Historical evolution of pancreatic fistula definition and current grading limitations and potential improvements / 国际外科学杂志

Pancreatic fistula is one of the most important complications after pancreatic surgery. The International Study Group on Pancreatic Fistula proposed the definition and classification of postoperative pancreatic fistula (POPF) in 2005 firstly, which has promoted the development of pancreatic surgery research. And the International Study Group on Pancreatic Surgery modified the POPF standard in 2016 and paid more attention to clinical relevance. The POPF is often used to evaluate anastomotic methods. However, this grading version is based on clinical outcomes, which more represents the comprehensive treatment effect than reflects the quality of pancreaticojejunostomy. Using the current POPF grading criteria for the purpose of improving anastomosis methods is not very accurate, so an indicator that only reflects anastomosis′ quality is needed for the comparison of various surgical methods. To avoid the influence of non-reconstruction elements on the incidence and degree of POPF, this research team prefer the total drainage fluid amylase(DFA)or the duration of high DFA. And in this way, the comparation among different anastomotic operations could be specific and objective, which further helps to find out an ideal method for pancreatic digestive tract reconstruction.

Accuracy analysis of amylase, C-reactive protein and procalcitonin in abdominal cavity of postoperative gastric cancer in predicting the occurrence of clinically related pancreatic fistula / 国际外科学杂志

Objective:To evaluate the relationship between abdominal amylase, C-reactive protein (CRP), procalcitonin (PCT) and clinically relevant pancreatic fistula in the early stage after radical gastrectomy for gastric cancer, and to explore whether they can be used as early predictors of pancreatic fistula and their accuracy, in order to help identify pancreatic fistula in the early stage after gastrectomy.Methods:The clinical data of 372 patients diagnosed as gastric cancer and underwent gastrectomy in Shouguang People′s Hospital from January 2017 to December 2021 were retrospectively analyzed, including 190 males and 182 femals, aged from 28 to 32 years old, with the average years of 63.5±10.6. The receiver operating characteristic (ROC) curves of abdominal amylase on the first day and serum CRP and procalcitonin on the third day after surgery for gastric cancer were analyzed. The ROC curve was used to determine the optimal cutoff value and the sensitivity, specificity, positive and negative predictions, and accuracy of the optimal cutoff value were calculated. Single factor and multivariate analysis were used to analyze the risk factors of pancreatic fistula after gastric cancer surgery. SPSS 25.0 software was used for statistical analysis.Results:The incidence of clinically relevant pancreatic fistula after surgery for gastric cancer was 5.37%(20/372), including 18 cases of grade B pancreatic fistula and 2 cases of grade C pancreatic fistula. The critical values of amylase on the first postoperative day of clinically relevant pancreatic fistula after surgery for gastric cancer are predicted to be 2036 U/L, serum CRP 18 mg/dL, and procalcitonin 0.85 μg/L. In univariate analysis, body mass index, abdominal amylase concentration on the 1st postoperative day, serum CRP and procalcitonin on the 3rd postoperative day were the influencing factors for the occurance of pancreatic fistula after gastric cancer surgery. Multivariate Logistic regression analysis showed that body mass index>25 kg/m 2, abdominal amylase >2036 U/L on the first postoperative day and serum CRP>18 mg/dL on the third postoperative day were the independent predictors for pancreatic fistula. The sensitivity and specificity of the combination of intraperitoneal amylase on the first day and serum CRP on the third day after surgery for gastric cancer in predicting the occurrence of clinically relevant pancreatic fistula were 87.6% and 90.4%, respectively. Conclusions:The combination of amylase in abdominal cavity on the 1st day and CRP on the 3rd day after radical gastrectomy has high sensitivity and specificity in predicting clinically related pancreatic fistula. PCT on the 3rd day after gastric cancer surgery has limited accuracy in predicting clinically related pancreatic fistula, so it is not recommended as an early prediction index of pancreatic fistula after gastric cancer surgery.

Related factors affecting the occurrence of severe pancreatic fistula after radical gastrectomy / 中国基层医药

