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Lunkov AP, Zubareva AA, Varlamov VP, Nechaeva AM, Drozd NN. Chemical modification of chitosan for developing of new hemostatic materials: A review. Int J Biol Macromol 2023; 253:127608. [PMID: 37879584 DOI: 10.1016/j.ijbiomac.2023.127608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
Uncontrolled bleeding that occurs during surgery, trauma, and in combat conditions is critical and require immediate action. Chitosan is a polysaccharide, obtained from natural sources with unique biological properties. It is often used as basis for local hemostatic agents (LHA). We summarized the data on hemostatic properties of chitosan, commercially available chitosan-based products with focus in the field of chemical modification of chitosan. Various approaches are used to enhance hemostatic activity of chitosan-based materials. The approach with chemical modification of chitosan allows changing the properties of the polymer in order to obtain an active macromolecule that contributes to hemostasis. Ongoing research on the mechanism of interaction with blood components in the case of different chitosan derivatives will make it possible to identify promising directions for chemical modification to obtain an effective LHA.
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Affiliation(s)
- A P Lunkov
- Institute of Bioengineering, Research Center of Biotechnology of the Russian Academy of Sciences, Moscow 119071, Russia.
| | - A A Zubareva
- Institute of Bioengineering, Research Center of Biotechnology of the Russian Academy of Sciences, Moscow 119071, Russia
| | - V P Varlamov
- Institute of Bioengineering, Research Center of Biotechnology of the Russian Academy of Sciences, Moscow 119071, Russia
| | - A M Nechaeva
- Department of Biomaterials, Mendeleev University of Chemical Technology of Russia, Moscow 125047, Russia
| | - N N Drozd
- National Medical Research Center for Hematology, Moscow 125167, Russia
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Chen XJ, Lei ZY, Liu P, Lei MJ, Xu H, Yu LJ, Ao MZ. An aminocaproic acid-grafted chitosan derivative with superior antibacterial and hemostatic properties for the prevention of secondary bleeding. Carbohydr Polym 2023; 316:120988. [PMID: 37321717 DOI: 10.1016/j.carbpol.2023.120988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023]
Abstract
Uncontrolled bleeding is one of the leading causes of human mortality. Existing hemostatic materials or techniques cannot meet the clinical requirements for safe and effective hemostasis. The development of novel hemostatic materials has always been of great interest. Chitosan hydrochloride (CSH), a derivative of chitin, is extensively used on wounds as an antibacterial and hemostatic agent. However, the formation of intra- or intermolecular hydrogen bonds between hydroxyl and amino groups limits its water solubility and dissolution rate and affects its effectiveness in promoting coagulation. Herein, we covalently grafted aminocaproic acid (AA) to the hydroxyl and amino groups of CSH via ester and amide bonds, respectively. The solubility of CSH in water (25 °C) was 11.39 ± 0.98 % (w/v), whereas the AA-grafted CSH (CSH-AA) reached 32.34 ± 1.23 % (w/v). Moreover, the dissolution rate of CSH-AA in water was 6.46 times higher than that of CSH. Subsequent studies proved that CSH-AA is non-toxic, biodegradable, and has superior antibacterial and hemostatic properties to CSH. Additionally, anti-plasmin activity can be exerted by the dissociated AA from the CSH-AA backbone, which can help to lessen secondary bleeding.
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Affiliation(s)
- Xiao-Juan Chen
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Zhi-Yong Lei
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Pan Liu
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Meng-Jie Lei
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Hang Xu
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Long-Jiang Yu
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; Key Laboratory of Molecular Biophysics, Ministry of Education, Wuhan 430074, China; Hubei Engineering Research Center for both Edible and Medicinal Resources, Wuhan 430074, China.
| | - Ming-Zhang Ao
- Institute of Resource Biology and Biotechnology, Department of Biotechnology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China; Key Laboratory of Molecular Biophysics, Ministry of Education, Wuhan 430074, China; Hubei Engineering Research Center for both Edible and Medicinal Resources, Wuhan 430074, China.
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Mascarenhas AR, Vediappan RS, Jukes AK, Bouras G, Kaukas LM, Chryssidis S, Manavis J, Finnie J, Moratti S, Vreugde S, Psaltis AJ, Wormald PJ. Haemostatic efficacy and inflammatory response of a novel beta-chitin patch in a cerebral small vessel injury model - A pilot study. J Clin Neurosci 2023; 114:70-76. [PMID: 37321020 DOI: 10.1016/j.jocn.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Rapid and efficacious haemostasis is paramount in neurosurgery. Assessing the efficacy and short- and long-term safety of haemostatic agents utilised within cerebral tissue is essential. This pilot study investigates the haemostatic efficacy and long-term safety of a novel beta-chitin patch against traditionally used agents, bipolar and Floseal, within cerebral tissue. METHODS Eighteen Merino sheep underwent standardised distal cortical vessel injury via temporal craniotomy. Sheep were randomised to receive 2 mls Floseal, 2 cm novel beta-chitin patch, or bipolar cautery to manage bleeding. All sheep underwent cerebral magnetic resonance imaging (MRI) at three months, before euthanasia and brain harvesting for histological assessment. RESULTS Beta-chitin demonstrated a trend towards a faster mean time to haemostasis (TTH) compared to Floseal (223.3 ± 199 s v. 259.8 ± 186.4 s), albeit non-significant (p = 0.234). Radiologically, cerebrocortical necrosis (p = 0.842) and oedema (p = 0.368) were noted slightly more frequently in the beta-chitin group. Histologically, severe fibrotic (p = 0.017) and granulomatous changes at the craniotomy sites were only present in the beta-chitin group (p = 0.002). Neuronal degeneration was seen in all with Floseal, but beta-chitin showed a trend towards more severe reaction when present. Bipolar use predominantly showed an inflammatory cortical reaction with substantial microvascular proliferation, and Floseal showed worse severity and depth of subpial oedema, however no statistical significance was reached. CONCLUSION All haemostats controlled bleeding, with beta-chitin demonstrating a non-inferior TTH compared to Floseal. However, it resulted in intense granulomatous and fibrotic changes, including degenerative neuronal reactions. More extensive studies are needed to assess these trends, to make further clinical inferences.
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Affiliation(s)
- Annika R Mascarenhas
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia.
| | - Rajan S Vediappan
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Alistair K Jukes
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - George Bouras
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Lola M Kaukas
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Steve Chryssidis
- Department of Medical Imaging, Flinders Medical Centre, Adelaide, Australia
| | - Jim Manavis
- Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - John Finnie
- Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Stephen Moratti
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Sarah Vreugde
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia
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Gupta R, Mohanty S, Verma D. Current status of hemostatic agents, their mechanism of action, and future directions. J BIOACT COMPAT POL 2023. [DOI: 10.1177/08839115221147935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The bleeding problem might seem straightforward, but it involves a plethora of complex biochemical pathways and responses. Hemorrhage control remains one of the leading causes of “preventable deaths” worldwide. The past few decades have seen a wide range of biomaterials and their derivatives targeted to serve as hemostatic agents, but none can be deemed as an ideal solution. In this review, we have highlighted the current diversity in hemostatic agents and their modalities. We have enclosed a comprehensive outlook of the proposed solutions and their clinical performance so far. In addition to these, several promising compositions are still in their infancy or developmental phases. The inclusion of novel upcoming nanocomposites has further widened the potencies of existing formulations as well.
