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Topic Review
Microvascular Thrombosis and Liver Fibrosis Progression
Fibrosis is a frequent consequence of organ injury. The formation of an extracellular matrix (ECM) depends on a complex cascade of cellular and molecular pathways, the chronic activation of which results in a sustained fibrogenic process that leads to structural changes and, ultimately, to dysfunction of the affected organ. Thus, fibrosis is a major contributor to organ failure in human pathophysiology.
  • 758
  • 06 Jul 2023
Topic Review
Artificial Intelligence in Colonoscopy
The early endoscopic identification, resection, and treatment of precancerous adenoma and early-stage cancer has been shown to reduce not only the prevalence of colorectal cancer but also its mortality rate. Recent advances in endoscopic devices and imaging technology have dramatically improved the ability to detect colorectal lesions and predict their pathological diagnosis. In addition to this, rapid advances in artificial intelligence (AI) technology mean that AI-related research and development is now progressing in the diagnostic imaging field, particularly colonoscopy, and AIs (i.e., devices that mimic cognitive abilities, such as learning and problem-solving) already approved as medical devices are now being introduced into everyday clinical practice. There is an increasing expectation that sophisticated AIs will be able to provide high-level diagnostic performance irrespective of the level of skill of the endoscopist.
  • 756
  • 10 Jun 2022
Topic Review
Diabetes Mellitus and Gut Microbiota
The gut microbiota is a complex ecosystem consisting of bacteria, fungi, archaea, and viruses living in symbiosis with the human organism. This collection of bacteria, archaea, and eukaryotes that colonize the digestive system has developed this fascinating symbiotic relationship with its host over thousands of years, characterized by a complex mutually beneficial interaction.
  • 754
  • 02 Mar 2023
Topic Review
Osteoporosis/Sarcopenia in Chronic Liver Disease
The prevalence of osteoporosis and sarcopenia is significantly higher in patients with liver disease than in those without liver disease and osteoporosis and sarcopenia negatively influence morbidity and mortality in liver disease.
  • 753
  • 27 Apr 2021
Topic Review
Management of Hyponatremia in Cirrhosis
Hyponatremia is a strong predictor of mortality and is also associated with an increased probability of hepatorenal syndrome, disturbance of consciousness, infections, and unfavorable post-transplant outcomes. In the management of hyponatremia, it is crucial to distinguish between hypovolemic and hypervolemic hyponatremia. The treatment of hypervolemic hyponatremia should be started only in symptomatic patients. The cessation of the treatment with traditional diuretics and fluid restriction may prevent further decrease in natremia. Pharmacological treatment is directed towards cirrhosis itself, precipitating factor, or hyponatremia directly. Currently, only albumin infusions can be recommended routinely. Other possibilities, such as vaptans, splanchnic vasoconstrictors, niravoline, or osmotic diuretics, are restricted to specific use cases (e.g., imminent liver transplantation) or need more research to determine their efficacy.
  • 750
  • 16 Oct 2023
Topic Review
Lenvatinib for Hepatocellular Carcinoma
Lenvatinib, which is an oral multikinase inhibitor, showed non-inferiority to the sorafenib in terms of overall survival (OS) and a higher objective response rate (ORR) and better progression-free survival (PFS) in patients with hepatocellular carcinoma (HCC). A good liver function and Barcelona Clinic Liver Cancer (BCLC) intermediate stage were key factors in achieving therapeutic efficacy. The management of adverse events plays an important role in continuing lenvatinib treatment. While sequential therapies contributed to prolonging overall survival, effective molecular targeted agents for administration after lenvatinib have not been established. Repeated transcatheter arterial chemoembolization (TACE) was associated with a decline in the liver function and poor therapeutic response in BCLC intermediate patients. Recently, the Asia-Pacific Primary Liver Cancer Expert (APPLE) Consensus Statement proposed the criteria for TACE unsuitability. Upfront systemic therapy may be better for BCLC intermediate stage HCC patients with a high tumor burden, while selective TACE will be recommended to obtain a curative response in patients with a low tumor burden. This entry introduce the therapeutic response, management of adverse events, post-progression treatment after lenvatinib and treatment strategy for BCLC intermediate stage HCC.
