Effective Control Of Bleeding Research Articles

Major Orthopaedic Surgery in Persons with Haemophilia A with and without Inhibitors Treated by Emicizumab: A Mid-Term, Large, and Successful Series at a Single Center.

Introduction: Patients with Haemophilia (PWH) need orthopaedic treatments and often they undergo surgery. Classically, PWH with inhibitors have to face such procedures earlier than other patients. Major orthopaedic surgery is not easy and complications are frequent. Emicizumab is the first monoclonal antibody introduced for haematological prophylaxis for PWH with inhibitors, achieving an efficacious haemostasis also in patients with severe haemophilia A with inhibitors, later demonstrated for PWH without inhibitors. A few years ago, emicizumab was also proposed for PWH undergoing surgery, as it supports excellent bleeding control. The literature on orthopaedic surgery using an emicizumab protocol is scarce: only isolated case reports with short-term follow-ups are available. Aim: The purpose of this study is the assessment of the mid-term outcomes of major orthopaedic surgery performed in a population of patients with and without inhibitors and an emicizumab regimen. Methods: We reviewed the records of 13 PWH (eight with high-titre inhibitors, five without) with a mean age of 54.6 years, undergoing 15 orthopaedic surgical procedures between 2017 and 2022: primary knee and hip arthroplasty, revision, pseudotumor excision, or amputation. Their prophylaxis consisted of the combination of emicizumab and boluses of rFVIIa (PWH with inhibitors) or rFVIII (PWH without inhibitors). The clinical parameters of evaluation were: VAS, Haemophilic Joint Health Score (HJHS), and standard radiologic studies. Follow-up was conducted at 1, 3, 6 months, and then yearly. The survival rate of all implants was also assessed. Results: The mean follow-up was 38.8 months (range: 12-65). All patients were successfully treated without complications during surgery. During the postoperative period, a patient affected by a septic complication two months after his pseudotumor excision underwent an above-the-knee amputation. All patients were regularly discharged to the rehabilitative ward, reporting satisfaction for pain reduction and improved joint and global function at the VAS and HJHS scores. No revisions or implant failures were recorded. Conclusions: A prophylaxis regimen with emicizumab and factor replacement in PWH with or without inhibitors undergoing major orthopaedic surgery ensures effective bleeding control and good postoperative clinical outcomes at mid-term follow-up, and may be routinely adopted in dedicated high-volume hospitals. This series is the most consistent to date reported at a single Haemophilia centre.

Nanofibrous chitin/Andrias davidianus skin secretion bioactive sponges with tunable biodegradation rates for bleeding wounds treatment

Shape-memory sponges offer unique prospects for the treatment of uncontrollable bleeding. However, the development of mechanically robust and bioactive shape-memory hemostatic sponges capable of addressing diverse wound scenarios, including noncompressible hemorrhages and bone bleeding, remains a challenge. Herein, a shape-memory nanofibrous sponge composed of chitin (Chn) nanofibers and a bioactive material of skin secretion of Andrias davidianus (SSAD) is fabricated for effective hemorrhage control. The obtained Chn/SSAD sponge exhibits a series of coveted properties, such as tunable biodegradation rate, high water/blood absorption capacity, rapid shape recovery, as well as procoagulant, antibacterial and pro-osteogenesis abilities. The biomedical efficacy of the Chn/SSAD sponges was assessed in vivo using rat models of liver-perforation hemorrhage and alveolar bone defect. This innovative shape-memory Chn/SSAD sponge shows great promise in addressing diverse wound conditions.

Postoperative nausea and vomiting in orthognathic surgery: systematic review and meta-analysis.

