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Lazar DR, Cainap S, Maniu D, Blag C, Bota M, Lazar FL, Achim A, Colceriu MC, Zdrenghea M. Anthracycline's Effects on Heart Rate Variability in Children with Acute Lymphoblastic Leukemia: Early Toxicity Signs-Pilot Study. J Clin Med 2023; 12:7052. [PMID: 38002666 PMCID: PMC10672281 DOI: 10.3390/jcm12227052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Anthracycline treatments are known to cause cardiotoxic long-term side effects in cancer survivors. Recently, a decrease in heart rate variability (HRV) has been identified in these patients, signaling autonomic dysfunction and altered cardiac fitness. This study aimed at evaluating changes in HRV in children treated with anthracyclines. A total of 35 pediatric patients with acute lymphoblastic leukemia were evaluated by means of a 24 h Holter ECG, at baseline and after reaching half the total cumulative dose of doxorubicin equivalent (120 mg/m2). Parameters of HRV were assessed, as well as any arrhythmic episodes, bradycardia and tachycardia percentages. The results showed a significant decrease in both time-domain and frequency-domain HRV parameters, following anthracycline treatment. The low-frequency (LF) to high-frequency (HF) parameters' ratio also displayed a significant difference (p = 0.035), suggestive of early cardiac autonomic dysfunction. Of note, none of the patients presented symptoms of heart disease or elevated troponins, and only two patients presented echocardiographic signs of diastolic dysfunction. The present study showed that cardiac autonomic nervous system regulation is compromised in children treated with anthracyclines even before reaching the total cumulative dose. Therefore, HRV parameters could be the first indicators of subclinical cardiac toxicity, making Holter ECG monitoring of the oncological patient a necessity.
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Affiliation(s)
- Diana R. Lazar
- Department No. 11, Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Pediatric Cardiology, Emergency Hospital for Children, 400394 Cluj-Napoca, Romania
| | - Simona Cainap
- Department of Pediatric Cardiology, Emergency Hospital for Children, 400394 Cluj-Napoca, Romania
- Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Dana Maniu
- Biomolecular Physics Department, Faculty of Physics, “Babes-Bolyai” University, 400347 Cluj-Napoca, Romania
| | - Cristina Blag
- Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Pediatric Oncology and Hematology, Emergency Hospital for Children, 400394 Cluj-Napoca, Romania
| | - Madalina Bota
- Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Pediatric Oncology and Hematology, Emergency Hospital for Children, 400394 Cluj-Napoca, Romania
| | - Florin-Leontin Lazar
- Department No. 5, Internal Medicine, Medical Clinic Number 1, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Achim
- Department of Cardiology, “Niculae Stancioiu” Heart Institute, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Marius C. Colceriu
- Department of Functional Biosciences, Discipline of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihnea Zdrenghea
- Department No. 11, Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Hematology, “Ion Chiricuta” Oncology Institute, 400015 Cluj-Napoca, Romania
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2
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Autier P, Bota M. 199P Breast cancer overdiagnosis in England, 1995-2019. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.234] [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: 11/01/2022] Open
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3
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Cainap C, Ungur RA, Bochis OV, Achimas P, Vlad C, Havasi A, Vidrean A, Farcas A, Tat T, Gherman A, Piciu A, Bota M, Constantin AM, Pop LA, Maniu D, Crisan O, Cioban CV, Balacescu O, Coza O, Balacescu L, Marta MM, Dronca E, Cainap S. Partnering bevacizumab with irinotecan as first line-therapy of metastatic colorectal cancer improves progression free survival-A retrospective analysis. PLoS One 2021; 16:e0248922. [PMID: 33909622 PMCID: PMC8081186 DOI: 10.1371/journal.pone.0248922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/08/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer remains one of the most frequent malignancies (third place at both genders) worldwide in the last decade, owing to significant changes in modern dietary habits. Approximately half of the patients develop metastases during the course of their disease. The available therapeutic armamentarium is constantly evolving, raising questions regarding the best approach for improving survival. Bevacizumab remains one of the most widely used therapies for treating metastatic colorectal cancer and can be used after progression. This study aimed to identify the best chemotherapy partner for bevacizumab after progression. We performed a retrospective analysis of patients with metastatic colorectal cancer who were treated with bevacizumab as first- and second-line chemotherapy. Data were collected for 151 patients, 40 of whom were treated with double-dose bevacizumab after the first progression. The two standard chemotherapy regimens combined with bevacizumab were FOLFIRI/CAPIRI and FOLFOX4/CAPEOX. The initiation of first-line treatment with irinotecan-based chemotherapy improved progression-free survival and time to treatment failure but not overall survival. After the first progression, retreatment with the same regimen as that used in the induction phase was the best approach for improving overall survival (median overall survival: 46.5 vs. 27.0 months for the same vs. switched strategy, respectively). No correlations were observed between the dose intensity of irinotecan, oxaliplatin, 5-fluorouracil, or bevacizumab and the overall survival, progression-free survival in the first-/second-line treatment, and time to treatment failure. Interaction between an irinotecan-based regimen as a second-line treatment and double-dose bevacizumab after progression was associated with an improved overall survival (p = 0.06). Initiating systemic treatment with an irinotecan-based regimen in combination with bevacizumab improved the progression-free survival in the first-line treatment and time to treatment failure. In terms of overall survival, bevacizumab treatment after the first progression is better partnered with the same regimen as that used in the induction phase.
