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Swaminathan AC, Barfield R, Zhang M, Povysil G, Chen C, Frankel C, Kelly F, McKinney M, Todd JL, Allen A, Palmer SM. Prevalence and significance of clonal hematopoiesis of indeterminate potential in lung transplant recipients. BMC Pulm Med 2023; 23:414. [PMID: 37904125 PMCID: PMC10614406 DOI: 10.1186/s12890-023-02703-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Clonal hematopoiesis of indeterminate potential (CHIP), the age-related acquisition of somatic mutations that leads to an expanded blood cell clone, has been associated with development of a pro-inflammatory state. An enhanced or dysregulated inflammatory response may contribute to rejection after lung transplantation, however the prevalence of CHIP in lung recipients and influence of CHIP on allograft outcomes is unknown. METHODS We analyzed whole-exome sequencing data in 279 lung recipients to detect CHIP, defined by pre-specified somatic mutations in 74 genes known to promote clonal expansion of hematopoietic stem cells. We compared the burden of acute rejection (AR) over the first post-transplant year in lung recipients with vs. without CHIP using multivariable ordinal regression. Multivariate Cox proportional hazards models were used to assess the association between CHIP and CLAD-free survival. An exploratory analysis evaluated the association between the number of CHIP-associated variants and chronic lung allograft dysfunction (CLAD)-free survival. RESULTS We detected 64 CHIP-associated mutations in 45 individuals (15.7%), most commonly in TET2 (10.8%), DNMT3A (9.2%), and U2AF1 (9.2%). Patients with CHIP tended to be older but did not significantly differ from patients without CHIP in terms of race or native lung disease. Patients with CHIP did not have a higher incidence of AR over the first post-transplant year (p = 0.45) or a significantly increased risk of death or CLAD (adjusted HR 1.25, 95% CI 0.88-1.78). We did observe a significant association between the number of CHIP variants and CLAD-free survival, specifically patients with 2 or more CHIP-associated variants had an increased risk for death or CLAD (adjusted HR 3.79, 95% CI 1.98-7.27). CONCLUSIONS Lung recipients have a higher prevalence of CHIP and a larger variety of genes with CHIP-associated mutations compared with previous reports for the general population. CHIP did not increase the risk of AR, CLAD, or death in lung recipients.
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Affiliation(s)
- Aparna C Swaminathan
- Duke Clinical Research Institute, Durham, NC, USA.
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Richard Barfield
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, USA
- Center for Human Systems Immunology, School of Medicine, Duke University, Durham, USA
| | - Mengqi Zhang
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, USA
| | - Gundula Povysil
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
| | - Cliburn Chen
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, USA
- Center for Human Systems Immunology, School of Medicine, Duke University, Durham, USA
| | - Courtney Frankel
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Francine Kelly
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Matthew McKinney
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jamie L Todd
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Andrew Allen
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, USA
| | - Scott M Palmer
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Goldsby J, Beermann K, Frankel C, Parish A, Stauffer N, Schandert A, Erkanli A, Reynolds JM. Preemptive immune globulin therapy in sensitized lung transplant recipients. Transpl Immunol 2023; 80:101904. [PMID: 37499884 PMCID: PMC10631014 DOI: 10.1016/j.trim.2023.101904] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Sensitized lung transplant recipients are at increased risk of developing donor-specific antibodies, which have been associated with acute and chronic rejection. Perioperative intravenous immune globulin has been used in sensitized individuals to down-regulate antibody production. METHODS We compared patients with a pre-transplant calculated panel reactive antibody ≥25% who did not receive preemptive immune globulin therapy to a historical control that received preemptive immune globulin therapy. Our cohort included 59 patients, 17 patients did not receive immune globulin therapy and 42 patients received therapy. RESULTS Donor specific antibody development was numerically higher in the non-immune globulin group compared to the immune globulin group (58.8% vs 33.3%, respectively, odds ratio 2.80, 95% confidence interval [0.77, 10.79], p = 0.13). Median time to antibody development was 9 days (Q1, Q3: 7, 19) and 28 days (Q1, Q3: 7, 58) in the non-immune globulin and immune globulin groups, respectively. There was no significant difference between groups in the incidence of primary graft dysfunction at 72 h post-transplant or acute cellular rejection, antibody-mediated rejection, and chronic lung allograft dysfunction at 12 months. CONCLUSION These findings are hypothesis generating and emphasize the need for larger, randomized studies to determine association of immune globulin therapy with clinical outcomes.
