Preparation and characterization of carboxymethylated cotton fabrics as hemostatic wound dressing

Carboxymethylated polysaccharides from Chrysanthemum indicum with antimicrobial and hemostatic properties for promoting wound healing

Seeking potential active ingredients with suitable functions to promote the entire wound repair process remains an unmet requirement. In this study, the polysaccharide (CIP) with an average molecular weight of 5.85 × 104 g/mol was isolated from dried Chrysanthemum indicum flowers. This polysaccharide was then chemically modified using chloroacetic acid, resulting in the synthesis of a series of carboxymethylated modification polysaccharides (CMCI). Notably, as the degree of substitution (DS) increased in CMCI samples, there was a gradual improvement in solubility, accompanied by a decrease in zeta potential and particle size. Importantly, CMCI-3 with the highest DS (≈0.6) exhibited excellent antioxidant and antibacterial activities. Additionally, CMCI-3 demonstrated the ability to enhance fibroblast proliferation and migration without causing significant cytotoxicity in vitro. Surprisingly, compared with pure CIP, CMCI-3 achieved more rapid hemostasis and significantly reduced blood loss in both rat tail amputation and liver injury models. Furthermore, animal skin defect experiments confirmed that CMCI-3 promoted wound healing effectively. Overall, these findings indicate that CMCI-3 is a promising functional polysaccharide for future clinical management of skin defect repair.

Functionalization strategy of carboxymethyl cotton gauze fabrics with zeolitic imidazolate framework-67 (ZIF-67) as a recyclable material for biomedical applications

The accumulation of uremic toxins in the human body poses a deadly risk because it causes chronic kidney disease. To increase the effectiveness of hemodialysis and raise the survival rate, these toxins must be effectively removed from the bloodstream. Developing effective materials for removing these dangerous substances requires a thorough understanding of the interactions between an adsorbent and the uremic toxins. Thankfully, metal-organic frameworks (MOFs) have shown considerable promise for the identification and treatment of kidney disorders. Herein, cotton gauze fabrics (CGF) were carboxylated using monochloroacetic acid to produce carboxymethylated cotton gauze fabrics (CM-CGF). CM-CGF was subsequently decorated in situ with zeolitic imidazolate framework-67, resulting in carboxymethylated cotton gauze fabrics-zeolitic imidazolate framework-67 (CM-CGF-ZIF). The CGF, CM-CGF, and CM-CGF-ZIF were evaluated for potential kidney applications by removing uric acid and creatinine from mimic blood. The results showed that CM-CGF-ZIF had the highest adsorption of uric acid and creatinine. The maximum adsorption capacity of uric acid and creatinine was 164 and 222 mg/g for CM-CGF-ZIF, respectively, compared to 45 and 67 mg/g for CGF. CM-CGF-ZIF showed excellent antibacterial activity, good antifungal activity, low cytotoxicity, and a satisfactory level of blood compatibility.

Advances of biological macromolecules hemostatic materials: A review

Achieving hemostasis is a necessary intervention to rapidly and effectively control bleeding. Conventional hemostatic materials currently used in clinical practice may aggravate the damage at the bleeding site due to factors such as poor adhesion and poor adaptation. Compared to most traditional hemostatic materials, polymer-based hemostatic materials have better biocompatibility and offer several advantages. They provide a more effective method of stopping bleeding and avoiding additional damage to the body in case of excessive blood loss. Various hemostatic materials with greater functionality have been developed in recent years for different organs using diverse design strategies. This article reviews the latest advances in the development of polymeric hemostatic materials. We introduce the coagulation cascade reaction after bleeding and then discuss the hemostatic mechanisms and advantages and disadvantages of various polymer materials, including natural, synthetic, and composite polymer hemostatic materials. We further focus on the design strategies, properties, and characterization of hemostatic materials, along with their applications in different organs. Finally, challenges and prospects for the application of hemostatic polymeric materials are summarized and discussed. We believe that this review can provide a reference for related research on hemostatic materials, contributing to the further development of polymer hemostatic materials.

