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Kisivan K, Farkas A, Kovacs P, Glavak C, Lukacs G, Mahr K, Szabo Z, Csima MP, Gulyban A, Toth Z, Kaposztas Z, Lakosi F. Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold. Pathol Oncol Res 2023; 29:1611456. [PMID: 38188611 PMCID: PMC10767757 DOI: 10.3389/pore.2023.1611456] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024]
Abstract
Background: We aim to present our linear accelerator-based workflow for pancreatic stereotactic ablative radiotherapy (SABR) in order to address the following issues: intrafractional organ motion management, Cone Beam CT (CBCT) image quality, residual errors with dosimetric consequences, treatment time, and clinical results. Methods: Between 2016 and 2021, 14 patients with locally advanced pancreatic cancer were treated with induction chemotherapy and SABR using volumetric modulated arc therapy (VMAT). Internal target volume (ITV) concept (5), phase-gated (4), or breath hold (5) techniques were used. Treatment was verified by CBCT before and after irradiation, while tumor motion was monitored and controlled by kV triggered imaging and beam hold using peritumoral surgical clips. Beam interruptions and treatment time were recorded. The CBCT image quality was scored and supplemented by an agreement analysis (Krippendorff's-α) of breath-hold CBCT images to determine the position of OARs relative to the planning risk volumes (PRV). Residual errors and their dosimetry impact were also calculated. Progression free (PFS) and overall survival (OS) were assessed by the Kaplan-Meier analysis with acute and late toxicity reporting (CTCAEv4). Results: On average, beams were interrupted once (range: 0-3) per treatment session on triggered imaging. The total median treatment time was 16.7 ± 10.8 min, significantly less for breath-hold vs. phase-gated sessions (18.8 ± 6.2 vs. 26.5 ± 13.4, p < 0.001). The best image quality was achieved by breath hold CBCT. The Krippendorff's-α test showed a strong agreement among five radiation therapists (mean K-α value: 0.8 (97.5%). The mean residual errors were <0.2 cm in each direction resulting in an average difference of <2% in dosimetry for OAR and target volume. Two patients received offline adaptation. The median OS/PFS after induction chemotherapy and SABR was 20/12 months and 15/8 months. No Gr. ≥2 acute/late RT-related toxicity was noted. Conclusion: Linear accelerator based pancreatic SABR with the combination of CBCT and triggered imaging + beam hold is feasible. Peritumoral fiducials improve utility while breath-hold CBCT provides the best image quality at a reasonable treatment time with offline adaptation possibilities. In well-selected cases, it can be an effective alternative in clinics where CBCT/MRI-guided online adaptive workflow is not available.
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Affiliation(s)
- Katalin Kisivan
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Andrea Farkas
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Peter Kovacs
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Csaba Glavak
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Gabor Lukacs
- Department of Medical Oncology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Karoly Mahr
- Department of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, Hungary
| | - Zsolt Szabo
- Department of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, Hungary
| | - Melinda Petone Csima
- Institute of Education, Hungarian University of Agricultural and Life Sciences, Gödöllő, Hungary
- Faculty of Health Sciences, University of Pecs, Pecs, Hungary
| | - Akos Gulyban
- Department of Medical Physics, Institut Jules Bordet, Brussels, Belgium
- Radiophysics and MRI Physics Laboratory, Université Libre De Bruxelles (ULB), Brussels, Belgium
| | - Zoltan Toth
- Medicopus Nonprofit Ltd., Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
- PET Center, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Kaposztas
- Department of Surgery, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Ferenc Lakosi
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
- Faculty of Health Sciences, University of Pecs, Pecs, Hungary
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Macharia JM, Mwangi RW, Szabó I, Zand A, Kaposztas Z, Varjas T, Rozmann N, Raposa BL. Regulatory activities of Warbugia ugandensis ethanolic extracts on colorectal cancer-specific genome expression dose-dependently. Biomed Pharmacother 2023; 166:115325. [PMID: 37586118 DOI: 10.1016/j.biopha.2023.115325] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023] Open
Abstract
The evaluation of natural biomass sources is a promising strategy in accelerating the development of novel anti-cancer medications. Our study aimed to evaluate the activity of W. ugandensis ethanolic roots and stems extracts on the expression of five targeted genes (COX-2, CASPS-9, Bcl-xL, Bcl2 and 5-LOX) in colorectal cancer (CRC) cell lines (Caco-2). Plant extracts were obtained using serial exhaustive extraction and dissolved in Dimethyl sulfoxide appropriately for bioassay. Caco-2 cell lines were passaged, treated with plant extracts at varying concentrations and their RNA's isolated for evaluation. Our unique study reports on W. ugandensis as efficient natural inhibitors of CRC growth, by directly linking its phytoconstituents to; downregulation of COX-2, 5-LOX, Bcl-xL, Bcl2 and upregulation of CASPS9 genes dose-dependently. We present W. ugandensis ethanolic roots and stems extracts as promising natural inhibitors for CRC carcinogenesis and recommend in vivo and subsequent clinical trials, with substantial clinical effects postulated. We further suggest studies on identification and characterization of the specific metabolites in W. ugandensis involved in the modulatory mechanisms, resulting to inhibition of CRC growth and possible metastases.
