Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis

AIM: To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis.METHODS: Thirty-one intensive care unit(ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group(n = 15; July 1, 2012 to June 30, 2014) or a control group(n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration(CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 m L/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups.RESULTS: The mortality rate on day 28 was significantly lower in the study group than in the control group(13.33% vs 37.50%; P < 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group(7.4 ± 1.35 d vs 9.19 ± 2.99 d, P < 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group(3.47 ± 0.52 d vs 7.90 ± 1.14 d, P < 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups(60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment(37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P < 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups.CONCLUSION: Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.

Experimental study of osthole on treatment of hyperlipidemic and alcoholic fatty liver in animals

AIM： To evaluate the effects of osthole on fatty liver, and investigate the possible mechanism. METHODS： A quail model with hyperlipidemic fatty liver and rat model with alcoholic fatty liver were set up by feeding high fat diet and alcohol, respectively. These experimental animals were then treated with osthole 5-20 mg/kg for 6 wk, respectively. Whereafter, the lipid in serum and hepatic tissue, and coefficient of hepatic weight were measured. RESULTS： After treatment with osthole the levels of serum total cholesterol （TC）, triglyceride （TG）, lower density lipoprotein-cholesterol （LDL-C）, coefficient of hepatic weight, and the hepatic tissue contents of TC and TG were significantly decreased. The activity of superoxide dismutase （SOD） in liver was improved. In alcohol-induced fatty liver rats, the level of malondialdehyde （MDA） in liver was decreased. In high fat-induced fatty liver quails, glutathione peroxidase （GSH-PX） in liver was significantly improved. The histological evaluation of liver specimens demonstrated that the osthole dramatically decreased lipid accumulation. CONCLUSION： These results suggested that osthole had therapeutic effects on both alcohol and high fatinduced fatty liver. The mechanism might be associated with its antioxidation.

Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase

A 54-year old man with a family history of hyperlipidemia was admitted with a 12 h history of severe generalized abdominal pain associated with nausea, vomiting and abdominal distension. Examination of the abdomen revealed tenderness in the periumblical area with shifting dullness. Serum pancreatic amylase was 29 IU/L and lipase 44 IU/L, triglyceride 36.28 mmol/L. Ultrasound showed ascites. CT of the abdomen with contrast showed inflammatory changes surrounding the pancreas consistent with acute pancreatitis. Ultrasound (US) guided abdomen paracentesis yielded a milky fluid with high triglyceride content consistent with chylous ascites. The patient was kept fasting and intravenous fluid hydration was provided. Meperidine was administered for pain relief. On the following days the patient’s condition improved and he was gradually restarted on a low-fat diet, and fat lowering agent (gemfibrozil) was begun, 600 mg twice a day. On d 14, abdomen US was repeated and showed fluid free peritoneal cavity. The patient was discharged after 18 d of hospitalization with 600 mg gemfibrozil twice a day. At the time of discharge, the fasting triglyceride was 4.2 mmol/L. After four weeks the patient was seen in the clinic, he was well.

Therapeutic plasma exchange for hyperlipidemic pancreatitis:Current evidence and unmet needs

With changes in lifestyle and diet worldwide,the prevalence of hyperlipidemic acute pancreatitis(HLAP)has greatly increased,and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol.There are many available therapies for HLAP,including oral lipid-lowering agents,intravenous insulin,heparin,and therapeutic plasmapheresis(TPE).It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides(TG),thus a rapid decrease in serum TG level is the key to the successful management of HLAP.TPE has emerged as an effective modality in rapidly reducing serum TG levels.However,due to its cost and accessibility,TPE remains poorly evaluated until now.Some studies revealed its efficacy in helping to treat and prevent the recurrence,while some studies suggested that TG levels were not correlated with disease severity,mortality,or length of hospital stay.Thus TPE might have no beneficial effect for the outcome.This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors,adverse effects of the procedure,and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis.Future direction of TPE research for HLAP is also discussed in this review.

