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Table 3 Resectability criteria and societies. However, with a vastly larger absolute aged population, Asia bears a unique burden of HZ. Accessed 17 Jan Both mFFX and gemcitabine plus nab-paclitaxel improve median OS compared to gemcitabine monotherapy[]. Biomed Res Int. По ссылке of randomized clinical trials winddows safety and efficacy of biliary drainage windows 10 1703 download iso itaxia surgery for obstructive jaundice.

Pancreatic cancer in What you need to know to win – PMC – {dialog-heading}

J Cutan Med Surg. Lloyd A. An attenuation difference between tumor and normal pancreas is best achieved after peak enhancement of the aorta in the arterial phase but before the one of the liver, in the portal venous phase. Australas J Dermatol. Histologic definition of a solid lesion of the pancreas should be the first option, as opposed to radiologic monitoring alone. Int J Epidemiol.


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A case of human immunodeficiency virus infection initially presented with disseminated herpes zoster. A case of human immunodeficiency virus infection in recurrent herpes zoster. A 5-year period clinical study of 16 cases with disseminated herpes zoster — Visceral varicella zoster virus infection after allogeneic stem cell transplantation. Transpl Infect Dis. Varicella-zoster virus-associated fulminant hepatitis following allogeneic hematopoietic stem cell transplantation for multiple myeloma.

Autologous hematopoietic stem cell transplantation for progressive multiple sclerosis: report of efficacy and safety at three yr of follow up in 21 patients. Clin Transplant. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as a manifestation of visceral varicella zoster virus infection in a patient with non-Hodgkin’s lymphoma. Am J Hematol. A case of fatal varicella zoster infection with refractory abdominal pain as an early symptom. Kansenshogaku Zasshi.

Disseminated zoster, hyponatraemia, severe abdominal pain and leukaemia relapse: recognition of a new clinical quartet after bone marrow transplantation. Acalculous cholecystitis, multifocal gastrointestinal infarction and pancreatitis resulting from Varicella-zoster virus.

Intern Med J. Acute pancreatitis associated with herpes zoster: Case report and literature review. World J Gastroenterol. A case of herpes zoster associated with colitis. J Dermatol. Ching DW. Severe, disseminated, life threatening herpes zoster infection in a patient with rheumatoid arthritis treated with methotrexate. Ann Rheum Dis. Hashizume H, Umayahara T.

Acute respiratory distress syndrome due to varicella zoster virus pneumonitis in an immunocompromised patient with herpes zoster. Pneumonia caused by varicella-zoster virus in a patient with rheumatoid arthritis. Nihon Kyobu Shikkan Gakkai Zasshi. Treatment and recent topics of postherpetic neuralgia.

Japan Med Assoc J. Sanford M, Keating GM. Zoster vaccine Zostavax : a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults. Drugs Aging. Cheong C, Lee TJ. Prevalence and healthcare utilization of herpes zoster and postherpetic neuralgia in South Korea: disparity among patients with different immune statuses.

Epidemiol Health. Severity of skin lesions of herpes zoster at the worst phase rather than age and involved region most influences the duration of acute herpetic pain.

The relationship among pain, depression, and anxiety in patients with herpes zoster. Factors influencing pain outcome in herpes zoster: An observational study with valaciclovir. J Eur Acad Dermatol Venereol. A clinical study of herpes zoster focused on the characteristics of pruritus in herpes zoster.

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Seroepidemiology of varicella and the reliability of a self-reported history of varicella infection in Singapore military recruits. Ann Acad Med Singapore. Chow VTK. Rapid detection of varicella-zoster viral antibodies by latex agglutination assay: A practical experience for medical and science undergraduates.

Biochem Educ. Changing seroprevalence of varicella zoster virus infection in a tropical city state, Singapore. Seroprevalence of hepatitis A virus and varicella zoster antibodies in a Javanese community Yogyakarta, Indonesia.

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Effect of climatic factors and population density on varicella zoster virus epidemiology within a tropical country. Am J Trop Med Hyg. Evidence of vaccine protection among Thai medical students and implications for occupational health.

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High seroprevalence of antibodies to varicella zoster virus in adult women in a tropical climate. The seroepidemiology and transmission dynamics of varicella in Australia. A seroepidemiological study of Varicella-Zoster virus in Taipei City. Varicella zoster virus infection among healthcare workers in Taiwan: seroprevalence and predictive value of history of varicella infection. J Hosp Infect. Seroprevalence of antibodies to human herpesviruses in England and Hong Kong. Seroprevalence of varicella zoster virus among pregnant women in Hong Kong: comparison with self-reported history.

Seroepidemiology of varicella-zoster virus infection measured by the fluorescent antibody to membrane antigen test.

Survey of seroprevalence of varicella zoster virus in healthy population in Shanghai. Chin J Vaccin Immun. Wang Y. Seroepidemiological survey of prevalence of varicella-zoster virus in healthy population in Shenzen City. Chin Trop Med. A sero-epidemiological investigation on varicella-zoster virus in healthy people in Fujian. Pract Prev Med. Seroepidemiology of varicella-zoster virus in Korean adolescents and adults using fluorescent antibody to membrane antigen test.

Incidence of herpes zoster and seroprevalence of varicella-zoster virus in young adults of South Korea. Genotype of varicella zoster virus isolated from Korean elderly patients with herpes zoster. Seroepidemiology of varicella-zoster virus in Korea. J Korean Med Sci.

