Talk:Metabolic dysfunction–associated steatotic liver disease: Difference between revisions

re protein kinase

Stuff going on re protein kinase[1]. JFW | T@lk 23:26, 7 March 2007 (UTC)

Epidemiology

doi:10.1111/j.1365-2036.2007.03246.x, Dr Angulo about the epidemiology of this entity. JFW | T@lk 14:51, 1 April 2007 (UTC)

HRQOL

HRQOL poorer than in chronic viral hepatitis! doi:10.1111/j.1365-2036.2007.03426.x JFW | T@lk 23:24, 2 July 2007 (UTC)

Fatigue, in particular, is quite marked. It is associated with daytime somnolonce but is not worse or better depending on the severity of the NAFLD on biopsy. doi:10.1136/gut.2007.139303 JFW | T@lk 21:24, 13 May 2008 (UTC)

Diagnosis and monitoring

doi:10.1002/hep.21768 (Hepatology review) JFW | T@lk 09:39, 29 July 2007 (UTC)

AASLD

Raja92 (talk · contribs) added some information presented at the AASLD annual meeting. Unfortunately, these papers have not yet been printed. I'm just posting a reminder here that we need to trace the studies on PubMed in the future.

Meta-analysis suggests that bariatric surgery improves NASH in 80%: R. Mummadi (University of Texas Medical Branch) - Mummadi R, et al "Effect of Bariatric Surgery on Nonalcoholic Fatty Liver Disease (NAFLD): A meta-analysis" AASLD Meeting 2007; Abstract 130 presented Nov. 5.

I have asked Raja92 to keep an eye out as well. JFW | T@lk 06:04, 25 November 2007 (UTC)

Children

doi:10.1111/j.1365-2036.2008.03703.x JFW | T@lk 14:36, 6 April 2008 (UTC)

Super size me

Do a Morgan Spurlock, get elevated ALT within a couple of weeks: doi:10.1136/gut.2007.131797 JFW | T@lk 05:50, 14 April 2008 (UTC)

Wine

PMID 18454505 was added. This is a study using the NHANES III dataset where it was demonstrated that unexplained mildly raised ALT was much less likely in people who drink one glass of wine a day. I have no access to the fulltext article, but I can see that this was an observational study that does not seem to have confirmed diagnosis of NAFLD in any way. This casts significant doubts on the choice of endpoint, and makes it a poor choice for a general purpose encyclpedia. JFW | T@lk 05:48, 30 May 2008 (UTC)

Antioxidants

Last submission regarding the benefit ( or lack ) of antioxidants would need to be reworded in Light of Cochrane evaluation below

Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004996. Links Antioxidant supplements for non-alcoholic fatty liver disease and/or steatohepatitis.Lirussi F, Azzalini L, Orando S, Orlando R, Angelico F. University of Padova Medical School, Department of Medical and Surgical Sciences, Via Giustiniani, 2, Padova, Italy. flavio.lirussi@unipd.it

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is characterised by fatty deposition in the hepatocytes of patients with minimal or no alcohol intake and without other known cause. NAFLD includes a wide spectrum of histologic abnormalities ranging from hepatic steatosis to non-alcoholic steatohepatitis (NASH), or even cirrhosis. Antioxidant supplements, therefore, could potentially protect cellular structures against oxidative stress and the resulting lipid peroxidation. OBJECTIVES: To systematically evaluate the beneficial and harmful effects of antioxidant supplements versus no intervention, placebo, or other interventions for patients with NAFLD or NASH. SEARCH STRATEGY: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (June 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2006), MEDLINE (1966 to June 2006), EMBASE (1980 to June 2006), and the Chinese Biomedical Database (1978 to June 2006). No language restrictions were applied. SELECTION CRITERIA: Randomised clinical trials evaluating any antioxidant supplements versus no intervention, placebo, or other interventions in patients with NAFLD or NASH. Our inclusion criteria for NAFLD or NASH were based on history of minimal or no alcohol intake, imaging techniques showing hepatic steatosis, and/or histological evidence of hepatic damage (including simple steatosis, fatty infiltration plus nonspecific inflammation, steatohepatitis, fibrosis, and cirrhosis), and by exclusion of other causes of hepatic steatosis. DATA COLLECTION AND ANALYSIS: We extracted data from the identified trials and contacted authors. We used a random-effects model and fixed-effect model with the significant level set at P = 0.05. We evaluated the methodological quality of the randomised trials by looking at how the generation of allocation sequence, allocation concealment, blinding, and follow-up were performed. We made our analyses following the intention-to-treat method by imputing missing data. MAIN RESULTS: We identified six trials: two were regarded of high methodological quality and four of low methodological quality. None of the trials reported any deaths. Treatment with antioxidant supplements showed a significant, though not clinically relevant, amelioration of aspartate aminotransferase levels, but not of alanine aminotransferase levels, as compared to placebo or other interventions. Gamma-glutamyl-transpeptidase was decreased, albeit not significantly, in the treatment arm. Radiological and histological data were too limited to draw any definite conclusions on the effectiveness of these agents. Adverse events were non-specific and of no major clinical relevance. AUTHORS' CONCLUSIONS: There is insufficient data to either support or refute the use of antioxidant supplements for patients with NAFLD. It may be advisable to carry out large prospective randomised clinical trials on this topic.