Expansion-clotting chitosan fabrics based on unidirectional fast-absorption fibers for rapid hemorrhage control

The rapid absorption of water from the blood to concentrate erythrocytes and platelets, thus triggering quick closure, is important for hemostasis. Herein, expansion-clotting chitosan fabrics are designed and fabricated by ring spinning of polylactic acid (PLA) filaments as the core layer and highly hydrophilic carboxyethyl chitosan (CECS) fibers as the sheath layer, and subsequent knitting of obtained PLA@CECS core spun yarns. Due to the unidirectional fast-absorption capacity of CECS fibers, the chitosan fabrics can achieve erythrocytes and platelets aggregate quickly by concentrating blood, thus promoting the formation of blood clots. Furthermore, the loop structure of coils formed in the knitted fabric can help them to expand by absorbing water to close their pores, providing effective sealing for bleeding. Besides, They have enough mechanical properties, anti-penetrating ability, and good tissue-adhesion ability in wet conditions, which can form a physical barrier to resist blood pressure during hemostasis and prevent them from falling off the wound, thus enhancing hemostasis synergistically. Therefore, the fabrics exhibit superior hemostatic performance in the rabbit liver, spleen, and femoral artery puncture injury model compared to the gauze group. This chitosan fabric is a promising hemostatic material for hemorrhage control.

Fabrication, characterization and efficacy evaluation of natural gum-based bioactive haemostatic gauzes with antibacterial properties

Management of uncontrolled bleeding due to traumatic injuries occurring in battlefields and road traffic accidents is a major healthcare concern, especially in developing countries like India. Since natural coagulation mechanism alone is insufficient to achieve haemostasis quickly in such cases, application of an external haemostatic product is generally required to accelerate the coagulation process. We had recently reported preliminary comparison of four natural absorbent gums, which indicated towards haemostatic potential of gum tragacanth (GT) and xanthan gum (XG). Present study involves fabrication of haemostatic dressings incorporated with different concentrations of GT or XG, along with ciprofloxacin (a broad-spectrum antibiotic) and other excipients over woven cotton gauze. Prepared gauzes were investigated for physico-chemical characteristics, in-vitro blood interaction studies, antibacterial effect and in-vivo haemostatic efficacy in Sprague Dawley rats using two bleeding models. Acute dermal toxicity studies were also carried out as per OECD guidelines. SEM studies showed that gauzes coated with XG had thin, uniform layer of coating, while in case of GT; coating was comparatively rough with insoluble particles of GT adhering over gauze surface, forming voids on the fibers. Coated gauzes exhibited optimum mechanical properties in terms of tensile strength and percent extension at break. GT coated dressings showed good fluid uptake and retention ability in-vitro. Test gauzes were non-hemolytic in nature, did not elicit any dermal toxicity on animals' skin and had the ability to protect against E. coli infection. In-vivo efficacy studies in rat femoral artery and liver laceration bleeding models indicated that gauzes coated with 4% GT were able to clot blood in least time (36.67 ± 3.33s and 40 ± 2.58s respectively) as compared to other gum combinations and commercially available dressing 'Surgispon® (103.3 ± 4.22s and 85 ± 5.62s respectively). Results of this study validate our initial findings of the potential of gum tragacanth to be developed into a suitable haemostatic product.

A wet-adhesive carboxymethylated yeast β-glucan sponge with radical scavenging, bacteriostasis and anti-inflammatory functions for rapid hemostasis

Local hemostats still face obstacles to efficiently achieving hemostasis and promoting wound healing. Herein, a series of multifunctional well-degradable hemostatic sponges based-on carboxymethylated yeast β-glucan (CMYG) were fabricated by lyophilization. The porous CMYG sponge not only could absorb blood quickly (44.12 g/g), but also possessed unexpected tissue adhesion (∼30 kPa), and it represented good biocompatibility in vitro on fibroblasts and red blood cells. Notably, compared with the commercial Celox™, the CMYG sponge achieved more rapid hemostasis and significantly reduced blood loss in liver injury rat models by rapid wound block. Interestingly, the developed sponge showed an outstanding effect on antioxidant, anti-infection, anti-inflammatory, and cell proliferation, which are beneficial for further wound repair. Overall, these results suggest that the CMYG sponge is a promising candidate for the clinical management of uncontrollable hemorrhage and the further development of wound dressing materials throughout skin defect repair.