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Antibody titers against measles, rubella, mumps and varicella-zoster viruses in medical students. Sangyo Eiseigaku Zasshi. National Institute of Infectious Diseases, Japan. Accessed 27 Sept Disease burden and epidemiology of herpes zoster in pre-vaccine Taiwan. Epidemiological features and costs of herpes zoster in Taiwan: a national study to Acta Derm Venereol. Population-based study of the epidemiology of herpes zoster in Korea.

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Local stability analysis of age structural model for herpes zoster in Thailand. Evidence of increasing frequency of herpes zoster management in Australian general practice since the introduction of a varicella vaccine. Med J Aust. Decreased varicella and increased herpes zoster incidence at a sentinel medical deputising service in a setting of increasing varicella vaccine coverage in Victoria, Australia, to Euro Surveill. A decline in varicella but an uncertain impact on zoster following varicella vaccination in Victoria, Australia.

Bak H, Ahn SK. A statistical study of dermatoses — Annual Epidemiological Surveillance Reports. Accessed 03 Aug Herpes zoster risk reduction through exposure to chickenpox patients: A systematic multidisciplinary review. Herpes zoster in Australia: Evidence of increase in incidence in adults attributable to varicella immunization? Recurrence rate of herpes zoster during the previous decade. Tunsuriyawong S, Puavilai S. Herpes zoster, clinical course and associated diseases: A 5-year retrospective study at Ramathibodi Hospital.

Impaired specific cellular immunity to the varicella-zoster virus in patients with herpes zoster oticus. J Laryngol Otol. A community-based survey of varicella-zoster virus-specific immune responses in the elderly.

A comparison of herpes zoster incidence across the spectrum of chronic kidney disease, dialysis and transplantation. Am J Nephrol. Risk of Herpes zoster in patients with underlying diseases: a retrospective hospital-based cohort study. Risk of herpes zoster in patients treated with long-term hemodialysis: a matched cohort study. Am J Kidney Dis.

Risk of herpes zoster in CKD: a matched-cohort study based on administrative data. Risk of herpes zoster in patients with systemic lupus erythematosus: a three-year follow-up study using a nationwide population-based cohort. Clinics Sao Paulo. Increased risk of varicella zoster virus infection in inflammatory bowel disease in an Asian population: a nationwide population-based cohort study.

Increased incidence of herpes zoster in adult patients with peptic ulcer disease: A population-based cohort study. Int J Epidemiol. Risk of herpes zoster among patients with chronic obstructive pulmonary disease: a population-based study.

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Leuk Lymphoma. Clinical features of dermatology-consulted inpatients – Focus on the differences between individual departments. Results of heart transplantation in Korea. Korean J Med.

Varicella zoster virus infection after allogeneic or autologous hemopoietic stem cell transplantation. J Formos Med Assoc. Autologous stem cell transplantation with PCR-negative graft would be associated with a favorable outcome in core-binding factor acute myeloid leukemia. Biol Blood Marrow Transplant.

A phase I-II trial of autologous peripheral blood stem cell transplantation in the treatment of refractory autoimmune disease. The incidence of herpes zoster after hematopoietic stem cell transplantation. Chin J Infect Chemother. Spectrum of dermatological lesions in renal allograft recipients in a tropical environment. Mucocutaneous lesions in transplant recipient in a tropical country. Viral infection following kidney transplantation: long-term follow-up in a single center. Increased incidence of herpes zoster in the setting of cytomegalovirus preemptive therapy after kidney transplantation.

Opportunistic infections non-cytomegalovirus in live related renal transplant recipients. Indian J Urol. Ocular complications of heart, lung, and liver transplantation.

Br J Ophthalmol. Long-term benefits with sirolimus-based therapy after early cyclosporine withdrawal. J Am Soc Nephrol. Varicella-zoster virus infection in adult patients after unrelated cord blood transplantation: a single institute experience in Japan. Br J Haematol. Incidence and risk of postherpetic neuralgia after varicella zoster virus infection in hematopoietic cell transplantation recipients: Hokkaido Hematology Study Group.

Herpesvirus-associated central nervous system diseases after allogeneic hematopoietic stem cell transplantation. Varicella zoster virus meningoencephalitis after allogeneic hematopoietic stem cell transplantation. Concomitant zoster myelitis and cerebral leukemia relapse after stem cell transplantation.

Ann Hematol. Varicella-zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome-overt leukemia. Int J Hematol. Clinical features and treatment response in 18 cases with idiopathic nonspecific interstitial pneumonia. Tuberc Respir Dis. Nephrotic syndrome in the elderly—clinicopathological study. Nihon Jinzo Gakkai Shi.

Recurrent varicella-zoster virus retinitis in a patient treated with systemic corticosteroids. Ocul Immunol Inflamm.

Clinical features and treatment of angioimmunoblastic T-cell lymphoma. Chin J Clin Oncol. The frequency and risk factor of herpes zoster infection in non-Hodgkin’s lymphoma patients. Jpn J Cancer Chemother. Frequent varicella zoster reactivation associated with therapeutic use of arsenic trioxide: portents of an old scourge.

J Am Acad Dermatol. Clinical analysis of hematologic disorders complicated with herpes zoster after treating with arsenic trioxide. J Leuk Lymphoma. High frequency of varicella zoster virus reactivation associated with the use of arsenic trioxide in patients with acute promyelocytic leukemia.