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Affiliation(s)
- Ritvesh Gupta
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Odisha, India
| | - Sibanwita Mohanty
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Odisha, India
| | - Devendra Verma
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Odisha, India
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Sabab A, Vediappan RS, Finnie J, McAdam CJ, Jukes A, Vreugde S, Wormald PJ. Efficacy and Safety of Novel Beta-Chitin Patches as Haemostat in Rat Vascular and Neurosurgical Model. Front Surg 2022; 9:830364. [PMID: 35465434 PMCID: PMC9023757 DOI: 10.3389/fsurg.2022.830364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIntraoperative hemorrhage is a major cause of poor post-operative outcome. Beta-chitin patch has previously been found to be an effective haemostat, but whether modifying the patch can improve its efficacy and safety, remains unknown. In this study, beta-chitin patches were modified using polyethylene oxide, Pluronic-F127 (Chi/F127), calcium (Chi/20%Ca), increased thickness (Chi/Thick) or polyphosphate (Chi/PP).ObjectiveUsing rat (Wistar Albino; 8–10 weeks old) vascular and neurosurgical models, this project investigated and compared the efficacy and safety of beta-chitin patches with gauze, Surgicel and FloSeal.MethodsNinety rats underwent a standardized femoral artery injury and were randomized to receive either beta-chitin patches, gauze, Surgicel or FloSeal. The bleeding time and total blood loss was measured. For the neurosurgical model, forty-four rats underwent a standardized cortical injury and randomization to a treatment group. Following a 48 h recovery period, their brains were collected for histopathological examination.ResultsThe mean bleeding time with Chitin (120.8 s) and Chi/PP (117.3 s) was ~60 s lower than Chi/F127, Chi/20%Ca and Chi/Thick (p < 0.05). Chitin and Chi/PP had a significantly lower bleeding time than FloSeal (174.2 s) (p < 0.05), but not Surgicel (172.7 s). Gauze (400 s) had a significantly higher bleeding time compared to all other groups (p < 0.05). There were no significant differences in the total blood loss between the groups. Histopathological examination of brains found no adverse inflammatory reaction to any of the haemostatic compounds.ConclusionChi/PP had superior haemostatic efficacy compared to Surgicel and FloSeal, but not compared to non-modified beta-chitin patch. All of the haemostats were equally safe.
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Affiliation(s)
- Ahad Sabab
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Rajan Sundaresan Vediappan
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - John Finnie
- Discipline of Anatomy and Pathology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - C. John McAdam
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Alistair Jukes
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Peter-John Wormald
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Sabab A, Vreugde S, Jukes A, Wormald PJ. The potential of chitosan-based haemostats for use in neurosurgical setting - Literature review. J Clin Neurosci 2021; 94:128-134. [PMID: 34863426 DOI: 10.1016/j.jocn.2021.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Abstract
Haemorrhage is a major nuance in neurosurgery since blood can distort the surgeon's field of view and increase the risk of post-operative complications. Currently a variety of commercially available haemostats have been approved for use in neurosurgery, but they have caveats to their use in the brain, including, localised tissue compression, neural toxicity, induce immune reaction or form thrombus within the vessel. Thus, there is a need for haemostats that are efficacious and safe for application on brain and spinal tissue. Chitosan is a naturally occurring bio-polymer that is found on the exoskeleton of arthropods and the cell wall of fungi. Chitosan has been shown to accelerate haemostasis through a myriad of physiological pathways. These findings have led to the development of multiple chitosan-based haemostats, for use in peripheral human tissue. Although, clinical data regarding the use of chitosan-based haemostats in the brain is lacking, a range on in vivo studies have proven chitosan to be efficacious and safe in managing neurosurgical bleeds. Similarly, literature comparing chitosan-based haemostats with commercial haemostats used commonly in neurosurgery, have all demonstrated chitosan to be the superior agent. Additionally, clinical trials of chitosan-based haemostat used in peripheral tissue have all demonstrated chitosan to be safe for human use. The marriage of these findings indicates that the safety and superior efficacy of chitosan-based haemostat, makes it a potentially suitable haemostat for use in neurosurgical setting. However, further research pertaining to the clinical use of chitosan-based haemostat within the central nervous system needs to be conducted.
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Affiliation(s)
- Ahad Sabab
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Alistair Jukes
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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Verbraeken B, Lammens M, Van Rompaey V, Ahmed M, Szewczyk K, Hermans C, Menovsky T. Efficacy and histopathological effects of self-assembling peptides RADA16 and IEIK13 in neurosurgical hemostasis. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2021; 40:102485. [PMID: 34748959 DOI: 10.1016/j.nano.2021.102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/13/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
There is a continued need for effective hemostatic agents that are safe for neurosurgical use. Self-assembling peptide hydrogels have been suggested as novel hemostatic agents. They offer some advantages for neurosurgical hemostasis (e.g., transparency), but their efficacy and safety for neurosurgery has not been established. In this paper, the efficacy and safety of two self-assembling peptides, RADA16 and IEIK13, are explored for hemostasis of oozing bleeding on the rat cerebral cortex (n=56). Chronic safety was evaluated by neuropathological evaluation at one, four, and twelve weeks after craniotomy (n=32). An inactive control and oxidized cellulose served as comparators. Mean time-to-hemostasis was significantly shorter for RADA16 and IEIK13 compared to controls, while safety evaluation yielded similar results. Histopathological response consisted primarily of macrophage infiltration at the lesion site in all groups. This study confirms the hemostatic potential and safety of RADA16 and IEIK13 for hemostasis in the rat brain.
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Affiliation(s)
- Barbara Verbraeken
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Neurosurgery, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Martin Lammens
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Pathology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Vincent Van Rompaey
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Melek Ahmed
- Department of Pathology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Krystyna Szewczyk
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Christophe Hermans
- Department of Pathology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium; Center for Oncological Research (CORE), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Tomas Menovsky
- Department of Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Neurosurgery, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium.
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Sabab A, Liu S, Javadiyan S, McAdam CJ, Hanton LR, Jukes A, Vreugde S, Wormald PJ. The effect of chemical and structural modifiers on the haemostatic process and cytotoxicity of the beta-chitin patch. Sci Rep 2021; 11:18577. [PMID: 34535704 PMCID: PMC8448852 DOI: 10.1038/s41598-021-97781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/30/2021] [Indexed: 12/03/2022] Open
Abstract
Beta-chitin patch has previously been proven to be an effective haemostat, but whether modifying the patch affects its efficacy and safety, remains unanswered. In this study, the patch was modified using polyethylene oxide, Pluronic-F127, calcium, increased thickness or polyphosphate, and their effect on the process of haemostasis and cytotoxicity was tested and compared with standard-of-care, Surgicel and FloSeal. Whole blood collected from volunteers was applied to the patches to test their whole blood clotting and thrombin generation capacities, whilst platelet isolates were used to test their platelet aggregation ability. The fluid absorption capacity of the patches was tested using simulated body fluid. Cytotoxicity of the patches was tested using AlamarBlue assays and PC12 cells and the results were compared with the standard-of-care. In this study, beta-chitin patch modifications failed to improve its whole blood clotting, platelet aggregation and thrombin generation capacity. Compared to non-modified patch, modifications with polyethylene oxide or calcium reduced platelet aggregation and thrombin generation capacity, while increasing the thickness or adding polyphosphate decreased platelet aggregation capacity. The cytotoxicity assays demonstrated that the beta-chitin patches were non-toxic to cells. In vivo research is required to evaluate the safety and efficacy of the beta-chitin patches in a clinical setting.
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Affiliation(s)
- Ahad Sabab
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
| | - Sha Liu
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Shari Javadiyan
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - C John McAdam
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Lyall R Hanton
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Alistair Jukes
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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The role of hemostatic devices in neurosurgery. A systematic review. J Clin Neurosci 2021; 89:151-157. [PMID: 34119260 DOI: 10.1016/j.jocn.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
Hemostasis represents a fundamental step in every surgical procedure. During neurosurgical procedures, proper and robust hemostasis into confined spaces can significantly reduce the odds of perioperative complications. Over the decades, multiple methods have been applied, and several medical devices have been developed to promote and guarantee proper hemostasis. This study presents a systematic review of the most used intraoperative hemostatic methods and devices in neurosurgery. Insightful research was performed on the PubMed database according to the PRISMA guidelines. This comprehensive review of scientific literature represents a synoptic panel where the most used intraoperative hemostatic methods and devices available today in neurosurgery are classified and described.