Objective:To investigate the related factors that affect the occurrence of severe pancreatic fistula after radical gastrectomy.Methods:The clinical data of 460 patients undergoing radical gastrectomy in The People's Hospital of Shouguang from January 2015 to January 2021 were retrospectively analyzed. These patients were divided into severe pancreatic fistula group ( n = 24) and non-severe pancreatic fistula group ( n = 436) according to whether they developed severe pancreatic fistula after surgery. Preoperative clinical data, surgical data, and abdominal drainage fluid amylase level in the first postoperative days were compared. The receiver operating characteristics (ROC) curve was used to calculate the cutoff value of abdominal drainage fluid amylase level on the 1 st and 3 rd days of developing severe pancreatic fistula after radical gastrectomy. The incidence of pancreatic fistula was compared between different amylase level groups. Multivariate logistic regression was performed to analyze the independent risk factors of severe pancreatic fistula after surgery. Results:There were significant differences in body mass index, operative time, intraoperative blood loss, peritoneal drainage fluid amylase level on the 1 st and 3 rd days after surgery, and the number of cases undergoing splenectomy between the two groups (all P < 0.05). The cutoff values of amylase level in peritoneal drainage fluid (D-AMY) on the 1 st and 3 rd days after surgery were 2 156 IU/L and 596 IU/L respectively, which had high sensitivity and specificity. On the 1 st and 3 rd days after surgery, the incidence of pancreatic fistula in the high-level amylase group was significantly higher than that in the low-level amylase group [26.2% (16/61) vs. 0.8% (3/334), χ2 = 62.82, P < 0.05). Multivariate logistic analysis showed that obesity, splenectomy, and abdominal drainage fluid amylase level higher than the cut-off value on the 1 st and 3 rd days after surgery were independent risk factors for severe pancreatic fistula, and the differences were statistically significant (all P < 0.05). Conclusion:Obesity, splenectomy, and abdominal drainage fluid amylase level higher than the cut-off value on the 1 st and 3 rd days after surgery are independent risk factors affecting the occurrence of severe pancreatic fistula. D-AMY (> 2 156 IU/L) on the 1 st day and D-AMY (> 596 IU/L) on the 3 rd day in the early postoperative days can be used as cutoff values to predict the occurrence of severe pancreatic fistula after radical gastrectomy.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

Abstract: There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Patients´ Anxiety Related to Dental Radiographic Examinations: Levels, Perception and Management

ABSTRACT: This study evaluated patients´ anxiety levels related to dental radiographic examinations in addition to dentists' perception and management. Salivary alpha-amylase (sAA) activity of 47 patients was measured before and after exposure to radiographic examinations to assess their anxiety level and compared using Wilcoxon test. Mann-Whitney test assessed the sAA activity related to sex, type of examination, and previous experience with radiographic examinations. 50 dentists were interviewed using a semi-structured script containing open-ended questions perception on their patients' anxiety. Before the radiographic examination, sAA activity was significantly higher for women (p ≤0.05). SAA activity significantly increased after the examination for men, patients of both sexes with no previous experience and for those who underwent CBCT (p≤0.05). Anxiety was reported to be observed in adult patients' speech and pediatric patients' behavior. Dental radiographic examinations may be a source of anxiety for women before the examination. After the examination, men, patients with no previous experience, and those subjected to CBCT present higher anxiety levels. Dentists perceive anxiety in adult and pediatric patients differently.

RESUMEN: Este estudio evaluó los niveles de ansiedad en los pacientes relacionados con exámenes radiográficos dentales, además de la percepción y el manejo de los dentistas. Se midió la actividad de la alfa-amilasa salival (sAA) de 47 pacientes antes y después de la exposición a exámenes radiográficos para evaluar su nivel de ansiedad y se comparó mediante la prueba de Wilcoxon. La prueba de Mann-Whitney evaluó la actividad de la sAA relacionada con el sexo, el tipo de examen y la experiencia previa con exámenes radiográficos. Se entrevistó a 50 dentistas utilizando un guión semiestructurado de preguntas abiertas sobre la percepción de la ansiedad de sus pacientes. Antes del examen radiográfico, la actividad de la sAA era significativamente mayor para las mujeres (p≤0.05). La actividad de SAA aumentó significativamente después del examen para los hombres, pacientes de ambos sexos sin experiencia previa y para los que se sometieron a CBCT (p≤0.05). Se informó que se observa ansiedad en el habla de los pacientes adultos y en el comportamiento de los pacientes pediátricos. Los exámenes radiográficos dentales pueden ser una fuente de ansiedad para las mujeres antes del examen. Tras la exploración, los hombres, los pacientes sin experiencia previa y los sometidos a CBCT presentan niveles de ansiedad más elevados. Los dentistas perciben la ansiedad en los pacientes adultos y pacientes pediátricos de manera diferente.

Abdominal drain amylase on the first day after pancreatectomy: a predictive factor for pancreatic fistula

SUMMARY OBJECTIVE: To analyze abdominal drain on the first postoperative day and evaluate its predictive nature for the diagnosis of Pancreatic Fistula exclusion, seeking to establish a cutoff point from which lower values demonstrate safety in excluding the possibility of this complication. METHODS: From August 2017 to June 2020, data from 48 patients undergoing pancreatic resection were collected and analyzed from a prospective cohort. The patients were divided into two groups, one group consisting of patients who did not develop PF (Group A), and the other composed of patients who developed PF (Group B). The receiver operation characteristic curve was constructed, and cutoff points were evaluated by calculating sensitivity and specificity. RESULTS: Group A brought 30 patients together (62.5%) and Group B brought 18 patients together (37.5%). The 444 U/L value was the most satisfactory cutoff point for the receiver operation characteristic curve (CI 0.690-0.941), with a sensitivity of 94.4% and a specificity of 60%, thus being able to select 18 of 30 patients who did not succumb to PF. CONCLUSIONS: Abdominal drain on the first postoperative day can be used as a predictive factor in the diagnosis of PF exclusion (CI 0.690-0.941), with the value of 444 U/L being the best performance cutoff point.

