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Diabetes Type 2 And Pancreatic Cancer

Diabetes Is A Major Risk Factor Of Cancer Of The Pancreas

Diabetes Is A Major Risk Factor Of Cancer Of The Pancreas

In 2014 about 25 million people had diabetes in the US. About another estimated 60 million are borderline diabetic when blood glucose levels are not quite high enough for an actual diagnosis of diabetes. Most medical research conclude that diabetes is a definite pancreatic cancer risk factor although studies differ on the degree of risk. Some studies show that almost 30% of pancreatic cancer cases are caused by diabetes. Types and Causes of Diabetes One of the roles of the pancreas is producing insulin which balances levels of blood sugars. Diabetes is a disease in which the pancreas fails to either produce sufficient levels of insulin, or the body does not efficiently use the insulin to maintain normal blood glucose levels. Insulin permits glucose to enter cells as a required source of energy. With diabetes, glucose will remain in the blood instead of entering cells. This results in high blood glucose levels which can lead to cell damage creating major health problems including a higher risk of developing cancer of the pancreas. Diabetes can either be a risk or a symptom of pancreatic cancer. Some studies show that 1% of patients diagnosed with diabetes after the age of 50 will be diagnosed with pancreatic cancer within 3 years of their diagnosis of diabetes. Therefore, new onset of diabetes after the age of 50 may be an early warning sign of pancreatic cancer. Sudden changes in blood sugar levels in patients who previously had well-controlled diabetes could also be a sign of pancreas cancer. Those symptoms must be discussed with a physician. Type 1 Diabetes (Insulin-Dependent). Also known as “juvenile diabetes” because it primarily is diagnosed at childhood although it can occur in adults. It results when the pancreas either does not produce insulin or not enough Continue reading >>

Diabetes Type 2 And Pancreatic Cancer: A History Unfolding

Diabetes Type 2 And Pancreatic Cancer: A History Unfolding

Diabetes Type 2 and Pancreatic Cancer: A History Unfolding Andre De Souza 1 , Khawaja Irfan 2 , Faisal Masud 3 , Muhammad Wasif Saif 1 1Department of Hematology and Oncology, Tufts Medical Center, Boston, MA, USA 2Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Lahore, Pakistan 3King Edward Medical University, Lahore, Pakistan Director, Section of GI Cancers and Experimental Therapeutics Tufts University School of Medicine and Tufts Cancer Center 800 Washington Street, Boston, MA 02111, USA Received October 8th, 2015 Accepted November 3rd, 2015 Visit for more related articles at JOP. Journal of the Pancreas Pancreatic Cancer is the fourth cause of cancer-related deaths in the United States. Up to 80% of pancreatic cancer patients present with either new-onset type 2 diabetes or impaired glucose tolerance at the time of diagnosis. Recent literature suggests that diabetes mellitus type 2 is a risk factor, a manifestation and a prognostic factor for pancreatic cancer . This article is intended to clarify the evidence about diabetes as a risk factor for pancreatic cancer. Diabetes Mellitus, Type 2; Hyperinsulinemia; Pancreatic Neoplasms; Prognosis DPAC ductal adenocarcinoma of the pancreas; PCR polymerase chain reaction Ductal adenocarcinoma of the pancreas is the fifth leading cause of death related to cancer in developed countries after lung, stomach, colorectal and breast cancer , with 23% of the patients alive 1 year after diagnosis and a 5 year survival rate of 6% mostly due to advanced stage at the time of the diagnosis [ 1 ]. It is the thirteenth most common type of cancer worldwide and the eight most common cause of cancer-related deaths [ 2 ]. It is the fourth cause of cancer-related deaths in the United States, with a lifetime Continue reading >>

