Noninvasive monitoring of liver fat during treatment with GLP-1 analogues and SGLT-2 inhibitors in a real-world setting.

INTRODUCTION: Patients with NAFLD have a two-fold increased risk of diabetes, and conversely, NAFLD affects up to 80% of patients with type 2 diabetes. Due to the co-occurrence of both diseases and the lack of approved pharmacotherapy for NAFLD, the anti-steatogenic potential of diabetes-related drugs is being explored. In this study, we aim to monitor liver fat noninvasively during treatment with SGLT-2 inhibitors or GLP-1 analogues in a real-world setting. METHODS: Overall, 39 patients (49% women, age 57.7 ± 10.9 years) with type 2 diabetes and hepatic steatosis (defined by controlled attenuation parameter [CAP] values ≥ 215 dB/m) were observed for 6 months and routinely monitored with respect to hepatic fat contents and liver stiffness (VCTE); body composition (BIA); and blood biochemistry, including liver function tests (LFTs), serum lipids and glucose metabolism markers. RESULTS: Median liver fat contents were significantly (P = .026) reduced by 9% in patients taking either SGLT-2 (n = 22) or GLP-1 (n = 17) for 6 months (absolute median CAP decrease: -32 dB/m [-58 to 32 dB/m]). In parallel, serum ALT and γ-GT activities decreased significantly (P = .002 and P = .049, respectively). These improvements were accompanied by significant (P < .0001) changes to body weight and BMI (-2.5 ± 3.3 kg and -0.9 ± 1.2 kg/m2, respectively) and glucose homeostasis, with significant reductions in HbA1c and fasting plasma glucose (FDG) (both P < .0001). Of note, significant reductions of intrahepatic lipid contents occured in patients receiving SGLT-2 inhibitors only. CONCLUSIONS: In this real-world observational evaluation of fatty liver monitored noninvasively in patients with type 2 diabetes treated with either SGLT2 or GLP-1, improvements in measures of hepatic steatosis, glucose and weight parameters were observed after 6 months, with significant reductions of intrahepatic lipid contents seen specifically in the SGLT2 subgroup.

Flavonoids and the Risk of Gastric Cancer: An Exploratory Case-Control Study in the MCC-Spain Study.

Several epidemiological studies have investigated the association between the dietary flavonoid intake and gastric cancer (GC) risk; however, the results remain inconclusive. Investigating the relationship between the different classes of flavonoids and the histological types and origin of GC can be of interest to the research community. We used data from a population-based multi-case control study (MCC-Spain) obtained from 12 different regions of Spain. 2700 controls and 329 GC cases were included in this study. Odds ratios (ORs) were calculated using the mixed effects logistic regression considering quartiles of flavonoid intakes and log2. Flavonoid intake was associated with a lower GC risk (ORlog2 = 0.76; 95% CI = 0.65-0.89; ORq4vsq1 = 0.60; 95%CI = 0.40-0.89; ptrend = 0.007). Inverse and statistically significant associations were observed with anthocyanidins, chalcones, dihydroflavonols and flavan-3-ols. The isoflavanoid intake was positively associated with higher cancer risk, but without reaching a statistical significance. In general, no differences were observed in the GC risk according to the location and histological type. The flavonoid intake seems to be a protective factor against GC within the MCC-study. This effect may vary depending on the flavonoid class but not by the histological type and location of the tumor. Broader studies with larger sample size and greater geographical variability are necessary.

Loosening of the fixing screw in single implant crowns: predisposing factors, prevention and treatment options.

The problem of technical complications in implants and implant-supported restorations has existed for decades. The most frequent complication is the loosening of the fixing screw, which although is not catastrophic, if it occurs repeatedly, it may affect the success of the implant therapy and the patient satisfaction. Factors that affect the frequency of prosthetic complications include: the implant-abutment connection, para-functional habits, cantilevers, and the type of restoration. Regarding the implant-abutment connection, the first systems were those with an external hexagon. Because of their small height and the disadvantages that this entails, other connection types were developed, such as those of hexagonal and conical connection, which decreased the complication rates, including the loosening of the fixing screw. On the dilemma "cement- or screw-retained restoration", the choice depends on biological, technical, and aesthetic factors. Cement-retained restorations are simpler in construction with lower cost and clinicians are more familiar with the clinical procedure. On the other side, if the fixing screw of the abutment is loosened in a cement-retained restoration, it may be a difficult and demanding clinical task to fix this prosthetic complication. Screw-retained restorations are more prone to loosening of the fixing screw, but allow easy retrievability and repair. Their use however, is often restricted because of diverting or unfavorable inclination of the alveolar ridge and the implant. The aim of this article was to present clinical solutions for the complication of screw-loosening through clinical examples and discuss the factors that may predispose to its occurrence. CLINICAL SIGNIFICANCE: The problem of technical complications in implants and implant-supported restorations has existed for decades. The most frequent complication is the loosening of the fixing screw which, although is not catastrophic, if it occurs repeatedly, it may affect the success of the implant therapy and the patient satisfaction. Factors that affect the frequency of prosthetic complications include: the implant-abutment connection, para-functional habits, cantilevers and the type of restoration. The treatment options for the clinician are limited but certain preventing measures during construction of the restoration may be helpful to overcome this clinical problem.

Predicting the final result in implant-supported fixed restorations for completely edentulous patients.

UNLABELLED: Predicting the final result is a very important factor in implant restorations. When a fixed implant-supported restoration is planned for the restoration of completely edentulous patients, it is important to recognize the esthetic performance of the prosthesis in the initial stages. Bone resorbtion may result in an unfavorable interarch relationship, and soft tissue support may be needed. A detailed presurgical evaluation (including tooth setup, construction of radiological and surgical guide) is needed to ensure the placement of implants in prosthetically favored positions. In this paper, a technique is presented where a detailed wax-up of the restoration is accomplished on provisional implant abutments and tried on the patient after implant placement. This setup may offer valuable information on the expected lip support and the need of gingiva-colored ceramic. In this way, the esthetic result can be evaluated at early stages before any irreversible laboratory stages are performed and needed corrections can be done accordingly. CLINICAL SIGNIFICANCE: In extended implant-supported fixed restorations, it is very important to predict the final esthetic result at an early stage. The presented technique allows a safe and accurate evaluation of the expected esthetic result before any construction stage.