Acta Haematol. Oral arsenic trioxide-based maintenance regimens for first complete remission of acute promyelocytic leukemia: a year follow-up study.

Outcome of 85 lupus nephritis patients treated with intravenous clophosphamide: A single centre 10 year experience. Med J Malays. Sequential therapy for diffuse proliferative and membranous lupus nephritis: cyclophosphamide and prednisolone followed by azathioprine and prednisolone. Treatment of membranous lupus nephritis with nephrotic syndrome by sequential immunosuppression.

Treatment of diffuse proliferative lupus glomerulonephritis: a comparison of two cyclophosphamide-containing regimens. Study on bolus cyclosphamide treatment for 64 cases of lupus nephritis. Outcome of protein-losing gastroenteropathy in systemic lupus erythematosus treated with prednisolone and azathioprine. Rheumatology Oxford. Korean J Gastroenterol. Three-year results of a randomized, double-blind, controlled trial of mycophenolate mofetil versus azathioprine in cardiac transplant recipients.

J Heart Lung Transplant. Efficacy and safety of enteric-coated mycophenolate sodium in combination with two glucocorticoid regimens for the treatment of active lupus nephritis. Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement.

Nephrol Dial Transplant. Clear benefit of mycophenolate mofetil-based triple therapy in reducing the incidence of acute rejection after living donor renal transplantations. A prospective multicentre study of mycophenolate mofetil combined with prednisolone as induction therapy in patients with active lupus nephritis. Extensive herpes zoster involvement following mycophenolate mofetil therapy for sarcoidosis.

J Ophthalmic Inflamm Infect. The influence of mycophenolate mofetil versus azathioprine and mycophenolic acid pharmacokinetics on the incidence of acute rejection and infectious complications after renal transplantation. Pilot 24 month study to compare mycophenolate mofetil and tacrolimus in the treatment of membranous lupus nephritis with nephrotic syndrome. Nephrology Carlton. Efficacy of enteric-coated mycophenolate sodium in patients with active lupus nephritis.

Mycophenolate mofetil treatment for diffuse proliferative lupus nephritis: a multicenter clinical trial in China. Zhonghua Nei Ke Za Zhi. Application of low-dosage mycophenolate mofetil in living renal transplantation of lineal consanguinity. Leflunomide-associated infections in rheumatoid arthritis. J Rheumatol. Risk factors of severe infections in patients with rheumatoid arthritis treated with leflunomide. Mod Rheumatol. Treatment of proliferative lupus nephritis with leflunomide and steroid: a prospective multi-center controlled clinical trial.

Cladribine tablets: in relapsing-remitting multiple sclerosis. CNS Drugs. Non-bacterial infections in Asian patients treated with alemtuzumab: A retrospective study of the Asian Lymphoma Study Group.

Clinical outcome in patients with chronic antibody-mediated rejection treated with and without rituximab and intravenous immunoglobulin combination therapy. Transpl Immunol. Alteration in antibody-mediated immunity in patients with rituximab-combined chemotherapy and incidence of herpes zoster. Gan To Kagaku Ryoho. Immune reconstitution of B-cell lymphoma patients receiving CHOP-based chemotherapy containing rituximab.

Hematol Oncol. ABO-incompatible living donor liver transplantation without graft local infusion and splenectomy. HPB Oxford. Efficacy and safety of fludarabine-based combination chemotherapy in patients with previously untreated follicular non-Hodgkin’s lymphoma. Efficacy and safety of abatacept in lupus nephritis: A twelve-month, randomized, double-blind study. Arthritis Rheum. Tofacitinib versus methotrexate in rheumatoid arthritis.

Herpes zoster and tofacitinib therapy in patients with rheumatoid arthritis. Herpes zoster in Crohn’s disease during treatment with infliximab.

Eur J Gastroenterol Hepatol. Efficacy and safety of treatment with infliximab in Crohn’s disease-the experience of single center in Korea.

Clinical outcome of treatment with infliximab in Crohn’s disease: a single-center experience. The risk factors for herpes zoster in bortezomib treatment in patients with multiple myeloma. Korean J Hematol. Bortezomib and the increased incidence of herpes zoster in patients with multiple myeloma. Clin Lymphoma Myeloma. Outcomes of combination therapy for chronic antibody-mediated rejection in renal transplantation.

The high incidence of varicella herpes zoster with the use of bortezomib in 10 patients. Bortezomib combined with other drugs for treating 60 cases of multiple myeloma. Ophthalmic manifestations of herpes zoster virus in patients with multiple myeloma following bone marrow transplantation.

PAD regimen for relapsed or refractory patients with multiple myeloma. Safety evaluation of bortezomib in multiple myeloma patients with severe renal failure.

Therapeutic efficacy of bortezomib-based chemotherapy on 40 patients with multiple myeloma. Bortezomib, dexamethasone plus thalidomide for treatment of newly diagnosed multiple myeloma patients with or without renal impairment. Chin J Cancer Res. The choice of regimens based on bortezomib for patients with newly diagnosed multiple myeloma.

Successful treatment of renal light chain AL amyloidosis with bortezomib and dexamethasone VD. Pathol Biol Paris. Bortezomib combined with doxorubicin and dexamethasone for patients with refractory senile mantle cell lymphoma. Effect of treatment by bortezomib with other drugs for the refractory multiple myeloma.

