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Background: Metabolic-associated fatty liver disease (MAFLD) affects approximately 30% of the global population and is associated with obesity and metabolic syndrome. Anthropometric indices such as body mass index (BMI), waist circumference (WC), and weight are crucial markers for evaluating the progression of MAFLD. Curcumin, a bioactive compound with anti-inflammatory and antioxidant properties, has been investigated for its potential to improve metabolic outcomes. This umbrella review aimed to systematically evaluate the effects of curcumin supplementation on anthropometric indices in patients with MAFLD, considering epidemiological strength and power analysis. Methods: An umbrella review of meta-analyses from randomized controlled trials was conducted. PubMed, Scopus, and Web of Science were searched up to September 2024. Meta-analyses assessing curcumin’s effects on BMI, weight, and WC in MAFLD patients were included. Quality was assessed using the A Measurement Tool to Assess Systematic Reviews version (AMSTAR-2) tool, and heterogeneity was evaluated using the I 2 statistic. Statistical analyses were performed using R and Stata 18 software. Results: Curcumin supplementation had no significant effect on BMI (standardized mean difference [SMD]: −0.01; 95% confidence interval [CI]: −0.24 to 0.21, P = .91) with low power (1-β = 0.03) and a low epidemiological grade according to GRADE criteria. Similarly, curcumin showed no significant effect on WC (SMD: −0.27; 95% CI: −0.57 to 0.04, P = .08) with high power (1-β = 0.96) but low epidemiological strength. However, curcumin significantly reduced weight (SMD: −0.12; 95% CI: −0.19 to −0.04, P < .01) with moderate power (1-β = 0.56) and moderate epidemiological strength. No significant effect of dose or effect of supplementation duration was found. Conclusion: Curcumin supplementation may result in a statistically detectable but clinically modest reduction in body weight in patients with MAFLD, while showing limited or no efficacy on BMI and waist circumference. The epidemiological strength of the evidence varies across outcomes and is of low to moderate quality. Further well-designed, high-quality randomized controlled trials are needed to confirm the clinical relevance of curcumin’s effects on anthropometric indices.

Abstract Through emerging interpretations of individual “medical freedoms,” a panoply of state legislative bills seeks to undermine long-standing public health and health care requirements including recommendations to test, screen, treat, and vaccinate persons. To the extent these bills could upend decades of laws and policies protecting individual and communal health, especially among vulnerable individuals, they threaten the health — and freedoms — of all persons.

Introduction Historic series have demonstrated the importance of construct rigidity in the treatment of pelvic discontinuities, but there remains limited data comparing different constructs, especially contemporary cup-cages and custom triflange components. The aim of this study was to evaluate reconstructive constructs with emphasis on implant survivorship, radiographic results, complications, and clinical outcomes. Methods We reviewed 184 revision THAs with unilateral pelvic discontinuity at a single institution between 1998–2022. Mean age was 66 years, 83% were female, and mean BMI was 29 kg/m2. Constructs included uncemented cup and plating (n=66, 36%), cup-cages (n=59, 32%), jumbo uncemented acetabular components (n=30, 16%), conventional antiprotrusio cages (n=16, 9%), and custom triflanges (n=13, 7%). Since 2013, 73% of cases were treated with either a cup-cage or custom triflange. Acetabular distraction (n=36, 20%) and porous augments (n=33, 18%) were used as adjuncts. Mean follow-up was 8 years. Results The 5-year survivorships free of revision for aseptic loosening, any revision, and any reoperation were 92%, 79%, and 75%. Of 43 revisions, the most common indications were aseptic loosening (n=15) and dislocation (n=15). For each construct, the 5-year survivorships free of revision for aseptic loosening were 100% (triflange), 94% (cup-cage), 92% (uncemented jumbo acetabular component), 90% (plating), and 86% (conventional anti-protrusio cage). Radiographic analysis demonstrated discontinuity healing in 85% of unrevised patients. Of the 15 re-revisions for aseptic loosening, 92% involved loss of fixation from inferior hemipelvis. There were 63 complications with dislocation (n=32), nerve palsy (n=10), and wound problems (n=9) most common. Mean Harris hip scores improved from 51 to 70 at 5 years. Conclusion In this series, the 5-year survivorship free from aseptic loosening was very good (92%), especially with contemporary techniques like custom triflange (100%) and cup-cage constructs (94%). Survivorship free from any revision (79%) and reoperation (75%) remain lower due to dislocation and infection.

Introduction There is a growing interest in therapy applications of cell-free extracellular vesicles (EVs) but systemically administered EVs predominantly accumulate in the liver and thereby limit their applications in extrahepatic tissues. One way of diverting EVs to extrahepatic tissues is by tethering or expressing targeting vectors onto the surface of EVs but this requires chemical or genetic modifications with potential drawbacks. There is an unmet need to direct systemically administered EVs to a desired site without genetic or chemical modifications. Methods Herein, we employed positron emission tomography imaging of 89 Zr-labeled EVs to explore the ability of various substances to alter EV trafficking in the body. Results and discussion Subcutaneous injections of phenothiazine and poly(ethylene) glycol into the hind limb of BALB/c mice significantly increased the accumulation of intravenously administered 89 Zr-labeled EVs to the hind limb. Expanding these findings, we investigated EVs isolated from various sources, the influence of timing of the administration of phenothiazine with respect to labeled EV administration, and the relationship of the trafficking of EVs to the site of phenothiazine administration with overall change in biodistribution. The findings support further exploration of phenothiazine analogs for site specific enhancement of EV trafficking in therapeutic applications.

Introduction Female distance runners are at elevated risk for impaired bone remodeling due to high mechanical loading, potential low energy availability, and sustained inflammatory stress. Collagen peptide (CP) supplementation has been proposed as a nutritional strategy to support type I collagen synthesis and modulate osteoimmune signaling; however, evidence in premenopausal endurance athletes is limited. This pilot randomized, double-blind, placebo-controlled trial examined the effects of four weeks of high-dose CP supplementation on markers of bone metabolism and inflammatory activity in endurance-trained premenopausal women. Methods Twenty-two participants (18–35 years; ≥35 miles/week [&gt;56km/week]) were randomized to CP (INT; 20 g/day) or isocaloric maltodextrin (CON). Pre- and post-intervention assessments, conducted in the early follicular phase, included serum procollagen type I N-terminal propeptide (P1NP), plasma C-terminal telopeptide of type I collagen (CTX-1), serum soluble receptor activator of nuclear factor-κB ligand (sRANKL), osteoprotegerin (OPG), the sRANKL/OPG ratio, and interleukin-6 (IL-6). Repeated-measures ANCOVAs were performed, adjusting for accumulated running distance and vitamin D status. Results A significant group × time interaction was observed for P1NP ( p = 0.04), with increases in INT and no change in CON. No significant interaction was observed for CTX-1 ( p = 0.13). Significant interactions were also observed for sRANKL ( p = 0.046) and IL-6 ( p = 0.03). No significant interaction effects were detected for sRANKL, OPG, or the sRANKL/OPG ratio. Discussion Short-term CP supplementation increased a marker of bone formation, altered osteoclast-related signaling, and reduced IL-6 in endurance-trained premenopausal women. These findings support the potential for CP-mediated modulation of bone turnover and inflammatory activity and warrant further investigation in larger, adequately powered trials incorporating structural bone outcomes.