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Topic Review
Anti-SARS-CoV-2 Vaccines in Patients with Cirrhosis
Liver cirrhosis is followed by a profound immune dysfunction characterized by alterations in innate (decreased complement activity, reduced chemotaxis, and phagocytosis) and adaptive immunity (decreased memory cells, CD4 helper cells, T cell exhaustion) which leads to an inadequate immune response against a wide range of pathogens. The pathogenesis of what is known as ‘cirrhosis-associated immune dysfunction’ resides mainly in impairment of the hepatic reticulo-endothelial system, defective protein production, blood cell dysfunction, and systemic inflammation that is related to hepatocyte destruction.
  • 824
  • 21 Feb 2023
Topic Review
Impact of SARS-CoV-2 Pandemic on Hepatocellular Carcinoma
Worldwide, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) significantly increases mortality and morbidity. The Coronavirus Disease 2019 (COVID-19) outbreak has had a considerable impact on healthcare systems all around the world, having a significant effect on planned patient activity and established care pathways, in order to meet the difficult task of the global pandemic. Patients with hepatocellular carcinoma (HCC) are considered a particularly susceptible population and conceivably at increased risk for severe COVID-19 because of two combined risk factors: chronic advanced liver disease and HCC itself. In these challenging times, it is mandatory to reshape clinical practice in a prompt way to preserve the highest standards of patient care and safety.
  • 823
  • 25 Aug 2022
Topic Review
The Impact of MicroRNAs during Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a debilitating autoimmune disease characterised by chronic inflammation along the GI tract. Patients diagnosed with IBD are symptomatic for recurrent intestinal inflammation, diarrhoea, abdominal pain, rectal bleeding, weight loss and anaemia. Due to its complexity, a number of factors are attributed to IBD aetiology, including patients’ genetics and makeup of microbiota, food and pharmaceutical consumption, and even limiting antigen exposure due to excessive sanitation. All these aspects further contribute to changes in miRNA expression.
  • 819
  • 24 Apr 2022
Topic Review
Consequences of COVID-19 for Pancreas
Coronaviruses are enveloped, single- and positive-stranded RNA viruses that infect birds and mammals. In humans, coronaviruses cause respiratory tract infection, usually the common cold, but they can also cause severe respiratory illness including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), caused by severe acute respiratory syndrome-related coronavirus (SARS-CoV) and Middle East respiratory syndrome-related coronavirus (MERS-CoV), respectively. Although coronavirus disease 2019 (COVID-19)-related major health consequences involve the lungs, a growing body of evidence indicates that COVID-19 is not inert to the pancreas either. 
  • 815
  • 26 Jan 2022
Topic Review
Nanomedicine in Clostridioides difficile Infection
Clostridioides difficile, a spore-forming bacterium, is a nosocomial infectious pathogen which can be found in animals as well. Although various antibiotics and disinfectants were developed, C. difficile infection (CDI) remains a serious health problem. C. difficile spores have complex structures and dormant characteristics that contribute to their resistance to harsh environments, successful transmission and recurrence.
  • 813
  • 20 Aug 2021
Topic Review
Role of the Immune System in IBD-Associated Cancer
Patients with inflammatory bowel disease (IBD) have increased incidence of colorectal cancer (CRC). IBD-associated cancer follows a well-characterized sequence of intestinal epithelial changes, in which genetic mutations and molecular aberrations play a key role. IBD-associated cancer develops against a background of chronic inflammation and pro-inflammatory immune cells, and their products contribute to cancer development and progression. In recent years, the effect of the immunosuppressive microenvironment in cancer development and progression has gained more attention, mainly because of the unprecedented anti-tumor effects of immune checkpoint inhibitors in selected groups of patients. Even though IBD-associated cancer develops in the background of chronic inflammation which is associated with activation of endogenous anti-inflammatory or suppressive mechanisms, the potential role of an immunosuppressive microenvironment in these cancers is largely unknown.