PMID: 17253535 [PubMed - indexed for MEDLINE]76.177.138.94 (talk) 17:25, 25 November 2008 (UTC)MJHARD

NAFLD vs NASH

I think the nomenclature is confusing enough as is; the article isn't as clear as it could be in explaining the difference and prognostic implications. I'll try to find some time to work on this Wawot1 (talk) 01:43, 21 January 2010 (UTC)

I thought NASH is the most severe form of NAFLD, and the subtype that may progress to fibrosis and cirrhosis. Sadly the terms are often used interchangeably in the workspace. JFW | T@lk 10:11, 21 February 2010 (UTC)

JCEM on NAFLD as prognostic marker

doi:10.1210/jc.2012-3093 JFW | T@lk 11:33, 1 May 2013 (UTC)

fatty liver

I do not drink I used to be skinny then I weigh 238 pounds now I weight 156 I have alot of stomach problems I get bacteria in my stomach all the time they did a sope on me a few years back and said my liver was fat but did not help me I due to have a sope down my throat and the one that goes up your bum iam on high blood pressure meds and other meds to lower my colestrol Kenny42303 (talk) 03:00, 4 June 2015 (UTC)

Review

JAMA doi:10.1001/jama.2015.5370 JFW | T@lk 22:02, 9 June 2015 (UTC)

Why is this a "disease"?

If 20-30% of the US population has it, and the vast majority of people have no symptoms, how can this be called a "disease"? Is having freckles a "disease"? Gnuish (talk) 19:34, 15 September 2015 (UTC)

No mention of choline?

I'm surprised to see no mention of choline in this article. Chris Masterjohn did a survey of the literature, and describes the crucial relationship between choline and fatty liver. Could someone less medically challenged than me try to add something about this please? --Brian Fenton (talk) 17:54, 16 December 2015 (UTC)

Sugar-sweetened beverages

doi:10.1093/qjmed/hcv172 JFW | T@lk 13:36, 29 June 2016 (UTC)

Moved

"Foods high in fat and cholesterol, such as meat, dairy, cheese, and oils contribute to non-alcoholic fatty liver disease. A study of 9,000 American adults followed for 13 years showed a strong association between dietary cholesterol intake and hospitalization, and death from cirrhosis and liver cancer. To limit the excess dietary cholesterol, the liver tries to rid itself of cholesterol by dumping it into the bloodstream. Therefore, reducing dietary cholesterol intake, as well as food and beverage high in sugar, one can prevent non-alcoholic fatty liver disease. "

Dies bir appear to support.

References

--Doc James (talk · contribs · email) 13:28, 1 September 2016 (UTC)

Risk factor

NASH is an independent risk factor for several other diseases doi:10.1136/gutjnl-2017-313884 JFW | T@lk 19:43, 14 May 2017 (UTC)

NEJM

doi:10.1056/NEJMra1503519 JFW | T@lk 10:48, 23 November 2017 (UTC)

Issue with references?

@Jytdog: Thank you for your message of my talk page, I was not aware of the new content guideline for medical related articles. However, I am surprised of your last revert [2], could you please explain the reasons why? From my (admittedly quite fresh) understanding of the content guideline, this article, which is a review (it's written on the page, no need to have full access) should be considered a secondary source, isn't it? Thank you for your reply in advance, --Signimu (talk) 17:27, 27 July 2018 (UTC)

MEDRS is not new.