Bortezomib combined with epirubicin and dexamethasone in treatment of multiple myeloma. J Pract Oncol. A retrospective analysis of bortezomib therapy for Japanese patients with relapsed or refractory multiple myeloma: beta2-microglobulin associated with time to progression.

Bortezomib plus rituximab versus rituximab alone in patients with relapsed, rituximab-naive or rituximab-sensitive, follicular lymphoma: a randomised phase 3 trial. Lancet Oncol. Sequential therapy of BTD and MPT regimen for the newly-diagnosed multiple myeloma patients no eligible for bone marrow transplantation.

Treatment of primary systemic amyloidosis with the combination of bortezomib and dexamethasone. Efficacy comparison between standard and reduced doses of bortezomib combined with adriamycin and dexamethasone in the treatment of patients with multiple myeloma. Sacral herpes zoster presenting as sciatica. Sachdeva S, Prasher P.

Herpes zoster following saphenous venectomy for coronary bypass surgery. J Card Surg. Delayed facial nerve weakness after intact canal wall tympanomastoidectomy. Lee MR, Ryman W. Herpes zoster following cryosurgery. Australas J Dermatol. Development of bilateral herpes zoster following thoracoscopic splanchnicectomy. Anaesth Intensive Care. Acute postoperative herpes zoster with a sciatic nerve distribution after total joint arthroplasty of the ipsilateral hip and contralateral knee.

J Arthroplasty. Herpes zoster developing within recent subciliary incision scar. J Craniofac Surg. Reactivation of herpes zoster along the trigeminal nerve with intractable pain after facial trauma: a case report and literature review. Reactivation of varicella-zoster virus in delayed facial palsy after dental treatment and oro-facial surgery. Delayed facial palsy after microvascular decompression for hemifacial spasm due to reactivation of varicella-zoster virus.

No Shinkei Geka. Varicella zoster virus iridocyclitis following macular hole surgery in a case of von Hippel-Lindau disease. Jpn J Clin Ophthalmol. Fujitani A, Hayasaka S. Herpes zoster ophthalmicus after cataract surgery in a patient with a history of gastric cancer. Ann Ophthalmol Glaucoma. Koide C. Multiple cranial nerve dysfunction after uncomplicated neurovascular decompression for hemifacial spasm. Otolaryngol Head Neck Surg Tokyo.

Herpetic corneal endotheliitis in a case after deep lamellar keratoplasty for bacterial keratitis. Gyo K, Honda N. Delayed facial palsy after middle-ear surgery due to reactivation of varicella-zoster virus. Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report.

Walland MJ. Presumed ophthalmic Herpes zoster after contralateral cataract extraction. Acta Ophthalmol Scand. Zoster related multiple cranial nerve palsies: an unusual complication following percutaneous balloon compression for trigeminal neuralgia. J Clin Neurosci. Herpes zoster: Are selective nerve root injections the treatment or the cause?

Pain Phys. The treatment outcome of elderly patients with idiopathic trigeminal neuralgia : Micro-vascular decompression versus gamma knife radiosurgery. J Korean Neurosurg Soc. Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries. Br J Anaesth. Drug induced herpes zoster Do statin induce herpes zoster? Herpes zoster is associated with prior statin use: a population-based case—control study.

Acta Derm-Venereol. Clinical and biological characteristics of human immunodeficiency virus- infected and uninfected intravascular drug users in Ho Chi Minh City, Vietnam.

Prevalence of skin disease in patients infected with human immunodeficiency virus in Bangkok, Thailand. Cutaneous manifestations in HIV positive patients. Clinical analysis of skin and mucosa manifestations in patients with HIV. Wiwanitkit V. Prevalence of dermatological disorders in Thai HIV-infected patients correlated with different CD4 lymphocyte count statuses: a note on cases. Opportunistic infections after the initiation of highly active antiretroviral therapy in advanced AIDS patients in an area with a high prevalence of tuberculosis.

Cutaneous manifestations of human immunodeficiency virus infection in Taiwan. Kaohsiung J Med Sci. Acta Med Indones. Clinical analysis of skin lesions in Chinese HIV- positive patients. Spectrum of opportunistic infections and malignancies in patients with human immunodeficiency virus infection in South Korea. Clin Infect Dis. Wani KA.

Mucocutaneous manifestations of HIV infection. HIV infection in families in and around Amritsar. J Indian Acad Clin Med.

Incidence of common opportunistic infections in HIV-infected individuals in Pune, India: analysis by stages of immunosuppression represented by CD4 counts. Indian J Med Res. HIV seroprevalence and HIV associated dermatoses among patients presenting with skin and mucocutaneous disorders.

Mucocutaneous disorders in Hiv positive patients. Srirangaraj S, Venkatesha D. Indian J Med Microbiol. Recent trends in the spectrum of opportunistic infections in human immunodeficiency virus infected individuals on antiretroviral therapy in South India. J Nat Sci Biol Med. J Acquired Immune Defic Syndr. The clinical study of hematoimmunologic features and opportunistic infections of patients with AIDS. Opportunistic infections and malignancies in patients with HIV infection. Korean J Infect Dis.

Herpes zoster and the stage and prognosis of HIV-1 infection. Genitourin Med. Herpes zoster in HIVinfected patients in the era of highly active antiretroviral therapy: a prospective observational study.

