Synergy in thrombin-graphene sponge for improved hemostatic efficacy and facile utilization

A silk nanofiber and hyaluronic acid composite hemostatic sponge for compressible hemostasis

Uncontrolled traumatic blood loss is a leading cause of hemorrhagic shock and death, highlighting the critical need for compressible and rapid hemostatic first-aid materials. In this study, silk nanofibers (MA-SNFs) were prepared through maleic acid (MA) hydrolysis decorated with enriched carboxyl groups. The MA-SNFs were then combined with hyaluronic acid (HA) through EDC/NHS crosslinking to form a porous sponge (i.e., MA-SNF/HA) through freeze-drying. The fabricated MA-SNF/HA sponges demonstrated excellent blood compatibility (hemolysis ratio < 5 %), outstanding hemocompatibility (blood clotting index (BCI) < 35 % within 60 s), and good cytocompatibility (cell viability >85 %). Among the different sponges prepared, M4-H6 (MA-SNFs: HA = 4:6) exhibited the best liquid reabsorption capacity after 80 % compression, outperforming M6-H4 and M5-H5 sponges. Furthermore, M4-H6 sponge absorbed liquid rapidly (~30 s) while matching the liquid absorption capacity of commercial gelatin sponge (GS), which require over 5 min for similar absorption (2232.84 ± 141.69 %). These findings suggest that M4-H6 sponge is highly suitable for compressible hemostasis applications and provide further insights into its potential hemostatic mechanism.

Tri-network PVA/chitosan/gelatin hydrogel modified by tannic acid with self-healing, adhesive and anti-inflammatory properties to accelerate wound healing

Wound inflammation is a key issue in wound healing as it often causes serious complications and delays wound healing. In this study, hemostatic and antimicrobial hydrogels composed of polyvinyl alcohol (PVA), chitosan (CS) and gelatin (Gel) were prepared. Phenylboronic acid (3-CPBA) and tannic acid (TA) were introduced to modify the multinetwork hydrogel to promote wound repair. PGCPT-1.2 hydrogel had a water content of >85 % and was biocompatible. Due to the antibacterial effect of chitosan itself. The PGCPT hydrogel exhibited 100 % antimicrobial activity against both Escherichia coli and Staphylococcus aureus within 12 h. The hydrogel exhibited shape memory behavior and self-healing ability. Histological analysis showed that PGCPT-1.2 hydrogel reduced tumor necrosis factor-α (TNF-α) levels by accelerating collagen deposition. The wound healing rate at day 14 was 97 % ± 0.4 %. PGCPT-1.2 hydrogel dressing with 1.2 % TA addition had the best effect in promoting wound healing, and it is a promising dressing for promoting wound healing and a therapeutic strategy worth developing.

Precision surface-immobilized peptide on graphene/chitosan composite sponge for rapid hemostasis of uncontrolled bleeding

Efficient and safe hemostasis for trauma-induced bleeding remains a critical challenge. In this study, we developed a peptide-immobilized graphene/chitosan composite sponge (GCCS-TRAP) for enhanced hemostatic performance. The thrombin receptor-activating peptide (TRAP) was precisely immobilized on the surface of a graphene/chitosan crosslinked sponge via thiol-ene photoclick chemistry. GCCS-TRAP exhibited outstanding liquid absorption capabilities, absorbing up to 30 times its own weight with a rapid absorption rate of 0.27 seconds. The sponge also demonstrated remarkable mechanical strength of 96.3 kPa. More importantly, GCCS-TRAP effectively activated platelets and the coagulation cascade, showing superior in vitro coagulation properties with a blood coagulation index of 7.1 %. In a rat femoral artery hemorrhage model, GCCS-TRAP achieved rapid hemostasis within 81.3 seconds, reducing blood loss by up to 62 % compared to commercial hemostatic materials such as chitosan-based powders, gelatin-based sponge, and polysaccharide-based powders. Additionally, GCCS-TRAP exhibited excellent biocompatibility, with minimal hemolysis and cytotoxicity. This innovative strategy of peptide immobilization via light-controlled chemistry offers a promising approach to designing next-generation hemostatic agents, optimizing peptide usage while maximizing hemostatic efficacy and safety.