It would save other people time if you would include the PMID, like the message on your talk page advises.

PMID 18824034 is a review but is 9 years old and fails the WP:MEDDATE part of MEDRS

PMID 22297845 is a six year old primary source; not a review so fails MEDRS

PMID 19293782 is a nine year old primary source. Jytdog (talk) 17:31, 27 July 2018 (UTC)

@Jytdog: Thank you for your fast reply! Ok I did not know about automatic PMID linking, that's a nice feature! So I am here talking about PMID 18824034. Yes indeed it is old, but I did not find any more recent resource that is more complete, and to my understanding WP:MEDDATE does not prevent the use of "old" reviews if they are not superseeded by newer ones? --Signimu (talk) 17:37, 27 July 2018 (UTC)

I will look for a newer source over the weekend. Jytdog (talk) 17:43, 27 July 2018 (UTC)

Ok thank you very much! However I suggest we add this review until then, as I am not sure whether a newer review on the pathways exist? But it seems you know the field better so I let you decide about it! --Signimu (talk) 17:46, 27 July 2018 (UTC)

There is no deadline here. This has been a very hot field; it would be staggering if there were not a newer source. I have no more time for this today. Jytdog (talk) 17:47, 27 July 2018 (UTC)

Ah I did not know it had become a hot field! It's good then, I have been following this topic for years and not much progressed before... Well thank you @Jytdog:! I am going to post here a few more recent reviews I have found:

PMID 29300050 is a 2018 Nature review on the pathogenesis so quite good I think but it's quite short (2 pages).

PMID 25848481 is from 2015 and longer but not about pathogenesis (predatory journal)

[3] is a 2015 review on prevalence (we learn that NASH was the 2nd leading etiology of liver disease in US in 2015), treatments and outcomes.

PMID 26663351 is another 2015 review on pathophysiology and diet and weight loss, where we learn that « weight loss is the most effective way to promote liver fat removal. ».

PMID 26907882 is a 2016 review about management of NAFLD and NASH where we learn that NAFLD is estimated to affect 30% of USA population becoming the most common cause of liver disease, that NASH is the progressive subtype of NAFLD and some more discussion on the possible treatments.

--Signimu (talk) 18:09, 27 July 2018 (UTC)

PMID 25848481 is by a predatory publisher (see here). Please disregard it and please be wary of predatory publishers. We do not cite them.Jytdog (talk) 18:21, 27 July 2018 (UTC)

Yes good catch! --Signimu (talk) 20:59, 27 July 2018 (UTC)

Some additional references:

[4] : chronic intermittent hypoxia caused by «obstructive sleep apnoea is associated with an increased risk of NAFLD, NASH and fibrosis. OSAS patients should be screened for the presence and severity of NAFLD.»

[5] [NICE] guidance for NAFLD in 2016. They do not recommend the administration of Omega-3 based on high quality evidence from randomized trials, statins can be continued to be consumed unless liver enzyme levels double within 3 months of starting statins, and NAFLD is a risk factor for hypertension, chronic kidney disease, atrial fibrillation, myocardial infarction, ischaemic stroke and death from cardiovascular causes based on very low to low quality evidence from observational studies.

[6] The rate of liver cancer associated with NASH is steadily increasing from 2002 to 2012.

More to come...

--Signimu (talk) 15:09, 28 July 2018 (UTC)

[7] Global prevalence of NAFLD is estimated at 24% in 2017, and a substantial proportion of patients are lean ("lean NAFLD") with a lower median survival rate (free of liver transplantation) than in patients who were not lean according to am international cohort study including 483 patients with biopsy-diagnosed NAFLD with a mean follow-up period of over 11 years, and being overweight in childhood and adolescence is associated with increased risk of NAFLD later in life, with adult NAFLD predicted in a 31-year follow-up study by «risk factors during childhood including BMI and plasma insulin levels, male sex, genetic background (that is, PNPLA3 and TM6SF2 variants) and low birth weight, an emerging risk factor for adulthood NAFLD».

--Signimu (talk) 18:41, 28 July 2018 (UTC)

have you looked at the box of the very top of this page? It provides a link to recent reviews in pubmed.

