Incidence and risk factors for Chyle leak after pancreatic surgery for cancer: A comprehensive systematic review

BackgroundChyle leak (CL) is a clinically relevant complication after pancreatectomy. Its incidence and the associated risk factors are ill defined, and various treatments options have been described. There is no consensus, however, regarding optimal management. The present study aims to systematically review the literature on CL after pancreatectomy.MethodsA systematic review from PubMed, Scopus and Embase database was performed. Studies using a clear definition for CL and published from January 2000 to January 2021 were included. The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score was used to assess methodological quality.ResultsLiterature search found 361 reports, 99 of which were duplicates. The titles and abstracts of 262 articles were finally screened. The references from the remaining 181 articles were manually assessed. After the exclusions, 43 articles were thoroughly assessed. A total of 23 articles were ultimately included for this review. The number of patients varied from 54 to 3532. Incidence of post pancreatectomy CL varied from 1.3% to 22.1%. Main risk factors were the extent of the surgery and early oral or enteral feeding. CL dried up spontaneously or after conservative management within 14 days in 53% to 100% of the cases.ConclusionsThe extent of surgery is the most common predictor of risk of CL. Conservative treatment has been shown to be effective in most cases and can be considered the treatment of choice. We propose a management algorithm based on the current available evidence.     

Heparin-binding EGF-like growth factor (HB-EGF) antisense oligonucleotide protected against hyperlipidemia-associated atherosclerosis

Background and aims

Heparin-binding EGF-like growth factor (HB-EGF) is a representative EGF family member that interacts with EGFR under diverse stress environment. Previously, we reported that the HB-EGF-targeting using antisense oligonucleotide (ASO) effectively suppressed an aortic aneurysm in the vessel wall and circulatory lipid levels. In this study, we further examined the effects of the HB-EGF ASO administration on the development of hyperlipidemia-associated atherosclerosis using an atherogenic mouse model.

Lomitapide for the treatment of hypertriglyceridemia

Introduction: Severe genetic forms of hypertriglyceridemia carry a risk of life-threatening pancreatitis and lack available effective treatments. Lomitapide is a microsomal triglyceride transfer protein inhibitor currently approved for treatment of homozygous familial hypercholesterolemia that may be useful in the management of severe hypertriglyceridemia.

Areas covered: Published trials of lomitapide that reported plasma triglyceride response were reviewed, as was a case report of a patient with hypertriglyceridemia who was treated for 13 years with lomitapide. ClinicalTrials.gov was also reviewed for any unpublished results and ongoing trials.

Expert opinion: Lomitapide demonstrates effective triglyceride lowering and may be a useful treatment for patients with genetic hypertriglyceridemia and recurrent acute pancreatitis who are refractory to traditional treatment. However, long term hepatic safety may be a concern and direct clinical trial-level data are lacking for this indication.     

海参EPA-PC对非酒精性脂肪肝大鼠三酰甘油代谢的改善作用

摘要：目的 探究海参磷脂型二十碳五烯酸（EPA-PC）对非酒精性脂肪肝（non-alcoholic fatty liver disease, NAFLD）大鼠甘油三酯代谢的影响。方法 采用饮食中添加乳清酸的方法诱导建立NAFLD大鼠模型。雄性Wistar大鼠随机分为5组,分别为正常组、模型组、洛伐他汀对照组、EPA-PC高、低剂量组。饲喂3周后,检测大鼠肝脏及血清中总胆固醇（Total cholesterol,TC）及甘油三酯（Triglycerides,TG）含量;RT-PCR法检测大鼠肝脏中TG合成相关基因GPAT和DGAT,TG分解相关基因ATGL和HSL以及AMPK信号通路相关基因CAMKK和LKB1 mRNA的表达水平。结果 EPA-PC可以显著降低NAFLD大鼠血清和肝脏中TG和TC的含量,显著下调GPAT、DGAT和HSL的表达,显著上调ATGL和AMPK信号通路相关基因表达。结论 EPA-PC可以通过抑制TG合成,促进TG分解,并激活AMPK信号通路,从而改善NAFLD大鼠的TG的代谢。