A facile way to fabricate a thrombin immobilized composite sponge with dual hemostatic effects for acute hemorrhage control

Uncontrolled bleeding and excessive blood loss stand as the leading causes of death in complex surgeries, civilian traumas, and military operations. Sponges have been used for developing efficiency hemostats, but most commonly used hemostatic sponges possess only one single coagulation mechanism or lack inherent blood clotting ability. Herein, we proposed simple yet innovative approaches for creating novel hemostatic composite sponges with dual hemostatic effects. Bacterial cellulose (BC) was first introduced into polyvinyl alcohol (PVA) matrix to develop a BC/PVA (CP) sponge featuring a unique cellulose-embedded porous network structure and desirable properties. Subsequently, thrombin was immobilized on CP through an easy method that combines physical adsorption and covalent binding to fabricate thrombin-carrying CP (TCP) composite sponges. The resulting composites boasted a highly porous structure, outstanding liquid-absorption capacity, low hemolysis rate, and superior biocompatibility. In vitro clotting tests revealed that TCP displayed potent coagulation capabilities, a rapid blood absorption rate, and the ability to stimulate and activate blood components along with the coagulation cascade. In vivo hemostatic assessments further confirmed that TCP offered high hemostatic efficiency and multifaceted hemostatic effects, making it suitable for the management of acute and severe bleeding.

Tannic acid coating gauze immobilized with thrombin with ultra-high coagulation activity and antimicrobial property for uncontrollable hemorrhage

Rapid and safe hemostasis is crucial for the survival of bleeding patients in prehospital care. It is urgent to develop high performance hemostatic material to control the massive hemorrhage in the military field and accidental trauma. In this work, an efficient protein hemostat of thrombin was immobilized onto commercial gauze, which was mediated by self-polymerization and anchoring of tannic acid (TA). Through TA treatment, the efficient immobilization of thrombin was achieved, preserving both the biological activity of thrombin and the physical properties of the dressing, including absorbency, breathability, and mechanical performance. Moreover, in the presence of TA coating and thrombin, Gau@TA/Thr could obviously shortened clotting time and enriched blood components such as plasma proteins, platelets, and red blood cells, thereby exhibiting an enhanced in vitro coagulation effect. In SD rat liver volume defect and artery transection hemorrhage models, Gau@TA/Thr still had outstanding hemostatic performance. Besides, the Gau@TA/Thr gauze had inherent antibacterial property and demonstrated excellent biocompatibility. All results suggested that Gau@TA/Thr would be a potential candidate for treating uncontrollable hemorrhage in prehospital care.

Development of an efficient hemostatic material based on cuttlefish ink nanoparticles loaded in cuttlebone biocomposite

Traumatic hemorrhage is one of the main causes of mortality in civilian and military accidents. This study aimed to evaluate the effectiveness of cuttlefish bone (cuttlebone, CB) and CB loaded with cuttlefish ink (CB-CFI) nanoparticles for hemorrhage control. CB and CB-CFI were prepared and characterized using different methods. The hemostasis behavior of constructed biocomposites was investigated in vitro and in vivo using a rat model. Results showed that CFI nanoparticles (NPs) are uniformly dispersed throughout the CB surface. CB-CFI10 (10 mg CFI in 1.0 g of CB) showed the best blood clotting performance in both in vitro and in vivo tests. In vitro findings revealed that the blood clotting time of CB, CFI, and CB-CFI10 was found to be 275.4 ± 12.4 s, 229.9 ± 19.9 s, and 144.0 ± 17.5 s, respectively. The bleeding time in rat liver injury treated with CB, CFI, and CB-CFI10 was 158.1 ± 9.2 s, 114.0 ± 5.7 s, and 46.8 ± 2.7 s, respectively. CB-CFI10 composite resulted in more reduction of aPTT (11.31 ± 1.51 s) in comparison with CB (17.34 ± 2.12 s) and CFI (16.79 ± 1.46 s) (p < 0.05). Furthermore, CB and CB-CFI10 exhibited excellent hemocompatibility. The CB and CB-CFI did not show any cytotoxicity on human foreskin fibroblast (HFF) cells. The CB-CFI has a negative surface charge and may activate coagulation factors through direct contact with their components, including CaCO3, chitin, and CFI-NPs with blood. Thus, the superior hemostatic potential, low cost, abundant, simple, and time-saving preparation process make CB-CFI a very favorable hemostatic material for traumatic bleeding control in clinical applications.