Janus Self-Propelled Chitosan-Based Hydrogel Spheres for Rapid Bleeding Control

Uncontrolled hemorrhage is a major cause of potentially preventable death in civilian trauma nowadays. Considerable concern has been given to the development of efficient hemostats with high blood absorption, self-propelled property, and Ca2+ release ability, for irregularly shaped and noncompressible hemorrhage. Herein, Janus self-propelled chitosan-based hydrogel with CaCO3 (J-CMH@CaCO3 ) is developed by partial ionic crosslinking of carboxylated chitosan (CCS) and Ca2+ , gravity settlement, and photopolymerization, followed by removing the shell of CCS. The obtained J-CMH@CaCO3 is further used as a hemostat powered by the internal CaCO3 and coordinated protonated tranexamic acid (J-CMH@CaCO3 /T). Bubbles are generated and detached to provide the driving force, accompanied by the release of Ca2+ . The two aspects work in synergy to accelerate clot formation, endowing the J-CMH@CaCO3 /T with excellent hemostatic efficiency. The J-CMH@CaCO3 /T presents high blood absorption, favorable blood-clotting ability, desired erythrocyte and platelet aggregation, and acceptable hemocompatibility and cytocompatibility. In rodent and rabbit bleeding models, the J-CMH@CaCO3 /T exhibits the most effective hemostasis to the best knowledge of the authors, wherein the hemorrhage is rapidly halted within 39 s. It is believed that the J-CMH@CaCO3 /T with self-propelled property opens up a new avenue to design high-performance hemostats for clinical application.

Intrafibrillar Dispersion of Cuprous Oxide (Cu2O) Nanoflowers within Cotton Cellulose Fabrics for Permanent Antibacterial, Antifungal and Antiviral Activity

With increasingly frequent highly infectious global pandemics, the textile industry has responded by developing commercial fabric products by incorporating antibacterial metal oxide nanoparticles, particularly copper oxide in cleaning products and personal care items including antimicrobial wipes, hospital gowns and masks. Current methods use a surface adsorption method to functionalize nanomaterials to fibers. However, this results in poor durability and decreased antimicrobial activity after consecutive launderings. In this study, cuprous oxide nanoparticles with nanoflower morphology (Cu₂O nanoflowers) are synthesized in situ within the cotton fiber under mild conditions and without added chemical reducing agents from a copper (II) precursor with an average maximal Feret diameter of 72.0 ± 51.8 nm and concentration of 17,489 ± 15 mg/kg. Analysis of the Cu₂O NF-infused cotton fiber cross-section by transmission electron microscopy (TEM) confirmed the internal formation, and X-ray photoelectron spectroscopy (XPS) confirmed the copper (I) reduced oxidation state. An exponential correlation (R² = 0.9979) between the UV-vis surface plasmon resonance (SPR) intensity at 320 nm of the Cu₂O NFs and the concentration of copper in cotton was determined. The laundering durability of the Cu₂O NF-cotton fabric was investigated, and the superior nanoparticle-leach resistance was observed, with the fabrics releasing only 19% of copper after 50 home laundering cycles. The internally immobilized Cu₂O NFs within the cotton fiber exhibited continuing antibacterial activity (≥99.995%) against K. pneumoniae, E. coli and S. aureus), complete antifungal activity (100%) against A. niger and antiviral activity (≥90%) against Human coronavirus, strain 229E, even after 50 laundering cycles.

Engineered Hemostatic Biomaterials for Sealing Wounds

Hemostatic biomaterials show great promise in wound control for the treatment of uncontrolled bleeding associated with damaged tissues, traumatic wounds, and surgical incisions. A surge of interest has been directed at boosting hemostatic properties of bioactive materials via mechanisms triggering the coagulation cascade. A wide variety of biocompatible and biodegradable materials has been applied to the design of hemostatic platforms for rapid blood coagulation. Recent trends in the design of hemostatic agents emphasize chemical conjugation of charged moieties to biomacromolecules, physical incorporation of blood-coagulating agents in biomaterials systems, and superabsorbing materials in either dry (foams) or wet (hydrogel) states. In addition, tough bioadhesives are emerging for efficient and physical sealing of incisions. In this Review, we highlight the biomacromolecular design approaches adopted to develop hemostatic bioactive materials. We discuss the mechanistic pathways of hemostasis along with the current standard experimental procedures for characterization of the hemostasis efficacy. Finally, we discuss the potential for clinical translation of hemostatic technologies, future trends, and research opportunities for the development of next-generation surgical materials with hemostatic properties for wound management.