Evaluation of Hemodialysis Patients’ Tumor Marker

Evaluation of Hemodialysis Patients’ Tumor Marker CEA tumor marker level associates comorbidity of hemodialysis patients Purposes: Hemodialysis (HD) affects serum concentration of biomarkers. However, it remains unclear about the effect of HD on the levels of biomarkers, and efficacy of biomarkers in HD. The aim of this study is to evaluate the effects of HD on commonly used tumor markers. Methods: A total of 28 unselected patients (22 men, 6 women) with end-stage renal disease (ESRD), treated with maintenance HD, were enrolled in this study. GOT and tumor markers CA-153, CA-125, and CEA are measured. Results: The mean age was 57.6  ± 12.6 years, HD duration was 51.0  ± 34.0 months. Tumor marker CEA level is correlated to Charlson’s score of HD patients, levels of CA153 and CA125 are not correlated to age, duration of dialysis and Charlson’s score. GOT level is correlated to age, and Charlson’s score. Mean value of CEA level (5.9 ±4.0 ng/ml compared to normal value of 3 ng/ml for non-smoker and 5 ng/ml for smoker) is larger than normal value. Levels of CA153 (13.3 ±11.6 U/ml), CA125 (35.2 ±38.9 U/ml) and GOT value (20.4 ±8.9 U/L) fall in normal range. Conclusions: Concentration of CEA tumor marker is correlated with Charlson’s score which strongly correlated with HD outcome. GOT value is correlated with age and Charlson’s score which implies liver function drop in long term HD patients. Keywords: biomarkers, End-Stage Renal Disease, evaluation, hemodialysis, CEA. Introduction Hemodialysis (HD) is widely used for kidney failure patients who may represent a variety of underlying causes, including diabetes, hypertension, and glomerulonephritis. The dialysis membrane in artificial kidney tube filtrates out small molecules especially for small molecular weight proteins (i.e., et. al. shows that cancer-free HD man demonstrated significantly lower PSA compared to controls [8]. Here we examine the serum level of commonly used molecular biomarkers, i.e., CA-153, CA125, CEA, and GOT of HD patients. Patient and materials Study subjects Experiments performed in this study complied with the current laws and regulations in Taiwan, Republic of China. All procedures are followed by the ethnical guideline and approved by Kaohsiung Armed Forces Hospital committee, Taiwan. A total of 28 persons between the ages of 37 and 76 years with end-stage renal disease, receiving dialysis treatment three times per week, were enrolled in a prospective study in March 2008. Dialysis was carried out using a Nikkiso DBB-22B dialysis machine with 4 hours session. Dialyzer with APS 18MD (Asahi Kasei, Osaka, Japan, polysulfone membrane, surface area 1.8 m2, in vitro clearances for urea, 198 ml/min for QB-200 ml/min). Blood flow rate was setting at 200 ml/min. Patients with vascular success insufficiency which can’t reach required blood flow rate was excluded. Ultrafiltration rate (512 ±85 ml/h) was adjusted according to the patients’ needs. The flow and temperature of the dialysate was 500 ml/min and 37oC, respectively. Vascu lar access was either via an arterio-venous fistula (sixteen treatments), graft (nine treatments), or a Perm catheter (three treatment). Serum CA-153, CA125, CEA, GOT levels were measured before and immediately after HD using low-flux membrane. Blood/serum collection Serum samples were collected from HD patients during and after the course of HD treatment. 5 ml blood was collected in EDTA tube. The serum were then stored in 4oC and processed within 12 hours. The serum samples were centrifuged at 2000 rpm for 10 min prior to splitting into aliquots and stored at -20oC. Laboratory methods The serum levels of CA-153, CA125, CEA and GOT were measured with Abbott Axsym analyzer (Abbott Laboratories, Abbott Park, III). The reference ranges of the markers were: CA-153, 0-31.3 U/ml; CA-125, 0-35 U/ml; CEA, 0-3 ng/ml for non-smoker, and 0-5 ng/ml for smoker; GOT, 0-32 U/L. Statistical analysis The data reported are means  ± standard deviations (SD). Pearson correlation coefficient (r) was used for analyses of linear associations. Because the concentrations of serum tumor markers were not normally distributed, significance of differences was assessed by Wilcoxon Matched-Pairs Signed-Ranks Test. The level of statistical significance was always set at P Results Baseline demographic and clinical data We analyzed 28 patients, of which 22 were men and 6 were women. The baseline demographic and clinical data are summarized in Table 1. All patients are diagnosed as end-stage