Recent research advances on polysaccharide-, peptide-, and protein-based hemostatic materials: A review

Hemorrhage is a potentially life-threatening emergency that can occur at any time or place. Whether traumatic, congenital, surgical, disease-related, or drug-induced, bleeding can lead to severe complications or death. Therefore, the development of efficient hemostatic materials is critical. However, the results and prognosis demonstrated by clinical means of hemostasis do not reach expectations. With the development of technology, novel hemostatic materials have been developed from polysaccharides (chitosan, hyaluronic acid, alginate, cellulose, cyclodextrins, starch, dextran, and carrageenan), peptides (self-assembling peptides), and proteins (silk fibroin, collagen, gelatin, keratin, and thrombin). These new materials exhibit high hemostatic efficacy due to the enhancement or interaction of various hemostatic mechanisms. The main forms include adhesives, sealants, bandages, hemostatic powders, and hemostatic sponges. This article introduces the clotting process and principles of hemostatic methods and reviews the research on polysaccharide-, peptide-, and protein-based hemostatic materials in the last five years. The design ideas and hemostatic principles of polysaccharide-, peptide-, and protein-based hemostatic materials are mainly introduced. Finally, we summarize material designs, advantages, disadvantages, and challenges regarding hemostatic materials.

Hydrophilic chitosan/graphene oxide composite sponge for rapid hemostasis and non-rebleeding removal

Hydrophilic hemostatic sponge plays an important role in trauma bleeding control because of its robust coagulant functions. However, its strong tissue adhesion can easily result in wound tear and rebleeding during removing the sponge. Herein, the design of a hydrophilic anti-adhesive chitosan/graphene oxide composite sponge (CSAG) that possesses stable mechanical strength, rapid liquid absorption and strong intrinsic/extrinsic coagulation stimulations, is reported. For one thing, CSAG exhibits outstanding hemostatic performance, which significantly outperforms two commercial hemostats in two in vivo serious bleeding models. For another, CSAG shows low tissue adhesion; its peeling force is approximately 79.3 % lower than the commercial gauze. Moreover, in the peeling process, CSAG triggers partial detachment of the blood scab, because of the exist of bubbles or cavities at the interface, allowing the CSAG to be easily and safely peeled off from the wound without rebleeding. This study opens new avenues in constructing anti-adhesive trauma hemostatic materials.

Super-Elastic Carbonized Mushroom Aerogel for Management of Uncontrolled Hemorrhage

Uncontrolled hemorrhage is still the most common cause of potentially preventable death after trauma in prehospital settings. However, there rarely are hemostatic materials that can achieve safely and efficiently rapid hemostasis simultaneously. Here, new carbonized cellulose-based aerogel hemostatic material is developed for the management of noncompressible torso hemorrhage, the most intractable issue of uncontrolled hemorrhage. The carbonized cellulose aerogel is derived from the Agaricus bisporus after a series of processing, including cutting, carbonization, purification, and freeze-drying. In vitro, the carbonized cellulose aerogels with porous structure show improved hydrophilicity, good blood absorption, and coagulation ability, rapid shape recoverable ability under wet conditions. And in vivo, the carbonized aerogels show effective hemostatic ability in both small and big animal serious hemorrhage models. The amount of blood loss and the hemostatic time of carbonized aerogels are all better than the positive control group. Moreover, the mechanism studies reveal that the good hemostatic ability of the carbonized cellulose aerogel is associated with high hemoglobin binding efficiency, red blood cell absorption, and platelets absorption and activation. Together, the carbonized aerogel developed in this study could be promising for the management of uncontrolled hemorrhage.

Mussel-inspired nanoparticle composite hydrogels for hemostasis and wound healing

Uncontrolled hemorrhage caused by trauma can easily lead to death. Efficient and safe hemostatic materials are an urgent and increasing need for hemostatic research. Following a trauma, wound healing is induced by various cellular mechanisms and proteins. Hemostatic biomaterials that can not only halt bleeding quickly but also provide an environment to promote wound healing have been the focus of research in recent years. Mussel-inspired nanoparticle composite hydrogels have been propelling the development of hemostatic materials owing to their unique advantages in adhesion, hemostasis, and bacteriostasis. This review summarizes the hemostatic and antimicrobial fundamentals of polydopamine (PDA)-based nanomaterials and emphasizes current developments in hemorrhage-related PDA nanomaterials. Moreover, it briefly discusses safety concerns and clinical application problems with PDA hemostatic nanomaterials.

Design of biopolymer-based hemostatic material: Starting from molecular structures and forms

Uncontrolled bleeding remains as a leading cause of death in surgical, traumatic, and emergency situations. Management of the hemorrhage and development of hemostatic materials are paramount for patient survival. Owing to their inherent biocompatibility, biodegradability and bioactivity, biopolymers such as polysaccharides and polypeptides have been extensively researched and become a focus for the development of next-generation hemostatic materials. The construction of novel hemostatic materials requires in-depth understanding of the physiological hemostatic process, fundamental hemostatic mechanisms, and the effects of material chemistry/physics. Herein, we have recapitulated the common hemostatic strategies and development status of biopolymer-based hemostatic materials. Furthermore, the hemostatic mechanisms of various molecular structures (components and chemical modifications) are summarized from a microscopic perspective, and the design based on them are introduced. From a macroscopic perspective, the design of various forms of hemostatic materials, e.g., powder, sponge, hydrogel and gauze, is summarized and compared, which may provide an enlightenment for the optimization of hemostat design. It has also highlighted current challenges to the development of biopolymer-based hemostatic materials and proposed future directions in chemistry design, advanced form and clinical application.

