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Owing to its unique geometry, the kagome lattice hosts various many-body quantum states including frustrated magnetism, superconductivity, and charge-density waves (CDWs). In this work, using inelastic X-ray scattering, we discover a dynamic short-range [Formula: see text] CDW that is dominant in the kagome metal ScV6Sn6 above TCDW ≈ 91 K, competing with the [Formula: see text] CDW that orders below TCDW. The competing CDW instabilities lead to an unusual CDW formation process, with the most pronounced phonon softening and the static CDW occurring at different wavevectors. First-principles calculations indicate that the [Formula: see text] CDW is energetically favored, while a wavevector-dependent electron-phonon coupling (EPC) promotes the [Formula: see text] CDW as the ground state, and leads to enhanced electron scattering above TCDW. These findings underscore EPC-driven correlated many-body physics in ScV6Sn6 and motivate studies of emergent quantum phases in the strong EPC regime.
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An accurate pressure scale is a fundamental requirement to understand planetary interiors. Here, we establish a primary pressure scale extending to the multimegabar pressures of Earth's core, by combined measurement of the acoustic velocities and the density from a rhenium sample in a diamond anvil cell using inelastic x-ray scattering and x-ray diffraction. Our scale agrees well with previous primary scales and shock Hugoniots in each experimental pressure range and reveals that previous scales have overestimated laboratory pressures by at least 20% at 230 gigapascals. It suggests that the light element content in Earth's inner core (the density deficit relative to iron) is likely to be double what was previously estimated, or Earth's inner core temperature is much higher than expected, or some combination thereof.
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Here we determine the compressional and shear wave velocities (vp and vs) of hexagonal close-packed iron, a candidate for the main constituent of the Earth's inner core, to pressures above 300 gigapascals using a newly designed diamond anvil cell and inelastic X-ray scattering combined with X-ray diffraction. The present results reveal that the vp and vs of the Preliminary reference Earth model (PREM) inner core are 4(±2)% and 36(±17)% slower than those of the pure iron, respectively at the centre of the core. The density and sound velocity of the PREM inner core can be explained by addition of 3(±1) wt% silicon and 3(±2) wt% sulphur to ironâ5 wt% nickel alloy. Our suggested inner core composition is consistent with the existing outer core model with oxygen, as the growth of the inner core may have created a secular enrichment of the element in the outer core.
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We have measured the lattice volume of ice VIII in different pressure-temperature pathways and found that the volume depends on the pathway, implying that deviatoric stress makes the volume larger. Dense ice is in the ice VIII phase with the molar volume of 6.56 cm3 and in a high-pressure phase with the molar volume of 6.45 cm3 at 10 K where the pressure can be estimated as 57.0 ± 3.4 and 60.4 ± 3.6 GPa, respectively, based on the third-order Birch-Murnaghan equation with parameters determined in this study (K0 = 30.8 ± 1.3 GPa and K'0 = 3.7 ± 0.1 with V0 fixed to 12.030 cm3).
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The compositional difference between subducting slabs and their surrounding lower-mantle can yield the difference in incorporation mechanism of Fe and Al into bridgmanite between both regions, which should cause heterogeneity in physical properties and rheology of the lower mantle. However, the precise cation-distribution has not been examined in bridgmanites with Fe- and Al-contents expected in a mid-ocean ridge basalt component of subducting slabs. Here we report on Mg0.662Fe0.338Si0.662Al0.338O3 bridgmanite single-crystal characterized by a combination of single-crystal X-ray diffraction, synchrotron 57Fe-Mössbauer spectroscopy and electron probe microanalysis. We find that the charge-coupled substitution AMg2+ + BSi4+ â AFe3+(high-spin) + BAl3+ is predominant in the incorporation of Fe and Al into the practically eightfold-coordinated A-site and the sixfold-coordinated B-site in bridgmanite structure. The incorporation of both cations via this substitution enhances the structural distortion due to the tilting of BO6 octahedra, yielding the unusual expansion of mean
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We observed trees of the Japanese apricot, Prunus mume 'Nanko' (Rosaceae), bearing two types of flowers: 34% had blue fluorescent pollen under UV irradiation, and 66% had non-fluorescent pollen. The fluorescent pollen grains were abnormally crushed, sterile, and devoid of intine and pollenkitt. The development of microspores within anthers was investigated: in the abnormally developed anthers, tapetal cells were vacuolated at the unicellular microspore stage, and fluorescent pollen was produced. Compounds responsible for the blue fluorescence of pollen were identified as chlorogenic acid and 1-O-feruloyl-ß-D-glucose. The anthers with fluorescent pollen contained 6.7-fold higher and 3.8-fold lower amounts of chlorogenic acid and N 1,N 5,N 10-tri-p-coumaroylspermidine, respectively, compared to those with non-fluorescent pollen. The tapetal vacuolization, highly accumulated chlorogenic acid, and deficiency of N 1,N 5,N 10-tri-p-coumaroylspermidine imply that low-temperature stress during the early unicellular microspore stage caused a failure in microsporogenesis. Furthermore, potential effects of the visual difference on the bee behavior were also discussed through the colorimetry. The sterility, likely induced by low-temperature stress, and the preference of honeybees for fluorescence may reduce the pollination efficiency of P. mume.
