The Role of GLP1-RAs in Direct Modulation of Lipid Metabolism in Hepatic Tissue as Determined Using In Vitro Models of NAFLD

Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have been shown to improve glucose and lipid homeostasis, promote weight loss, and reduce cardiovascular risk factors. They are a promising therapeutic option for non-alcoholic fatty liver disease (NAFLD), the most common liver disease, associated with T2DM, obesity, and metabolic syndrome. GLP-1RAs have been approved for the treatment of T2DM and obesity, but not for NAFLD. Most recent clinical trials have suggested the importance of early pharmacologic intervention with GLP-1RAs in alleviating and limiting NAFLD, as well as highlighting the relative scarcity of in vitro studies on semaglutide, indicating the need for further research. However, extra-hepatic factors contribute to the GLP-1RA results of in vivo studies. Cell culture models of NAFLD can be helpful in eliminating extrahepatic effects on the alleviation of hepatic steatosis, modulation of lipid metabolism pathways, reduction of inflammation, and prevention of the progression of NAFLD to severe hepatic conditions. In this review article, we discuss the role of GLP-1 and GLP-1RA in the treatment of NAFLD using human hepatocyte models.

Preclinical Models and Promising Pharmacotherapeutic Strategies in Liver Fibrosis: An Update

Liver fibrosis represents one of the greatest challenges in medicine. The fact that it develops with the progression of numerous diseases with high prevalence (NAFLD, viral hepatitis, etc.) makes liver fibrosis an even greater global health problem. Accordingly, it has received much attention from numerous researchers who have developed various in vitro and in vivo models to better understand the mechanisms underlying fibrosis development. All these efforts led to the discovery of numerous agents with antifibrotic properties, with hepatic stellate cells and the extracellular matrix at the center of these pharmacotherapeutic strategies. This review focuses on the current data on numerous in vivo and in vitro models of liver fibrosis and on various pharmacotherapeutic targets in the treatment of liver fibrosis.

Management of Glycemia during Acute Aerobic and Resistance Training in Patients with Diabetes Type 1: A Croatian Pilot Study

(1) Background: The increased risk of developing hypoglycemia and worsening of glycemic stability during exercise is a major cause of concern for patients with type 1 diabetes mellitus (T1DM). (2) Aim: This pilot study aimed to assess glycemic stability and hypoglycemic episodes during and after aerobic versus resistance exercises using a flash glucose monitoring system in patients with T1DM. (3) Participants and Methods: We conducted a randomized crossover prospective study including 14 adult patients with T1DM. Patients were randomized according to the type of exercise (aerobic vs. resistance) with a recovery period of three days between a change of groups. Glucose stability and hypoglycemic episodes were evaluated during and 24 h after the exercise. Growth hormone (GH), cortisol, and lactate levels were determined at rest, 0, 30, and 60 min post-exercise period. (4) Results: The median age of patients was 53 years, with a median HbA1c of 7.1% and a duration of diabetes of 30 years. During both training sessions, there was a drop in glucose levels immediately after the exercise (0'), followed by an increase at 30' and 60', although the difference was not statistically significant. However, glucose levels significantly decreased from 60' to 24 h in the post-exercise period (p = 0.001) for both types of exercise. Glycemic stability was comparable prior to and after exercise for both training sessions. No differences in the number of hypoglycemic episodes, duration of hypoglycemia, and average glucose level in 24 h post-exercise period were observed between groups. Time to hypoglycemia onset was prolonged after the resistance as opposed to aerobic training (13 vs. 8 h, p = NS). There were no nocturnal hypoglycemic episodes (between 0 and 6 a.m.) after the resistance compared to aerobic exercise (4 vs. 0, p = NS). GH and cortisol responses were similar between the two sessions, while lactate levels were significantly more increased after resistance training. (5) Conclusion: Both exercise regimes induced similar blood glucose responses during and immediately following acute exercise.

[Analysis of requests for help. Emergency calls to the fire department and emergency medical services, as well as to the general medical practitioners' emergency services in a rescue service area]

There is no doubt that a single emergency phone number is desirable, but in contrast to other countries, in Germany different emergency phone numbers and dispatching centers exist for the fire brigade (FB), the emergency medical service system (EMS), and the general practitioners' emergency service (GPS). Due to this fact, valuable time is often wasted by connecting or transferring emergency calls from one dispatching center to another. The purpose of this study was to analyse all calls received by the different dispatching centers in the city and county area of Mainz with respect to total number, fraction of emergency calls, and specificity. Further, the total number of calls potentially referring to a hypothetic single dispatching center with a general emergency phone number (112) was calculated. During a 4-month period, all telephone calls were registered and related to day, time, and origin of the call (city or county) and classified as non-urgent or emergency calls, calls appropriate to the dispatching center dialed, emergency calls to be transferred, or unspecific calls. A total of 80,987 calls were received (city area 84.3%, county area 15.7%), most of them directed to the FB of Mainz (33,086). The EMS dispatching center received 31,286 calls, the five GPS-centers 15,256 calls; 1359 emergency calls that were directed to the police or FB needed transfer to the EMS. During weekdays the EMS and FB received the most calls, with a reduced frequency on Saturdays and Sundays (Table 2). Nevertheless, the highest total numbers of calls were received on Saturdays due to multiple calls directed to the GPS.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fiberoptic intubation in the prone position. Anesthesia in a thoraco-abdominal knife stab wound]