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Affiliation(s)
- John M Macharia
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Pẻcs, Hungary.
| | - Ruth W Mwangi
- Hungarian University of Agriculture and Life Sciences, Institute of Horticultural Sciences, Budapest, Hungary
| | - István Szabó
- University of Pẻcs, Medical School, Department of Public Health Medicine, Pẻcs, Hungary
| | - Afshin Zand
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Pẻcs, Hungary; University of Pẻcs, Medical School, Department of Public Health Medicine, Pẻcs, Hungary
| | | | - Tímea Varjas
- University of Pẻcs, Medical School, Department of Public Health Medicine, Pẻcs, Hungary
| | - Nóra Rozmann
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, Pẻcs, Hungary
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Macharia JM, Kaposztas Z, Varjas T, Budán F, Zand A, Bodnar I, Bence RL. Targeted lactate dehydrogenase genes silencing in probiotic lactic acid bacteria: A possible paradigm shift in colorectal cancer treatment? Biomed Pharmacother 2023; 160:114371. [PMID: 36758316 DOI: 10.1016/j.biopha.2023.114371] [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: 01/13/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Even though the pathophysiology of colorectal cancer (CRC) is complicated and poorly understood, interactions between risk factors appear to be key in the development and progression of the malignancy. The popularity of using lactic acid bacteria (LAB) prebiotics and probiotics to modulate the tumor microenvironment (TME) has grown widely over the past decade. The objective of this study was therefore to determine the detrimental effects of LAB-derived lactic acid in the colonic mucosa in colorectal cancer management. Six library databases and a web search engine were used to execute a structured systematic search of the existing literature, considering all publications published up until August 2022. A total of 7817 papers were screened, all of which were published between 1995 and August 2022. However, only 118 articles met the inclusion criterion. Lactic acid has been directly linked to the massive proliferation of cancerous cells since the glycolytic pathway provides cancerous cells with not only ATP, but also biosynthetic intermediates for rapid growth and proliferation. Our research suggests that targeting LAB metabolic pathways is capable of suppressing tumor growth and that the LDH gene is critical for tumorigenesis. Silencing of Lactate dehydrogenase, A (LDHA), B (LDHB), (LDHL), and hicD genes should be explored to inhibit fermentative glycolysis yielding lactic acid as the by-product. More studies are necessary for a solid understanding of this topic so that LAB and their corresponding lactic acid by-products do not have more adverse effects than their widely touted positive outcomes in CRC management.
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Affiliation(s)
- John M Macharia
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary.