The Effect on Hemostasis of Gelatin-Graphene Oxide Aerogels Loaded with Grape Skin Proanthocyanidins: In Vitro and In Vivo Evaluation

Using in vitro and in vivo models, this study investigated the hemostatic potential to control bleeding of both unloaded gelatin-graphene oxide aerogels and the same loaded with proanthocyanidins (PAs) from Vitis vinifera grape skin extract. Our results showed that the physicochemical and mechanical properties of the aerogels were not affected by PA inclusion. In vitro studies showed that PA-loaded aerogels increased the surface charge, blood absorption capacity and cell viability compared to unloaded ones. These results are relevant for hemostasis, since a greater accumulation of blood cells on the aerogel surface favors aerogel–blood cell interactions. Although PAs alone were not able to promote hemostasis through extrinsic and intrinsic pathways, their incorporation into aerogels did not affect the in vitro hemostatic activity of these composites. In vivo studies demonstrated that both aerogels had significantly increased hemostatic performance compared to SpongostanTM and gauze sponge, and no noticeable effects of PA alone on the in vivo hemostatic performance of aerogels were observed; this may have been related to its poor diffusion from the aerogel matrix. Thus, PAs have a positive effect on hemostasis when incorporated into aerogels, although further studies should be conducted to elucidate the role of this extract in the different stages of hemostasis.

Novel and effective hemostats based on graphene oxide-polymer aerogels: In vitro and in vivo evaluation

In this study, graphene oxide (GO)-based aerogels cross-linked with chitosan (CS), gelatin (GEL), and polyvinyl alcohol (PVA) were characterized and their hemostatic efficiencies both in vitro and in vivo were investigated and compared to commercial materials (ChitoGauze®XR and Spongostan™). All aerogels exhibited highly porous structures and a negative surface charge density favorable to their interaction with blood cells. The in vitro studies showed that all aerogels coagulated >60 % of the blood contained in their structures after 240 s of the whole-blood clotting assay, the GO-CS aerogel being the one with the highest blood clotting. All aerogels showed high hemocompatibility, with hemolytic rates <5 %, indicating their use as biomaterials. Among them, the GO-GEL aerogel exhibited the lowest hemolytic activity, due possibly to its high GEL content compared to the GO amount. According to their blood clotting activity, aerogels did not promote coagulation through extrinsic and intrinsic pathways. However, their surfaces are suitable for accelerating hemostasis by promoting alternative routes. All aerogels adhered platelets and gathered RBCs on their surfaces, and in addition the GO-CS aerogel surface also promoted the formation of filamentous fibrin networks adhered on its structure. Furthermore, in vivo evaluations revealed that all aerogels significantly shortened the hemostatic times and reduced the blood loss amounts compared both to the Spongostan™ and ChitoGauze®XR commercial materials and to the gauze sponge (control group). The hemostatic performance in vitro and in vivo of these aerogels suggests that they could be used as hemostats for controlling profuse bleedings.

Green hemostatic sponge-like scaffold composed of soy protein and chitin for the treatment of epistaxis

Epistaxis is one of the most common otorhinolaryngology emergencies worldwide. Although there are currently several treatments available, they present several disadvantages. This, in addition to the increasing social need of being environmentally respectful, led us to investigate whether a sponge-like scaffold (SP–CH) produced from natural by-products of the food industry — soy protein and β-chitin — can be employed as a nasal pack for the treatment of epistaxis. To evaluate the potential of our material as a nasal pack, it was compared with two of the most commonly used nasal packs in the clinic: a basic gauze and the gold standard Merocel®. Our SP-CH presented great physicochemical and mechanical properties, lost weight in aqueous medium, and could even partially degrade when incubated in blood. It was shown to be both biocompatible and hemocompatible in vitro, clearing up any doubt about its safety. It showed increased blood clotting capacity in vitro, as well as increased capacity to bind both red blood cells and platelets, compared to the standard gauze and Merocel®. Finally, a rat-tail amputation model revealed that our SP-CH could even reduce bleeding time in vivo. This work, carried out from a circular economy approach, demonstrates that a green strategy can be followed to manufacture nasal packs using valorized by-products of the food industry, with equal or even better hemostatic properties than the gold standard in the clinic.

