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Topic Review
Circulating Adaptive Immune Cells in End-Stage Liver Disease
End-stage liver disease (ESLD) from acute liver failure to compensated advanced chronic liver disease and decompensated cirrhosis at different stages (chronic decompensation, acute decompensation with or without acute-on-chronic liver failure) has high disease severity and poor patient outcome. Infection is a common complication in patients with ESLD and it is associated with a high mortality rate. Multiple mechanisms are involved in this marked susceptibility to infections, noticeably the inadequate immune response known as immune paresis, as part of cirrhosis-associated immune dysfunction (CAID). Specifically in the adaptive immune arm, lymphocyte impairments—including inadequate activation, reduced ability to secrete effector molecules and enhanced immune suppressive phenotypes—result in compromised systemic immune responses and increased risk of infections. 
  • 240
  • 08 Aug 2023
Topic Review
Precision Medicine in Inflammatory Bowel Disease
Ulcerative colitis and Crohn’s disease are traditionally defined as the two main subtypes of inflammatory bowel disease. However, a more recent view considers inflammatory bowel diseases (IBDs) as a spectrum of heterogeneous phenotypes with consistent differences in clinical presentation and behaviors, likely explained by differences in underlying pathogenetic mechanisms. The etiology is still elusive, and the suggested pathogenesis is a complex interplay among genetic predisposition and abnormal immune response at the mucosal intestinal level, activated by only partially identified environmental triggers leading to altered intestinal permeability and impaired handling of gut microbiota. The undeniable continuous progress of medical therapy with more frequent shifts from traditional to more advanced modalities also underlines the actual unmet needs. 
  • 240
  • 27 Oct 2023
Topic Review
Microbiome Influences Neurodevelopment in the Central Nervous System
The brain is traditionally viewed as an immunologically privileged site; however, there are known to be multiple resident immune cells that influence the central nervous system (CNS) environment and are reactive to extra-CNS signaling. Microglia are an important component of this system, which influences early neurodevelopment in addition to modulating inflammation and regenerative responses to injury and infection. Microglia are influenced by gut microbiome-derived metabolites, both as part of their normal function and potentially in pathological patterns that may induce neurodevelopmental disabilities or behavioral changes. 
  • 235
  • 17 Nov 2023
Topic Review
Surgical Management of Gastroesophageal Junction Adenocarcinoma
Gastroesophageal (GE) junction adenocarcinoma is an aggressive malignancy of growing incidence and is associated with public health issues such as obesity and GERD. Management has evolved over the last two decades to incorporate a multidisciplinary approach, including endoscopic intervention, neoadjuvant chemotherapy/chemoradiation, and open or minimally invasive surgical approaches. Surgical approaches include esophagectomy, total gastrectomy, and, more recently, proximal gastrectomy. 
  • 227
  • 21 Feb 2024
Topic Review
Hepatocellular Carcinoma in Non-Fibrotic Liver
Hepatocellular carcinoma (HCC) in a non-fibrotic liver (F0) is considered to be rare, and there is a marked paucity of studies in the literature on this HCC type. A review of the literature shows some important clinical and tumor characteristics: (a) it occurs mainly in young female and elder male patients; (b) clinically, under normal hepatic function, alpha-fetoprotein level is often normal, and there are no risk factors; (c) associated with metabolic disease; (d) macroscopically, single large lesions are noted; and (e) microscopically, the lesions are well-differentiated and encapsulated. Radiological imaging results are straightforward, showing arterial hyperenhancement and later wash-out. The combined use of B-mode and contrast-enhanced (CE) ultrasound (US) is the most reliable and cost-effective diagnostic method. Few peri-and post-operative complications are noted and 5-year survival is not inferior to patients with HCC on fibrosis liver despite the lesion’s large size. Most clinicians believe that HCC is unlikely to occur if patients have no symptoms and normal hepatic function.