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Affiliation(s)
- Jessica Goldsby
- Department of Pharmacy, Duke Health, DUHS Box 3089, Durham, NC 27710, United States
| | - Kristi Beermann
- Department of Pharmacy, Duke Health, DUHS Box 3089, Durham, NC 27710, United States.
| | - Courtney Frankel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke Health, 330 Trent Drive, Box 102352, Durham, NC 27710, United States
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, United States
| | - Nicolas Stauffer
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, United States
| | - Amanda Schandert
- Department of Pharmacy, Duke Health, DUHS Box 3089, Durham, NC 27710, United States
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, Durham, NC 27710, United States
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke Health, 330 Trent Drive, Box 102352, Durham, NC 27710, United States
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Swaminathan AC, McConnell A, Peskoe S, Bashir MR, Buckley EB, Frankel C, Turner D, Smith P, Zaffiri L, Singer LG, Snyder LD. Evaluation of Frailty Measures and Short-term Outcomes After Lung Transplantation. Chest 2023:S0012-3692(23)00121-6. [PMID: 36681147 DOI: 10.1016/j.chest.2023.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/01/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Frailty, measured as a single construct, is associated variably with poor outcomes before and after lung transplantation. The usefulness of a comprehensive frailty assessment before transplantation is unknown. RESEARCH QUESTION How are multiple frailty constructs, including phenotypic and cumulative deficit models, muscle mass, exercise tolerance, and social vulnerabilities, measured before transplantation, associated with short-term outcomes after lung transplantation? STUDY DESIGN AND METHODS We conducted a retrospective cohort study of 515 lung recipients who underwent frailty assessments before transplantation, including the short physical performance battery (SPPB), transplant-specific frailty index (FI), 6-min walk distance (6MWD), thoracic sarcopenia, and social vulnerability indexes. We tested the association between frailty measures before transplantation and outcomes after transplantation using logistic regression to model 1-year survival and zero-inflated negative binomial regression to model hospital-free days (HFDs) in the first 90 days after transplantation. Adjustment covariates included age, sex, native lung disease, transplantation type, lung allocation score, BMI, and primary graft dysfunction. RESULTS Before transplantation, 51.3% of patients were frail by FI (FI ≥ 0.25) and no patients were frail by SPPB. In multivariate adjusted models that also included FI, SPPB, and 6MWD, greater frailty by FI, but not SPPB, was associated with fewer HFDs (-0.006 per 0.01 unit worsening; 95% CI, -0.01 to -0.002 per 0.01 unit worsening) among discharged patients. Greater SPPB deficits were associated with decreased odds of 1-year survival (OR, 0.51 per 1 unit worsening; 95% CI, 0.28-0.93 per 1 unit worsening). Correlation among frailty measurements overall was poor. No association was found between thoracic sarcopenia, 6MWD, or social vulnerability assessments and short-term outcomes after lung transplantation. INTERPRETATION Both phenotypic and cumulative deficit models measured before transplantation are associated with short-term outcomes after lung transplantation. Cumulative deficit measures of frailty may be more relevant in the first 90 days after transplantation, whereas phenotypic frailty may have a stronger association with 1-year survival.
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Affiliation(s)
- Aparna C Swaminathan
- Department of Medicine, Duke University School of Medicine, Durham, NC, Canada; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, Canada.
