Copper-based nanoparticles, especially metallic copper (Cu NPs) and copper oxide (CuO NPs), have attracted increasing attention due to their redox activity, biological efficacy, and technological applications. However, conventional chemical synthesis often involves toxic reagents, limiting their biomedical applicability. In this context, plant-mediated green synthesis has evolved and has become a sustainable and cost-effective alternative. This review provides a comprehensive overview of recent advances in the biosynthesis of Cu and CuO nanoparticles using plant extracts. The main synthesis pathways are examined, with emphasis on the role of phytochemicals as reducing, stabilizing, and capping agents, as well as the influence of reaction parameters on nanoparticle yield. The review highlights the diversity of plant species and extract types used and clarifies their effects on nanoparticle size, morphology, oxidation state, and surface chemistry. Key physicochemical characterization techniques (ultraviolet–visible (UV–Vis) spectroscopy, Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), electron microscopy, and zeta potential analysis) are systematically discussed. Moreover, a summary of in vitro and in vivo biological activities is provided, including antimicrobial, antioxidant, cytotoxic, anticancer, wound-healing, and plant-growth-promoting effects. Overall, plant-mediated copper-based nanoparticles demonstrate significant potential as biofunctional nanomaterials. Nevertheless, challenges concerning reproducibility, mechanistic understanding, standardization and toxicological evaluation must be addressed to facilitate reliable translation into biomedical applications.

A varied family of polyphenolic chemicals, flavonoids, are becoming more and more important in bone tissue engineering because of their osteogenic, anti-inflammatory, and antioxidant effects. Recent developments incorporating flavonoids into different biomaterial platforms to improve bone regeneration are emphasized in this study. Osteocalcin (OCN) expression was 2.1-fold greater in scaffolds loaded with flavonoids—such as those made of polycaprolactone (PCL)—greatly increasing human mesenchymal stem cell (hMSC) proliferation and mineralization. Comparably, a threefold increase in calcium deposition indicates increased mineralization when hydroxyapatite (HA) was functionalized with flavonoids such as quercetin. These HA scaffolds with flavonoids also showed a 45% decrease in osteoclast activity, therefore promoting balanced bone remodeling. Concurrent with flavonoids like EGCG and quercetin, chitosan-based scaffolds encouraged osteogenic differentiation with increases in osteogenic markers like osteopontin (OPN) and alkaline phosphatase (ALP) expression by up to 82%. These scaffolds also showed 82% bone defect repair after six weeks in vivo, suggesting their promise in rapid bone regeneration. With an increase of up to 32% in the bone volume-to-total volume ratio (BV/TV) and 28% greater bone–implant contact (BIC), flavonoid coatings on titanium implants enhanced osteointegration in implantology. Displaying successful osteogenesis and immunomodulation, the addition of flavonoids into metal–organic frameworks (MOFs) and injectable hydrogels demonstrated a 72% increase in new bone formation in vivo. Though further research is required to confirm long-term clinical effectiveness, these findings show the great promise of flavonoid-functionalized biomaterials in bone regeneration.

With around 40 species spread throughout temperate and subtropical environments, mostly in East Asia and North America, the genus Lespedeza (Fabaceae) includes a variety of species that have been used in traditional folk medicine for centuries. Particularly in antioxidant, anti-inflammatory, anticancer, and antidiabetic applications, Lespedeza species show notable pharmacological promise, due in large part to their high polyphenolic content. With a 2,2-diphenyl-1-picrylhydrazyl (DPPH) IC50 of 20–25 µg/mL and a ferric ion reducing antioxidant power (FRAP) value of 819.5 µmol Fe²⁺/g, L. cuneata demonstrated the highest antioxidant activity among the three Lespedeza species. The rich polyphenolic profile includes quercetin, catechin, rutin, and special substances like lespeflorin B/C and lespecunioside A/B, which explain its efficacy. Its broad-spectrum action across DPPH, 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), and nitric oxide (NO) tests points to its importance for neuroprotective and anti-aging uses. Anti-inflammatory studies support its capacity to downregulate tumor necrosis factor (TNF-α) and interleukin 6 (IL-6) via nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) suppression. L. bicolor has shown excellent promise, owing to its high total flavonoid content (109.2 mg QE/g) and presence of bioactives including kaempferol-3-O-rutinoside and xanthoangelol, albeit displaying somewhat lower antioxidant capacity (FRAP: 912.3 µmol Fe²⁺/g). In macrophage models it showed clear anti-inflammatory action. Its capacity to prevent advanced glycation end products’ (AGEs) generation ties it to possible antidiabetic and antiaging effects. Although it showed the worst antioxidant profile (IC50: 40–60 µg/mL; FRAP: 743.2 µmol Fe²⁺/g), L. capitata nonetheless had useful components like quercetin, chlorogenic acid, and lespedecapitoside (syn. isoorientin). Though little researched, they have modest antioxidant, nephroprotective, and anti-inflammatory action.