  • 742
  • 12 Oct 2021
Topic Review
Sarcopenic Obesity in Liver Cirrhosis
The picture of chronic liver diseases (CLDs) has changed considerably in recent years. One of them is the increase of non-alcoholic fatty liver disease. More and more CLD patients, even those with liver cirrhosis (LC), tend to be presenting with obesity these days. The annual rate of muscle loss increases with worsening liver reserve, and thus LC patients are more likely to complicate with sarcopenia. LC is also characterized by protein-energy malnutrition (PEM). Since the PEM in LC can be invariable, the patients probably present with sarcopenic obesity (Sa-O), which involves both sarcopenia and obesity. Currently, there is no mention of Sa-O in the guidelines; however, the rapidly increasing prevalence and poorer clinical consequences of Sa-O are recognized as an important public health problem, and the diagnostic value of Sa-O is expected to increase in the future. Sa-O involves a complex interplay of physiological mechanisms, including increased inflammatory cytokines, oxidative stress, insulin resistance, hormonal disorders, and decline of physical activity. The pathogenesis of Sa-O in LC is diverse, with a lot of perturbations in the muscle–liver–adipose tissue axis. 
  • 741
  • 20 Apr 2021
Topic Review
Immune Cells in Gastric Cancer
Despite the fact that the incidence of gastric cancer has declined over the last decade, it is still the world’s leading cause of cancer-related death. The diagnosis of early gastric cancer is difficult, as symptoms of this cancer only manifest at a late stage of cancer progression. Thus, the prognosis of gastric cancer is poor, and the current treatment for improving patients’ outcomes involves the application of surgery and chemotherapy. Immunotherapy is one of the most recent therapies for gastric cancer, whereby the immune system of the host is programmed to combat cancer cells, and the therapy differs based upon the patient’s immune system. However, an understanding of the role of immune cells, namely the cell-mediated immune response and the humoral immune response, is pertinent for applications of immunotherapy. The roles of immune cells in the prognosis of gastric cancer have yielded conflicting results.
  • 741
  • 23 Aug 2022
Topic Review
Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma
Cholangiocarcinoma (CCA) is the most common malignancy in patients with primary sclerosing cholangitis (PSC), accounting for 2–8% of cases and being the leading cause of death in these patients. The majority of PSC-associated CCAs (PSC-CCA) develop within the first few years after PSC diagnosis. Older age and male sex, as well as concomitant inflammatory bowel disease (IBD) or high-grade biliary stenosis, are some of the most relevant risk factors. PSC-CCA pathogenesis is characterised by peculiar molecular and genetic features, being a distinct disease from the novo CCA. There has been a significant push to develop innovative strategies for PSC-CCA early diagnosis and surveillance. 
  • 741
  • 23 Oct 2023
Topic Review
Endoscopic Vacuum Therapy in the Upper Gastrointestinal Tract
Anastomotic leaks after gastrointestinal surgery have an important impact on surgical outcomes because of the high morbidity and mortality rates. Multiple treatment options exist requiring an individualized patient-tailored treatment plan after multidisciplinary discussion. Endoscopic vacuum therapy (EVT) is a novel treatment option that is nowadays recognized as an effective and useful endoscopic approach to treat leaks or perforations in both the upper and lower gastrointestinal tract.
  • 740
  • 28 Jun 2023
Topic Review
Therapeutic Options against Chronic HBV
Currently, Chronic Hepatitis B (CHB) is controlled but not cured by approved antivirals. For instance, transcriptionally active HBV DNA in the nucleus is not directly targeted. Except for interferon-α (IFN-α) and pegylated IFN-α, all other licensed drugs are nucleoside (Lamivudine, Clevudine, Entecavir, Telbivudine) and nucleotide analogues (Adefovir dipivoxil, Tenofovir disoproxil fumarate, Tenofovir alafenamide). All these drugs are potent at reducing viral loads and normalizing alanine transaminase levels in CHB patients. However, long-term treatment with many of these drugs leads to the development of multiple drug resistance mutations. In addition, while a limited reduction in cccDNA is achieved, long-term nucleos(t)ide analogue treatment does not reduce hepatitis B surface antigen (HBsAg) levels.
  • 739
  • 14 Jul 2021
Topic Review
γδ T Cells in Hepatocellular Carcinoma Immunotherapy
Hepatocellular carcinoma (HCC) remains a global health challenge with limited treatment options and a poor prognosis for advanced-stage patients. Recent advancements in cancer immunotherapy have generated significant interest in exploring novel approaches to combat HCC. One such approach involves the unique and versatile subset of T cells known as γδ T cells. γδ T cells represent a distinct subset of T lymphocytes that differ from conventional αβ T cells in terms of antigen recognition and effector functions. They play a crucial role in immunosurveillance against various malignancies, including HCC.
  • 739
  • 30 Jan 2024
Topic Review
Cholangiocarcinoma Detection and Staging of Extrahepatic Cholangiocarcinom
Extrahepatic cholangiocarcinoma (CCA) is a rare and aggressive type of cancer, presenting as a mass or as a biliary stricture. Depending on their localization, CCAs are classified into intrahepatic, perihilar, and distal. The EUS detection rate for distal CCAs is higher than that for the proximal CCAs. The accuracy of T staging varies between 60 and 80%, and vascular involvement is correctly assessed by conventional EUS.