| | - Alec McConnell
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, Canada
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, Canada
| | - Mustafa R Bashir
- Department of Radiology, Duke University School of Medicine, Durham, NC, Canada
| | - Erika Bush Buckley
- Department of Medicine, Duke University School of Medicine, Durham, NC, Canada
| | - Courtney Frankel
- Department of Medicine, Duke University School of Medicine, Durham, NC, Canada
| | - Daniel Turner
- Department of Medicine, Duke University School of Medicine, Durham, NC, Canada
| | - Patrick Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, Canada
| | - Lorenzo Zaffiri
- Department of Medicine, Duke University School of Medicine, Durham, NC, Canada
| | - Lianne G Singer
- Division of Respirology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Laurie D Snyder
- Department of Medicine, Duke University School of Medicine, Durham, NC, Canada; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, Canada
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Schneeberger P, Zhang C, Santilli J, Wijesinha Z, Levy L, Chen B, Xu W, Lee Y, Huszti E, Ahmed M, Boonstra K, Moshkelgosha S, Weigt S, Shah P, Budev M, Frankel C, Todd J, Snyder L, Palmer S, Yeung J, Keshavjee S, Singer L, Coburn B, Martinu T. The Pulmonary Microbiome after Lung Transplantation is Associated with Gastroesophageal Reflux Disease, Inflammation, and Allograft Dysfunction. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1885] [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: 10/21/2022] Open
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5
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Zaffiri L, Frankel C, Bush EJ, Neely ML, Pavlisko EN, Mokrova IL, Luftig MA, Palmer SM. Evidence of Epstein-Barr virus heterogeneous gene expression in adult lung transplant recipients with posttransplant lymphoproliferative disorder. J Med Virol 2021; 93:5040-5047. [PMID: 33704812 PMCID: PMC9208898 DOI: 10.1002/jmv.26936] [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: 12/23/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 11/10/2022]
Abstract
Epstein-Barr virus (EBV)-driven posttransplant lymphoproliferative disorder (PTLD) is a serious complication following lung transplant. The extent to which the presence of EBV in PTLD tissue is associated with survival is uncertain. Moreover, whether the heterogeneity in expression of EBV latency programs is related to the timing of PTLD onset remains unexplored. We retrospectively performed a comprehensive histological evaluation of EBV markers at the tissue level in 34 adult lung transplant recipients with early- and late-onset PTLD. Early-onset PTLD, occurring within the first 12 months posttransplant, had higher odds to express EBV markers. The presence of EBV in PTLD was not associated with a difference in survival relative to EBV-negative tumors. However, we found evidence of heterogeneous expression of EBV latency programs, including type III, IIb, IIa, and 0/I. Our study suggests that the heterogeneous expression of EBV latency programs may represent a mechanism for immune evasion in patients with PLTD after lung transplants. The recognition of multiple EBV latency programs can be used in personalized medicine in patients who are nonresponsive to traditional types of chemotherapy and can be potentially evaluated in other types of solid organ transplants.
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Affiliation(s)
- Lorenzo Zaffiri
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Courtney Frankel
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Erika J Bush
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Megan L Neely
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | | | - Irina L Mokrova
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Micah A Luftig
- Department of Molecular Genetics and Microbiology, Duke Center for Virology, Duke University, Durham, North Carolina, USA
| | - Scott M Palmer
- Department of Medicine, Duke University, Durham, North Carolina, USA
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Snyder LD, Belperio J, Budev M, Frankel C, Kirchner J, Martinu T, Neely ML, Reynolds JM, Shah P, Singer LG, Todd JL, Tsuang W, Weigt S, Palmer SM. Highlights from the clinical trials in organ transplantation (CTOT)-20 and CTOT-22 Consortium studies in lung transplant. Am J Transplant 2020; 20:1489-1494. [PMID: 32342596 PMCID: PMC7323580 DOI: 10.1111/ajt.15957] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 01/25/2023]
Abstract
Long-term survival after lung transplant lags behind that of other commonly transplanted organs, reflecting the current incomplete understanding of the mechanisms involved in the development of posttransplant lung injury, rejection, infection, and chronic allograft dysfunction. To address this unmet need, 2 ongoing National Institute of Allergy and Infectious Disease funded studies through the Clinical Trials in Organ Transplant Consortium (CTOT) CTOT-20 and CTOT-22 were dedicated to understanding the clinical factors and biological mechanisms that drive chronic lung allograft dysfunction and those that maintain cytomegalovirus polyfunctional protective immunity. The CTOT-20 and CTOT-22 studies enrolled 800 lung transplant recipients at 5 North American centers over 3 years. Given the number and complexity of subjects included, CTOT-20 and CTOT-22 utilized innovative data transfers and capitalized on patient-entered data collection to minimize site manual data entry. The data were coupled with an extensive biosample collection strategy that included DNA, RNA, plasma, serum, bronchoalveolar lavage fluid, and bronchoalveolar lavage cell pellet. This Special Article describes the CTOT-20 and CTOT-22 protocols, data and biosample strategy, initial results, and lessons learned through study execution.