I don't understand what you are doing here. There are lots of recent reviews. Jytdog (talk) 15:37, 28 July 2018 (UTC)

@Jytdog: I don't understand what you mean. I am simply trying to increase the amount and quality of information in the article, isn't this what we are supposed to do? If you agree with the quality of these sources, I can do some commits. If not, please explain why? --Signimu (talk) 17:12, 28 July 2018 (UTC)

Please note that I do not simply provide references but also what content I think would be interesting to add. I can add these modifications myself if you agree. Per BOLD I should go on directly but I would prefer that we stay/start on the same page first :-) --Signimu (talk) 17:15, 28 July 2018 (UTC)

You appear to be grabbing random MEDRS-ish sources and posting them here with some random comments. If your goal is to update this article:

there are two very good citations posted above that nobody has used yet.

in the article itself:

There are "citations needed" tags, that it would be useful to find recent high quality refs for, and add them and update the content if needed

There are many old sources here, and whatever the topic of the content sourced from the old refs is, it would be good to find more recent high quality refs covering those topics and update the content, citing the new source.

That would be work focused on improving the existing content. Jytdog (talk) 17:45, 28 July 2018 (UTC)

@Jytdog: Thank you for pointing out these parts, but I disagree that current works should be directed only towards updating what's already in the article without new content. I am currently reviewing the litterature, I am NOT just grabbing some random references and posting them here, I am reading (at least partially, I'm not doing a scientific meta-analysis meh) all of the references I cited above and I try to select the most pertinent and qualitative ones. I am unsure why you would like all modifications to be restrained to what is already present, because for the moment the reasons you put forward are clearly not enough to convince me. I am continuing my readings but when I feel ready I plan on modifying the article (including adding new content), unless you give me a good reason not to do so... --Signimu (talk) 18:14, 28 July 2018 (UTC)

I no where said "updating what's already in the article without new content". I did not say that. Jytdog (talk) 18:40, 28 July 2018 (UTC)

The existing content is decent in following MEDMOS with respect to the sectioning and the kinds of content that are here; it definitely needs updating, in content and sourcing. Be sure you read and follow WP:MEDMOS and WP:MEDHOW along with MEDRS. Jytdog (talk) 18:41, 28 July 2018 (UTC)

@Jytdog: Sorry then I misunderstood you. I will also take into account updating the old references, but it depends on what I find in the reviews of course! ;-) Yes thank you I tried to read them through, I might have missed a point or two though so please feel free to call me on my mistakes if some happen! :-) --Signimu (talk) 18:43, 28 July 2018 (UTC)

@Jytdog: Thank you very much for cleaning the article! :-D As you might have noticed, I am more of an "adder" than a cleaner because I often feel unsure about removing content... BTW I am mostly done with my modifications, I am just trying to dig up some more official guidelines I think I still have in my tabs and I will be gone ;-) (until more scientific research is done!) --Signimu (talk) 00:55, 29 July 2018 (UTC)

You improved the article. Thanks for that. Jytdog (talk) 01:06, 29 July 2018 (UTC)

@Jytdog: Thank you very much for your help! You saved me countless hours by pointing me at the WP:MEDRS and the citation tool, I would have made a lot less contributions if I had to manually format everything ;-) I think I'm done now! I will just write down what I could not do as a future todo :-) --Signimu (talk) 04:02, 29 July 2018 (UTC)

Pathophysiology, pathogenesis and guidelines

I think there are currently some great resources about the potential mechanisms of NAFLD, but my molecular biology knowledge is not enough to apprehend this material! If someone is feeling more comfortable, please feel free to review these articles and add more infos!

• PMID 29300050
• [8]
• [9]

Also I tried to add as much info as I could from the AASLD 2018 guidelines but I am not a physician so any help is appreciated to complete the article with these guidelines [10] ! --Signimu (talk) 04:06, 29 July 2018 (UTC)

There is preliminary evidence that intermittent fasting (here Ramadan fasting) may be beneficial for NAFLD [11]. --Signimu (talk) 14:36, 4 August 2018 (UTC)

And there is another strong evidence, from an interventional study, that treating obstructive sleep apnea improves NAFLD and metabolic syndrome [12]. --Signimu (talk) 14:48, 4 August 2018 (UTC)

Finally, one review investigating recent findings on animals treated with resveratrol [13]. --Signimu (talk) 15:08, 4 August 2018 (UTC)

