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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

Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention

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World Journal of Gastroenterology 2010年第17期16卷 2094-2099页

作者： Roland Andersson Department of Surgery Clinical Sciences LundLund University lund university hospital SE-221 85 LundSweden

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in acute pancreatitis still represents a substantial problem,with a mortality rate in the range of 30%-40%.The present review evaluates underlying pathophysiological mechanisms in both ALI and ARDS and potential clinical *** mediators and pathophysiological pathways are involved during the different phases of ALI and *** initial exudative phase is characterized by diffuse alveolar damage,microvascular injury and influx of inflammatory *** phase is followed by a fibro-proliferative phase with lung repair,type Ⅱ pneumocyte hypoplasia and proliferation of *** derived from polymorphonuclear neutrophils,various pro-inflammatory mediators,and phospholipases are all involved,among *** factors that promote pancreatitis-associated ALI may be found in the gut and mesenteric *** is a lack of complete understanding of the underlying mechanisms,and by improving our knowledge,novel tools for prevention and intervention may be developed,thus contributing to improved outcome.

关键词： Acute lung injury Acute respiratory distress syndrome Acute pancreatitis Etiology Pathophysiology

Reduced peripheral vascular reactivity in refractory angina pectoris:Effect of enhanced external counterpulsation

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Journal of Geriatric Cardiology 2011年第4期8卷 215-223页

作者： Susanne M Bondesson Marie-Louise Edvinsson Thomas Pettersson Lars Edvinsson Department of Medicine Kristianstad HospitalSE-29185 KristianstadSweden Department of Health Sciences lund Lund UniversitySE-22100 LundSweden Department of Emergency Medicine Lund University HospitalSE-22185 LundSweden

Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory *** Twenty patients diagnosed with refractory angina were divided into EECP(n=10)or no EECP(n=10)*** data were compared to matched healthy subjects(n=20).The cutaneous forearm microvascular blood flow was measured by Laser-Doppler *** vascular responsiveness to iontophoretic administration of acetylcholine(ACh),sodium nitroprusside(SNP)and local skin warming were *** of Canadian Cardiovascular Society(CCS)-class,blood pressure and plasma samples were *** EECP patients showed reduced CCS-class compared to no EECP(P<0.05).Both EECP and no EECP(P<0.05)groups had decreased systolic blood pressure(SBP)as compared to SBP at baseline(P<0.05).There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of *** to heating,the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects(P<0.05).EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and *** Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh,SNP and heat compared to healthy *** EECP reduced the CCS-class,this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.

关键词： refractory angina pectoris flowmetry microcirculation enhanced external counterpulsation

Target blood pressure in diabetes patients with hypertension——What is the accumulated evidence in 2011?

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Journal of Zhejiang university-Science B(Biomedicine & Biotechnology) 2011年第8期12卷 611-623页

作者： Peter M.NILSSON Department of Clinical Sciences Lund UniversityUniversity Hospital

There is overwhelming evidence that hypertension is an important risk factor for both macrovascular and microvascular complications in patients with diabetes,but the problem remains to identify appropriate goals for preventive therapies.A number of guidelines (the European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) 2007,the Joint National Committee (JNC)-Ⅶ 2003,the American Diabetes Association (ADA) 2011) have for example advocated a blood pressure goal of less than 130/80 mmHg,but this suggestion has been challenged by findings in recent trials and meta-analyses (2011).The European Society of Hypertension (ESH) therefore recommends a systolic blood pressure goal of "well below" 140 *** on evidence from both randomized controlled trials (hypertension optimal treatment (HOT),action in diabetes and vascular disease:preterax and diamicron MR controlled evaluation (ADVANCE),action to control cardiovascular risk in diabetes (ACCORD)) and observational studies (ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET),international verapamil-trandolapril study (INVEST),treat to new targets (TNT),and the National Diabetes Register (NDR)),it has been shown that the benefit for stroke reduction remains even at lower achieved blood pressure levels,but the risk of coronary events may be uninfluenced or even increased at lower systolic blood pressure *** a recent meta-analysis,it was therefore concluded that the new recommended goal should be 130-135 mmHg systolic blood pressure for most patients with type 2 *** risk factors should also be controlled with a more ambitious strategy applied in the younger patients with shorter diabetes duration,but a more cautious approach in the elderly and frail patients with a number of vascular or non-vascular *** patients from East Asia,such as China,the stroke risk is relatively higher than the risk of coronary *** must al

关键词： Blood pressure Cardiovascular Diabetes Goal Hypertension Treatment

Deteriorated function of cutaneous microcirculation in chronic congestive heart failure

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Journal of Geriatric Cardiology 2011年第2期8卷 82-87页

作者： Marie-Louise Edvinsson Erik Uddman Sven E Andersson Department of Emergency Medicine Lund University Hospital SE- 221 85 LUND Sweden