Chopra S, Arora U. J Clin Diagn Res. Pattern of mucocutaneous manifestations in human immunodeficiency virus-positive patients in North India. Indian J Sex Transm Dis. Cutaneous manifestations in HIV infected patients in rural area. J Pure Appl Microbiol. J Infect. Clinical features of HIV infection in drug users of Manipur. Natl Med J India. India Indian J Med Res. Lloyd A. A hospital based cross sectional study of mucocutaneous manifestations in the HIV infected. Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count.

Immune restoration diseases reflect diverse immunopathological mechanisms. Clin Microbiol Rev. Herpes zoster immune reconstitution inflammatory syndrome in a HIV-infected patient: Case report and literature review. Dermatologic immune restoration syndrome: report of five cases from a tertiary care center in north India.

J Cutan Med Surg. Immune reconstitution inflammatory syndrome. Incidence of herpes zoster in pediatricians and family practitioners Estimation of efficacy of varicella vaccine for protection against herpes zoster in the elderly.

Kawasaki Med J. Infectivity of varicella and herpes zoster. Epidemic of herpes zoster in a family. Detection of aerosolized varicella-zoster virus DNA in patients with localized herpes zoster. J Infect Dis. Detection of varicella-zoster virus DNA in throat swabs of patients with herpes zoster and on air purifier filters.

Rapid contamination of the environments with varicella-zoster virus DNA from a patient with herpes zoster. Cutaneous tuberculosis complicated with squamous cell carcinoma.

Kansal HM, Goel S. Cutaneous manifestations in cases of pulmonary tuberculosis: A clinical profile. Images in clinical medicine. Herpes zoster. Reactivation of Herpes zoster in an adult with Plasmodium infection.

J Vector Borne Dis. Analysis of dermatoses in pregnant patients. Investigation of the clinical manifestations of herpes zoster during pregnancy and its impact on the perinatal outcome.

Herpes zoster during pregnancy near term: to treat or not to treat? J Microbiol Immunol Infect. Nutritional factors in herpes zoster, postherpetic neuralgia, and zoster vaccination.

Popul Health Manag. Serum vitamin D levels are positively associated with varicella zoster immunity in chronic dialysis patients. Sci Rep. Risk factors for herpes zoster reactivation in maintenance hemodialysis patients. Eur J Intern Med. Skip to main content. Search all BMC articles Search. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific.

Download PDF. Poblete 15 , Philip J. Abstract Background Herpes zoster HZ is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Results From retrieved articles, we screened-out duplicates and excluded extraneous articles, leaving unique articles. Background Herpes zoster HZ is a prevalent and debilitating viral disease that often causes serious complications and proves challenging to treat.

Methodology Literature search strategy We reviewed literature on HZ published over 21 years by authors from 14 Asia-Pacific countries. Literature search results The database searches returned articles Fig. Full size image. Clinicopathology Herpes zoster is caused by reactivation of VZV dormant in nerve root ganglia since a primary varicella infection Chickenpox.

Epidemiology and risk factors Seroepidemiology The aetiologic prerequisite of HZ is prior VZV infection, which most people contract in childhood, unless vaccinated preemptively [ 2 , 7 , , ]. Table 1 Herpes zoster incidence rates in Asia-Pacific Full size table. Table 2 Trends in herpes zoster incidence, hospitalisation and healthcare costs in Asia-Pacific countries Full size table. Table 3 Asia-Pacific countries with national varicella immunisation programmes Full size table. Table 4 Common comorbidities of herpes zoster in Asia-Pacific patient populations Full size table.

Complicating presentations and disease associations Post-herpetic neuralgia The most common complication of HZ in adults everywhere is pain outlasting the eruptive phase [ 94 ].

Table 5 Herpes zoster complication rates in Asia-Pacific patients Full size table. Sometimes, because of the extent or location of the tumor, a total pancreasectomy is required to achieve microscopically negative resection margins[ , ]. However, the metabolic consequences of this procedure, which include permanent exocrine insufficiency and brittle diabetes, have a detrimental impact on the quality of life and long-term survival[ ]. Diarrhea is the most important symptom[ ].

Tomlinson et al [ ] evaluated the minimum number of lymph nodes removed during pancreasectomy that are essential for proper staging. They consider a number of 15 Lymph nodes as the optimal cut-off. Therefore, the cut-off of 12 lymph nodes reported by Schwarz, represents a more easily threshold value, but sufficient for correct staging. Standard lymphadenectomy should strive to resect lymph node stations 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b[ ].

In some centres, mainly in Japan, surgeons routinely perform extensive lymph node dissection, including all 8, 9, all 12, all 14, 16a2, and 16b1 lymph nodes. A systematic review comparing standard vs extended lymphadenectomy demonstrated that there are no differences in OS between the two groups at one, three, or five years. However, the risk of complications was significantly increased after extended lymphadenectomy[ ]. Nevertheless, many surgeons prefer to treat patients with PV or SMV involvement with neoadjuvant systemic chemotherapy before surgery.

It increases the number of patients who can undergo curative surgery and improves long term prognosis in a selected group of patients[ ]. However, post-operative morbidity and mortality increase markedly when arterial resections are performed and few data are available to support these procedures[ – ].

