Cystatin C for early detection of renal impairment in diabetes

ObjectivesEvaluation of glomerular filtration rate is of crucial importance in diabetes. Cystatin C, a cysteine protease inhibitor seems to be an interesting parameter.Design and methods67 diabetic patients with normal creatinine are evaluated. Cystatin C is compared to renal markers, by reference to Cr EDTA clearance.ResultsSignificant correlations are found between cystatin C and creatinine (r = 0.54). GFR MDRD (r = ? 0.47) and GFR Cr EDTA (r = ? 0.47). The AUC of the receiver operating curves is better for GFR MDRD (0.83) and cystatin C (0.75) than for creatinine (0.63) considering the cut off value of 80 mL/min for GFR EDTA.ConclusionCystatin C seems to be a more sensitive parameter than creatinine for the detection of an incipient nephropathy in diabetes.     

The age related association is more pronounced for cystatin C estimated GFR than for creatinine estimated GFR in primary care patients

ObjectivesThere is an age associated change in GFR but this association may be influenced by the method used. The aims of the present study were to assess the association between age and cystatin C and creatinine based glomerular filtration rate estimates in primary care patients, and to determine the proportion of patients with clinically important renal impairment.Materials and methods1552 samples with simultaneous requests for creatinine and cystatin C from 1552 primary care patients in the county of Uppsala, Sweden were analysed. MDRD, CKD-EPI and cystatin C equations were used to calculate glomerular filtration rate (GFR) and the associations between GFR and age were explored.ResultsThe yearly change in cystatin C estimated GFR was 1.24 mL/min/1.73 m² while the corresponding decline for creatinine estimated GFR was 0.76 mL/min/1.73 m² for MDRD and 0.99 mL/min/1.73 m² for CKD-EPI.ConclusionsThe age related association with GFR estimates is smaller for creatinine estimates than for cystatin C estimates. This leads to differences in the number of patients with reduced eGFR detected with the three estimates and the patient treatment will depend on the estimate used. This is not coherent with a good patient care and we thus need to develop new eGFR equations with better agreement between the estimates.     

Estimated glomerular filtration rate for drug dose adjustment: Cockcroft and Gault or abbreviated MDRD equation?

ObjectivesEvaluate if Cockcroft and Gault (CG) estimated glomerular filtration rate (eGFR) might be replaced by abbreviated MDRD eGFR for drug dose adjustment.Design and methodseGFR was determined in 140 hospitalized patients (median: 68 years, 65 kg) treated by nephrotoxic and/or renally cleared drugs.ResultsCG eGFR was 61 mL/min vs. 78 mL/min/1.73 m² for MDRD (p < 0.0001). CG-MDRD difference ranged from ? 93 to + 34 mL/min, influenced by patient age, weight, and gender (p < 0.001).ConclusionsCG eGFR cannot be easily replaced by abbreviated MDRD eGFR for drug dose adjustment.     

Serum vascular adhesion protein-1 is higher in subjects with early stages of chronic kidney disease

ObjectivesAn increased level of serum vascular adhesion protein-1 (VAP-1) has been found in patients with diabetes mellitus and vascular disorders. This study examined whether serum VAP-1 levels are associated with chronic kidney disease (CKD).Design and methodsWe included 262 subjects aged 30 and above with fasting plasma glucose level < 7 mmol/L checked within 1 year. First morning urine specimens were collected. Microalbuminuria was defined if urinary albumin-to-creatinine ratio ≥ 30 μg/mg creatinine. The glomerular filtration rate (GFR) was estimated. CKD stages were defined according to the suggestions of the National Kidney Foundation. Serum VAP-1 levels were analyzed by immunofluorometric assay.ResultsSerum VAP-1 levels were positively associated with the urinary albumin-to-creatinine ratio ( r = 0.29, p < 0.0001) and negatively associated with estimated GFR (r = ?0.24, p =  0.0001). Subjects with CKD stage 2 (N =  51) and stage 3 (N =  91) had significantly higher levels of serum VAP-1 than those without CKD (p =  0.0003 and p =  0.035, adjusted for age and gender, respectively). A high serum VAP-1 level was associated with the presence of CKD (OR 1.63 for 1 SD increase of VAP-1, p =  0.018), adjusting for age, sex, and smoking. Ordered logit models revealed that high serum VAP-1 levels correlated with advanced stages of CKD.ConclusionsSerum levels of VAP-1 are associated with the severity of kidney damage or stages of kidney disease. The true mechanism which links the serum VAP-1 and CKD remains to be elucidated in further studies.     