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Affiliation(s)
- Calin Cainap
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rodica Ana Ungur
- Department of Medical Specialties, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- * E-mail:
| | | | - Patriciu Achimas
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Catalin Vlad
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Havasi
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | | | - Anca Farcas
- Department of Medical Specialties, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tiberiu Tat
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Alexandra Gherman
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andra Piciu
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Madalina Bota
- Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anne-Marie Constantin
- Department of Morphological Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laura Ancuta Pop
- Department of Molecular Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Maniu
- Faculty of Physics, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Ovidiu Crisan
- Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin Vasile Cioban
- Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Ovidiu Coza
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Monica Mihaela Marta
- Department of Medical Education, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Eleonora Dronca
- Department of Molecular Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Cainap
- Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Căinap C, Bochiş OV, Vlad C, Popita R, Achimaş-Cadariu P, Havasi A, Vidrean A, Dranca A, Piciu A, Constantin AM, Tat T, Dana M, Crişan O, Cioban CV, Bălăcescu O, Coza O, Bălăcescu L, Marta MM, Bota M, Căinap S. Doubling the Dose of Bevacizumab Beyond Progression in Metastatic Colorectal Cancer-the Experience of a Tertiary Cancer Center. Front Pharmacol 2021; 12:487316. [PMID: 33776758 PMCID: PMC7991840 DOI: 10.3389/fphar.2021.487316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/20/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Colorectal cancer (CRC) is the third most common cancer in Europe, with an annual increase in incidence ranging between 0.4 and 3.6% in various countries. Although the development of CRC was extensively studied, limited number of new therapies were developed in the last few years. Bevacizumab is frequently used as first- and second-line therapy for management of metastatic CRC (mCRC). The aim of this study is to present our experience with using bevacizumab beyond disease progression at different dosage levels in mCRC patients, in terms of overall survival, progression-free survival, time to treatment failure, and toxicities. Methods: We performed a consecutive retrospective analysis of patients with confirmed mCRC who were treated with bevacizumab at "Prof Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania. We included patients who had received bevacizumab as first- or second-line therapy and further stratified them according to the dose administered as a second-line (either standard dose of 5 mg/kg every 2 weeks or 7.5 mg/kg every 3 weeks, or double dose of 10 mg/kg every 2 weeks or 15 mg/kg every 3 weeks–depending on the classical chemotherapy partner). All patients had received bevacizumab beyond progression (BYP) which is defined as continuing bevacizumab administration through second-line treatment despite disease progression. In each group, we evaluated the prognostic factors that influenced survival and treatment outcome. Results: One hundred and fifty-one (151) patients were included in the study. Themedian age of patients receiving double dose bevacizumab (DDB) and standard dose bevacizumab (SDB) was 58 years (range 41–71) and 57 years (range 19–75), respectively. The median overall survival in the DDB group was 41 months (range 27–49) compared to 25 months (range 23–29) in the SDB group (p = 0.01 log-rank test). First-line oxaliplatin-based treatment was used more frequently regardless of group, while irinotecan-based more frequently used as a second-line treatment (p = 0.014). Both oxaliplatin- and irinotecan-based regimens were found to be suitable partners for BYP. Statistical analysis revealed that dose intensity, primary tumor location, and cumulative exposure to BYP had significant influence on survival. Conclusion: Doubling the dose of bevacizumab after first progression may improve survival in mCRC patients. Increasing bevacizumab dose intensity could override the prognostic impact of primary tumor location in patients receiving double the dose of bevacizumab after first disease progression.
