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  • Organ Donor Research: Overcoming Challenges, Increasing Opportunities

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    JAMA. 2017; doi: 10.1001/jama.2017.16442

    This Viewpoint discusses a 2017 National Academies of Sciences, Engineering, and Medicine report about ways to support research on pretransplantation organs to reduce organ waste, upgrade the quality and quantity of transplants, and improve patient outcomes.

  • JAMA November 22, 2016

    Figure 1: Participant Flow in a Randomized Clinical Trial of Inpatient Palliative Care Compared With Standard Transplant Care Among Patients Hospitalized for Hematopoietic Stem Cell Transplantation (HCT)

    aReasons for ineligibility included language barrier (n = 10), benign disease (n = 6), previous HCT (n=15), clinician refusal (n = 2), enrollment in another supportive care trial (n = 8), transplantation aborted within 24 hours of admission (n = 6), combined solid organ transplantation and HCT (n = 3), and primarily outpatient transplantation (n = 6).
  • JAMA November 1, 2016

    Figure 1: Clinical and Microscopic Analysis of Autologous Collagen VII Gene–Corrected Grafts in Patients 1 and 2

    Clinical representation of recessive dystrophic epidermolysis bullosa (RDEB) phenotype (top row in each panel), indirect immunofluorescence microscopy (middle row in each panel), and immunoelectron microscopy (bottom row in each panel) analysis of type VII collagen expression in skin grafts. Dotted lines in patient 2 represent the margins of the original grafts. Clinical images were obtained with Canfield Vectra 3D camera and then stitched together to create a comprehensive 3D image. Using Mirror Software (Canfield), landmarks were selected and numbered to identify corresponding locations on each image, and then melded into a single image. In the top rows, the graft boundaries are indicated with purple dashed lines. The presence of RDEB is apparent by the characteristic spontaneous blisters prior to corrected skin transplantation compared with corrected skin 3, 6, and 12 months after grafting. For the middle rows, the nuclear staining dye used was Hoechst 33342 (blue), the scale bar is 100 μm, and the green staining shows the type VII collagen at the dermal-epidermal basement membrane of the corrected tissue grafts. For immunoelectron microscopy analyses of corrected RDEB skin grafts (bottom rows), tissue sections were labeled en bloc with anti–type VII collagen noncollagenous domain 2 monoclonal antibody LH24 antibody, followed by antimouse IgM-conjugated immunogold particles (black dots), which decorate anchoring fibrils (indicated by arrowheads).
  • JAMA November 1, 2016

    Figure 2: Clinical and Microscopic Analysis of Autologous Collagen VII Gene–Corrected Grafts in Patients 3 and 4 and Untreated Wounds From Patient 4

    Clinical representation of recessive dystrophic epidermolysis bullosa (RDEB) phenotype (top row in panels A and B), indirect immunofluorescence microscopy (middle row in panels A and B), and immunoelectron microscopy (bottom row in panels A and B) analysis of type VII collagen expression in skin grafts. In the top rows of panels A and B, the dotted lines represent the margins of the original grafts. Clinical images were obtained with Canfield Vectra 3D camera and then stitched together to create a comprehensive 3D image. Using Mirror Software (Canfield), landmarks were selected and numbered to identify corresponding locations on each image, and then melded into a single image. In the top rows in panels A and B, the graft boundaries are indicated with purple dashed lines. In panels A and B, the presence of RDEB is apparent by the characteristic spontaneous blisters prior to corrected skin transplantation and in untreated wounds (panel C) compared with corrected skin 3, 6, and 12 months after grafting. For the middle rows in panels A and B, the nuclear staining dye used was Hoechst 33342 (blue), the scale bar is 100 μm, and the green staining shows the type VII collagen at the dermal-epidermal basement membrane of the corrected tissue grafts. For immunoelectron microscopy analyses of corrected RDEB skin grafts (bottom rows in panels A and B), tissue sections were labeled en bloc with anti–type VII collagen noncollagenous domain 2 monoclonal antibody LH24 antibody, followed by antimouse IgM-conjugated immunogold particles (black dots), which decorate anchoring fibrils (indicated by arrowheads).
  • Nondisclosure

    Abstract Full Text
    JAMA. 2016; 316(8):821-821. doi: 10.1001/jama.2016.5348
  • US Hospitals Prepare for Penis Transplants

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    JAMA. 2016; 315(13):1322-1324. doi: 10.1001/jama.2016.0209

    This Medical News & Perspectives story discusses the clinical advances and future promise of penis transplants.

  • JAMA January 12, 2016

    Figure: Flow of Participants in Double-Blind Randomized Clinical Trial of Frozen or Fresh Fecal Microbiota Transplantation

    CDI indicates Clostridium difficile infection; FMT, fecal microbiota transplantation.
  • JAMA January 12, 2016

    Figure: Correlation Between Stem Cell Source and National Income

    There were 49 countries with more than 5 hematopoietic stem cell transplantations for bone marrow failure between 2009 and 2010 according to World Health Organization regions. Each data marker represents the proportion of bone marrow as stem cell source and gross national income per capita in each country. Association of these variables was estimated by linear regression analysis using the least-squares method. Taiwan and Argentina were excluded from the analysis because of the lack of data about gross national income per capita.
  • JAMA August 25, 2015

    Figure 3: Day 30 Mutation Clearance Patterns by Patient for 50 Acute Myeloid Leukemia Cases