| | | | - Tímea Varjas
- University of Pẻcs, Medical School, Department of Public Health Medicine, City of Pẻcs, Hungary
| | - Ferenc Budán
- University of Pẻcs, Medical School, Institute of Transdisciplinary Discoveries, City of Pẻcs, Hungary; University of Pécs, Medical School, Institute of Physiology, City of Pécs, Hungary
| | - Afshin Zand
- University of Pẻcs, Medical School, Department of Public Health Medicine, City of Pẻcs, Hungary
| | - Imre Bodnar
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary
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Macharia JM, Gakenye GW, Rozmann N, Onchonga D, Mwangi RW, Kaposztas Z, Mathenge JM, Pusztai D, Pinter M, Sugar M, Raposa BL. An empirical assessment of the factors influencing acceptance of COVID-19 vaccine uptake between Kenyan and Hungarian residing populations: A cross-sectional study. Sci Rep 2022; 12:22262. [PMID: 36564451 PMCID: PMC9786518 DOI: 10.1038/s41598-022-26824-5] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
The development of effective, safe, and acceptable vaccines is a long process. COVID-19 vaccine hesitancy continues to elicit mixed reactions among different quarters despite numerous evidence of their effectiveness. This study aimed to determine the availability and acceptance rates of SARS-CoV-2 vaccines, among Kenyan and Hungarian residing populations and the underlying reasons contributing to the hesitancy of uptake. A non-probability, snowball sampling design was employed, and a survey questionnaire tool link was expeditiously disseminated. Data were carefully analyzed descriptively. Demographic variables, COVID-19 awareness, possible exposure, reasons associated with hesitancy in taking up a vaccine, choice of a vaccine, and availability of vaccines among other important variables were tested to explore their associations with vaccine acceptance rates between the two distinct countries. A total of 1960 participants were successfully enrolled in the research study, while 67 participants were excluded based on the inclusion criterion set. There was, however, no significant difference in COVID-19 public awareness between the Kenyan and Hungarian-residing participants, p = 0.300. Of the respondents, 62.4% were willing and ready to receive vaccines against COVID-19 disease. There was a significant difference (p = 0.014) between the Kenyan and Hungarian-residing respondents concerning vaccine uptake and acceptance rates. The vaccine acceptance rates in Hungary were higher than in Kenya, with mean = 0.27, SD = 0.446, S. E = 0.045 for the Hungarian population sample and mean = 0.40, SD = 0.492, S. E = 0.026, for the Kenyan sample respectively. Concerning gender and vaccine acceptance, there was a notable significant difference between males and females, p = 0.001, where the mean for males and females were 0.29 and 0.46 respectively. Acceptance rates among males were higher than among females. The functions of One-Way ANOVA and Chi-square were used to establish any significant differences and associations between means and variables respectively. Concerns regarding the safety, efficacy, and accuracy of information about the developed vaccines are significant factors that must be promptly addressed, to arrest crises revolving around COVID-19 vaccine hesitancy, especially in Kenya and among females in both populations, where acceptance rates were lower. Expansion of the screening program to incorporate antibody (serology) tests, is also highly recommended in the present circumstance. Equitable distribution of vaccines globally should be encouraged and promoted to adequately cover low- and middle-income countries. To enhance effective combat on vaccination hesitancy and apprehension in different countries, mitigation techniques unique to those countries must be adopted.
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Affiliation(s)
- John M Macharia
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pecs, Vorosmarty Mihaly Str. 4, Pecs, 7621, Hungary.
| | - Grace W Gakenye
- Faculty of Business and Economics, University of Pecs, Pecs, Hungary
| | - Nóra Rozmann
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pecs, Vorosmarty Mihaly Str. 4, Pecs, 7621, Hungary
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Ruth W Mwangi
- Faculty of Science, Department of Biological Sciences, Egerton University, Nakuru, Kenya
- Doctoral School of Horticultural Sciences, Institute of Vegetables and Mushroom Growing, Hungarian University of Agriculture and Life Sciences, Budapest, Hungary
| | - Zsolt Kaposztas
- Faculty of Health Science, University of Pẻcs, Pẻcs, Hungary
| | - John M Mathenge
- School of Agriculture and Enterprise Development, Kenyatta University, Nairobi, Kenya
| | - Dorina Pusztai
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pecs, Vorosmarty Mihaly Str. 4, Pecs, 7621, Hungary
| | - Marton Pinter
- Faculty of Health Science, University of Pẻcs, Pẻcs, Hungary
| | - Miklos Sugar
- Doctoral School of Health Sciences, Faculty of Health Science, University of Pecs, Vorosmarty Mihaly Str. 4, Pecs, 7621, Hungary
| | - Bence L Raposa