The Relationship Between Diabetes And Pancreatic Cancer

The Relationship Between Diabetes And Pancreatic Cancer

Go to: Review The early symptoms of pancreatic cancer, such as abdominal pain, weight loss, fatigue, jaundice, and nausea, are nonspecific and may occur late in the course of the disease [1,2]. As a result, pancreatic cancer is usually diagnosed at an advanced stage, frequently after the tumor has already metastasized. Pancreatic cancer is insensitive to pharmacological and radiological intervention and often recurs after apparently curative surgery. All these factors contribute to the dismal prognosis of the disease [3]. About 80% of pancreatic cancer patients have glucose intolerance or frank diabetes [4,5]. This observation has led to the following two hypotheses: i. pancreatic cancer causes diabetes and ii. diabetes is a risk factor for the development of pancreatic cancer. Numerous studies have been performed in order to elucidate the relationship between these two diseases. Evidence suggesting that pancreatic cancer causes diabetes The majority of diabetes associated with pancreatic cancer is diagnosed either concomitantly with the cancer or during the two years before the cancer is found [6]; 71% of the glucose intolerance found in pancreatic cancer patients is unknown before the cancer is diagnosed [5]. These suggest that recently-developed glucose intolerance or diabetes may be a consequence of pancreatic cancer and that recent onset of glucose intolerance or diabetes may be an early sign of pancreatic cancer. Several studies have demonstrated that diabetes in pancreatic cancer patients is characterized by peripheral insulin resistance [4,5,7]. Insulin resistance is also found in non-diabetic or glucose intolerant pancreatic cancer patients, though to a lesser degree [7]. Insulin sensitivity and overall diabetic state in pancreatic cancer patients who undergo t Continue reading >>

Role Of Obesity, Type 2 Diabetes, And Metabolic Factors In Pancreatic Cancer: A Mendelian Randomization Study | Jnci: Journal Of The National Cancer Institute | Oxford Academic

Role Of Obesity, Type 2 Diabetes, And Metabolic Factors In Pancreatic Cancer: A Mendelian Randomization Study | Jnci: Journal Of The National Cancer Institute | Oxford Academic

Risk factors for pancreatic cancer include a cluster of metabolic conditions such as obesity, hypertension, dyslipidemia, insulin resistance, and type 2 diabetes. Given that these risk factors are correlated, separating out causal from confounded effects is challenging. Mendelian randomization (MR), or the use of genetic instrumental variables, may facilitate the identification of the metabolic drivers of pancreatic cancer. We identified genetic instruments for obesity, body shape, dyslipidemia, insulin resistance, and type 2 diabetes in order to evaluate their causal role in pancreatic cancer etiology. These instruments were analyzed in relation to risk using a likelihood-based MR approach within a series of 7110 pancreatic cancer patients and 7264 control subjects using genome-wide data from the Pancreatic Cancer Cohort Consortium (PanScan) and the Pancreatic Cancer Case-Control Consortium (PanC4). Potential unknown pleiotropic effects were assessed using a weighted median approach and MR-Egger sensitivity analyses. Results indicated a robust causal association of increasing body mass index (BMI) with pancreatic cancer risk (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.09 to 1.65, for each standard deviation increase in BMI [4.6 kg/m2]). There was also evidence that genetically increased fasting insulin levels were causally associated with an increased risk of pancreatic cancer (OR = 1.66, 95% CI = 1.05 to 2.63, per SD [44.4 pmol/L]). Notably, no evidence of a causal relationship was observed for type 2 diabetes, nor for dyslipidemia. Sensitivity analyses did not indicate that pleiotropy was an important source of bias. Our results suggest a causal role of BMI and fasting insulin in pancreatic cancer etiology. Pancreatic cancer is usually asymptomatic at Continue reading >>

Diabetes Could Be A Warning Sign Of Pancreatic Cancer

Diabetes Could Be A Warning Sign Of Pancreatic Cancer

"Experts have revealed the onset of diabetes, or existing diabetes getting much worse could be a sign of hidden pancreatic cancer," reports The Daily Express. The media reports follow a press release of a study presented at the European Cancer Congress (ECCO) yesterday. The research analysed nearly a million people with type 2 diabetes in Belgium and Italy, some of whom went on to be diagnosed with pancreatic cancer. The recent onset of diabetes appeared to be a possible warning sign of pancreatic cancer, with 25% of cases in Belgium and 18% in Italy being diagnosed within three months of a diabetes diagnosis. Faster progression of diabetes (where patients needed insulin or other more intensive treatments sooner) was also associated with a greater chance of being diagnosed with pancreatic cancer. Pancreatic cancer is rare and often has a poor outcome, partly because it is difficult to detect at an early stage. However, it's important to put these findings in context. Diabetes has previously been linked with pancreatic cancer, though it is unclear why. It could be that diabetes increases the risk of pancreatic cancer. What is probably more likely is that rapid onset or progression of diabetes could be a symptom of the cancer itself. Diabetes is fairly common in the UK, with around 4 million cases, while pancreatic cancer remains very rare. Just because you have diabetes does not mean you will go on to get pancreatic cancer. However, if you are concerned that you may have diabetes or that your diabetes is poorly controlled, you should talk to your GP. There are also steps you can take to reduce your risk of developing diabetes. Where did the story come from? The study was carried out by researchers from the International Prevention Research Institute in Lyon, France. The Continue reading >>