Isolation and identification of proteolytic, amylolytic, lipolytic, and chitinolytic bacteria from shrimp waste / Aislamiento e identificación de bacterias proteolíticas, amilolíticas, lipolíticas y quitinolíticas de residuos de langostinos

Abstract Bacteria and microbial enzymes are biocatalysts and can be used as an alternative to industrial chemical processes. The present study focused on isolating and identifying bacterial strains from shrimp waste, that produce amylases, lipases, proteases and chitinases with potential use on shrimp waste treatment. Thirtytwo bacterial strains were isolated, phenotypically characterized, and identified by the API system and the molecular analysis of the 16S rDNA. It was found that 28.13% of the isolated bacterial strains had amylolytic capacity, 87.50% lipolytic, 96.88% proteolytic and 28.13% chitinolytic capacity on agar plates with specific substrates. The genera Bacillus, Burkholderia, Ochrobactrum, Vibrio, Pseudomonas and Shewanella were identified. Bacteria with enzymatic capacities isolated in the present study, could be used to obtain by-products from shrimp waste as well as other industrial applications.

Resumen Las bacterias y enzimas microbianas son biocatalizadores y pueden ser usadas como alternativa en los procesos químicos industriales. El presente estudio se centró en aislar e identificar cepas bacterianas a partir de desechos de langostinos, capaces de producir amilasas, lipasas, proteasas y quitinasas, que tuvieran potencial aplicación en el tratamiento de residuos de langostinos. Se aisló treinta y dos cepas bacterianas, caracterizadas fenotípicamente e identificadas mediante el sistema API 20 y mediante análisis molecular basado en el ADNr 16S. Se encontró que el 28.13% de las cepas bacterianas aisladas tenían capacidad amilolítica, 87.50% lipolítica, 96.88% proteolítica y 28.13% capacidad quitinolítica en placas de agar con sustratos específicos. Los géneros identificados fueron Bacillus, Burkholderia, Ochrobactrum, Vibrio, Pseudomonas y Shewanella. Las bacterias con capacidades enzimáticas aisladas en el presente estudio, podrían ser usadas para obtener subproductos de los desechos de langostinos, así como en otras aplicaciones industriales.

Association of salivary alpha-amylase with anxiety and stress in nursing professionals / Associação da alfa amilase salivar com a ansiedade e o estresse de profissionais de enfermagem / Asociación de la alfa amilasa salival con la ansiedad y el estrés en profesionales de enfermería

Objective: to assess if changes in salivary alpha-amylase activity are associated with anxiety and stress among hospital nursing professionals and whether anxiety and stress are associated with sociodemographic, epidemiological, and occupational factors. Method: cross-sectional, quantitative study, carried out with 210 nursing professionals from a hospital. For data collection, we used a questionnaire to characterize workers, Beck's Anxiety Inventory, Lipp's Stress Symptoms Inventory for Adults and samples and saliva samples collected in work shifts. The data were analyzed descriptively and inferentially using the software Statistical Package for the Social Science and GraphPad Prism. Results: most professionals experienced stress and anxiety. The variables age group, number of children, use of medication and workload were associated with anxiety; age group, smoking and medication use were associated with stress. An increase in the salivary alpha-amylase activity was observed in the middle of the work shift. Professionals who had stress and anxiety had significant changes in alpha-amylase in the night shift. Conclusion: changes in salivary alpha-amylase were associated with anxiety and stress among nursing professionals, indicating that this enzyme can be a possible biomarker of anxiety and stress in workers.

Objetivo: avaliar se a alteração na atividade da alfa amilase salivar está associada à ansiedade e ao estresse dos profissionais de enfermagem hospitalar e, se a ansiedade e o estresse estão associados aos fatores sociodemográficos, epidemiológicos e laborais. Método: estudo transversal, quantitativo, desenvolvido com 210 profissionais de enfermagem de uma instituição hospitalar. Para a coleta de dados, utilizouse um questionário de caracterização dos trabalhadores, o Inventário de Ansiedade de Beck, o Inventário de Sintomas de Stress para Adultos de Lipp e as amostras de saliva coletadas durante os turnos de trabalho. Os dados foram analisados de forma descritiva e inferencial utilizando os softwares Statistical Package for the Social Science e GraphPad Prism. Resultados: a maioria dos profissionais apresentou estresse e ansiedade. As variáveis faixa etária, quantidade de filhos, uso de medicamentos e carga horária de trabalho estavam associadas à ansiedade; faixa etária, tabagismo e uso de medicamentos estavam associadas ao estresse. Observouse um aumento da atividade da alfa amilase salivar no meio do turno de trabalho. Os profissionais que tinham estresse e ansiedade apresentaram alteração significativa da alfa amilase no turno da noite. Conclusão: as alterações na atividade da alfa amilase estavam associadas à ansiedade e ao estresse dos profissionais de enfermagem, demonstrando que essa enzima pode ser um possível biomarcador de ansiedade e estresse em trabalhadores.