- Faculty of Health Science, University of Pẻcs, Pẻcs, Hungary
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Macharia JM, Zhang L, Mwangi RW, Rozmann N, Kaposztas Z, Varjas T, Sugár M, Alfatafta H, Pintér M, Bence RL. Are chemical compounds in medical mushrooms potent against colorectal cancer carcinogenesis and antimicrobial growth? Cancer Cell Int 2022; 22:379. [PMID: 36457023 PMCID: PMC9714114 DOI: 10.1186/s12935-022-02798-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
After cardiovascular diseases, cancer is the second main cause of death globally. Mushrooms have been demonstrated to contain amalgamation with properties capable of inhibiting carcinogenesis and microbial growth, principally secondary metabolites such as quinolones, steroids, terpenes, anthraquinones, and benzoic acid derivatives among others. This study aimed to substantiate their potency concerning colon cancer carcinogenesis and antimicrobial growth. A systematic search of important literature was performed considering all the articles published until April 2022. Screening was performed by searching the BMC Springer, Elsevier, Embase, Web of Science, Ovid, and MEDLINE databases. In addition, Google Scholar was used to supplement information. Titles and abstracts that matched the established criteria were selected for full-text article scrutiny and subsequently used in the updated present review. Bioactive compounds present in medicinal mushrooms such as ascorbic acid, organic acids, flavonoids, polysaccharides, glycosides, phenols, linoleic acid, grifolin, and tocopherols among other compounds play a key role in suppressing the proliferation of cancerous cells and selectively act as antibacterial and antifungal agents. These metabolites actively scavenge oxygen free radicals, hydroxyl radicals, and nitrite radicals that would otherwise increase the risks of the growth and development of cancerous cells. Mushrooms' bioactive compounds and metabolites actively inhibit nuclear factor-kappa activation, protein kinase B processes, and ultimately the expression of Cyclooxygenases 2 in cancerous cells. Medicinal mushrooms should be considered as alternative natural chemo-preventive agents in the global fight against colon cancer and the evolution of drug-resistant pathogenic microorganisms, as they exhibit robust potency. They have not been reported to exhibit adverse harmful effects compared to synthetic chemotherapies, yet they have been reported to demonstrate significant beneficial effects.
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Affiliation(s)
- John M. Macharia
- grid.9679.10000 0001 0663 9479Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary
| | - Lu Zhang
- grid.9679.10000 0001 0663 9479Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary
| | - Ruth W. Mwangi
- grid.129553.90000 0001 1015 7851Doctoral School of Horticultural Sciences, Institute of Vegetables and Mushroom Growing, Hungarian University of Agriculture and Life Sciences, Budapest City, Hungary ,grid.8301.a0000 0001 0431 4443Faculty of Science, Department of Biological Sciences, Egerton University, Nakuru City, Kenya
| | - Nora Rozmann
- grid.9679.10000 0001 0663 9479Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary
| | - Zsolt Kaposztas
- grid.9679.10000 0001 0663 9479Faculty of Health Sciences, University of Pécs, City of Pécs, Hungary
| | - Tímea Varjas
- grid.9679.10000 0001 0663 9479Medical School, Department of Public Health Medicine, University of Pẻcs, City of Pẻcs, Hungary
| | - Miklós Sugár
- grid.9679.10000 0001 0663 9479Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary
| | - Huda Alfatafta
- grid.9679.10000 0001 0663 9479Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary
| | - Márton Pintér
- grid.9679.10000 0001 0663 9479Doctoral School of Health Sciences, Faculty of Health Science, University of Pẻcs, City of Pẻcs, Hungary
| | - Raposa L. Bence
- grid.9679.10000 0001 0663 9479Faculty of Health Sciences, University of Pécs, City of Pécs, Hungary
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Kisivan K, Glavak C, Laszlo Z, Petone Csima M, Somogyine Ezer E, Mahr K, Gulyban A, Kaposztas Z, Lakosi F. PH-0433 DIBH SABR for abdominal tumors while monitoring with fiducial markers and triggered images. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07324-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Balint IB, Csaszar F, Somodi K, Ternyik L, Biro A, Kaposztas Z. Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy? Langenbecks Arch Surg 2021; 406:1363-1377. [PMID: 33712874 PMCID: PMC8370966 DOI: 10.1007/s00423-021-02131-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS. METHODS A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes. RESULTS A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): -0.03 and confidence interval (CI): -0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01-0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: -0.03, CI: -0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74-1.59 for BMI changes). CONCLUSION Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors' hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.
