Surgery News - September 2008 - (Page 2) NEWS SURGERY NEWS • S E P T E M B E R 2 0 0 8 Tissue Engineering Takes Hold Vascular Grafts • Key Players Identified Health Reform • from page 1 from page 1 autologous bone marrow. Eight grafts, including seven seeded and one unseeded control, were implanted as inferior vena cava interposition grafts in juvenile lambs. One of the seven seeded grafts was explanted after 1 month; all others were explanted 6 months after implantation. All of the grafts explanted at 6 months were patent and increased in volume, according to Dr. Breuer and his colleagues. The tissue-engineered vascular grafts at explant averaged 126.9% (plus or minus 9.9%) of their volume at 1 month. The grafts resembled the native inferior vena cava histologically and had comparable collagen, elastin, and glycosaminoglycan contents. Testing showed that ephrin-B4, a determinant of normal venous development, was acquired in the seeded grafts 6 months after implantation. The researchers found that tissue-engineered vascular grafts demonstrated evidence of growth and venous development when implanted in the inferior vena cava of a juvenile lamb model. “The vessels contract, and they grow,”said Dr. Breuer. Researchers led by Dr. Toshiharu Shinoka at the Heart Institute of Japan, Tokyo Women’s Medical University, have implanted the tissue-engineered grafts in 25 patients thus far, Dr. Breuer said; the oldest graft has been in place for about 6 or 7 years. Dr. Shinoka, who is now associate professor and director of pediatric cardiovascular surgery at Yale, is continuing his research with Dr. Breuer. They are seeking Food and Drug Administration approval to use the animal-tested tissue-engineered grafts to repair congenital heart defects in pediatric patients. “We’re in the lab developing the next generation of tissue grafts,” Dr. Breuer said. Using a mouse model, they are examining the potential for unseeded grafts that are coated with an immune system chemical to spur blood vessel growth. “All along, we had this theory that we had been putting the cells on a scaffold, kind of like putting the bricks on the walls of a house—the cells are the bricks.” The theory held that those seeded cells would survive and multiply to create the new venous graft, he said. Instead, the researchers realized something else was happening. “The cells we were seeding actually disappeared, and were being replaced by cells from the animals themselves. So those cells, instead of being the building blocks, served as a kind of template. We leveraged the body’s own ability to repair itself, and then improved it,” Dr. Breuer explained. The researchers identified an immune system chemical, MCP-1, which “is really critical to the whole process,” Dr. Breuer said. “We were then able to redesign the scaffold so that it now releases MCP-1. If you can take that chemical and put it on a scaffold, it will be much more user friendly and available to everyone.” With their mouse model, the surgeons have created tissue-engineered vascular grafts without bone marrow cells by using MCP-1 on the mesh tubes, he said. “If you just take the regular scaffold without MCP-1, it doesn’t work as well,” he added. The technology may work for angioaccess in dialysis patients, for whom the current mostly synthetic grafts “work very poorly, with a lifetime of 1-2 years,” Dr. Breuer said, and could be used in patients who do not have enough of their own graft material left to undergo lifesaving or limb-saving surgery, Dr. Breuer said. He disclosed that funding for the clinical trial has been received from Gunze. ■ deeper than before,” he said, adding, “It’s still going to require a lot of presidential leadership. But the Congress has to be an equal, more than it has before.” Several proposals are likely starting points for congressional negotiations with the new administration, he said. First is the Healthy Americans Act, introduced in January 2007 by Sen. Ron Wyden (D-Ore.) and Sen. Bob Bennett (R-Utah). It has 16 cosponsors from both parties, including Sen. Chuck Grassley (R-Iowa), the Finance Committee’s ranking minority member. The bill is being championed in the House by Rep. Debbie Wasserman Schultz (D-Fla.) and Rep. Jo Ann Emerson (R-Mo.). Rep. Wasserman Schultz is important “because she’s a rising star and has impeccable liberal credentials,” said Mr. Nichols. In a paper published in the policy journal Health Affairs, Sen. Wyden and Sen. Bennett said they saw “signs of an ideological truce” on the Hill, with agreement that there is a need for the Democratic-backed universal coverage and the Republican-supported desire for market forces to promote competition and innovation. “The Healthy Americans Act strikes a balance between these ideals,” they wrote (Health Affairs 2008;27:68992). The bill would require individuals to purchase insurance for themselves and their dependent children, and would require insurers to offer a prescribed package of benefits. It would subsidize coverage for Americans with incomes up to 400% of the federal poverty level. Employers would convert benefit dollars into salary; such compensation would be tax free, with the goal that the money would be used to purchase coverage. Sen. Wyden is likely to be front and center in crafting a bill, because he is a member of the finance and budget committees, which, along with the Health, Education, Labor and Pensions (HELP) Committee “will play very important roles,” Mr. Nichols said. Ron Pollack, executive director of the advocacy group Families USA, speculated that Sen. Max Baucus (D-Mont.) “is going to be as instrumental in the process as anyone.” Sen. Baucus, chairman of the Finance Committee, held a health care summit in mid-June. Staff from the Finance Committee and the HELP Committee, led by Sen. Edward M. Kennedy (D-Mass.), have been coordinating meetings with those two panels and the Budget Committee, Mr. Pollack said in an interview. Committee chairs have the greatest influence on the legislative process, he said. Both Mr. Pollack and Mr. Nichols also expect Sen. Kennedy to play a very significant part in creating the legislation, as much as his cancer will allow. Even so, “to pass anything of significance will require bipartisanship,” said Mr. Pollack. The House is not as far along in preparing for health reform, but staffers on the four relevant committees with jurisdiction over health care have been meeting, said Mr. Pollack. “I don’t think any of the proposals that have come out so far are going to be the proposals [for health care reform],” said Mr. Pollack. Instead, the expectation is that a health reform bill will be developed during the transition period between November and January, he said. ■ SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chief, Division of Cardiothoracic Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Patricia L. Turner, M.D., FACS, Assistant Professor of Surgery, University of Maryland Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgeon-in-Chief, Hasbro Children's Hospital Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Ted A. James, M.D., Assistant Professor of Surgery, University of Vermont Surgical Oncology: James P. Neifeld, M.D., FACS, Chairman, Department of Surgery, Virginia Commonwealth University Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from
Table of Contents Feed for the Digital Edition of Surgery News - September 2008 Surgery News - September 2008 Contents Appreciation Low Scores News From the College: New Leader Practice Trends: High Price to Pay Surgery News - September 2008 Surgery News - September 2008 - Contents (Page 1) Surgery News - September 2008 - Contents (Page 2) Surgery News - September 2008 - Contents (Page 3) Surgery News - September 2008 - Appreciation (Page 4) Surgery News - September 2008 - Low Scores (Page 5) Surgery News - September 2008 - Low Scores (Page 6) Surgery News - September 2008 - Low Scores (Page 7) Surgery News - September 2008 - News From the College: New Leader (Page 8) Surgery News - September 2008 - News From the College: New Leader (Page 9) Surgery News - September 2008 - News From the College: New Leader (Page 10) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 11) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 12) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 13) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 14) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 15) Surgery News - September 2008 - Practice Trends: High Price to Pay (Page 16)
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