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Affiliation(s)
| | | | | | | | - Jerry Kirchner
- Duke Clinical Research institute, Durham, North Carolina
| | | | | | | | - Pali Shah
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Samuel Weigt
- University of California, Los Angeles, California
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7
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Zhang CYK, Ahmed M, Huszti E, Levy L, Hunter SE, Boonstra KM, Moshkelgosha S, Sage AT, Azad S, Zamel R, Ghany R, Yeung JC, Crespin OM, Frankel C, Budev M, Shah P, Reynolds JM, Snyder LD, Belperio JA, Singer LG, Weigt SS, Todd JL, Palmer SM, Keshavjee S, Martinu T. Bronchoalveolar bile acid and inflammatory markers to identify high-risk lung transplant recipients with reflux and microaspiration. J Heart Lung Transplant 2020; 39:934-944. [PMID: 32487471 DOI: 10.1016/j.healun.2020.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 10/23/2019] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a risk factor for chronic lung allograft dysfunction. Bile acids-putative markers of gastric microaspiration-and inflammatory proteins in the bronchoalveolar lavage (BAL) have been associated with chronic lung allograft dysfunction, but their relationship with GERD remains unclear. Although GERD is thought to drive chronic microaspiration, the selection of patients for anti-reflux surgery lacks precision. This multicenter study aimed to test the association of BAL bile acids with GERD, lung inflammation, allograft function, and anti-reflux surgery. METHODS We analyzed BAL obtained during the first post-transplant year from a retrospective cohort of patients with and without GERD, as well as BAL obtained before and after Nissen fundoplication anti-reflux surgery from a separate cohort. Levels of taurocholic acid (TCA), glycocholic acid, and cholic acid were measured using mass spectrometry. Protein markers of inflammation and injury were measured using multiplex assay and enzyme-linked immunosorbent assay. RESULTS At 3 months after transplantation, TCA, IL-1β, IL-12p70, and CCL5 were higher in the BAL of patients with GERD than in that of no-GERD controls. Elevated TCA and glycocholic acid were associated with concurrent acute lung allograft dysfunction and inflammatory proteins. The BAL obtained after anti-reflux surgery contained reduced TCA and inflammatory proteins compared with that obtained before anti-reflux surgery. CONCLUSIONS Targeted monitoring of TCA and selected inflammatory proteins may be useful in lung transplant recipients with suspected reflux and microaspiration to support diagnosis and guide therapy. Patients with elevated biomarker levels may benefit most from anti-reflux surgery to reduce microaspiration and allograft inflammation.
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Affiliation(s)
- Chen Yang Kevin Zhang
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Musawir Ahmed
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Liran Levy
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Sarah E Hunter
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Kristen M Boonstra
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Sajad Moshkelgosha
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Andrew T Sage
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Sassan Azad
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Ricardo Zamel
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Rasheed Ghany
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Yeung
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Oscar M Crespin
- Division of General Surgery, University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Pali Shah
- Johns Hopkins University Hospital, Baltimore, Maryland
| | | | | | | | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | | | - Jamie L Todd
- Duke University Medical Center, Durham, North Carolina
| | | | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Tereza Martinu
- Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada.
