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Pancreatic function,quality of life and costs at long-term follow-up after acute pancreatitis

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World Journal of Gastroenterology 2010年第39期16卷 4944-4951页

作者： Bodil andersson Marie-Louise Pendse roland andersson Department of Surgery Clinical Siences LundLund University Lund University Hospital

AIM:To evaluate long-term endocrine and exocrine pancreatic function,quality of life and health care costs after mild acute pancreatitis and severe acute pancreatitis(SAP).METHODS:Patients prospectively included in 2001-2005 were followed-up after 42(36-53)*** function was evaluated with laboratory tests,the oral glucose tolerance test(OGTT),fecal elastase-1 and a *** Form(SF)-36,was ***:Fourteen patients with a history of SAP and 26 with mild acute pancreatitis were *** glucose after OGTT was higher after SAP(9.2 mmol/L vs 7.0 mmol/L,P=0.044).Diabetes mellitus or impaired glucose tolerance in fasting plasma glucose and/or 120 min plasma glucose were more common in SAP patients(11/14 vs 11/25,P=0.037).Sick leave,time until the patients could take up recreational activities and time until they had recovered were all longer after SAP(P <0.001).No significant differences in SF-36 were seen between the groups,or when comparing with age and gender matched reference *** hospital costs,including primary care,follow-up and treatment of complications,were higher after SAP(median€16572 vs €5000,P<0.001).CONCLUSION:Endocrine pancreatic function was affected,especially after severe *** requires greater resource use with long recovery,but most patients regained a good quality of life.

关键词： Acute pancreatitis Endocrine function Exocrine function Quality of life Cost

Radiofrequency ablation or percutaneous ethanol injection for the treatment of liver tumors

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World Journal of Gastroenterology 2012年第10期18卷 1003-1008页

作者： Daniel Ansari roland andersson Department of Surgery Clinical Sciences Lund Skane University Hospital and Lund University

The liver is a common location of both primary and secondary malignancies. For unresectable liver cancer, many local ablative therapies have been developed. These include e.g., percutaneous ethanol injection (PEI), percutaneous acetic acid injection, radiofrequency ablation (RFA), cryoablation, microwave ablation, laserinduced thermotherapy, and high-intensity focused ultrasound. RFA has recently gained interest and is the most widely applied thermoablative technique. RFA allows more effective tumor control in fewer treatment sessions compared with PEI, but with a higher rate of complications. However, there are certain circumstances where PEI therapy represents a better strategy to control liver tumors than RFA, especially in situations where RFA is difficult, for example when large vessels surround the tumor. In the context of hepatocellular carcinoma (HCC), both RFA and PEI are feasible and of benefit in non-operable patients. RFA seems superior to PEI in HCC > 2 cm, and the combination of interventions may be of benefit in selected patients. Liver resection is superior to RFA for patients with HCC meeting the Milan criteria, but RFA can be employed in tumors ≤ 3 cm and where there is an increased expected operative mortality. In addition, some lines of evidence indicate that RFA and PEI can be employed as a bridge to liver transplantation. The use of RFA in colorectal liver metastases is currently limited to unresectable disease and for patients unfit for surgery. The aim of this article is to summarize the current status of RFA in the management of liver tumors and compare it to the cheap and readily available technique of PEI.

关键词： Colorectal liver metastases Hepatocellular cancer Liver resection Percutaneous ethanol injection Radiofrequency ablation

Intervention on toll-like receptors in pancreatic cancer

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World Journal of Gastroenterology 2014年第19期20卷 5808-5817页

作者： Juan Vaz roland andersson Department of Surgery Clinical Sciences LundSkne University Hospital LundLund UniversitySE-221 85 LundSweden

Pancreatic ductal adenocarcinoma(PDA)is a devastating disease with pronounced morbidity and a high mortality *** available treatments lack convincing cost-efficiency determinations and are in most cases not associated with relevant success *** stimulation of the immune system in murine PDA models has revealed some promising *** receptors(TLRs)are pillars of the immune system that have been linked to several forms of malignancy,including lung,breast and colon *** humans,TLRs are expressed in the pancreatic cancer tissue and in several cancer cell lines,whereas they are not expressed in the normal *** the present review,we explore the current knowledge concerning the role of different TLRs associated to *** if almost all known TLRs are expressed in the pancreatic cancer microenvironment,there are only five TLRs suggested as possible therapeutic *** data points at TLR2 and TLR9 as effective tumor markers and agonists could potentially be used as *** adjuvant *** elucidation of the role of TLR3 in PDA is only in its initial *** inhibition/blockage of TLR4-related pathways has shown some promising effects,but there are still many steps left before TLR4 inhibitors can be considered as possible therapeutic ***,TLR7 antagonists seem to be potential candidates for *** of their potential in immunotherapies,all existing data indicate that TLRs are strongly involved in the pathophysiology and development of PDA.