MXene-Enhanced Chitin Composite Sponges with Antibacterial and Hemostatic Activity for Wound Healing

This study shows the effective use of MXene-based nanomaterials to improve the performance of biocomposite sponges in wound healing. In this way, diverse chitin/MXene composite sponges are fabricated by incorporating MXene-based nanomaterials with various morphology (accordion-shaped, intercalated, single-layer, gold nanoparticles (AuNPs)-loaded single-layer) into the network of chitin sponge (CH), which can prevent massive blood losses and promote the healing process of bacterial-infected wounds. With the addition of MXene-based nanomaterials, the hemostatic efficacy of CH is enhanced due to the improved hemophilicity and accelerated blood coagulation kinetics. Furthermore, the composite sponges show a predominant antibacterial activity through the synergy between the capture and the photothermal effects. Importantly, the addition of AuNPs to composite sponges further improves hemostatic performance and promotes normal skin cell migration to heal the infected wound, achieving wound closure rates of 84% on day 9. These initial studies expand the applications of MXene-based nanomaterials in biomedical fields.

Effects of degree of deacetylation on hemostatic performance of partially deacetylated chitin sponges

Chitin/chitosan hemostatic materials have long been studied for uncontrolled hemorrhage, an urgent clinical problem due to severe blood-vessel damage or hemophilia. As one of the basic structural parameters of chitin, the degree of deacetylation (DD) significantly affects the material's physical, chemical, as well as biological properties. In this study, partially deacetylated chitins with a wide range of DD (23-81%) were prepared by homogeneous deacetylation, and sponges with these various chitins were fabricated by freeze-drying to study the effects of DD on their hemostatic properties. Among all sponge samples, the chitosan sponge with a DD of 48% showed the highest water absorption, whole blood adsorption, RBC adsorption rate, and the best hemostatic performance in an uncontrolled bleeding model of the rat femoral artery, demonstrating that a certain proportion of acetyl amino and amino groups could also activate the coagulation system and promote the adhesion of platelet and erythrocyte.

Hemostatic materials in wound care

Blood plays an essential role in the human body. Hemorrhage is a critical cause of both military and civilian casualties. The human body has its own hemostatic mechanism that involves complex processes and has limited capacity. However, in emergency situations such as battlefields and hospitals, when the hemostatic mechanism of the human body itself cannot stop bleeding effectively, hemostatic materials are needed for saving lives. In this review, the hemostatic mechanisms and performance of the most commonly used hemostatic materials, (including fibrin, collagen, zeolite, gelatin, alginate, chitosan, cellulose and cyanoacrylate) and the commercial wound dressings based on these materials, will be discussed. These materials may have limitations, such as poor tissue adhesion, risk of infection and exothermic reactions, that may lessen their hemostatic efficacy and cause secondary injuries. High-performance hemostatic materials, therefore, have been designed and developed to improve hemostatic efficiency in clinical use. In this review, hemostatic materials with advanced performances, such as antibacterial capacity, superhydrophobicity/superhydrophilicity, superelasticity, high porosity and/or biomimicry, will be introduced. Future prospects of hemostatic materials will also be discussed in this review.

Improved hemocompatibility for gelatin-graphene oxide composite aerogels reinforced with proanthocyanidins for wound dressing applications

Aerogels based on gelatin and graphene oxide (GO) were synthesized by microwave-assisted reactions, incorporating grape skin extracts -high in proanthocyanidins (PAs)- to develop a hemostatic device with improved properties. The effects of incorporating PAs into the aerogels were investigated in relation to their physicochemical properties, absorption ability, clotting activity and cytotoxicity in human dermal fibroblast (HDF) cells. The aerogels presented highly resistant porous structures, capable of absorbing more than 50 times their weight when in contact with a phosphate saline solution (PBS) and fresh human blood. Interestingly, the addition of PAs increased the negative surface charges and the blood absorption ability of the aerogels, which may make them suitable for hemostasis. The incorporation of 5% and 10% (w/w) of extracts into the aerogels increased the total coagulated blood content by 36.6% and 24.5% compared with gelatin-GO aerogel, respectively. These improvements in the hemostatic properties of the aerogels were greater with the inclusion of 5% (w/w) of grape skin extracts into the aerogels. The aerogels were also able to adhere red blood cells onto their surfaces, which could favor the formation of stable fibrin networks to promote hemostasis. Their clotting activity suggested the activation of alternative routes based on complement coagulation systems. Finally, the aerogels were non-toxic for HDF cells and the PAs were successfully released from their matrices. Thus, gelatin-GO aerogels reinforced with PAs are promising as topical phytodrug delivery systems, with great potential for wound healing processes.