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8
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Blumenthal JA, Smith PJ, Sherwood A, Mabe S, Snyder L, Frankel C, McKee DC, Hamilton N, Keefe FJ, Shearer S, Schwartz J, Palmer S. Remote Therapy to Improve Outcomes in Lung Transplant Recipients: Design of the INSPIRE-III Randomized Clinical Trial. Transplant Direct 2020; 6:e535. [PMID: 32195326 PMCID: PMC7056276 DOI: 10.1097/txd.0000000000000979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Impaired functional capacity and emotional distress are associated with lower quality of life (QoL) and worse clinical outcomes in post lung transplant patients. Strategies to increase physical activity and reduce distress are needed. METHODS The Investigational Study of Psychological Interventions in Recipients of Lung Transplant-III study is a single site, parallel group randomized clinical trial in which 150 lung transplant recipients will be randomly assigned to 3 months of telephone-delivered coping skills training combined with aerobic exercise (CSTEX) or to a Standard of Care plus Education control group. The primary endpoints are a global measure of distress and distance walked on the 6-Minute Walk Test. Secondary outcomes include measures of transplant-specific QoL, frailty, health behaviors, and chronic lung allograft dysfunction-free survival. RESULTS Participants will be evaluated at baseline, at the conclusion of 3 months of weekly treatment, at 1-year follow-up, and followed annually thereafter for clinical events for up to 4 years (median = 2 y). We also will determine whether functional capacity, distress, and health behaviors (eg, physical activity, medication adherence, and volume of air forcefully exhaled in 1 second (FEV1), mediate the effects of the CSTEX intervention on clinical outcomes. CONCLUSIONS Should the CSTEX intervention result in better outcomes compared with the standard of care plus post-transplant education, the remotely delivered CSTEX intervention can be made available to all lung transplant recipients as a way of enhancing their QoL and improving clinical outcomes.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Laurie Snyder
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Courtney Frankel
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Daphne C. McKee
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Natalie Hamilton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Sheila Shearer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jeanne Schwartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Scott Palmer
- Department of Medicine, Duke University Medical Center, Durham, NC
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9
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Snyder L, Neely M, Kopetskie H, Sever M, Kirchner J, Frankel C, Todd J, Smith P, Williams N, Robien M, Belperio J, Ross D, Rozenberg D, Budev M, Tsuang W, Shah P, Reynolds J, Palmer S, Singer L. Improvements in Health-Related Quality of Life with Lung Transplantation: A Prospective Multicenter Cohort Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.828] [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: 10/27/2022] Open
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10
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Smith P, Frankel C, Bacon D, Bush E, Snyder L. Depressive Symptoms, Physical Activity, and Post-Transplant Outcomes: The ADAPT Prospective Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Zhang K, Hunter S, Huszti E, Ahmed M, Levy L, Boonstra K, Sage A, Azad S, Zamel R, Frankel C, Budev M, Shah P, Snyder L, Belperio J, Singer L, Weigt S, Todd J, Keshavjee S, Palmer S, Martinu T. Effects of Nissen Fundoplication on Markers of Microaspiration and Inflammation after Lung Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.166] [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: 10/27/2022] Open
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12
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Clausen ES, Frankel C, Palmer SM, Snyder LD, Smith PJ. Pre-transplant weight loss and clinical outcomes after lung transplantation. J Heart Lung Transplant 2018; 37:1443-1447. [PMID: 30228085 DOI: 10.1016/j.healun.2018.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/21/2018] [Revised: 06/20/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients with greater adiposity before lung transplantation are at an increased risk for worse post-transplant outcomes. Few studies have addressed whether pre-transplant weight loss mitigates this risk. In this study we examined the association between pre-transplant weight loss and post-transplant clinical outcomes. METHODS We conducted a retrospective cohort study of patients who received a lung transplant at the Duke University Hospital from May 1, 2005 to April 30, 2015. The sample included adult transplant recipients with restrictive, obstructive, and vascular diseases. Cox proportional hazards models were used to examine mortality and chronic lung allograft dysfunction (CLAD)-free survival, and negative binomial regression analyses were used to examine length of stay (LOS). Weight loss was assessed from change in body mass index (BMI). RESULTS The cohort consisted of 810 patients. Initially, 403 (50%) were overweight and 109 (13%) were obese by BMI criteria. Greater pre-transplant weight loss was associated with dose-response improvements in survival (hazard ratio [HR] 0.83 [0.72 to 0.97], p = 0.018), with modest (0% to 3%, HR 0.91), moderate (7% to 10%, HR 0.83), and high (>15%, HR 0.71) levels of weight loss conferring longer survival, independent of initial weight (p = 0.533 for interaction). Weight loss was also associated with improved CLAD-free survival (HR 0.84 [0.71 to 0.99], p = 0.034) and shorter LOS (b = ‒0.17, p < 0.001). CONCLUSIONS Weight loss before transplantation was associated with improved short- and long-term clinical outcomes, independent of initial weight. Survival improved proportionally to percentage of weight lost. The mechanisms by which weight loss improve clinical outcomes warrant further exploration.