  • 223
  • 15 Nov 2023
Topic Review
Microwave Ablation Techniques for Pancreatic Lesions
Thermal ablation is increasingly being utilized for the management of solid parenchymal tumors, such as hepatocellular cancer, renal tumors, thyroid nodules, and pulmonary tumors. However, its application in the management of pancreas lesions was delayed due to fears of causing iatrogenic thermal injury to the surrounding organs. The initial success of radiofrequency ablation (RFA) in inoperable pancreatic cancers led to its application in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms (PCLs).
  • 220
  • 15 Nov 2023
Topic Review
Assessment of Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is an immune-mediated disease that manifests with dysphagia and is characterized by the predominantly eosinophilic infiltration of the esophageal mucosa. Several instruments have been developed to assess the symptoms of EoE.
  • 219
  • 11 Jan 2024
Topic Review
Thyroid Hormone and MASLD
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly termed nonalcoholic fatty liver disease (NAFLD), is a widespread global health concern that affects around 25% of the global population. Its influence is expanding, and it is anticipated to overtake alcohol as the leading cause of liver failure and liver-related death worldwide. Mitochondrial dysfunction is strongly linked to the development of MASLD. 
  • 216
  • 21 Dec 2023
Topic Review
Biologic Therapy for Inflammatory Bowel Disease Patients
Many patients with inflammatory bowel disease (IBD) experience a loss of effectiveness to biologic therapy (i.e., anti-TNF therapy, etc.). Therefore, in addition to the adverse effects of the treatment, these patients also face failure to achieve and maintain remission. Immunogenicity, the process of production of antibodies to biological agents, is fundamental to the evolution of loss of response to treatment in IBD patients.
  • 214
  • 07 Mar 2024
Topic Review
The Role of Cholangioscopy in Biliary Diseases
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). 
  • 210
  • 25 Sep 2023
Topic Review
Microbiota Changes in Irritable Bowel Syndrome Subtypes
Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits. It can be subclassified in different subtypes according to the main clinical manifestation: constipation, diarrhea, mixed, and unclassified. The role of gut microbiota in IBS has garnered significant attention in the scientific community. Emerging research spotlights the intricate involvement of microbiota dysbiosis in IBS pathogenesis. Studies have demonstrated reduced microbial diversity and stability and specific microbial alterations for each disease subgroup. Microbiota-targeted treatments, such as antibiotics, probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and even diet, offer exciting prospects for managing IBS.
  • 210
  • 07 Oct 2023
Topic Review
Gene Variants in Non-Alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) describes a steatotic (or fatty) liver occurring as a consequence of a combination of metabolic, environmental, and genetic factors, in the absence of significant alcohol consumption and other liver diseases. Many liver disease-related gene variants have been identified from large-scale genome-wide association studies (GWAS).
  • 207
  • 26 Oct 2023
Topic Review
The Role of IL-23 Inhibitors in Crohn’s Disease
Promoting a Th17 pathogenic response, the interleukin (IL)-23 pathway is crucial in the pathophysiology of inflammatory bowel disease (IBD). With a favorable safety profile, ustekinumab, a monoclonal antibody targeting the shared p40 component of IL-12/23, is currently approved for the treatment of IBD in patients with disease refractory to corticosteroids and biologic drugs. Risankizumab, mirikizumab, and guselkumab are specific IL-23p19 antagonists tested for the treatment of Crohn’s disease (CD). However, only risankizumab currently has been approved for its treatment. Trials with guselkumab and mirikizumab are currently ongoing, with promising preliminary efficacy and safety results.
  • 206
  • 11 Jan 2024
Topic Review
Diet and Nutritional Interventions in Early Life
The infant gut microbiome plays a key role in the healthy development of the human organism and appears to be influenced by dietary practices through multiple pathways. First, maternal diet during pregnancy and infant nutrition significantly influence the infant gut microbiota. Moreover, breastfeeding fosters the proliferation of beneficial bacteria, while formula feeding increases microbial diversity. The timing of introducing solid foods also influences gut microbiota composition. In preterm infants the gut microbiota development is influenced by multiple factors, including the time since birth and the intake of breast milk, and interventions such as probiotics and prebiotics supplementation show promising results in reducing morbidity and mortality in this population.