Pancreatic Cancer And Diabetes: A Two-way Relationship In The Perspective Of Diabetologist - Sciencedirect

Pancreatic Cancer And Diabetes: A Two-way Relationship In The Perspective Of Diabetologist - Sciencedirect

Pancreatic cancer and diabetes: A two-way relationship in the perspective of diabetologist Author links open overlay panel TeresaSalvatorea Diabetes is a risk factor for pancreatic cancer as roughly half of all patients with pancreatic cancer are found to have diabetes at time of diagnosis. Moreover, an around 2-fold risk of pancreatic malignancy in diabetic patients has even be recently resulted from two meta-analysis. Actually, there is a bidirectional association between the two entities that implies a complex and reverse causality. In fact, while the risk for pancreatic cancer is modestly but significantly increased in patients with long-standing diabetes, recent-onset diabetes appears to be very frequently associated with pancreatic malignancy. Therefore, diabetes could serve as an excellent clue for early detection of pancreatic cancer. Moreover, recent epidemiological findings support the hypothesis that chronic exposure to hyperglycemia, higher insulin concentrations, and insulin resistance may be responsible for the enhanced risk of developing pancreatic cancer. Epidemiological data suggest that the type of anti-diabetic therapy may affect the risk of developing pancreatic cancer. In particular, metformin has been shown to reduce the risk of pancreatic cancer, as well as several other malignancies. On the other hand, some hypoglycemic agents could determine an increase of pancreatic cancer risk. These last findings were not confirmed. Finally, pancreatic cancer necessitates of a multidisciplinary management, primarily including surgeons and oncologists. In this context, the diabetologist plays an important role, given that his actions may influence the prevention and early diagnosis of pancreatic cancer, the perioperative complications associated to glycemic d Continue reading >>

Diabetes May Be Warning Sign Of Pancreatic Cancer

Diabetes May Be Warning Sign Of Pancreatic Cancer

A presentation to the European Cancer Congress in Amsterdam reports that 50% of people in two sample groups who had been diagnosed with pancreatic cancer had been diagnosed with type 2 diabetes in the previous year and been given their first medication to control it. Fewer than 5 out of 100 people can expect to be alive 5 years after being diagnosed with pancreatic cancer. Survival rates are poor because the cancer doesn't usually cause any symptoms until late in the disease. The American Cancer Society estimates more than 53,000 people will be diagnosed with pancreatic cancer in 2017. "Although it has been known for some time that there is an association between type 2 diabetes and pancreatic cancer, the relationship between the two conditions is complex," Alice Koechlin, from the International Prevention Research Institute in Lyon, France, told the conference. The pancreas contains cells that make insulin. Type 2 diabetes happens when these cells are unable to make enough insulin or the insulin doesn't work properly. The study involved 368,377 people with type 2 diabetes in Belgium and 456,311 in Italy. Among these patients over a 5-year period, there were 885 and 1,872 cases of pancreatic cancer diagnosed respectively. The researchers found that patients had a 3.5 times higher risk of being diagnosed with pancreatic cancer compared to those on other non-insulin, non-incretin diabetes treatments in the first 3 months after their first prescription for a class of diabetes medications known as incretins. The risks decreased with time. These are hormones that stimulate the pancreas to produce more insulin. Among patients who already had type 2 diabetes, the need to switch to injecting insulin because their condition got worse was associated with a seven-times-higher risk Continue reading >>

Cancer Incidence In Patients With Type 1 Diabetes Mellitus: A Population-based Cohort Study In Sweden

Cancer Incidence In Patients With Type 1 Diabetes Mellitus: A Population-based Cohort Study In Sweden