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Affiliation(s)
- Emily Siu Clausen
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA.
| | - Courtney Frankel
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Scott M Palmer
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Laurie D Snyder
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick J Smith
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Llanes–Quevedo A, Alfonso González M, Cárdenas Mena R, Frankel C, Espinosa Lopez G. Microsatellite variability of the wood stork Mycteria americana (Aves, Ciconidae) in Cuba: implications for its conservation. Anim Biodiv Conserv 2018. [DOI: 10.32800/abc.2018.41.0357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Petrovski S, Todd JL, Durheim MT, Wang Q, Chien JW, Kelly FL, Frankel C, Mebane CM, Ren Z, Bridgers J, Urban TJ, Malone CD, Finlen Copeland A, Brinkley C, Allen AS, O'Riordan T, McHutchison JG, Palmer SM, Goldstein DB. An Exome Sequencing Study to Assess the Role of Rare Genetic Variation in Pulmonary Fibrosis. Am J Respir Crit Care Med 2017; 196:82-93. [PMID: 28099038 DOI: 10.1164/rccm.201610-2088oc] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Idiopathic pulmonary fibrosis (IPF) is an increasingly recognized, often fatal lung disease of unknown etiology. OBJECTIVES The aim of this study was to use whole-exome sequencing to improve understanding of the genetic architecture of pulmonary fibrosis. METHODS We performed a case-control exome-wide collapsing analysis including 262 unrelated individuals with pulmonary fibrosis clinically classified as IPF according to American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association guidelines (81.3%), usual interstitial pneumonia secondary to autoimmune conditions (11.5%), or fibrosing nonspecific interstitial pneumonia (7.2%). The majority (87%) of case subjects reported no family history of pulmonary fibrosis. MEASUREMENTS AND MAIN RESULTS We searched 18,668 protein-coding genes for an excess of rare deleterious genetic variation using whole-exome sequence data from 262 case subjects with pulmonary fibrosis and 4,141 control subjects drawn from among a set of individuals of European ancestry. Comparing genetic variation across 18,668 protein-coding genes, we found a study-wide significant (P < 4.5 × 10-7) case enrichment of qualifying variants in TERT, RTEL1, and PARN. A model qualifying ultrarare, deleterious, nonsynonymous variants implicated TERT and RTEL1, and a model specifically qualifying loss-of-function variants implicated RTEL1 and PARN. A subanalysis of 186 case subjects with sporadic IPF confirmed TERT, RTEL1, and PARN as study-wide significant contributors to sporadic IPF. Collectively, 11.3% of case subjects with sporadic IPF carried a qualifying variant in one of these three genes compared with the 0.3% carrier rate observed among control subjects (odds ratio, 47.7; 95% confidence interval, 21.5-111.6; P = 5.5 × 10-22). CONCLUSIONS We identified TERT, RTEL1, and PARN-three telomere-related genes previously implicated in familial pulmonary fibrosis-as significant contributors to sporadic IPF. These results support the idea that telomere dysfunction is involved in IPF pathogenesis.
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Affiliation(s)
- Slavé Petrovski
- 1 Institute for Genomic Medicine, Columbia University Medical Center, New York, New York.,2 Department of Medicine, Austin Health and Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jamie L Todd
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,4 Duke Clinical Research Institute, Durham, North Carolina
| | - Michael T Durheim
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,4 Duke Clinical Research Institute, Durham, North Carolina
| | - Quanli Wang
- 1 Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | | | - Fran L Kelly
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Courtney Frankel
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Caroline M Mebane
- 1 Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Zhong Ren
- 1 Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Joshua Bridgers
- 1 Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Thomas J Urban
- 6 Division of Pharmacotherapy and Experimental Therapeutics, Center for Pharmacogenomics and Individualized Therapy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina; and
| | - Colin D Malone
- 1 Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
| | - Ashley Finlen Copeland
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Christie Brinkley
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew S Allen
- 7 Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | | | | | - Scott M Palmer
- 3 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,4 Duke Clinical Research Institute, Durham, North Carolina
| | - David B Goldstein
- 1 Institute for Genomic Medicine, Columbia University Medical Center, New York, New York
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Zaffiri L, Frankel C, Pavlisko E, Palmer S, Snyder L. Post-Transplant Lymphoproliferative Disorder After Lung Transplantation: 10-Year Experience at Duke University. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.242] [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: 10/19/2022] Open
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16
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Franco SX, Perez A, Tan-Chiu E, Gokce F, Frankel C, Schwartzberg LS, Krill E, Jakub J, Abramson N, Vogel C. Updated results of a multicenter phase II trial of neoadjuvant docetaxel, carboplatin and capecitabine for inflammatory and locally advanced breast cancer (LABC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10685] [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: 11/20/2022] Open
