A global research priority agenda to advance public health responses to fatty liver disease

Background & aims An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had 90% combined agreement. Conclusions Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat

Ensaios mecânicos de um sistema de fixação pedicular com barra transversal Mechanical assay of a pedicular fixation system with transversal rod

Foi realizado estudo biomecânico de um protótipo de sistema de fixação vertebral que utiliza o pedículo vertebral como ponto de ancoragem dos implantes, associado a hastes que conectam transversalmente os parafusos pediculares. De modo diferente dos sistemas convencionais, nos quais os parafusos são conectados no sentido longitudinal, no sistema desenvolvido as hastes são conectadas transversalmente aos parafusos. Foram realizados ensaios mecânicos (flexo-compressão, flexão lateral e torção) utilizando-se corpos de prova de madeira em máquina universal de testes, com a finalidade de comparar a resistência desse sistema de fixação com o sistema convencionalmente utilizado. Os testes biomecânicos mostraram que o sistema desenvolvido apresentou menor resistência nos ensaios mecânicos realizados, quando comparado com o sistema de fixação convencional.<br>A biomechanical study of a spine fixation prototype was performed. This system uses vertebral pedicle as anchor point of the implants in association with transversally connecting rods. This is different form the usual systems where longitudinally placed rods connect the pedicular screws. Mechanical assays were performed (flexo-compression, lateral flexion, torsion) using probe wood pieces in an universal testing machine, aiming to compare the resistance of this system of fixation to the conventionally used ones. Biomechanical tests showed that the system was less resistant to the mechanical assays when compared to conventional systems

Estudo mecânico de implante para fixação do segmento lombossacro da coluna vertebral

Foram estudados, do ponto de vista mecânico, a rigidez e os pontos críticos de um implante para fixação interna da coluna lombossacra. Aplicou-se o implante sobre um modelo de madeira simulando o segmento lombossacro da coluna. Realizamos sete ensaios de flexo-compressão, sete de rigidez axial, sete de rigidez radial e um ensaio destrutivo. Os resultados demonstraram que o implante foi eficiente e seguro para uso em seres humanos.This work consists of a mechanical analysis of the resistance and critical points of a stainless steel device for lumbossacral spinal fixation. The device was fixed into a wooden model representing the spinal lumbossacral segment. The experiment comprised seven tests of flexo-compression, seven tests of axial rigidity, seven tests of radial rigidity, and one destructive test. The critical points are the intersection of the pedicular screws threads and the attrition rate between the vise and the rod. The results demonstrated the device to be efficient and safe when used in human beings