Lipase and pancreatic amylase activities in diagnosis of acute pancreatitis in patients with hyperamylasemia

BACKGROUND: Measurement of total serum amylase (AMY) is the most widely used biochemical test for the diagnosis of acute pancreatitis, but it is commonly considered a nonspecific marker. To improve the biochemical diagnosis of acute pancreatitis, lipase ( LIP ) and pancreatic amylase (PAMY) have been tested in recent years. The present study was designed to evaluate whether serum LIP and pancreatic PAMY tests could replace total amylase test to improve diagnostic efficiency in the evaluation of acute pancreatitis in patients with hyperamylasemia. METHODS: LIP and PAMY values were determined in serum samples from 92 patients with hyperamylasemia. Reference values for each enzyme were derived from serum samples of 147 healthy subjects. The activities of LIP and PAMY in patients with various diseases were shown directly by the boxplot graph. The diagnostic accuracy of LIP and PAMY was defined as the area under the receiver operating characteristic (ROC) curve. Their sensitivity and specificity in detecting acute pancreatitis at varying cutoff points were shown by the curve, and the best cutoff value for each enzyme was shown by the modified ROC curve. The diagnostic values of LIP, PAMY and LIP + AMY with each upper limit of reference range (ULR) were compared with the corresponding best cutoff values. RESULTS: The references values of LIP and PAMY were 12.2-47.6 U/L and 28-95 U/L, respectively. These values in patients with acute pancreatitis were higher than those patients with other diseases. The areas under the ROC curve ( AUC) of LIP and PAMY were 0. 799 and 0. 792, respectively, With the best diagnostic cutoff point of maximum (sensitivity + specificity) -100%, we obtained values of 97.9 U/L(LIP97.9 =2. 06 × ULR) for LIP and 209 U/L (PAMY209 =2.20 ×ULR) for PAMY. The best cutoff values for LIP, PAMY and LIP +AMY demonstrated the specificity, positive predictive value, and diagnostic efficiency higher than the corresponding ULRs. CONCLUSIONS: Serum LIP and PAMY are specific for the pancreas and might replace total amylase for the diagnosis of acute pancreatitis in hyperamylasemia patients. LIP97.9 is more efficient than PAMY209 in the diagnosis of acute pancreatitis. A combined test of both enzymes is not superior to single test of either enzyme in diagnostic accuracy.

Hypothyroidism with elevated pancreatic amylase and lipase without clinical symptoms: A case report

BACKGROUND Hypothyroidism is an endocrine disorder that has worldwide prevalence and can affect multiple organ systems.We report a case of hypothyroidism with elevated pancreatic amylase and trypsin without acute pancreatitis.No such case has been previously reported.CASE SUMMARY A 29-year-old woman did not pay much attention to a fever 4 d prior.During this time,she experienced anorexia and only drank a small amount of water every day.She did not present with abdominal distension,postprandial nausea,vomiting,cough or expectoration.After physical and laboratory examinations,the patient was diagnosed with hypothyroidism.During the course of the disease,hypothyroidism was generally accompanied by constantly increased pancreatic amylase and trypsin.After admission,the possible etiology of the patient was excluded and the concentrations of pancreatic lipase and amylase in serum were>2000U/L(reference range 23-300 U/L)and 410 U/L(reference range 30-110 U/L),respectively.So we highly suspected that it may be acute pancreatitis.Interestingly,she never developed any complications associated with acute pancreatitis despite high levels of serum pancreatic amylase and trypsin,and she reported no symptoms of abdominal pain.Serum amylase and lipase decreased gradually after active thyroxine supplementation,and the patient was discharged from the hospital after active treatment.CONCLUSION This case suggests that clinicians should pay attention to hypothyroidism with elevated pancreatic amylase and trypsin,even if no complications of acute pancreatitis are reported.

Monitoring salivary amylase activity is useful for providing timely analgesia under sedation