Cystatin C as a predictor of all-cause mortality and myocardial infarction in patients with non-ST-elevation acute coronary syndrome

ObjectivesTo investigate the predictive value of cystatin C among patients diagnosed with non-ST-elevation acute coronary syndrome (nSTE-ACS).Design and methodsAdmission serum samples from 245 nSTE-ACS patients were measured with a novel cystatin C immunoassay based on a dry-reagent, double monoclonal design. Creatinine concentrations, estimated glomerular filtration rates (eGFR) and one-year follow-up data were available for these patients.ResultsDuring the follow-up period, 34 (14%) of patients had myocardial infarction (MI) and 25 (11%) died. Increased serum cystatin C was an independent predictor of all-cause mortality and combined events (all-cause mortality and MI) after adjustment to non-biomarker baseline factors, hazard ratio (HR) 2.19 (per increase of 1 tertile; 95% Cl 1.28–3.78, p = 0.0046) and 1.75 (1.22–2.51, p = 0.0024), respectively. Corresponding values for eGFR were 2.56 (1.43–4.59, p = 0.0016) and 1.76 (1.23–2.53, p = 0.0022), respectively. Creatinine was not an independent predictor of endpoints (p > 0.05).ConclusionsCystatin C was associated with an increased risk of death and combined events in patients with nSTE-ACS.     

Staff outcomes from the caring for aged dementia care resident study (CADRES): a cluster randomised trial

BackgroundDementia care mapping and person centred care are well-accepted as processes for improving care and well-being for persons with dementia living in the residential setting. However, the impact of dementia care mapping and person centred care on staff has not been well researched.ObjectivesThe impact of person centred care and dementia care mapping compared to each other and to usual dementia care on staff outcomes was examined in terms of staff burnout, general well-being, attitudes and reactions towards resident behavioural disturbances, perceived managerial support, and quality of care interactions.DesignA cluster-randomised, controlled trial.SettingsThe study was conducted between 2005 and 2007 in 15 residential aged care sites in the Sydney metropolitan area, Australia, with comparable management structures, staffing mix and ratios, and standards of care.Participants194 consenting managers, nurses, therapists and nurse assistants working in the participating sites.MethodsIntervention care sites received training and support in either person centred care (n = 5) or dementia care mapping (n = 5); control sites continued with usual dementia care (n = 5). Staff outcomes of those three groups were assessed before, directly after the four month intervention (post) and after a further four months (follow-up). The primary outcome measures were the Maslach Burnout Inventory-Human Services Survey and the 12-item General Health Questionnaire. Analysis involved repeated measures analyses of variance for each of the outcome measures and adjustment for potential confounders to limit bias.ResultsThe Maslach Burnout Inventory-Human Services Survey results showed that change over time in emotional exhaustion scores differed between the three groups. Post-hoc analyses for each group separately revealed that the only significant time effect was in the dementia care mapping group (p = 0.006), with emotional exhaustion scores declining over time. At baseline, more perceived support from management was associated with less emotional exhaustion (r_s = 0.26, p = 0.004, n = 122) and less depersonalisation (r_s = 0.21, p = 0.023, n = 122), but not for any of the other outcome measures.ConclusionsThis study has shown that person centred approaches of care, in particular with dementia care mapping, may contribute to reducing staff job related burnout. The findings also highlight a potentially important role of managerial support and a whole of system approach.     

Tools for measuring the impact of informal caregiving of the elderly: a literature review

Objectives(1) Describe available tools to assess the impact of informal caregiving of home-dwelling elderly, (2) identify an acceptable and appropriate tool for a study aiming at the evaluation of the impact of innovative projects for care and support of care for elderly at home, on their main informal caregiver and (3) find a definition of ‘main informal caregiver’.Study designLiterature review by searches of the following electronic databases: MEDLINE, CINAHL, EMBASE, using firstly keywords and exclusion criteria, then citations and reference search.ResultsThis review has identified 105 scales assessing the impact of informal caregiving of the elderly. Those scales were described in terms of characteristics of the care receiver population, content and psychometric properties. Most retrieved scales are intended to measure the impact of caregiving on caregivers’ health of elderly with dementia (n = 49), overall elderly (n = 21), cancer patients (n = 7), chronically ill patients (n = 7), psychiatric patients (n = 7) and stroke patients (n = 3).Dimensions of the impact of caregiving were classified into its positive (n = 34), negative (n = 55) or neither positive nor negative (n = 16) consequences on the informal caregiver's health. Internal consistency varied from 0.48 to 0.99 and in half of the cases (n = 52), construct validity was reported. Scales comprised 1–200 questions. The Zarit Burden Interview (ZBI-12) was selected for the study and an operational definition of the concept of “main informal caregiver” was constructed.ConclusionThis review identified a large number of scales that can be used to assess the impact of caregiving, viewed through different dimensions. The Zarit Burden Interview can be a useful tool for researchers and clinicians due to its user-friendliness, extensively validation and international use, making comparisons between groups possible. Despite the fact that only the original version of each scale was selected, this inventory should be a useful tool for intervention studies and even clinicians work.     

