The influence of obesity on the complications and outcomes of shoulder arthroplasty: A systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to determine whether obesity has a negative impact on the incidence of complications and functional scores of all types of shoulder arthroplasty. METHODS: Electronic databases such as PubMed, Embase, Web of Science, and Cochrane were systematically searched for publications concerning obesity and shoulder arthroplasty. The Newcastle-Ottawa scale criteria were used to evaluate the study's quality. A total of 15 studies were identified involving total shoulder arthroplasty, reverse total shoulder arthroplasty, or hemiarthroplasty. The studies com- paring the outcome of shoulder arthroplasty in different weight groups were conducted after the search of related literature and grouped according to different weights and compared with each other. Counted data used odds ratio value and its 95% CI for data analysis, and measurement data used weighted mean difference and its 95% CI for statistical analysis. RESULTS: The remaining 12 articles met the inclusion criteria and were included in this review. Any infection was reported in 6 studies, including 197 013 patients. Infections were more likely to occur in obese patients, with an odds ratio of 3.38 (95% CI, 2.28-5.02). The operation time of overweight patients (body mass index >25 kg/m2) was significantly longer than that of normal-weight patients (odds ratio, 6.90; 95% CI, 3.79-10.00). The venous thromboembolism was more likely to occur in obese patients (odds ratio, 3.39; 95% CI, 3.6- 4.28). In addition, there was no significant difference in the dislocation rate and revision rate of prostheses among the groups. Patients who undergo shoulder arthroplasty could obtain a good American Shoulder and Elbow Surgeons score (Mean Difference [MD], 1.87; 95% CI, -2.08 to 5.82), regardless of their body mass index. CONCLUSION: Obesity had a negative impact on the prognosis of patients treated with shoulder arthroplasty. Additionally, obese patients require longer surgical times than normal-weight patients, although all patients can attain positive functional outcomes. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Efficacy of Heshouwu () on gut mircobiota in mice with autoimmune encephalomyelitis.

OBJECTIVE: To learn the mechanisms between gut microbiome and the autoimmunity benefits on Traditional Chinese Medicine (TCM) in central nervous system (CNS), we investigated the neuro-protection effects and gut mircobiota changes of Heshouwu () on experimental autoimmune encepha-lomyelitis (EAE), an animal model of multiple sclerosis (MS). METHODS: Mice were randomly divided into four groups: EAE mice (control phosphate-buffered saline group), 50 mg·kg·d Heshouwu ()-treated EAE mice, 100 mg·kg·d Heshouwu ()-treated EAE mice, and 200 mg·kg·d Heshouwu ()-treated EAE mice. The spinal cords were stained with hematoxylin and eosin (HE) and luxol fast blue for evaluating inflammatory infiltration and demyelination. The percentages of granulocyte macrophage-colony stimulating factor (GM-CSF)+CD4+, interleukin 17 (IL-17)+CD4+, Foxp3 CD4+, and interferon-γ (IFN-γ)+CD4+ T cells in the inguinal lymph nodes (LNs) and brain were determined by flow cytometry analysis. 16S rRNA gene sequencing was employed to analyze the changes in gut microbiota. RESULTS: We found that Heshouwu () alleviated the disease severity and neuropathology of EAE as evaluated by clinical and histopathologyical scores. Heshouwu () increased the diversity and abundance of the gut microbiota, and decreased / ratio (F/B ratio). Heshouwu () also decreased the concentrations of IL-10, and IL-21 and increase the levels of GM-CSF, IL-17A, IL-17F and IL-22 in serum of EAE mice. Moreover, Heshouwu () modulated the T cell responses by inhibiting Th17 cells and restoring Treg cells in the small intestine lymphoid tissues and inguinal lymph nodes. Microbiota-depleted mice receiving Heshouwu ()-treated fecal microbiota trans-plantation had lower disease severity, neuropathology scores and alleviation of Th17/Treg imbalance compared to ad libitum group. CONCLUSIONS: Our findings suggested that the vital neuro-protection role of Heshouwu () (TCM) in immunomodulation effects partly by regulations of gut microbiome.

Modeling secondary accidents identified by traffic shock waves.

The high potential for occurrence and the negative consequences of secondary accidents make them an issue of great concern affecting freeway safety. Using accident records from a three-year period together with California interstate freeway loop data, a dynamic method for more accurate classification based on the traffic shock wave detecting method was used to identify secondary accidents. Spatio-temporal gaps between the primary and secondary accident were proven be fit via a mixture of Weibull and normal distribution. A logistic regression model was developed to investigate major factors contributing to secondary accident occurrence. Traffic shock wave speed and volume at the occurrence of a primary accident were explicitly considered in the model, as a secondary accident is defined as an accident that occurs within the spatio-temporal impact scope of the primary accident. Results show that the shock waves originating in the wake of a primary accident have a more significant impact on the likelihood of a secondary accident occurrence than the effects of traffic volume. Primary accidents with long durations can significantly increase the possibility of secondary accidents. Unsafe speed and weather are other factors contributing to secondary crash occurrence. It is strongly suggested that when police or rescue personnel arrive at the scene of an accident, they should not suddenly block, decrease, or unblock the traffic flow, but instead endeavor to control traffic in a smooth and controlled manner. Also it is important to reduce accident processing time to reduce the risk of secondary accident.

Involvement of the spinal NMDA receptor/PKCγ signaling pathway in the development of bone cancer pain.

N-methyl-d-aspartate (NMDA) receptor and protein kinase C (PKC) play important roles in the induction and maintenance of central sensitization during pain states. It has been shown that spinal NMDA receptor-dependent activation of PKCgamma facilitates nociception during neuropathic and inflammatory pain, but its involvement in bone cancer pain has not previously been established. The aim of this study was to examine the potential role of the spinal NMDA receptor/PKCgamma signaling pathway in the development of bone cancer pain. Osteosarcoma NCTC 2472 cells were implanted into the intramedullary space of the right femurs of C3H/HeJ mice to induce ongoing bone cancer-related pain behaviors. At day 7, 10 and 14 after operation, the expression of PKCgamma mRNA in the spinal cord was higher in tumor-bearing mice compared to the sham mice. At day 14, intrathecal administration of 5 microg of NR2B subunit-specific NMDA receptor antagonist ifenprodil attenuated the up-regulation of PKCgamma mRNA in the spinal cord as well as bone cancer-evoked thermal hyperalgesia and mechanical allodynia. Furthermore, intrathecal injection of 10 microg of PKC inhibitor H-7 attenuated cancer-evoked thermal hyperalgesia and mechanical allodynia at day 14. These results suggest that the NMDA receptor/PKCgamma signaling pathway may participate in the development of bone cancer pain, and ifenprodil may be a useful alternative or adjunct therapy for bone cancer pain.