AIM:To detect the criteria and cause of elevated salivary amylase activity(sAMY)in patients undergoing endoscopic submucosal dissection(ESD)under sedation.METHODS:A total of 41 patients with early gastric cancer removed via ESD under deep sedation(DS)were enrolled.The perioperative sAMY,which was shown as sympathetic excitements(SE),was measured.The time at which a patient exhibited a relatively increased rate of sAMY compared with the preoperative baseline level(IR,%)≥100%(twice the actual value)was assumed as the moment when the patient received SE.Among the 41 patients,we focused on 14 patients who exhibited an IR≥100% at any time that was associated with sAMY elevation during ESD(H-group)and examined whether any particular endoscopic procedures can cause SE by simultaneously monitoring the sAMY level.If a patient demonstrated an elevated sAMY level above twice the baseline level,the endoscopic procedure was immediately stopped.In the impossible case of discontinuance,analgesic medicines were administered.This study was performed prospectively.RESULTS:A total of 26 episodes of sAMY eruption were considered moments of SE in the H-group.The baseline level of sAMY significantly increased in association with an IR of>100% at 5 min,with a significant difference(IR immediately before elevation/IR at elevation of sAMY=8.72±173/958±1391%,P<0.001).However,effective intervention decreased the elevated sAMY level immediately within only 5 min,with a significant difference(IR at sAMY elevation/immediately after intervention=958±1391/476±1031,P<0.001).The bispectral indices,systolic blood pressure and pulse rates,which were measured at the same time,remained stable throughout the ESD.Forceful endoscopic insertion or over insufflation was performed during 22 of the 26 episodes.Release of the gastric wall tension and/or the administration of analgesic medication resulted in the immediate recovery of the elevated sAMY level,independent of body movement.CONCLUSION:By detecting twice the actual sAMY based on the preoperative level,the release of the gastric wall tension or the administration of analgesic agents should be considered.

Drainage fluid and serum amylase levels accurately predict development of postoperative pancreatic fistula

AIM To investigate potential biomarkers for predicting postoperative pancreatic fistula( POPF) after pancreaticoduodenectomy(PD).METHODS We prospectively recruited 83 patients to this study. All patients underwent PD(Child's procedure) at the Division of Hepatobiliary and Pancreas Surgery at the First Bethune Hospital of Jilin University between June 2011 and April 2015. Data pertaining to demographic variables, clinical characteristics, texture of pancreas, surgical approach, histopathological results, white blood cell count, amylase and choline levels in the serum, pancreatic/gastric drainage fluid, and choline and amylase levels in abdominal drainage fluid were included in the analysis. Potential correlations between these parameters and postoperative complications such as, POPF, acute pancreatitis, hemorrhage, delayed gastric emptying, and biliary fistula, were assessed. RESULTS Twenty-eight out of the 83(33.7%) patients developed POPF. The severity of POPF was classified as Grade A in 8(28%) patients, grade B in 16(58%), and grade C in4(14%), according to the pancreatic fistula criteria. On univariate and multivariate logistic regression analyses, higher amylase level in the abdominal drainage fluid on postoperative day(POD)1 and higher serum amylase levels on POD4 showed a significant correlation with POPF(P < 0.05). On receiver operating characteristic curve analysis, amylase cut-off level of 2365.5 U/L in the abdominal drainage fluid was associated with a 78.6% sensitivity and 80% specificity [area under the curve(AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 44.2 U/L was associated with a 78.6% sensitivity and 70.9% specificity(AUC: 0.784; P = 0.05).CONCLUSION Amylase level in the abdominal drainage fluid on POD1 and serum amylase level on POD4 represent novel biomarkers associated with POPF development.

Drain amylase value as an early predictor of pancreatic fistula after cephalic duodenopancreatectomy

AIM: To determine predictors of clinically relevant pancreatic fistulas (CRPF) by measuring drain fluid amylase (DFA) in the early postoperative period.

Types of voltage-dependent calcium channels involved in high potassium depolarization-induced amylase secretion in the exocrine pancreatic tumour cell line AR4-2J

In the perifused fura-2 loaded exocrine pancreatic acinar cell line AR4-2J pulses of high potassium induced repetitive increases in intracellular calcium. Attached cells when stimulated with high potassium secreted large amount of amylase. High potassium-induced secretion was dependent both on the concentration of potassium and duration of stimulation. High potassium induced increases in intracellular calcium were inhibited by voltage-dependent calcium channel antagonists with an order of potency as follows: nifedipine > ω-agatoxin IVA > ω-conotoxin GVIA. In contrast, the L-type calcium channel antagonist nifedipine almost completely inhibited potassium-induced amylase secretion, whereas the N-type channel antagonist ω-conotoxin GVIA was without effect. The P-type channel antagonist ω-agatoxin IVA had a small inhibitory effect, but this inhibition was not significant at the level of amylase secretion. In conclusion, the AR4-2J cell line possesses different voltage-dependent calcium channels (L, P,N) with the L-type predominantly involved in depolarization induced amylase secretion.