A systematic review identified 27 retrospective studies, including close to patients who underwent pancreasectomy minimally invasive, open [ ]. The laparoscopic approach was associated with longer operative times [mean difference MD 71 min], but lower intraoperative blood loss MD mL. The rate of lymph node retrieval was significantly higher in the minimally invasive group MD 1. Hospital stay, postoperative hemorrhage and wound infection were significantly lower in the laparoscopic group, while the rate of overall mortality, reoperations, vascular resection, pancreatic fistula, delayed gastric emptying and bile leak were similar between the two groups[ – ].

In some high-volume surgical centres, robotic-assisted pancreatic resection has been adopted. Experienced surgeon reported the same morbidity and mortality of open surgery. Decreased blood loss, higher number of adequate lymphadenectomy and improved gastric emptying are reported in some studies. These results may improve OS, but, because robotic-assisted pancreasectomy is still in its infancy, available long-term oncologic outcomes are limited[ – ].

The only treatment with curative potential for pancreatic cancer is surgery. For patients with PDAC resectable or borderline resectable, surgical resection is followed by adjuvant chemotherapy. Some high-volume centers also use neoadjuvant therapy in these categories of patients[ , ]. Several adjuvant chemotherapy regimens have been evaluated in randomized controlled trials[ – ].

Currently, mFFX is the recommended therapy for patients with a good performance status. According to a meta-analysis[ ], S1 was ranked best for overall and disease-free survival followed by mFFX.

However, the results should be interpreted with care, as S-1 has shown good results in the Asian population, but its performance in Caucasians remains unclear due to the different expression of cytochrome P Adjuvant chemotherapy should be administered between 28 and 59 d after surgery. This timing appears to provide better survival than administering before 28 or after 59 d[ , ].

A study compared the efficacy between adjuvant chemotherapy and chemoradiation therapy in relation to AJCC stage. The main purpose of neoadjuvant chemotherapy NACT differs according to the stage.

For patients with primary resectable PDAC the purpose is to increase the proportion of patients receiving chemotherapy, because half of patients undergoing surgery, do not receive adjuvant chemotherapy due to postoperative morbidity or poor general condition[ ]. In , important advances were made in this field. A study of the University of Texas showed that patients who received neoadjuvant CRT had significantly improved R0 resection rates, lymph node resection rates, and locoregional recurrence rates, compared with those who received NACT[ ].

Although early data suggest the importance of integrating both NACT and CRT into the treatment, large prospective trial data are lacking[ ]. For primary resectable cancer, the potential benefit of NACT has been validated, particularly when initiated within 6 wk of diagnosis[ ]. The SWOG S study observed that patients who received gemcitabine and nab-paclitaxel had a greater pathologic response and median survival comparable to those who received mFFX[ ].

Several chemotherapeutic agents for resectable pancreatic cancer are currently being studied in several RCTs[ ]. In the Asian population, treatment regimens differ. The resection rate and morbidity of surgery remain the same[ ]. Based on these results, the latest Japanese guidelines recommend GS therapy as standard neoadjuvant therapy for patients with resectable PDAC. Among several ongoing RCTs on treatments for borderline resectable pancreatic cancer, a Japanese trial is comparing neoadjuvant therapy with gemcitabine plus nab-paclitaxel and CRT therapy with S-1[ ].

A subset of patients does not respond to NACT. There is therefore a need to find markers that can predict response to NACT. Phase of trial and level of evidence of trial about chemotherapy for resectable and borderline resectable pancreatic ductal adenocarcinoma. LA PDAC is still nonmetastatic, but due to the local growth, curative resection is not possible at the time of diagnosis. Treatment involves chemotherapy with regimens that are also used in the metastatic setting, such as mFFX or gemcitabine plus nab-paclitaxel[ – ].

A small percentage of patients, with excellent response to chemotherapy, may become eligible for surgical resection. The majority have incurable disease. The mFFX was superior in both the conversion rate to surgery It is unclear whether these conclusions still hold true in the setting of newer combination chemotherapy regimens and improved radiation therapy techniques, such as stereotactic radiation therapy and proton therapy.

Half of patients have metastatic disease at the time of diagnosis. The primary treatment is systemic chemotherapy, with the goal of increasing survival and palliating cancer-related symptoms. Both mFFX and gemcitabine plus nab-paclitaxel improve median OS compared to gemcitabine monotherapy[ , ].

In clinical practice, for patients who are fitter, mFFX is generally preferred, reserving gemcitabine plus nab-paclitaxel as a second-line option if they have adequate performance status[ , ]. For patients who have received first-line gemcitabine and have progressed, a good option might be the combination of fluorouracil plus leucovorin with nanoliposomal irinotecan[ ].

In these patients, disease progression had not occurred during at least 4 mo of first-line platinum derivative-based chemotherapy. Patients were randomized to receive olaparib or placebo. Olaparib showed a benefit in terms of PFS and a relatively safe toxicity profile. Although AIFA has not yet approved the indication, this study suggests a role for olaparib as maintenance therapy[ ].

CPI devimistat is an inhibitor of pyruvate dehydrogenase and a-ketoglutarate, key enzymes of the Krebs cycle. It has already shown good results in a phase I study[ ]. Although chemotherapy is the recommended treatment for patients with advanced PDAC, its efficacy is not satisfactory.

The major hurdle is considered the dense dysplastic stroma. It also prevents proper action of immune system cells, which are unable to reach the target site.

The result is a chemoresistant and immunoresistant tumor[ , ]. HA promotes the survival, proliferation, and migration of tumor cells[ ]. Another element to be acted upon is the Hedgehog signaling pathway, which is generally overactivated in pancreatic cancer. Vismodegib, in combination with gemcitabine or erlotinib, was studied for this purpose. It did not significantly affect survival compared with these two drugs administered as monotherapy[ , ].