  • 738
  • 12 Apr 2023
Topic Review
Immunotherapy in MS-Stable Colorectal Cancer
Immunotherapy is an innovative treatment that is highly effective against certain cancers, such as skin and lung cancer. However, for colorectal cancer, one of the most prevalent cancers, it does not benefit most patients. Recent research suggests that by treating liver metastases first, immunotherapy might become effective for those with colorectal cancer.
  • 736
  • 22 Nov 2023
Topic Review
Pancreatic Disorders in Inflammatory Bowel Diseases
The relationship between chronic intestinal disease, including inflammatory bowel disease (IBD), and pancreatic disorders has been little investigated. Although an increased risk of acute pancreatitis (AP), exocrine pancreatic insufficiency with or without chronic pancreatitis, and chronic asymptomatic pancreatic hyperenzymemia have been described in these patients, the pathogenetic link remains unclear. It may potentially involve drugs, altered microcirculation, gut permeability/motility with disruption of enteric-mediated hormone secretion, bacterial translocation, and activation of the gut-associated lymphoid tissue related to chronic inflammation.
  • 735
  • 25 May 2023
Topic Review
Oral Health Status in Inflammatory Bowel Diseases Patients
Inflammatory bowel diseases (IBD) are chronic disorders that affect the gastrointestinal tract, including the oral cavity. Both Crohn’s disease (CD) and ulcerative colitis (UC) patients have an increased odds of periodontitis coincidence compared to the controls. Moreover, in most studies, patients with IBD are characterized by higher values of caries indices. In conclusion, the risk of oral diseases in IBD patients cannot be clearly established due to the possible association of other factors, e.g., sociodemographic or environmental factors.
  • 734
  • 24 Nov 2021
Topic Review
Crohn’s Disease Complication
Crohn’s Disease (CD) is a chronic inflammatory disorder in which up to 50% of patients develop fistula within 20 years after the initial diagnosis, and half of these patients suffer perianal fistulizing disease. The etiopathogenesis of CD-related perianal fistula is still unclear, and its phenotypical and molecular characteristics are even more indefinite. A better understanding would be crucial to develop targeted and more effective therapeutic strategies.
  • 732
  • 06 Dec 2021
Topic Review
Exercise Is Medicine for Nonalcoholic Fatty Liver Disease
Upwards of 30% of the world’s population has nonalcoholic fatty liver disease (NAFLD). There is no regulatory-agency-approved effective drug therapy or cure, and lifestyle modification with dietary change and increased physical activity remains crucial in the clinical management of all types of NAFLD, leads to many benefits within and outside the liver in patients with NAFLD. These benefits include an improvement in liver fat, histologic NASH activity, change in body composition, gain in physical fitness, reduction in markers of cardiovascular risk, improvement in health-related quality of life and possibly a reduction in oncologic risk. 
  • 732
  • 06 Jun 2023
Topic Review
Relationship between Gut Microbiota and Cardiovascular Disease
Cardiovascular disease (CVD) is a leading cause of death and morbidity worldwide. Identification of possible preventive strategies is of central interest to avoid CVD onset and progression. In this regard, intensive medical and scientific activity is currently employed in the management of traditional risk factors, but despite maximum medical therapy, there is still a residual risk of undetermined etiology. The gut microbiota is gaining increasing interest as one of the potentially modifiable factors that are involved in the pathogenesis of several diseases, including CVD. A multitude of microorganisms lives symbiotically with the human host; 10–100 trillion microbes among bacteria, viruses, fungi, and helminths are located in the gut. They serve a multitude of functions, which include maintenance of intestinal homeostasis and defence against external aggressive agents, modulation of the immune response, and production of metabolites. 
  • 729
  • 01 Jun 2023
Topic Review
Influence of Gut–Liver Axis on Portal Hypertension
Clinically significant portal hypertension is associated with most complications of advanced chronic liver disease (ACLD), including variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. Gut dysbiosis is a hallmark of ACLD with portal hypertension and consists of the overgrowth of potentially pathogenic bacteria and a decrease in autochthonous bacteria; additionally, congestion makes the intestinal barrier more permeable to bacteria and their products, which contributes to the development of complications through inflammatory mechanisms within the gut–liver axis. The identification of the gut–liver liver-axis-related metabolic and molecular pathways may serve as a target for new therapeutic strategies through the modulation of the intestinal environment.
  • 727
  • 01 Sep 2022
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