  • 205
  • 27 Feb 2024
Topic Review
Low-Dose Alcohol Consumption on Chronic Liver Disease
Although alcohol is one of the most important etiologic agents in the development of chronic liver disease worldwide, also recognized as a promoter of carcinogenesis, several studies have shown a beneficial effect of moderate consumption in terms of reduced cardiovascular morbidity and mortality. Whether this benefit is also present in patients with liver disease due to other causes (viral, metabolic, and others) is still debated. Although there is no clear evidence emerging from guidelines and scientific literature, total abstention from drinking is usually prescribed in clinical practice.
  • 202
  • 06 Mar 2024
Topic Review
Gut–Brain Axis, Microbiota and Probiotics
Irritable bowel syndrome (IBS) is a relatively common digestive disorder. It is estimated that IBS has a prevalence of 10–15% in the general population in industrialized countries and is a factor with a significant impact on both the individual and society in terms of quality of life and health care costs. Depending on symptomatology, comorbidities, quality of life and healthcare needs, IBS can have a mild, moderate, or severe clinical course. Some studies have shown that the severe form occurs in 15–40% of patients with IBS.
  • 199
  • 05 Dec 2023
Topic Review
The Effect of COVID-19 on Gut Microbiota
The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to significant global health implications. Although the respiratory manifestations of COVID-19 are widely recognized, emerging evidence suggests that the disease may also significantly affect the gut microbiota, the intricate community of bacteria that lives within the gastrointestinal system.
  • 196
  • 22 Aug 2023
Topic Review
Biological Drugs in EoE and Their Targets
Eosinophilic esophagitis (EoE) is a multifaceted disease characterized by a wide heterogeneity of clinical manifestations, endoscopic and histopathologic patterns, and responsiveness to therapy. From the perspective of an effective approach to the patient, the different inflammatory mechanisms involved in the pathogenesis of EoE and biologics, in particular monoclonal antibodies (mAbs), targeting these pathways are needed. Currently, the most relevant is dupilumab, which interferes with both interleukin (IL)-4 and IL-13 pathways by binding IL-4 receptor α, and is the only mAb approved by the European Medicine Agency and US Food and Drug Administration for the treatment of EoE. Other mAbs investigated include mepolizumab, reslizumab, and benralizumab (interfering with IL-5 axis), cendakimab and dectrekumab (anti-IL-13s), tezepelumab (anti-TSLP), lirentelimab (anti-SIGLEG-8), and many others.
  • 194
  • 08 Feb 2024
Topic Review
Endoscopic Salvage of Gastrointestinal Anastomosis Leaks
Anastomotic leakage, which is defined as a defect in the integrity of a surgical join between two hollow viscera leading to communication between the intraluminal and extraluminal compartments, continues to be of high incidence and one of the most feared complications following gastrointestinal surgery, with a significant potential for a fatal outcome. Surgical options for management are limited and carry a high risk of morbidity and mortality; thus, surgeons are urged to look for alternative options which are minimally invasive, repeatable, non-operative, and do not require general anesthesia. 
  • 191
  • 07 Oct 2023
Topic Review
Genetic Changes of NF-κB Signaling in Colorectal Cancer
Colorectal cancer (CRC) is the third leading cause of cancer mortality in the United States, with an estimated 52,000 deaths in 2023. Though significant progress has been made in both diagnosis and treatment of CRC in recent years, genetic heterogeneity of CRC—the culprit for possible CRC relapse and drug resistance, is still an insurmountable challenge. Thus, developing more effective therapeutics to overcome this challenge in new CRC treatment strategies is imperative. Genetic and epigenetic changes are well recognized to be responsible for the stepwise development of CRC malignancy. 
  • 188
  • 02 Jan 2024
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