[Organ donation in Germany - when and how? A task for in-house coordinators]. / Organspende in Deutschland - wann und wie? Ein Fall für Transplantationsbeauftragte.

BACKGROUND: Organ donation of deceased is the main prerequisite for solid organ transplantation. The use of hospital-internal, independent staff as so-called "in-house coordinators" are required since 2012 in Germany. OBJECTIVES AND METHODS: Treatment algorithms and therapy recommendations of central organ donation processes based on the tasks and competencies of in-house coordinators who work in close cooperation with intensive care physicians, neurologists, neurosurgeons and the German organ procurement organisation are presented and discussed within the framework of a review. RESULTS: In all patients with acute severe brain damage and unfavorable cerebral prognosis, in the context of end-of-life decisions and especially after brain death diagnosis, the willingness of patients to donate organs is the decisive question. In addition to this difficult question, the detection, evaluation, selection, brain death confirmation, intensive care therapy of a potential donor as well as the organizational management and the accompaniment of relatives are core processes. CONCLUSION: The identification of potential organ donors and their treatment is a task for all emergency and intensive care physicians and in-house coordinators.

[Inhouse coordination to promote organ donation: a pilot project in three full-service hospitals]. / Inhouse-Koordination zur Förderung der Organspende: Erfahrungsbericht aus drei Kliniken der Maximalversorgung.

BACKGROUND: There is still a lack of organ donors in Germany to provide organs for everyone on the waiting list. Against this background, the project "inhouse coordination" was initiated in 112 German hospitals in order to promote organ donation. We report the first results and experiences with this project at three full-service university hospitals. METHODS: From April 2010 to March 2011 data on all deceased patients with primary or secondary brain damage were collected retrospectively. The analysis of anonymised data was carried out by using the Software "Transplant-check" of the German Hospital Institute, as well as in-house databases. RESULTS: In comparison to the year before, no increase in numbers of organ donation was achieved during the study period. A total of 544 patients were deceased with a primary or secondary brain damage as main or secondary diagnosis. In 40.3 % medical contraindications prevented organ donation. In 34.5 % treatment limitation was introduced. Brain death was diagnosed in 59 of 544 patients (10.8 %) and organ donation was possible in 5.5 %. CONCLUSION: In our analysis, a potential donor gap was noted which could not be clarified. Above all, it remains unclear in how many deceased patients with a fatal brain damage, the final diagnosis of brain death would have been possible. Even if these analyses did not lead to reliable results or conclusive evidence of organ donor potential, structural qualities were achieved in all hospitals. Ensuring the identification of potential organ donors and the accompanying support of the process should be of priority for future collaborative efforts of hospitals, transplant centers and the organ procurement organisation.

Rb2/p130 is the dominating pocket protein in the p53-p21 DNA damage response pathway leading to senescence.

The different pocket proteins are established as negative cell cycle regulators. With regard to the repressor functions of pocket proteins in cellular senescence, studies so far have mainly focused on pRb/p105. Here, we show that in a broad range of wild-type p53-expressing human tumor cells, and in human diploid fibroblasts, Rb2/p130 is the dominating pocket protein in replicative and in accelerated senescence. Senescent cells are arrested at the transition from late G1- to early S-phase, as indicated by the absence of S- and G2-phase cyclins A and B. Expression of cyclin A and entry into S-phase resumed after RNA interference-mediated knockdown of Rb2/p130. Activation of different upstream pathways by overexpression of either p21 or p16 converged on Rb2/p130 accumulation and induced senescence. In contrast, p53- or p21-negative cells treated with DNA-damaging agents failed to accumulate Rb2/p130 and to enter senescence. Our data suggest that Rb2/p130 is a member of the p53-p21 DNA damage signaling cascade, and represents the essential pocket protein family member needed for the induction of any type of senescence.

Clinical application of MRI in children for the assessment of pulmonary diseases.

The standard examination technique for the chest in children is an X-ray examination - it is fast, cheap and provides a good overview of anatomy and pathology. In cases with an unclear pathology or if more details are needed (i. e. pre-therapeutically), computed tomography is most often performed with the well known drawbacks of limited soft tissue contrast and radiation. Radiation should be avoided in children, especially if follow-up examinations are needed. Recent magnetic resonance (MR) techniques allow for fast and reliable assessment of pulmonary diseases in children. Due to the inherent soft tissue contrast, diagnosis can be frequently performed without contrast media application. This review provides an exemplary MR examination protocol for routine application in pediatric patients. The diagnostic value of MRI is shown in patients with infectious diseases, patients with immunodeficiency, anatomic abnormalities, acquired chronic diseases, and pulmonary tumors. Since MRI is especially suitable for functional imaging, an MR protocol is provided for the examination of thoracic deformities. This review summarizes the use of thoracic MRI in the clinical pediatric setting with special focus on the clinical indications as a radiation-free method.