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Li D, Chen J, Wang X, Zhang M, Li C, Zhou J. Recent Advances on Synthetic and Polysaccharide Adhesives for Biological Hemostatic Applications. Front Bioeng Biotechnol 2020; 8:926. [PMID: 32923431 PMCID: PMC7456874 DOI: 10.3389/fbioe.2020.00926] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Rapid hemostasis and formation of stable blood clots are very important to prevent massive blood loss from the excessive bleeding for living body, but their own clotting process cannot be completed in time for effective hemostasis without the help of hemostatic materials. In general, traditionally suturing and stapling techniques for wound closure are prone to cause the additional damages to the tissues, activated inflammatory responses, short usage periods and inevitable second operations in clinical applications. Especially for the large wounds that require the urgent closure of fluids or gases, these conventional closure methods are far from enough. To address these problems, various tissue adhesives, sealants and hemostatic materials are placed great expectation. In this review, we focused on the development of two main categories of tissue adhesive materials: synthetic polymeric adhesives and naturally derived polysaccharide adhesives. Research of the high performance of hemostatic adhesives with strong adhesion, better biocompatibility, easy usability and cheap price is highly demanded for both scientists and clinicians, and this review is also intended to provide a comprehensive summarization and inspiration for pursuit of more advanced hemostatic adhesives for biological fields.
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Affiliation(s)
- Dawei Li
- Eighth Medical Center of the General Hospital of the Chinese People’s Liberation Army, Beijing, China
| | - Jing Chen
- Department of Orthopedics, Aerospace Center Hospital, Beijing, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Mingming Zhang
- The People’s Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Chunlin Li
- Eighth Medical Center of the General Hospital of the Chinese People’s Liberation Army, Beijing, China
| | - Jin Zhou
- Eighth Medical Center of the General Hospital of the Chinese People’s Liberation Army, Beijing, China
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Wei W, Liu J, Peng Z, Liang M, Wang Y, Wang X. Gellable silk fibroin-polyethylene sponge for hemostasis. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2020; 48:28-36. [PMID: 31852256 DOI: 10.1080/21691401.2019.1699805] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Traditional haemostatic materials generally have slow hemostasis rate and poor biocompatibility. This paper reports on the haemostatic properties and mechanism of silk fibroin (SF). SF-PEG sponge that could be solubilised and changed to gel form by blood was fabricated through mixing SF and polyethylene glycol (PEG, 1500 Da) followed by lyophilisation of the mixed solution. SF-PEG sponge, together with control samples of SF sponge (no PEG) and a commercially available haemostatic material, gelatine sponge, were subjected to the hemostasis tests using a liver trauma model of rabbit. The results showed that SF was superior to gelatine sponge in hemostasis time (136.17 ± 62.27 s and 249.83 ± 29.18 s) and blood loss (2.16 ± 1.27 g vs. 4.97 ± 1.44 g). Furthermore, in vitro experiments indicated SF-PEG sol-gel transition promoted platelet adhesion and aggregation, as well as platelet-fibrinogen interaction. Therefore, except for the physical blocking of bleeding port due to PEG-induced SF fast gelation, SF might also have an impact on blood coagulation process, a phenomenon that has not been reported before. In conclusion, SF is a new type of haemostatic material that might be able to meet the requirements of speed, efficiency and biosafety in a variety of clinical applications.
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Affiliation(s)
- Wei Wei
- Department of Orthopaedics, The 1st Affiliated Hospital of Harbin Medical University, Harbin, China.,Department of Orthopaedics, Harbin 242 Hospital, Harbin, China
| | - Jian Liu
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, China.,Simatech Incorporation, Suzhou, China
| | - ZhiBin Peng
- Department of Orthopaedics, The 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Min Liang
- Department of Orthopaedics, The 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - YanSong Wang
- Department of Orthopaedics, The 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - XiaoQin Wang
- National Engineering Laboratory for Modern Silk, College of Textile and Clothing Engineering, Soochow University, Suzhou, China
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Jones M, Kujundzic M, John S, Bismarck A. Crab vs. Mushroom: A Review of Crustacean and Fungal Chitin in Wound Treatment. Mar Drugs 2020; 18:E64. [PMID: 31963764 PMCID: PMC7024172 DOI: 10.3390/md18010064] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/13/2022] Open
Abstract
Chitin and its derivative chitosan are popular constituents in wound-treatment technologies due to their nanoscale fibrous morphology and attractive biomedical properties that accelerate healing and reduce scarring. These abundant natural polymers found in arthropod exoskeletons and fungal cell walls affect almost every phase of the healing process, acting as hemostatic and antibacterial agents that also support cell proliferation and attachment. However, key differences exist in the structure, properties, processing, and associated polymers of fungal and arthropod chitin, affecting their respective application to wound treatment. High purity crustacean-derived chitin and chitosan have been widely investigated for wound-treatment applications, with research incorporating chemically modified chitosan derivatives and advanced nanocomposite dressings utilizing biocompatible additives, such as natural polysaccharides, mineral clays, and metal nanoparticles used to achieve excellent mechanical and biomedical properties. Conversely, fungi-derived chitin is covalently decorated with -glucan and has received less research interest despite its mass production potential, simple extraction process, variations in chitin and associated polymer content, and the established healing properties of fungal exopolysaccharides. This review investigates the proven biomedical properties of both fungal- and crustacean-derived chitin and chitosan, their healing mechanisms, and their potential to advance modern wound-treatment methods through further research and practical application.
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Affiliation(s)
- Mitchell Jones
- School of Engineering, RMIT University, Bundoora East Campus, P.O. Box 71, Bundoora VIC 3083, Australia
| | - Marina Kujundzic
- Institute of Material Chemistry and Research, Polymer and Composite Engineering (PaCE) Group, Faculty of Chemistry, University of Vienna, Währinger Straße 42, 1090 Vienna, Austria
| | - Sabu John
- School of Engineering, RMIT University, Bundoora East Campus, P.O. Box 71, Bundoora VIC 3083, Australia
| | - Alexander Bismarck
- Institute of Material Chemistry and Research, Polymer and Composite Engineering (PaCE) Group, Faculty of Chemistry, University of Vienna, Währinger Straße 42, 1090 Vienna, Austria
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Nawawi WMFBW, Jones M, Murphy RJ, Lee KY, Kontturi E, Bismarck A. Nanomaterials Derived from Fungal Sources-Is It the New Hype? Biomacromolecules 2020; 21:30-55. [PMID: 31592650 PMCID: PMC7076696 DOI: 10.1021/acs.biomac.9b01141] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/07/2019] [Indexed: 12/21/2022]
Abstract
Greener alternatives to synthetic polymers are constantly being investigated and sought after. Chitin is a natural polysaccharide that gives structural support to crustacean shells, insect exoskeletons, and fungal cell walls. Like cellulose, chitin resides in nanosized structural elements that can be isolated as nanofibers and nanocrystals by various top-down approaches, targeted at disintegrating the native construct. Chitin has, however, been largely overshadowed by cellulose when discussing the materials aspects of the nanosized components. This Perspective presents a thorough overview of chitin-related materials research with an analytical focus on nanocomposites and nanopapers. The red line running through the text emphasizes the use of fungal chitin that represents several advantages over the more popular crustacean sources, particularly in terms of nanofiber isolation from the native matrix. In addition, many β-glucans are preserved in chitin upon its isolation from the fungal matrix, enabling new horizons for various engineering solutions.
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Affiliation(s)
- Wan M. F. B. W. Nawawi
- Department
of Chemical Engineering, Imperial College
London, South Kensington Campus, London SW7 2AZ, U.K.
- Department
of Biotechnology Engineering, International
Islamic University Malaysia, P.O. Box 10, 50728 Kuala Lumpur, Malaysia
| | - Mitchell Jones
- School
of Engineering, RMIT University, Bundoora
East Campus, P.O. Box 71, Bundoora 3083, Victoria, Australia
- Polymer and
Composite Engineering (PaCE) Group, Institute of Materials Chemistry
and Research, Faculty of Chemistry, University
of Vienna, Währinger
Strasse 42, 1090 Vienna, Austria
| | - Richard J. Murphy
- Centre
for Environment & Sustainability, University
of Surrey, Arthur C Clarke
building, Floor 2, Guildford GU2 7XH, U.K.
| | - Koon-Yang Lee
- Department
of Aeronautics, Imperial College London,
South Kensington Campus, London SW7 2AZ, U.K.
| | - Eero Kontturi
- Department
of Bioproducts and Biosystems, Aalto University, P.O. Box 16300, FI-00076 Aalto, Finland
| | - Alexander Bismarck
- Department
of Chemical Engineering, Imperial College
London, South Kensington Campus, London SW7 2AZ, U.K.