Ag@MOF-loaded chitosan nanoparticle and polyvinyl alcohol/sodium alginate/chitosan bilayer dressing for wound healing applications

In this paper, Ag-Metal-organic framework loaded chitosan nanoparticles (0.1%Ag@MOF/1.5%CSNPs) and polyvinyl alcohol/sodium alginate/chitosan (PACS) were used as the upper and lower layers to successfully prepare a bilayer composite dressing for wound healing. The performance of bilayer dressing was evaluated. The lower layer (PACS) had uniform pore size distribution, good water retention, swelling, water vapor permeability, and biocompatibility while PACS had almost no antibacterial activity. The upper layer (Ag@MOF/CSNPs) possessed excellent antibacterial activity and poor biocompatibility. As the upper layer, it can avoid direct contact with the skin and inhibit microbial invasion. In addition, the bilayer can adhere to a large number of red blood cells and platelets, promoting blood coagulation and cell proliferation. Ag@MOF, CSNPs, Ag@MOF/CSNPs and bilayer showed antibacterial activity in ascending order, due to the synergistic antibacterial action of the upper and lower layer. In vivo evaluation showed that both bilayer and PACS could significantly accelerate the wound healing, and the bilayer dressing showed more complete re-epithelialization with less inflammatory cells. In summary, this new bilayer composite is an ideal dressing for accelerating wound healing.

Progresses in processing technologies for special foods with ultra-long shelf life

Foods for special applications have recently received much attention due to rapid development of space and military industries as well as to frequent occurrence of natural and man-made disasters. Since the way such foods are processed clearly and directly affects their consumer's acceptability and shelf life, it is of interest to explore in detail how these special foods can be processed. This article presents a review on the difficulties in the processing, application and storage as well as on how to ensure the shelf life and acceptability of special foods through the use of efficient processing technologies. Emphasis is made on the use of both conventional and alternative thermal processing and irradiation technologies. Appropriate packaging technologies for each of the discussed special foods are also mentioned along with the way to overcome the problem of product quality degradation. Through comparison and analysis, it is found that foods with different attributes require different technologies and processes to achieve desirable results. Combined use of multiple technologies has also noted to be advantageous.

Epidural hemostasis by autologous fat graft in minimally invasive surgery for lumbar spinal stenosis: In vivo experimental study

BACKGROUND

Epidural hemostasis needs to use small, adapted material in minimally invasive surgery, including bilateral decompression via a unilateral approach for lumbar spinal stenosis. Most surgeons avoid external material for hemostasis because of possible neural tissue damage or complications. We compared epidural hemostasis in minimally invasive surgery by fat graft versus gelatin sponge.

METHODS

The design was a prospective randomized controlled in-vivo human experimental study. The 24 levels operated on for lumbar spinal stenosis were evaluated in two groups: Group A (control group: gelatin sponge) and Group B (experimental group: fat graft). International Normalized Ratio and Prothrombin Time were assessed preoperatively. Number of cotton hemostats and systolic and diastolic blood pressure were assessed intraoperatively. Epidural hemorrhage area, spinal cord size and ratio of epidural hemorrhage area to spinal cord size were evaluated on early postoperative lumbar MRI.

RESULTS

Mean epidural hemorrhage area in groups A and B was respectively 1.3±0.5 and 1.2±0.6cm², and mean spinal cord size 1.2±0.6 and 1.8±0.6cm² on early postoperative axial lumbar MRI. The two groups did not significantly differ in ratio of epidural hemorrhage/spinal cord size or number of intraoperative hemostats (P=0.36, and P=0.71).

CONCLUSIONS

The autologous fat graft ensured sufficient and safe epidural hemostasis without serious adverse events in minimally invasive spinal surgery, and is preferable as autologous tissue is easily and quickly harvested. The surgeon feels safe with this technique and does not need external hemostatic agents.

Sponges with Janus Character from Nanocellulose: Preparation and Applications in the Treatment of Hemorrhagic Wounds

The development of a rapid and effective hemostatic dressing is highly desired in the treatment of hemorrhagic wounds. In this study, sponges with Janus character are developed using cellulose nanofibers (CNFs) that exhibit materials facets of different wettability characteristics using heterogeneous mixing and freeze-drying. The bonding of the interface between the hydrophilic and hydrophobic facets is achieved by using interpenetrating chemical cross-linking between CNFs and organosilanes. The hydrophilic layer absorbs water from blood and works synergistically with the inherent hemostatic chitosan-rich complementary layer to accelerate blood clotting, displaying both active and passive hemostatic mechanisms. The hydrophobic layer prevents blood penetration into the construct and exerts proper pressure on the wound. Compared with the hydrophilic control samples and commercial gauzes, the Janus sponges can achieve effective bleeding control with nearly 50% less blood loss in a femoral artery injury model and prolong the survival time in a carotid artery injury model. Compared with the only hydrophilic layer, the time to hemostasis of Janus sponge are reduced from 165 ± 20 to 131 ± 26 s in femoral artery injury model and from 102 ± 21 to 83 ± 15 s in liver femoral artery injury model.