The effects of consumption of raw garlic on serum lipid level, blood sugar and a number of effective hormones on lipid and sugar metabolism in hyperglycemic and/or hyperlipidemic individuals ——Benefit of raw garlic consumption

Diabetes mellitus is one of the worldwide largest growing metabolic diseases. In this study the effects of consumption of raw garlic on serum lipid level, blood sugar and a number of effective hormones on lipid and sugar metabolism (thyroid hormones and insulin) in individuals either with high level of blood sugar or lipid were investigated. Eighty five volunteers having following clinical history enrolled in the study: Group 1: having blood sugar more than 126 mg/dl (30 vo-lunteers);Group 2: having cholesterol higher than 245 mg/dl (30 volunteers);Group 3: having blood sugar over 126 mg/dl and cholesterol more than 245 mg/dl (25 volunteers). In group 1, there wasn’t a sig-nificant differences between biochemical factors be-fore and after garlic consumption, whereas, in the second group after 6 weeks of garlic consumption a decline in cholesterol (P < 0.001), FBS and TG (P < 0.01) was observed but HDL-C (P < 0.001) was in-creased. Six weeks after termination of garlic con-sumption, cholesterol (P < 0.001), FBS and TG (P < 0.05) were in- creased and HDL-C (P < 0.01) was de-creased. In the third group, total cholesterol (P < 0.001), FBS (P < 0.01) and HbA1c decreased while HDL-C was in- creased. Other factors, including thy-roid hormones (T3, T4), TSH and insulin showed no significant alte- ration. In conclusion our results shown that raw garlic consumption can reduce the FBS and Lipid in hyperglycemic and/or hyperlipidemic individuals.

Studies on the comparative pharmacokinetic of three phenolic acids of Salvia miltiorrhiza Bunge in normal and hyperlipidemic rats by liquid chromatography-tandem mass spectrometry

The hydrophilic phenolic acid is the main component of Salvia miltiorrhiza Bunge against cardiovascular diseases.A validated and sensitive liquid chromatography-tandem mass spectrometry(LC-MS/MS)method was established to simultaneously determinate three phenolic acids(danshensu,protocatechuic acid and rosmarinic acid)in rats to investigate their pharmacokinetic profiles firstly.The values for limit of quantification were in range of 0.25-1.25μg/L.Meanwhile,the suitable intra-day and inter-day precision as well as extraction recoveries were also obtained.And such an established method was finally successfully applied to compare the pharmacokinetic behaviors of three phenolic acids in normal and hyperlipidemic rats after oral administration of Salvia miltiorrhiza Bunge.The results showed there were significant differences in pharmacokinetic parameters between normal and hyperlipidemic groups.In especial,the plasma level of three phenolic acids in hyperlipidemic groups was significantly higher than normal ones.This comparative pharmacokinetic study provided direct evidence for improving clinical rational use of Salvia miltiorrhiza Bunge.

Administration Rule of Hyperlipidemic Acute Pancreatitis Based on Data Mining

Objective:To excavate the medical pattern of hyperlipidemic acute pancreatitis based on Chinese Medicine Inheritance Assistant Platform software,hope to offer ideas for the treatment of the disease.Methods:Inpatient cases admitted to the Department of Gastroenterology of Shenzhen Hospital of Traditional Chinese Medicine for HLAP from September 2013 to June 2020 were collected,information on evidence patterns and formulations was extracted,an Excel database was established and professional terms were standardized,and data mining methods such as association rules and entropy clustering of complex systems were used to analyze medical patterns.Results:The main symbols of HLAP include abdominal pain,abdominal distinction,vomiting,fever,etc.The common used drags include Immature Orange Fruit,Baical Skullcap Root,Rhubarb and Chinese Thorowax Root,etc.The main drug pairs based on association rule analysis are"Baical Skullcap Root,Immature Orange Fruit","Rhubarb,Immature Orange Fruit","Baical Skullcap Root,Rhubarb,Immature Orange Fruit",etc,and 14 drug core combinations and 7 new formulations were extracted.Conclusion:The main synthesis of HLAP are solid-heat knots in the internal organs and dam-heat in the liver and gallbladder,and the formula is based on Da-chai-hu Decoction,the clinical treatment is based on attacking stagnation,activating blood circulation and removing dampness,which can offer reference for the clinical treatment of the disease.

