Rapidly Expandable Zeolite-Poly(vinyl Alcohol) Sponge for Fast Bleeding Control in Severe Femoral Artery Hemorrhage.

ABSTRACTBACKGROUND:Failure to achieve effective bleeding control and problems related to transfusion in liver surgery are the most common causes of post-operative mortality and morbidity. Various methods/drugs including topical hemostatic agents have been employed for bleeding control in liver surgery. This study was aimed to investigate the hemostatic properties of the herb mixture extract of Inula viscosa and Capsella bursa-pastoris (IvCbp) in rat liver laceration model, which have been traditionally used as antiseptic and hemostatic agents public in Hatay/Tukey.METHODS:Thirty rats were divided into three groups equally for each group and blood samples were taken from all rats for preoperative hemoglobin (Hb) measurements. Then, the standard liver resection model was applied to all rats. Sponge for the first rat group, Ankaferd Blood Stopper® Trend-Tech for the second rat group and IvCbp plant extract mixture for the third group were applied to resection areas for 3 minutes. Liver samples of all rats were evaluated in terms of inflammation and necrosis intensity on the 5th post-operative day.RESULTS:Post-operative Hb values were found as 11.0±1.1 g/dL in the sponge group, 11.9±2.0 g/dL in the Ankaferd group, and 14.1±1.2 g/dL in the IvCbp herb mixture group (p<0.001). In the histopathological examination, less necrosis was observed in the herb mixture group compared to the sponge and Ankaferd groups (p=0.001). In addition, no statistically significant necrosis difference was observed between the sponge and Ankaferd groups. While less inflammation was observed in the herb mixture group compared to the other groups, the Ankaferd group had the highest inflammation score (p<0.001).CONCLUSION:IvCbp herb mixture extract group provide effective hemostatic control, caused less Hb decrease and resulted in less inflammation and necrosis compared to the Ankaferd and sponge groups in a rat liver resection model.

Self-expanding hemostatic sponge plays an important role in the control of non-compressible hemorrhage in deep wound. After hemostasis is accomplished, the sponge adheres to the wound via blood clots, posing a considerable challenge in wound debridement. A kind of protocatechualdehyde modified chitosan/sodium alginate composite hemostatic sponge with on-demand removal performance is designed in this study. After absorbing blood, the compression sponge rapidly expands and compresses the damaged blood vessels. The physical compression of the hemostatic sponge and the chemical adhesion of catechol is used to promote rapid hemostasis of the wound. The composite hemostatic sponge demonstrated outstanding hemostasis performance in both mouse liver and rat femoral artery bleeding model. Notably, after complete hemostasis of the rat femoral artery, the composite sponge is rapidly removed from the wound by rinsing it with a suitable concentration of Sodium carbonate (Na2CO3) solution. This composite hemostatic sponge featuring the on-demand removal capability demonstrates outstanding application potential for non-compressible hemorrhage in deep wounds and provides a novel way for constructing removable hemostatic sponges.

Mussel-inspired oxidized sodium alginate/cellulose composite sponge with excellent shape recovery and antibacterial properties for the efficient control of non-compressible hemorrhage

IntroductionThis study was performed to compare the efficacy and safety of PreserFlo MicroShunt (PMS) implantation with mitomycin C (MMC) applied by sub-tenon injection versus conventional application by MMC-soaked sponges.MethodsThis retrospective, 1-year cohort study included 100 eyes of 100 patients with glaucoma who underwent PMS implantation with MMC (0.4 mg/ml) delivered either by sub-tenon injection (50 eyes) or via soaked sponges (50 eyes). The primary outcome measure at 1 year was intraocular pressure (IOP) reduction, with complete success defined as an IOP reduction of ≥ 20% and achieving a target IOP of ≤ 21 or 18 mmHg without the use of medication. Secondary outcomes, including corneal endothelial cell density (CECD) loss, the number of medications, and complications, were assessed and compared between the groups.ResultsSustained reductions in mean IOP were observed in both groups over the 1-year follow-up, with no significant differences between the groups. The complete success rate, with a target IOP of ≤ 21 mmHg after 1 year, was 19.3% in the sponge group and 26.4% in the injection group. The qualified success rate was 59.0% and 87.4% in the sponge and injection groups, respectively. A longer survival rate was observed in the injection group than in the sponge group when IOP was below 21 mmHg. The mean CECD significantly decreased (P < 0.01) from baseline to each postoperative follow-up time point in both groups. At 1 year postoperatively, the percentage of total CECD loss was 8.1% in the sponge group and 8.0% in the injection group. However, no significant differences in mean CECD values, the number of medications, or adverse events were found between the groups.ConclusionsPMS implantation with sub-tenon injection of MMC was comparable in terms of efficacy and safety to traditional MMC delivery via soaked sponges. However, the injection group demonstrated a significantly higher success rate than the sponge group.