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Recent studies have suggested that an alteration in the gut microbiota and their products, particularly endotoxins derived from Gram-negative bacteria, may play a major role in the pathogenesis of liver diseases. Gut dysbiosis caused by a high-fat diet and alcohol consumption induces increased intestinal permeability, which means higher translocation of bacteria and their products and components, including endotoxins, the so-called "leaky gut". Clinical studies have found that plasma endotoxin levels are elevated in patients with chronic liver diseases, including alcoholic liver disease and nonalcoholic liver disease. A decrease in commensal nonpathogenic bacteria including Ruminococaceae and Lactobacillus and an overgrowth of pathogenic bacteria such as Bacteroidaceae and Enterobacteriaceae are observed in cirrhotic patients. The decreased diversity of the gut microbiota in cirrhotic patients before liver transplantation is also related to a higher incidence of post-transplant infections and cognitive impairment. The exposure to endotoxins activates macrophages via Toll-like receptor 4 (TLR4), leading to a greater production of proinflammatory cytokines and chemokines including tumor necrosis factor-alpha, interleukin (IL)-6, and IL-8, which play key roles in the progression of liver diseases. TLR4 is a major receptor activated by the binding of endotoxins in macrophages, and its downstream signal induces proinflammatory cytokines. The expression of TLR4 is also observed in nonimmune cells in the liver, such as hepatic stellate cells, which play a crucial role in the progression of liver fibrosis that develops into hepatocarcinogenesis, suggesting the importance of the interaction between endotoxemia and TLR4 signaling as a target for preventing liver disease progression. In this review, we summarize the findings for the role of gut-derived endotoxemia underlying the progression of liver pathogenesis.
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Cirrosis Hepática/metabolismo , Hepatopatías Alcohólicas/metabolismo , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Animales , Humanos , Receptor Toll-Like 4/metabolismoRESUMEN
Portal blood flows into the liver containing the gut microbiome and its products such as endotoxin and bacterial DNA. The cirrhotic liver acts and detoxifies as the initial site of microbial products. In so-called "leaky gut," the increased intestinal permeability for bacteria and their products constitutes an important pathogenetic factor for major complications in patients with liver cirrhosis. Prolonged gastric and small intestinal transit may induce intestinal bacterial overgrowth, a condition in which colonic bacteria translocate into the small gut. Cirrhotic patients further show gut dysbiosis characterized by an overgrowth of potentially pathogenic bacteria and a decrease in autochthonous nonpathogenic bacteria. Pathological bacterial translocation (BT) is a contributing factor in the development of various severe complications. Bile acids (BAs) undergo extensive enterohepatic circulation and play important roles in the gut-liver axis. BT-induced inflammation prevents synthesis of BAs in the liver through inhibition of BA-synthesizing enzyme CYP7A1. A lower abundance of 7α-dehydroxylating gut bacteria leads to decreased conversion of primary to secondary BAs. Decreases in total and secondary BAs may play an important role in the gut dysbiosis characterized by a proinflammatory and toxic gut microbiome inducing BT and endotoxemia, as addressed in my previous reviews. Selective intestinal decontamination by the use of various antimicrobial drugs for management of complications has a long history. Lactobacillus GG decreasing endotoxemia is reported to improve the microbiome with beneficial changes in amino acid, vitamin and secondary BA metabolism. Current approaches for hepatic encephalopathy are the use of nonabsorbable antibiotics and disaccharides. Probiotics may become an additional therapeutic option for advanced liver cirrhosis.