renal failure. The mean age was 57.8  ± 12.6 years. Mean dialysis vintage was 51.0  ± 34.0 months. Measurement of tumor marker concentration of hemodialysis patients The mean value of CA-153, CA125, and GOT fall in normal range (16.5 ±16.3 before hemodialysis, and 18.6 ±16.3 after hemodialysis, compared with 31.3 U/ml normal value, 35.2 ±38.9 before dialysis, and 34.3 ±41.2 after hemodialysis, compared to Correlates of serum markers Correlations between serum markers levels and age, duration of dialysis and Charlson’s score are tested. Of all variables, patient age and Charlson’s score are correlated with levels of some serum markers. CEA level was correlated with Charlson’s score (r=0.42, p=0.03) (Fig. 1).GOT level was correlated with age (r=0.42, p=0.02) (Fig. 2) and Charlson’s score (r=0.48, p=0.01) (Fig. 3). Other variables, including CA-153, CA125 is not correlated with age (r=0.07, p=0.7; r=0.2, p=0.3, respectively), and also not correlated with duration of HD, Charlson’s score (Table 2). Direct effect of hemodialysis on concentration of serum markers Since the data of CA-153, CA125, CEA and GOT fail in normal distribution test, Wilcoson signed rank tested is chosen to compare groups before and after hemodialysis. Groups of CA-153, CA125, CEA, and GOT before hemodialysis are not significantly different to that after hemodialysis (Table 3). Discussion CA-153, CA-125, CEA are commonly used tumor markers. CA-125 is a glycoprotein with high molecular weight (> 200 kDa), and is a cancer antigen for monitor mesothelium especially for ovarian cancer. Recently, CA-125 is used to monitor mesothelial cell viability in PD patients [9,10]. CEA is carcinoembryonic antigen with a molecular weight about 180-200 kDa, commonly used for monitoring gastric cancer [11], weakly correlate with carotid atherosclerosis [12], and with prognostic value of colorectal cancer in PD patients [13]. The mean value of CEA of 28 patients is higher than normal value, which is consistent with previous reports that patients with ESRD are usually with higher risk of cancer, and with higher levels of tumor markers [14]. In our cases, patient no.2, 5, 9, 13 and 27 were expired within 1 year after diagnosis. Patient no. 2 is finally diagnosed as hepatoma, patient no. 5 is cirrhosis of liver and died in septicemia, patient no. 9 is died in leukemia, and patient no 13 is died in lung cancer. It shows that high levels of CEA correlated with Charlson’s score which implies poor outcome, however it remain further confirmation. CA-153 is correlated to risk of liver disease. Though 8% patients were diagnosed liver diseases, but their GOT value fall in normal range, and CA-153 values of them were also normal. There are many reports indicated that long term hemodialysis may affect levels of biomarkers. We showed that biomarkers alter non-significantly after one HD procedure. It is interesting that recent report indicated acute effects of HD treatment on up- or down regulation of apoptotic genes in blood leucocytes [15] Tumor markers were produced by neoplastic cells, and can also be secreted by normal tissue. Many chronic diseases, e.g., inflammation, chronic bronchitis, cirrhosis of liver and renal diseases, affect the metabolism and elimination of tumor markers, may contribute the long term elevation of tumor markers. Our data show that short term effect of HD on patients is not significant. And all 4 serum markers are not correlated with duration of HD. It seems that the response of patients to HD doesn’t directly affect levels of these serum markers. However, CEA and GOT are shown to be candidates markers for monitoring HD outcome as they are positively correlated with Charlsonà ¢â‚¬â„¢s score. Table I Baseline demographic and clinical data GFR, glomerular filtration rate; NPCR, normalized protein catabolic rate, *Modified Charlson’s comorbidity score is calculated according to Beddhu S, 2000. Table II. Correlation of serum markers and age, duration of HD, and Charlson’s score. Table III. Comparison of serum tumor markers before and after hemodialysis Legends to Figures Figure 1.Scatter plots, regression line, and 95% confidence intervals reflecting correlations between serum levels of CEA and Charlson’s score of 28 HD patients. Figure 2.Scatter plots, regression line, and 95% confidence intervals reflecting correlations between serum levels of GOT and Charlson’s score of 28 HD patients. Figure 3.Scatter plots, regression line, and 95% confidence intervals reflecting correlations between serum levels of GOT and age of 28 HD patients.