An ambulance was dispatched to a 40-year-old man with a stab wound. On arrival, the emergency physician found the patient lying face down with a large knife protruding from his back between the scapula and spinal column (Fig. 1). The vital signs were stable (blood pressure 120/70 mmHg, heart rate 90 min, respiratory rate 25-30 min, oxygen saturation 94%); the estimated blood loss was 500 ml. Oxygen was administered and two i.v. lines were inserted. After light sedation (diazepam), the patient was transported to the clinic in the face-down position. X-ray films and physical examination showed that the knife, with a length of about 30 cm, had penetrated 15 cm into the thorax; the tip was located at the diaphragm (Fig. 2). Endotracheal intubation for the surgical revision was performed with the patient in the face-down position: after topical anaesthesia of the nasal mucosa (cocaine), a fiberoptic device was introduced. Additional topical anaesthetic (lignocaine) was applied through the biopsy channel onto the mucosa of the larynx and pharynx. After a sufficient waiting period, the endotracheal tube was pushed over the fiberoptic device into the trachea without problems (Fig. 3). During the entire period the patient was awake and breathing spontaneously; no coughing or change of body position occurred. After correct placement of the tube, general anaesthesia was induced. During positioning of the patient in the operating theatre, the knife was unintentionally dislodged and critical bleeding occurred. The situation could be controlled by immediate transfusions and rapid surgical revision, which revealed injuries to the lung, diaphragm, and stomach. The patient recovered without severe complications.(ABSTRACT TRUNCATED AT 250 WORDS)

[Petit mal status in hyperthyroidism]

A 68-year-old woman who, for the first time, had a generalized tonic-clonic seizure and persisting confusional state was found to have nodular enlargement of the thyroid and a tachycardic arrhythmia. Electroencephalography (EEG) demonstrated a continuous irregular polyspike wave pattern. Total T4 concentration was elevated to 23 micrograms/dl. Consecutive Administration of 250 mg phenytoin, 4 mg clonazepam and 7.5 mg midazolam changed neither the clinical nor the EEG findings. But after general intensive care measures and high-dose thyrostatic treatment (40 mg thiamazole intravenously every four hours) the clinical and neurological status became normal. Serial EEGs over the subsequent weeks and months showed gradual disappearance of the abnormal changes with increasingly prolonged periods of normal activity.

[Thyroxine vs iodine and thyroxine. Comparison of the TSH suppression test]

In a crossover study 20 subjects (12 with non-toxic goiter) were given 150 micrograms levo-thyroxine (LT4) or a combination of 100 micrograms LT4 and 100 micrograms iodide daily for 8 weeks. Group I took 150 micrograms LT4 and group II the combination. After 4 weeks the two groups switched medications. A clinical examination, an intravenous TRH test and thyroid sonography were performed before the start of the study and 4 and 8 weeks thereafter. 150 micrograms LT4 daily resulted in significantly higher TSH suppression than the combination. A decrease in thyroid volume from 45 ml (mean range 24-85) to 26 ml (17-70 ml) was registered after as little as 4 weeks' therapy in 12 of 20 subjects with goiter.

Exophthalmos and basilar impression. A contribution to differential diagnosis of endocrine orbitopathy

We report on a male patient with exophthalmos of unclear etiology, basilar impression, syringohydromyelia and type II Arnold-Chiari malformation. Two diseases involving the orbital region were to be considered in differential diagnostic terms: endocrine orbitopathy and osseous orbit dysplasia. The typical physical appearance associated with basilar impression as well as suppurative keratitis in Lagophthalmos was striking. Tetraspasticity with pareses, bulbar symptoms, proximally pronounced muscular atrophy as well as a left hemihypesthesia was shown neurologically. Although the orbit CT was normal, sonography revealed thickened ocular muscles. There was euthyroidism in diffuse goiter with negative thyroid autoantibody findings. Because of lack of definitive detection of muscular swelling, tumor, or vascular anomaly in the various images, orbital dysplasia in the context of a malformation syndrome affecting several organs is suggested as the cause of the exophthalmos.