Resveratrol can kill

We found that for neurological disorders, cardiovascular diseases, and diabetes, the current clinical trials show that resveratrol was well tolerated and beneficially influenced disease biomarkers. However resveratrol had ambiguous and sometimes even detrimental effects in certain types of cancers and in NAFLD. In most of the clinical trials, the major obstacle presented was resveratrol’s poor bioavailability.ref — Preceding unsigned comment added by 2A02:587:4111:400:38E2:9E27:9189:440F (talk) 13:56, 14 August 2018 (UTC)

I fixed the formatting and the header is hyperbolic. But the ref is PMID 28989978; that is from Nature Precision Oncology and is not a bad journal; we can use it. Jytdog (talk) 14:19, 14 August 2018 (UTC)

It's now added succinctly in the article:[14], thank you both for the input! --Signimu (talk) 17:20, 2 November 2018 (UTC)

HELP please

Séralini(yeah *that* one) is involved in a 2017 paper [Multiomics reveal non-alcoholic fatty liver disease in rats following chronic exposure to an ultra-low dose of Roundup herbicide. / Mesnage, Robin; Renney, George; Séralini, Gilles-Eric; Ward, Malcolm; Antoniou, Michael N. In: Scientific Reports, Vol. 7, 09.01.2017, p. 39328.] and, of course, it's being seized upon by the usual anti-glyphosate crew. It's hard to debunk this one as it's outside of my wheelhouse and there's a correlation/causation problem since the initial diagnosis of the effect correlates roughly with the introduction of RoundUp and similar. I noted at least one other author is vehemently anti-GMO and that always raises questions for me, particularly in research bias. And yes, I KNOW this is a pay-per-play journal but it's out there and people are citing it. Apologies as ever for my inability to work Wikipedia, I'm rarely here but I know there are people who enjoy this stuff.17:04, 16 September 2018 (UTC) — Preceding unsigned comment added by Smidoid (talk • contribs)

Apparently, it was not a well-done study. I have no idea who is citing it, nor why.--Quisqualis (talk) 20:00, 16 September 2018 (UTC)

Ginger supplement pilot study

Hi @Signimu:, thanks for tracking down the study on ginger supplimentation. The research design is at scholarly rigorous level that satisfies clinicians and practitioners so i’m Impressed to tracked this down. However it’s a pilot study which are used as an indication to whether or not a main study is worthwhile pursuing, and the chosen statistical analysis suits the statistical variables/factors (fun stuff like the types of logistic regression, ANOVA, MANCOVA etc) that the researchers are considering to use. So it sounds like the results of that study have ticked all the boxes to do just that. However in the our WP article it sounds like a main study has been completed. So in cases like this it’s best to state somethin like, “a double blind randomised control polit study resulted in showing___etc, and (if the case is such) a main study is planned” or “underway”.

So I’m encouraging you to go ahead to modify that because it’s your edit and a worthwhile one especially because we know so little about the modifiable factors related to treatment. It just needs qualifying a bit. And hopefully when the main study is completed, you/we can come back and update that point if it proves to be a clinically efficacious treatment. Wow wouldn’t it be great if it turns out that to be just that!

Also the cited link did not lead me to the article, so if you could make that work it would be helpful too! I can help you if you get stuck on stuff, but I’d like to encourage you to go ahead to give it that little bit of spit n polish.

Ultimately contributions like yours, meaning you have the capacity to understand and identify what research utilises the “gold standard” accepted among clinical researchers and which practitioners is valuable to our WP medical articles. It ensures WP medical articles are scholarly rigorous enough for clinicians to refer to when considering how they improve the QoL of their patients, as well as giving access to that level of information to the general lay person (patient). In turn patients and clinicians can potentially communicate better. So that’s why I’ve taken the time to encourage you make this happen even though it might only be a sentence of two, all learns and stands to benefit.

