Blood Coagulation Indexes Research Articles

Optimization Preparation and Evaluation of Chitosan Grafted Norfloxacin as a Hemostatic Sponge.

Considering the great harm to the human body caused by severe and massive bleeding, in this study, chitosan-grafted norfloxacin (CTS-NF) composites were prepared with chitosan (CTS) and norfloxacin (NF) as raw materials by a 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide-mediated coupling method to solve the limitations of slow hemostatic and poor anti-infective effects of current dressings on the market. The effects of the mass ratio of CTS to NF (MCTS/MNF), reaction temperature T and reaction time t on the grafting rate (η%) of the products were investigated through single factor tests. The preparation process was optimized with the η% as an evaluation index by means of the Box-Behnken test design and response surface analysis. The antimicrobial activity was evaluated by inhibition zone assay, and the hemostatic activity of the prepared composites was evaluated in vitro and in vivo. The results suggested that the optimum preparation conditions were the mass ratio of CTS to NF (MCTS/MNF) 5:3, reaction temperature 65 °C, and reaction time 4 h. Under this condition, the η% of CTS-NF was 45.5%. The CTS-NF composites displayed significant antimicrobial activities. Moreover, in vitro hemostasis results revealed that the CTS-NF composite had a lower blood clotting index and absorbed red blood cells to promote aggregation. In vivo ear and live hemostasis, the CTS-NF groups showed short hemostatic time (49.75 ± 3.32 s and 50.00 ± 7.21 s) and more blood loss (0.07 ± 0.010 g and 0.075 ± 0.013 g). The results showed that CTS-NF reduced the bleeding time and volume, exhibiting a significant coagulation effect. Therefore, the CTS-NF sponge is expected to be a new, effective hemostatic and antibacterial material in the future.

Construction of porous structure-based carboxymethyl chitosan/ sodium alginate/ tea polyphenols for wound dressing

Polysaccharide-based materials with porous structure were selected as the basic skeleton to prepare a flexible and biodegradable wound dressing. The carboxymethyl chitosan/sodium alginate/tea polyphenols (CC/SA/TP) with a two-layer porous structure exhibits a variety of performances. The specific combined structure with ordered and lamellar porous structure was constructed by high-speed homogenized foaming, Ca2+ crosslinking and two-step freeze-drying methods. Moreover, the CC/SA/TP porous structure owns better shape retention and recovery because of the 3D network with an “egg-box” structure formed by impregnation. Tea polyphenols are efficiently encapsulated into a porous structure and released in a sustained pattern. After storing for 60 days, the CC/SA/TP porous structure still exhibits great suitable water vapor transmittance, efficient antibacterial activity and ultrarapid antioxidant activity. Meanwhile, the relatively low differential blood clotting index (BCI) and cytotoxicity of the CC/SA/TP porous structure indicate that it possesses the possibility of adjusting and controlling wound bleeding. The test results reveal that the CC/SA/TP porous structure might be expected to play a great potential role in biomedical applications of wound dressing.

Neutrophil-to-lymphocyte ratio (NLR) as a predictive index for liver and coagulation dysfunction in preeclampsia patients

BackgroundPre-eclampsia (PE) is a pregnancy disorder that is related to an enhanced immune response. Immune cell characteristics such as neutrophil or monocyte to lymphocyte ratios (NLR, MLR) are known to be related to kidney and liver dysfunction in hypertensive patients. Here, we aimed to analyze the correlations between NLR, MLR and platelet to lymphocyte ratio (PLR) and liver, renal and coagulation functional parameters and the impacts of these immune cell profiles to the prognostic significance in PE patients.MethodsPre-delivery hematological and biochemical parameters of 320 first-time pregnant women registered at the Obstetrics Department of Yanbian University Hospital from 2016 to 2019 were analyzed retrospectively. Patients were divided into normal pregnancy (normal, n = 161), mild PE (mPE, n = 28) and severe PE (sPE, n = 131) groups according to diagnostic criteria. Pearson correlation analysis were performed and area under the curve (AUC) were conducted for the diagnostic values of NLR, MLR and PLR. Results were validated with data from the Department of Obstetrics and Gynecology of Seoul National University Hospital (SNUH).ResultsKidney functional indexes were adversative in mPE and sPE and liver and coagulation indexes were worse in sPE compared to normal groups. Among immune cells, lymphocytes were increased in mPE and sPE patients, resulted in reduced NLR, MLR and PLR in PE groups, more significant difference were shown in sPE. NLR and PLR were associated with CREA and/or BUN negatively and positive associations were observed with total protein (TP) and albumin (ALB) in sPE. Only NLR showed positive associations with coagulation indexes (PT and APTT) in sPE. AUC analysis for NLR, MLR and PLR were 0.700, 0.656, 0.643, respectively, and NLR < 3.7 predicted hypertension (95% CI in all participants: 0.647–0.749, p < 0.001). Blood pressure, liver, kidney and coagulation indexes were worse at cut off value (NLR < 3.7), and this was validated with the data from SNUH.ConclusionNLR could be used as an independent predictor of liver and coagulation dysfunction in PE patients. Our results may provide non-invasive and efficient way of the risk assessment among PE patients.

