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Pros and cons of different dietary patterns for the treatment of metabolic dysfunction-associated steatotic liver disease
No full textMetabolic dysfunction-associated steatotic liver disease (MASLD) is becoming the most prevalent hepatic disorder, affecting up to 33 % of the global population. An altered lifestyle, characterized by extended physical inactivity and increased consumption of highly caloric food, often low in nutritional value, is recognised as one of the main contributing factors for MASLD. Cornerstone for MASLD treatment is a healthy lifestyle, starting from diet. However, the most appropriate dietary pattern for the treatment of MASLD remains a subject of debate. The aims of this narrative review are therefore to explore the mechanisms through which nutrition influences MASLD pathogenesis and to evaluate different dietary patterns for MASLD treatment, highlighting their advantages and limitations. Multiple dietary patterns-including the Mediterranean Diet (MD), the Dietary Approaches to Stop Hypertension (DASH), the Low-Carb Diet (LCD), the Ketogenic Diet (specifically the Very Low-Calorie Ketogenic Diet, VLCKD), the Low-Fat Diet (LFD), Vegetarian Diets (VDs), and Intermittent Fasting (IF)-are reviewed, with a focus on their efficacy on MASLD and the ameliorating of the associated cardiometabolic risks factors (CMRF)
The clinical and biomechanical implications of hallux rigidus and related surgical interventions on gait
No full textComprehensive Analysis of the Melanoma DNA Methylome Identifies LY75 Methylation as an Independent Marker Predicting Poor Clinical Outcome
No full textAccurate risk assessment of local recurrences or metastases is essential for melanoma treatment, but current clinical parameters are suboptimal. Therefore, we conducted a comprehensive DNA methylation analysis to identify prognostic markers that could improve risk prediction in patients with melanoma. We integrated methyl-binding domain sequencing, RNA sequencing, Infinium HumanMethylation450 analyses, and The Cancer Genome Atlas data to identify potential prognostic DNA methylation markers. Validation was performed using methylation-specific PCR in 2 independent melanoma cohorts as well as an in silico validation using The Cancer Genome Atlas data. Cox proportional hazards models and backward stepwise elimination determined the prognostic value of candidate markers. LY75 promoter methylation, Breslow thickness, and metastatic disease at diagnosis were significant independent predictors of recurrence-free survival. LY75 promoter methylation was also found to be an independent predictor of metastatic disease development in patients with localized stage I/II melanoma specifically. This association was confirmed in a second validation cohort and The Cancer Genome Atlas melanoma dataset. LY75 promoter methylation identifies patients at high risk of recurrences or metastases, independent of conventional prognostic parameters. This marker could help refine patient selection for sentinel node biopsies, imaging, (neo)adjuvant treatment, and closer monitoring, ultimately leading to improved clinical outcomes.</p
Measurement instruments of pain-related avoidance in chronic pain:a systematic review of psychometric properties
No full textAvoiding harmful events is adaptive in the short term but eventually may compromise functioning in daily life. Therefore, assessing pain-related avoidance is important in both pain research and treatment. Despite a variety of available measurement instruments, a systematic analysis of their quality and limitations is lacking. We evaluated the measurement properties of instruments used to assess pain-related avoidance in individuals with chronic pain. A systematic review following COSMIN guidelines was conducted (PROSPERO registration: CRD42020181461), including an electronic search of Cochrane, PsycArticles, PubMed, PubPsych, Scopus, and Web of Science as well as grey literature from inception to January 2024. Eligible studies were English, German, or French publications that explicitly claimed to evaluate one or more psychometric properties of measurement instruments assessing pain-related avoidance in adults with chronic pain. Of 703 screened records, 140 original articles were included, covering 20 self-reported questionnaires, one therapist-reported outcome measure, and one performance-based measure. Based on the current evidence, only the Brazilian Portuguese language version of the Chronic Pain Coping Inventory and the Italian version of the Chronic Pain Coping Inventory-42 fulfilled criteria to be recommended for use. Although the commonly used Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia were the most extensively studied, the study quality was mixed. The review further highlights extensive research on internal consistency, reliability, and construct validity but reveals a lack of high-quality evidence on measurement error and criterion validity. This work was supported by funding from the Flemish Government (METH/15/011)