- Polymer and
Composite Engineering (PaCE) Group, Institute of Materials Chemistry
and Research, Faculty of Chemistry, University
of Vienna, Währinger
Strasse 42, 1090 Vienna, Austria
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Rodríguez-Vázquez M, Ramos-Zúñiga R. Chitosan-Hydroxyapatite Scaffold for Tissue Engineering in Experimental Lumbar Laminectomy and Posterolateral Spinal Fusion in Wistar Rats. Asian Spine J 2019; 14:139-147. [PMID: 31679322 PMCID: PMC7113459 DOI: 10.31616/asj.2019.0091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Study Design Experimental study with an animal model. Purpose To evaluate the role of a chitosan and hydroxyapatite composite for spinal fusion in a lumbar experimental model based on regenerative tissue engineering principles. Overview of Literature Chitosan and hydroxyapatite represent an alternative biodegradable implant material for tissue engineering and regeneration. The combination of chitosan and hydroxyapatite in a 20:80 ratio could potentiate their individual properties as an implantable composite for experimental laminectomy. Methods Phase I: design and synthesis of a porous composite scaffold composed of chitosan-hydroxyapatite using a freeze drying technique. Phase II: experimental microsurgical lumbar laminectomy at L5. A total of 35 Wistar rats were categorized into three experimental groups: control (laminectomy alone), experimental (laminectomy with implant), and reference (intact spine) (n=5 per group). Postoperative structural and functional evaluations were performed using computed tomography scans. In addition, radiologic, clinical, histological, and immunohistochemical microstructures were evaluated. Results At the laminectomy site, the composite implant induced bone regeneration, which was observed in the axial reconstruction of the rat lumbar spine in all cases. Biomechanical changes in the lumbar spine were observed by radiology in both groups after the surgery. The posterolateral space was covered by a bone structure in the treated spine, a condition not seen in the control group. The range of motion was 7.662°±0.81° in the scaffold group versus 20.72°±3.47° in the control group. Histological findings revealed qualitatively more bone tissue formation in the implant group. Conclusions A composite of chitosan-hydroxyapatite at a 20:80 ratio induced bone formation after experimental laminectomy in rats and led to spinal fusion, which was assessed by radiology and biomechanical tests. No functional complications in posture or walking were observed at 90 days post-surgery, despite biomechanical changes in the spine.
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Affiliation(s)
- Martin Rodríguez-Vázquez
- Department of Neurosciences, Translational Institute of Neuroscience, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Rodrigo Ramos-Zúñiga
- Department of Neurosciences, Translational Institute of Neuroscience, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
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Logun MT, Dowling MB, Raghavan SR, Wallace ML, Schmiedt C, Stice S, Karumbaiah L. Expanding Hydrophobically Modified Chitosan Foam for Internal Surgical Hemostasis: Safety Evaluation in a Murine Model. J Surg Res 2019; 239:269-277. [PMID: 30884383 DOI: 10.1016/j.jss.2019.01.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 12/19/2018] [Accepted: 01/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A novel injectable expanding foam based on hydrophobically modified chitosan (HM-CS) was developed to improve hemostasis during surgeries. HM-CS is an amphiphilic derivative of the natural biopolymer chitosan (CS); HM-CS has been shown to improve the natural hemostatic characteristics of CS, but its internal safety has not been systematically evaluated. The goal of this study was to compare the long-term in vivo safety of HM-CS relative to a commonly used fibrin sealant (FS), TISSEEL (Baxter). METHODS Sixty-four Sprague-Dawley rats (275-325 g obtained from Charles River Laboratories) were randomly assigned to control (n = 16) or experimental (n = 48) groups. Samples of the test materials (HM-CS [n = 16], CS [n = 16], and FS [n = 16]) applied to a nonlethal liver excision (0.4 ± 0.3 g of the medial lobe) in rats were left inside the abdomen to degrade. Animals were observed daily for signs of morbidity and mortality. Surviving animals were sacrificed at 1 and 6 wk; the explanted injury sites were microscopically assessed. RESULTS All animals (64/64) survived both the 1- and 6-wk time points without signs of morbidity. Histological examination showed a comparable pattern of degradation for the various test materials. FS remnants and significant adhesions to neighboring tissues were observed at 6 wk. Residual CS and HM-CS were observed at the 6 wk with fatty deposits at the site of injury. Minimal adhesions were observed for CS and HM-CS. CONCLUSIONS The internal safety observed in the HM-CS test group after abdominal implantation indicates that injectable HM-CS expanding foam may be an appropriate internal use hemostatic candidate.
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Affiliation(s)
- Meghan T Logun
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia
| | | | - Srinivasa R Raghavan
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland
| | - Mandy L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Chad Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Steven Stice
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia
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Sanandiya ND, Lee S, Rho S, Lee H, Kim IS, Hwang DS. Tunichrome-inspired pyrogallol functionalized chitosan for tissue adhesion and hemostasis. Carbohydr Polym 2019; 208:77-85. [DOI: 10.1016/j.carbpol.2018.12.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 01/02/2023]
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ChiBio: An Integrated Bio-refinery for Processing Chitin-Rich Bio-waste to Specialty Chemicals. GRAND CHALLENGES IN MARINE BIOTECHNOLOGY 2018. [DOI: 10.1007/978-3-319-69075-9_14] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yan T, Cheng F, Wei X, Huang Y, He J. Biodegradable collagen sponge reinforced with chitosan/calcium pyrophosphate nanoflowers for rapid hemostasis. Carbohydr Polym 2017; 170:271-280. [DOI: 10.1016/j.carbpol.2017.04.080] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/22/2022]
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Yang X, Liu W, Li N, Wang M, Liang B, Ullah I, Luis Neve A, Feng Y, Chen H, Shi C. Design and development of polysaccharide hemostatic materials and their hemostatic mechanism. Biomater Sci 2017; 5:2357-2368. [DOI: 10.1039/c7bm00554g] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The formation of stable blood clots or hemostasis is essential to prevent major blood loss and death from excessive bleeding.
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Abstract
The prehospital treatment of severe extremity bleeding has remained unchanged for years and relies on compression with absorbent gauze dressings. Advances in haemostasis technology have identified several new methods of improving bleeding control. These are examined with a view to possible inclusion in a new prehospital dressing aimed at reducing the degree of exsanguination and associated mortality and morbidity from a major extremity injury.