Postoperative nausea and vomiting (PONV) is a frequently reported adverse event following orthognathic surgery. The aim of this work is to conduct a systematic review of the literature on the subject, and to discuss the role of maxillofacial surgeons and the steps that can be taken to prevent or control PONV in orthognathic surgery. A systematic review was conducted according to the PRISMA guidelines, using the search strategy: (orthognathic AND (nausea OR vomiting)). The authors searched PubMed, Embase, Dimensions, Web of Science and Google Scholar databases, without any language restrictions. RevMan 5.4 was used to create a risk of bias graph and a forest plot. The included articles were classified as having a low risk of bias, despite the limited literature on the subject. Various measures have been reported to be beneficial in preventing or managing PONV, such as the use of dexamethasone, antiemetic drugs, gastric aspiration, and anesthetic blocks. Effective bleeding control and faster surgeries can also be helpful. Throat packs have not been found to be effective in preventing PONV. Although no definitive protocol has been established in the literature, the Enhanced Recovery After Surgery (ERAS) protocol could be a useful approach. Overall, a multimodal approach may be taken to prevent PONV, and further research is needed to establish definitive protocols.

An injectable and coagulation-independent Tetra-PEG hydrogel bioadhesive for post-extraction hemostasis and alveolar bone regeneration

Effective control of post-extraction hemorrhage and alveolar bone resorption is critical for successful extraction socket treatment, which remains an unmet clinical challenge. Herein, an injectable Tetra-PEG hydrogel that possesses rapid gelation, firm tissue adhesion, high mechanical strength, suitable degradability, and excellent biocompatibility is developed as a sutureless and coagulation-independent bioadhesive for the management of extraction sockets. Our results demonstrate that the rapid and robust adhesive sealing of the extraction socket by the Tetra-PEG hydrogel can provide reliable protection for the underlying wound and stabilize blood clots to facilitate tissue healing. In vivo experiments using an anticoagulated rat tooth extraction model show that the hydrogel significantly outperformed clinically used cotton and gelatin sponge in hemostatic efficacy, wound closure, alveolar ridge preservation, and in situ alveolar bone regeneration. Histomorphological evaluations reveal the mechanisms for accelerated bone repair through suppressed long-term inflammation, elevated collagen deposition, higher osteoblast activity, and enhanced angiogenesis. Together, our study highlights the clinical potential of the developed injectable Tetra-PEG hydrogel for treating anticoagulant-related post-extraction hemorrhage and improving socket healing.

MXene-NH2/chitosan hemostatic sponges for rapid wound healing

Effective control of wound bleeding and sustained promotion of wound healing remain a major challenge for hemostatic materials. In this study, the hemostatic sponge with controllable antibacterial and adjustable continuous promotion of wound healing (CMNCu) was prepared by chitosan, aminated MXene and copper ion. Interestingly, the internal topological point-line-surface interaction endowed the CMN-Cu sponge longitudinal staggered tubular porous microstructure, combined with the lipophilic properties obtained by modified MXene, which greatly improved its flexibility, wet elasticity and blood enrichment capacity. In addition, the sponge achieved controlled release of active ingredients, which made it present highly effective antibacterial activity and long-lasting ability to promote wound healing. In vitro and in vivo experiments confirmed that CMN-Cu sponge presented high-efficient hemostatic performance. Last but not least, a series of cell experiments showed that the CMN-Cu sponge had excellent safety as a hemostatic material.

Superwettable calcium ion exchanged carboxymethyl cellulose powder with self-gelation, tissue adhesion and bioabsorption for effective hemorrhage control

Water-soluble polymers can be used to develop self-gelling hemostatic powders, and powder wettability potentially plays the key role in determining their hemostatic efficacy. Herein, a superwettable calcium ion exchanged carboxymethyl cellulose (Ca-ex-CMC) powder is reported for effective hemorrhage control. Despite being water-soluble, Ca-ex-CMC powder can form a physically crosslinked hydrogel upon contact with water (self-gelation), and the rate of water permeating the hydrogel to achieve dissolution is extremely slow. With increased calcium content, Ca-ex-CMC powder shows not only improved procoagulant activity, but enhanced wettability which can facilitate the fusion of the powders with water, resulting in promoted water uptake and in-situ formation of strong hydrogel barriers with enhanced tissue adhesion. Applying Ca-ex-CMC powder to non-compressible (liver and tail) and massive (artery) hemorrhage wounds in rat and rabbit models can stanch bleeding instantly, because of complete sealing of the bleeding sites by enhanced in-situ self-gelation. Moreover, owing to water-solubility, Ca-ex-CMC powder shows outstanding bioabsorbability and histocompatibility after implantation into rabbit liver and gluteus. These findings not only support Ca-ex-CMC powder as a promising hemostatic agent for extensive application but identify the critical role of wettability in promoting hemostasis for self-gelling powders.