Effect of surface structure on the antithrombogenicity performance of poly(-caprolactone)-cellulose acetate small-diameter tubular scaffolds

Small-diameter artificial blood vessels have always faced the problem of thrombosis. In this research, three types of poly(-caprolactone)-cellulose acetate (PCL-CA) composite nanofiber membranes were prepared by various collectors to make into a tubular scaffold with a 4.5-mm diameter. The collector consisted of two sizes of stainless steel wire mesh large-mesh (LM) and small-mesh (SM), respectively. There is also a random flat (RF) that acts as the third type collector. The nanofiber membrane's surface structure mimicked the collectors' surface morphology, they named LM, SM and RF scaffolds. The water contact angles of RF and LM scaffolds are 126.5° and 105.5°, and the distinct square-groove construction greatly improves the contact angle of LM. The tubular scaffolds' radial mechanical property test demonstrated that the large-mesh (LM) tubular scaffold enhanced the strain and tensile strength; the tensile strength and strain are 30 % and 148 % higher than that of the random-flat (RF) tubular scaffold, respectively. The suture retention strength value of the LM tubular scaffold was 103 % higher than that of the RF tubular scaffold. The cytotoxicity and antithrombogenicity performance were also evaluated, the LM tubular scaffold has 88 % cell viability, and the 5-min blood coagulation index (BCI) value was 89 %, which is much higher than other tubular scaffolds. The findings indicate that changing the tubular scaffold's surface morphology cannot only enhance the mechanical and hydrophilic properties but also increase cell survival and antithrombogenicity performance. Thus, the development of a small-diameter artificial blood vessel will be a big step toward solving the problem on thrombosis. Furthermore, artificial blood vessel is expected to be a candidate material for biomedical applications.

Hemostatic effect and safety evaluation of the absorbable macroporous polysaccharides composite hemostatic material prepared by a green fabrication approach.

Carboxymethyl chitosan is widely used in the medical field such as wound healing and other medical fields. We previously fabricated the absorbable macroporous polysaccharides composite hemostatics (AMPCs) mainly composed of carboxymethyl chitosan which possess excellent hemostatic effect. To further elucidate the impact of CMCTs on the hemostatic effect and biosafety of AMPCs, carboxymethyl chitosan with different properties were used to prepare AMPCs. By comparing the physical and chemical properties, AMPCs performed high water absorption ability, especially Group 1 (swelling ratio reached 5792%), which facilitated the rapid formation of blood clots. It was confirmed by blood clotting index (BCI) and blood coagulation tests in vitro that Group 1 showed a slightly higher coagulation capacity than groups 2 and 3, which may be due to the positive charge on the surface of the cations in the salts attaches to the negative charge on the surface of the red blood cells, an electrostatic neutralization reaction occurs. The biosafety was a preliminary evaluation by implanted AMPCs into the back of Sprague-Dawley rats and the tissue was harvested after feeding for 28days. The AMPCs exhibited good biosafety for whole blood and major organs during the degradation in vivo: during the degradation of AMPCs, excluding changes in some serum indicators, no tissue necrosis or inflammatory cell infiltration was observed in these organs, either by gross observation or histological analysis. These findings demonstrate that expecting to develop a highly functional and safe hemostatic agent based on Group 1 for rapid hemostasis applications in emergencies.