It Is “Too Late” or Is It? Bereaved Family Member Perceptions of Hospice Referral When Their Family Member Was on Hospice for Seven Days or Less

ContextMany family members of patients enrolled in hospice for less than seven days state that the hospice referral was made “at the right time.”ObjectivesTo examine bereaved family members’ perceptions of the timing of hospice referral to identify aspects of the referral process that can be improved.MethodsOpen-ended interviews were conducted in seven hospice programs, interviewing bereaved family members of hospice patients who died within the first week of hospice enrollment.ResultsOf the 100 narrative interviews, 99 respondents stated that their family member was either referred “too late” (n = 41) or “at the right time” (n = 58) to hospice services. When families stated that referral was “at the right time,” their perceptions were based on the patient having refused earlier referral (n = 8), a rapid decline in the patient’s condition resulting in the late referral (n = 20), or a belief in all things coming together as they were meant to (n = 11). In contrast, when families stated that referral was “too late,” their reasons were centered on concerns with the health care providers’ role in decision making (n = 24), with the leading concerns being inadequate physician communication (n = 7), not recognizing the patient as dying (n = 11), or problematic hospice delays in referral from the nursing home or home health agency (n = 4). Despite the patient refusing an earlier hospice referral, five family members believed the referral was “too late.”ConclusionWhereas family members identified expected concerns with communication, more than one in three stated an earlier hospice referral was not possible.     

Oxidative modification of patient's plasma proteins and its role in pathogenesis of multiple sclerosis

BackgroundOxidative stress plays an important role in multiple sclerosis (MS).Objective and methodsThe present study was designed to evaluate the modifications of plasma proteins by estimation markers of oxidative/nitrosative stress: carbonyl groups and 3-nitrotyrosines (3-NT) levels in relapsing-remitting (RR) (n = 10) and secondary progressive (SP) (n = 10) clinical course of multiple sclerosis. Moreover, we estimated the level of uric acid (UA) in plasma of MS patients.ResultsCompared to controls (n = 10), the levels of carbonyl groups in plasma proteins were elevated (P < 0.0001) as well in RRMS as in SPMS. The highest concentration of 3-NT was observed in plasma proteins obtained from SPMS patients (P < 0.0005). The level of uric acid in plasma was significantly lower in RRMS (P < 0.0001) than SPMS.ConclusionThis is the first report which presented differences between SPMS and RRMS patients in 3-NT and protein carbonyl groups in plasma proteins.     

Reference intervals for serum creatinine with enzymatic assay and evaluation of four equations to estimate glomerular filtration rate in a healthy Chinese adult population

BackgroundWith the wide usage of enzymatic assays to determine serum creatinine (Scr) in China, reference interval (RI) needs to be established. At the same time, the performance of Scr based equations to calculate estimated glomerular filtration rate (eGFR) in healthy Chinese adults has not been extensively investigated.MethodsThis study has strictly followed the International Federation of Clinical Chemistry (IFCC) recommendations and the Clinical Laboratory Standards Institute (CLSI) C28-A2 document. A total number of 778 healthy Chinese adults (male 433, female 345) were enrolled in this study.ResultsBy nonparametric method, RIs for males were: < 60 years, 58–93 μmol/l and > 60 years, 54–109 μmol/l; RIs for females were: < 60 years, 42–69 μmol/l and > 60 years, 43–83 μmol/l. Modification of Diet in Renal Disease (MDRD) equation and MDRD for Japanese made the percentage of eGFR > 90 ml/min/1.73 m² 31.7% and 4.9%; percentage of eGFR 60–89 ml/min/1.73 m² 65.2% and 64.0%, respectively. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and CKD-EPI for Asian made the percentage of eGFR > 90 ml/min/1.73 m² 89.2% and 94.0%; percentage of eGFR 60–89 ml/min/1.73 m² 10.3% and 5.7%, respectively.ConclusionScr RIs of healthy Chinese adults were found to be lower than those of Caucasians. Two MDRD equations underestimated GFR, while two CKD-EPI equations seemed to estimate a reasonable distribution of eGFR in healthy Chinese adult populations.     