Determinants of 30-day mortality in elderly patients admitted to a cardiovascular surgery intensive care unit.

This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery. Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed. Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05). By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.

A Self-Assembly Pro-Coagulant Powder Capable of Rapid Gelling Transformation and Wet Adhesion for the Efficient Control of Non-Compressible Hemorrhage.

Rapid and effective control of non-compressible massive hemorrhage poses a great challenge in first-aid and clinical settings. Herein, a biopolymer-based powder is developed for the control of non-compressible hemorrhage. The powder is designed to facilitate rapid hemostasis by its excellent hydrophilicity, great specific surface area, and adaptability to the shape of wound, enabling it to rapidly absorb fluid from the wound. Specifically, the powder can undergo sequential cross-linking based on "click" chemistry and Schiff base reaction upon contact with the blood, leading to rapid self-gelling. It also exhibits robust tissue adhesion through covalent/non-covalent interactions with the tissues (adhesive strength: 89.57±6.62KPa, which is 3.75 times that of fibrin glue). Collectively, this material leverages the fortes of powder and hydrogel. Experiments with animal models for severe bleeding have shown that it can reduce the blood loss by 48.9%. Studies on the hemostatic mechanism also revealed that, apart from its physical sealing effect, the powder can enhance blood cell adhesion, capture fibrinogen, and synergistically induce the formation of fibrin networks. Taken together, this hemostatic powder has the advantages for convenient preparation, sprayable use, and reliable hemostatic effect, conferring it with a great potential for the control of non-compressible hemorrhage.

Ruggedized Self-Propelling Hemostatic Gauze Delivers Low Dose of Thrombin and Systemic Tranexamic Acid and Achieves High Survival in Swine With Junctional Hemorrhage.

Hemorrhage is responsible for 91% of preventable prehospital deaths in combat. Bleeding from anatomic junctions such as the groin, neck, and axillae make up 19% of these deaths, and reports estimate that effective control of junctional hemorrhage could have prevented 5% of fatalities in Afghanistan. Hemostatic dressings are effective but are time-consuming to apply and are limited when proper packing and manual pressure are not feasible, such as during care under fire. CounterFlow-Gauze is a hemostatic dressing that is effective without compression and delivers thrombin and tranexamic acid into wounds. Here, an advanced prototype of CounterFlow-Gauze, containing a range of low thrombin doses, was tested in a lethal swine model of junctional hemorrhage. Outcomes were compared with those of Combat Gauze, the current dressing recommended by Tactical Combat Casualty Care. CounterFlow-Gauze containing thrombin doses of 0, 20, 200, and 500 IU was prepared. Swine received femoral arteriotomies, and CounterFlow-Gauze was packed into wounds without additional manual compression. In a separate study using a similar model of junctional hemorrhage without additional compression, CounterFlow-Gauze containing 500 IU thrombin was tested and compared with Combat Gauze. In both studies, the primary outcomes were survival to 3 h and volume of blood loss. CounterFlow-Gauze with 200 and 500 IU had the highest 3-h survival, achieving 70 and 75% survival, respectively. CounterFlow-Gauze resulted in mean peak plasma tranexamic acid concentrations of 9.6 ± 1.0 µg/mL (mean ± SEM) within 3 h. In a separate study with smaller injury, CounterFlow-Gauze with 500 IU achieved 100% survival to 3 h compared with 92% in Combat Gauze animals. An advanced preclinical prototype of CounterFlow-Gauze formulated with a minimized thrombin dose is highly effective at managing junctional hemorrhage without compression. These results demonstrate that CounterFlow-Gauze could be developed into a feasible alternative to Combat Gauze for hemorrhage control on the battlefield.