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Affiliation(s)
- Istvan Bence Balint
- Department of Surgery and Vascular Surgery, Zala County Saint Rafael Hospital, H-8900 Zrinyi Miklos street 1., Zalaegerszeg, Hungary.
| | - Ferenc Csaszar
- Doctoral School of Neurosciences, University of Pecs, Pécs, Hungary
| | - Krisztian Somodi
- Department of Surgery, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Laszlo Ternyik
- Department of Surgery, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Adrienn Biro
- Department of Surgery, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Kaposztas
- Department of Surgery, Somogy County Kaposi Mor Teaching Hospital, Kaposvár, Hungary
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Mowbray NG, Chin C, Duncan P, O'Reilly D, Kaposztas Z, Junnarkar S, Kumar N. How successful is liver resection for colorectal cancer liver metastases in patients over 75 years old? Ann Hepatobiliary Pancreat Surg 2021; 25:18-24. [PMID: 33649250 PMCID: PMC7952666 DOI: 10.14701/ahbps.2021.25.1.18] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 01/17/2023] Open
Abstract
Backgrounds/Aims As populations age, an increased incidence of colorectal cancer will generate an increase in colorectal cancer liver metastases (CRLM). In order to guide treatment decisions, this study aimed to identify the contemporary complication rates of elderly patients undergoing liver resection for CRLM in a, centralised, UK centre. Methods All patients undergoing operative procedures for CRLM between January 2013 and January 2019 were included. Patient, tumour and operative data were analysed, including the prognostic marker; tumour burden score. Results 339 operations were performed on 289 consecutive patients with CRLM (272 patients <75 years old, 67 patients ≥75 years old). Median age was 66 years (range 20-93). There was no difference in major complication rates between the two age cohorts (6.65 vs. 6.0%, p=0.847) or operative mortality (1.1% vs. 1.4%, p=0.794). Younger patients had higher R1 resection rates (20.4% vs. 4.5%, p=0.002) and post-operative chemotherapy rates (60.3% vs. 35.8%, p< 0.001). The 1, 3 and 5-year OS was 90.2%, 70.5% and 52.3% respectively, median 70 months, with no difference between age cohorts (p=0.772). Tumour Burden score and operation type were independent predictors of overall survival. Conclusions Liver resection for CRLM in patients 75 years and older is feasible, safe and confers a similar 5-year survival rate to younger patients. The current outcomes from surgery are better than historical datasets.
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Affiliation(s)
| | - Carven Chin
- Cardiff University School of Medicine, Cardiff, UK
| | - Patricia Duncan
- Cardiff Liver Unit, University Hospital of Wales, Cardiff, UK
| | - David O'Reilly
- Cardiff Liver Unit, University Hospital of Wales, Cardiff, UK
| | - Zsolt Kaposztas
- Department of Surgery, Moritz Kaposi Teaching General Hospital, Kaposvár, Hungary
| | | | - Nagappan Kumar
- Cardiff Liver Unit, University Hospital of Wales, Cardiff, UK
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Rees M, Thomas S, Kaposztas Z, Kumar N. 77. Patient satisfaction at Cardiff Liver Unit: Improving the standard of tertiary based cancer care. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.074] [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: 10/24/2022] Open
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Gyurus E, Kaposztas Z, Kahan BD. Sirolimus therapy predisposes to new-onset diabetes mellitus after renal transplantation: a long-term analysis of various treatment regimens. Transplant Proc 2011; 43:1583-92. [PMID: 21693238 DOI: 10.1016/j.transproceed.2011.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [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: 12/23/2022]
Abstract
PURPOSE This retrospective analysis evaluated the impacts of sirolimus (SRL), cyclosporine (CsA), and steroids (S) on the occurrence, treatment, and complications of new-onset diabetes after transplantation (NODAT). METHODS We compared 4 groups: group 1, SRL plus full-exposure CsA/S (n = 118); group 2, full-exposure CsA/S/no SRL ± antiproliferative drug (n = 141); group 3, SRL plus reduced CsA exposure/S (n = 212); and group 4, no SRL/full-exposure CsA/S ± antiproliferative drug (n = 43). RESULTS NODAT rates reflected the level of CsA exposure; at 10 years 54% versus 30% for groups 1 versus 2 (P = .0001); at 5 years 30% versus 21% for Groups 3 versus 4 (P = .3); 81% of cases were detected within 1 year. The lower NODAT rate in group 3 reflected a benefit of reduced CsA exposure (P = .02; hazard ratio (HR), 1.006). Group 1 showed higher CsA (P = .0001) and lower SRL concentrations (P = .016) versus group 3. CsA exposure closely correlating with NODAT among group 1 (P = .0001) was the major difference between groups 1 and 3 (P = .04; HR, 0.97). Differences in steroid treatment did not play a significant role in NODAT. Comparing groups 1 and 2, SRL was an independent risk factor for NODAT (P = .004; HR, 3.5). CONCLUSIONS Our 10-year experience revealed SRL to be an etiologic agent for NODAT, displaying interactive, possibly pharmacokinetic, and pharmacodynamic effects with concomitant CsA in combination treatment.