  • 810
  • 13 Dec 2021
Topic Review
Barrett’s Esophagus
Given that endoscopic findings can be used to predict the potential of neoplastic progression in Barrett’s esophagus (BE) cases, the detection rate of dysplastic Barrett’s lesions may become higher even in laborious endoscopic surveillance because a special attention is consequently paid. However, endoscopic findings for effective detection of the risk of neoplastic progression to esophageal adenocarcinoma (EAC) have not been confirmed, though some typical appearances are suggestive. In the present review, endoscopic findings that can be used predict malignant potential to EAC in BE cases are discussed. Conventional results obtained with white light endoscopy, such as length of BE, presence of esophagitis, ulceration, hiatal hernia and nodularity, are used as indicators of a higher risk of neoplastic progression. However, there are controversies in some of those findings. Absence of palisade vessels may be also a new candidate predictor, as that reveals degree of intense inflammation and of cyclooxygenase-2 protein expression with accelerated cellular proliferation. Furthermore, an open type of mucosal pattern and enriched stromal blood vessels, which can be observed by image-enhanced endoscopy including narrow band imaging, have been confirmed as factors useful for prediction of neoplastic progression of BE because they indicate more frequent cyclooxygenase-2 protein expression along with accelerated cellular proliferation. Should the malignant potential of BE be shown predictable by these endoscopic findings, that would simplify methods used for an effective surveillance, because patients requiring careful monitoring would be more easily identified. Development in the near future of a comprehensive scoring system for BE based on clinical factors, biomarkers and endoscopic predictors is required.
  • 805
  • 05 Nov 2020
Topic Review
MicroRNAs in Ulcerative Colitis
Ulcerative colitis (UC) is a major type of inflammatory bowel disease (IBD), characterized by chronic inflammation of the colon and rectum. Inflammation confined to the mucosa is distributed continuously from the rectum to the proximal colon in UC and causes bloody stools, diarrhea, and abdominal pain.
  • 805
  • 20 Dec 2021
Topic Review
Oxidative Stress and Nervous Distress in Gastrointestinal Disorders
Oxidative stress is increasingly recognized as a central player in a range of gastrointestinal (GI) disorders, as well as complications stemming from therapeutic interventions. The dysfunction of the ENS is characteristic of a spectrum of disorders, including neurointestinal diseases and conditions such as inflammatory bowel disease (IBD), diabetic gastroparesis, and chemotherapy-induced GI side effects. Neurons in the Enteric nervous system (ENS), while essential for normal gut function, appear particularly vulnerable to oxidative damage. Mechanistically, oxidative stress in enteric neurons can result from intrinsic nitrosative injury, mitochondrial dysfunction, or inflammation-related pathways. Although antioxidant-based therapies have shown limited efficacy, recognizing the multifaceted role of oxidative stress in GI diseases offers a promising avenue for future interventions.
  • 805
  • 01 Nov 2023
Topic Review
Lenvatinib in Hepatocellular Carcinoma Treatment
Hepatocellular carcinoma (HCC) is a major public health issue and, as the most common primary liver tumour, its incidence reaches one million new cases per year worldwide. Sorafenib has been the standard treatment of care since 2007, based on improved overall survival (OS) in randomised controlled trials compared to placebo. However, the management of advanced HCC has been modified since 2017 with the development of new and effective systemic treatments that improve both OS and progression free survival (PFS). Lenvatinib has been approved by the United States Food and Drug Administration and the European Medicines Agency after demonstration of the non-inferiority to sorafenib as first-line treatment for patients with advanced or unresectable HCC who have not received prior systemic therapy, based on the results of the phase III REFLECT study. Two other TKIs, regorafenib and cabozantinib, were also approved in second line after sorafenib.