关键词： Pancreatic cancer Pathophysiological mechanism Toll-like receptor Intervention Adjuvant therapy

Tissue factor in predicted severe acute pancreatitis

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World Journal of Gastroenterology 2010年第48期16卷 6128-6134页

作者： Ellen andersson Jakob Axelsson Gunilla Eckerwall Daniel Ansari roland andersson Department of Surgery Clinical Sciences LundLund University Lund University Hospital

AIM: To study tissue factor (TF) in acute pancreatitis and evaluate the role of TF as a predictive marker of severity. METHODS: Forty-nine consecutive patients admitted to Lund University Hospital, fulfilling the criteria of predicted severe acute pancreatitis (AP), were recruited prospectively between 2002 and 2004. Blood samples for TF analyses were drawn at inclusion in the study and 12 h, 1 d and 3 d later. RESULTS: Twenty-seven patients developed mild AP, and 22 patients severe AP. At inclusion in the study, the groups were comparable with respect to gender, aetiology, Acute Physiology and Chronic Health Evaluation Ⅱ score, and duration of pain. At inclusion in the study and at 12 h, TF was higher in the severe AP group (P = 0.035 and P = 0.049, respectively). After 1 and 3 d, no differences in TF levels were noted. Interleukin (IL)-6 was significantly higher in the severe AP group at all of the studied time points. C-reactive protein (CRP) was significantly higher in the AP group at 1 and 3 d. In receiver operating characteristic-curves, the area under the curve (AUC) for TF was 0.679 (P = 0.035) at inclusion in the study, and a cut off level for TF of 40 pg/mL showed a sensitivity of 71% and a specificity of 67%, whereas corresponding AUC for IL-6 was 0.775, P = 0.001, and for CRP was 0.653. IL-6 showed better AUC-values than TF at all time points studied. CONCLUSION: TF-levels are raised early in severe AP. TF as an early predictive marker of severe AP is superior to CRP, but inferior to IL-6.

关键词： Acute pancreatitis Coagulation Prediction of severity Tissue factor

hENT1 expression is predictive of gemcitabine outcome in pancreatic cancer: A systematic review

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World Journal of Gastroenterology 2014年第26期20卷 8482-8490页

作者： Stina Nordh Daniel Ansari roland andersson Department of Surgery Clinical Sciences LundLund University and Sk?ne University Hospital

High human equilibrative nucleoside transporter 1(hENT1)-expression has shown a survival benefit in pancreatic cancer patients treated with gemcitabine in several *** aim of this systematic review was to summarize the results and try to assess the predictive value of hENT1 for determining gemcitabine outcome in pancreatic *** articles were obtained from PubMed,Embase and Cochrane *** evaluating hENT1-expression in pancreatic tumor cells from patients treated with gemcitabine were *** measures were overall survival,disease-free survival(DFS),toxicity and response *** database searches identified 10 studies that met the eligibility criteria,and a total of 855 patients were *** of 10 studies showed a statistically significant longer overall survival in univariate analyses in patients with high hENT1-expression compared to those with low *** the 7 studies that reported DFS as an outcome measure,6 had statistically longer DFS in the high hENT1 *** toxicity and response rate were reported in only 2 articles and it was therefore hard to draw any major *** review provides evidence that hENT1 is a predictive marker for pancreatic cancer patients treated with *** limitations of the review have to be taken into consideration,the majority of the included studies had a retrospective design,and there was no standardized scoring protocol for hENT1-expression.