The two subtypes of diabetes mellitus have fundamentally different metabolic and hormonal characteristics. Type 2 diabetes is characterized by impaired insulin release and/or decreased hepatic and extrahepatic insulin sensitivities (1,2), whereas type 1 diabetes is characterized by the cessation of insulin biosynthesis due to the autoimmune destruction of insulin-producing pancreatic β cells. Increased circulating levels of insulin precursors (i.e., proinsulin and related peptides) have been implicated as mediators of the elevated risks of cancer of the liver, pancreas, kidney, and endometrium among type 2 diabetes patients (3–6). If hyperinsulinemia acts as a critical link between the observed increased cancer risk and type 2 diabetes, one would predict that patients with type 1 diabetes would have a different cancer risk pattern than patients with type 2 diabetes because the former patients are exposed to lower levels of exogenously administered insulin. Our previous attempts to examine cancer risks associated with type 1 diabetes were limited by small sample sizes, short follow-ups, and a questionable algorithm for the identification of patients with type 1 diabetes (4,7–9). Another cohort study from Denmark also had these limitations (6). We therefore sought to obtain precise estimates of cancer risk in type 1 diabetes patients by performing a large population-based retrospective cohort study. We used the Swedish Inpatient Register created by the National Board of Health and Welfare to identify the study cohort (10). Each record in this register includes the patient's national registration number and the discharge diagnoses coded throughout the study period according to the 7th through 10th revised versions of the International Classification of Diseases (ICD) Continue reading >>

Pancreatic Cancer

Pancreatic Cancer

Tweet Pancreatic cancer, or cancer of the pancreas, is one of the more dangerous forms of cancer. Diabetes is listed as a risk factor and also a potential consequence of pancreatic cancer. Famous people that have been diagnosed with pancreatic cancer include Steve Jobs, co-founder of Apple Inc. What is pancreatic cancer? The pancreas is an organ that sits close behind the stomach and plays an important part in digestion as well as in keeping our blood sugar levels at safe levels. Pancreatic cancer is when cells start being produced in the pancreas in an uncontrolled fashion by the body. This can lead to a number of health risks which can include diabetes in some cases. How common is pancreatic cancer? Cancer research reports that pancreatic cancer accounts for about 3% of all cancer cases. In 2010, around 8,500 people in the UK were diagnosed with pancreatic cancer. Survival rates from pancreatic cancer are low. In 2005-2009, only 4% of people diagnosed with pancreatic cancer survived for 5 years or more. Pancreatic cancer is relatively rare in younger people. Diabetes and pancreatic cancer Type 2 diabetes and pancreatic cancer have been shown to be linked but researchers have found it difficult to work out which may have the biggest influence on the other. Higher than normal levels of circulating insulin and increased pressure on the pancreas to produce insulin have been suggested as possible reasons for diabetes leading to a higher risk of pancreatic cancer. Looking at the other side of the coin, pancreatic cancer may lead to insulin resistance by increasing the amount of insulin produced by the pancreas and pancreatic cancer can also lead to a loss of insulin producing capacity. Both of these situations can therefore lead to increased risk of diabetes. If the pancrea Continue reading >>

The Connection Between Diabetes And Your Pancreas

The Connection Between Diabetes And Your Pancreas

A direct connection exists between the pancreas and diabetes. The pancreas is an organ deep in your abdomen behind your stomach. It’s an important part of your digestive system. The pancreas produces enzymes and hormones that help you digest food. One of those hormones, insulin, is necessary to regulate glucose. Glucose refers to sugars in your body. Every cell in your body needs glucose for energy. Think of insulin as a lock to the cell. Insulin must open the cell to allow it to use glucose for energy. If your pancreas doesn’t make enough insulin or doesn’t make good use of it, glucose builds up in your bloodstream, leaving your cells starved for energy. When glucose builds up in your bloodstream, this is known as hyperglycemia. The symptoms of hyperglycemia include thirst, nausea, and shortness of breath. Low glucose, known as hypoglycemia, also causes many symptoms, including shakiness, dizziness, and loss of consciousness. Hyperglycemia and hypoglycemia can quickly become life-threatening. Each type of diabetes involves the pancreas not functioning properly. The way in which the pancreas doesn’t function properly differs depending on the type. No matter what type of diabetes you have, it requires ongoing monitoring of blood glucose levels so you can take the appropriate action. Type 1 diabetes In type 1 diabetes the immune system erroneously attacks the beta cells that produce insulin in your pancreas. It causes permanent damage, leaving your pancreas unable to produce insulin. Exactly what triggers the immune system to do that isn’t clear. Genetic and environmental factors may play a role. You’re more likely to develop type 1 diabetes if you have a family history of the disease. About 5 percent of people with diabetes have type 1 diabetes. People who ha Continue reading >>