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Affiliation(s)
- Călin Căinap
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Cătălin Vlad
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Raluca Popita
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Surgical Specialities, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Patriciu Achimaş-Cadariu
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Havasi
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Andreea Vidrean
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Alexandra Dranca
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Andra Piciu
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anne-Marie Constantin
- Department of Morphological Sciences, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tiberiu Tat
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Anesthesia and Intensive Care I, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maniu Dana
- Faculty of Physics, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Ovidiu Crişan
- Faculty of Pharmacy, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin Vasile Cioban
- Faculty of Dental Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ovidiu Bălăcescu
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Ovidiu Coza
- "Prof Dr Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Monica Mihaela Marta
- Department of Medical Education, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Madalina Bota
- Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Căinap
- Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Deac S, Stana MM, Havasi AD, Cainap C, Popita AR, Bordeianu AM, Cainap S, Bota M, Bochis OV. Paraneoplastic cerebellar degeneration associated with anti-Yo antibodies in an ovarian cancer case: A case report. Gynecol Oncol Rep 2021; 35:100695. [PMID: 33490355 PMCID: PMC7808941 DOI: 10.1016/j.gore.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/06/2020] [Accepted: 12/27/2020] [Indexed: 12/16/2022] Open
Abstract
Paraneoplastic cerebellar degeneration may precede the diagnosis of cancer. Early diagnosis of paraneoplastic cerebellar degeneration improve the prognosis. Treatment includes immunotherapy, oncological therapy and supportive therapy. Paraneoplastic cerebellar degeneration suspected in neurological symptoms in women.
Paraneoplastic neurologic syndromes (PNS) are a rare heterogeneous group of disorders associated with malignancy that can result in significant functional impairment. One syndrome in particular, paraneoplastic cerebellar degeneration (PCD), may be severely disabling. PCD is a rare neurological syndrome, associated with active or subclinical cancer, characterized by acute or subacute onset cerebellar ataxia due to tumor-induced autoimmunity against cerebellar antigens. Treatment of paraneoplastic syndromes is generally unsatisfactory, but early diagnosis and treatment of PCD, which includes neurological treatment, immunotherapy and oncological treatment of associated malignancy, may improve the neurological prognosis. We reported the case of a 59-year-old woman who presented PCD as the first sign of ovarian cancer. Laboratory investigations showed the presence of anti-Yo antibodies in the serum. The brain MRI revealed specific modifications for PCD. After oncological treatment, intravenous immunoglobulin therapy and corticosteroid therapy, the oncological response was satisfactory, but no improvement of the neurologic symptoms was achieved.
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Affiliation(s)
- Sandra Deac
- Oncology Institute "Ion Chiricuta", Medical Oncology Department, Cluj Napoca, Romania
| | | | - Andrei Dan Havasi
- Oncology Institute "Ion Chiricuta", Medical Oncology Department, Cluj Napoca, Romania
| | - Calin Cainap
- Oncology Institute "Ion Chiricuta", Medical Oncology Department, Cluj Napoca, Romania.,Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Anca-Raluca Popita
- Oncology Institute "Ion Chiricuta", Radiology and Medical Imaging Department, Cluj Napoca, Romania
| | | | - Simona Cainap
- Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Madalina Bota
- Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ovidiu Vasile Bochis
- Oncology Institute "Ion Chiricuta", Medical Oncology Department, Cluj Napoca, Romania
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Bochiș OV, Vlad C, Căinap C, Achimaș Cadariu P, Sur D, Havasi A, Vidrean A, Mureșan A, Piciu A, Bota M, Constantin AM, Tat T, Maniu D, Crișan O, Vasile Cioban C, Bălăcescu O, Coza O, Bălăcescu L, Marta MM, Căinap S. Treatment beyond progression in metastatic colorectal cancer: to double or not to double the dose of bevacizumab? J BUON 2020; 25:875-883. [PMID: 32521881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Bevacizumab or cetuximab represent the standard treatment in association with classical chemotherapy in confirmed metastatic colorectal cancer (mCRC). Bevacizumab could be continued after the first disease progression with an overall survival (OS) advantage, compared to chemotherapy alone, but the optimal dose remains a debatable issue. METHODS In a retrospective analysis of mCRC patients treated with bevacizumab, we selected patients with administration beyond progression, and stratified them according to the dose received- same