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ObjectiveIn this study, our objective was to provide practice recommendations by thoroughly examining lifestyle interventions for adults diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD). This was achieved through a systematic review of the literature, specifically focusing on lifestyle modification interventions in adults with MASLD.MethodsThe PIPOST (Population, Intervention, Professional, Outcome, Setting, and Type of evidence) framework was used to identify the questions for summarizing evidence. Utilizing the 6S model for the hierarchy of evidence, a computerized search was conducted to retrieve articles pertaining to lifestyle interventions for adults with MASLD from websites such as the UpToDate Clinical Advisor, BMJ Best Practice, JBI Library, Cochrane Library, International Guidelines Library, and PubMed, among others. The available research included clinical decisions, clinical practice guidelines, evidence summaries, systematic evaluation, expert consensus, and expert opinions. Two researchers independently evaluated the methodology of the studies, and evidence was subsequently extracted and grouped thematically. Our review encompassed publications from January 2018 to March 2023.ResultsA total of 26 publications were identified for the final review, consisting of seven guidelines, nine systematic evaluations, and 10 expert consensuses/opinions. From these sources, we derived six themes, 28 pieces of evidence: intervention modalities, diet management, exercise management, weight loss management, personalized management, and multidisciplinary collaboration.ConclusionIn the management of adults with MASLD, healthcare professionals should embrace a multidisciplinary team approach, adhere to the best available evidence, and develop structured and personalized interventions based on the best evidence for lifestyle modifications.

ABSTRACT: There are many factors affecting the instability of the submarine hydrate-bearing slope (SHBS), and the interaction with hydrate is very complicated. In this paper, the mechanical mechanism of the static liquefaction and instability of submarine slope caused by the dissociation of natural gas hydrate (NGH) resulting in the rapid increase of pore pressure of gas hydrate-bearing sediments (GHBS) and the decrease of effective stress are analyzed based on the time series and type of SHBS. Then, taking the typical submarine slope in the northern South China Sea as an example, four important factors affecting the stability of SHBS are selected, such as the degree of hydrate dissociation, the depth of hydrate burial, the thickness of hydrate, and the depth of seawater. According to the principle of orthogonal method, 25 orthogonal test schemes with 4 factors and 5 levels are designed and the safety factors of submarine slope stability of each scheme are calculated by using the strength reduction finite element method. By means of the orthogonal design range analysis and the variance analysis, sensitivity of influential factors on stability of SHBS are obtained. The results show that the degree of hydrate dissociation is the most sensitive, followed by hydrate burial depth, the thickness of hydrate and the depth of seawater. Finally, the concept of gas hydrate critical burial depth is put forward according to the influence law of gas hydrate burial depth, and the numerical simulation for specific submarine slope is carried out, which indicates the existence of critical burial depth.

Purpose: Periprosthetic fracture (PPF) is one of the severe complications in patients with osteosarcoma and carries the risk of limb loss. This study describes the characteristics, treatment strategies, and outcomes of this complication., Methods: Patients were consecutively included who were treated at our institution between 2016 and 2020 with a PPF of distal femur. The treatment strategies included two types: 1) open reduction and internal fixation with plates and screws and 2) replacement with long-stem endoprosthesis and reinforcement with wire rope if necessary., Results: A total of 11 patients (mean age 12.2 years (9-14)) were included, and the mean follow-up period was 36.5 (21-54) months. Most fractures were caused by direct or indirect trauma (n = 8), and others (n = 3) underwent PPF without obvious cause. The first type of treatment was performed on four patients, and the second type was performed on seven patients. The mean Musculoskeletal Tumor Society (MSTS) score was 20 (17-23). All patients recovered from the complication, and limb preservation could be achieved., Conclusion: PPF is a big challenge for musculoskeletal oncologists, particularly in younger patients. Additionally, PPF poses a challenge for orthopedic surgeons, as limb preservation should be an important goal. Hence, internal fixation with plates and endoprosthetic replacement are optional treatment strategies based on fracture type and patient needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jin, Su, Du, Hou, Lu, Dai, Lei, Chen and Li.)