The gut–liver axis in immune remodeling of hepatic cirrhosis

In healthy settings, the gut–liver axis allows host–microbiota communications and mediates immune homeostasis through bidirectional regulation. Meanwhile, in diseases, gut dysbiosis, combined with an impaired intestinal barrier, introduces pathogens and their toxic metabolites into the system, causing massive immune alternations in the liver and other extrahepatic organs. Accumulating evidence suggests that these immune changes are associated with the progression of many liver diseases, especially hepatic cirrhosis. Pathogen-associated molecular patterns that originated from gut microbes directly stimulate hepatocytes and liver immune cells through different pattern recognition receptors, a process further facilitated by damage-associated molecular patterns released from injured hepatocytes. Hepatic stellate cells, along with other immune cells, contribute to this proinflammatory and profibrogenic transformation. Moreover, cirrhosis-associated immune dysfunction, an imbalanced immune status characterized by systemic inflammation and immune deficiency, is linked to gut dysbiosis. Though the systemic inflammation hypothesis starts to link gut dysbiosis to decompensated cirrhosis from a clinical perspective, a clearer demonstration is still needed for the role of the gut–liver–immune axis in cirrhosis progression. This review discusses the different immune states of the gut–liver axis in both healthy and cirrhotic settings and, more importantly, summarizes the current evidence about how microbiota-derived immune remodeling contributes to the progression of hepatic cirrhosis via the gut–liver axis

Osteointegration of soft tissue grafts within the bone tunnels in anterior cruciate ligament reconstruction can be enhanced

Anterior cruciate ligament reconstruction with a soft tissue autograft (hamstring autograft) has grown in popularity in the last 10 years. However, the issues of a relatively long healing time and an inferior histological healing result in terms of Sharpey-like fibers connection in soft tissue grafts are still unsolved. To obtain a promising outcome in the long run, prompt osteointegration of the tendon graft within the bone tunnel is essential. In recent decades, numerous methods have been reported to enhance osteointegration of soft tissue graft in the bone tunnel. In this article, we review the current literature in this research area, mainly focusing on strategies applied to the local bone tunnel environment. Biological strategies such as stem cell and gene transfer technology, as well as the local application of specific growth factors have been reported to yield exciting results. The use of biological bone substitute and physical stimulation also obtained promising results. Artificially engineered tissue has promise as a solution to the problem of donor site morbidity. Despite these encouraging results, the current available evidence is still experimental. Further clinical studies in terms of randomized control trial in the future should be conducted to extrapolate these basic science study findings into clinical practice. © 2009 Springer-Verlag.postprin

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Extended trapezius myocutaneous free flap for the reconstruction of a foot defect lacking adjacent recipient vessels

Foot reconstruction requires tissue that is durable and can withstand the extremes of pressure and stress. The trapezius myocutaneous flap has not been used previously as a free flap for foot reconstruction. In this report, the trapezius was used as an extended myocutaneous free flap for the reconstruction of a foot wound lacking adjacent and adequate recipient vessels. The extended trapezius flap may be one of the longest free flaps that can be harvested. The indications for the use of this flap are limited. In an extremity that lacks adequate recipient vessels adjacent to the defect, this flap can be extended such that more proximal vessels in the leg can be used as the recipient vessels without the need for vein grafts to bridge the distance. The donor-site morbidity of this flap is minimal when the superior fibers of the trapezius muscle and its innervation are preserved