Background Chronic congestive heart failure is a complex condition that leads to dysfunction in the peripheral microcirculation. We have previously shown that vascular reactivity is reduced with increasing age. In this study, we examined a group of very old patients with severe chronic heart failure to test the hypothesis that vascular function is further compromised by a combination of heart failure and aging. Methods Cutaneous forearm blood flow was measured by laser Doppler flowmetry and compared among three groups： Group 1 （n = 20, mean ±SE： 85.5 ±4 years）, heart failure patients with New York Heart Association class Ⅳ （NYHA Ⅳ） and with a NT-proBNP level ≥5000 ng/L; Group 2 （n = 15, mean ±SE： 76.5 ±2 years）, heart failure patients with NYHA II and NT-proBNP ≤2000 ng/L, and Group 3 （n = 10, mean ±SE： 67.6 ±3.0 years）, healthy controls with no clinical signs of heart failure. The vasodilator response to the iontophoretic administration of acetylcholine （ACh）, acting via an endothelial mechanism, and sodium nitroprusside （SNP）, acting via a smooth muscle cell mechanism, were studied. Results All patients with heart failure had significantly reduced vascular reactivity independent of the mode of stimulation （ACh, SNP or heat） when compared to healthy controls. However, the responses did not differ between the two groups of heart failure patients. Conclusions Cutaneous vascular reactivity is reduced in heart failure patients and does not correlate with the severity of the condition or age of patients.

关键词： heart failure cutaneous microcirculation endothelial responses acetylcholine smooth muscle responses

Risk factors and outcomes for patients with pancreatic cancer undergoing surgical exploration without resection due to metastatic disease:A national cohort study

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 279-284页

作者： Emil Sahlstrom Paulina Bereza-Carlson Johan Nilsson Bobby Tingstedt Bodil Andersson Department of Clinical Sciences lund SurgeryLund UniversitySweden Department of Surgery Central Hospital KristianstadSweden Department of Translational Medicine Cardiothoracic surgery and bioinformaticsLund UniversitySweden Department of Thoracic and vascular surgery Skane University hospitalLundSweden Department of Surgery Skane University HospitalLundSweden

Background:Unresectable disease is sometimes diagnosed during surgery in patients with pancreatic ductal adenocarcinoma(PDAC).This study aimed to identify preoperative risk factors for metastatic disease diagnosed at surgical exploration and to investigate and compare survival in resected and nonresected ***:Patients were identified from the Swedish National Pancreatic and Periampullary Cancer Registry *** of metastatic disease were evaluated with a multivariable logistic regression model,and survival was evaluated with Kaplan-Meier estimates and log-rank ***:In total,1938 patients with PDAC were scheduled for *** unresectable situation was diagnosed intraoperatively in 399 patients(20.6%),including 234(12.1%)with metastasized *** risk factors for metastasis were involuntary weight loss(OR=1.72;95%CI:1.27-2.33)and elevated carbohydrate antigen 19-9(CA19-9)(35-599 U/m L,OR=1.79,95%CI:1.11-2.89;≥600 U/m L,OR=3.24,95%CI:2.04-5.17).Overall survival was lower among patients with metastasized disease than that among patients with a resectable tumor(P<0.001).Conclusions:Involuntary weight loss and an elevation of CA19-9 are preoperative risk factors for diagnosing metastasized disease during surgical exploration.

关键词： Pancreatic cancer Surgery Metastasized Exploration

Brain natriuretic peptide is a potent vasodilator in aged human microcircula- tion and shows a blunted response in heart failure patients

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Journal of Geriatric Cardiology 2014年第1期11卷 50-56页

作者： Marie-Louise Edvinsson Erik Uddman Lars Edvinsson Sven E. Andersson Department of Emergency and Internal Medicine Institute of Clinical Sciences Lund University Lund University Hospital SE- 221 85 Lund Sweden

Background Brain natriuretic peptide （BNP） is normally present in low levels in the circulation, but it is elevated in parallel with the degree of congestion in heart failure subjects （CHF）. BNP has natriuretic effects and is a potent vasodilator. It is suggested that BNP could be a therapeutic alternative in CHF. However, we postulated that the high levels of circulating BNP in CHF may downregulate the response of microvascular natriuretic receptors. This was tested by comparing 15 CHF patients （BNP 〉 3000 ng/L） with 10 matched, healthy controls. Methods Cutaneous microvascular blood flow in the forearm was measured by laser Doppler Flowmetry. Local heating （＋44°C, 10 min） was used to evoke a maximum local dilator response. Results Non-invasive iontophoretic administration of either BNP or acetylcholine （ACh）, a known endothelium-dependent dilator, elicited an increase in local flow. The nitric oxide synthase inhibitor, l-N-Arginine- methyl-ester （L-NAME）, blocked the BNP response （in controls）. Interestingly, responses to BNP in CHF patients were reduced to about one third of those seen in healthy controls （increase in flow： 251% in CHF vs. 908% in controls; P 〈 0.001）. In contrast, the vasodilator responses to ACh and to local heating were only somewhat attenuated in CHF patients. Thus, dilator capacity and nitric oxide signalling were not af- fected to the same extent as BNP-mediated dilation, indicating a specific downregulation of the latter response. Conclusions The findings show for the first time that microvascular responses to BNP are markedly reduced in CHF patients. This is consistent with the hypothesis of BNP receptor function is downregulated in CHF.

关键词： Heart failure Cutaneous microcirculation Endothelial responses Acetylcholine, Brain natriuretic peptide Nitric oxide

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

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