Objetivo: evaluar si la alteración en la actividad de la alfa amilasa salival está asociada a la ansiedad y al estrés de los profesionales de enfermería hospitalaria y, si la ansiedad y el estrés están asociados a factores sociodemográficos, epidemiológicos y laborales. Método: estudio transversal, cuantitativo, desarrollado en 210 profesionales de enfermería, en una institución hospitalaria. Para la recogida de datos, se utilizó un cuestionario de caracterización de los trabajadores, el Inventario de Ansiedad de Beck, el Inventario de Síntomas de Stress para Adultos de Lipp y las muestras de saliva recogidas durante los turnos de trabajo. Los datos fueron analizados de forma descriptiva e inferencial utilizando los softwares Statistical Package for the Social Science y GraphPad Prism. Resultados: la mayoría de los profesionales presentó estrés y ansiedad. Las variables intervalo etario, cantidad de hijos, uso de medicamentos y carga horaria de trabajo estaban asociadas a la ansiedad; el intervalo etario, el tabaquismo y el uso de medicamentos estaban asociados al estrés. Se observó un aumento de la actividad de la alfa amilasa salival en los ambientes de los turnos de trabajo. Los profesionales que tenían estrés y ansiedad presentaron alteración significativa de la alfa amilasa en el turno de la noche. Conclusión: las alteraciones en la actividad de la alfa amilasa estaban asociadas a la ansiedad y al estrés de los profesionales de enfermería, demostrando que esa enzima puede ser un posible biomarcador de ansiedad y estrés en trabajadores.

Amylase from Bacillus sp. Produced by Solid State Fermentation Using Cassava Bagasse as Starch Source

Abstract Amylases are enzymes involved in starch hydrolysis, generating the most diverse products, such as maltose, glucose and dextrins. This work aimed the study of the production of amylolytic enzymes via solid-state fermentation (SSF) using "crueira", an essentially starchy cassava residue, as substrate-support and Bacillus sp. as microorganism. For the implementation of the experimental part, a Central Composite Design (CCD) with three variables (initial moisture, pH and temperature) was made. Each test was examined at 24, 48 and 72 hours by the method of starch dextrinizing activity. The optimum production conditions were 60% initial moisture, pH 6 and 37 °C. The maximum yield was 437.76 U/g in 72 hours of fermentation. The optimum temperature of enzyme performance was 65 °C. The pH optimum range was 4 to 6. The Co2 +, Ca2 + and K+ ions positively influenced the activity of enzymes and the Fe2+ ion had no effect on enzymatic activity. On the other hand, the ions Hg2+, Zn2+, Cu2+, Mn2+ and Mg2+ adversely influenced enzymatic activity. Therefore, producing amylases from Bacillus sp. and using crueira as a substrate is possible.

Actividad hipoglucemiante in vitro de los polisacáridos digeridos de Nostoc sphaericum Vaucher ex Bornet & Flahault (cushuro) / In vitro hypoglycemic activity of polysaccharides digested from Nostoc sphaericum Vaucher ex Bornet & Flahault (cushuro)

Objetivo: Evaluar el potencial inhibitorio de las enzimas α-amilasa y α-glucosidasa, así como la inhibición de la difusión de la glucosa, por los polisacáridos aislados de Nostoc Sphaericum Vaucher ex Bornet & Flahault tratados mediante digestión gastrointestinal simulada a nivel in vitro. Materiales y métodos: Los polisacáridos obtenidos de microalga fueron purificados y tratados mediante digestibilidad gastrointestinal in vitro, con la finalidad de simular su digestión. Se evaluó la actividad hipoglucemiante mediante los métodos de inhibición de la α-glucosidasa, α-amilasa y la difusión de la glucosa de los polisacáridos digeridos, comparados con el medicamento acarbosa. Resultados: Los resultados mostraron que la concentración de 50 mg/mL de polisacáridos digeridos disminuye en un 85,26 % la difusión de la glucosa a nivel in vitro. La concentración inhibitoria (CI50) de la enzima α-glucosidasa fue de 314,23 ± 4,87 mg/mL y la enzima α-amilasa 113,59 ± 3,10 mg/mL. Conclusiones: Los polisacáridos de Nostoc sphaericum tratados mediante digestión gastrointestinal in vitro, mostraron capacidad de inhibir las enzimas α-amilasa, α-glucosidasa y la difusión de glucosa; motivo por el cual la especie sería considerado promisoria para un posible tratamiento coadyuvante de la diabetes tipo 2