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Disbiosis , Microbioma Gastrointestinal , Traslocación Bacteriana , Humanos , Hígado , Cirrosis HepáticaRESUMEN
Patients with liver cirrhosis frequently experience non-specific symptoms and report severe reductions in their quality of life (QOL). The underlying mechanisms of the disease are multifactorial that may be specific to the disease or directly related to the liver. The major concern of liver cirrhosis with ascites, however, is the decreased QOL. Therefore, in the present study, the Ascites Symptom Inventory-7 (ASI-7) questionnaire was applied to subjectively evaluate the symptoms in patients with cirrhotic ascites following tolvaptan administration. In total, 69 patients with liver cirrhosis with ascites hospitalized to Nara Medical University were evaluated after being treated with tolvaptan (3.75-7.5 mg/day) and conventional diuretics between December 2013 and April 2018. A follow-up assessment was conducted 7 days after tolvaptan treatment, whilst ASI-7 was used on days 1 and 8 of the study. After an uneventful 7-day tolvaptan treatment regimens, 49 patients (71.0%) lost >1.5 kg of their body weight, who were referred to as responders, with the change in the ASI-7 score being found to correlate with the body weight change. By contrast, changes in urine volume did not correlate with those in the ASI-7 score. The responders experienced a greater reduction in the ASI-7 score after 7 days compared with those in the non-responders (P<0.01). ASI-7 scores were also found to correlate with body weight after tolvaptan administration. In conclusion, ASI-7 accurately reflected changes in body weight but not urine volume and results of the study highlighted the value of ASI-7 in the evaluation of ascitic volume and effectiveness of tolvaptan in cirrhotic ascites. The present clinical trial was registered onto the UMIN-Clinical Trial Registry on 1st March 2014 (registration no. UMIN000013095).
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Accumulating evidence supports that gut dysbiosis may relate to various liver diseases. Alcoholics with high intestinal permeability had a decrease in the abundance of Ruminnococcus. Intestinal dysmotility, increased gastric pH, and altered immune responses in addition to environmental and genetic factors are likely to cause alcohol-associated gut microbial changes. Alcohol-induced dysbiosis may be associated with gut barrier dysfunction, as microbiota and their products modulate barrier function by affecting epithelial pro-inflammatory responses and mucosal repair functions. High levels of plasma endotoxin are detected in alcoholics, in moderate fatty liver to advanced cirrhosis. Decreased abundance of Faecalibacterium prausnitzii, an anti-inflammatory commensal, stimulating IL-10 secretion and inhibiting IL-12 and interferon-γ expression. Proteobacteria, Enterobacteriaceae, and Escherichia were reported to be increased in NAFLD (nonalcoholic fatty liver disease) patients. Increased abundance of fecal Escherichia to elevated blood alcohol levels in these patients and gut microbiota enriched in alcohol-producing bacteria produce more alcohol (alcohol hypothesis). Some undetermined pathological sequences related to gut dysbiosis may facilitate energy-producing and proinflammatory conditions for the progression of NAFLD. A shortage of autochthonous non-pathogenic bacteria and an overgrowth of potentially pathogenic bacteria are common findings in cirrhotic patients. The ratio of the amounts of beneficial autochthonous taxa (Lachnospiraceae + Ruminococaceae + Veillonellaceae + Clostridiales Incertae Sedis XIV) to those of potentially pathogenic taxa (Enterobacteriaceae + Bacteroidaceae) was low in those with early death and organ failure. Cirrhotic patients with decreased microbial diversity before liver transplantation were more likely to develop post-transplant infections and cognitive impairment related to residual dysbiosis. Patients with PSC had marked reduction of bacterial diversity. Enterococcus and Lactobacillus were increased in PSC patients (without liver cirrhosis.) Treatment-naive PBC patients were associated with altered composition and function of gut microbiota, as well as a lower level of diversity. As serum anti-gp210 antibody has been considered as an index of disease progression, relatively lower species richness and lower abundance of Faecalibacterium spp. in gp210-positive patients are interesting. The dysbiosis-induced altered bacterial metabolites such as a hepatocarcinogenesis promotor DCA, together with a leaky gut and bacterial translocation. Gut protective Akkermansia and butyrate-producing genera were decreased, while genera producing-lipopolysaccharide were increased in early hepatocellular carcinoma (HCC) patients.