Finding the Right Balance: Partial REBOA in a Swine Model of Uncontrolled Vascular Injury.

We have previously shown that partial REBOA (pREBOA) deployment in the thoracic aorta is safe for 2 to 4 hours, but it is unclear whether the distal blood flow after partial aortic occlusion would lead to ongoing hemorrhage. The objective of this study was to evaluate the hemostatic efficacy of pREBOA in a model of uncontrolled vascular injury. Female Yorkshire swine (n = 10, 40 to 45 kg) were anesthetized and instrumented. A through-and-through injury was created in the common iliac artery. The animals were randomly assigned to: (1) pREBOA-PRO deployment after 3 minutes and (2) control. Both groups were given normal saline resuscitation for hypotension. The pREBOA was adjusted to partial occlusion (distal mean arterial pressure of 30 mmHg), and then left without titration for 2 hours. Then, fresh frozen plasma was transfused and the vessel repaired. The balloon was deflated and the animals were monitored for 2 hours. In the critical care period, 2 L of normal saline was infused, norepinephrine was given for mean arterial pressure ≤55, and electrolytes and acidosis were corrected. Organs were examined for gross and histologic evidence of ischemic injuries. The primary endpoint was post-inflation blood loss. All the pREBOA animals survived until the end, whereas control animals had a mean survival time of 38.2 minutes (p < 0.05). The pREBOA group showed significantly less bleeding after balloon deployment (93.8 vs 1,980.0 mL, p < 0.05), and had appropriate lactate clearance, with minimal histologic distal organ ischemia. Partial aortic occlusion with the newly designed balloon can achieve the desired balance between effective hemorrhage control and adequate distal flow, without a need for ongoing balloon titration.

Real-World Utilization of an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device.

To assess the real-world effectiveness and safety of a U.S. Food and Drug Administration (FDA)-cleared intrauterine vacuum-induced-hemorrhage control device for postpartum hemorrhage (PPH) management. Sixteen centers in the United States participated in this observational, postmarket registry medical record review (October 2020 through March 2022). The primary effectiveness outcome was treatment success , defined as bleeding control after insertion with no treatment escalation or bleeding recurrence. Additional outcomes included blood loss, time to device insertion, indwelling time, bleeding recurrence, and time to bleeding control. Treatment success and severe maternal morbidity measures (transfusion of 4 or more units of red blood cell, intensive care unit admission, and hysterectomy) were evaluated by blood loss before insertion. To assess safety, serious adverse events (SAEs) and adverse device effects were collected. All outcomes were summarized by mode of delivery; treatment success was summarized by bleeding cause (all causes, any atony, isolated atony, nonatony). In total, 800 individuals (530 vaginal births, 270 cesarean births) were treated with the device; 94.3% had uterine atony (alone or in combination with other causes). Median total blood loss at device insertion was 1,050 mL in vaginal births and 1,600 mL in cesarean births. Across all bleeding causes, the treatment success rate was 92.5% for vaginal births and was 83.7% for cesarean births (95.8% [n=307] and 88.2% [n=220], respectively, in isolated atony). Median indwelling time was 3.1 hours and 4.6 hours, respectively. In vaginal births, 14 SAEs were reported among 13 individuals (2.5%). In cesarean births, 22 SAEs were reported among 21 individuals (7.8%). Three (0.4%) SAEs were deemed possibly related to the device or procedure. No uterine perforations or deaths were reported. For both vaginal and cesarean births in real-world settings, rapid and effective bleeding control was achieved with an FDA-cleared intrauterine vacuum-induced hemorrhage-control device. The safety profile was consistent with that observed in the registrational trial (NCT02883673), and SAEs or adverse device effects were of the nature and severity expected in the setting of PPH. This device is an important new tool for managing a life-threatening condition, and timely utilization may help to improve obstetric hemorrhage outcomes. ClinicalTrials.gov , NCT04995887.