Anyway I hope that helps, and all the best with this and your future endeavours.Cheers, Dr.khatmando (talk) 15:59, 2 November 2018 (UTC)

Good stuff @Signimu:. I added a wikilink for pilot study. Mmm yes i’m not sure why I get a deadlink for the citation. I’m not the best at that stuff as I cite from so many different sources I’ve resigned my self to always making that work properly or i’ll just get caught up in a word full of painful code learning...but usually someone with impeccable skills in that error will descend and help out sometime fairly soon. Thanks for your help and contribution I value that. See you around more WP medical articles sometime. All the best, Dr.khatmando (talk) 16:58, 2 November 2018 (UTC)

@Dr.khatmando: Thank you very much for your feedback! Yes indeed I added quickly this reference as I stumbled upon it totally by chance I now updated the sentence with your advices (I saw you thanked me so I guess what I just did was fine ). The link and reference was generated by DOI, I have no idea why the link is broken, probably the journal forgot to redirect after reorganizing their website (but for sure it's not on our side!)... BTW I agree with all you said, that's why I worked on this article following a medical conference on the topic, as I found that the article did not reflect the state of the art, and that was a shame for all the current and future patients and their families since this is getting more and more prevalent! Have a nice day! --Signimu (talk) 17:01, 2 November 2018 (UTC)

Hi @Jytdog:, I thought that content was included under research. As such can you point out what’s not compliant. We’re trying to encourage people with capacity to comeback to contributing to WP medical articles. At least this is what I understand to be why I was approached to join the editorial board at the Wikijournal of Medicine which is looking to promote this activity on both original research for the journal and new and improved WP articles published through the journal. Correct me if i’ve misunderstood the interplay of purposes here. Or as I have done explain the rational rather than just point to the relevant WP guidelines. You know them better than others so it’s helpful to make this a learning experience rather than just the outright rejection of an contribution made in good faith. This is one of the reasons why we lost so many clinician contributions to WP articles. I’m not trying to put anyone’s nose out of joint here, but i’m advocating for a Spirit you can see in the above thread here. Your thoughts? Dr.khatmando (talk) 17:21, 2 November 2018 (UTC)

If you look at WP:MEDMOS the research section should not be a collection of individual studies (we ~could~ list hundreds there, in exactly this way, right?), but rather describe research trends - what are the questions being asked, where do we stand with them - that sort of thing. Jytdog (talk) 17:34, 2 November 2018 (UTC)

@Jytdog: Ah ok, I thought a double-blind controlled study would be OK as preliminary research. Thank you for watching and your clarification --Signimu (talk) 18:26, 2 November 2018 (UTC)

• overall the page is looking good; sourcing looks very solid overall. Thanks for the improvements! Jytdog (talk) 18:22, 2 November 2018 (UTC)

Thank you for your help and your patience! :-D --Signimu (talk) 18:26, 2 November 2018 (UTC)

Current hepatology reports

@Jytdog: Thank you for watching the article and your modifications. Good catch, thank you for the tip on[15]! Just out of curiosity, how did you find the exact impact factor? I searched but I did not find :-/ BTW thanks to this change I have found other much better and exciting research on the topic! Thank you very much! --Signimu (talk) 17:33, 2 November 2018 (UTC)

the journal website. Here is the NLM page btw. Jytdog (talk) 17:35, 2 November 2018 (UTC)

@Jytdog: Thank you very much! Yes I found the NLM page on MEDRS too (but it's in the footnotes! Not quite obvious to find ). --Signimu (talk) 18:21, 2 November 2018 (UTC)

(PS: ahhh it's not in full-text, the impact factor is in a picture, and it's called CiteScore WTF! Thank you very much for yet another tip :-D). --Signimu (talk) 18:24, 2 November 2018 (UTC)

UTC)

Yes I agree and I think there’s an eye for what research is rigorous. I was just in another discussion via email about IFs. They’re helpful as a quick indicator of the potential of the article being in a ballpark standart. It just means that when there’s articles that are published in Journals with meh kind of IFs it doesn’t mean the research isn’t top notch. But you really need to read and assess the article from a drawing from a good understanding of research, learnt formally or through other means (I see the human capacity as valid not how you got it)

There’s a class I used to teach this stuff to undergrads students who would rather cr$p in their hands and clap, than get excited about this stuff. And I see it that’s why you guys, and myself when something catches my eye, can make this work. So I appreciate what you do and for the link to the article working for me you provided. I’ll try and come back to have a look at my next round on WP. I appreciate your dedication and commitment here. It’s very encouraging. And I see Jytdog often putting in the good work...I think we’ve discussed stuff before on translation stuff?..mmm...anyway talk again soon. This article is one of the more important onesDr.khatmando (talk) 18:45, 2 November 2018 (UTC)