dose bevacizumab (SDB) as first-line chemotherapy or double dose bevacizumab (DDB). For each group we evaluated OS, time to treatment failure (TTF) and progression-free survival in the first-line (PFS1) and in the second-line (PFS2). RESULTS In the first-line therapy, oxaliplatin backbone regimen was used in 73% SDB, compared with 22.5% DDB patients, while irinotecan was used in 75% DDB and 27% SDB patients. Second-line oxaliplatin was given to 50% DDB and 29.7% SDB patients, while irinotecan was administered to 47.5% DDB and 70.3% SDB patients. The median values were: OS - 41 months in the DDB group and 25 months in the SDB group (p = 0.01); TTF - 24 months in the DDB group and 19 months in the SDB group (p=0.009); PFS1 - 17 months in the DDB group and 12 months in the SDB group (p=0.008); PFS2 - 9 months in the DDB group and 5 months in the SDB group (p = 0.03). CONCLUSIONS Doubling the dose of bevacizumab at progression seems to provide OS and PFS advantage for mCRC patients.
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7
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Raluca Maniu D, Blag C, Popa G, Bota M, Vlad C, Cainap C, Balacescu O, Pop L, Cainap SS. The role of biomarkers and echocardiography in the evaluation of cardiotoxicity risk in children treated for leukemia. J BUON 2018; 23:122-131. [PMID: 30722121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To describe the high-risk profile group, susceptible to develop anthracycline-induced cardiomyopathy in children with acute leukemia. METHODS The study involved 35 pediatric patients diagnosed with acute lymphoblastic (ALL) or acute myeloblastic leukemia (AML), from March 2014 to December 2016. Serologic markers used for the analysis of cardiac dysfunction were troponin T, NT-proBNP and PCRhs. Also, the patients have had echocardiographic evaluation at the beginning of treatment to determine LVEF, SF and A, E, E' Doppler waves. RESULTS Positive linear correlation was shown between NT-proBNP and leukocyte values, NT-proBNP and blast cells value, and NT-proBNP and LDH. Significant linear negative correlations between LVEF with leukocyte values, blast cells values, LDH, SF and leukocyte values, LVEF and NT-proBNP values and LVEF and troponin T values were also identified. A weak negative correlation between E/E' ratio and blast cells values has been observed. All of these correlations were statistically significant (p<0.05). CONCLUSIONS Leukocyte value, as well as the other serological markers assessed (NT-proBNP, Troponin T), are useful tools to evaluate the risk of anthracycline-induced cardiotoxicity. The variation of the biological markers at the beginning of the cytotoxic treatment confirms the presence of an early myocardial dysfunction, emphasizing the importance of systematic evaluation of this particular group of patients.
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Affiliation(s)
- Diana Raluca Maniu
- Emergency County Hospital for Children, Pediatric Clinic no 2, Department of Pediatric Cardiology, Cluj-Napoca, Romania
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8
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Bochis OV, Bota M, Mihut E, Buiga R, Hazbei DS, Irimie A. Solid pseudopapillary tumor of the pancreas: clinical-pathological features and management of 13 cases. ACTA ACUST UNITED AC 2017; 90:171-178. [PMID: 28559701 PMCID: PMC5433569 DOI: 10.15386/cjmed-672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/06/2016] [Indexed: 12/31/2022]
Abstract
Background and aim Solid pseudopapillary tumor (SPT) of the pancreas is a rare pathological condition, representing less than 3% of all exocrine pancreatic tumors. SPT usually occurs in young females, without notable symptoms, with a low malignant potential and excellent prognosis. Method We conducted a retrospective study during the period January 2005 – January 2015. SPT patients admitted in our institution were reviewed by describing demographic data, clinico-pathologic and radiological features, therapeutic management and prognosis records. Results Thirteen patients with SPT were identified (10 females), with a median age of 30 years. The main clinical presentation was abdominal pain (92.3%). The tumor was mostly located in the body or tail of the pancreas (77%), and the mean size was 8.2 cm. Regarding the surgical approach there were 5 distal pancreatectomies with splenectomy, 3 body and tail pancreatectomies, 2 body and tail pancreatectomies with splenectomy, 2 pancreato-duodenectomy, 1 partial enucleation and of all only 2 partial resections. Postoperative hematoxylin- eosin staining and immunohistochemistry confirmed the diagnosis in all cases. None of the patients had lymph nodes metastases. Only one local invasion. There was one case of death due to postoperative complications. Four cases followed adjuvant systemic chemotherapy. The mean follow-up was 18 months, without evidence of recurrence during this period. Conclusion SPT should always be considered in the differential diagnosis in young women with a pancreatic tumor. Complete surgical excision is the treatment of choice, and is usually curative. The decision to administer systemic therapy must be individualized. Malignant behavior and late recurrences mandates long-term follow-up for patients with SPT.