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Electronic structures of dense solid oxygen have been investigated up to 140 GPa with oxygen K-edge X-ray Raman scattering spectroscopy with the help of ab initio calculations based on density functional theory with semilocal metageneralized gradient approximation and nonlocal van der Waals density functionals. The present study demonstrates that the transition energies (Pi*, Sigma*, and the continuum) increase with compression, and the slopes of the pressure dependences then change at 94 GPa. The change in the slopes indicates that the electronic structure changes at the metallic transition. The change in the Pi* and Sigma* bands implies metallic characteristics of dense solid oxygen not only in the crystal a-b plane but also parallel to the c axis. The pressure evolution of the spectra also changes at â¼40 GPa. The experimental results are qualitatively reproduced in the calculations, indicating that dense solid oxygen transforms from insulator to metal via the semimetallic transition.
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The crystal, electronic and magnetic structures of solid oxygen in the epsilon phase have been investigated using the strongly constrained appropriately normed (SCAN) + rVV10 method and the generalized gradient approximation (GGA) + vdW-D + U method. The spin-polarized SCAN + rVV10 method with an 8-atom primitive unit cell provides lattice parameters consistent with the experimental results over the entire pressure range, including the epsilon-zeta structural phase transition at high pressure, but does not provide accurate values of the intermolecular distances d1 and d2 at low pressure. The agreement between the intermolecular distances and the experimental values is greatly improved when a 16-atom conventional unit cell is used. Therefore, the SCAN + rVV10 method with a 16-atom unit cell can be considered the most suitable model for the epsilon phase of solid oxygen. The spin-polarized SCAN + rVV10 model predicts a magnetic phase at low pressure. Since the lattice parameters of the predicted magnetic structure are consistent with the experimental lattice parameters measured at room temperature, our results may suggest that the epsilon phase is magnetic even at room temperature. The GGA + vdW-D + U (with an ad hoc value of Ueff = 2 eV at low pressure instead of the first-principles value of Ulreff ~ 9 eV) and hybrid functional methods provide similar results to the SCAN + rVV10 method; however, they do not provide reasonable values for the intermolecular distances.
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We report the high-pressure behavior of plasmon in polycrystalline Li up to 15 GPa at room temperature studied by inelastic x-ray scattering and ab initio calculation. The plasmon energy ([Formula: see text]) increases with decreasing atomic volume ([Formula: see text]), and the [Formula: see text] slope exhibits a discontinuity at bcc â fcc structural phase boundary reflecting the electronic band structure change. The plasmon peak width ([Formula: see text]) versus momentum transfer (q) curve of bcc-Li below 6.5 GPa keeps similar parabola-like shape. Above 8.4 GPa, where Li is in fcc, it changes from that of bcc-Li and has a convex shape.
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Monoclinic ZrO2 baddeleyite exhibits anomalous softenings of the bulk modulus and atom vibrations with compression. The pressure evolution of the structure is investigated using neutron powder diffraction combined with ab initio calculations. The results show that the anomalous pressure response of the bulk modulus is related not to the change in the bonding characters but to the deformation of an oxygen sublattice, especially one of the layers made of oxygen atoms in the crystallographic a* plane. The layer consists of two parallelograms; one is rotated with little distortion and the other is distorted with increasing pressure. The deformation of this layer lengthens one of the Zr-O distances, resulting in the softening of some atom vibrational modes.
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BACKGROUND: Several noninvasive biomarkers are available for diagnosing liver fibrosis stage and predicting hepatocellular carcinoma (HCC) development in patients with chronic hepatitis and liver cirrhosis. However, these biomarkers are not sufficiently accurate. Recently, von Willebrand factor (VWF) has been related to angiogenesis and apoptosis. Furthermore, VWF is associated with hepatic spare ability and HCC. OBJECTIVE: We aimed to determine whether VWF is a potential biomarker for liver fibrosis and HCC development. METHODS: Two hundred and twelve patients with chronic hepatitis B and C were recruited. VWF antigen (VWF: Ag) levels in each patient were determined via enzyme-linked immunosorbent assay. Univariable and multivariable analyses were used to determine the risk factor of HCC. RESULTS: The VWF: Ag levels were higher in patients with severe liver fibrosis stage and/or HCC development than in those without. The area under the curve of VWF: Ag for diagnosis of severe liver fibrosis stage was 0.721. Multivariable analysis showed that only VWF: Ag was a predictive biomarker for HCC development. CONCLUSIONS: VWF: Ag is related to liver fibrosis and may be useful for predicting HCC development. VWF is a potentially useful biomarker to diagnose severe liver fibrosis and predict HCC development.