  • 803
  • 29 Dec 2021
Topic Review
Sarcopenia and Osteosarcopenia in CLD
The liver plays a pivotal role in nutrient/energy metabolism and storage, anabolic hormone regulation, ammonia detoxification, and cytokine production. Impaired liver function can cause malnutrition, hyperammonemia, and chronic inflammation, leading to an imbalance between muscle protein synthesis and proteolysis. Patients with chronic liver disease (CLD) have a high prevalence of sarcopenia, characterized by progressive loss of muscle mass and function, affecting health-related quality of life and prognosis. Recent reports have revealed that osteosarcopenia, defined as the concomitant occurrence of sarcopenia and osteoporosis, is also highly prevalent in patients with CLD. Since the differentiation and growth of muscles and bones are closely interrelated through mechanical and biochemical communication, sarcopenia and osteoporosis often progress concurrently and affect each other. Osteosarcopenia further exacerbates unfavorable health outcomes, such as vertebral fracture and frailty. Therefore, a comprehensive assessment of sarcopenia, osteoporosis, and osteosarcopenia, and an understanding of the pathogenic mechanisms involving the liver, bones, and muscles, are important for prevention and treatment.
  • 803
  • 17 Sep 2021
Topic Review
Endoscopic Bariatric and Metabolic Therapies
Obesity is a chronic disease that is becoming increasingly more prevalent and is associated with many health problems, such as metabolic syndrome. The treatment options for obese patients include lifestyle modification, medications, endoscopic bariatric and metabolic therapies (EBMTs), and surgery. In particular, EBMTs have an excellent therapeutic effect and are less invasive than bariatric surgery.
  • 802
  • 10 Aug 2021
Topic Review
Dietary and Nutritional Support in Esophageal Diseases
The esophagus is the centerpiece of the digestive system of individuals and plays an essential role in transporting swallowed nutrients to the stomach. Diseases of the esophagus can alter this mechanism either by causing anatomical damage that obstructs the lumen of the organ (e.g., peptic, or eosinophilic stricture) or by generating severe motility disorders that impair the progression of the alimentary bolus (e.g., severe dysphagia of neurological origin or achalasia). In all cases, nutrient assimilation may be compromised. In some cases (e.g., ingestion of corrosive agents), a hypercatabolic state is generated, which increases resting energy expenditure.
  • 799
  • 24 Nov 2022
Topic Review
Cytokines and Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) represents a worldwide health matter with a major care burden, high prevalence, and poor prognosis. Its pathogenesis mainly varies depending on the underlying etiological factors, although it develops from liver cirrhosis in the majority of cases. In the premalignant environment, inflammatory cells release a wide range of cytokines, chemokines, growth factors, prostaglandins, and proangiogenic factors, making the liver environment more suitable for hepatocyte tumor progression that starts from acquired genetic mutations. A complex interaction of pro-inflammatory (IL-6, TNF-α) and anti-inflammatory cytokines (TGF-α and -β), pro-angiogenic molecules (including the Angiopoietins, HGF, PECAM-1, HIF-1α, VEGF), different transcription factors (NF-kB, STAT-3), and their signaling pathways are involved in the development of HCC. Since cytokines are expressed and released during the different stages of HCC progression, their measurement, by different available methods, can provide in-depth information on the identification and management of HCC. 
  • 798
  • 13 Jan 2023
Topic Review
Role of Chronic Fatigue in Crohn Disease Patients
Crohn’s disease (CD) is a chronic, relapsing disorder belonging to inflammatory bowel diseases (IBD). It is manifested by relapsing transmural inflammation found in any segment of the gastrointestinal tract. Chronic fatigue is a common and underrecognized symptom of CD for which the prevalence is much higher in the population of CD patients compared to the healthy population. It stems from an intricate web of interactions between various risk factors. The implementation of routine screening and a holistic, multidisciplinary approach involving psychological support may be crucial in the management of CD patients with chronic fatigue.