Objective: To evaluate the inhibitory potential of the α-amylase and α-glucosidase enzymes, as well as the inhibition of glucose diffusion, using polysaccharides isolated from Nostoc sphaericum Vaucher ex Bornet & Flahault and treated by in vitro simulated gastrointestinal digestion. Materials and methods: The polysaccharides obtained from the microalga were purified and treated through in vitro gastrointestinal digestibility in order to simulate digestion. The hypoglycemic activity was evaluated by methods such as the inhibition of α-glucosidase and α-amylase, and glucose diffusion of the digested polysaccharides, and compared with the medication acarbose. Results: The results showed that the concentration of 50 mg/mL of digested polysaccharides decreases by 85.26 % the spread of in vitro glucose. The inhibitory concentration (IC50) of the α-glucosidase enzyme was 314.23 ± 4.87 mg/mL and that of the α-amylase enzyme was 113.59 ± 3.10 mg/mL. Conclusions: Nostoc sphaericum polysaccharides treated by in vitro gastrointestinal digestion showed the ability to inhibit the α-amylase and α-glucosidase enzymes, and glucose diffusion. Therefore, this species would be considered promising for a possible adjuvant treatment of type 2 diabetes

The clinical analysis of endoscopic pancreaticobiliary separation in the treatment of occult pancreaticobiliary reflux / 中华普通外科杂志

Objective To evaluate endoscopic pancreaticobiliary separation (EPBS) in patients with gallstone and occult pancreaticobiliary reflux (OPBR).Methods The clinical data of 47 cases with gallstone and OPBR from Oct 2013 to Oct 2016 was analyzed retrospectively.Results The mean gallbladder bile amylase (GBA) was (864 ± 575) U/L.40 cases have undergone the treatment of endoscopic retrograde cholangiopancreatography.26 cases were diagnosed as duodenal papillitis,16 cases as periampullary diverticula,14 cases as long nipple,5 cases as atrophic papilla,3 cases as ampulla stone and 2 cases as papillary tumor.9 were diagnosed as pancreaticobiliary maljunction in the 14 patients with long nipple.33 cases were performed with EPBS.GBA was tested in 16 cases,and the GBA of 15 cases returned to normal level.The difference of GBA was statistically significant [(1 161 ±764) U/L vs.(47 ± 17) U/L,(t =5.641,P ＜ 0.05)].Patients were followed up for 1 to 4 years,among 36 cases without cholecystectomy,there was no recurrence of cholecystolithiasis after EPBS in 27 cases,but 2 cases had recurrent gallstones in 9 cases without EPBS,and the difference of gallstone recurrence rate was statistically significant (x2 =21.340,P ＜ 0.05).Conclusions Pancreaticobiliary junction diseases is an important cause for gallstone formation and OPBR.EPBS can avoid pancreaticobiliary reflux and reduce the recurrence rate of gallstone after choledochoscopic lithotomy.

Abdominal pain without bruising or sign of trauma: pancreatic injuries in children is difficult to predict

Pancreatic injuries due to trauma in children are rare. An early diagnosis is difficult as the signs and symptoms are insidious, but delays in diagnosis can lead to significant complications. We report a case of a child who visited the emergency department with aggravating abdominal pain. The physicians first diagnosed the abdominal pain as being caused by a disease in the emergency department, but the patient was subsequently diagnosed with pancreatic injury. Clinicians should be aware of a possible trauma in children who complain of vague abdominal pain even in the absence of corresponding history.

Existe associação entre α -amilase salivar, escala hospitalar de ansiedade e depressão e autorrelato em estudantes com sintomas de ansiedade? / Is there an association between salivary α -amylase, hospital scale of anxiety and depression and self-report in students with anxiety symptoms?

Objetivo: Verificar se existe associação entre a α-amilase salivar, a escala hospitalar de ansiedade e a depressão e autorrelato de estudantes universitários com sintomas da ansiedade. Métodos: Estudo observacional, realizado com 67 estudantes de uma universidade pública. Para a coleta de dados, foram utilizada a Escala Hospitalar de Ansiedade e Depressão, o autorrelato de ansiedade e a aferição da α-amilase salivar por meio do dispositivo Cocoro Meter®. Os dados foram analisados por meio do teste de qui-quadrado. Resultados: Não houve associação entre α-amilase salivar e a Escala Hospitalar de Ansiedade e Depressão (p=0,51), nem entre a α-amilase salivar e o autor- relato de ansiedade (p=0,51), o que indica que o biomarcador não produz resposta dessas duas variáveis ao mensurar a ansiedade. Conclusão: O biomarcador α-amilase salivar não possui a mesma capacidade em mensurar a ansiedade quando associado com à Escala Hospitalar de Ansiedade de Depressão e ao autorrelato em estudantes universitários com sintomas de ansiedade.

Objective: Verifying if there is an association between the salivary α-amylase biomarker, the hospital scale of anxiety and depression, and a self-report of university students with anxiety symptoms. Methods: An observational study carried out with 67 students from a public university. For the data collection, the Hospital Anxiety and Depression Scale, the self-reported anxiety, and the salivary α-amylase measurement were carried out with the Cocoro Meter® device. The data were analyzed by using the chi-square test. Results: There is no association between salivary α-amylase and the Hospital Anxiety and Depression Scale (p = 0.51), and neither between the salivary α-amylase and the self-reported anxiety (p = 0.51), which indicates that the biomarker does not produce any response of these two variables when measuring anxiety. Conclusion: The salivary α-amylase biomarker does not have the same ability to measure anxiety when associated with the Hospital Anxiety and Depression Scale and with the self-report in university students with anxiety symptoms.

