Randomized controlled multicenter trial on the effectiveness of the collagen hemostat Sangustop® compared with a carrier-bound fibrin sealant during liver resection (ESSCALIVER study, NCT00918619).

BACKGROUND: Despite improvements in liver surgery over the past decades, hemostasis during hepatic resections remains challenging. This multicenter randomized study compares the hemostatic effect of a collagen hemostat vs. a carrier-bound fibrin sealant after hepatic resection. METHODS: Patients scheduled for elective liver resection were randomized intraoperatively to receive either the collagen hemostat (COLL) or the carrier-bound fibrin sealant (CBFS) for secondary hemostasis. The primary endpoint was the proportion of patients with hemostasis after 3 min. Secondary parameters were the proportions of patients with hemostasis after 5 and 10 min, the total time to hemostasis, and the complication rates during a 3 months follow-up period. RESULTS: A total of 128 patients were included. In the COLL group, 53 out of 61 patients (86.9 %) achieved complete hemostasis within 3 min after application of the hemostat compared to 52 out of 65 patients (80.0 %) in the CBFS group. The 95 % confidence interval for this difference [-6.0 %, 19.8 %] does not include the lower noninferiority margin (-10 %). Thus, the COLL treatment can be regarded as noninferior to the comparator. The proportions of patients with hemostasis after 3, 5, and 10 min were not significantly different between the two study arms. Postoperative mortality and morbidity were similar in both treatment groups. CONCLUSION: The collagen hemostat is as effective as the carrier-bound fibrin sealant in obtaining secondary hemostasis during liver resection with a comparable complication rate.

Effect of TGF-beta(1) antisense S-oligonucleotide on synthesis and accumulation of matrix proteoglycans in balloon catheter-injured neointima of rabbit carotid arteries.

Arterial matrix proteoglycans (PG) are necessary for the maintenance of viscoelastic properties of the vessel wall, but excess levels, particularly of versican and biglycan in primary and restenotic intimal thickenings, are correlated with increased tissue volume and with atherogenicity. There is good evidence that the primary stimulus to increased PG synthesis, including versican and biglycan, is transforming growth factor-beta(1) (TGF-beta(1)). The aim of this study was to determine the effects of reducing endogenous TGF-beta(1) on rates and patterns of PG synthesis and on versican, biglycan and decorin accumulation in vivo. Rabbit common carotid arteries subjected to balloon catheter injury were treated with a TGF-beta(1) antisense phosphorothioate oligonucleotide applied in a pluronic gel to the adventitia. Control animals received a nonsense oligonucleotide or gel alone. TGF-beta(1) antisense (1) significantly (p < 0.005) inhibited, at day 2, the balloon catheter-induced increase in TGF-beta(1) mRNA relative to beta-actin mRNA; (2) inhibited intimal thickening at 23 days by approximately 40% (p < 0.05); (3) inhibited (p < 0.05) PG synthesis, measured by autoradiographic detection of [(3)H]glucosamine, in the media of day 2 ballooned carotids and in the subendothelial zone of day 23 neointima, and (4) decreased immunostaining intensity for versican (p < 0.03) and TGF-beta(1) (p < 0.001) in the neointima. Biglycan was reduced to a lesser extent but not significantly and decorin was not affected. Proliferating cell nuclear antigen indices were variable and not significantly changed. These findings confirm a role for TGF-beta(1) in developing neointima and demonstrate a specific effect on the synthesis, distribution, and accumulation of matrix PG, particularly versican.

Polyurethane vascular prostheses decreases neointimal formation compared with expanded polytetrafluoroethylene.

PURPOSE: Synthetic grafts have been increasingly used for complex vascular reconstructions in patients with limited autologous vein availability. Materials currently in use induce increased stenosis and graft thrombosis compared with autologous vein, especially in smaller vessels. We examined whether grafts constructed of a porous biodegradation-resistant polycarbonate polyurethane (PU) exert better biocompatibility in terms of faster endothelialization and decreased chronic proliferation of intimal cells compared with expanded polytetrafluoroethylene (ePTFE). METHODS: PU or ePTFE interposition grafts were implanted into the abdominal aortas of male Sprague-Dawley rats (PU, n = 37; ePTFE, n = 32). Grafts were removed at days 1, 7, 14, 28, and 56 and 6 months and were evaluated by immunohistochemical, electron microscopic, and morphometric techniques. Bromodeoxyuridine (BrdU) was injected at 1 and 24 hours before death to determine cellular proliferation. Endothelial cells and smooth muscle cells were identified with antibodies to von Willebrand factor and alpha-actin, respectively. RESULTS: The luminal surface of PU grafts took 4 weeks to completely endothelialize, whereas ePTFE grafts took 24 weeks (P <.05). Neointimal cell proliferation was lower in PU grafts compared with ePTFE at 56 days (1.4 +/- 0.1 versus 8.6 +/- 1.5, P <.001) and at 6 months (0.15 +/- 0.002 versus 3.4 +/- 0.5, p <.001). Neointimal thickness at 6 months after implantation was 3.2 +/- 0.8 micrometer for PU compared with 10.3 +/- 3.1 micrometer for ePTFE (P <.05). CONCLUSION: Polycarbonate polyurethane small vascular prostheses promoted faster luminal endothelialization, induced less chronic intimal proliferation, and produced a significantly thinner neointima than ePTFE grafts. These findings suggest that aliphatic-polycarbonate urethanes may offer advantages over standard materials such as ePTFE for vascular graft construction.

Confocal analysis of primary cilia structure and colocalization with the Golgi apparatus in chondrocytes and aortic smooth muscle cells.

Detyrosinated and acetylated alpha-tubulins represent a stable pool of tubulin typically associated with microtubules of the centrosome and primary cilium of eukaryotic cells. Although primary cilium-centrosome and centrosome-Golgi relationships have been identified independently, the precise structural relationship between the primary cilium and Golgi has yet to be specifically defined. Confocal immunohistochemistry was used to localize detyrosinated (ID5) and acetylated (6-11B-1) tubulin antibodies in primary cilia of chondrocytes and smooth muscle cells, and to demonstrate their relationship to the Golgi complex identified by complementary lectin staining with wheat germ agglutinin. The results demonstrate the distribution and inherent structural variation of primary cilia tubulins, and the anatomical interrelationship between the primary cilium, the Golgi apparatus and the nucleus. We suggest that these interrelationships may form part of a functional feedback mechanism which could facilitate the directed secretion of newly synthesized connective tissue macromolecules.

Experimental improvement of microvascular allografts with the new material polyurethane and microvessel endothelial cell seeding.

The major aim of this experimental study was the improvement of hemo- and biocompatibility of microvascular allografts. Comparison of polyurethane and ePTFE (expanded polytetrafluoroethene) micrografts did not show a significant advantage of the new material polyurethane. When the endothelial cell seeding method was applied, endothelial cell harvesting from rat fat proved to be very difficult. Therefore, further research on microvessel endothelial cell seeding is planned.