Diabetes And Pancreatic Cancer

Diabetes And Pancreatic Cancer

Approximately 25.8 million people in the United States, approximately 8.3% of the population, have diabetes. It is estimated that 18.8 million have been diagnosed, but unfortunately, 7.0 million people, or over one fourth, are unaware that they have the disease. Diabetes is a disease in which the body does not make or properly use a pancreatic hormone called insulin. Insulin helps the body utilize glucose (sugar) efficiently. Normally, insulin allows glucose to enter cells to be used for energy. In the case of diabetes, either the body does not produce enough insulin or the amount that is produced is not fully effective. Instead of entering cells, the glucose remains in the blood resulting in high blood glucose levels. Diabetes can cause major health problems, such as high-blood pressure, blindness, kidney disease and neuropathy. Long-term high blood glucose levels can lead to cell damage and long-term complications. There are several types of diabetes. Type 1 diabetes results from the bodys inability to produce insulin and accounts for approximately 5% of those diagnosed with the disease. Type 2 diabetes results from the bodys failure to properly use insulin combined with insulin deficiency and accounts for most diagnosed cases of diabetes in the United States. Pre-diabetes occurs when a persons blood glucose levels are higher than normal, but are not high enough to be diagnosed as type 2 diabetes. Approximately 79 million Americans are pre-diabetic. Other types of diabetes result from specific genetic conditions, surgery, medications, infections, pancreatic diseases and other illnesses. How does diabetes relate to pancreatic cancer? Diabetes may be either a risk factor or a symptom of pancreatic cancer. Pancreatic cancer is more likely to occur in people who have lon Continue reading >>

Pancreatic Cancer Symptoms: Diabetes Could Be A Warning Sign For Deadly Disease

Pancreatic Cancer Symptoms: Diabetes Could Be A Warning Sign For Deadly Disease

Pancreatic cancer is hard to diagnose in its early stages as the tumour doesn't usually cause any symptoms. The disease affects around 8,800 people every year in the UK. Diabetic have an increased risk of pancreatic cancer - however now experts have suggested cancer can cause some cases of diabetes. Experts have revealed the onset of diabetes, or existing diabetes getting much worse could be a sign of hidden pancreatic cancer. Medical records and the type of diabetic medicines they are prescribed could be a tool in identifying those at risk, scientists from the International Prevention Research Institute in Lyon said. An analysis of nearly a million patients with type 2 diabetes in Italy and Belgium with pancreatic cancer found half were diagnosed within one year of being found to have type 2 diabetes and being given their first prescription to control it. Experts said they had a 3.5 times greater risk of being diagnosed with the disease in the first three months after their first prescription for incretins, hormones which stimulate the pancreas to produce more insulin to lower blood sugar levels. Injecting insulin was associated with a seven-fold increased risk of being diagnosed with pancreatic cancer. Professor Philippe Autier said: "Although it has been known for some time that there is an association between type 2 diabetes and pancreatic cancer, the relationship between the two conditions is complex. "Incretin therapies reduce diabetic hyperglycemia through stimulating the release of insulin by the pancreas. "These drugs are typically prescribed when the oral anti-diabetic drugs can no longer control blood glucose levels. "Because of their stimulating effects on the pancreas, it has long been thought that the incretin therapies could promote the occurrence of panc Continue reading >>