O valor da amilase, obtido precocemente nos drenos abdominais, é teste útil em prever a ocorrência de fístula pancreática após duodenopancreatectomia: lições aprendidas de um centro do Sul do Brasil / Early drain fluid amylase is useful to predict pancreatic fistula after pancreatoduodenectomy: lessons learned from a southern brazilian center

ABSTRACT BACKGROUND: Pancreatic fistula represents the most feared complication after pancreatoduodenectomies, being the major responsible for the high morbidity and mortality after this operation. Its incidence remains around 10% to 30%. In recent years, several authors have studied the value of amylase in abdominal drains fluid, measured at an early stage after the surgical procedure, as a useful tool to identify patients at risk of developing pancreatic fistula. OBJECTIVE: To analyze the value of early drain fluid amylase as a method to predict the occurrence and severity of postoperative pancreatic fistula in patients undergoing pancreatoduodenectomies. METHODS: We evaluated 102 prospective patients submitted to pancreatoduodenectomies from January 2013 to June 2017. The mensuration of amylase in abdominal drains was performed on days 1, 3, 5 and 7 in all patients. Patients were divided into three groups according to postoperative day 1 (POD1) results: values <270 U/L (group 1); between 271 and 5.000 U/L (group 2); and values >5.000 U/L (group 3). RESULTS: The incidence of pancreatic fistula was 25.5%, being 3.33%, 27.3% and 41.02% in the three groups, respectively. Compared with group 1, the risk of developing pancreatic fistula increased with increasing amylase values on POD1. Amylase values on POD1 and POD3 of patients with pancreatic fistula were higher than in the other ones without this complication (P<0.001). In addition, in group 3, 37.5% of patients with pancreatic fistula evolved to death (P<0.001). Finally, in this group, patients who died had drain fluid amylase values on POD1 significantly higher than the others in the same group (P<0.001). CONCLUSION: Early drain fluid amylase value is a useful test to stratify patients in relation to the risk of developing pancreatic fistula after pancreatoduodenectomies, in addition to correlate with the severity of this complication.

RESUMO CONTEXTO: A fístula pancreática representa a complicação mais temida após as duodenopancreatectomias, sendo a grande responsável pela elevada morbi-mortalidade após esta operação. Sua incidência permanece em torno de 10% a 30%. Nos últimos anos, diversos trabalhos têm estudado o valor da amilase nos drenos abdominais, medido de forma precoce após o procedimento cirúrgico, como ferramenta útil para a identificação dos pacientes sob risco de desenvolver fístula pancreática. OBJETIVO: Avaliar o valor da amilase no fluido dos drenos abdominais, obtido precocemente no pós-operatório, como método para prever a ocorrência e severidade da fístula pancreática nos pacientes submetidos a duodenopancreatectomias. MÉTODOS: Foram avaliados 102 pacientes prospectivos submetidos a duodenopancreatectomias no período de janeiro de 2013 a junho de 2017. A dosagem da amilase nos drenos abdominais foi realizada nos dias 1, 3, 5 e 7 em todos os pacientes. Os pacientes foram divididos em três grupos conforme os resultados do 1o PO: valores <270 U/L (grupo 1); entre 271 e 5.000 U/L (grupo 2); e valores >5.000 U/L (grupo 3). RESULTADOS: A incidência de fístula pancreática foi de 25,5%, sendo 3,33%, 27,3% e 41,02% nos três grupos, respectivamente. Comparados ao grupo 1, o risco de desenvolver fístula pancreática foi crescente com o aumento da amilase no 1o PO. Os valores das amilases no 1o PO e 3o PO dos pacientes com fístula pancreática foram maiores do que nos pacientes sem essa complicação (P<0,001). Além disso, no grupo 3, 37,5% dos pacientes com fístula pancreática evoluíram para óbito (P<0,001). Por fim, neste grupo, os pacientes que evoluíram para óbito tiveram valores de amilase no 1o PO significativamente maiores do que os demais pacientes (P<0,001). CONCLUSÃO: O valor da amilase, medido de forma precoce nos drenos abdominais no pós-operatório de duodenopancreatectomias, é teste útil para estratificar pacientes em relação ao risco de apresentar fístula pancreática, além de se correlacionar com a severidade dessa complicação.

Molecular cloning and biochemical characterization of an α-amylase family from Aspergillus niger