Total Knee Arthroplasty: The Impact of Tourniquet Usage on Cement Penetration, Operation Time, and Bleeding Control

Objective: The cementing technique employed in total knee arthroplasty (TKA) significantly influences the penetration of cement into the bone, ultimately affecting the stability of the joint. This study aimed to assess the impact of tourniquet usage on tibial cement penetration, operative time, bleeding, and functional outcomes following TKA. Materials and Methods: A retrospective evaluation was conducted on 103 patients who had undergone TKA and had a minimum follow-up period of 2 years. The patients were categorized into three groups: Group 1 utilized a tourniquet throughout the entire surgery, Group 2 released the tourniquet immediately after prosthesis implantation, just before cement hardening, and Group 3 did not employ a tourniquet at any stage of the procedure. Tibial cement penetration was assessed via X-ray examination, following the Knee Society Scoring System criteria. Operative time, bleeding levels, and Lysholm and Oxford scores were compared among the groups. Statistical analysis was performed using SPSS version 22.0 software. Results: In Group 1, bone penetration of cement was significantly higher than in both Group 2 and Group 3, except for zone 1 in the anterior-posterior (AP) view (p &lt; 0.017). Group 3 exhibited significantly less bleeding compared to the other groups (p &lt; 0.017). There was no significant difference in terms of bleeding between Group 1 and Group 2. The operation time was significantly shorter in Group 1 compared to the other groups (p &lt; 0.017). The mean cement penetration depth across all groups was measured at 2.44 ± 0.27 mm. Bleeding volume and operation time did not have a significant effect on mean cement penetration (p &gt; 0.05). Additionally, there were no significant differences observed between the groups in terms of the Lysholm and Oxford functional test results (p &gt; 0.017). Conclusions: The use of a tourniquet was found to increase cement penetration and reduce operation time; however, it did not have a significant impact on reducing bleeding. Based on our findings, we recommend considering a shorter tourniquet time and implementing effective bleeding control measures to mitigate potential complications associated with tourniquet usage.

МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА РАНЫ ПЕЧЕНИ ПРИ ЕЕ РЕЗЕКЦИИ С ПРИМЕНЕНИЕМ НЕКОТОРЫХ МЕТОДОВ ЛОКАЛЬНОГО ГЕМОСТАЗА В ЭКСПЕРИМЕНТЕ

Background. Due to an increasing number of liver surgery, the problems of using secure hemostatic techniques during its resection are still relevant and require further study. Objective. To determine the optimal technique of local hemostasis during liver resection based on a comparative morphological assessment of the liver wound. Material and methods. The study was performed on 30 outbred white rats using local hemostatic techniques with further morphological examination of biological material on 7th and 21st days. Results. It has been established that cryohemostasis, electrocoagulation and local application methods of hemostasis are adequate ways to stop blood loss from a wound during liver resection. The analysis of the histological image of micro-preparations showed that the inflammatory response is present in all experiment series, regardless of hemostatic techniques. The disadvantage of using a TachoComb sponge is the need for its fixation to the wound surface, that of a collagen hemostatic sponge – a long period of its resorption, that of electrocoagulation – a damaging effect on liver tissue with marked inflammation. Conclusions. Local cryohemostasis appeared to be the most effective bleeding control technique. Its advantages are the following: it stops bleeding much faster than application techniques; it is characterized by minimal abdominal adhesions; it has a less pronounced damaging effect on liver parenchyma; it facilitates scar tissue formation and it is less likely to cause inflammatory changes in the resection zone.