The relationship between psychological distress with salivary <i>α</i>-amylase and stress related symptoms among breast cancer survivors

Background and Aims: This study examined the stress levels, the stressors and biomarker such as Alpha (α)-Amylase enzyme which is secreted under distress conditions. The aim was to determine the relationship between these three variables. Methods: The study respondents were made up of cancer outpatients from 3 hospitals namely the Hospital Kuala Lumpur, Seberang Jaya and Johor Baru, Pantai Ipoh and Putrajaya. The Personal Stress Inventory (PSI) questionnaire was used to identify stressors, while the Hospital Anxiety and Depression Scale (HADS) were used to determine the psychological distress levels. The Salimentary Oral Swab (SOS) Technique was used to collect the saliva and then the Salivary α-Amylase Assay Kit was used to analyse for α amylase. Results: The majority of respondents were stressed due to their sensitive emotion and nervousness in their daily lives (68.7%), they had poor memory and short attention spans of carrying out job tasks (67.3%) as well as they were emotionally depressed (65.3%). Their poor memory and short attention span (p = 0.037), heavy work load and poor task delivery (p = 0.008) were predictors for distress using HADS. The salivary α-amylase concentration was significantly related to the stress levels (p = 0.002). Conclusion: Breast cancer respondents with musculoskeletal system related symptoms, with heavy work load and poor task delivery, as well as had poor memory and short attention span were at higher risk of experiencing psychological distress. The salivary α-amylase which had significant relationships with psychological distress was therefore, a potential biological indicator for distress, while the musculoskeletal system related symptoms from the PSI questionnaire were predictors for distress.

Effects of Exposure to GSM Mobile Phone Base Station Signals on Salivary Cortisol,Alpha-Amylase,and Immunoglobulin A

Objective The present study aimed to test whether exposure to radiofrequency electromagnetic fields （RF-EMF） emitted by mobile phone base stations may have effects on salivary alpha-amylase, immunoglobulin A （IgA）, and cortisol levels. Methods Fifty seven participants were randomly allocated to one of three different experimental scenarios （22 participants to scenario 1, 26 to scenario 2, and 9 to scenario 3）. Each participant went through five 50-minute exposure sessions. The main RF-EMF source was a GSM-900-MHz antenna located at the outer wall of the building. In scenarios 1 and 2, the first, third, and fifth sessions were ＂low＂ （median power flux density 5.2 μW/m^2） exposure. The second session was ＂high＂ （2126.8 μW/m^2）, and the fourth session was ＂medium＂ （153.6 μW/m^2） in scenario 1, and vice versa in scenario 2. Scenario 3 had four ＂low＂ exposure conditions, followed by a ＂high＂ exposure condition. Biomedical parameters were collected by saliva samples three times a session. Exposure levels were created by shielding curtains. Results In scenario 3 from session 4 to session 5 （from ＂low＂ to ＂high＂ exposure）, an increase of cortisol was detected, while in scenarios 1 and 2, a higher concentration of alpha-amylase related to the baseline was identified as compared to that in scenario 3. IgA concentration was not significantly related to the exposure. Conclusions RF-EMF in considerably lower field densities than ICNIRP-gnidelines may influence certain psychobiological stress markers.

Salivary Alpha-Amylase Reactivity under Psycho-Physiological Stress. A Nonverbal Communication Measurement Tool?

Previous studies have shown that changes in salivary alpha-amylase (sAA) levels are dependent on psychosocial stress stimulation and reflect the activity of the sympathetic nervous system. sAA measurement can be performed easily and quickly;therefore, it may be useful for evaluating psychosocial or physical stress. The aim of this preliminary study was to examine the use of sAA measurements as objective indicators of psychological and physiological stress levels by examining sAA changes in volunteers subjected to conditions similar to those suffered by children with severe motor and intellectual disabilities and cerebral paralysis. Twelve healthy volunteers were required to not move or speak, as is found in patients suffering from total paralysis, for 30 min. Saliva samples were taken at three points, and sAA activity was measured using a hand-held monitor before the test, immediately after the test, and 10 min after the test. In the present study, a marked increase in sAA activity due to physiological stress and a rapid return to the baseline level were observed. Many subjects felt bodily pain and psychotic discomfort. This measurement method is useful for evaluating stress in children with severe motor and intellectual disabilities, who can not fully express their emotions or communicate with their caregivers.