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Affiliation(s)
- E Gyurus
- Division of Immunology and Organ Transplantation, University of Texas Medical School, Houston, Texas 77030, USA
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Kaposztas Z, Gyurus E, Kahan BD. New-onset diabetes after renal transplantation: diagnosis, incidence, risk factors, impact on outcomes, and novel implications. Transplant Proc 2011; 43:1375-94. [PMID: 21693204 DOI: 10.1016/j.transproceed.2011.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [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: 02/07/2023]
Abstract
OBJECTIVE New-onset diabetes after transplantation (NODAT) is a multifactorial, complex metabolic disorder associated with impaired long-term graft function, reduced recipient survival, and increased risks of cardiovascular disease and infectious complications. The impact of NODAT is generally underestimated partly due to the inconsistent criteria that have been previously used for its diagnosis and to the generally short observation periods. The aim of this article was to review the recent literature on NODAT and to highlight the novel implications. FINDINGS The 2010 American Diabetes Association guidelines provide useful, simplified criteria to unify the diagnosis including application of hemoglobin A1C levels. We sought to establish the impact of various modifiable and nonmodifiable risk factors. A vast number of papers have examined the effects of immunosuppressive medications on the development of NODAT: Neither calcineurin inhibitor nor sirolimus (SRL) or steroids seems to be innocent of contributing to it. Immunosuppressants account for 74% of the occurrence of NODAT. Among modifiable risk factors, obesity is independent and significant, with great prevalence in the population. In additional to lifestyle modifications, the role of bariatric surgery (BS) either before or after transplantation is highlighted herein as a strategy to reduce disease in the view of the results among overweight, nontransplanted patients. SUMMARY Because of the strong association between high glucose values in the early posttransplant period and the development of NODAT, the condition must be recognized early after (or even before) transplantation by intensive screening. Patients at risk for NODAT must modify appropriate risk factors and particularly undergo pretransplant planning and/or posttransplant adjustment individualizing immunosuppressive therapy to mitigate the risk of this serious complication.
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Affiliation(s)
- Z Kaposztas
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, Wales
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Kaposztas Z, Kahan BD, Katz SM, Van Buren CT, Cherem L. Bortezomib successfully reverses early recurrence of light-chain deposition disease in a renal allograft: a case report. Transplant Proc 2010; 41:4407-10. [PMID: 20005409 DOI: 10.1016/j.transproceed.2009.10.005] [Citation(s) in RCA: 21] [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] [Indexed: 10/20/2022]
Abstract
Light-Chain Deposition Disease (LCDD) frequently recurs after renal transplantation, displaying a pernicious course. Herein we have described a 39-year-old Caucasian man with a history of immunoglobulin G-kappa multiple myeloma who failed two chemotherapy regimens, but ultimately responded to the combination of thalidomide, bortezomib, and dexamethasone followed by high-dose melphalan and autologous stem cell transplantation 3 years prior to transplantation, during which time he showed no evidence of persistent or recurrent disease. At 3 days following spousal living related renal transplantation, he displayed a rapid deterioration of renal function requiring dialysis therapy. This episode failed to respond to empiric antirejection therapy including anti-thymocyte globulin, plasmapheresis, and anti-CD20 monoclonal antibody. Increasing evidence suggested recurrence of LCDD, including positive immunofluorescence staining of basement membranes and vessels for kappa light chains as well as free kappa light chains in his urine and serum. Following suspension of sirolimus, he was initiated on and responded to bortezomib (1.3 mg/m(2)) with discontinuation of dialysis within 3 weeks and progressively improving renal function. His maintenance therapy, in addition to six 2-week-long cycles of bortezomib separated by 1-week rest periods, includes cyclosporine (50 mg twice daily), prednisone (10 mg daily), and curcumin (9 g daily). In sum, bortezomib rescue therapy salvaged a spousal renal transplant afflicted with recurrent LCDD.