A calcium and zinc composite alginate hydrogel for pre-hospital hemostasis and wound care

We developed, characterized, and examined the hemostatic potential of sodium alginate-based Ca2+ and Zn2+ composite hydrogel (SA-CZ). SA-CZ hydrogel showed substantial in-vitro efficacy, as observed by the significant reduction in coagulation time with better blood coagulation index (BCI) and no evident hemolysis in human blood. SA-CZ significantly reduced bleeding time (≈60 %) and mean blood loss (≈65 %) in the tail bleeding and liver incision in the mice hemorrhage model (p ≤ 0.001). SA-CZ also showed enhanced cellular migration (1.58-fold) in-vitro and improved wound closure (≈70 %) as compared with betadine (≈38 %) and saline (≈34 %) at the 7th-day post-wound creation in-vivo (p < 0.005). Subcutaneous implantation and intra-venous gamma-scintigraphy of hydrogel revealed ample body clearance and non-considerable accumulation in any vital organ, proving its non-thromboembolic nature. Overall, SA-CZ showed good biocompatibility along with efficient hemostasis and wound healing qualities, making it suitable as a safe and effective aid for bleeding wounds.

Graphene oxide reinforced hemostasis of gelatin sponge in noncompressible hemorrhage via synergistic effects

Effective hemostasis for noncompressible bleeding has been a key challenge because of the deep, narrow, and irregular wounds. Swellable gelatin is an available hemostatic material but is limited by weak mechanical strength and slow liquid absorption. Herein, the design of a gelatin and graphene oxide (GO) composite sponge (GP-GO) that possesses stable cross-linked networks and excellent absorbability, is reported. The GP-GOs are constructed via the thermal radical polymerization technique, using methacrylate gelatin (Gel-MA) and poly(ethylene glycol) diacrylate (PEGDA) as the crosslinker, while GO is uniformly fixed in the network via the curing reaction to further strengthen the stability. The optimized GP-GO5 with GO addition (5 wt%) exhibits high porosity (> 90%), distinguished liquid absorption rate (106 ms), rapidly responsive swelling (422% expansion within 10 s), and stable mechanical properties. The addition of GO effectively reinforces coagulation stimulation of GP-GOs though the stimulation of platelets and the enrichment effect at the interface, significantly reducing the blood coagulation index (BCI) (< 17.5%). Hemostatic mechanism study indicated the liquid absorbability of GP-GOs is the critical foundation to trigger the subsequent physical expansion, blood cells enrichment, and coagulation stimulations. Besides, GP-GO5 exhibits excellent biosafety assessed by hemolysis and cytotoxicity. Under the synergistic effects, the biocompatible GP-GO5 showed excellent hemostatic properties in the hemostasis of severe bleeding and noncompressible wounds compared with a pure gelatin sponge (GP) and the commercial hemostatic agent Celox™. This study demonstrated a promising candidate for practical application of noncompressible wound hemostasis.

A Biodegradable Flexible Micro/Nano-Structured Porous Hemostatic Dental Sponge.

A biodegradable micro/nano-structured porous hemostatic gelatin-based sponge as a dentistry surgery foam was prepared using a freeze-drying method. In vitro function evaluation tests were performed to ensure its hemostatic effect. Biocompatibility tests were also performed to show the compatibility of the sponge on human fetal foreskin fibroblasts (HFFF2) cells and red blood cells (RBCs). Then, 10 patients who required the extraction of two teeth were selected, and after teeth extraction, for dressing, the produced sponge was placed in one of the extracavities while a commercial sponge was placed in the cavity in the other tooth as a control. The total weight of the absorbed blood in each group was compared. The results showed a porous structure with micrometric and nanometric pores, flexibility, a two-week range for degradation, and an ability to absorb blood 35 times its weight in vitro. The prepared sponge showed lower blood clotting times (BCTs) (243.33 ± 2.35 s) and a lower blood clotting index (BCI) (10.67 ± 0.004%) compared to two commercial sponges that displayed its ability for faster coagulation and good hemostatic function. It also had no toxic effects on the HFFF2 cells and RBCs. The clinical assessment showed a better ability of blood absorption for the produced sponge (p-value = 0.0015). The sponge is recommended for use in dental surgeries because of its outstanding abilities.