Facts Over Partisanship:Evidence-Based Updating of Trust in Partisan Sources
No full textA prominent explanation for the proliferation of political misinformation and the growing belief polarization is that people engage in motivated reasoning to affirm their ideology and to protect their political identities. An alternative explanation is that people seek the truth but use partisanship as a heuristic to discern credible from dubious sources of political information. In three experiments, we test these competing explanations in a dynamic setting where participants are repeatedly exposed to messages from ingroup or outgroup partisan sources and can learn which source is reliable based on external feedback. Participants initially showed a partisan bias as they incorporated information from ingroup sources more than from outgroup sources. This pattern was stronger among partisans that displayed high affective polarization. With experience, this partisan bias declined or even changed direction, as supporters of both groups gradually incorporated information from reliable sources more than unreliable sources irrespective of the source's partisanship. Importantly, the content of the shared information (i.e., neutral vs. political), the presence of partisan sources as opposed to neutral sources and the presence of external monetary accuracy incentives did not affect the learning process indicating the presence of strong internal accuracy motives. In contrast, increased uncertainty regarding source reliability undermined the learning process. These findings demonstrate that partisans follow Bayesian learning dynamics. Although participants initially display a partisan bias in the incorporation of information, they overcome this bias in the presence of external feedback and learn to trust credible sources irrespective of partisanship
Making the Invisible Visible: Opportunities and points of contention arising from partnerships for the detection and investigation of human trafficking victims
No full textMensenhandel blijft zowel in Nederland als wereldwijd ondergedetecteerd en ondervervolgd. Opsporingsdiensten en banken hebben elk wettelijke plichten en expertise met betrekking tot de detectie van slachtoffers van dit misdrijf, maar hun inspanningen zijn vooralsnog voornamelijk gericht op de aanpak van andere winstgevende vormen van criminaliteit, zoals witwassen en het financieren van terrorisme. Hierdoor worden de mogelijkheden die ontstaan uit samenwerkingsverbanden tussen deze publieke en private instellingen op het tevens lucratieve maar vaker meer verborgen misdrijf mensenhandel onvoldoende verkend of benut. Door de sterke punten van beide partijen te combineren binnen publiek-private samenwerkingsverbanden, kunnen opsporingsdiensten en banken bijdragen aan de proactieve detectie van slachtoffers van mensenhandel. Banken kunnen zoeken naar slachtoffers binnen realtime gegevens en melden ongebruikelijke transacties omtrent mensenhandel aan opsporingsdiensten, waardoor politie en justitie minder afhankelijk zijn van aangiften van slachtoffers en verklaringen van getuigen. Daarbij is het belangrijk dat deze partijen bewust zijn van de mogelijke twistpunten die kunnen ontstaan door de dubbele rol van banken als publieke poortwachter en private winstmaker. Dit artikel presenteert een eerste, verkennende analyse van de kansen en twistpunten die voortkomen uit publiek-private samenwerkingen aangaande mensenhandel. Het doel is om allen aan te moedigen door te gaan met het verkennen van innovatieve manieren om het veelal onzichtbare mensenhandel zichtbaarder te maken
Can ChatGPT provide responses to patients for orthopaedic-related questions? A comparison between ChatGPT and medical support staff
No full textIntroduction: Patient Engagement Platforms, particularly chat functionalities, potentially improve communication but may also heighten workload, contributing to burnout among healthcare professionals. Natural Language Processing advancements, like ChatGPT and Med-PaLM, offer human-like responses to various questions, but concerns about their use in healthcare remain. This study evaluates whether Large Language Models can respond to patient questions as well as support staff in terms of quality and empathy. Methods: In this cross-sectional study, 111 patient questions on lower limb arthroplasty, answered by support staff via an app, were selected. These questions were put into ChatGPT 3.5 to generate