Dual-polarized multiplexed meta-holograms utilizing coding metasurface

In this paper, a novel method is proposed to achieve two distinct information channels by simultaneously manipulating both the transmitted cross- and co-polarized components of a 1-bit coding metasurface under linearly polarized incidence. Compared to previously demonstrated incidence-switchable or position multiplexed holograms, our proposed coding meta-hologram can simultaneously project two independent holographic images without inevitable change of the incidence state and can at the same time also avoid crosstalk between different channels. Moreover, the orientation of the double-layered split ring (SR) apertures is specially designed to be 45° or 135° to achieve identical multiplexed functionality for both x-polarized and y-polarized incidences. The proof-of-concept experimental demonstrations present total transmittance efficiency above 30% for the dual linearly polarized incidences at 15 GHz, and good imaging performances with 53.98%/48.18% imaging efficiency, 1.55%/1.46% RMSE, and 29.9/28.72 peak signal-to-noise ratio for the cross-/co-polarized channels under y-polarized incidence, and 47.27%/45.75% imaging efficiency, 1.55%/1.43% RMSE, and 18.74/25.93 peak signal-to-noise ratio under x-polarized incidence, demonstrating great potential of the proposed multiplexed coding meta-hologram in practical applications such as data storage and information processing

A solitary osteolytic lesion with pathological fracture in the cervical spine - a case report

Abstract Background Langerhans cell histiocytosis (LCH) is a rare disorder. The treatment options vary depending on how many organs are involved and how extensive the disease is. In this report, a case of LCH with isolated 6th cervical vertebra (C6) collapse was presented. This case was treated with anterior corpectomy and instrumented fusion, followed by local radiotherapy (RT), with a good clinical outcome up to postoperative six months. Case presentation This was a 47-year-old female patient with a complaint of neck pain and bilateral shoulder pain for two months before consultation. She was initially treated with analgesics, but the pain was persistent. Further radiological evaluations revealed an osteolytic lesion within the C6 vertebral body with a pathological fracture. Magnetic resonance imaging (MRI) with contrast of the cervical spine revealed diffused hypointense signal changes on the T1-weighted images and hyperintense signal changes on the T2-weighted images in the C6 vertebral body, with significant contrast-enhanced infiltration signals. Furthermore, in positron emission tomography-computed tomography (PET-CT), focal hypermetabolism and abnormal uptake signals were seen only in the C6 vertebral body. The patient underwent an anterior cervical corpectomy with instrumented fusion. The histopathological results confirmed the diagnosis of LCH. The patient reported significant pain relief on postoperative day one. Moreover, she was treated by local RT at postoperative one month. Good clinical outcomes were achieved in the form of no pain and recovery in neck mobility up to postoperative six months. No evidence of recurrence was observed at the final follow-up. Conclusions This case report describes a treatment option for a solitary C6 collapse with LCH managed by anterior corpectomy and instrumented fusion, followed by local RT, with a good clinical outcome at postoperative six months. More studies are needed to elucidate whether such a treatment strategy is superior to surgery or RT alone

Biomass-Derived Porous Carbons Derived from Soybean Residues for High Performance Solid State Supercapacitors

A series of heteroatom-containing porous carbons with high surface area and hierarchical porosity were successfully prepared by hydrothermal, chemical activation, and carbonization processes from soybean residues. The initial concentration of soybean residues has a significant impact on the textural and surface functional properties of the obtained biomass-derived porous carbons (BDPCs). SRAC5 sample with a BET surface area of 1945 m2 g&minus;1 and a wide micro/mesopore size distribution, nitrogen content of 3.8 at %, and oxygen content of 15.8 at % presents the best electrochemical performance, reaching 489 F g&minus;1 at 1 A g&minus;1 in 6 M LiNO3 aqueous solution. A solid-state symmetric supercapacitor (SSC) device delivers a specific capacitance of 123 F g&minus;1 at 1 A g&minus;1 and a high energy density of 68.2 Wh kg&minus;1 at a power density of 1 kW kg&minus;1 with a wide voltage window of 2.0 V and maintains good cycling stability of 89.9% capacitance retention at 2A g&minus;1 (over 5000 cycles). The outstanding electrochemical performances are ascribed to the synergistic effects of the high specific surface area, appropriate pore distribution, favorable heteroatom functional groups, and suitable electrolyte, which facilitates electrical double-layer and pseudocapacitive mechanisms for power and energy storage, respectively