Hemostatic Efficacy of Modified Amylopectin Powder in a Lethal Porcine Model of Extremity Arterial Injury

Effective control of large and deep wounds with incompressible bleeding is essential for pre-hospital first aid. The development of rapid and effective emergency hemostatic materials could reduce the amount of blood loss, promote wound healing, and improve the survival rate. In this study, a carboxymethyl chitosan/ Panax notoginseng polysaccharide (CMCS&PNP) sponge with a layered porous structure was developed, which has high hemostatic and antibacterial effects. The unique bark-like layered porous structure was prepared by the rapid freezing method, which enabled CMCS&PNP to quickly adsorb the water from the bottom of the sponge to the upper layer (the water absorption rate within 3min could reach 256.83±2.04%). The smaller pores between the two layers allow red blood cells and fibrin to be trapped on the surface of the bottom of the sponge, thereby concentrating the tangible components of the blood and speeding up clotting. The pro-coagulant activity, pro-healing ability, and antibacterial properties of CMCS&PNP were confirmed by in vivo and in vitro experiments. This study not only developed a new composite sponge with high efficiency in hemostasis but also promoted healing. In addition, we also studied the effect of the layered porous structure prepared by rapid freezing on hemostasis and wound healing, providing a new perspective for the development of a composite hemostatic sponge.

Deep and tunneling wounds are a challenge to apply and maintain most advanced wound dressings to promote effective healing. An autologous whole blood clot is a topical treatment and has been found to be safe and effective in healing cutaneous wounds. The active coagulation whole blood (ACWB) clot treatment, using the patient's own blood, is used to treat deep and tunneling wounds, by mixing the blood with coagulation components and applying it into the wound cavity allowing the clot to re-form inside the wound. We aimed to explore ACWB treatment in hard-to-heal wounds. 5 patients with multiple comorbidities, exhibiting surgical abdominal wound, chronic pilonidal sinus, stage 4 sacral pressure ulcer with exposed bone, post-amputation surgical site wound, and non-healing wound dehiscence at the site of a prior hip replacement, were all treated with the ACWB clot treatment. Complete wound healing was observed in 4/5 cases. In the fifth case, there was a 70% reduction in the depth and surface area of the abdominal surgical wound. The ACWB treatment was found to be effective in deep wounds with cavities and exposed structures. ACWB, in its flowable form, can effectively provide coverage of the deepest interstices of the wound's cavities by virtue of its liquid properties, forming a fibrin matrix, mimicking the role of the extracellular matrix. The flowable formulation of ACWB treatment safely and efficiently provides coverage of the entirety of the wound surface to improve the time and process of complex wound surface healing.

