Covert hepatic encephalopathy (CHE) is a highly prevalent complication of liver cirrhosis. Despite the absence of overt symptoms, CHE is strongly associated with impaired quality-of-life, overt hepatic encephalopathy, and mortality. Over the past two decades, evidence regarding the pathophysiology, diagnosis, and treatment of CHE has accumulated considerably, and clinical guidelines recommend screening in patients with cirrhosis. Nevertheless, diagnostic and therapeutic algorithms have not been fully implemented in real-world practice, and many patients remain undiagnosed and untreated. Understanding the natural history of CHE is essential to improve cirrhosis care, as it provides a framework for appropriate screening, treatment decision-making, and patient counseling. CHE is a multi-organ syndrome with complex interactions between the liver, gut, skeletal muscle, kidneys, and brain, with impaired ammonia handling and systemic inflammation acting as central drivers of this organ crosstalk. Hyperammonemia induces astrocytic dysfunction, brain edema, and neuroinflammation, while systemic inflammation, oxidative stress, sarcopenia, gut dysbiosis, and altered microbial metabolites, including bile acids and short-chain fatty acids, further modulate disease expression. In this review, we summarize current understanding of CHE pathophysiology, diagnostic testing, including psychometric batteries and point-of-care tools, such as the Stroop test and animal naming test, and therapeutic options, ranging from lactulose and rifaximin to microbiome-targeted approaches, including fecal microbiota transplantation. We also highlight major challenges in CHE management, including limited implementation of testing, inadequate biomarkers, diagnostic difficulties in geriatric cirrhosis, and unmet needs in fall and driving risk management, and emphasize the importance of multidisciplinary team-based approaches to improve patient outcomes.
Ligand-controlled palladium-catalyzed reactions of acyl fluorides with hydrosilanes enables the selective generation and isolation of silicon-fluorine species, R3Si-F, which have typically been regarded as inert by-products in organosilicon chemistry. The formation of these silicon-fluorine compounds was confirmed by both F-19 NMR and Si-29{H-1} NMR spectroscopic analyses, and one of the isolated species, Ph3Si-F, was found to undergo a subsequent palladium-catalyzed transformation via Si-F bond cleavage. These results demonstrate silicon-fluorine species as potential viable intermediates in palladium catalysis and expand the synthetic utility of acyl fluorides as versatile fluorine sources.
The APC (adenomatous polyposis coli) gene, which was first discovered as a colorectal cancer suppressor gene, is highly expressed in the nervous system. The Apc gene/Apc protein is deeply involved in brain development and morphogenesis. In the postnatal brain, Apc/Apc is involved in synaptic transmission, axon growth, and intracellular transport. Apc/Apc expressed in glial cells is involved in glial cell differentiation and neural circuit formation through glial cell functions. Reports from disease model animals and familial adenomatous polyposis (FAP) patients suggest that APC may be involved in the onset of autism, cognitive impairment, and schizophrenia.
Carbon dioxide (CO2) has recently been regarded as a mild stimulus for modulating polymer properties. This study investigates how the amine content governs CO2-triggered structural and physical property changes in amine-modified polydimethylsiloxane (amine-PDMS) across a wide composition range. Upon CO2 exposure, the amine groups in amine-PDMS predominantly form ammonium carbamates that serve as physical cross-links and induce microphase separation, thereby increasing both the glass transition temperature (T-g) and elastic modulus. When the amine content is approximately 40 mol % or higher, rubbery samples vitrify upon CO2 exposure, with T-g rising to near or above room temperature and the shear storage modulus (G ') reaching approximately 1 GPa in representative cases. Meanwhile, the apparent rate constant (k app) for CO2 capture decreases with increasing amine concentration and drops sharply near 50 mol %, a trend attributed to limited CO2 penetration into the material caused by surface hardening during CO2 exposure. Notably, this transformation is reversible: upon heating above 80 degrees C, CO(2 )desorbs and the material reverts to its rubbery state. Furthermore, the T g of the CO2-cured material is composition-programmable, spanning approximately -20 to 60 degrees C depending on the amine concentration. Collectively, these findings provide fundamental insights into CO2-triggered changes in the structural and mechanical properties of amine-PDMS and highlight its potential as a promising platform for the development of advanced CO2-responsive polymeric materials.
This paper proposes a boundary integral equation to analyze two-dimensional metallic hollow waveguides. The proposed integral equation has a similar form to that for electromagnetic scattering problems although the unknown function is modified. The infinitely long boundary of the proposed integral equation can be truncated to finite length when the boundary element method is applied to it. The proposed integral equation can be solved combined with the auxiliary equations that are derived by using the orthogonality of modes between the proposed integral equation and a guided or evanescent mode. In order to validate the proposed method, we perform numerical calculation for three asymmetric waveguides, single step, N-step, and taper waveguides. Numerical results by our method are in good agreement with those by the mode matching method. Moreover, all numerical results satisfy the law of energy conservation to an accuracy of five decimal places.