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Affiliation(s)
- Z Kaposztas
- Department of Surgery, University of Texas Medical School at Houston, Houston, Texas 77030, USA
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Petero VG, Kaposztas Z, Kahan BD. Repeat renal allografts treated with sirolimus, cyclosporine, anti-thymocyte globulin induction and continuous steroids achieve similar immunosuppressive efficacy as primary transplants. Clin Transplant 2009; 24:243-51. [PMID: 19694771 DOI: 10.1111/j.1399-0012.2009.01055.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to examine repeat versus primary renal transplantations using sirolimus-based regimens. METHODS We compared 98 repeat versus 200 matched primary recipients treated de novo with sirolimus plus cyclosporine. Every repeat case received polyclonal antibody induction and continuous steroids. Outcomes were evaluated over a mean five-year follow-up by univariate and multivariate techniques. Kaplan-Meier plots were analyzed with using log-rank statistics with significance at P < or = 0.05. RESULTS Significant differences in demographic features included greater panel reactive antibody (PRA), younger age, fewer HLA-mismatches and more pre-emptive repeat versus primary grafts. Neither graft and patient survivals, nor incidences of biopsy-proven acute rejection (BPAR), chronic vasculopathy or tubular atrophy/interstitial fibrosis among biopsies performed for cause were significantly different at 1 and 5 years. Younger recipients, better HLA matches and absence of diabetes promoted repeat graft survival; whereas older age, longer cold ischemia time and BPAR reduced primary transplant outcomes. Renal function was similar at 1, 3, 12, 24, 48 and 60 months. CONCLUSION At 5 years this sirolimus regimen achieved similar efficacy for repeat versus primary transplantations.
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Affiliation(s)
- Virgilio G Petero
- Division of Immunology and Organ Transplantation, The University of Texas - Health Science Center at Houston Medical School, Houston, TX 77030, USA
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Kaposztas Z, Podder H, Mauiyyedi S, Illoh O, Kerman R, Reyes M, Pollard V, Kahan BD. Impact of rituximab therapy for treatment of acute humoral rejection. Clin Transplant 2009; 23:63-73. [PMID: 19200217 DOI: 10.1111/j.1399-0012.2008.00902.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Antibody mediated rejection (AMR) is associated with a greater incidence of allograft loss because traditional approaches - pulse steroid or anti-lymphocyte antibodies are usually ineffective. This retrospective analysis documented the benefit of rituximab administration in addition to plasmapheresis (PP). METHODS We retrospectively reviewed the data from 54 kidney transplant patients treated for AMR between 2001 and 2006, including 26 patients who received PP plus rituximab (Group A), versus 28 subjects who underwent PP without rituximab (Group B). Only patients whose serum IgG levels were below normal values received intravenous gamma globulin (IVIG). In addition to clinical and demographic variables we evaluated graft/patient survivals at two years post-diagnosis, Banff classification of rejections, serum creatinine and calculated GFR values at baseline, rejection, resolution as well as three, six, 12 and 24 months thereafter. RESULTS The demographic features of the cohorts showed no significant differences. The two-year graft survival for patients treated with rituximab plus PP was 90%, significantly better than 60% in the PP cohort (p = 0.005). Upon multivariate analysis administration of rituximab was the most significant factor (>or= 0.009); whereas, IVIG also produced a useful effect (p = 0.05). Neither the mean (>or= 0.42) nor the slope (p = 0.25) of GFR values showed a significant difference among salvaged kidneys over 24 months after completion of AMR treatment. The rates and types of infectious complications at three and six months did not show significant differences or impact on graft survival. CONCLUSION Addition of rituximab improved the outcomes of PP treatment of antibody mediated rejection episodes.
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Affiliation(s)
- Z Kaposztas
- Department of Surgery, The University of Texas Medical School at Houston, Houston, Texas, USA
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Kaposztas Z, Etheridge W, Kahan B. Case Report: Successful Treatment of Posttransplant Lymphoproliferative Disorder and Quiescence of Dermatomyositis With Rituximab and Sirolimus. Transplant Proc 2008; 40:1744-6. [DOI: 10.1016/j.transproceed.2007.11.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 11/07/2007] [Indexed: 10/21/2022]
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