Nitrogen Doped Carbon-Dot Embedded Poly(lactic acid-co-glycolic acid) Composite Films for Potential Use in Food Packing Industry and Wound Dressing

Here, nitrogen-doped carbon dots (N-doped CDs) were synthesized by the hydrothermal method embedded within poly(lactic acid-co-glycolic acid) ((PLGA)) films at different amounts. The N-doped CDs (or CD) that possess fluorescence properties also have antimicrobial properties against S. aureus and E. coli microorganisms, determined by the disc diffusion method with 19 ± 2 and 18 ± 1 mm zone diameters, respectively. The CD embedded PLGA films (CD@PLGA) with different CD contents revealed an increased fluorescence intensity with the increased amount of CD. Moreover, the antibacterial potency of 50% CD containing PLGA (50-CD@PLGA) films (by weight) against S. aureus and E. coli microorganisms was examined and the zone diameters were found to be 14 ± 1 and 13 ± 1 mm, respectively. In addition, CD release studies from different amounts of CD (2.5–50 by weight) containing composite films showed that 50-CD@PLGA film released 127 ± 16 mg/g CD dots, which is 38 ± 5% of the embedded CDs in about 12 days, suggesting their potential application in food packing and wound dressing. Moreover, all CD@PLGA films were found to be blood compatible via hemolysis and blood clotting index tests with &lt;5% hemolysis and &gt;90% blood clotting indices regardless of their CD content.

Porous photothermal antibacterial antioxidant dual–crosslinked cryogel based on hyaluronic acid/ polydopamine for non-compressible hemostasis and infectious wound repair

• A series of antioxidant and photothermal antibacterial dual–crosslinked cryogels was designed. • The cryogels showed stable mechanical property and biocompatibility. • These cryogels rapidly stopped irregularly shaped and non-compressible bleeding. • The cryogels significantly improved the MRSA-infected full-thickness skin defect wound healing. Cryogel dressings with good absorption ability and photothermal antibacterial properties for preventing wound infections and treating infected wounds have attracted widespread attention. In this work, a series of cryogels with macroporous structure, antioxidant and photothermal properties were prepared based on adipic dihydrazide modified hyaluronic acid (HA-ADH), and dopamine (DA). The antioxidant properties, hemostatic properties, near infrared (NIR) assisted photothermal antibacterial ability provided by polydopamine, recyclable compression mechanical properties, and cytocompatibility were tested. The results demonstrated that the HA-ADH/DA cryogels have stable mechanical properties, great antibacterial properties against E. coli (EC) and methicillin-resistant S. aureus (MRSA). The high swelling ratio due to the high water retention of HA equipped the cryogels with the capability of absorbing exuded blood and excessive tissue fluid in the infected full-thickness skin defect model of mouse. The cryogels demonstrated good cytocompatibility and antioxidant performance through cell tests and 1, 1-diphenyl-2-methylbenzohydrazino (DPPH) scavenging efficiency test. The cryogels showed enhanced blood-clotting index (BCI) and better hemostatic ability in the mouse liver trauma model and the rat deep non-compressible liver defect model compared with gauze and gelatin sponge. Furthermore, compared with commercial Tegaderm TM dressing in vivo , the HA-ADH/DA cryogels could greatly promote infected skin wound healing in a full-thickness infected skin defect wound model. In summary, the macroporous HA-ADH/DA cryogels with good antioxidant, high swelling ratio, photothermal antibacterial property, and biocompatibility are a promising hemostatic material and wound healing dressing.

Optimization of Oligomer Chitosan/Polyvinylpyrrolidone Coating for Enhancing Antibacterial, Hemostatic Effects and Biocompatibility of Nanofibrous Wound Dressing.