关键词： Pancreatic cancer Gemcitabine hENT1 Predictive Survival

Update on the management of pancreatic cancer:Surgery is not enough

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World Journal of Gastroenterology 2015年第11期21卷 3157-3165页

作者： Daniel Ansari Adam Gustafsson roland andersson Department of Surgery Clinical Sciences LundLund University and Sk?ne University Hospital

Pancreatic ductal adenocarcinoma(PDAC) represents the fourth cause of death in cancer and has a 5-year survival of < 5%.Only about 15% of the patients present with a resectable PDAC with potential to undergo "curative" *** surgery,local and systemic recurrence,is though very *** median survival of resected patients with adjuvant chemotherapy after surgery is only 20-23 *** underscores the significant need to improve PDAC management *** survival rate is dependent on new breakthroughs in our understanding of not at least tumor *** aim of this review is to update and comment on recent knowledge concerning PDAC biology and new diagnostics and treatment *** fundamental approach to improve survival rates is by earlier and improved diagnosis of the *** recent years,novel blood-based biomarkers have emerged based on genetic,epigenetic and protein changes in PDAC with very promising *** biomarkers to enter clinical practice they need to have been developed using adequate control groups and provide high sensitivity and specificity and by this identify patients at risk already in a pre-symptomatic *** way to improve outcomes,is by employing neoadjuvant treatments thereby increasing the number of resectable *** systemic treatment regimes like FOLFIRINOX and nab-paclitaxel have demonstrated improvements in prolonging survival in advanced cases,but long-term survival is still *** future improved understanding of PDAC biology will inevitably render new treatment options directed against both the cancer cells and the surrounding microenvironment.

关键词： Pancreatic cancer Diagnosis Genetics Epigenetics P

Controversial role of toll-like receptors in acute pancreatitis

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World Journal of Gastroenterology 2013年第5期19卷 616-630页

作者： Juan Vaz Hamid Akbarshahi roland andersson Department of Surgery Clinical Sciences LundSkne University Hospital LundLund UniversitySE-221 85 LundSweden

Acute pancreatitis(AP)is a common clinical condition with an incidence of about 300 or more patients per million *** 10%-15%of patients will develop severe acute pancreatitis(SAP)and of those, 10%-30%may die due to SAP-associated *** the improvements done in the diagnosis and management of AP,the mortality rate has not significantly declined during the last ***-like receptors(TLRs)are pattern-recognition receptors that seem to play a major role in the development of numerous diseases,which make these molecules attractive as potential therapeutic *** are involved in the development of the systemic inflammatory response syndrome,a potentially lethal complication in *** the present review,we explore the current knowledge about the role of different TLRs that have been described associated with *** main candidate for targeting seems to be TLR4,which recognizes numerous damage-associated molecular patterns related to ***2 has also been linked with AP,but there are only limited studies that exclusively studied its role in *** is also data suggesting that TLR9 may play a role in AP.

关键词： Acute pancreatitis Severe acute pancreatitis Pathophysiological mechanism Toll-like receptors Intervention

Re-evaluation of classical prognostic factors in resectable ductal adenocarcinoma of the pancreas

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World Journal of Gastroenterology 2016年第28期22卷 6424-6433页

作者： Daniel Akerberg Daniel Ansari roland andersson Department of Surgery Clinical Sciences Lund Lund University and Skane University Hospital SE-221 85 Lund Sweden

Pancreatic ductal adenocarcinoma carries a poor prognosis with annual deaths almost matching the reported incidence rates. Surgical resection offers the only potential cure. Yet, even among patients that undergo tumor resection, recurrence rates are high and long-term survival is scarce. Various tumorrelated factors have been identified as predictors of survival after potentially curative resection. These factors include tumor size, lymph node disease, tumor grade, vascular invasion, perineural invasion and surgical resection margin. This article will re-evaluate the importance of these factors based on recent publications on the topic, with potential implications for treatment and outcome in patients with pancreatic cancer.

关键词： Pancreatic cancer Survival Prognostic factors

Pancreatic cancer screening in high-risk individuals with genetic susceptibility

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Hepatobiliary Surgery and Nutrition 2023年第4期12卷 590-592页

作者： roland andersson Daniel Ansari Department of Surgery Clinical Sciences LundLund University and Skåne University HospitalLundSweden

Pancreatic cancer is still associated with a dismal prognosis,sometimes with a 5-year survival reported up to 10%,but the true figure is probably about 5%(1).Major breakthroughs in outcomes are *** avenue for improving is survival is by earlier tumor detection,thereby increasing the proportion of patients that can undergo curative-intent surgery and concomitant *** recent years,optimistic outcomes have been reported for localized-stage disease,with 5-year survival rates of up to 44%(2).

关键词： Screening pancreatic cancer genetic