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Affiliation(s)
- JP Garner
- Biomedical Sciences, Dstl Porton Down, Salisbury, UK,
| | - RFR Brown
- Biomedical Sciences, Dstl Porton Down, Salisbury, UK
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Bugnicourt L, Ladavière C. Interests of chitosan nanoparticles ionically cross-linked with tripolyphosphate for biomedical applications. Prog Polym Sci 2016. [DOI: 10.1016/j.progpolymsci.2016.06.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Crofton A, Chrisler J, Hudson S, Inceoglu S, Petersen F, Kirsch W. Effect of Plasma Sterilization on the Hemostatic Efficacy of a Chitosan Hemostatic Agent in a Rat Model. Adv Ther 2016; 33:268-81. [PMID: 26833305 DOI: 10.1007/s12325-016-0289-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The United States military has had success with chitosan (CS)-based hemostatic agents to control trauma-induced hemorrhages. Despite the positive reviews, additional physical forms of CS may enhance its hemostatic efficacy. Additionally, standard sterilization techniques may negatively affect the hemostatic efficacy of CS. We studied the effects of a CS-based hemostatic pad, the Clo-Sur P.A.D.™ (Scion Cardio-Vascular, Inc.), on severe femoral vessel bleeding in a rat model. The effects of different sterilization techniques on the bioadhesivity, surface atomic concentrations, and hemostatic efficacy of the P.A.D. were also evaluated. METHODS Hemostatic efficacy, bioadhesivity, and surface atomic concentrations of the P.A.D. were evaluated in its unsterilized form, after sterilization with standard e-beam treatment, and after sterilization with one of three types of non-thermal nitrogen plasma: nitrogen gas, air, or nitrous oxide plasma. After standardized puncture of the femoral artery or transection of the femoral vessels, rats were treated with either a CS P.A.D. or gauze pad. RESULTS The Clo-Sur P.A.D., regardless of sterilization technique, stopped arterial and mixed arterial/venous bleeding in all cases in <90 s with the time to hemostasis (TTH) significantly less for all P.A.D. treatment groups (P < 0.001; n = 4-5/group) compared to gauze-treated controls (n = 3). E-beam sterilized P.A.D.s consistently showed non-significant trends toward increased TTH and worse hemostasis scores compared to unsterilized and plasma sterilized P.A.D.s. Treating e-beam sterilized P.A.D.s with N2 plasma reverted the hemostatic efficacy to levels equivalent to native, unsterilized PADs. CONCLUSION A CS-based hemostatic pad successfully controlled severe bleeding in a rat model with combined e-beam and plasma sterilized P.A.D.s showing the most promising results. Further studies are warranted.
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Affiliation(s)
- Andrew Crofton
- Department of Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, USA
- Neurosurgery Center for Research, Training, and Education, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - John Chrisler
- Animal Care Facility, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Samuel Hudson
- College of Textiles, North Carolina State University, Raleigh, NC, USA
| | - Serkan Inceoglu
- Department of Orthopedic Surgery, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Floyd Petersen
- Neurosurgery Center for Research, Training, and Education, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Wolff Kirsch
- Neurosurgery Center for Research, Training, and Education, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
- Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
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Zargar V, Asghari M, Dashti A. A Review on Chitin and Chitosan Polymers: Structure, Chemistry, Solubility, Derivatives, and Applications. CHEMBIOENG REVIEWS 2015. [DOI: 10.1002/cben.201400025] [Citation(s) in RCA: 470] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Li YH, Cheng CY, Wang NK, Tan HY, Tsai YJ, Hsiao CH, Ma DHK, Yeh LK. Characterization of the modified chitosan membrane cross-linked with genipin for the cultured corneal epithelial cells. Colloids Surf B Biointerfaces 2014; 126:237-44. [PMID: 25576808 DOI: 10.1016/j.colsurfb.2014.12.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/13/2014] [Accepted: 12/16/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To modify a chitosan membrane (CM) by cross-linking the chitosan with genipin, a naturally occurring cross-linker extracted from Gardenia jasminoides fructus, with the aim of developing a new cell culture support and to observe the phenotypes of cultured human corneal epithelial cells (HCECs) on genipin-cross-linked chitosan membrane (GCM). METHODS We tested the cross-linking characteristics and mechanical strength of the GCM. CMs modified by cross-linking with different concentrations of genipin were prepared to investigate the rate of membrane degradation. The biocompatibility of the GCMs was investigated by determining the viability of HCECs cultured on them in vitro. The morphology of the HCECs cultured on CM or GCM was analyzed by confocal microscopy and scanning electron microscopy (SEM). Immunocytochemical staining was conducted to determine the phenotypes of the cultured cells. RESULTS The fixation index of the GCM was 31 ± 3% after treatment of CM with 0.5mM genipin. A stress-strain test showed that the GCM could tolerate three times the mechanical force of noncross-linked CM. The biodegradation rate of GCM was much slower than for CM. A 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay showed that cell viability was not affected by cross-linking with 5.0mM genipin. SEM showed that the cultured HCECs adhered to and grew well on the surface of the GCM. Immunocytochemical staining showed keratin 3 (K3) and connexin 43 (Cx-43) immunoreactive HCECs on the GCM and their proliferative ability was not significantly affected by strong immunoreactivity of Ki-67 and p63 markers. CONCLUSIONS GCM has potential as a scaffold for corneal epithelium in ocular surface surgery and greater mechanical strength and slower degradation than unmodified CM.
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Affiliation(s)
- Ya-Han Li
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yi Cheng
- Department of Cosmetic Science, Graduate Institute of Health Industry Technology, Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kwei-Shan, Tao-Yuan, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Yueh-Ju Tsai
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan.
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Synthesis and characterization of poly(lactic-co-glycolic) acid nanoparticles-loaded chitosan/bioactive glass scaffolds as a localized delivery system in the bone defects. BIOMED RESEARCH INTERNATIONAL 2014; 2014:898930. [PMID: 24949477 PMCID: PMC4037621 DOI: 10.1155/2014/898930] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/01/2014] [Indexed: 01/02/2023]
Abstract
The functionality of tissue engineering scaffolds can be enhanced by localized delivery of appropriate biological macromolecules incorporated within biodegradable nanoparticles. In this research, chitosan/58 S-bioactive glass (58 S-BG) containing poly(lactic-co-glycolic) acid (PLGA) nanoparticles has been prepared and then characterized. The effects of further addition of 58 S-BG on the structure of scaffolds have been investigated to optimize the characteristics of the scaffolds for bone tissue engineering applications. The results showed that the scaffolds had high porosity with open pores. It was also shown that the porosity decreased with increasing 58 S-BG content. Furthermore, the PLGA nanoparticles were homogenously distributed within the scaffolds. According to the obtained results, the nanocomposites could be considered as highly bioactive bone tissue engineering scaffolds with the potential of localized delivery of biological macromolecules.
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Gopalakrishnan L, Ramana LN, Sethuraman S, Krishnan UM. Ellagic acid encapsulated chitosan nanoparticles as anti-hemorrhagic agent. Carbohydr Polym 2014; 111:215-21. [PMID: 25037345 DOI: 10.1016/j.carbpol.2014.03.093] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 01/06/2023]
Abstract
Ellagic acid, a naturally occurring polyphenol was encapsulated in chitosan particles prepared by ionotropic gelation and characterized for its physicochemical properties. A maximum encapsulation efficiency of 49% was achieved. The blood clotting time and clot retraction time were calculated for different concentrations of ellagic acid, chitosan and ellagic acid-encapsulated chitosan. A reduction of 34% in the clot time and 16.4% in the retraction time was observed in ellagic acid-encapsulated chitosan when compared with free ellagic acid at concentrations as low as 0.1mg/mL. The physical blend in comparison to free ellagic acid displayed a reduction of 13.8% and 4.6% in the clotting time and retraction time respectively under similar conditions. This suggests that the encapsulation of ellagic acid favors thrombosis due to synergistic action of chitosan and ellagic acid on same molecular targets. This study demonstrates the potential of ellagic acid-chitosan system as an effective anti-hemorrhagic system.
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Affiliation(s)
- Lalitha Gopalakrishnan
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India
| | - Lakshmi Narashimhan Ramana
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India
| | - Swaminathan Sethuraman
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India
| | - Uma Maheswari Krishnan
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), School of Chemical & Biotechnology, SASTRA University, Thanjavur - 613 401, Tamil Nadu, India.