The therapy was associated with an increased R0 resection rate[ ]. A clinical trial evaluated the efficacy of focused ultrasound combined with gemcitabine microbubble delivery in PDAC patients. Patients treated with the combination tolerated multiple chemotherapy cycles of gemcitabine. Poor results were obtained from stroma depletion in clinical settings.

They are due to the fact that, although stroma-targeting therapy enhances the delivery of chemotherapeutic agents, it might also promote tumor chemoresistance and metastasis a double-edged sword [ ]. According to several experts, future research should focus on the tumor ECM biology, biomarkers correlated with treatment benefit as ADAM12 [ ] and pharmacological agents able to alter the tumor microenvironment TME. One of the most interesting discoveries in this regard involves clodronate liposomes.

They prevent metastasis formation by inhibiting the activity of PDAC-associated macrophages and altering the microenvironment of key organs that are sites of metastatic invasion.

They are therefore valuable candidates to be evaluated in combination with target therapy against stroma[ ]. Although they resulted in remarkable successes in other cancers, ipilimumab, BMS and tremelimumab showed little efficacy in PDAC[ – ].

Currently, the development of immune checkpoint inhibitors for PDAC is focused on combination therapy with chemotherapeutic agents[ – ]. Therapeutic cancer vaccines present of immunogenic tumor antigens to the immune system, resulting in activation of the anti-cancer response.

More promising results were instead obtained with KIF20A[ – ]. K-RAS vaccines have been tested in the past, but data remain unclear and with no prominent advantages in metastatic patients[ – ]. CAR-T cell therapy is a type of adoptive cell therapy. CAR-T cells are T lymphocytes that are extracted from a patient’s blood sample or from a donor by apheresis, genetically modified to express the receptor for chimeric antigen CAR , and cultured in the laboratory.

They are then re-infused into the patient. The resulting T cells are able to recognize tumor cells and activate the immune system response against the disease[ ]. An additional patient had complete remission of all liver metastases[ ]. Combination of immunotherapy drugs was experienced and showed good results over time.

Combination therapy showed an increase in median OS 5. Chung et al [ ] evaluated the combination of Pembrolizumab with modified pexpressing Ankara vaccinia virus p53MVA. Three of eleven patients experienced disease stabilization by 30, 32, and 49 wk. Good OS and PFS results were also obtained using DC and cytokine-induced killer cell immunotherapy in combination with S-1 chemotherapy, compared with chemotherapy or supportive care alone[ ].

Several trials of immunotherapy-based treatment combinations with targeted agents are ongoing for patients with pancreatic cancer[ – ]. Oncolytic viruses are modified therapeutic drugs that selectively infect and self-replicate in tumor cells with tumor-dissolving effect.

They also activate the anti-tumor immunity and change the TME from an immunosuppressed state to an immune-activated state. Futhermore, oncolytic viruses have the advantages of specificity, low toxicity, and low drug resistance[ ]. However most of the studies have shown unsatisfactory results. Phase and level of evidence of trials about immunotherapy for pancreatic ductal adenocarcinoma. Some genetic alterations produce cellular changes in neoplastic cells that are potentially therapeutically targetable.

They showed to be targetable in metastatic colon cancer where the combination of Encorafenib and Cetuximab has recently been approved[ , ]. Furthermore, pancreatic tumors with NTRK gene fusions can be treated with tropomyosin receptor kinase inhibitors[ , ].

Similarly, some wild-type Kras pancreatic tumors hosting somatic NRG1 gene fusions respond to treatment with a kinase inhibitor of the HER family[ , ]. However, the results of the targeted therapies have been unsatisfactory, mainly due to the low life expectancy. There is no time to sequence the tumors and develop a treatment based on mutations[ ].

The exceptions were the germline alterations. Patients with Lynch syndrome MSI-high respond well to treatment with immune checkpoint inhibitors[ – ] and those with ATM mutations could respond to the drugs, targeting the ATR-checkpoint kinase 1 Chk1 pathway[ , ].

The elephant in the targeted therapy room remains Kras[ ]. It has been considered “undrinkable”[ – ] because the protein lacks an efficient small-molecule binding pocket and has a high affinity for cellular guanosine triphosphate GTP , which is highly concentrated in the cytoplasm. A druggable variant of Kras appears to be G12C. Although Kras G12C mutations are only a small fraction of Kras mutations in PDAC, these drugs represent a chance to take down a previously thought invincible adversary.

Recent studies have shown the gut microbiota GM may play a role in the development of PDAC and its response to therapy. These agents activate Toll-like-receptors and trigger chronic inflammation that are related to carcinogenesis. Several bacterial products are considered potential carcinogens.

Cyclomodulins promote tumorigenesis through active interference with host cell cycles. Colibactin and Bacteroides fragilis toxin act synergistically with Escherichia coli to create double-stranded DNA damage[ ]. The presence of an Helicobacter pylori infection and high concentrations of Fusobacterium spp and Porphyromonas gingivalis bacteria generally present in the oral cavity are associated with an increased risk of pancreatic cancer[ – ].

Moreover, other studies correlated a large number of microbes with immune suppression, downregulation of tumor suppressive pathways and the upregulation of oncogenic pathways[ ]. Dysbiosis is also related to obesity, chronic pancreatitis and diabetes, well-established risk factors of PDAC[ , ].

