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Keslova P, Formankova R, Riha P, Sramkova L, Snajderova M, Malinova B, Luks A, Sterba J, Stary J, Sedlacek P. Total body irradiation is a crucial risk factor for developing secondary carcinomas after allogeneic hematopoietic stem cell transplantation in childhood. Neoplasma 2020; 67:1164-1169. [PMID: 32657609 DOI: 10.4149/neo_2020_200214n131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/30/2020] [Indexed: 11/08/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) has become a standard part of therapy for a variety of malignant and non-malignant disorders. With improved outcomes after HSCT, increasing attention has been drawn to late complications in long-term survivors. The development of secondary malignancies is recognized as one of the most serious complications. We have evaluated data from 426 patients (272 males, 154 females) who underwent allogeneic transplantation at a median age of 7.9 years from 1989 till 2017 and were alive more than one year after transplantation for the occurrence of secondary solid tumors. We have documented the occurrence of secondary solid tumors in 20 patients (4.7%). The median duration of the development of secondary solid cancer from HSCT was 11.7 (range, 5.4-21.5 years). 18 out of 20 patients (90%) had total body irradiation (TBI) 12-14.4 Gy as a part of a conditioning regimen. All but two had transplantation for malignant disease. All patients underwent surgery and/or chemo-radiotherapy. Eighteen are alive, and two died due to the progression of their secondary malignancy. The most frequent solid cancer was thyroid carcinoma (n=9). Cumulative incidence of secondary solid cancer in all groups was 15.2±3.9%, in a group using TBI based regimen 34.7±8.9%, in non-TBI (only chemo) group was 1.5±1.1%. Overall, the cumulative incidence is statistically significantly different between the TBI based and non-TBI (chemo only) group. The incidence and number of complications following allogeneic HSCT in childhood are increasing in time. The early diagnosis of secondary malignancies is one of the key tasks of long-life multidisciplinary post-transplant care.
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Affiliation(s)
- P Keslova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - R Formankova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - P Riha
- Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - L Sramkova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - M Snajderova
- Department of Pediatrics, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - B Malinova
- Department of Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - A Luks
- Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - J Sterba
- Department of Pediatric Oncology, University Hospital Brno and School of Medicine, Masaryk University, Brno, Czech Republic
| | - J Stary
- Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
| | - P Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, 2nd Medical School, Charles University Prague, Prague, Czech Republic
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Krejci D, Zapletalova M, Svobodová I, Pehalova L, Muzik J, Klimes D, Snajdrova L, Bajciova V, Múdrý P, Kodýtková D, Smelhaus V, Janotova I, Vrzalová A, Luks A, Sterba J, Starý J, Dusek L. Epidemiological Trends for Childhood and Adolescent Cancers in the Period 1994-2016 in the Czech Republic. Klin Onkol 2020; 32:426-435. [PMID: 31842561 DOI: 10.14735/amko2019426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Our study aimed to evaluate incidence and mortality trends for childhood and adolescent cancers in the period 1994-2016 in the Czech Republic. MATERIAL AND METHODS Data on childhood cancers, which are recorded in the Czech National Cancer Registry, were validated using a clinical database of childhood cancer patients and combined with data from the National Register of Hospitalised Patients and with data from death certificates. These validated data were used to establish cancer incidence. Data from death certificates were used to evaluate long-term trends in mortality. Incidence and mortality trends were assessed by the average annual percentage change. RESULTS The age-standardised incidence trend for childhood cancers (i.e. those diagnosed in patients aged 0-19 years) showed a statistically significant slight long-term increase in the number of new cases, +0.5% annually on average (p < 0.01), more specifically an increase of +0.6% in girls and a statistically insignificant decrease of 0.1% in boys. In children aged 0-14 years, other malignant epithelial neoplasms and malignant melanomas showed the largest statistically significant average annual increase in incidence (+4.9%; p < 0.01), followed by central nervous system neoplasms (+1.3%; p < 0.05). Lymphomas, by contrast, showed a statistically significant average annual decrease in incidence in children aged 0-14 years (2.1%; p < 0.01). In adolescents aged 15-19 years, other malignant epithelial neoplasms and malignant melanomas also showed a statistically significant average annual increase in incidence (+5.2%; p < 0.01), followed by central nervous system neoplasms (+1.5%; p < 0.05). Mortality trends showed a statistically significant long-term decrease: on average, 5.1% annually in children aged 0-14 years (p < 0.01), and 3.7% annually in adolescents aged 15-19 years (p < 0.01). CONCLUSION Available data make it possible to analyse long-term trends in childhood cancer incidence and mortality.