A Biodegradable Antibacterial Nanocomposite Based on Oxidized Bacterial Nanocellulose for Rapid Hemostasis and Wound Healing

The development of biodegradable and antibacterial hemostatic materials with high blood absorption to halt the internal hemorrhage of deep noncompressible wounds remains a challenge. In this study, a novel hemostatic nanocomposite (OBC/COL/CS) was fabricated by coupling oxidized bacterial cellulose (OBC) and chitosan (CS) with collagen (COL), that is, during the electrostatic self-assembly of OBC with CS (OBC/CS), COL was ingeniously attached as a functional component by the electrostatic attraction of cationic CS and anionic OBC. The introduction of collagen was anticipated to provide functional properties such as enhanced hemostasis and promotion of wound healing so as to achieve a new functional composite. This study is the first to evaluate the performance of OBC, OBC/CS, and the OBC/COL/CS composite for rapid internal hemostasis using a rat liver injury model. To our knowledge, this is also the first study to report that OBC has a faster biodegradability in vivo than commercial hemostatic oxidized regenerated plant cellulose (ORC). The OBC/COL/CS nanocomposite exhibited appropriate mechanical strength, broad spectrum antimicrobial properties, and excellent biodegradation in vivo. Furthermore, excellent hemostatic efficacy of the composite was confirmed in vivo. OBC/COL/CS exhibited greater procoagulant properties and blood-clotting capability, higher adhesion of erythrocytes and platelets with concomitant lower blood loss, in addition to ultrafast cessation of bleeding, superior to the commercial hemostatic ORC product Surgicel gauze. The results suggest that the OBC/COL/CS is a fast and efficient procoagulant agent with good antibacterial properties and great potential for use as an absorbable hemostat for control of internal bleeding.

Research status and development potential of composite hemostatic materials

Through the discussion of the coagulation mechanism of compositehemostatic materials, the future development potential of hemostatic materials is proposed.

Comprehensive assessment of Nile tilapia skin collagen sponges as hemostatic dressings

Nile tilapia skin collagen sponge was fabricated by lyophilization and cross-linked with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide in the presence of N-hydroxysuccinimide (EDC/NHS). The physicochemical properties were examined. The EDC/NHS cross-linked collagen sponge presented an enhanced water absorption capacity. In addition, biocompatibility and hemostatic efficiency were evaluated by acute systemic toxicity assay, dermal irritation test, intradermal reaction test, sensitization test, cytotoxicity, blood clotting assay in vitro, and liver and femoral artery hemorrhage models in vivo. Results showed that the produced collagen sponges before and after EDC/NHS cross-linking had excellent biocompatibility. Furthermore, EDC/NHS cross-linking promoted fibroblast cells viability and proliferation reflected by the MTT reduction assay. Meanwhile, EDC/NHS cross-linked collagen sponge exhibited the best blood clotting ability and hemostatic efficiency in rat femoral artery hemorrhage model in comparison with non-crosslinked and commercial collagen sponges. Our results demonstrated that the fabricated collagen sponges could be used as perfect hemostatic dressings.

Eliminating Heat Injury of Zeolite in Hemostasis via Thermal Conductivity of Graphene Sponge

Thermal release of zeolite is conducive in hemostasis, but losing control will cause serious burns. How to balance the advantages and disadvantages is a challenge. Herein, a zeolite/cross-linked graphene sponge (Z-CGS) was design to break through this challenge. The CGS managed the heat release of zeolite by thermal conduction of graphene. Infrared thermal imager demonstrated the mild exothermic process and good thermal conductivity of the optimized Z-CGS. It controlled wound temperature below 42 °C effectively, as compared to 70 °C of naked zeolite. Blood clotting index further confirmed the contribution of thermal stimulation in Z-CGS. On the synergy of thermal and charge stimulations of zeolite, as well as physical adsorption of CGS, Z-CGS achieved outstanding hemostatic performance. Bleeding was stopped within 69 s in rat artery injury model, faster than that of the Quikclot Combat Gauze. Additionally, cytotoxicity assay and pathological analysis highlighted its biocompatibility. Z-CGS, therefore, was an outstanding composite of combining advantages of zeolite and graphene, while getting rid of the shortcomings of the basic unit. The thermal conductibility of graphene renews an avenue for the safe and highly efficient use of zeolite in hemostasis.