Increase in Salivary Alpha-Amylase Levels among Non-Attending Junior High School Students Diagnosed with Social Anxiety Disorder

Purpose: Several studies have demonstrated that the measurement of salivary alpha-amylase (sAA) levels is a useful tool for evaluating the autonomic nervous system. Psychosocial stress increases the release of sAA as a useful marker for autonomic nervous system (ANS). To our knowledge, although some studies have evaluated sAA levels under psychosocial stress, no studies have investigated the changes in sAA activity that occur in junior high school students who are not attending school due to social anxiety disorder (SAD). We aimed to investigate the relationship between the sAA levels and psychiatric states of such patients. Methods: The study subjects consisted of SAD patients (n = 39) and healthy controls (n = 57). We used a portable hand-held monitor to measure the level of sAA and State-Trait Anxiety Index (STAI) to evaluate the psychiatric state. Results: The patients’ sAA activity was significantly higher than that of the controls (n = 57) (p < 0.001). Significant differences in heart rate (HR) (76.10 ± 11.96 vs. 68.69 ± 10.61, respectively, p < 0.01) and STAI scores (both the STAI-State and STAI-Trait scores) (49.35 ± 10.57 vs. 41.24 ± 8.59, respectively, p < 0.01;55.69 ± 10.44 vs. 45.61 ± 9.36, respectively, p < 0.001) were detected between the patients and healthy controls. Conclusions: These results indicated that junior high school students with SAD exhibit a higher state of anxiety and high autonomic activity, probably due to changes in the sympathetic nervous system. As a result, junior high school students with SAD are expected to exhibit high levels of sAA accompanied by anxiety symptoms.

Salivary alpha-amylase activity—An indicator of relaxation response in perioperative patients

The psychological stress of most perioperative patients has been reduced by many interventions. In order to evaluate the effects of these interventions, biomarkers are being considered as objective assessment tools in addition to the subjective assessment tools. It has been thought that salivary α-amylase (sAA) activity is associated with sympathetic nervous system activity, which reflects psychological stress. We examined the relationship between sAA, self-reported data, and autonomic nervous system activity to assess the reliability of sAA as a marker for relaxing response in surgery-related stress. The sAA, the State anxiety, Visual Analogue Scale (VAS) of pain, and heart rate variability were used to assess prior to and after the relaxation on the day before surgery, and on postoperative days (POD) 1, 2, 3, and 7. A total of 75 patients participated and 301 relaxing response readings were obtained. We found that the sAA significantly decreased depending upon the pain and anxiety by relaxation, but they were unrelated to sympathetic nervous system activity. There was weak correlation between the change in sAA, and anxiety and VAS pain. Thus, sAA appears to be an easy-to-use, non-invasive and good marker for relaxing response within a short period in surgery-related stress patients.

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.

Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure

AIM: To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS: Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS: Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs ≥ 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION: Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.

Low serum amylase and obesity, diabetes and metabolic syndrome: A novel interpretation

For the last decade, low serum amylase(hypoamylasemia) has been reported in certain common cardiometabolic conditions such as obesity, diabetes(regardless of type), and metabolic syndrome, all of which appear to have a common etiology of insufficient insulin action due to insulin resistance and/or diminished insulin secretion. Some clinical studies have shown that salivary amylase may be preferentially decreased in obese individuals, whereas others have revealed that pancreatic amylase may be preferentially decreased in diabetic subjects with insulin dependence. Despite this accumulated evidence, the clinical relevance of serum, salivary, and pancreatic amylase and the underlying mechanisms have not been fully elucidated. In recent years, copy number variations(CNVs) in the salivary amylase gene(AMY1), which range more broadly than the pancreatic amylase gene(AMY2A and AMY2B), have been shown to be well correlated with salivary and serum amylase levels. In addition, low CNV of AMY1, indicating low salivary amylase, was associated with insulin resistance, obesity, low taste perception/satiety, and postprandial hyperglycemia through impaired insulin secretion at early cephalic phase. In most populations, insulin-dependent diabetes is less prevalent(minor contribution) compared with insulin-independent diabetes, and obesity is highly prevalent compared with low body weight. Therefore, obesity as a condition that elicits cardiometabolic diseases relating to insulin resistance(major contribution) may be a common determinant for low serum amylase in a general population. In this review, the novel interpretation of low serum, salivary, and pancreas amylase is discussed in terms of major contributions of obesity, diabetes, and metabolic syndrome.

Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis

AIM To estimate the efficacy of 2 h post-endoscopic retrograde cholangiopancreatography(ERCP) serum amylase levels and other factors for predicting postERCP pancreatitis.METHODS This was a retrospective,single-center cohort study of consecutive patients who underwent ERCP from January 2010 to December 2013.Serum amylase levels were measured 2 h post-procedure,and patient- and procedure-related pancreatitis(PEP) risk factors wereanalyzed using a logistic model.RESULTS A total of 1520 cases(average age 72 ± 12 years,60% male) were initially enrolled in this study,and 1403 cases(725 patients) were ultimately analyzed after the exclusion of 117 cases.Fifty-five of these cases developed PEP.We established a 2 h serum amylase cutoff level of two times the upper limit of normal for predicting PEP.Multivariate analysis revealed that a cannulation time of more than 13 min [odds ratio(OR) 2.28,95%CI:1.132-4.651,P=0.0210] and 2 h amylase levels greater than the cutoff level(OR=24.1,95%CI:11.56-57.13,P<0.0001) were significant predictive factors for PEP.Forty-seven of the 55 patients who developed PEP exhibited 2 h amylase levels greater than the cutoff level(85%),and six of the remaining eight patients who developed PEP(75%) required longer cannulation times.Only 2 of the 1403 patients(0.14%) who developed PEP did not exhibit concerning 2 h amylase levels or require longer cannulation times.CONCLUSION These findings indicate that the combination of 2 h post-ERCP serum amylase levels and cannulation times represents a valuable marker for identifying patients at high risk for PEP.

Is the measurement of drain amylase content useful for predicting pancreas-related complications after gastrectomy with systematic lymphadenectomy?

Many studies investigating postoperative pancreatic fistula(POPF)after gastrectomy,including studies measuring drain amylase content(D-AMY)as a predictive factor have been reported.This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy.The causes of pancreatic fluid leakage are;the parenchymal and/or thermal injury to the pancreas,and blunt injury to the pancreas by compression and retraction.Measurement of D-AMY to predict POPF has become common in clinical practice after pancreatic surgery and was later extended to the gastric surgery.Several studies have reported associations between D-AMY and POPF after gastrectomy,and the high value of D-AMY on postoperative day(POD)1 was an independent risk factor.To improve both sensitivity and specificity,attempts have been made to enhance the predictive accuracy of factors on POD 1 as well as on POD 3 as combined markers.Although several studies have shown a high predictive ability of POPF,it has not necessarily been exploited in clinical practice.Many problems remain unresolved;ideal timing for measurement,optimal cut-off value,and means of intervention after prediction.Prospective clinical trial could be imperative in order to develop D-AMY measurement in common clinical practice for gastric surgery.

Sampling Small Volumes of Saliva for Determination of the Stress Hormone α-Amylase: A Comparative Methodological Study

Two sampling devices that allow saliva collection through absorption to a cotton roll (Salivette?-method) or to small cotton pellets (VectaSpinTM Micro [VSM]-method) were studied. Any loss of salivary alpha-amylase (sAA) activity in relation to the saliva volume absorbed and harvested by centrifugation was examined. A pooled saliva sample prepared from stimulated whole saliva (collected by drooling) of 30 subjects was used. Three different saliva volumes (2.9 ml, 1.5 ml, and 0.8 ml) were tested on cotton rolls and two (0.03 ml, and 0.015 ml) on cotton pellets. The sample sAA activity was determined from the hydrolysis of 2-chloro-4-nitrophenyl-α-D-maltotrioside. In comparison with the original drooling sample, no sAA loss was observed in 1.5 ml samples tested with Salivette, while a significant decrease of activity was recorded with smaller volumes. VSM collected samples showed a non-volume dependent decrease of sAA activity of about 25%. Salivette requires large saliva volumes to allow an accurate sAA estimation. With cases of limited saliva access, VSM may be a suitable sampling device.

Association between salivary α-amylase activity and pain relief scale scores in cancer patients with bone metastases treated with radiotherapy