Free Essays: Odysseus of the Odyssey and Moses of Exodus :: comparison compare contrast essays

Odysseus of the Odyssey and Moses of Exodus The Book of Exodus is considered to be an epic poem as by definition. An epic poem as defined by Funk and Wagnalls is a poem celebrating in stately, formal verse the achievements of heroes, gods, and demigods (426). The Book of Exodus as well as the entire Bible was written in the form of an epic poem. Major characteristics of epic poems are that there is always a heroic figure. Moses is indeed comparable to Odysseus, the heroic figure in the Odyssey. Although both men had different purposes they are still considered comparable according to the definition of an epic. Like Odysseus, Moses was at one with the gods. In Moses' case it was only one almighty god. Moses had a special covenant with God. It was as if Moses was Gods' body on earth. Moses spoke Gods' words and acted upon his request. Moses possessed many characteristics that made him a great man. In the Exodus there were many examples where Moses showed his great wisdom. He also possessed somewhat magical power given to him by God. He also had a divine purpose in life. Moses was on a "mission from god" so to speak to deliver his people from bondage. His mission was similar to those of other typical epics. It was of course a very dangerous and exhausting journey that lasted a very long time. There were many obstacles to overcome as well as internal affairs among the Hebrews. Moses was born a Hebrew but was raised as the prince of Egypt. Just like Odysseus, Moses was a man of nobility. Moses did not know he was a Hebrew until he was a much older man. He was living a lie without even realizing it. "And it came to pass in those days, when Moses was grown, that he went out unto his brethren, and looked on their burdens: and he spied an Egyptian smiting an Hebrew, one of his brethren (Exodus 2. 11). It was then that Moses realized who he was, but he was still unaware of his destiny to lead his people out of bondage. When Moses realized who he was he fled to the land of Midian. Free Essays: Odysseus of the Odyssey and Moses of Exodus :: comparison compare contrast essays Odysseus of the Odyssey and Moses of Exodus The Book of Exodus is considered to be an epic poem as by definition. An epic poem as defined by Funk and Wagnalls is a poem celebrating in stately, formal verse the achievements of heroes, gods, and demigods (426). The Book of Exodus as well as the entire Bible was written in the form of an epic poem. Major characteristics of epic poems are that there is always a heroic figure. Moses is indeed comparable to Odysseus, the heroic figure in the Odyssey. Although both men had different purposes they are still considered comparable according to the definition of an epic. Like Odysseus, Moses was at one with the gods. In Moses' case it was only one almighty god. Moses had a special covenant with God. It was as if Moses was Gods' body on earth. Moses spoke Gods' words and acted upon his request. Moses possessed many characteristics that made him a great man. In the Exodus there were many examples where Moses showed his great wisdom. He also possessed somewhat magical power given to him by God. He also had a divine purpose in life. Moses was on a "mission from god" so to speak to deliver his people from bondage. His mission was similar to those of other typical epics. It was of course a very dangerous and exhausting journey that lasted a very long time. There were many obstacles to overcome as well as internal affairs among the Hebrews. Moses was born a Hebrew but was raised as the prince of Egypt. Just like Odysseus, Moses was a man of nobility. Moses did not know he was a Hebrew until he was a much older man. He was living a lie without even realizing it. "And it came to pass in those days, when Moses was grown, that he went out unto his brethren, and looked on their burdens: and he spied an Egyptian smiting an Hebrew, one of his brethren (Exodus 2. 11). It was then that Moses realized who he was, but he was still unaware of his destiny to lead his people out of bondage. When Moses realized who he was he fled to the land of Midian.

A Memorable Moment in My Life

There are many memorable moments in my life, but the one that stands out most to me would be the day that my husband Eric got bit by a copperhead snake. I was working as a dental assistant at the time and we would go to the nursing home once a week and see patients there. I had just arrived to the nursing home and was getting everything set up and ready for the dentist, as I was doing so my phone rang. It was a guy named Gary that Eric worked with.He said, â€Å"Tina this is Gary and I need you to stay calm when I tell you this. I said, â€Å"Gary what is it just tell me what is going on? † He then began to tell me that he and Eric were walking up a hill to spray the ride away and when Eric got to the top of the hill he put his hand down to pull himself up and put his hand right on the copperhead and it latched onto his thumb and bit him. Gary told me that he was already in the ambulance and on his way to the hospital, but his hand was already swollen really bad and had turn black.I quickly got off the phone and went straight to Paul B. Hall Regional Medical Center the hospital they were taking Eric to. I arrived at the same time he did I ran up to the Doctor at the E. R. his name was Dr. Arnold. I ask him is he going to be okay because I knew that he had gotten a lot of the venom because his arm was twice the size it normally was. Dr. Arnold told me he would take good care of him and make sure he had the best care possible.He had nurses in the room for 13 hours measuring his arm and taking his vitals. And after about thirteen hours of praying God stopped the swelling and he got to go home. I stayed up all night checking his vitals myself and measuring every fifteen minutes and by the grace of God he didn’t loose any fingers or his hand and that was a big concern. Although he does have a lot of significant damage he is alive and that’s what matters to me.

The State Of Georgia Have Quality Early Childhood Education

†¢ Purpose The purpose of this policy is to ensure that all children in the state of Georgia have quality Early Childhood Programs that are accessible, affordable, comprehensive, and sustainable. Crafting strategic and thoughtful policy in the forefront will ensure the academic achievement, social development and future success of the state’s youth. †¢ Scope This policy will aim to address the social, academic and general health needs of all children from birth to the age of 8 years in the state of Georgia. Key players (stakeholders) include students, parents, educators, community members, community leaders and policymakers in Georgia. †¢ Definitions o Early Childhood Education o Low socioeconomic status o Certified teacher o Prison Pipeline o Holistic Education o Cradle to College †¢ Background and Rationale The Need: Time and time again, people agree upon the need for and the benefits of an early childhood education system, but very little change takes place. 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