A synergistic multilayer membrane design is necessary to satisfy a multitude of requirements of an ideal wound dressing. In this study, trilayer dressings with asymmetric wettability, composed of electrospun polycaprolactone (PCL) base membranes coated with oligomer chitosan (COS) in various concentrations of polyvinylpyrrolidone (PVP), are fabricated for wound dressing application. The membranes are expected to synergize the hygroscopic, antibacterial, hemostatic, and biocompatible properties of PCL and COS. The wound dressing was coated by spraying the solution of 3% COS and 6% PVP on the PCL base membrane (PVP6–3) three times, which shows good interaction with biological subjects, including bacterial strains and blood components. PVP6–3 samples confirm the diameter of inhibition zones of 20.0 ± 2.5 and 17.9 ± 2.5 mm against Pseudomonas aeruginosa and Staphylococcus aureus, respectively. The membrane induces hemostasis with a blood clotting index of 74% after 5 min of contact. In the mice model, wounds treated with PVP6–3 closed 95% of the area after 10 days. Histological study determines the progression of skin regeneration with the construction of granulation tissue, new vascular systems, and hair follicles. Furthermore, the newly-growth skin shares structural resemblances to that of native tissue. This study suggests a simple approach to a multi-purpose wound dressing for clinical treatment.

Efficacy and safety of transjugular intrahepatic portosystemic shunt for the treatment of schistosomiasis-induced portal hypertension: a retrospective case series.

The aim of this study was to evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension caused by schistosomiasis. This study included 43 patients with schistosomiasis-induced portal hypertension treated with TIPS in our institution from December 2015 to May 2021. The demographic, imaging, clinical and follow-up data of patients were recorded retrospectively to evaluate the efficacy and safety of the procedure. All patients were successfully implanted with stents to establish shunt, and 90.7% of the patients were in good postoperative condition with no complications. After TIPS, the Yerdel grade of portal vein thrombosis decreased, and the portal pressure gradient decreased from 27.0 ± 4.9 mmHg to 11.3 ± 3.8 mmHg (P < 0.001). Bleeding was effectively controlled, with a postoperative rebleeding rate of 9.3%, which was an 87.9% reduction from the preoperative rate. The cumulative incidence of postoperative refractory ascites, shunt dysfunction, overt hepatic encephalopathy (OHE) and death were all similar to those of TIPS for nonschistosomiasis portal hypertension. There were no differences in liver and kidney function and blood coagulation indexes before and 3 months after TIPS. Albumin was identified as an independent risk factor for mortality after TIPS for schistosomal liver fibrosis. TIPS can be used as a well-tolerated and effective treatment for schistosomiasis-induced portal hypertension, effectively reduce portal pressure gradient and improve portal vein thrombosis.

"Jianbing" styling multifunctional electrospinning composite membranes for wound healing.

Wound infection and excessive exudate can affect the process of wound healing. However, the disadvantage of the anti-microbial wound dressings is that the biological fluids are ineffectively removed. Inspired by making “Chinese Jianbing”, a composite wound nano-dressing was developed consisting of a hydrophilic outer layer (chitosan&polyvinyl alcohol: CTS-PVA) and a hydrophobic inner layer (propolis&polycaprolactone: PRO-PCL) by combining casting and electrospinning methods for effective antibacterial and unidirectional removing excess biofluids. In vitro, the composite wound nano-dressing of PRO-PCL and CTS-PVA (PPCP) could strongly inhibit Pseudomonas aeruginosa. Furthermore, PPCP wound dressing had excellent antioxidant properties and blood coagulation index for effective hemostatic. Importantly, it had a preferable water absorption for removing excess biofluid. In vivo, it had anti-inflammatory properties and promoted collagen Ⅰ preparation, which realized 80% wound healing on day 7. In short, the PPCP wound dressing provides a new direction and option for antibacterial and removes excess biofluid.

Effects of CDT on Hemodynamics and Quality of Life in a Subgroup of Patients with Lower Limb Deep Vein Thrombosis Carel: A Case-Control Study.