Exploring generalizability in a study of costs for community-based palliative care

ContextPalliative care researchers face challenges recruiting and retaining study subjects.ObjectivesThis article investigates selection, study site, and participation biases to assess generalizability of a cost analysis of palliative care program (PCP) clients receiving care at home.MethodsStudy subjects’ sociodemographic, geographic, survival, disease, and treatment characteristics were compared for the same year and region with those of three populations. Comparison I was with nonstudy subjects enrolled in the PCP to assess selection bias. Comparison II was with adults who died of cancer to assess study site bias. Comparison III was with study-eligible persons who declined to participate in order to assess participation bias.ResultsComparison I: When compared with the other 1010 PCP clients, the 50 study subjects were on average 3.6 years younger (P = 0.03), enrolled 70 days longer in the PCP (P < 0.001), lived 6.7 km closer to the PCP (P < 0.0001), and were more likely to have cancer (96.0% vs. 86.4%, P = 0.05). Comparison II: Compared with all cancer decedents, the 45 study subjects who died of cancer were on average 7.0 years younger (P < 0.001), lived 2.7 km closer to the PCP (P < 0.001), and were more likely to have had radiotherapy (62.2% vs. 33.8%, P < 0.0001) and medical oncology (28.9% vs. 14.8%, P = 0.01) consultations. Comparison III: The 50 study subjects lived on average 42 days longer after their diagnosis (P = 0.03) and 2.6 km closer to the PCP (P = 0.01) than the 110 eligible persons who declined to participate.ConclusionIf the study findings are applied to populations that differ from the study subjects, inaccurate conclusions are possible.     

"It depends": viewpoints of patients, physicians, and nurses on patient-practitioner prayer in the setting of advanced cancer

ContextAlthough prayer potentially serves as an important practice in offering religious/spiritual support, its role in the clinical setting remains disputed. Few data exist to guide the role of patient-practitioner prayer in the setting of advanced illness.ObjectivesTo inform the role of prayer in the setting of life-threatening illness, this study used mixed quantitative-qualitative methods to describe the viewpoints expressed by patients with advanced cancer, oncology nurses, and oncology physicians concerning the appropriateness of clinician prayer.MethodsThis is a cross-sectional, multisite, mixed-methods study of advanced cancer patients (n = 70), oncology physicians (n = 206), and oncology nurses (n = 115). Semistructured interviews were used to assess respondents’ attitudes toward the appropriate role of prayer in the context of advanced cancer. Theme extraction was performed based on interdisciplinary input using grounded theory.ResultsMost advanced cancer patients (71%), nurses (83%), and physicians (65%) reported that patient-initiated patient-practitioner prayer was at least occasionally appropriate. Furthermore, clinician prayer was viewed as at least occasionally appropriate by the majority of patients (64%), nurses (76%), and physicians (59%). Of those patients who could envision themselves asking their physician or nurse for prayer (61%), 86% would find this form of prayer spiritually supportive. Most patients (80%) viewed practitioner-initiated prayer as spiritually supportive. Open-ended responses regarding the appropriateness of patient-practitioner prayer in the advanced cancer setting revealed six themes shaping respondents’ viewpoints: necessary conditions for prayer, potential benefits of prayer, critical attitudes toward prayer, positive attitudes toward prayer, potential negative consequences of prayer, and prayer alternatives.ConclusionMost patients and practitioners view patient-practitioner prayer as at least occasionally appropriate in the advanced cancer setting, and most patients view prayer as spiritually supportive. However, the appropriateness of patient-practitioner prayer is case specific, requiring consideration of multiple factors.     