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Cepelova M, Kruseova J, Luks A, Capek V, Cepela P, Potockova J, Kraml P. Accelerated atherosclerosis, hyperlipoproteinemia and insulin resistance in long-term survivors of Hodgkin lymphoma during childhood and adolescence. Neoplasma 2019; 66:978-987. [PMID: 31305124 DOI: 10.4149/neo_2019_190115n45] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/10/2019] [Indexed: 11/08/2022]
Abstract
Long-term survivors of Hodgkin lymphoma during childhood or adolescence (HL survivors) are at high risk of developing treatment-related late cardiovascular sequelae. In our study we evaluated the presence of modifiable cardiovascular risk factors (hypertension, hyperlipoproteinemia, hyperinsulinemia, obesity), endothelial and inflammatory markers (E-selectin, PAI-1, hs-CRP) and atherosclerotic changes in the common carotid arteries. Assessment was performed in 80 young adult Hodgkin lymphoma long-term survivors at more than 10 years after the potentially cardiovascular toxic anticancer treatment (median age at evaluation 34.7 years; range 24.1-40.9 years). The HL survivors were compared with 83 age- and gender-matched healthy volunteers. The HL survivors showed unfavorable lipid profiles compared to those of healthy controls: triglycerides (p=0.01), total cholesterol (p=0.0004), low density lipoprotein cholesterol (p=0.005). In HL survivors, we found a higher prevalence of hypertension (p=0.004) and insulin resistance - HOMA-IR (p=0.0002). Ultrasonographic examination of both common carotid arteries revealed a higher prevalence of atherosclerotic plaques (p=0.0009) and higher carotid intima-media thickness (p<0.0001) in HL survivors. Markers of oxidative stress (advanced oxidation protein products, oxidized low-density lipoprotein), inflammation (hs-CRP) and endothelial dysfunction (E-selectin, PAI-1) were also higher in HL survivors (p<0.0001, p=0.0002, p=0.0031, p=0.0087, p=0.004, respectively). Adult survivors of Hodgkin lymphoma during childhood and adolescence need closer follow-up with screening of metabolic syndrome components, unfavorable lifestyle factors and early management of these risk factors.
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Affiliation(s)
- M Cepelova
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty Charles University and University Hospital in Motol, Charles University, Prague, Czech Republic
| | - J Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty Charles University and University Hospital in Motol, Charles University, Prague, Czech Republic
| | - A Luks
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty Charles University and University Hospital in Motol, Charles University, Prague, Czech Republic
| | - V Capek
- Department of Pediatric Hematology and Oncology, 2nd Medical Faculty Charles University and University Hospital in Motol, Charles University, Prague, Czech Republic
| | - P Cepela
- 2nd Internal Clinic, 3rd Medical Faculty Charles University and Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - J Potockova
- 2nd Internal Clinic, 3rd Medical Faculty Charles University and Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
| | - P Kraml
- 2nd Internal Clinic, 3rd Medical Faculty Charles University and Kralovske Vinohrady University Hospital, Charles University, Prague, Czech Republic
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Cepelova M, Kruseova J, Ganevová M, Luks A, Malis J, Kabickova E, Gilik J, Fiedler J. Cardiovascular Sequelae in Young Adult Survivors of Childhood Hodgkin Lymphoma. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Intramuscular rocuronium, in doses of 1,000 microg/kg in infants and 1,800 microg/kg in children, produces complete twitch depression in 5-6 min. To determine the rate and extent of absorption of rocuronium after intramuscular administration, blood was sampled at various intervals after rocuronium administration by both intramuscular and intravenous routes to determine plasma concentrations (Cp) of rocuronium. METHODS Twenty-nine pediatric patients ages 3 months to 5 yr were anesthetized with N2O and halothane. The trachea was intubated, ventilation was controlled, and adductor pollicis twitch tension was measured. When anesthetic conditions were stable, rocuronium (1,000 microg/kg for infants and 1,800 microg/kg for children) was injected either intramuscularly (in the deltoid muscle) or intravenously. Four venous plasma samples were obtained from each child 2-240 min after rocuronium administration. A mixed-effects population pharmacokinetic analysis was applied to these values to determine bioavailability, absorption rate constant, and time to peak Cp with intramuscular administration. RESULTS With intramuscular administration, rocuronium's bioavailability averaged 82.6% and its absorption rate constant was 0.105 min(-1). Simulation indicated that Cp peaked 13 min after rocuronium was given intramuscularly, and that 30 min after intramuscular administration, less than 4% of the administered dose remained to be absorbed from the intramuscular depot. CONCLUSIONS After rocuronium is administered into the deltoid muscle, plasma concentrations peak at 13 min, and approximately 80% of the administered drug is absorbed systemically.