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Chitosan effects on glass matrices evaluated by biomaterial. MAS-NMR and biological investigations. KOREAN J CHEM ENG 2013. [DOI: 10.1007/s11814-013-0104-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rajiv S, Harding M, Bassiouni A, Jardeleza C, Drilling A, James C, Ha T, Moratti S, Robinson S, Wormald PJ. The efficacy and safety of chitosan dextran gel in a burr hole neurosurgical sheep model. Acta Neurochir (Wien) 2013; 155:1361-6; discussion 1366. [PMID: 23709005 DOI: 10.1007/s00701-013-1767-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 05/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Achieving and maintaining haemostasis is of paramount importance in neurosurgery. Chitosan has been shown in both animal and human models to be significantly effective in haemostasis as well as in reducing adhesion formation. OBJECTIVES To evaluate the haemostatic potential and to study histopathological changes caused by novel chitosan dextran gel in a neurosurgical sheep model. METHOD Ten sheep underwent neurosurgical burr hole procedure. Bleeding control was tested at the level of bone, dura and brain separately with both chitosan gel and Gelfoam paste on separate burr holes. Baseline bleeding was measured at the time of injury using the Boezaart scale, and then every 2 min after the application of each agent until complete haemostasis or 10 min, whichever was earlier. Safety was assessed through MRI scans and histopathological analysis. RESULTS Mixed modeling showed no statistical difference in time to haemostasis between chitosan gel and Gelfoam paste (means of log-normalized areas under the curve were 1.3688 and 1.3196 respectively) for each burr hole (p = 0.7768). Logistic regression modeling showed that Chitosan significantly decreased the incidence of bleeding beyond the first time point measured after application of the treatment when compared to Gelfoam (OR = 2.7, p = 0.04). Average edema volume (cm(3)) on post-operative MRI was 0.97 for Gelfoam and 1.11 for (p = 0.49) while average histology scores were 2.5 for Gelfoam versus 3.3 for chitosan (p = 0.32). CONCLUSION Chitosan dextran gel is an effective haemostatic agent to control bleeding in brain tissue. It is safe and nontoxic to neural tissue.
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Affiliation(s)
- Sukanya Rajiv
- Department of Surgery- Otorhinolaryngology Head and Neck Surgery, The Queen Elizabeth Hospital and the University of Adelaide, Adelaide, South Australia, Australia.
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Nadesh R, Narayanan D, P R S, Vadakumpully S, Mony U, Koyakkutty M, Nair SV, Menon D. Hematotoxicological analysis of surface-modified and -unmodified chitosan nanoparticles. J Biomed Mater Res A 2013; 101:2957-66. [PMID: 23613460 DOI: 10.1002/jbm.a.34591] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/29/2012] [Accepted: 12/11/2012] [Indexed: 11/06/2022]
Abstract
The increasing interest in using chitosan nanoparticles for controlled drug delivery is hampered by its blood incompatibility, especially for intravenous applications. This study investigated the effects of processing solvents (acetic acid/lactic acid), dispersing media (acidic medium/saline), and surface modifiers (polyethylene glycol, polyvinyl alcohol, and ethylenediaminetetraacetatic acid) on the hemocompatibility of chitosan. Blood compatibility of chitosan nanoparticles prepared by ionotropic gelation with altered surface chemistry was evaluated by assessing their hemolytic activity, platelet aggregation, coagulation, and cytokine induction. It was observed that nanoparticles prepared in lactic acid and dispersed in saline did not show hemolysis, platelet aggregation, or coagulation, whereas nanoparticles prepared in acetic acid showed strong hemolysis. Surface modifiers were not observed to significantly affect blood compatibility, with the exception of EDTA, which delayed blood clotting times. Thus, chitosan nanoparticles prepared in lactic acid and dispersed in saline may be an ideal nanocarrier for parenteral applications.
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Affiliation(s)
- Ragima Nadesh
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
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Determination of efficacy of novel modified chitosan sponge dressing in a lethal arterial injury model in swine. J Trauma Acute Care Surg 2012; 72:899-907. [PMID: 22491602 DOI: 10.1097/ta.0b013e318248baa1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chitosan is a functional biopolymer that has been widely used as a hemostat. Recently, its efficacy has been questioned due to clinical failures as a result of poor adhesiveness. The purpose of this study was to compare, in a severe groin injury model in swine, the hemostatic properties of an unmodified standard chitosan sponge with standard gauze dressing and a novel hydrophobically modified (hm) chitosan sponge. Previous studies have demonstrated that hm-chitosan provides greatly enhanced cellular adhesion and hemostatic effect via noncovalent insertion of hydrophobic pendant groups into cell membranes. METHODS Twenty-four Yorkshire swine were randomized to receive hm-chitosan (n = 8), unmodified chitosan (n = 8), or standard Accu-Sorb gauze dressing (n = 8) for hemostatic control. A complex groin injury involving arterial puncture (4.4-mm punch) of the femoral artery was made after splenectomy. After 30 seconds of uncontrolled hemorrhage, the randomized dressing was applied and compression was held for 3 minutes. Fluid resuscitation was initiated to achieve and maintain the baseline mean arterial pressure and the wound was inspected for bleeding. Failure of hemostasis was defined as pooling of blood outside the wound. Animals were then monitored for 180 minutes and surviving animals were killed. RESULTS Blood loss before treatment was similar between groups (p < 0.1). Compared with the hm-chitosan sponge group, which had no failures, the unmodified chitosan sponge group and the standard gauze group each had eight failures over the 180-minute observation period. For the unmodified chitosan sponge failures, six of which provided initial hemostasis, secondary rebleeding was observed 44 minutes ± 28 minutes after application. Standard gauze provided no initial hemostasis after the 3-minute compression interval. CONCLUSIONS Hm-chitosan is superior to unmodified chitosan sponges (p < 0.001) or standard gauze for controlling bleeding from a lethal arterial injury. The hm-chitosan technology may provide an advantage over native chitosan-based dressings for control of active hemorrhage.
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Yeh HY, Lin JC. Surface characterization and in vitro platelet compatibility study of surface sulfonated chitosan membrane with amino group protection–deprotection strategy. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 19:291-310. [DOI: 10.1163/156856208783720985] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hsi-Yi Yeh
- a Department of Chemical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Jui-Che Lin
- b Department of Chemical Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
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Bui XV, Oudadesse H, Le Gal Y, Merdrignac-Conanec O, Cathelineau G. Bioactivity behaviour of biodegradable material comprising bioactive glass. KOREAN J CHEM ENG 2011. [DOI: 10.1007/s11814-011-0151-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Shelma R, Sharma CP. Development of lauroyl sulfated chitosan for enhancing hemocompatibility of chitosan. Colloids Surf B Biointerfaces 2011; 84:561-70. [DOI: 10.1016/j.colsurfb.2011.02.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 02/05/2011] [Accepted: 02/05/2011] [Indexed: 10/18/2022]
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Molecular imprinted macroporous chitosan coated mesoporous silica xerogels for hemorrhage control. Biomaterials 2010; 31:7620-30. [DOI: 10.1016/j.biomaterials.2010.06.049] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 06/28/2010] [Indexed: 11/19/2022]
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Preparation of chitosan films mixed with superabsorbent polymer and evaluation of its haemostatic and antibacterial activities. J Appl Polym Sci 2010. [DOI: 10.1002/app.31910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Valentine R, Athanasiadis T, Moratti S, Robinson S, Wormald PJ. The Efficacy of a Novel Chitosan Gel on Hemostasis after Endoscopic Sinus Surgery in a Sheep Model of Chronic Rhinosinusitis. Am J Rhinol Allergy 2009; 23:71-5. [DOI: 10.2500/ajra.2009.23.3266] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Postoperative bleeding remains a major problem after endoscopic sinus surgery (ESS). Patients who continue to bleed after ESS are at risk of airway compromise from inhalation of blood clots or from aspiration of blood-stained vomitus. The aim of this study was to determine the in vivo efficacy of a novel gel on hemostasis after ESS in a sheep model of chronic rhinosinusitis. Methods Twenty-one sheep infested with Oestrus ovus underwent ESS with standardized mucosal injuries created at the anterior ethmoid region using a microdebrider. Immediately after injury a baseline bleeding time was taken using the Boezaart Surgical Field Grading Scale. Computer randomization was performed to either receive chitosan/dextran (CD) gel or no treatment (control). Boezaart bleeding scores were calculated for each side every 2 minutes. Each postoperative day videoendoscopy was performed to document crusting/CD gel dissolution. Results The CD gel side was significantly more hemostatic at 2, 4, and 6 minutes after injury. Average time to hemostasis was significantly better for the intervention side versus control side, 4.09 (±1.61) versus 6.57 (±2.20), respectively (p = 0.049). Complete hemostasis occurred by 6 minutes for all CD gel sides; however, control side bleeding was noted on three sides at 8 minutes and on one side at 10 minutes. There was no significant difference in crusts scores at days 1, 3, 7, and 14. Conclusion In the sheep model of ESS, CD gel significantly improved hemostasis compared with the control at 2, 4, and 6 minutes after mucosal injury.
