Komplikationsmanagement nach Lebertransplantation: Erhöhung der Patientensicherheit durch standardisiertes Vorgehen und interdisziplinäre Kooperation

Polyphenols as potential enhancers of stem cell therapy against neurodegeneration

The potential of polyphenols for treating chronic-degenerative diseases (particularly neurodegenerative diseases) is attractive. However, the selection of the best polyphenol for each treatment, the mechanisms by which they act, and their efficacy are frequently discussed. In this review, the basics and the advances in the field, as well as suggestions for using natural and synthetic polyphenols alone or in a combinatorial strategy with stem cell assays, are compiled and discussed. Thus, stem cells exhibit several responses when polyphenols are added to their environment, which could provide us with knowledge for advancing the elucidation of the origin of neurodegeneration. But also, polyphenols are being included in the innovative strategies of novel therapies for treating neurodegenerative diseases as well as metabolic diseases related to neurodegeneration. In this regard, flavonoid compounds are suggested as the best natural polyphenols due to their several mechanisms for acting in ameliorative effects; but increasing reports are involving other polyphenols. Even if some facts limiting bioactivity prevent them from conventional use, some natural polyphenols and derivatives hold the promise for being improved compounds, judged by their induced effects. The current results suggest polyphenols as enhancers of stem cell therapy against the targeted diseases.

[Update: Immunosuppression in organ transplantation]

Immunosuppression is an essential prerequisite for successful transplantation. In order to reduce the sometimes-considerable side effects, combination therapies with different agents are used. This article aims to provide an up-to-date overview of immunosuppression after liver and kidney transplantation.

Minimum Volume Standards in Surgery - Are We There Yet?

The quality of surgery is directly dependent on the quantity, more specifically, on the number of operations performed at a given hospital as well as on the designated surgeon. This fact is supported by numerous studies and meta-analyses that will be presented in the following text. Most of the convincing data for complex procedures can be obtained from visceral (upper and lower gastrointestinal) surgery studies. Mortality of large oncological procedures, such as esophageal or pancreatic surgery, can be reduced by 50% if a certain number of interventions are guaranteed per year. Centralizing these operations performed by specialized surgeons is the key to success. This also ensures that the minimum volume amounts within a given hospital are well above the required levels, thus enabling to teach the necessary expertise step by step. The obligatory 'learning curve' for complex interventions cannot be completed within the framework of reference figures during residency training. Together, surgeons and their respective societies have introduced a proposal for efficient case-oriented centralized surgery. Whether 'we are there yet' in surgery will depend in the end on how these efforts will be incorporated into administrative requirements and the guidelines that will then be implemented across the board.

Training, work, and lifestyle of transplant physicians and surgeons in Germany

BACKGROUND

International data on training, work, and lifestyle of transplant physicians and surgeons are scarce. Such data might help in development of uniform education paths and provide insights for young clinicians interested in this field. This study aimed at the evaluation of these data in all transplant-associated medical disciplines.

METHODS

A survey on professional and academic training, workload, and lifestyle was generated. The questionnaire was distributed to all members of the German Transplant Association (DTG), utilizing the tool SurveyMonkey(®) .

RESULTS

A total of 127 members of the DTG responded (male/female 66.1%/33.9%, 45.8±10.3 years). The majority had been working in transplant medicine for more than 10 years (61.9%). Fifteen respondents (11.8%) obtained an official European certification (European Union of Medical Specialists). A total of 57 (48.3%) respondents worked full time on research during training. The research focus was clinical for most respondents (n=72, 61.5%). An average working time of 62±1.5 h/wk was reported. Fifty-eight percent of all respondents complained of inadequate remuneration and 50% reported inadequate acknowledgment of their professional performance.

CONCLUSION

This is the first study reporting characteristics of training, work, and lifestyle in an interdisciplinary cohort of German transplant physicians and surgeons. Enormous efforts in clinical and research work were reported, associated with high rates of professional and financial dissatisfaction.