Objective To explore the effects of combined catheter-directed thrombolysis (CDT) on hemodynamics and quality of life in a subgroup of patients with lower limb deep vein thrombosis carel by using a case-control study. Methods Eighty-four patients with deep venous thrombosis (DVT: acute DVT and chronic DVT) of lower extremities treated in our hospital from April 2017 to June 2021 were randomly assigned into the control group (n = 42) and the research group (n = 42). The control group only received routine nursing combined with CDT; the research group was treated with cluster nursing l combined with CDT. The clinical efficacy, the difference in limb circumference, hemorheology, hemodynamics, coagulation index and life quality before and after treatment, and the nursing satisfaction scores were calculated. The effects of cluster nursing l combined with CDT on hemodynamics and life quality in patients with DVT of lower extremities were analyzed. Results The clinical curative effect of the research group was better than that of the control group (P < 0.05). After intervention, the difference in the thigh and leg perimeter in the research group was reduced, and the difference in the thigh and leg perimeter in the research group was significantly lower than that in the control group (P < 0.05). After intervention, the whole blood low shear viscosity, plasma viscosity, platelet aggregation rate, and fibrinogen in the research group were lower than those in the control group (P < 0.05). After intervention, segmental venous volume (SVC), maximum venous blood flow (MVO), and SVC/MVO in the research group were significantly higher than those before intervention, VRT was significantly prolonged, and MVO and venous pressure recovery time (VRT) were significantly higher than those in the control group. After intervention, D-dimer and fibrinogen decreased, prothrombin time and activated partial thromboplastin time increased in the research group, and the improvement of blood coagulation index in the research group was significantly better than that in the control group (P < 0.05). After intervention, the scores of quality of life in the research group decreased, and the scores of physiological function, psychological function, social function, and health self-cognition in the research group were lower than those in the control group (P < 0.05). The satisfaction of patients in the research group was significantly higher than that in the control group (P < 0.05). Conclusion The application of cluster nursing l combined with CDT can effectively prevent lower limb venous thrombosis after operation and can enhance patients' hemorheology, hemodynamics, and blood coagulation function and significantly promote their life quality, nursing satisfaction is high, and it is worth popularizing and applying in clinic.

Preparation and property of soluble hemostatic material with 3D knitted structure

To solve the problems of low mechanical properties and poor coagulation effect of soluble hemostatic dressings, a new type of soluble hemostatic fabric with three-dimensional knitted structure is proposed in this paper. Three-dimensional knitted fabrics had good extension and porous structure. This three-dimensional soluble knitted fabric can be used for skin wounds clotting and healing. This paper mainly studied the influence of structural thickness on the performance of three-dimensional knitted dressings. Characterization analysis showed that three-dimensional knitted soluble hemostatic dressings had appropriate porosity and water vapor transmission rate (WVTR), and the fabric with the maximum thickness had good elongation (70.04%) and a very low blood clotting index (BCI) (11.18%). This suggests the potential application for soluble three-dimensional knitted structure fabric on skin wound hemostasis.

Superporous poly(β-Cyclodextrin) cryogels as promising materials for simultaneous delivery of both hydrophilic and hydrophobic drugs

Here, one step, simple preparation of superporous p(β-cyclodextrin) (p(β-CD)) cryogels in the presence of various ratios of crosslinker, divinyl sulfone (DVS) e.g., 100, 150, 200% mole with respect to the mole ratio of 6 hydroxyl groups on β-CD unit under cryogenic conditions were reported for the first time. The swelling properties, and hydrolytic degradation of p(β-CD) cryogels was directly related to the used crosslinker ratio. It was observed that the p(β-CD) cryogels showed higher swelling% in DMSO and DMF than in DI water. The prepared p(β-CD)-1 cryogel that was 100% crosslinked exhibited 14 ± 3.7%, 34 ± 4.8%, and 45 ± 6.2% weight losses within 20 days in pH 5.4, 7.4, and 9.0 buffer solutions, respectively. An acceptable hemolysis index of < 5% and a blood coagulation index, >89% were observed for the p(β-CD) cryogels at 1 mg/mL concentrations. Additionally, the potential useability of p(β-CD) cryogels as in vitro drug delivery systems for both hydrophilic vancomycin, and hydrophobic tetracycline as model drugs were individually illustrated at pH 7.4 in PBS. The cumulative drug release from p(β-CD) cryogels, in sustained release profiles with 76.7 ± 9.0 mg/g of vancomycin (89.9 ± 10.5% of the loaded amount) and 146.5 ± 19.4 mg/g tetracycline g (83.1 ± 6.3% of the loaded amount) were attained in 6 and 54 h, respectively at pH 7.4 in PBS. Most importantly, p(β-CD) cryogels exhibited simultaneous loading and releasing the ability for both hydrophilic vancomycin, and hydrophobic tetracycline drugs by concurrently releasing 37.0 ± 2.7 mg/g (23.4 ± 1.8% of the loaded amount), and 36.3 ± 1.3 mg/g (23.6 ± 0.8% of the loaded amount), respectively at pH 7.4 (PBS) in 10 h.