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Affiliation(s)
- Rowan Valentine
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery University of Adelaide, Adelaide, Australia
| | - Theo Athanasiadis
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery University of Adelaide, Adelaide, Australia
| | - Stephen Moratti
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Simon Robinson
- Wakefield Nasal and Sinus Institute, Wakefield Hospital, Wellington, New Zealand
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery University of Adelaide, Adelaide, Australia
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Effects of a novel chitosan gel on mucosal wound healing following endoscopic sinus surgery in a sheep model of chronic rhinosinusitis. Laryngoscope 2008; 118:1088-94. [PMID: 18401274 DOI: 10.1097/mlg.0b013e31816ba576] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Postoperative bleeding and adhesion formation remain the two major problems after endoscopic sinus surgery (ESS). This study investigates the effect on adhesion formation and wound healing in a sheep model of chronic sinusitis of three topical agents: recombinant tissue factor (rTF, Dade Innovin, Marburg, Germany), poly-ethylene glycol (SprayGel, Confluent Surgical, Waltham, MA), and a novel chitosan-dextran derivative gel (CD, Department of Chemistry, University of Otago, Dunedin, New Zealand). METHODS Twenty sheep with chronic sinusitis underwent ESS with standardized mucosal injuries created on the lateral nasal wall and the ethmoid region. Injured areas were divided into four groups, and one of the three agents or control (no treatment) was randomly applied. The presence and severity of adhesions were noted and the healing was evaluated by taking brushings for ciliary beat frequency and biopsies of the injured regions at day 28, 56, 84, and 112 post initial surgery. The biopsy specimens were assessed for re-epithelialisation using light microscopy and scanning electron microscopy for reciliation. The cytobrush specimens assessed cilial function by measuring ciliary beat frequency. RESULTS CD significantly decreased lateral nasal wall and ethmoidal adhesions compared to tissue factor at all time points (5% vs. 25%, and 0 vs. 50%, respectively). There was a noticeable trend toward decreased adhesions on the lateral nasal wall and ethmoids in the SprayGel group (10% and 14%) and the CD group (10% and 0%) compared to controls (15% and 40%). The CD group had a significantly greater percentage of re-epithelialisation at day 28 and day 84 compared to the rTF group (70% vs. 33%, P < .001; 84.5% vs. 61%, P < 0.05). At day 28, the CD group was significantly more ciliated than control (62% vs. 31%, P < .01) and than rTF (62% vs. 23%, P < .001). This difference between CD and rTF reciliation remained significant at day 56 (67% vs. 40%, P < .05). In addition, the mean cilial grade for CD at day 112 was significantly better than control (1.9 vs. 2.7, P < .05). CONCLUSION In the sheep model of chronic sinusitis, CD significantly improves microscopic wound healing and reduces adhesion formation after ESS.
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Hayes M, Carney B, Slater J, Brück W. Mining marine shellfish wastes for bioactive molecules: Chitin and chitosan – Part B: Applications. Biotechnol J 2008; 3:878-89. [DOI: 10.1002/biot.200800027] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Xie H, Khajanchee YS, Teach JS, Shaffer BS. Use of a chitosan-based hemostatic dressing in laparoscopic partial nephrectomy. J Biomed Mater Res B Appl Biomater 2008; 85:267-71. [DOI: 10.1002/jbm.b.30946] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hoemann CD, Sun J, McKee MD, Chevrier A, Rossomacha E, Rivard GE, Hurtig M, Buschmann MD. Chitosan-glycerol phosphate/blood implants elicit hyaline cartilage repair integrated with porous subchondral bone in microdrilled rabbit defects. Osteoarthritis Cartilage 2007; 15:78-89. [PMID: 16895758 DOI: 10.1016/j.joca.2006.06.015] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 06/25/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We have previously shown that microfractured ovine defects are repaired with more hyaline cartilage when the defect is treated with in situ-solidified implants of chitosan-glycerol phosphate (chitosan-GP) mixed with autologous whole blood. The objectives of this study were (1) to characterize chitosan-GP/blood clots in vitro, and (2) to develop a rabbit marrow stimulation model in order to determine the effects of the chitosan-GP/blood implant and of debridement on the formation of incipient cartilage repair tissue. METHODS Blood clots were characterized by histology and in vitro clot retraction tests. Bilateral 3.5 x 4 mm trochlear defects debrided into the calcified layer were pierced with four microdrill holes and filled with a chitosan-GP/blood implant or allowed to bleed freely as a control. At 1 day post-surgery, initial defects were characterized by histomorphometry (n=3). After 8 weeks of repair, osteochondral repair tissues between or through the drill holes were evaluated by histology, histomorphometry, collagen type II expression, and stereology (n=16). RESULTS Chitosan-GP solutions structurally stabilized the blood clots by inhibiting clot retraction. Treatment of drilled defects with chitosan-GP/blood clots led to the formation of a more integrated and hyaline repair tissue above a more porous and vascularized subchondral bone plate compared to drilling alone. Correlation analysis of repair tissue between the drill holes revealed that the absence of calcified cartilage and the presence of a porous subchondral bone plate were predictors of greater repair tissue integration with subchondral bone (P<0.005), and of a higher total O'Driscoll score (P<0.005 and P<0.01, respectively). CONCLUSIONS Chitosan-GP/blood implants applied in conjunction with drilling, compared to drilling alone, elicited a more hyaline and integrated repair tissue associated with a porous subchondral bone replete with blood vessels. Concomitant regeneration of a vascularized bone plate during cartilage repair could provide progenitors, anabolic factors and nutrients that aid in the formation of hyaline cartilage.
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Affiliation(s)
- C D Hoemann
- Department of Chemical Engineering, Ecole Polytechnique, Montreal, QC, Canada; Institute of Biomedical Engineering, Ecole Polytechnique, Montreal, QC, Canada.
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Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. ACTA ACUST UNITED AC 2006; 60:655-8. [PMID: 16531872 DOI: 10.1097/01.ta.0000199392.91772.44] [Citation(s) in RCA: 374] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hemorrhage remains a leading cause of death in both civilian and military trauma patients. The HemCon chitosan-based hemostatic dressing is approved by the US Food and Drug Administration (FDA) for hemorrhage control. Animal data have shown the HemCon dressing to reduce hemorrhage and improve survival. The purpose of this article is to report preliminary results of the hemostatic efficacy of the HemCon dressing used in the prehospital setting on combat casualties. METHODS A request for case information on use of HemCon dressings in Operation Iraqi Freedom and Operation Enduring Freedom was sent to deployed Special Forces combat medics, physicians, and physician assistants. RESULTS Sixty-eight uses of the HemCon dressing were reported and reviewed by two US Army physicians. Four of the 68 cases were determined duplicative resulting in a total of 64 combat uses. Dressings were utilized externally on the chest, groin, buttock, and abdomen in 25 cases; on extremities in 35 cases; and on neck or facial wounds in 4 cases. In 66% of cases, dressings were utilized following gauze failure and were 100% successful. In 62 (97%) of the cases, the use of the HemCon dressing resulted in cessation of bleeding or improvement in hemostasis. There were two reported dressing failures that occurred with blind application of bandages up into large cavitational injuries. Dressings were reported to be most useful on areas where tourniquets could not be applied to control bleeding. The dressings were reported to be most difficult to use in extremity injuries where they could not be placed easily onto or into the wounds. No complications or adverse events were reported. CONCLUSION This report on the field use of the HemCon dressing by medics suggests that it is a useful hemostatic dressing for prehospital combat casualties and supports further study to confirm efficacy.