Chitosan-bound carboxymethylated cotton fabric and its application as wound dressing

Cotton fabric (CF) is commonly used in wound treatment, however, its hemostatic efficiency is far from sufficient. In this study, modified cotton fabric (MCF-0.39) was obtained by a carboxymethylation process, which endowed MCF-0.39 with good swelling ability and water absorption capacity. Chitosan (CHI) was bound to MCF-0.39 by the binder sodium carboxymethyl cellulose (NaCMC) via flat-screen printing technique to prepare the hybrid hemostatic material (CHI-MCF-0.39). The blood clotting index (BCI) of CHI-MCF-0.39 was 3.15-fold lower than that of CF, demonstrating the good clotting ability of the material. In rat liver injury and femoral artery animal model, the groups using CHI-MCF-0.39 had less hemostasis time and blood loss compared with those groups using CF. All the above results indicate that the prepared CHI-MCF-0.39 has promising future applications as effective hemostatic material in trauma treatment.

Comparison the efficacy of hemorrhage control of Surgiflo Haemostatic Matrix and absorbable gelatin sponge in posterior lumbar surgery: A randomized controlled study

OBJECTIVE

To compare the hemostatic effect of hematostatic agent Surgiflo and absorbable gelatin sponge (AGS) in posterior lumbar surgery.

METHODS

A total of 60 cases were recruited during August 2016 and June 2017 according to the inclusion and exclusion criteria. Patients were randomly allocated to the Surgiflo Haemostatic Matrix (SHM) group or the AGS group (AGS) by computer-generated randomization codes. The success rates of hemostasis for 3 minutes and 5 minutes, the time of operation, the amount of intraoperative bleeding, the volume of autogenously blood transfusion, the amount of blood during hemostasis, the amount of blood transfusion, and BP, RBC, HCT, HB of preoperative, 2 to 3 days, and 5 to 7 days following operation were recorded to compare. Daily drainage and all adverse events after operation were also compared.

RESULTS

All the patients were followed up for at least 1 month. The RBC and HCT of the AGS group before operation were lower than those in the control group (P = .039, P = .029), but there was no difference after operation (P >.05). In the control group, 19 cases were successfully hemostatic in 3 minutes, 4 cases were successful in 5 minutes, and 7 cases were combined with hemostasis. In the SHM group, it was 22, 3, and 5 cases respectively. There was significant difference in blood loss during hemostatic process between the 2 groups (P <.001). There was no difference in the amount of blood loss and autologous blood transfusion between the 2 groups, and there was no difference in the operation time between the 2 groups. In the AGS group, allogeneic blood was infused in 1 case during operation, and no allogeneic blood was infused in the other patients. The drainage volume on the 1st day and the 2nd to 4th day after operation in the AGS group was less than that in the control group (P = .015, P = .010).

CONCLUSION

Compared with AGS, SHM could decrease the blood loss during hemostatic process and the postoperative drainage volume in posterior operation of lumbar degenerative disease. SHM is a safe and effective hemostatic agent in lumbar posterior surgery.

Polydopamine reinforced hemostasis of a graphene oxide sponge via enhanced platelet stimulation

Graphene oxide (GO) is a promising hemostatic material because of its platelet stimulatory activity. However, our previous studies on cross-linked graphene sponges demonstrated that those sponges lost the GO function of platelet stimulation due to the pristine GO was reduced under the harsh reaction conditions. Accordingly, a mild cross-linking strategy is expected to preserve the oxygen-containing groups to further increase the hemostatic performance of the sponges. Here, we present a polydopamine (PDA) cross-linked GO sponge (DCGO) by using mild and facile wet chemistry. The obtained DCGO possessed a high surface charge (-31.3 ± 0.3 mV) and showed strong platelet stimulation. Moreover, this method strengthened the mechanical properties of the DCGO, which supported 350 times its own weight without deformation, thus ensuring its absorbability. For the synergy of platelet stimulation and physical absorption, DCGO achieved outstanding hemostatic performance. Bleeding stopped within 105 ± 15 s, which was 165 s faster than that of the un-cross-linked GO aerogel and 96 s faster than that of the cross-linked graphene sponge (CGS). The DCGO combines the advantages of both PDA and GO, thus supplying a new material and method for the field of trauma hemostasis.