Prediction of the neurological outcome with intrathecal high mobility group box 1 and S100B in cardiac arrest victims: a pilot study

ObjectivesTo investigate whether high mobility group box 1 (HMGB1) and S100B in cerebrospinal fluid (CSF) and the serum predict the neurological outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA).Materials and methodsThis study was designed as a prospective observational study. Twenty-five patients, who received standard cardiopulmonary resuscitation and post-resuscitation intensive care, were enrolled in this study. The patients were divided into two groups according to Glasgow-Pittsburgh Cerebral Performance categories (CPCs) at 6 months after return of spontaneous circulation (ROSC), Group G (n = 7, CPC 1 or 2) and Group P (n = 18, CPC ≥ 3). Their blood samples were taken at 6, 24, and 48 h after ROSC. The patients, whose CSF was sampled at 48 h, were also divided into either sub-Group G (n = 6) or sub-Group P (n = 8) at 6 months after ROSC.ResultsHMGB1 and S100B in CSF in sub-Group P were significantly higher than those in sub-Group G (HMGB1, <1.0 vs. 12.4 ng/ml, P = 0.009; S100B, 2.68 vs. 84.2 ng/ml, P = 0.007, respectively). HMGB1 in CSF was strongly correlated with S100B (σ = 0.81, P = 0.001). HMGB1 was elevated in serum at 6 h and normalized within 48 h after ROSC without any significant differences between the two groups. Serum S100B in Group P was significantly higher than that in Group G at each time point.ConclusionsThe significant elevations of HMGB1 and S100B in CSF, and S100B in serum are associated with the neurologically poor outcome in OHCA patients.     

The alarm secretory leukocyte protease inhibitor increases with progressive metabolic dysfunction

BackgroundSecretory leukocyte protease inhibitor (SLPI) is an alarm antiprotease secreted by neutrophils and mucous membranes that potently inhibits the inflammatory cascade; however, the role of SLPI in human disease remains largely unknown. We hypothesized that SLPI is related to chronic low-grade inflammatory diseases, such as metabolic syndrome (MS) or type-2 diabetes (T2DM).MethodsWe examined associations between circulating SLPI (ELISA) and quantitative traits of MS (ATPIII criteria) in 261 Caucasian men with various degrees of metabolic dysfunction. Subjects had neither MS nor T2DM (n = 140), either diagnosis (n = 44) or both diagnoses (n = 77).ResultsCirculating SLPI increased with progressive metabolic dysfunction, with a mean increase of 4.4 ng/ml (95% IC 2.4 to 6.3 ng/ml; p < 0.001) for each unit increase in the criteria used to define MS. Circulating SLPI showed independent associations with uric acid [β = 5.1 (95% CI 3.4 to 6.7), p < 0.00001], serum lipids, pulse pressure and inflammatory markers.ConclusionsCirculating SLPI increases with progressive metabolic dysfunction and is related to metabolic and inflammatory parameters in men.     

Particle enhanced turbidimetric immunoassay for the determination of urine cystatin C on Cobas c501

ObjectiveUrinary cystatin C has been reported to be a good marker for tubular damage and acute kidney injury. The aim of this study was to develop a high throughput assay for the quantification of urine cystatin C.MethodsAntigen-excess, imprecision, interference, linearity, recovery, sample stability and reference values were evaluated on Cobas c501.ResultsThe assay was linear over the dynamic range of the study (R² = 0.9994). The total assay imprecision was below 5%. The assay recovery was estimated at 87–100%. No tendency to antigen-excess (up to 35 mg/L), nor interference with haemoglobin (1.25–10 g/L) was observed. Cystatin C was stable for 1 day at ambient temperature (19–23 °C) but for 2 days at + 4 °C. The reference interval for cystatin C in urine was < 0.414 mg/L.ConclusionsThe urinary cystatin C assay verified to be a reliable assay with convenient performance characteristics, enabling routine testing on clinical chemistry platforms.     

Assessment of urinary γ-glutamyltransferase and alkaline phosphatase for diagnosis of diabetic nephropathy

BackgroundUrinary biomarkers of tubular damage can be useful for early diagnosis of diabetic nephropathy. Thus, the aim of this study was to test the diagnostic accuracy of the urinary excretion of γ-glutamyltransferase (GGT) and alkaline phosphatase (ALP) for diagnosis of diabetic nephropathy (DN).MethodsFasting glucose, fructosamine, serum creatinine, glomerular filtration rate (GFR), serum uric acid, serum albumin, and urinary albumin, creatinine, GGT and ALP were assessed in 74 type 2 diabetic patients without nephropathy and 38 type 2 diabetic patients with nephropathy.ResultsUrinary GGT and ALP were threefold higher in type 2 diabetic patients with nephropathy. Significant correlations were observed between urinary albumin and GGT (r = 0.439, P < 0.001) and urinary albumin and ALP (r = 0.305, P < 0.01). Areas under the curve for GGT and ALP were 0.7696 (P < 0.001) and 0.7233 (P < 0.001), respectively. At a cut-off value of 72 U/g creatinine, GGT demonstrated a sensitivity of 96.0% and a specificity of 52.6%. At a cut-off value of 20 U/g creatinine, ALP demonstrated a sensitivity and specificity of 83.8% and 36.8%, respectively.ConclusionsUrinary GGT and ALP have potential value in the diagnosis of nephropathy in type 2 diabetic patients, but GGT has a slightly higher ability to discriminate nephropathy than ALP.     

