 (72%) white and 19 (28%) nonwhite patients participating in the following sports: baseball/softball (45), volleyball (8), band/musician (3), cheerleading/gymnastics (5), diving (1), football (1), swimming (1), other (1), and who performed at the high school (36), collegiate (24) and professional levels (7). Survey results (Tables I and II) revealed that 90% were improved in pain medication use, 75% would undergo FRRS on the contralateral side if needed, 82% had resolution of TOS symptoms, 94% were able to perform activities of daily living without limitation, 73% returned to at least the same or better level of athletic activity after FRRS, and this occurred within 1 year in 70%. Although 37% of respondents required another procedure after FRRS overwhelmingly 95% felt that they had made the right decision. Multivariable regression analysis showed increase in age to significantly increase the duration of supervised physical therapy, and pre-op narcotics use to be associated with increased resolution of nTOS symptoms. Other risks factors were statistically insignificant.Conclusions: The majority of CAs are able to return to their precompetitive state after FRRS and few have limitations in their activities of daily living. Although additional procedures are necessary in over one-third of these patients, almost one-half returned to competition by 6 months and the majority within 1 year. The vast majority of the CAs are pleased with their decision to have FRRS and would do it again. Further investigation remains to be done for predictive factors for successful return to competitive athletics in this population.

Patients presenting with a PAA at 20 mm or >20 mm in diameter, presence of luminal thrombus, or atrial fibrillation may need to be observed at more frequent scanning intervals than those without these risk factors. Further studies are required to validate these predictive growth factors.