Uncontrollable hemorrhage and subsequent wound infection pose severe threats to life, especially in the case of deep, non-compressible, massive bleeding. Here, a wool keratin/zeolitic imidazolate framework-8 (WK/ZIF-8) composite shape memory sponge is prepared by incorporating ZIF-8 nanoparticles into wool keratin. The combination of keratin and ZIF-8 particles not only reduces the effect of ZIF-8 particles on cell viability but also bolsters the mechanical properties of the keratin sponge and endows it with antibacterial efficacy. Due to the synergistic effect of the excellent hemostatic performance of keratin and Zn2+ release from ZIF-8 nanoparticles, the porous structure suitable for blood cell adhesion and the shape recovery ability of sponges, the WK/ZIF-8 composite sponge exhibits superior hemostatic performance to commercial medical sponges in SD rat and rabbit hemorrhage models. In addition, in vitro and in vivo antibacterial experiments demonstrate the anti-infection activity of the composite sponge. Overall, the WK/ZIF-8 composite sponge provides a promising approach to rapidly control bleeding and promote wound healing.

To investigate the influence of polyester gauze on evaporation capacity and its clinical effect after escharectomy of deep burn wound and micro-skin grafting. Twenty patients with deep burn admitted within 24 hours after injury underwent escharectomy and Meek skin grafting. Two surfaces of wound with the area of about 1% as the whole wound surface were used, one covered by Meek skin graft and polyester gauze as inner dressing (polyester gauze group), and the other covered by split-thickness skin sheet 0.3 mm x 0.3 mm in size and vaseline oil gauze as inner dressing (vaseline oil gauze group). Five days after skin grafting, the evaporation capacities of the surface of inner dressing, wound surface without dressing (nude wound), and normal skin near the wound were tested by evaporation test equipment. The complete healing time and survival rate of skin sheet in both groups were observed. The degree of pain during dressing change was evaluated with visual analog scale. The evaporation capacity of the inner dressing surface of polyester gauze group was (24.8 +/- 5.2) ml x h(-1) x m(-2), significantly lower than those of the vaseline oil gauze group [(35.4 +/- 5.0) ml x h(-1) x m(-2), P < 0.01] and nude wound [(41.3 +/- 4.5) ml x h(-1) x m(-2), P < 0.01], and similar to that of the normal skin near the wound [(21.1 +/- 5.1) ml x h(-1) x m(-2), P > 0.05]. The evaporation capacity of the inner dressing surface of vaseline oil gauze group was significantly lower than nude wound [(40.7 +/- 3.6) ml x h(-1) x m(-2), P < 0.01], but significantly higher than the normal skin near the wound [(21.2 +/- 3.8) ml x h(-1) x m(-2), P < 0.01]. The survival rate of skin sheets of the polyester gauze group was 98% +/- 3%, not significantly different from that of the vaseline oil gauze group (98% +/- 2% , P > 0.05). The wound healing rates on days 10, 15, and 20 of the polyester gauze group were 80% +/- 20%, 96% +/- 7%, and 100% respectively, all significantly higher than those of the vaseline oil gauze group (70% +/- 33%, 81% +/- 21%, and 97% +/- 11% respectively, all P < 0.01). The complete healing time of the polyester gauze group was (13.6 +/- 1.9) days, significantly shorter than that of the vaseline oil gauze group [(16.7 +/- 2.6) days, P < 0.01]. The pain scores during dressing change 5 and 10 days after grafting of the polyester gauze group were (3.2 +/- 0.8) and (4.9 +/- 0.4) respectively, both significantly lower than those of the vaseline oil gauze group [(5.1 +/- 0.6) and (8.2 +/- 0.5) respectively, both P < 0.01]. Polyester gauze has quite good abilities to retain moisture and can promote the migration and proliferation of epithelial cells, relieves the pain caused by tearing of dressings off the wound, thus raising its acceptability. It is a relatively ideal carrier of skin grafting, as well as a new type of inner cover for the wound.