Background: α-Amylase is widely used in the starch processing, food and paper industries, hydrolyzing starch, glycogen and other polysaccharides into glucose, maltose and oligosaccharides. An α-amylase gene family from Aspergillus niger CBS513.88 encode eight putative α-amylases. The differences and similarities, biochemical properties and functional diversity among these eight α-amylases remain unknown. Results: The eight genes were cloned and expressed in Pichia pastoris GS115 by shaking-flask fermentation under the induction of methanol. The sequence alignment, biochemical characterizations and product analysis of starch hydrolysis by these α-amylases were investigated. It is found that the eight α-amylases belonged to three different groups with the typical structure of fungal α-amylase. They exhibited maximal activities at 30­40°C except AmyG and were all stable at acidic pH. Ca2+ and EDTA had no effects on the activities of α-amylases except AmyF and AmyH, indicating that the six amylases were Ca2+ independent. Two novel α-amylases of AmyE and AmyF were found. AmyE hydrolyzed starch into maltose, maltotriose and a small amount of glucose, while AmyF hydrolyzed starch into mainly glucose. The excellent physical and chemical properties including high acidic stability, Ca2+-independent and high maltotriose-forming capacity make AmyE suitable in food and sugar syrup industries. Conclusions: This study illustrates that a gene family can encode multiple enzymes members having remarkable differences in biochemical properties. It provides not only new insights into evolution and functional divergence among different members of an α-amylase family, but the development of new enzymes for industrial application.

Clinical significance of serum levels of sFlt-1, AMY and hs-CRP in patients with acute pancreatitis / 中国医师杂志

Objective To investigate the dynamic changes of soluble fms-like tyrosine kinase 1 (sFlt-1),Amylase (AMY) and high sensitvie C reactive protein (hs-CRP) in the early diagnosis of acute pancreatitis (AP) and its clinical significance.Methods 72 patients with AP were selected and divided into mild group (n =45) and severe group (n =27).Another 30 healthy subjects in the same period were selected as control group (n =30).Serum sFlt-1 levels were measured by enzyme-linked immunosorbent assay (ELISA) on the 1st,3rd and 7th day after admission.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score was used to assess acute physiology and chronic health status,and AMY and hsCRP levels were measured.Results Serum levels of sFlt-1,AMY and hs-CRP in the severe group were significandy higher than those in the mild group on the 1 st,3rd and 7th day after admission (all P ＜ 0.01).The levels of sFlt-1,AMY and hs-CRP in the mild group were significantly higher than those in the control group (all P ＜ 0.01).The scores of APACHE Ⅱ in the severe group were significantly higher than those in the mild group on the 1st,3rd and 7th day after admission (all P ＜ 0.01).There was a positive correlation between serum sFlt-1 level and AMY,hs-CRP,APACHE Ⅱ scores on the first day of admission (respectively r =0.738,P =0.00;r =0.563,P =0.000;r =0.233,P =0.028),on the third day of admission (respectively r =0.622,P =0.000;r =0.584,P =0.000;r =0.218,P =0.032),on the seventh day of admission (respectively r =0.593,P =0.000;r =0.547,P =0.000;r =0.227,P =0.030).Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of serum sFlt-1,AMY and hs-CRP were 0.918 (95％ CI:0.865-0.971,P =0.000),0.948 (95％ CI:0.908-0.989,P=0.000) and 0.789 (95％ CI:0.696-0.882,P=0.000),respectively.Conclusions The level of sFlt-1 in peripheral blood is significantly increased in patients with AP,which is closely related to the severity of AP.Dynamic monitoring of serum sFlt-1,AMY and hs-CRP has important clinical value in the diagnosis,treatment,severity and prognosis of AP.

Improving the expression of recombinant pullulanase by increasing mRNA stability in Escherichia coli

Background: Pullulanase production in both wild-type strains and recombinantly engineered strains remains low. The Shine-Dalgarno (SD) sequence and stem-loop structure in the 5' or 3' untranslated region (UTR) are well-known determinants of mRNA stability. This study investigated the effect of mRNA stability on pullulanase heterologous expression. Results: We constructed four DNA fragments, pulA, SD-pulA, pulA-3t, and SD-pulA-3t, which were cloned into the expression vector pHT43 to generate four pullulanase expression plasmids. The DNA fragment pulA was the coding sequence (CDS) of pulA in Klebsiella variicola Z-13. SD-pulA was constructed by the addition of the 5' SD sequence at the 5' UTR of pulA. pulA-3t was constructed by the addition of a 3' stem-loop structure at the 3' UTR of pulA. SD-pulA-3t was constructed by the addition of the 5' SD sequence at the 5' UTR and a 3' stem-loop structure at the 3' UTR of pulA. The four vectors were transformed into Escherichia coli BL21(DE3). The pulA mRNA transcription of the transformant harboring pHT43-SD-pulA-3t was 338.6%, 34.9%, and 79.9% higher than that of the other three transformants, whereas the fermentation enzyme activities in culture broth and intracellularly were 107.0 and 584.1 times, 1.2 and 2.0 times, and 62.0 and 531.5 times the amount of the other three transformants (pulA, SD-pulA, and pulA-3 t), respectively. Conclusion: The addition of the 5' SD sequence at the 5' UTR and a 3' stem-loop structure at the 3' UTR of the pulA gene is an effective approach to increase pulA gene expression and fermentation enzyme activity.