Effect of Aqueous Extract of Boscia senegalensis on Hyperglycemia, Hyperlipidemia and Oxidative Stress Induced in Rats

Boscia aqueous extract. senegalensis on hyperglycemia, hyperlipidemia and oxidative stress induced in rats. The aqueous extract was prepared from B. senegalensis seed powders under the extraction conditions: time (10 min), temperature (55˚C) and the ratio of mass of flour/volume of water (3/10 g/mL). Male wistar rats aged 6 to 8 weeks were acclimated and divided into 8 groups of 5 rats each: two normal control groups which received a normal standard diet (3810 kcal/kg), and six test groups which were subjected to a hyperlipidemic diet (5310 Kcal/kg). All groups of animals were fed in this manner for 8 weeks to induce hyperglycemia, hyperlipidemia and oxidative stress. After induction the animals were treated either with distilled water for the normal and negative control groups or with atorvastatin for the positive control group or with the extract of B. senegalensis. (125, 250 and 500 mg/kg) for the test groups. Fasting blood glucose was taken every 7 days during induction. After sacrifice, biochemical and oxidative stress parameters were measured. The aqueous extract of B. senegalensis significantly decreased (p B. senegalensis at a dose of 500 mg/kg has the capacity to reduce blood sugar, improve the quality of the lipid profile and reduce oxidative stress. Thus, the results reveal that the aqueous extract of B. senegalensis has powerful hypoglycemic, hypolipidemic and antioxidant properties.

Effect of an Ilex asprella root decoction on the related genes of lipid metabolism from chronic stress and hyperlipidemic fatty liver in rats

Background The gradually increasing changes in a human hyperlipidemic diet along with chronic stress might play an important role in the increased numbers of fatty liver. This study investigated the effects of Ilex asprella root decoction on related genes of lipid metabolism in chronic stress in hyperlipidemic fatty liver in rats. Methods Forty-eight male Wistar rats were randomly divided into four groups： normal control group, model control group, simvastatin group, and Ilex asprella root group. To establish chronic stress and hyperlipidemic fatty liver models in rats, the levels of serum lipids, glucose, liver index, insulin （INS）, insulin resistant （IR） index, adiponectin, superoxide dismutase （SOD）, glutathione peroxidase （GSH-pX）, glutathione （GSH）, liver X receptor （LXR）, and sterol responsive element binding protein （$REBP）-lc in rats were measured. Results When compared to the normal control group, the levels of serum lipids, glucose, liver index, INS, IR index, and GSH in the model control group significantly increased （P 〈0.01）. The protein levels of LXRa and SREBP-lc increased （P 〈0.05）, and the serum adiponectin and the SOD and GSH-pX decreased significantly （P 〈0.01）. When compared to the model control group, the levels of serum lipids, glucose, liver index, INS, IR index, SOD, and GSH-pX in the simvastatin group and Ilex asprella root group increased in varying degrees （P 〈0.01 or 0.05）; the serum adiponectin and GSH decreased （P 〈0.05）, while the protein levels of LXRa and SREBP-lc decreased in varying degrees （P 〈0.01 or 0.05）. When compared to the simvastatin group, the IR index and protein levels of LXRa in the Ilex asprella root group decreased （P 〈0.05）, and the serum adiponectin and SOD increased （P 〈0.05）. Conclusion The Ilex asprella root decoction has some protective effects on regulating the related genes of lipid metabolism caused by chronic stress and hyperlipidemic fatty liver in rats.

Effects of alfalfa saponin extract on mRNA expression of Ldlr, LXRα, and FXR in BRL cells

We studied the effects of alfalfa saponin extract（ASE） on low density lipoprotein receptor（Ldlr）, liver X receptor α（LXRα）, and farnesoid X receptor（FXR） in normal and hyperlipidemic Buffalo rat liver（BRL） cells. Normal and hyperlipidemic BRL cells were divided into eight groups： normal, or normal cells treated with 50, 100, and 150 mg/L ASE, hyperlipidemic, or hyperlipidemic cells treated with 50, 100, and 150 mg/L ASE. After treatment for 24 h, Ldlr, LXRα, and FXR m RNA expression levels were measured by quantitative real-time polymerase chain reaction（q RT-PCR）. Data showed that m RNA expression of Ldlr in normal BRL cells was significantly up-regulated by ASE treatment and m RNA expressions of LXRα and FXR were significantly down-regulated both in normal and hyperlipidemic BRL cells after ASE treatment. Thus, ASE might ameliorate hepatic steatosis by regulating genes involved in cholesterol metabolism, including up-regulation of Ldlr as well as down-regulation of LXRα and FXR.