In the biomedical field, polyvinyl alcohol (PVA) sponge has been widely used. In particular, it is considered a potential implant material for repairing soft tissues. However, its insufficient water absorption and mechanical properties limit its application. In this work, a novel PVA/halloysite nanotubes (HNTs)/gelatin ternary composite sponge was prepared by water solution mixing and casting techniques. HNTs and gelatin/PVA solution were mixed at different weight ratios. The structure of the ternary composite sponges was characterized by using scanning electron microscopy. The physical properties of the ternary composite sponges were characterized. The maximum water absorption reached 1783.5% with a rapid water absorption speed at a weight ratio of HNTs/gelatin of 1:8. Owing to its interconnected macroporous structure and good interfacial interaction, its highest compression strength and tensile strength reached 8.22, 1.51 MPa, respectively. In addition, its thermal stability was enhanced as well, which demonstrated that the prepared composite sponge had better performance than the pure PVA sponge by constructing a ternary system. Therefore, the results suggest that the PVA/HNTs/gelatin ternary composite sponge shows a wider application value as a potential material for repairing soft tissue.Highlights A composite PVA sponge with promising applications in tissue engineering. Simple preparation method, water solution mixing and casting techniques. Pioneering a PVA/HNTs/gelatin ternary system sponge. Improved water absorption ability and mechanical properties.

Vacuum-assisted closure therapy guided by C-reactive protein level in patients with deep sternal wound infection.

Development of antibacterial and superabsorbent wound composite sponges containing carboxymethyl cellulose/gelatin/Cu-doped ZnO nanoparticles

Hemorrhage is a leading cause of death from trauma. An advanced hemostatic dressing could augment available hemostatic methods. We studied the effects of a new chitosan dressing on blood loss, survival, and fluid use after severe hepatic injury in swine. Swine received chitosan dressings or gauze sponges. Standardized, severe liver injuries were induced. After 30 seconds, dressings were applied and resuscitation initiated. Blood loss, hemostasis, resuscitation volume, and 60-minute survival were quantified. Posttreatment blood loss was reduced ( p< 0.01) in the chitosan group (264 mL; 95% confidence interval [CI], 82-852 mL) compared with the gauze group (2,879 mL; 95% CI, 788-10,513 mL). Fluid use was reduced ( p= 0.03) in the chitosan group (1,793 mL; 95% CI, 749-4,291) compared with the gauze group (6,614 mL; 95% CI, 2,519-17,363 mL). Survival was seven of eight and two of even in the chitosan and gauze groups ( p= 0.04), respectively. Hemostasis was improved in the chitosan group ( p= 0.03). A chitosan dressing reduced hemorrhage and improved survival after severe liver injury in swine. Further studies are warranted.

Hydroxybutyl chitosan/diatom-biosilica composite sponge for hemorrhage control

Acute wounds exhibit complex diversity, necessitating immediate hemostasis and tailored wound care strategies. To address these challenges, we developed protein- and polysaccharide-based hydrogel and aerogel dressings designed to adapt to the therapeutic demands of diverse clinical injury scenarios. Herein, a double cross-linked hydrogel based on type B gelatin (Gel), oxidized konjac glucomannan (OKGM), and borax was synthesized. We also fabricated an oriented network-structured aerogel composed of silk fibroin (SF), xanthan gum (XG), and poly(vinyl alcohol) (PVA) by ice templating. It has been demonstrated that the Gel-OKGM-Borax hydrogel possessed adjustable self-healing capabilities, injectability, biodegradability, and microstructural and physicochemical attributes, showing its potential for treating deep and irregular wounds. The SF-XG-PVA aerogel (unidirectional freezing, -20 °C) exhibited favorable flexibility, rapid water absorption rate (achieving equilibrium within 112 s), and slower degradation rate, indicating its suitability for the treatment of superficial and flat wounds. When applied in a hemostatic ability assay, the Gel-OKGM-Borax hydrogel elicited a hemostatic effect (32.87 ± 2.51 mg, 88 ± 13 s, P < 0.05), compared with the SF-XG-PVA aerogel (79.02 ± 6.31 mg, 126 ± 11 s, P < 0.05) and gauze group (123.94 ± 20.62 mg, 173 ± 4 s, P < 0.05). Notably, the Gel-OKGM-Borax hydrogel and SF-XG-PVA aerogel possessed good biocompatible, anti-inflammatory properties, and can promote skin wound healing. Overall, this study highlights the potential of the Gel-OKGM-Borax hydrogel and SF-XG-PVA aerogel as promising biomaterials in wound management.