Pancreatic Cancer And Diabetes – A Cellular Case Of Chicken And Egg

Pancreatic Cancer And Diabetes – A Cellular Case Of Chicken And Egg

We’ve all heard the age-old question about the chicken and the egg. Well scientists studying the link between diabetes (a condition where the amount of glucose in your blood is too high because the body cannot use it properly) and pancreatic cancer are facing a similar conundrum. It seems there’s a link between the two conditions, but it’s not clear which one comes first. While the majority of people with diabetes will never develop pancreatic cancer, the question of whether diabetes could be a cause or a consequence of pancreatic cancer is an important one. Answering this could help scientists better understand the biology of these two conditions, and might help spot people at higher risk of pancreatic cancer. So, as it’s pancreatic cancer awareness month, we’ve dug into the evidence to see what is known about these links, and which questions remain unanswered. We know there’s a link Doctors first started exploring the possibility of a link between diabetes and pancreatic cancer in the 1940s and 1950s. Several reports had come out saying that patients with pancreatic cancer were more likely to also have diabetes than other people. This has been shown for type 2 diabetes as well as type 1 and young onset diabetes. Since then, many studies have shown a link between the two conditions. Overall, it seems that people with diabetes are around twice as likely to be diagnosed with pancreatic cancer than the general population. And this makes sense, given that diabetes and pancreatic cancer are diseases that both affect the pancreas. The next big question is: how does this work? Does diabetes increase a person’s risk of pancreatic cancer or is it the cancer that causes diabetes? Or is there something else increasing the risk of both conditions? How pancreatic canc Continue reading >>

Diabetes And Pancreatic Cancer

Diabetes And Pancreatic Cancer

Your pancreas produces a hormone called insulin, which helps to control your blood sugar level. When you digest food and drink, carbohydrate is broken down into glucose, which is a type of sugar. This passes into your blood, and is used by the body. Normally, insulin controls the blood sugar level. But if you have pancreatic cancer or you have had all or part of your pancreas removed, your pancreas may not produce enough insulin. This means your blood sugar level may not be properly controlled, and you may develop diabetes. Diabetes is a condition where the amount of sugar in your blood is too high. If your blood sugar level is too high (hyperglycaemia), you may feel very thirsty, pass more urine, get headaches and feel tired. Your pancreas also produces a hormone called glucagon which also helps to control your blood sugar level. If your pancreas doesn’t produce enough glucagon when you need it, your blood sugar level may drop and become too low (hypoglycaemia). You may feel hungry, shaky or sweaty. This is more common if you have had surgery to remove your pancreas, such as a Whipple's operation. Managing diabetes If you are diagnosed with diabetes, you should see specialist diabetes or pancreatic dietitian. You may also see a diabetes nurse for help with managing any medication prescribed. It’s important that you get specialist advice, because managing your diabetes may be more difficult because of your pancreatic cancer. Your dietitian and diabetes nurse should discuss any changes to your diet and treatment with you. You may need to monitor your blood sugar level, and take tablets or have insulin injections to stop your blood sugar level becoming too high or too low. There are different types of diabetes, and information on the internet may not be right for you, Continue reading >>

Rapid Diabetes Deterioration -- Sign Of Pancreatic Cancer?

Rapid Diabetes Deterioration -- Sign Of Pancreatic Cancer?

Rapid Diabetes Deterioration -- Sign of Pancreatic Cancer? AMSTERDAM Patients with type 2 diabetes whose condition deteriorates rapidly soon after diagnosis may have asymptomatic pancreatic cancer, say European investigators. In a study of more than 550,000 diabetes patients, researchers found that patients who received glucagonlike peptide-1 (GLP-1) receptor agonists, or incretin mimetics, were at significantly increased risk of developing pancreatic cancer. However, the researchers observed that the increased risk diminished rapidly after diagnosis. Given that they also found that the risk for pancreatic cancer was markedly increased after starting insulin therapy, they suggested that "reverse causation" may be in play, with asymptomatic pancreatic cancer initially causing diabetes before progressing to a symptomatic stage. The new findings were presented here at the inaugural meeting of the European CanCer Organisation (ECCO) Congress 2017. Alice Koechlin, from the International Prevention Research Institute (IPRI) in Lyon, France, said in a statement: "Doctors and their diabetic patients should be aware that the onset of diabetes or rapidly deteriorating diabetes could be the first sign of hidden pancreatic cancer, and steps should be taken to investigate it." She cautioned that investigating the possibility of undiagnosed pancreatic cancer is "difficult," as there is currently no good, noninvasive method for detecting asymptomatic pancreatic cancer. "We hope that our results will encourage the search for blood markers indicating the presence of pancreatic cancer, which could guide decisions to perform a confirmation examination like endoscopy," she said. Peter Naredi, MD, PhD, chair of the Congress, president of ECCO, and professor of surgery at the Sahlgrenska Ac Continue reading >>

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