Evaluation of a predictive model for pancreatic fistula based on amylase value in drains after pancreatic resection

Background: Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers. Methods: A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF. Results: A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained. Conclusions: Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF.

show abstract

“…Also, several different measures of amylase in either serum or drain fluids have been proposed to correlate with fistula risk. [ 102–104 ]…”

Section: Resultsmentioning

confidence: 99%

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Søreide

Labori

2016

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…Amylase, especially α-amylase, is an important biological product with its wide applications in clinical practice [1, 2] and in industry [3, 4]. For this reason, bacteria are considered as an important cell factory to produce α-amylase [5], especially a Gram-positive bacterium, Bacillus subtilis , because of its high yield of designed proteins [6, 7], its free of endotoxins, and its simplicity in terms of a few hundreds of proteins making up a viable cell [8].…”

Section: Introductionmentioning

confidence: 99%

Bottleneck in secretion of α-amylase in Bacillus subtilis

Yan

2017

Microb Cell Fact

View full text Add to dashboard Cite

Amylase plays an important role in biotechnology industries, and Gram-positive bacterium Bacillus subtilis is a major host to produce heterogeneous α-amylases. However, the secretion stress limits the high yield of α-amylase in B. subtilis although huge efforts have been made to address this secretion bottleneck. In this question-oriented review, every effort is made to answer the following questions, which look simple but are long-standing, through reviewing of literature: (1) Does α-amylase need a specific and dedicated chaperone? (2) What signal sequence does CsaA recognize? (3) Does CsaA require ATP for its operation? (4) Does an unfolded α-amylase is less soluble than a folded one? (5) Does α-amylase aggregate before transporting through Sec secretion system? (6) Is α-amylase sufficient stable to prevent itself from misfolding? (7) Does α-amylase need more disulfide bonds to be stabilized? (8) Which secretion system does PrsA pass through? (9) Is PrsA ATP-dependent? (10) Is PrsA reused after folding of α-amylase? (11) What is the fate of PrsA? (12) Is trigger factor (TF) ATP-dependent? The literature review suggests that not only the most of those questions are still open to answers but also it is necessary to calculate ATP budget in order to better understand how B. subtilis uses its energy for production and secretion.

show abstract

“…In clinical settings, great interest is directed to hyperamylasemia that is associated with pancreatitis (Elsayed et al 2014 ; Hernández Garcés et al 2014 ) and biliopancreatic duct ligation (Fishman et al 2014 ), and the α-amylase level in urine is also clinically meaningful (Voskuil et al 2014 ). Still, α-amylase serves as a predictor of pancreatic fistula (Partelli et al 2014 ), and a salivary biomarker for acute stress (Koh 2014 ), gastricaspiration (Sole et al 2014 ), etc. On the one hand, α-amylase plays a role in degradation of dietary components by digestive tract microbiotic flora (Tzuc et al 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis on evolutionary relationship of amylases from archaea, bacteria and eukaryota

Yan

2016

World J Microbiol Biotechnol

View full text Add to dashboard Cite

Amylase is one of the earliest characterized enzymes and has many applications in clinical and industrial settings. In biotechnological industries, the amylase activity is enhanced through modifying amylase structure and through cloning and expressing targeted amylases in different species. It is important to understand how engineered amylases can survive from generation to generation. This study used phylogenetic and statistical approaches to explore general patterns of amylases evolution, including 3118 α-amylases and 280 β-amylases from archaea, eukaryota and bacteria with fully documented taxonomic lineage. First, the phylogenetic tree was created to analyze the evolution of amylases with focus on individual amylases used in biofuel industry. Second, the average pairwise p-distance was computed for each kingdom, phylum, class, order, family and genus, and its diversity implies multi-time and multi-clan evolution. Finally, the variance was further partitioned into inter-clan variance and intra-clan variance for each taxonomic group, and they represent horizontal and vertical gene transfer. Theoretically, the results show a full picture on the evolution of amylases in manners of vertical and horizontal gene transfer, and multi-time and multi-clan evolution as well. Practically, this study provides the information on the surviving chance of desired amylase in a given taxonomic group, which may potentially enhance the successful rate of cloning and expression of amylase gene in different species.Electronic supplementary materialThe online version of this article (doi:10.1007/s11274-015-1979-y) contains supplementary material, which is available to authorized users.

show abstract

Evaluation of a predictive model for pancreatic fistula based on amylase value in drains after pancreatic resection

Cited by 43 publications

References 20 publications

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Bottleneck in secretion of α-amylase in Bacillus subtilis

Analysis on evolutionary relationship of amylases from archaea, bacteria and eukaryota

Contact Info

Product

Resources

About