Background Subjective assessment tools such as visual analog scales （VAS） or pain scores are commonly used to evaluate the intensity of chronic cancer-induced pain.However,their value is limited in some cases.We measured changes in VAS pain scores and salivary a-amylase （sAA） concentrations in cancer patients receiving radiotherapy for bone metastases to ascertain the correlation between these measures.Methods We enrolled 30 patients with bone metastases attending a single institution from June 2010 to March 2011.All patients with cancer-induced bone pain received radiation therapy （RT） at the same dose （30 Gy） and fractionation （3 Gy/ fraction,5 days/week） for palliative pain relief.We assessed heart rate （HR）,systolic and diastolic blood pressures （DBP/SBP） and VAS pain scores before （d0） and after five （d5） and ten fractions （d10） of irradiation,sAA and salivary cortisol （SC）concentrations were measured using a portable analyzer and automated chemiluminescence analyzer,respectively.Results Radiotherapy markedly decreased VAS scores from （82.93±9.29） to （31.43±t16.73） mm （P ＜0.001） and sAA concentrations from （109.40±26.38） to （36.03±19.40） U/ml （P ＜0.001）.Moreover,there was a significant correlation between these two indices （P ＜0.01,r=0.541）.HR decreased by 6.5％ after radiotherapy,but did not correlate with VAS scores （P ＞0.05）.SC concentrations and BP did not change significantly during the study （P ＞0.05）.Conclusions The significant correlation between sAA concentrations and VAS pain scores identified in these preliminary results suggests that this biomarker may be a valuable,noninvasive and sensitive index for the objective assessment of pain intensity in patients with cancer-induced bone pain.

Cloning,expression,and characterization of a porcine pancreatic α-amylase in Pichia pastoris

Pancreatic α-amylase(α-1, 4-glucan-4-glucanohydrolase, EC.3.2.1.1) plays a primary role in the intestinal digestion of feed starch and is often deficient in weanling pigs.The objective of this study was to clone,express, and characterize porcine pancreatic α-amylase(PPA).The full-length c DNA encoding the PPA was isolated from pig pancreas by RT-PCR and cloned into the pPICZαA vector.After the resultant pPICZαА-PPA plasmid was transferred into Pichia pastoris, Ni Sepharose affinity column was used to purify the over-expressed extracellular recombinant PPA protein(re PPA) that contains a His-tag to the C terminus and was characterized against the natural enzyme(α-amylase from porcine pancreas).The re PPA exhibited a molecular mass of approximately 58 kDa and showed optimal temperature(50℃),optimal pH(7.5), K_m(47.8 mg/mL), and V_(max)(2,783 U/mg) similar to those of the natural enzyme.The recombinant enzyme was stable at 40℃ but lost 60% to 90%(P < 0.05) after exposure to heating at≥50℃ for 30 min.The enzyme activity was little affected by Cu^(2+)or Fe^(3+), but might be inhibited(40% to 50%) by Zn^(2+)at concentrations in pig digesta.However, Ca^(2+)exhibited a dose-dependent stimulation of the enzyme activity.In conclusion, the present study successfully cloned the porcine pancreatic aamylase gene and over-expressed the gene in P.pastoris as an extracellular, functional enzyme.The biochemical characterization of the over-produced enzyme depicts its potential and future improvement as an animal feed additive.

不同类型内镜逆行胰胆管造影术困难插管患者行胰管括约肌预切开术后的近期和远期疗效评价

目的 探讨不同类型内镜逆行胰胆管造影术(ERCP)困难插管患者行胰管括约肌预切开术后的近期和远期疗效。方法 回顾性分析2019年1月-2020年6月该院收治的100例ERCP插管困难患者的临床资料,按照治疗方法不同,将患者分为对照组(50例)和研究组(50例),对照组行常规ERCP插管,不做胰管切开,研究组在行常规ERCP插管的基础上,行胰管括约肌预切开术;统计两组患者插管成功时间、成功插管率和住院时间;采用酶联免疫吸附试验,检测两组患者术后C反应蛋白(CRP)、白细胞介素-6 (IL-6)和血淀粉酶水平;统计两组患者预切开操作相关的并发症发生率;随访两组患者术后3、6和12个月的反流性胆管炎和复发性胰腺炎发生情况,评价两组患者远期疗效。结果 与对照组比较,研究组成功插管时间缩短,成功插管率增加,差异均有统计学意义(P <0.05),两组患者住院时间比较,差异无统计学意义(P> 0.05);与对照组比较,研究组术后第1天CRP、IL-6和血淀粉酶水平降低,差异均有统计学意义(P <0.05);对照组急性胰腺炎4例,出血2例,穿孔1例,术后并发症发生率为14.0%,研究组出血1例,术后并发症发生率为2.0%,研究组明显低于对照组,差异有统计学意义(P <0.05);与对照组比较,研究组术后12个月反流性胆管炎发生率降低,术后3、6和12个月复发性胰腺炎发生率降低,差异均有统计学意义(P <0.05)。结论 胰管括约肌预切开术对ERCP困难插管患者全身炎症影响较轻,血淀粉酶指标正常,且未增加术后胰腺炎等并发症发生率,可提高插管成功率,远期疗效显著,安全、有效,值得临床应用。