Comparison of clinical characteristics of severe hyperlipidemic pancreatitis and severe acute gallstone pancreatitis / 中华全科医师杂志

Objective To compare the clinical characteristics and the outcomes of severe hyperlipidemic pancreatitis (SHLP) and severe acute gallstone pancreatitis (SAGP).Methods The clinical data of 22 patients with SHLP and 91 patients with SAGP admitted from January 2009 to December 2015 were retrospectively reviewed.The clinical manifestations,laboratory tests,organ dysfunction,medical treatment,complications and outcomes in 30 d after admission were analyzed and compared between two groups of patients.Results There were 16 males and 6 females with a mean age of (60.5 ± 9.1) years in SHLP group;while 32 males and 59 females with a mean age of (54.3 ± 5.4) years in SAGP group.The blood and urine amylase levels in SHLP group were significantly lower than those in SAGP group [(715 ±99) U/L vs.(1 551 ± 107) U/L,t =4.65,P =0.00;(382 ±56) U/L vs.(773 ± 66) U/L,t =4.52,P =0.00,respectively].The incidence of circulation insufficiency,respiratory insufficiency,renal dysfunction,and long-term puhnonary infection in SHAP patients was significantly higher than that in SAGP patients [36 ％ (8/22) vs.14 ％ (13/91),x2 =5.22,P =0.01;41％ (9/22) vs.7 ％ (6/91),x2 =9.46,P =0.01;23％(51/22) vs.5％ (5/91),x2 =4.20,P=0.03;55％(12/22) vs.32％ (29/91),x2 =7.02,P =0.01].Two cases died in the SHLP group and 9 cases died in SAGP group due to critical infection,cardiac events and bleeding.Conclusion Compared to SAGP patients,the blood and urine amylase levels are usually not remarkably high in SHLP patients,and the prevention and management of multi-organ failure and lung infection are more important for SHLP patients.

Salivary stress biomarkers and anxiety symptoms in children with and without temporomandibular disorders

Abstract The etiology of temporomandibular disorders (TMD), which are considered as a heterogeneous group of psychophysiological disturbances, remains a controversial issue in clinical dentistry. This study aimed to evaluate whether the salivary alpha-amylase (sAA), cortisol levels, and anxiety symptoms differ between children with and without TMD. Initially, 316 young subjects were screened in public schools (nonreferred sample); 76 subjects aged 7-14 years were selected and comprised the TMD and control groups with 38 subjects each matched by sex, age, and the presence/absence of sleep bruxism. Four saliva samples were collected: upon waking, 30 min and 1 h after awakening (fasting), and at night (at 8 PM) on 2 alternate days to examine the diurnal profiles of cortisol and sAA. Anxiety symptoms were screened using the Multidimensional Anxiety Scale for Children (MASC-Brazilian version). Shapiro-Wilk test, Student's t-test/Mann-Whitney U test, and correlation tests were used for data analysis. No significant differences were observed in the salivary cortisol area under the curve (AUCG mean ± SD = 90.22 ± 63.36 × 94.21 ± 63.13 µg/dL/min) and sAA AUCG (mean ± SD = 2544.52 ± 2142.00 × 2054.03 ± 1046.89 U/mL/min) between the TMD and control groups, respectively (p > 0.05); however, the clinical groups differed in social anxiety domain (t = 3.759; CI = 2.609, 8.496), separation/panic (t = 2.243; CI = 0.309, 5.217), physical symptoms (U = 433.500), and MASC total score (t = −3.527; CI = −23.062, −6.412), with a power of the test >80% and large effect size (d = 0.80), with no significant correlation between the MASC total score, cortisol, and sAA levels. Although children with TMD scored higher in anxiety symptoms, no difference was observed in the salivary stress biomarkers between children with and without TMD.

Prediction of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Using 4-Hour Post-Endoscopic Retrograde Cholangiopancreatography Serum Amylase and Lipase Levels

Early post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prediction may allow safe same-day outpatients discharge after ERCP and earlier proper management. This study aimed to assess the usefulness of the 4-hour post-ERCP serum amylase and lipase levels for PEP early prediction and to investigate predictive cut-off values for 4-hour post-ERCP serum amylase and lipase levels for safe discharge and urgent initiation of resuscitation. The data of 516 consecutive patients with native papilla who underwent ERCP between January 2013 and August 2014 were retrospectively reviewed. Serum amylase and lipase levels were measured before, and 4 and 24 hours after ERCP. PEP occurred in 16 (3.1%) patients. The receiver-operator characteristic curve for 4-hour post-ERCP serum amylase and lipase levels showed that the areas under the curve were 0.919 and 0.933, respectively, demonstrating good test performances as predictors for PEP (both P values 1.5 × the upper limit of reference (ULR) was found useful for PEP exclusion with a sensitivity of 93.8%, while 4 × ULR was found useful to guide preventive therapy with the best specificity of 93.2%. Similarly, the lipase level 2 × ULR showed best sensitivity, while 8 × ULR had the best specificity. Logistic regression analysis showed that 4-hour post-ERCP amylase level > 4 × ULR, lipase level > 8 × ULR, precut sphincterotomy, and pancreatic sphincterotomy were significant predictors for PEP. In conclusion, 4-hour post-ERCP amylase and lipase levels are useful early predictors of PEP that can ensure safe discharge or prompt resuscitation after ERCP.