Postsurgical inflammatory response is not associated with increased serum cystatin C values

ObjectivesCystatin C is used both as a glomerular filtration (GFR) marker and a cardiovascular risk marker. There are several studies showing an association between cystatin C and inflammatory markers and it has been suggested that the inflammatory response in itself could result in elevated cystatin C levels. The aim of this study was to evaluate if an induced inflammatory response has an effect on cystatin C levels in humans.Materials and methodsCRP and cystatin C were analyzed in serum samples from orthopedic surgery patients (n = 29). The patients were sampled prior to surgery and four and thirty days after surgery.ResultsThe surgery induced a pronounced CRP elevation on day four, median 137.3 (interquartile range 104.1–178.2) mg/L compared to 1.94 (1.20–8.70) mg/L before surgery, P < 0.001, but no significant difference in cystatin C levels before and four and thirty days after surgery could be seen.ConclusionsThe orthopedic surgery-induced inflammatory response does not cause changes in cystatin C levels.     

Validation of the Taiwanese version of the Athens Insomnia Scale and assessment of insomnia in Taiwanese cancer patients

ContextIt is well known that insomnia is highly prevalent in cancer patients. Although various studies have used the Athens Insomnia Scale (AIS) for insomnia assessment, it has never been applied to cancer patients with insomnia.ObjectivesThe purpose of this study was to establish the reliability and validity of the Taiwanese AIS version (AIS-T) and evaluate the severity of insomnia among cancer patients in Taiwan.MethodsUsing a cross-sectional research design, 195 cancer patients (n = 195) were recruited from outpatient oncology clinics.ResultsCronbach’s alpha for internal consistency was 0.83, and the test-retest reliability was 0.94 over an interval of three days, based on a sample of 30 patients. Moreover, concurrent validity could be evaluated by significant correlations of the AIS-T with the Pittsburgh Sleep Quality Index-Taiwan form (PSQI-T) (r = 0.82, P < 0.001) and sleep efficiency measured by Actiwatch parameters (r = ?0.54, P < 0.001). Construct validity could be established by the Brief Fatigue Inventory-Taiwan form (r = 0.56, P < 0.001) and Medical Outcomes Study Short Form-36-Taiwanese version (physical component summary: r = ?0.52, P < 0.001; mental component summary: r = ?0.53, P < 0.001). The AIS-T could detect significant known-group validity from sleep quality (PSQI-T ≥5 or <5, respectively). The Actiwatch parameters are consistent with the results of the AIS-T, and both data sets indicate that patients experienced sleep disturbances. The prevalence of insomnia, as defined by the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th ed., was 22.56%; 49.2% subjects had significant insomnia at the score ≥6 at AIS-T.ConclusionThis study concludes that the AIS-T is a reliable and valid instrument for assessing insomnia among cancer patients in Taiwan.     

Specific increase in serum autotaxin activity in patients with pancreatic cancer

ObjectivesTo evaluate the potential clinical significance of serum autotaxin (ATX) level in patients with cancers of the digestive system.Design and methodsSerum ATX activity was measured as the lysophospholipase D activity in patients with cancer of the esophagus (n = 8), stomach (n = 18), colorectum (n = 21), biliary tract (n = 19), or pancreas (n = 103) and in patients with benign pancreatic diseases (n = 73).ResultsAmong patients with various cancers of digestive system, increased serum ATX activity was predominantly observed among pancreatic cancer patients. Serum ATX activity was not increased in patients with chronic pancreatitis or pancreatic cysts. In the diagnosis of pancreatic cancer, the area under the receiver operating curve for serum ATX activity was 0.541 (95% CI, 0.435–0.648) for men and 0.772 (95% CI, 0.659–0.885) for women. No significant correlation was observed between serum ATX activity and CEA, CA19-9 or Dupan2 levels.ConclusionSerum ATX activity may be useful for identifying pancreatic cancer when used together with other serum markers of pancreatic cancer.