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Affiliation(s)
- Ovidiu Vasile Bochis
- Department of Medical Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Madalina Bota
- 2nd Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Emilia Mihut
- Department of Pediatric Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Rares Buiga
- Department of Pathology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Dan Samoila Hazbei
- Department of Pathology, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.,Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandru Irimie
- Department of Surgery, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania.,Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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9
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Autier P, Bota M, Boyle P, Leclerq A, Guillaume J, Van Damme N, Franchi M, Corrao G, Boniol M. Early detection of pancreatic cancer among diabetic patients: results from prescription database analyses. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30311-8] [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: 11/30/2022]
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10
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Slavescu KC, Chiorean R, Danescu S, Bota M, Rogojan L, Baican A. Diffuse cutaneous bullous mastocytosis with IgM deposits at dermo-epidermal junction. J Cutan Pathol 2015; 43:263-9. [DOI: 10.1111/cup.12635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/25/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Kinga Cristina Slavescu
- Department of Pediatrics II; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Roxana Chiorean
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Sorina Danescu
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Madalina Bota
- Department of Pediatrics II; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Liliana Rogojan
- Department of Pathology; Emergency Clinical Hospital; Cluj-Napoca Romania
| | - Adrian Baican
- Department of Dermatology; Iuliu Hatieganu University of Medicine and Pharmacy; Cluj-Napoca Romania
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Abstract
Infantile hemangiomas as frequent infancy tumors have been a controversial issue of medical scientists worldwide. Their clinical aspects are various and their physiopathology is yet to be fully understood. Numerous publications outline the characteristics, causes, evolution possibilities and therapeutic approaches. Deciding whether to treat or not is the main question of this kind of pathology. Hemangiomas that have complications or can cause irreversible damage need therapy. This is a brief review of up-to-date information regarding the presentation of infantile hemangiomas and target-therapies.
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Affiliation(s)
- Madalina Bota
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gheorghe Popa
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Blag
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandru Tataru
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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12
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Boyle P, Boniol M, Koechlin A, Bota M, Robertson C, Leroith D, Rosenstock J, Bolli GB, Autier P. Abstract P4-13-08: Diabetes, Related Factors and Breast Cancer Risk. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-13-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Diabetes and breast cancer are both extremely common conditions in women and may share common risk factors. It is natural to investigate any potential common risk factors and to seek biological clarification and improve prospects for prevention.
Therefore, in order to help clarify the potential association between diabetes, related factors and breast cancer risk, a comprehensive literature review and formal meta-analysis was carried out, planned, conducted and reported following PRISMA guidelines regarding meta-analysis of observational studies. Variables studies in relation to breast cancer risk were adiposity, physical activity, glycaemic load, glycaemic index, diabetes, IGF-1, fasting glucose, fasting insulin and C-peptide, adiponectin and metformin and glargine use among patients with diabetes. For all variables except diabetes and breast cancer, only prospective studies were included in meta-analyses. Summary Relative Risks (SRR) and corresponding 95% Confidence Intervals (CI) were calculated from random effect models.