Acute kidney injury (AKI) is a serious clinical condition that is linked to markedly higher rates of morbidity and mortality in cirrhosis patients. Its diagnosis is challenging due to overlapping clinical and laboratory features among causes such as hepatorenal syndrome (HRS), acute tubular injury (ATI), and prerenal hypovolemia. In order to address the distinct pathophysiology and clinical context of cirrhosis, the definitions and classification of AKI have changed over time, moving from RIFLE and AKIN to KDIGO and ICA-AKI. Because cirrhosis patients have altered muscle mass and fluid retention, traditional markers like serum creatinine (sCr) and urine output have significant limitations. Neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), and cystatin C (CysC) are some of the new biomarkers that have shown promise in early AKI detection and in differentiating structural from functional kidney injury. NGAL and KIM-1 are sensitive indicators of tubular damage with potential prognostic implications. IL-18 reflects inflammatory injury, and CysC offers a more reliable measure of glomerular filtration. Incorporating these markers may improve early diagnosis, risk stratification, and treatment decisions, representing a key direction for future research in managing AKI in cirrhosis.

Spontaneous bacterial peritonitis (SBP) is the most common bacterial infection in cirrhotic patients. Historically, the bacterial spectrum was dominated by Gram-negative bacteria. However, recent studies showed that fluoroquinolone (FQ)-based prophylaxis promotes the intestinal overgrowth of Gram-positive bacteria and contributes to the selection of quinolone-resistant Gram-negative bacteria, increasing multidrug-resistant (MDR) organism infections. FQ resistance rates reach up to nearly one-third in community-acquired cases and 50% in hospital-acquired cases, raising concerns about FQ efficacy. Moreover, rare but serious side effects further limit FQ use. Predictive factors of FQ treatment failure have been identified, guiding management strategies. Rifaximin has emerged as a promising alternative for SBP prophylaxis, with encouraging results. This review aims to explore the shifting role of FQ-based SBP prophylaxis, focusing on the emerging concerns, side effects, and alternative strategies. While norfloxacin remains a first-line prophylactic in cirrhotic patients with low ascitic protein levels, its efficacy appears to be reduced in those with advanced liver failure or additional risk factors for MDR organisms. In these subgroups, alternative prophylactics, such as trimethoprim–sulfamethoxazole or rifaximin, may be preferable. We propose a risk-stratification approach to guide treatment selection, with further studies needed to refine these criteria.

Background: Early rebleeding after endoscopic variceal ligation (EVL) represents a serious complication in patients with cirrhosis and is associated with poor short-term outcomes. This study aimed to identify independent predictors of early rebleeding after EVL, with a particular focus on distinguishing factors associated with variceal rebleeding from those related to post-banding ulcer (PBU) bleeding, and to assess predictors of six-week mortality. Methods: We conducted a retrospective cohort study including 217 cirrhotic patients who underwent first emergency EVL for an index episode of esophageal variceal bleeding at a tertiary referral center. Early rebleeding was defined as recurrent upper gastrointestinal bleeding occurring between days 6 and 42 after the index EVL. Results: Early rebleeding occurred in 38/217 patients (17.5%): 27/38 (71.1%) variceal rebleeding and 11/38 (28.9%) PBU rebleeding. In multivariable logistic regression analysis, lower hemoglobin (OR = 0.19, 95% CI: 0.067–0.539, p = 0.002) and a higher albumin–bilirubin (ALBI) grade (OR = 24.94, 95% CI: 1.134–548.342, p = 0.041) were independently associated with increased odds of early variceal rebleeding, whereas a higher number of bands applied during index EVL (OR = 0.52, 95% CI: 0.302–0.896, p = 0.019) was independently associated with reduced odds of rebleeding, with excellent model discrimination (area under the curve [AUC] 0.981; 95% CI: 0.959–1.000). For PBU rebleeding, lower fibrinogen level was the only independent predictor (OR = 0.957, 95% CI: 0.916–1.000, p = 0.047), with strong discriminative performance (AUC 0.945; 95% CI: 0.909–0.982). Model for End-Stage Liver Disease (MELD) score, serum albumin, platelet count, and PBU rebleeding independently predicted six-week mortality. Conclusions: Markers of liver function, along with endoscopic parameters, predict early rebleeding after EVL, emphasizing the importance of the complete assessment of cirrhotic patients for refined risk stratification and tailored post-EVL management.