  • 795
  • 10 Aug 2023
Topic Review
TAM Receptors in the Pathophysiology of Liver Disease
TAM receptors (Tyro3, Axl and MerTK) are a family of tyrosine kinase receptors that are expressed in a variety of cell populations, including liver parenchymal and non-parenchymal cells These receptors are vital for immune homeostasis, as they regulate the innate immune response by suppressing inflammation via toll-like receptor inhibition and by promoting tissue resolution through efferocytosis. However, there is increasing evidence indicating that aberrant TAM receptor signaling may play a role in pathophysiological processes in the context of liver disease. This review will explore the roles of TAM receptors and their ligands in liver homeostasis as well as a variety of disease settings, including acute liver injury, steatosis, fibrosis, cirrhosis-associated immune dysfunction and hepatocellular carcinoma. A better understanding of our current knowledge of TAM receptors in liver disease may identify new opportunities for disease monitoring as well as novel therapeutic targets. Nonetheless, this review also aims to highlight areas where further research on TAM receptor biology in liver disease is required.
  • 794
  • 28 Jan 2022
Topic Review
Janus-Faced Role of Autophagy in Hepatocellular Carcinoma
Autophagy is a multi-step catabolic process that occurs in cells at a basal level and is triggered by various stressors that disrupt cellular homeostasis. These stressors can include low levels of cellular ATP, nutrient and growth factor deficiencies, hypoxia, endoplasmic reticulum (ER) stress, pathogen entry, or exposure to anticancer drugs. 
  • 793
  • 21 Nov 2023
Topic Review
Elevated Serum Alpha-Fetoprotein Levels in Pregnant Women
The most common association related to alpha-fetoprotein (AFP) is fetal neural tube defect (NTD), and indeed, this is where the international career of this protein began. In times when ultrasonography was not yet technically advanced, the detection of high levels of AFP in maternal serum (MS-AFP) and amniotic fluid was the basis for suspecting neural tube defects. In cases where there was no confirmation of NTD, other causes were sought. It has been established that high titers of MS-AFP could originate in other defects or diseases, such as (1) increased proteinuria in severe fetal kidney diseases; (2) pathological overproduction in liver diseases; (3) penetration through the membranes of gastrointestinal organs exposed to amniotic fluid; (4) passage through the walls of skin vessels; and as a side effect of (5) hepatic hematopoiesis and increased transfer through the edematous placenta in fetal anemia. 
  • 790
  • 24 Jan 2024
Topic Review
Epidemiology of Eosinophilic Esophagitis
Eosinophilic esophagitis is a Th-2 antigen-mediated disease in which there is an influx of eosinophils to all layers of the esophagus, triggering an inflammatory response. Chronic inflammatory process causes esophageal remodeling, leading to difficulties in swallowing. Food impaction, heartburn, and chest pain are other characteristic (but not pathognomonic) symptoms in adults.
  • 789
  • 13 Apr 2023
Topic Review
Nutrition in Pediatric IBD
Inflammatory bowel disease (IBD) refers to a heterogeneous group of disorders encompassing Crohn’s disease (CD), ulcerative colitis (UC) and unclassified inflammatory bowel disease (IBD-U), characterized by a chronic inflammation of the intestinal tract with a relapsing-remitting behavior, and variably presenting with abdominal pain, diarrhea, rectal bleeding and weight loss. Dietary factors and malnutrition play a primary role in the onset and management of pediatric IBD. Moreover, an appropriate diet can decrease the risk of IBD flares, and an age-adequate nutritional status can decrease the risk of complications and surgery in the long-term stage of the disease. Enteral nutrition has a significant impact on mucosal inflammation in CD, and clinical response to oral polymeric diet is associated with down-regulation of mucosal pro-inflammatory cytokines. Nutritional strategies, such as exclusive enteral nutrition or CDED diet, have shown to be more effective than steroids in inducing clinical remission in pediatric patients.
  • 787
  • 13 Apr 2021
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