Real-world utilization of an intrauterine vacuum-induced hemorrhage-control device

Intrauterine vacuum-induced hemorrhage control device is a new tool in management of postpartum hemorrhage after being FDA-cleared in Aug 2020. The objective of this study was to report on real-world effectiveness and safety of this device. An observational, post-market registry chart review was conducted at 16 US centers selected for ability to readily collect data on device use (NCT04995887). We report baseline characteristics, treatment outcomes overall and by isolated uterine atony, and adverse events/device effects. The primary outcome, treatment success, was defined as device successfully controlling bleeding with no treatment escalation or bleeding recurrence. Data are presented by mode of delivery. From Oct 2020-Apr 2022, 800 individuals were treated with the device; 94.3% had uterine atony. Treatment success was 92.5% for vaginal births and 83.7% for cesarean births. In cases where uterine atony was the sole cause of bleeding (isolated uterine atony; n=307 vaginal, n=220 cesarean), treatment success was 95.8% for vaginal and 88.2% for cesarean births (Table 1). For vaginal births, mean indwelling time (insertion to removal) was 4.6 hours and bleeding recurred after device removal in 2.8% (Table 1). For cesarean births, mean indwelling time was 6.3 hours and 4.1% had bleeding recur (Table 1). Time to bleeding control was available in 49% of cases. In vaginal births (n=241), 73.8% (n=178) achieved bleeding control in ≤ 5 minutes. In cesarean births (n=151), 62.2% (n=94) achieved bleeding control in ≤ 5 minutes. Of the adverse events/device effects reported (Table 2), 3 serious events were deemed possibly related to the device or procedure [2 (0.4%) vaginal, 1 (0.4%) cesarean]. For both vaginal and cesarean births in real-world settings, rapid and effective bleeding control was observed with an FDA-cleared intrauterine vacuum-induced hemorrhage-control device. The adverse event profile was consistent with that observed in the registrational trial (NCT02883673). This device may help to decrease maternal morbidity and improve obstetric hemorrhage outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Advances in the therapy for von Willebrand disease

Von Willebrand disease (VWD) is caused by quantitative or qualitative deficiencies in the von Willebrand factor (VWF). VWF concentrate replacement therapy is required in certain situations, such as severe VWD subtype or critical bleeding, even in mild VWD subtypes. A single plasma-derived factor VIII/VWF concentrate has been available for decades in Japan. However, it has a theoretical risk of infectious disease transmission, allergic reactions, and thrombosis. A recombinant VWF (vonicog alfa) was approved by the Japanese Pharmaceuticals and Medical Devices Agency in 2020. Vonicog alfa is the only VWF product that contains ultralarge multimer, suggesting both effective bleeding control and excessive platelet plug formation. The efficacy and safety of vonicog alfa have been confirmed by three phases of clinical studies for on-demand usage, elective surgery, and prophylaxis. We also have a successful experience with vonicog alfa with minimal adverse events in two cases (hemostatic treatment in a patient with recurrent epistaxis and prophylaxis for delivery in a pregnant woman).

Role of Interventional Radiologists in Trauma Centers

Based on statistics available in Korea, trauma centers play a critical role in treatment of patients with trauma. Interventional radiologists in trauma centers perform various procedures, including embolization, which constitutes the basic treatment for control of hemorrhage, although interventions such as stent graft insertion may also be used. Although emergency interventional procedures have been used conventionally, rapid and effective hemorrhage control is important in patients with trauma. Therefore, it is important to accurately understand and implement the concept of damage control interventional radiology, which has gained attention in recent times, to reduce preventable trauma-induced mortality rates.

Esophageal stent placement for endoscopic treatment failure.

Up until approximately 10 years ago, the treatment for acute refractory esophageal variceal bleeding was balloon tamponading. Esophageal fully covered self-expanding stents are considered as effective as balloons and also much safer. They are kept in situ for longer periods, what eases the access to more definitive treatments with a low complication rate. We present 6 cases of patients with cirrhosis and massive bleeding due to esophageal varices refractory to conventional treatment, successfully treated with an esophageal fully covered self-expanding stent. There were no major complications, achieving an effective bleeding control in all cases.

Polysaccharide-Based Adhesive Antibacterial and Self-Healing Hydrogel for Sealing Hemostasis.