Biocompatible Hemostatic Sponge Exhibiting Broad-Spectrum Antibacterial Activity.

Hemorrhage during accidents or surgery is a significant challenge that can contribute to mortality. This is further aggravated due to bacterial infections at the injured site. Therefore, rapid application of a hemostatic and antibacterial material is highly necessary as a pretreatment for patients' survival. Herein, we have developed a hemostatic sponge (Hemobac) through amide crosslinking of gelatin and an N-(2-hydroxy) propyl-3-trimethylammonium chitosan (HTCC)-silver chloride nanocomposite (QAm1-Ag0.1) to mitigate bacterial infections, while aiding hemostasis. This Hemobac sponge completely eradicated (∼4-5 log) a wide range of Gram-positive and Gram-negative bacteria encompassing various clinical isolates within 6 h. The antihemorrhagic ability of Hemobac was ascertained through SEM images, which exhibited the presence of agglomerated blood cells onto the sponge with a significantly low blood-clotting index value (∼23 ± 1). Notably, Hemobac reduced the blood loss by ∼70-80% in the liver puncture model and femoral vein injury model in mice, displaying its improved hemostatic ability over a marketed gelatin-based sponge. Negligible hemolytic activity (∼6%) and retained healthy morphology of mammalian cells were observed upon exposure to the Hemobac sponge. Minimal immune response was noticed at the Hemobac-treated wound in mice through histopathology analysis. Collectively, these findings indicate that this biocompatible Hemobac sponge can stop the bleeding instantaneously and combat bacterial infections.

A Bionic Self-Assembly Hydrogel Constructed by Peptides With Favorable Biosecurity, Rapid Hemostasis and Antibacterial Property for Wound Healing.

Bionic self-assembly hydrogel derived by peptide as an effective biomedical hemostatic agent has always gained great attention. However, developing hydrogels with eminent-biosecurity, rapidly hemostatic and bactericidal function remains a critical challenge. Hence, we designed an injectable hydrogel with hemostatic and bactericidal function based on Bionic Self-Assembling Peptide (BSAP) in this study. BSAP was formed with two functionalized peptides containing (RADA)4 motif and possessed the ability to self-assemble into nanofibers. As expected, BSAP could rapidly co-assemble into hydrogel network structure in situ driven by Ca2+. The hydrogel with a concentration of 5% showed a superior microporous structure and excellent shear thinning characteristics, as well as injectability. Moreover, in the foot trauma model and tail amputation model, the fabricated hydrogel exhibited a lower blood clotting index and dramatically reduced blood clotting time and bleeding volume. Remarkably, the hydrogel reduced inflammatory responses by blocking bacterial infection, promoting wound healing. Finally, the hydrogel is highly hemocompatible and has no cytotoxicity. Overall, this work provides a strategy for developing a high-biosecurity hydrogel with hemostatic and antibacterial properties, which will allow for the clinical application of BSAP.

Effect Analysis of Preoperative Intravenous Tranexamic Acid Combined With Intraoperative Immersion in Reducing Perioperative Blood Loss of One Stage Posterior Thoracolumbar Tuberculosis.

BackgroundTo investigate the efficacy and safety of preoperative intravenous tranexamic acid (TXA) combined with intraoperative immersion in reducing perioperative blood loss in one-stage posterior thoracolumbar tuberculosis.MethodsAll patients were divided into four groups: Group A received an intravenous drip of TXA before surgery, group B received multiple local immersions during the operation, group C received an intravenous drip combined with multiple local immersions, and the control group (group CG) were not treated with TXA during the same period. The total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), postoperative drainage volume, maximum hemoglobin drop value (max Hb drop), liver and kidney function, coagulation indexes, blood transfusion rate, hospital stay and incidence of complications were compared among the four groups.ResultsTBL, IBL, HBL, max Hb drop, POD1 drainage, and POD2 drainage in group A, group B, and group C were significantly lower than those in group CG. TBL, IBL, HBL and max Hb drop were group C < group A < group B < group CG. The drainage volume of group C was significantly lower than that of the other groups. There was no significant difference in blood coagulation index (PT, D-D) or liver and kidney function (ALT, Cr) among the four groups. There was no difference in postoperative hospital stay between group A and group B, but it was significantly lower in group C than in the other three groups. All patients achieved satisfactory bone graft fusion at the last follow-up.ConclusionPreoperative intravenous drip of TXA combined with intraoperative multiple immersion can effectively reduce perioperative blood loss while not increasing the risk of thrombosis without affecting liver and kidney function, coagulation function or tuberculosis prognosis.

