Leptin in hepatocellular carcinoma

The risk factors for hepatocellular carcinoma (HCC) development have been established,and include chronic hepatitis B and C,heavy alcohol consumption,and aflatoxins.In fact,5%-30% of patients with HCC still lack a readily identifiable risk factor.It has been reported that the majority of "cryptogenic" HCC may be attributed to nonalcoholic fatty liver disease,the hepatic presentation of the metabolic syndrome (MS).Obesity is associated with the development of the MS.Recently,adipose tissue has been considered as an endocrine organ because of its capacity to secrete a variety of cytokines,which are collectively known as the adipokines.Leptin,the product of the obese gene,is mainly produced by adipose tissue.Since leptin was first characterized in 1994,accumulated literature has demonstrated the involvement of this adipokine in several areas of human physiology.After binding to its receptor,leptin initiates a cascade of signaling events and subsequent cellular effects.In addition to being the regulatory mediator of energy homeostasis,several in vitro studies have demonstrated the fibrogenic role of leptin in the liver.Furthermore,the deregulated expression of leptin and its receptor have been demonstrated to be associated with a variety of metabolic disorders as well as human cancers.Most importantly,direct evidence supporting the inhibitory and/or activating role of leptin in the process of carcinogenesis and progression of human HCC has been accumulating rapidly.This review aims to provide important insights into the potential mechanisms of leptin in the development of HCC.Hopefully,further investigations will shed light on a new therapeutic target in HCC.

International consensus statement on robotic pancreatic surgery

The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of;evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.