Background: Type 2 diabetes (T2D) has long been identified as an incurable chronic disease based on traditional means of treatment. Research now exists that suggests reversal is possible through other means that have only recently been embraced in the guidelines. This narrative review examines the evidence for T2D reversal using each of the three methods, including advantages and limitations for each. Methods: A literature search was performed, and a total of 99 original articles containing information pertaining to diabetes reversal or remission were included. Results: Evidence exists that T2D reversal is achievable using bariatric surgery, low-calorie diets (LCD), or carbohydrate restriction (LC). Bariatric surgery has been recommended for the treatment of T2D since 2016 by an international diabetes consensus group. Both the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) now recommend a LC eating pattern and support the short-term use of LCD for weight loss. However, only T2D treatment, not reversal, is discussed in their guidelines. Conclusion: Given the state of evidence for T2D reversal, healthcare providers need to be educated on reversal options so they can actively engage in counseling patients who may desire this approach to their disease.

Nutritional ketosis has been found to improve metabolic and inflammatory markers, including lipids, HbA1c, high-sensitivity CRP, fasting insulin and glucose levels, and aid in weight management. We discuss these findings and elaborate on potential mechanisms of ketones for promoting weight loss, decreasing hunger, and increasing satiety. Humans have evolved with the capacity for metabolic flexibility and the ability to use ketones for fuel. During states of low dietary carbohydrate intake, insulin levels remain low and ketogenesis takes place. These conditions promote breakdown of excess fat stores, sparing of lean muscle, and improvement in insulin sensitivity.

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Adrenal tumor size and need for concurrent procedures significantly impact the selection of patients for OA, the likelihood of conversion, and perioperative morbidity. These metrics should be considered when assessing operative approach and risks for adrenalectomy.

Background: Adrenal myelolipoma (AM) is a benign lesion for which adrenalectomy is infrequently indicated. We investigated operative indications and outcomes for AM in a large single-institution series. Subjects and Methods: A retrospective cohort study of prospectively collected data was conducted. Patients (q16 years of age) who underwent adrenalectomy in the Division of General Surgery at Barnes-Jewish Hospital (1993-2010 were grouped by operative indication (myelolipoma versus other pathology) and compared using nonparametric tests (a < 0.05). Results: Sixteen patients (4.0%) had myelolipomas resected out of 402 patients who underwent adrenalectomy. Fourteen patients with suspected AM underwent adrenalectomy, 13 (93%) of whom had AM confirmed on pathology. Indications for adrenalectomy were abdominal or flank pain, large tumor size (>8 cm), atypical radiologic appearance, and/or inferior vena cava compression. Three patients with suspected other adrenal lesions had AM confirmed on final pathology. Operative approach was laparoscopic in 15 cases and open in 1 case of a 21-cm lesion. Patients who underwent laparoscopic adrenalectomy for AM (n = 15) or other adrenal pathology (n = 343) were similar with respect to age, gender, American Society of Anesthesiologists classification, prior abdominal operation, tumor side, operative time, conversion rate, estimated blood loss, intraoperative complications, hospital length of stay, and 30-day morbidity. However, patients with resected AM had a higher body mass index (36.5 -8.1 kg/m 2 versus 30.1 -7.5 kg/m 2 ; P < .01) and a larger preoperative tumor size (8.4 -3.0 cm versus 3.1 -1.7 cm; P < .01). Conclusions: Laparoscopic adrenalectomy may be appropriate for patients with a presumptive diagnosis of AM and abdominal or flank pain, large tumor size, and/or uncertain diagnosis after imaging. Outcomes and morbidity following LA for AM and other adrenal pathology appear comparable.

We demonstrated, for the first time, that breast cancer subtype distribution varied significantly according to BMI status. Our results suggested that obesity might activate molecular pathways other than the well-known obesity/estrogen circuit in the pathogenesis of breast cancer. Future studies are needed to understand the molecular mechanisms that drive the variation in subtype distribution across BMI subgroups.

PURPOSE We evaluated suturing skills performance and retention in senior medical students (MS4) at the beginning of 4th-year and 7 months later. METHODS MS4 entering a surgical specialty were randomized to a proficiency-based suturing/knot-tying curriculum at the beginning of 4th year (Intervention, n=10) versus no training (Control, n=9). Time and technical proficiency (TP, proficiency ≥3) were assessed at baseline and 7 months. Performance was compared to past “Boot-Camp” MS4, categorical PGY-1 interns and PGY-2 residents. Data are mean ± SD. RESULTS At baseline, Intervention and Control MS4 had similar total task times (848 ± 199 vs. 845 ± 209sec) and TP scores (1.8 ± .15 vs. 1.8 ± .3). At 7 months, Intervention MS4 total task times were significantly faster (549 ± 80 vs. 719 ± 151sec, p< .01) and mean TP scores higher (3.3 ± 0.6 vs. 2.1 vs. 0.4, p<.001) than Control MS4. Intervention MS4 also performed better at 7 months than Boot-Camp MS4 (662 ± 171sec and 2.6 ±0.5, p<.04) and were similar to PGY-1 interns (601 ± 74sec, TP 2.7 ± 0.7) and end of PGY-2 residents (475 ± 81sec and 3.6 ± 0.3). CONCLUSION A proficiency-based suturing and knot-tying curriculum taught early in 4th-year results in improved MS4 performance compared to no training or a traditional “boot camp” program.

Purpose of Review Obesity and its related comorbidities make up a large part of healthcare expenditures. Despite a wide array of options for treatment of obesity, rates of sustained weight loss continue to be low, leading patients to seek alternative treatment options. Although the first medically utilized ketogenic diet was described nearly 100 years ago, it has made a resurgence as a treatment option for obesity. Despite increased popularity in the lay public and increased use of ketogenic dietary strategies for metabolic therapy, we are still beginning to unravel the metabolic impact of long-term dietary ketosis. Recent Findings There are a number of recent trials that have highlighted the short-and long-term benefits of ketogenic diet on weight, glycemic control, and other endocrine functions including reproductive hormones. Summary This review is a summary of available data on the effectiveness and durability of the ketogenic diet when compared to conventional interventions. Ketogenic dietary strategies may play a role in short-term improvement of important metabolic parameters with potential for long-term benefit. However, response may vary due to inter-individual ability to maintain longterm carbohydrate restriction.