    AML indicates acute myeloid leukemia; AML-RMG, recurrently mutated AML genes; EFS, event-free survival; VAF, variant allele frequency. Top: bar plots showing the number of mutations assessed at day 30, color coded according to whether they exceeded the day 30 VAF threshold of 2.5%. Mutations that occurred in AML-RMG are labeled with white diamonds. The panel is divided into samples with at least 1 variant with a day 30 VAF of 2.5% or more (left) and samples in which the day 30 VAF for all mutations was less than 2.5% (right). Bottom: key AML genes and pathways, showing patterns of mutations and clearance. aThree cases that received an allogeneic transplant in the first complete remission. Exclusion of these 3 cases from the analysis did not significantly alter the outcome results. bThe median event-free survival of cases with a day 30 VAF of less than 2.5% for all mutations was 17.9 months vs 6.0 months for the cases in which at least 1 variant persisted with a VAF threshold of 2.5% or more (P < .001).
  • A Potential Solution to the Shortage of Solid Organs for Transplantation

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    JAMA. 2015; 313(23):2321-2322. doi: 10.1001/jama.2015.5328

    This Viewpoint discusses an approach to expanding the pool of potential donors of solid organs for transplantation.

  • Association Between Donor Leukocyte Telomere Length and Survival After Unrelated Allogeneic Hematopoietic Cell Transplantation for Severe Aplastic Anemia

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    JAMA. 2015; 313(6):594-602. doi: 10.1001/jama.2015.7

    This study found that longer donor leukocyte telomere length was associated with increased 5-year survival for patients with severe aplastic anemia who had undergone a hematopoietic cell transplant.

  • Diagnosis and Treatment of Clostridium difficile in Adults: A Systematic Review

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    JAMA. 2015; 313(4):398-408. doi: 10.1001/jama.2014.17103

    This systematic review summarizes the diagnostic approaches for Clostridium difficile infection and evaluates which therapeutic approaches should be used.

  • JAMA January 27, 2015

    Figure 3: Possible Approach for the Treatment of Clostridium difficile Infection

    aSuggested approach for Clostridium difficile (CDI) treatment according to disease severity based on current guidelines, recent reviews and meta-analyses of fecal microbiota transplantation, and randomized controlled trials of fidaxomicin. This approach is not validated. There are no data supporting the use of fidaxomicin for complicated CDI.bTreatment response is defined by clinical improvement in diarrhea or other signs of infection. Response may require 3 to 5 days after starting therapy, but therapy escalation can be considered sooner based on disease severity.cIndicates that costs are substantially higher.dDuration of therapy depends on treatment response.eConsider postinfectious irritable bowel syndrome rather than recurrent CDI for mild symptoms.References
  • JAMA January 20, 2015

    Figure 1: Neurological Disability Before and After Hematopoietic Stem Cell Transplantation Measured by the Expanded Disability Status Scale (EDSS)

    Time zero is prior to transplant. Error bars represent 95% confidence intervals.
  • JAMA January 20, 2015

    Figure 2: Survival Status After Hematopoietic Stem Cell Transplantation

    Time zero is prior to transplant. Data are up to but not including 5 years of follow-up.aNo acute relapses.bNo increase in Expanded Disability Status Scale score.cNo acute relapses, no progression, no new gadolinium-enhanced or T2 lesions detected with magnetic resonance imaging.
  • Levofloxacin for BK Virus Prophylaxis Following Kidney Transplantation: A Randomized Clinical Trial

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    JAMA. 2014; 312(20):2106-2114. doi: 10.1001/jama.2014.14721

    In this randomized trial among kidney transplant recipients, a 3-month course of levofloxacin initiated early following transplantation did not prevent BK viruria and was associated with an increased risk of adverse events such as bacterial resistance.

  • Transplant-Transmitted Encephalitis

    Abstract Full Text
    JAMA. 2014; 312(15):1504-1504. doi: 10.1001/jama.2014.12455
  • JAMA July 2, 2014

    Figure 1: Donor Leukocyte Engraftment After Hematopoietic Stem Cell Transplantation (HSCT)

    Eleven patients who were still receiving immunosuppression medication (sirolimus) are shown in panels A (myeloid) and C (lymphoid). Fifteen patients who later discontinued immunosuppression medication are shown in panels B and D. The orange lines and data points represent values after patients ceased immunosuppression medication. At the very early time points, eg, 1 month after transplant when patients began to shows signs of white blood cell engraftment, there often were not sufficient numbers of leukocytes for chimerism analysis. Thus not all time points include all 26 data points. At later time point, some patients could not travel back at the half-year marks (eg, 2.5, 3.5, or 4.5 year) for chimerism analysis; thus, there are fewer data points at those times.
  • Nonmyeloablative HLA-Matched Sibling Allogeneic Hematopoietic Stem Cell Transplantation for Severe Sickle Cell Phenotype

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    JAMA. 2014; 312(1):48-56. doi: 10.1001/jama.2014.7192

    In a trial involving 30 adult patients with sickle cell phenotype with or without thalassemia, Hsieh and coauthors report that after undergoing nonmyeloablative allogeneic hematopoietic stem cell transplantation from human leukocyte antigen–matched siblings, 26 patients achieved long-term engraftment.

  • Be Your Own Philosopher

    Abstract Full Text
    JAMA. 2014; 311(19):2026-2026. doi: 10.1001/jama.2013.279509