responses, and were collected on July 2 and 3, 2024. Two blinded healthcare professionals, an orthopaedic surgeon and an anesthetist, evaluated both the responses generated by ChatGPT and support staff, on quality, empathy, and risk of potential adverse events, selecting their preferred responses and identifying what they thought was ChatGPT's response. A Patient Panel (n = 29) also assessed responses on empathy, preference, and source of the responses. Results: Fifty questions were available for a comparative analysis between ChatGPT and support staff responses. No quality difference was found (p = 0.075) between ChatGPT and support staff, though ChatGPT was rated as more empathetic (p < 0.001). No difference was found between the two responses in the risk of incorrect treatment (p = 0.377). Physicians identified ChatGPT's responses in 84–90 % of cases. The Patient Panel found ChatGPT to be more empathetic (p < 0.001) but showed no preference for ChatGPT (p = 0.086). Patients accurately identified ChatGPT's responses in 34.5 % of cases (p = 0.005). Three ChatGPT responses showed high-risk errors. Conclusion: This study shows ChatGPT generated high quality and empathetic responses to patient questions about lower limb arthroplasty. Further investigation is needed to optimize clinical use, but high appreciation for ChatGPT responses highlights the potential for use in clinical practice in the near future.</p
A Criminal Law Shield for Nature
No full textCriminal law has been widely used around the world to protect nature, but how to structure it for optimal protection remains unclear. This Article proposes a framework for applying criminal liability to offenders who create a risk of harm or harm to nature. First, it offers three models for liability, including abstract endangering, actual endangering, and independent/autonomous crime. Second, criminal penalties applied should be effective, dissuasive, and proportionate, including fines and imprisonment as well as remedies that restore the original state of nature and prevent future damage. Third, when corporations commit crimes against natural resources, both the corporations and individuals involved should be subject to criminal liability. The Article finds features of the framework within international and regional instruments, such as (1) the Convention on International Trade in Endangered Species of Wild Fauna and Flora, (2) the Rome Statute, (3) the Conventions on the Protection of the Environment Through Criminal Law, and (4) the Environmental Crime Directives. However, several problems can impede enforcement of criminal nature conservation laws, including (1) limited capacity and knowledge of judicial authorities; (2) lack of deterrence/dissuasion of potential offenders; (3) poor enforcement at the national level; and (4) lack of international cooperation
Stereotactic radiotherapy on Parkinson's disease induced tremors - a systematic review
No full textBackground: Parkinson's disease (PD) is a neurodegenerative disorder characterized by progressive disability due to bradykinesia, rigidity, and rest tremors. Especially in the treatment of tremors, pharmacological options often fall short. Invasive treatments such as deep brain stimulation are unsuitable in selected patients. Stereotactic radiotherapy (SRT) is a non-invasive alternative. However, implementation is hindered by inconsistent findings across studies. Materials and Methods: This study aims to evaluate the effect of SRT on tremors in PD patients. A PRISMA-guided systematic review identified 183 records. Six studies (n = 193 patients) met inclusion criteria. Outcomes were assessed after 12 months of SRT treatment. Results: All included studies used single-fraction SRT, prescribed doses ranged from 85-165 Gy, with 130-140 Gy being most frequently used. The ventral intermediate nucleus (VIM) was the most commonly targeted structure in three of the six studies. Across all studies tremor improvement was reported in 71 %-100 % of cases, with severity reduction of 38 %-67 % and tremor elimination in three studies varying from 0 % to 70 % of patients. Three studies noted medication reductions in 6 %-75 % of cases. Quality of life (QoL) and tremor recurrence were inconsistently reported: only one study reported no significant QoL improvement. Recurrence rates ranged from 3 %-24 %. Adverse events were present in 7 (7 %) patients. Conclusion: SRT is a promising non-invasive treatment for medically refractory PD tremor, with substantial tremor reduction and low toxicity. However, limitations such as the inconsistent reporting affect the strength of the findings. Future research should emphasize standardized reporting of treatment parameters and outcomes to strengthen evidence on SRT efficacy