For breast cancer at all ages, the calculated risks were as follows: diabetes (SRR = 1.27 95% CI (1.16, 1.39); physical activity (SRR = 0.88, 95% CI (0.85, 0.92)); glycaemic load (SRR = 1.06, 95% CI (1.00, 1.12)); glycaemic index (SRR = 1.04, 95% CI (0.99, 1.10)); fasting glucose (SRR = 1.12, 95% CI (1.01, 1.24)); serum insulin (SRR = 1.18, 95% CI (0.75, 1.85)); c-peptide (SRR = 1.29, 95% CI (0.91, 1.82)); adiponectin (SRR = 1.16, 95% CI (0.93, 1.46)); metformin (SRR = 1.00, 95% CI (0.69, 1.46)); and glargine (SRR = 1.11, 95% CI (1.00, 1.24)). An increase of 5 units in Body Mass Index (a weight increase if 14.5 kg in a person 1.70 metres tall) was associated in post-menopausal breast cancer (SRR = 1.12, 95% CI (1.08, 1.16)) but not at pre-menopausal ages (SRR = 0.83, 95% CI (0.72, 0.95)). Serum insulin was associated with breast cancer at post-menopausal ages but not at pre-menopausal ages whereas with c-peptide there was a significant association at pre-menopausal ages but not post-menopausal. For IGF-1, Hodge's Standardised Mean Difference (HSMD) was calculated in cohort studies and there was no significant association with breast cancer at all ages (HSMD = 0.003, 95% CI (−0.059, 0.065)), at post-menopausal ages (HSMD = −0.014, 95% CI (−0.106, 0.077)) or at pre-menopausal ages (HSMD = 0.039, 95% CI (−0.038, 0.117)).
The risk of breast cancer is increased among post-menopausal women who have diabetes. Among those factors related to diabetes, key risk factors for breast cancer appear to be adiposity and lack of physical activity which are both related to the risk of developing diabetes. Action on these lifestyle factors should form the basis of a common prevention strategy. There is a need to re-evaluate potential biological mechanisms to explain the increased risk in post-menopausal women with diabetes.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-08.
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Affiliation(s)
- P Boyle
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Boniol
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - A Koechlin
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Bota
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - C Robertson
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - D Leroith
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - J Rosenstock
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - GB Bolli
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - P Autier
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Mt. Sinai, New York; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
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13
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Boyle P, Koechlin A, Boniol M, Bota M, Robertson C, Rosenstock J, Bolli GB. Abstract P4-13-07: Meta-analysis of epidemiological studies of Insulin Glargine and Breast Cancer Risk. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p4-13-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
After having lain dormant for a while, the association between diabetes, its risk factors and treatments, and cancer risk and death is now high on the clinical and research agenda. The microscope is currently focused on the relationships between Pioglitazone and Bladder Cancer, Exenatide and Pancreas Cancer, Liraglutide and pancreas cancer and insulin use and lung cancer. The potential association between use of insulin glargine and breast cancer risk has been the subject of recent major studies.
All data regarding cancer risk and use of insulin glargine has been assembled and meta-analyses performed using state-of-the-art statistical methodology. A random effects model was employed with tests for heterogeneity (I2) and publication bias. These meta-analyses are based on reports from 21 epidemiological studies involving over one million patients and 3 million person-years of observation.
Based on independent estimates from these studies, the Summary Relative Risk (SRR) for all forms of cancer was (SRR = 0.91, 95% CI (0.84, 0.99)), and for breast cancer SRR = 1.11 (95% CI (1.00, 1.48)). For new users of glargine, the SRR for breast cancer was SRR = 1.22 (95% CI (1.00, 1.48)). For colorectal cancer the SRR = 0.83 (95% CI (0.74, 0.94)) and for prostate cancer SRR = 1.14 (95% CI (0.93, 1.39)). Overall, the risk of developing cancer among users of insulin glargine is reduced compared to the risk of users of other insulins. Similarly, the risk of colorectal cancer is reduced among users of glargine.
While the lower bound of the 95% confidence interval is 1.00, the risk of breast cancer does not increase with increasing duration of use of glargine. In some studies the trend in risk with increasing duration of use goes in opposite directions. The development of a detectable breast cancer from the initial carcinogenic event depends on the tumour doubling time. The time for a de novo breast cancer to become detectable ranges from 12.3 years for a doubling time of 150 days; 16.4 years for a doubling time of 200 days; and 20.5 years for a doubling time of 250 days. Most published studies have a maximum of 3–4 years of glargine use.