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Affiliation(s)
- L M Reynolds
- Department of Anesthesia, University of California, San Francisco 94143-0648, USA
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Lee GC, Iyengar S, Szenohradszky J, Caldwell JE, Wright PM, Brown R, Lau M, Luks A, Fisher DM. Improving the design of muscle relaxant studies. Stabilization period and tetanic recruitment. Anesthesiology 1997; 86:48-54. [PMID: 9009939 DOI: 10.1097/00000542-199701000-00008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The results from studies of muscle relaxants show wide variations among institutions. The authors hypothesized that some of this variability could be explained by differences in duration of nerve stimulation before drug administration (stabilization period). METHODS Train-of-four stimulation was applied every 12 s to both ulnar nerves and adductor pollicis twitch tension was measured in anesthetized participants given 30 micrograms/kg vecuronium. In phase 1, the stabilization period was > 30 min for both extremities. In phase 2-4, stabilization period was 20 min for one extremity and 2 min for the other. In addition, in phase 3, a 2-s 50-Hz tetanus initiated the 2-min stimulation period; in phase 4, duration of tetanus was 5 s. Twitch recovery was recorded until stable for more than 15 min. Time to 25% recovery (clinical duration) was calculated based on two indices: predrug and final (recovery) twitch tension. Values for onset and clinical duration were compared by paired parametric and nonparametric tests. RESULTS In phase 1, predrug and recovery twitch tension were similar in each extremity, and onset and clinical duration did not differ between extremities, permitting paired comparisons in remaining studies. In phase 2, onset was more rapid with 20-min of prestimulation. With 20-min prestimulation, predrug and recovery twitch tension were similar; with 2-min prestimulation, recovery twitch tension exceeded predrug values. When referenced to predrug twitch tension, clinical duration was shorter with 2-min, that with 20-min prestimulation. Initiating stimulation with 2-s or 5-s 50-Hz tetani (phases 3, 4) abolished differences between extremities in onset and recovery. CONCLUSIONS With only train-of-four stimulation (no tetani), onset and clinical duration vary with duration of prestimulation, suggesting that a brief period of predrug stimulation is inadequate. However, lengthy prestimulation may be impractical in clinical studies. Tetanic stimulation for 2 or 5 s obviates the need for prolonged stabilization during studies of muscle relaxants.
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Affiliation(s)
- G C Lee
- Department of Anesthesia, University of California, San Francisco 94143-0648, USA
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Abstract
BACKGROUND Rocuronium's rapid onset and intermediate duration of action with intravenous administration suggests that intramuscular administration might facilitate tracheal intubation without producing prolonged paralysis. Accordingly, in infants and children, the authors measured onset at the adductor pollicis and respiratory muscles to determine the optimal dose (phase I), then gave this optimal dose to determine the optimal time for tracheal intubation (phase II). METHODS The authors studied 45 unpremedicated patients aged 3 months to 5 yr. In phase I, 25 patients were anesthetized with nitrous oxide and halothane and breathed spontaneously; twitch tension and minute ventilation were measured. Rocuronium (800-2,400 micrograms/kg) was injected into the quadriceps or deltoid muscle; doses varied, using an "up-down" technique, the goal being to bracket the dose depressing twitch 75-90% within 5 min. In phase II, deltoid injections of the optimal dose from phase I (infants: 1,000 micrograms/kg; children: 1,800 micrograms/kg) were given to 20 patients anesthetized with 0.82-1.0% halothane. Tracheal intubation was attempted 1.5-3.0 min later; time to tracheal intubation was varied, using an "up-down" technique. RESULTS In phase I, 5 of 7 patients given quadriceps injections (1,200-2,200 micrograms/kg) had slow onset of twitch and ventilatory depression. With deltoid injections (800-2,400 micrograms/kg), all patients developed complete twitch depression; median time to 50% depression of minute ventilation was 3.2 min in infants and 2.8 min in children. In phase II, intubating conditions were consistently adequate or good-excellent at 2.5 min in infants and 3.0 min in children. Initial twitch recovery was at 57 +/- 13 min (mean +/- SD) in infants and 70 +/- 23 min in children. CONCLUSIONS Deltoid injections of rocuronium, 1,000 micrograms/kg in infants and 1,800 micrograms/kg in children, rapidly permit tracheal intubation in infants and children, despite a light plane of anesthesia. Duration of action of these large doses might limit clinical utility.
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Affiliation(s)
- L M Reynolds
- Department of Anesthesia, University of California, San Francisco 94143-0648, USA
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Perinová V, Luks A, Krepelka J. Conditional generation of special states using continuous measurements. Phys Rev A 1996; 54:821-842. [PMID: 9913540 DOI: 10.1103/physreva.54.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Perinová V, Luks A, Krepelka J. Ideal and destructive state reductions of correlated light fields and the continuous measurement of photon number. Phys Rev A 1996; 53:525-542. [PMID: 9912911 DOI: 10.1103/physreva.53.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Luks A, Perinová V, Krepelka J. Rotation angle, phases of oscillators with definite circular polarizations, and the composite ideal phase operator. Phys Rev A 1994; 50:818-830. [PMID: 9910956 DOI: 10.1103/physreva.50.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Luks A, Perinová V. Erratum: "Compatibility of the cosine and sine operators". Phys Rev A 1991; 44:2222. [PMID: 9920607 DOI: 10.1103/physreva.44.2222.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Luks A. Alcoholism: do threats and therapy mix? Hastings Cent Rep 1982; 12:7-11. [PMID: 7161082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Luks A, Komenda S. Modelling the school-achievement test through sequential randomization of parameters. Acta Univ Palacki Olomuc Fac Med 1980; 94:315-334. [PMID: 6231816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Dennis P, Williams P, McLeod L, Luks A. Lipoprotein abnormalities in patients under 52 years with ischaemic heart disease. Pathology 1973. [DOI: 10.1016/s0031-3025(16)39223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ryder L, Biegler B, Luks A, Dennis P. Serum lipids and lipoproteins following myocardial infarction. Pathology 1972. [DOI: 10.1016/s0031-3025(16)39308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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