Is Transforming Stem Cells to Pancreatic Beta Cells Still the Holy Grail for Type 2 Diabetes?

Diabetes is a progressive disease affecting millions of people worldwide. There are several medications and treatment options to improve the life quality of people with diabetes. One of the strategies for the treatment of diabetes could be the use of human pluripotent stem cells or induced pluripotent stem cells. The recent advances in differentiation of stem cells into insulin-secreting beta-like cells in vitro make the transplantation of the stem cell-derived beta-like cells an attractive approach for treatment of type 1 and type 2 diabetes. While stem cell-derived beta-like cells provide an unlimited cell source for beta cell replacement therapies, these cells can also be used as a platform for drug screening or modeling diseases.     

Hepatocellular Carcinoma: When to Transplant Outside of Milan Criteria

The worldwide incidence of hepatocellular carcinoma (HCC) continues to rise and liver transplantation (LT) represents an established curative treatment for early stage disease. As a result of organ shortage, guidelines have restricted transplantation to HCC patients with an expected 5-year post transplantation survival greater than 70 %. The Milan criteria (MC) remain a reliable and noninvasive instrument for selecting patients with 5-year survival meeting this criteria. Since the adoption of the MC by United Network for Organ Sharing (UNOS), attempts have been made to expand MC to account for the projected increase in the incidence of HCC over the next 20 years. An area of active debate focuses on identifying a subgroup of patients outside of MC with similar or better outcomes through either new expanded criteria or identifying other prognostic factors to enhance MC.     

Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Systems

Recent progress and evolution in device engineering, surgical implantation practices, and periprocedural management have advanced the promise of durable support with left ventricular assist systems (LVAS) in patients with stage D heart failure. With greater uptake of LVAS globally, a growing population of LVAS recipients have pre-existing cardiac implantable electronic devices (CIEDs). Strategies for optimal clinical management of CIEDs in patients with durable LVAS are evolving, and clinicians will increasingly face complex decisions regarding implantation, programming, deactivation, and removal of CIEDs. Traditional decision-making pathways for CIEDs may not apply to LVAS-supported patients, as few patients die of arrhythmic causes and many arrhythmias may be well tolerated. Given limited data, treatment decisions must be individualized and made collaboratively among electrophysiologists, advanced heart failure specialists, and patients and their caregivers. Large, prospective, well-conducted studies are needed to better understand the contemporary utility of CIEDs in patients with newer-generation LVAS.