The databases employed in these analyses were not designed for such epidemiological investigation. A major limitation is the absence of knowledge as to why a potential treatment was prescribed for an individual and why a change in therapy was indicated. Further potential limitations to this meta-analysis include that the comparison group was not the same in all studies but this could also be seen as a strength. The meta-analysis of the randomized trials had several insulin comparators and the retinopathy study had NPH as the comparator. This is not likely to invalidate the findings of this analysis nor would the fact that different adjustments were made in the individual studies.
The current evidence gives no support to the hypothesis that insulin glargine is associated with an increased risk of cancer as compared to other insulins and should give reassurance to physicians and their patients. In respect to breast cancer, there is no indication of a causal association between use of insulin glargine and increased risk of breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-07.
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Affiliation(s)
- P Boyle
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - A Koechlin
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Boniol
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - M Bota
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - C Robertson
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - J Rosenstock
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
| | - GB Bolli
- International Prevention Research Institute, Lyon, France; University of Strathclyde, Glasgow, United Kingdom; Dallas Diabetes and Endocrine Center, Dallas; University of Perugia, Italy
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14
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Murtagh MJ, Demir I, Jenkings KN, Wallace SE, Murtagh B, Boniol M, Bota M, Laflamme P, Boffetta P, Ferretti V, Burton PR. Securing the data economy: translating privacy and enacting security in the development of DataSHIELD. Public Health Genomics 2012; 15:243-53. [PMID: 22722688 DOI: 10.1159/000336673] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Contemporary bioscience is seeing the emergence of a new data economy: with data as its fundamental unit of exchange. While sharing data within this new 'economy' provides many potential advantages, the sharing of individual data raises important social and ethical concerns. We examine ongoing development of one technology, DataSHIELD, which appears to elide privacy concerns about sharing data by enabling shared analysis while not actually sharing any individual-level data. We combine presentation of the development of DataSHIELD with presentation of an ethnographic study of a workshop to test the technology. DataSHIELD produced an application of the norm of privacy that was practical, flexible and operationalizable in researchers' everyday activities, and one which fulfilled the requirements of ethics committees. We demonstrated that an analysis run via DataSHIELD could precisely replicate results produced by a standard analysis where all data are physically pooled and analyzed together. In developing DataSHIELD, the ethical concept of privacy was transformed into an issue of security. Development of DataSHIELD was based on social practices as well as scientific and ethical motivations. Therefore, the 'success' of DataSHIELD would, likewise, be dependent on more than just the mathematics and the security of the technology.
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Affiliation(s)
- M J Murtagh
- Data to Knowledge for Practice, University of Leicester, Leicester, UK.
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15
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Guazzelli A, Bota M, Arbib MA. Competitive Hebbian learning and the hippocampal place cell system: modeling the interaction of visual and path integration cues. Hippocampus 2002; 11:216-39. [PMID: 11769306 DOI: 10.1002/hipo.1039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The hippocampus has long been thought essential for implementing a cognitive map of the environment. However, almost 30 years since place cells were found in rodent hippocampal field CA1, it is still unclear how such an allocentric representation arises from an ego-centrically perceived world. By means of a competitive Hebbian learning rule responsible for coding visual and path integration cues, our model is able to explain the diversity of place cell responses observed in a large set of electrophysiological experiments with a single fixed set of parameters. Experiments included changes observed in place fields due to exploration of a new environment, darkness, retrosplenial cortex inactivation, and removal, rotation, and permutation of landmarks. To code for visual cues for each landmark, we defined two perceptual schemas representing landmark bearing and distance information over a linear array of cells. The information conveyed by the perceptual schemas is further processed through a network of adaptive layers which ultimately modulate the resulting activity of our simulated place cells. In path integration terms, our system is able to dynamically remap a bump of activity coding for the displacement of the animal in relation to an environmental anchor. We hypothesize that path integration information is computed in the rodent posterior parietal cortex and conveyed to the hippocampus where, together with visual information, it modulates place cell activity. The resulting network yields a more direct treatment of partial remapping of place fields than other models. In so doing, it makes new predictions regarding the nature of the interaction between visual and path integration cues during new learning and when the system is challenged with environmental changes.
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Affiliation(s)
- A Guazzelli
- University of Southern California Brain Project, Los Angeles, USA.
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