Abstract
10685 Background: Neoadjuvant chemotherapy for the treatment of LABC has become the standard of care but the best combination is not established. The combination of docetaxel and capecitabine demonstrates synergism in patients(pts) with metastatic breast cancer (MBC). Recent studies support the value of platinum salts in LABC and MBC. Methods: pts with stage IIA-IIIC or inflammatory BC, EGOG PS 0–1, are eligible.We are evaluating the combination of weekly docetaxel 30mg/m2, carboplatin AUC2 on D1, 8,15 of a 4-week cycle plus capecitabine 625 mg/m2 BID given on days 5–18 (based on the upregulation of thymidine phosphorylase) for 4 cycles prior to surgery. The primary objective of this phase II trial is pCR rate in breast. Results: 39 of 48 pts have been enrolled from 7 centers. Median age 46 (range 26–75), stage II 41%, stage III 59%. Median baseline tumor is 5.4cm (range 2.1–15); 1pt inflammatory BC; 10 pts N2 disease (36%); 12 tumors were ER+, 20 ER-, and 5 Her-2+. To date, 2,377 doses (including daily capecitabine doses) were administered out of a total of 2,560 (93% of intended doses) with only 10 dose delays and 8 dose reductions. 37 pts are evaluable for toxicities. No grade IV toxicities were seen, grade III neutropenia was seen in 3/37(8%) and grade III fatigue in 1/37(3%). There were no episodes of neutropenic fever.The most common grade I/II toxicities were nausea in 57%, diarrhea 38%, fatigue 43%, epiphora 24%, mucositis 24% and hand-foot syndrome 3%. No death related treatments have been reported. 32 pts have completed definitive surgery. Objective clinical response is 94% with 53% cCR. 5 patients had pCRs in breast(16%) and 5 pCR in breast and axilla(16%). 9 pts (28%) have microscopic residual disease in the breast (<3mm). 14 pts had complete axillary clearance (44%). Conclusions: The preoperative combination of docetaxel, carboplatin and capecitabine is feasible with very good response rate and a very acceptable toxicity profile. Accrual is ongoing. No significant financial relationships to disclose.
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Affiliation(s)
- S. X. Franco
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - A. Perez
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - E. Tan-Chiu
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - F. Gokce
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - C. Frankel
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - L. S. Schwartzberg
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - E. Krill
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - J. Jakub
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - N. Abramson
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
| | - C. Vogel
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; West Clinic, Memphis, TN; Mount Sinai Medical Center, Miami Beach, FL; Lakeland Regional Cancer Center, Lakeland, FL; Regional Consultants Hematology-Oncology, Jacksonville, FL
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Perez AT, Sear A, Frankel C, Franco SX, Tan-Chiu E, Gokce F, Vogel CL. Acupuncture for the management of hot flashes in women with early stage breast cancer treated with tamoxifen or an aromatase inhibitor: A pilot study of efficacy, safety and feasibility. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. T. Perez
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL
| | - A. Sear
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL
| | - C. Frankel
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL
| | - S. X. Franco
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL
| | - E. Tan-Chiu
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL
| | - F. Gokce
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL
| | - C. L. Vogel
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL
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Franco SX, Perez A, Frankel C, Tan-Chiu E, Schwartzberg L, Schwartz M, Krill E, Jakub J, Abramson N, Vogel C. Preliminary results of a multicenter phase II trial of neoadjuvant docetaxel, carboplatin and capecitabine for inflammatory and locally advanced breast cancer (LABC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. X. Franco
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - A. Perez
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - C. Frankel
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - E. Tan-Chiu
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - L. Schwartzberg
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - M. Schwartz
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - E. Krill
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - J. Jakub
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - N. Abramson
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
| | - C. Vogel
- Memorial Cancer Institute, Hollywood, FL; Cancer Research Network, Plantation, FL; ACORN-The West Clinic, Memphis, TN and Miami, FL; Mount Sinai Medcl Ctr, Miami Beach and Aventura, FL; Lakeland Regional Cancer Ctr, Lakeland, FL; Baptist Cancer Ctr, Jacksonville, FL
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Abstract
OBJECTIVES To review nursing management consideration for patients with advanced breast cancer who are candidates for trastuzumab. DATA SOURCES Research articles and the trastuzumab product insert. CONCLUSIONS Identification of appropriate candidates for trastuzumab therapy should include a review of HER2 status, previous treatments, presence of comorbid diseases, and determination of cardiac function. IMPLICATIONS FOR NURSING PRACTICE Nurses will manage the administration of trastuzumab. Therefore, they must understand how antibodies work at the cellular level, how to treat infusion-related events, and how to choose the best candidates for biological therapy.