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Affiliation(s)
- Ian Wedmore
- Madigan Army Medical Center, Fort Lewis, Washington, USA
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Whang HS, Kirsch W, Zhu YH, Yang CZ, Hudson SM. Hemostatic Agents Derived from Chitin and Chitosan. ACTA ACUST UNITED AC 2005. [DOI: 10.1080/15321790500304122] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Acheson EM, Kheirabadi BS, Deguzman R, Dick EJ, Holcomb JB. Comparison of Hemorrhage Control Agents Applied to Lethal Extremity Arterial Hemorrhages in Swine. ACTA ACUST UNITED AC 2005; 59:865-74; discussion 874-5. [PMID: 16374275 DOI: 10.1097/01.ta.0000187655.63698.9f] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND QuikClot powder (QC), chitosan dressing (CD), and fibrin sealant dressing (FSD) are new hemostatic products touted to be more effective in controlling severe extremity bleeding than the current standard gauze dressing. All have been utilized in the global war on terrorism. Our objective was to evaluate the hemostatic efficacy of these three products in a model of severe extremity arterial hemorrhage that could not be stopped by standard gauze treatment. METHODS A model of severe extremity arterial hemorrhage was developed in swine that was 100% fatal with standard gauze application and manual compression. The Army Field Bandage (AFB) was the standard gauze control. Anesthetized animals (n = 60, 15/group, 37.7 +/- 2.5 kg) were splenectomized and instrumented. A reproducible femoral artery injury was created using a 6 mm aortic punch, and free bleeding was allowed for 45 seconds. Each hemostatic agent was applied twice with three-minute compressions. All products were applied on actively bleeding wounds through a pool of blood. Fluid resuscitation was started with the first compression and titrated to a mean pressure of 65 mm Hg. Animals were observed for 180 minutes or until death. Endpoints were percent survival, survival time, blood loss, resuscitation volume, wound temperatures and tissue histology. Data are expressed as mean +/- SD and analyzed by Fisher's exact, logrank, and nonparametric ANOVA tests. RESULTS Baseline physiologic parameters were similar among groups. AFB did not produce hemostasis. QC also showed no hemostatic benefit, and QC treatment markedly increased maximum wound temperatures to an average of 70.8 +/- 4.2 degrees C (p < 0.001). CD stopped bleeding temporarily in only one animal. There were no survivors in the AFB, QC, or CD groups. CD numerically prolonged survival time (58.9 +/- 21.1 minute) compared with the control (38.4 +/- 24.7 minutes, p = 0.045) but the difference was not significant. FSD reduced bleeding (p < 0.05) and prevented exsanguination in 10/15 (2/3) animals, and resulted in a significantly longer average survival time (p < 0.0001). CONCLUSION FSD was superior to other currently utilized hemostatic products in controlling lethal arterial hemorrhage in this model of a fatal extremity wound. CD showed some hemostatic benefit. The exothermic reaction of QC was significant and resulted in gross and histologic tissue changes of unknown clinical significance. Controlled human studies with the promising products are required.
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Affiliation(s)
- Eric M Acheson
- US Army Institute of Surgical Research, Fort Sam Houston, TX, 78234, USA.
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Cho BC, Kim TG, Yang JD, Chung HY, Park JW, Kwon IC, Roh KH, Chung HS, Lee DS, Park NU, Kim IS. Effect of Calcium Sulfate-Chitosan Composite: Pellet on Bone Formation in Bone Defect. J Craniofac Surg 2005; 16:213-24; discussion 225-7. [PMID: 15750417 DOI: 10.1097/00001665-200503000-00006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this experiment was to study the effects of chitosan, calcium sulfate, and calcium sulfate-chitosan composite pellet on the osteogenesis of defective tibia in rabbits. Eighty New Zealand white rabbits, each weighing approximately 3 to 3.5 kg, were used for this study. A 1-cm ostectomy was made on the middle of the tibia of each rabbit with the periosteum preserved. Nothing was implanted in the control group (group 1), and five chitosan pellets (60 mg/pellet) were implanted in group 1, three OsteoSet pellets (100 mg/pellet) in group 3, and four calcium sulfate-chitosan composite pellets (1 pellet, 80 mg; calcium sulfate 40 mg/pellet, chitosan 40 mg/pellet) in group 4. For each group, a radiographic study, bone mineral density test, three-point bending test, and histologic examination were performed in the second, fourth, and sixth weeks. In the radiologic study, in group 1, cortical bone was not formed even at 6 weeks. In group 2, it was observed at 6 weeks. In groups 3 and 4, cortical bone was partially seen around the fourth week. At 6 weeks, it was clearly observed on both sides, and the projection of the marrow cavity became distinctive, so bone consolidation was considered to be much progressed. The bone mineral density test and three-point bending test results appeared to be highly similar in groups 3 and 4 and in groups 2 and 1. Particularly at 6 weeks, the measures for groups 3 and 4 were statistically significant compared with those for groups 1 and 2 (P < 0.05). In histologic examination, new bone formation began to be seen at 2 weeks in all groups, but it was more active and faster in groups 3 and 4. At 6 weeks, fibrous connective tissue still remained at the center in groups 1 and 2; however, the fibrous connective tissue at the center was replaced with callus, the bony bridge was obvious, and lamellation of callus was observed more in groups 3 and 4. The results indicate that chitosan pellets, OsteoSet, and chitosan-calcium sulfate composite pellets facilitate new bone formation on defected bone, and that particularly OsteoSet and chitosan-calcium sulfate composite pellets are more effective than chitosan.
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Affiliation(s)
- Byung Chae Cho
- Departments of Plastic and Reconstructive Surgery, Institute of Cell and Matrix Biology, School of Medicine, Kyungpook National University, Samduk 2 ga 50, 700-721 Daegu, Korea.
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Kang QK, An YH, Moreira PL, Demcheva MV, Vournakis JN. Arterial embolization using poly-N-acetyl glucosamine gel in a rat kidney model. ACTA ACUST UNITED AC 2005; 284:454-9. [PMID: 15803477 DOI: 10.1002/ar.a.20187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Aqueous solutions of poly-N-acetyl glucosamine (p-GlcNAc) exhibit a liquid-gel transition at physiological pH and temperature. This feature inspired the authors to conduct a study to evaluate the macro- and histological changes of rat kidneys after embolization using either p-GlcNAc gel injection into the renal artery or ligation of the renal artery. The procedures were performed in 46 rats through open abdominal surgeries. Animals were sacrificed at 3 days and at 1, 3, 5, and 8 weeks postoperatively. The results of both macro-observation and histological study showed that p-GlcNAc gels were effective in causing necrosis and subsequent fibrosis in all embolized kidneys. The data indicate that p-GlcNAc gel may have promise as an effective agent for therapeutic embolization.
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Affiliation(s)
- Qian K Kang
- Orthopaedic Research Laboratory, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Vournakis JN, Demcheva M, Whitson A, Guirca R, Pariser ER. Isolation, Purification, and Characterization of Poly-N-Acetyl Glucosamine Use as a Hemostatic Agent. ACTA ACUST UNITED AC 2004; 57:S2-6. [PMID: 15280743 DOI: 10.1097/01.ta.0000136741.66698.9d] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A new polymeric material, poly-N-acetyl glucosamine (p-GlcNAc) fiber, has been identified and is effective in achieving hemostasis in surgical procedures and trauma. The p-GlcNAc material is purified from large-scale cultures of a marine microalga. METHODS Poly-N-acetyl glucosamine materials have been formulated as films, sponges, gels, and microspheres. The polymer's structure has been characterized by chemical composition, carbohydrate analysis, spectroscopic techniques, intrinsic viscosity, and electron microscopy. RESULTS Carbohydrate analyses indicate that the primary sugar present in p-GlcNAc is N-acetyl glucosamine. Elemental analyses yield percentage values for carbon, nitrogen, and hydrogen that support that the polymer is fully acetylated. Molecular weight determinations indicate that the polymer has a molecular weight of 2.0 x 10(6) Da. Fourier transform infrared, nuclear magnetic resonance, and circular dichroism spectral data have defined a unique tertiary structure. Biologic testing demonstrated that p-GlcNAc materials are fully biocompatible. CONCLUSION The p-GlcNAc fiber has a unique beta-tertiary structure.
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Affiliation(s)
- John N Vournakis
- Marine Polymer Technologies, Inc., Burlington, Massachusetts 01803, USA.
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