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Among the various risky complications of liver cirrhosis, refractory ascites is associated with poor survival of cirrhotics and persistently worsens their quality of life (QOL). Major clinical guidelines worldwide define refractory ascites as ascites that cannot be managed by medical therapy either because of a lack of response to maximum doses of diuretics or because patients develop complications related to diuretic therapy that preclude the use of an effective dose of diuretics. Due to the difficulty in receiving a liver transplantation (LT), the ultimate solution for refractory ascites, most cirrhotic patients have selected the palliative therapy such as repeated serial paracentesis, transjugular intrahepatic portosystemic shunt, or peritoneovenous shunt to improve their QOL. During the past several decades, new interventions and methodologies, such as indwelling peritoneal catheter, peritoneal-urinary drainage, and cell-free and concentrated ascites reinfusion therapy, have been introduced. In addition, new medical treatments with vasoconstrictors or vasopressin V2 receptor antagonists have been proposed. Both the benefits and risks of these old and new modalities have been extensively studied in relation to the pathophysiological changes in ascites formation. Although the best solution for refractory ascites is to eliminate hepatic failure either by LT or by causal treatment, the selection of the best palliative therapy for individual patients is of utmost importance, aiming at achieving the longest possible, comfortable life. This review briefly summarizes the changing landscape of variable treatment modalities for cirrhotic patients with refractory ascites, aiming at clarifying their possibilities and limitations. Evolving issues with regard to the impact of gut-derived systemic and local infection on the clinical course of cirrhotic patients have paved the way for the development of a new gut microbiome-based therapeutics. Thus, it should be further investigated whether the early therapeutic approach to gut dysbiosis provides a better solution for the management of cirrhotic ascites.
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Flowering plants attract pollinators via various stimuli such as odor, color, and shape. Factors determining the foraging behavior of pollinators remain a major theme in ecological and evolutionary research, although the floral traits and cognitive ability of pollinators have been investigated for centuries. Here we show that the autofluorescence emitted from pollen and anthers under UV irradiation may act as another attractant for flower-visiting insects. We have identified fluorescent compounds from pollen and anthers of five plant species as hydroxycinnamoyl derivatives. The fluorescent compounds are also shown to quench UV energy and exhibit antioxidant activity, indicating a function as protectants of pollen genes from UV-induced damage. A two-choice assay using honeybees in the field demonstrated that they perceived the blue fluorescence emitted from the fluorescent compounds and were attracted to it. This result suggested that the fluorescence from pollen and anthers serves as a visual cue to attract pollinators under sunlight.
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Abejas/fisiología , Colorantes Fluorescentes/química , Magnoliopsida/metabolismo , Polen/química , Animales , Antioxidantes/química , Conducta Animal/efectos de los fármacos , Ácido Clorogénico/química , Ácido Clorogénico/farmacología , Cromatografía Líquida de Alta Presión , Flores/química , Flores/metabolismo , Magnoliopsida/química , Magnoliopsida/crecimiento & desarrollo , Espectrometría de Masas , Microscopía Confocal , Polen/metabolismo , Polinización , Espectrofotometría Ultravioleta , Rayos UltravioletaRESUMEN
AIM: Insufficient ADAMTS13 activity (ADAMTS13:AC) leads to increased levels of unusually large von Willebrand factor (VWF) multimers and causes microcirculatory disturbance and multiple organ failure (MOF). Endotoxin (Et) triggers the activation of coagulation and cytokine cascades, leading to MOF in severe inflammatory response syndrome. Here, we investigated the potential role of endotoxemia-related ADAMTS13 in acute cholangitis. METHODS: Twenty-four patients with acute cholangitis, including 7 with severe acute cholangitis, were recruited in this study. The levels of ADAMTS13:AC, VWF antigen (VWF:Ag), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α in each patient were determined by enzyme-linked immunosorbent assay, whereas Et levels were determined by Et activity assay (EAA) analysis. RESULTS: The ADAMTS13:AC and VWF:Ag levels were significantly lower and higher, respectively, in patients with acute cholangitis than in controls. The EAA levels were higher in patients with acute cholangitis than in controls, and were inversely correlated with that of ADAMTS13:AC. Patients with severe acute cholangitis had significantly lower ADAMTS13:AC and higher VWF:Ag levels than those with mild to moderate cholangitis. Notably, ADMTS13:AC was directly correlated with platelet counts and inversely correlated with IL-6 levels, and the VWF:Ag/ADAMTS13:AC ratio was directly correlated with IL-8 and TNF-α levels. CONCLUSIONS: Imbalance of ADAMTS13:AC and VWF:Ag levels might be associated with severe acute cholangitis, reflecting platelet hyperaggregability. Severe acute cholangitis has severe pathophysiological features and is complicated by endotoxemia and MOF. Notably, this is the first report indicating an association between the levels of ADAMTS13:AC and VWF:Ag and those of EAA and cytokines in acute cholangitis.