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Affiliation(s)
- C Frankel
- Comprehensive Cancer Research Group/Intercenter Cancer Research Group, Mount Sinai Comprehensive Cancer Center, Miami Beach, FL, USA
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Abstract
OBJECTIVES To provide a review of the two pivotal clinical trials evaluating trastuzumab in metastatic breast cancer, either in combination with chemotherapy or as a single agent. DATA SOURCES Research reports. CONCLUSIONS Trastuzumab is indicated as a single agent or in combination with chemotherapy for patients with metastatic breast cancer who overexpress the HER2 protein. The toxicity profile of trastuzumab is favorable; cardiac dysfunction has been the primary dose-limiting toxicity, especially when combined with anthracyclines. IMPLICATIONS FOR NURSING PRACTICE Nurses will deliver trastuzumab in the clinical setting and must be familiar with its efficacy and toxicity profile.
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Affiliation(s)
- C Frankel
- Comprehensive Cancer Research Group/Intercenter Cancer Research Group, Mount Sinai Comprehensive Cancer Center, Miami Beach, FL, USA
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Robergs RA, Frankel C. Relationship between fatty acid delivery and fatty acid oxidation during exercise. J Appl Physiol (1985) 1996; 81:1450-2. [PMID: 8889786 DOI: 10.1152/jappl.1996.81.3.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Abstract
Del(3)(p25pter) is associated with a characteristic multiple congenital anomalies/mental retardation syndrome. Early recognition of these manifestations and identification of the chromosome defect are essential for proper management and counseling.
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Affiliation(s)
- J C Ramer
- Department of Pediatrics, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033
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Abstract
ABSTRACT
A total of 65 Schizophyllum commune dikaryons of three different geno-types were synthesized, maintained on agar plates, prevented from fruiting, and macerated. The macerate was plated. Germlings of homokaryotic morphology were isolated using no chemical or genetic selection, grown, and tested for recombinant genotypes. Crossover types were plentiful among the homokaryons with recombinant genotypes, indicating that meiotic-like processes in vegetative dikaryons are common and may be as important as conventional basidial meiosis in the origin of recombinant strains.
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Affiliation(s)
- C Frankel
- Department of Biology, Pennsylvania State University, Hazleton, Pennsylvania 18201
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Abstract
ABSTRACT
Forty-eight useful new mutations of S. commune were obtained by mutagenesis with N-methyl-N'-nitro-N-nitrosoguanidine. Their requirements and meiotic linkage relationships to each other and previously mapped areas were investigated. Several of these new mutations were incorporated into diploid strains so that the diploids contained at least one marker on every linkage group. Analysis of somatic recombination in these diploids indicated that each meiotic linkage group corresponded to an independent chromosome.
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Affiliation(s)
- C Frankel
- Department of Botany, Michigan State University, East Lansing, Michigan 48824
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Abstract
Two sets of diploid cultures of S. commune were observed for sectoring due to haploidization or recombination. Each set consisted of compatible and common-AB diploids otherwise almost isogenic. One of the sets included two compatible diploids with a large proportion of dikaryotic cells. The sectors were isolated and analysed for evidence of aneuploidy and frequent crossing over to determine whether they arose via mitotic or meiotic-like events. It was found that the recombination process in both common-AB and compatible diploids was predominantly mitotic. However, the compatible diploids which developed a high frequency of dikaryotic components gave some evidence of meiotic-like activity. Thus, compatible mating-type factors are necessary for dikaryosis, but not sufficient in themselves to produce it. In compatible mycelia where dikaryosis does occur, meiotic-like recombination may also occur. It is proposed that both lapse into the dikaryotic state, and meiotic-like recombination was induced by different genes under control of the incompatibility factors. Dikaryosis and meiosis are thus seen as tandem phenomena, neither causal of the other but both induced by action of compatible mating-type factors.
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Affiliation(s)
- C Frankel
- Department of Botany, Michigan State University, East Lansing, Michigan 48824
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