Because it participates in drug metabolism and biotransformation and immune regulation, the GM is implicated in the efficacy of chemotherapeutic agents[ ].

The innate immune response activated by the GM potentiates the action of oxaliplatin[ ]. Gentamicin activity may be reduced by the enzymes pyrimidine nucleoside phosphorylase and cytidine deaminase, which are produced by Gamma-proteobacteria and mycoplasmas within PDAC. Thus, these data suggest the possibility of modulating GM to counteract the chemoresistance characteristic of pancreatic cancer[ ].

Intratumoral microorganisms can play a key role in anticancer therapy[ ]. Indeed, they can stimulate host immune responses with positive or negative impacts on therapy. Gamma proteobacteria contain the enzyme CDD which could be responsible for the ineffectiveness of gemcitabine[ ].

Escheria Coli is capable of inducing chemical changes in the structure of gemcitabine, fludarabine, cladribine, and CB[ ]. The desmoplastic response induced by tumor cells is dependent on MyD It is activated by Fusobacterium species.

The intratumoral microbiota thus emerges as a major proponent of the chemo-immunoresistant phenotype of pancreatic cancer and is related to long-term survival in PDAC patients. The most important prognostic factor is tumor stage. Other factors may influence the prognosis of PDAC after surgery: Surgical margin status, tumor grading, presence of lymphatic invasion, preoperative and postoperative serum levels of CA , and cigarette smoking[ – ].

Squamous subtypes have a poor prognosis. ZIP4 inhibits the expression of the gemcitabine transporter ENT1, so that cells take up smaller amounts of the drug. Activation of this pathway participates in the chemoresistance of pancreatic cancers[ ]; 8 The highly upregulated in liver cancer HULC lncRNA distinguishes patients with pancreatic cancer, patients with benign pancreatic disease, and healthy subjects and correlates with TNM stage.

The expression of each member is associated with the histological grade of PDAC and is a negative prognostic marker[ ]. Pancreatic cancer is a very treacherous, dangerous enemy and the results are still very unsatisfactory.

It is proof that we are encircling it, and at the end, we will win. The success of a fight is linked to the ability to move from one failure to another without losing one’s enthusiasm. Conflict-of-interest statement: No conflict of interest. Manuscript source: Invited manuscript. Peer-review started: January 28, Specialty type: Gastroenterology and hepatology. World J Gastroenterol. Published online Sep Valeria Tonini and Manuel Zanni. Author information Article notes Copyright and License information Disclaimer.

Author contributions: Tonini V and Zanni M wrote the manuscript; both authors reviewed and approved the final version. Published by Baishideng Publishing Group Inc. All rights reserved. This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers.

Abstract Pancreatic cancer is one of the solid tumors with the worst prognosis. Keywords: Pancreatic cancer treatment, Advanced pancreatic cancer, Metastatic pancreatic cancer, Pancreatic cancer surgery, Pancreatic cancer chemotherapy, Pancreatic cancer screening.

Table 1 Genetic syndromes predisposing to pancreatic cancer the frequency of mutated genes among patients with pancreatic ductal adenocarcinoma is indicated in brackets. Open in a separate window. Saliva Saliva is a suitable substance for screening because it is obtained in a simple and noninvasive manner.

Urine Several biomarkers have also been evaluated in urine. Positron emission tomography The role of positron emission tomography PET is limited for PDAC due to the high number of false positives and false negatives[ ]. Biopsy Biopsy of a pancreatic mass can be performed either percutaneously or via EUS. Pancreatic incidentaloma A systematic review[ ] evaluated 5 studies enrolling patients with incidentalomas and concluded that most solid lesions are malignant.

STAGING The goal of the staging workup is to delineate the extent of disease spread and to identify patients who are eligible for resection with curative intent.

Table 2 Resectability criteria. Table 3 Resectability criteria and societies. Pancreaticoduodenectomy PD is the classic operation performed for pancreatic tumors of the head or uncinate process.

Distal pancreasectomy Distal pancreasectomy with splenectomy is the conventional operation for PDAC located in the body or tail of the pancreas. Total pancreasectomy Sometimes, because of the extent or location of the tumor, a total pancreasectomy is required to achieve microscopically negative resection margins[ , ].

Lymphadenectomy Tomlinson et al [ ] evaluated the minimum number of lymph nodes removed during pancreasectomy that are essential for proper staging. Open vs minimally invasive approach A systematic review identified 27 retrospective studies, including close to patients who underwent pancreasectomy minimally invasive, open [ ]. Adjuvant chemotherapy Several adjuvant chemotherapy regimens have been evaluated in randomized controlled trials[ – ]. Neoadjuvant chemotherapy The main purpose of neoadjuvant chemotherapy NACT differs according to the stage.

Table 4 Phase of trial and level of evidence of trial about chemotherapy for resectable and borderline resectable pancreatic ductal adenocarcinoma. Therapeutic cancer vaccines Therapeutic cancer vaccines present of immunogenic tumor antigens to the immune system, resulting in activation of the anti-cancer response.

Oncolytic viruses Oncolytic viruses are modified therapeutic drugs that selectively infect and self-replicate in tumor cells with tumor-dissolving effect. Table 5 Phase and level of evidence of trials about immunotherapy for pancreatic ductal adenocarcinoma.

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