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Infections account for significant morbidity and mortality in liver cirrhosis and most are related to the gut microbiome. Fecal dysbiosis, characterized by an overgrowth of potentially pathogenic bacteria and a decrease in autochthonous non-pathogenic bacteria, becomes prominent with the progression of liver cirrhosis. In cirrhotic patients, disruption of the intestinal barrier causes intestinal hyperpermeability (i.e. leaky gut), which is closely related to gut dysmotility, dysbiosis and small intestinal bacterial overgrowth and may induce pathological bacterial translocation. Although the involved microbial taxa are somewhat different between the cirrhotic patients from the East and the West, the common manifestation of a shortage of bacteria that contribute to the production of short-chain fatty acids and secondary bile acids may facilitate intestinal inflammation, leaky gut and gut dysbiosis. Translocated endotoxin and bacterial DNA are capable of provoking potent inflammation and affecting the metabolic and hemodynamic systems, which may ultimately enhance the progression of liver cirrhosis and its various complications, such as hepatic encephalopathy (HE), variceal bleeding, infection and renal disturbances. Among studies on the microbiome-based therapeutics, findings of probiotic effects on HE have been contradictory in spite of several supportive results. However, the effects of synbiotics and prebiotics are substantially documented. The background of their effectiveness should be evaluated again in relation to the cirrhosis-related changes in gut microbiome and their metabolic effects. Strict indications for the antibiotic rifaximin remain unestablished, although its effect is promising, improving HE and other complications with little influence on microbial populations. The final goal of microbiome-based therapeutics is to adjust the gut-liver axis to the maximal benefit of cirrhotic patients, with the aid of evolving metagenomic and metabolomic analyses.
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Deficient ADAM metalloproteinase with thrombospondin type-1 motif, member 13 (ADAMTS13) activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and causes microcirculatory disturbances and multiple organ failure, while endotoxins trigger the activation of a coagulation cascade. The objective of the present study was to explore the role of ADAMTS13 in endotoxemia in patients with acute liver failure (ALF). Plasma concentrations of endotoxin and cytokines, including interleukin (IL)-6 and IL-8, and activity of the plasma ADAMTS13 inhibitor were determined, along with ADAMTS13:AC, the VWF antigen (VWF:Ag) and UL-VWFM, in 27 patients with acute hepatitis (AH), 11 patients with ALF, and 10 healthy controls. IL-6 and IL-8 concentrations on admission were significantly higher in patients with ALF than in those with AH or in healthy controls. ADAMTS13:AC concomitantly decreased and VWF:Ag progressively increased with increasing cytokine concentrations from the normal range to >100 pg/ml. The inhibitor was detected in 8 patients with ALF (0.6 to 2.4 BU/ml) and 6 patients with AH (0.6 to 0.8 BU/ml). Patients with the inhibitor reported lower ADAMTS13:AC, higher VWF:Ag and lower functional liver capacity than those without the inhibitor. Collectively, the findings suggested that decreased ADAMTS13:AC and increased VWF:Ag may be induced by pro-inflammatory cytokinemia as well as the presence of the ADAMTS13 inhibitor, both of which may be closely related to enhanced endotoxemia in patients with ALF.