Clinical effectiveness of Qilong capsule in patients with ischemic stroke: A prospective, multicenter, non-randomized controlled trial

BackgroundThe Qilong capsule (QLC) is a Chinese patented medicine characterized by an equal emphasis on replenishing Qi and activating blood circulation. In 2000, China's FDA approved the use of QLC for ischemic stroke (IS). However, there is not yet much high-quality evidence of the clinical effectiveness of QLC combined with conventional treatment (CT) for IS with Qi deficiency and blood stasis syndrome. PurposeIn this study, we conducted a prospective, multicenter, non-randomized controlled trial at 7 hospitals in China to investigate the clinical effectiveness of QLC combined with CT for IS with Qi deficiency and blood stasis syndrome. MethodsParticipants aged 35 to 80 years old diagnosed as IS with Qi deficiency and blood stasis syndrome in TCM were recruited. Participants were treated with QLC (intervention group) or non-QLC (control group). The intervention course of QLC was 12 weeks. All participants in two groups received standard treatment. All participants returned for in-person follow-up visits at the 12th week and 24th week. Primary outcome measures included a modified Rankin Scale (mRS), the National Institute of Health Stroke Scale (NIHSS), and the Barthel Index (BI). Secondary outcome measures included TCM syndromes (Qi deficiency syndrome score, blood stasis syndrome score), psychological index (self-rating depression scale, SDS; self-rating anxiety scale, SAS), blood lipid index, blood coagulation index, homocysteine, and favorable functional outcome (mRS 0 – 3). Multiple imputations were used for any missing data. Propensity score matching (PSM) was used to deal with any confounding factors (age, gender, scale score, etc.). Rank alignment transformation variance analysis (ART ANOVA) and generalized linear mixed model (GLMM) were introduced to improve the scientific and accuracy of repeated measurement data. All statistical calculations were carried out with R 3.6.1 statistical analysis software. ResultsA total of 2468 participants were screened from November 2016 to January 2019. Finally, 2302 eligible participants were included in the analysis. There were 1260 participants in the intervention group (QLC group) and 1042 participants in the control group (non-QLC group). After PSM matching, sub-samples of 300 participants in the QLC group and 300 participants in the non-QLC group were finally formed. The final results of clinical effectiveness are the same results shared by the total samples and sub-samples after PSM. In the 24th week after treatment, QLC combined with CT proved to be significantly better than CT alone in reducing the scores of mRS (p < 0.05), NIHSS (p < 0.001), Qi deficiency syndrome (p < 0.01), and blood stasis syndrome (p < 0.001), SAS (p < 0.05), as well as in improving BI score (p < 0.05). The favourable functional outcome (mRS score of 0 to 3 at week 12) was statistically different between QLC and non-QLC group in the sub-samples (p < 0.01, 97% vs 91.7%). The results of the ART ANOVA showed that the improvement of mRS (p < 0.01), BI (p < 0.05) and NIHSS (p < 0.001) in QLC group was better than non-QLC group when the interaction effect was considered. The results of GLMM showed that the reduction of mRS and NIHSS scores of patients in the QLC group were better than those of the non-QLC group (p < 0.001). The BI score of the QLC group in the sub-samples after PSM increased more than the non-QLC group (p < 0.001). There was no evidence showing that QLC can cause serious adverse reactions (ADRs) in treating patients with IS. ConclusionQLC combined with CT was better than CT alone in reducing mRS score, NIHSS score, Qi deficiency syndrome score, blood stasis syndrome score, and SAS score, as well as improving BI score after treatment. Further high-quality RCTs are needed to confirm the positive results. The study protocol was embedded in a registry study that registered in the Clinical Trials USA Registry (registration No. NCT03174535).