Adhesive hydrogels have been considered as one of the most ideal materials for wound dressing. However, most existing adhesive hydrogels still have disadvantages such as low mechanical properties, poor biological activity (antibacterial and hemostatic ability), and low biocompatibility, which largely limit their application. Thus, it is highly desired to prepare a hydrogel-based wound dressing with good self-healing, ideal adhesive properties, rapid hemostasis, and excellent wound infection prevention activity. In this study, a simple method was presented to prepare a PAM-Lignin-CS-Laponite-SA hydrogel for wound dressing. The obtained hydrogel displayed excellent self-healing ability and repeatable adhesive performance, benefiting from the introduction of hydrogen bonding and electrostatic interactions inside the hydrogel network. In addition, the PAM-Lignin-CS-Laponite-SA hydrogel also exhibited low cell cytotoxicity, good antibacterial activity, and outstanding hemostatic properties. In conclusion, the PAM-Lignin-CS-Laponite-SA hydrogel demonstrated good tissue adhesion, excellent self-healing ability, effective bleeding control, and good antibacterial activity to prevent wound infection, which provides a new idea for developing a multifunctional hydrogel-based tissue adhesive hemostatic dressing.

Modern treatment of massive hemothorax

Introduction and objective: Hemothorax is an umbrella term for pathologies with an extremely wide range of etiology and severity. Most commonly it is of tramuatic origin, frequently iatrogenic (intervention, blood coagulation altering therapy) and rarely unknown. Depending on the cause, volume, and dynamics, it requires a patient-adapted treatment determined by access to certain therapeutical methods. We aim to provide a practical overview of these. Methods: Retrospective analysis of patients treated for haemothorax at the Thoracic Surgery Department of Borsod-Abaúj-Zemplén County Teaching Hospital in the period 1 January 2017–31 December 2021 has been performed. We used the hospital’s database to collect data. In this paper, we analyze the cause of hemothorax, method of treatment, the efficacy of chosen therapeutic modality, duration of hospital stay, complication rate, 30-day survival. Results: 77 patients were treated with hemothorax, 57 male, 20 female patients. Average age was 53,4 (23–90, SD:14,9) years. Surgery was performed in 31 cases, with 10 cases needing reintervention. In 7 cases, multimodal approach was chosen, with chest wall stabilization. Average hospital stay: 14 (2–79) days. 30-day survival: 95%. Discussion: Thoracic drainage is our first therapeutic choice. The methods used in the treatment of hemothorax in our practice have been extended with the use of digital subtraction angiography (DSA), which yields immediate and effective bleeding control. We performed video-assisted thoracoscopic surgery (VATS) in increasing numbers. Conclusions: As long as the intensity of bleeding and patient’s general status allows it, after drainage, the first therapeutic option – when accessible – should be DSA bleeding control. In cases which do not resolve after drainage, VATS evacuation of hematoma is a safe method used in the treatment of hemothorax. In the past 5 years, we used thoracoscopy in increasing numbers while treating this entity. Based on our results and the literature, we can safely state that the use of thoracoscopy in the treatment of hemothorax is a safe and reliable option in eligible patients, and the results are comparable with those treated by thoracotomy.

Development of a post-mortem human specimen flow model for advanced bleeding control training

IntroductionPrompt and effective hemorrhage control is paramount to improve survival in patients with catastrophic bleeding. In the ever-expanding field of bleeding control techniques, there is a need for a realistic training model to practice these life-saving skills. This study aimed to create a realistic perfused post-mortem human specimen (PMHS) flow model that is suitable for training various bleeding control techniques. Materials and MethodsThis laboratory study was conducted in the SkillsLab & Simulation Center of Erasmus MC, University Medical Center Rotterdam, the Netherlands. One fresh frozen and five AnubiFiX® embalmed PMHS were used for the development of the model. Subsequent improvements in the exact preparation and design of the flow model were made based on model performance and challenges that occurred during this study and are described. ResultsCirculating arteriovenous flow with hypertonic saline was established throughout the entire body via inflow and outflow cannulas in the carotid artery and jugular vein of embalmed PMHS. We observed full circulation and major hemorrhage could be mimicked. Effective bleeding control was achieved by placing a resuscitative endovascular balloon occlusion of the aorta (REBOA) catheter in the model. Regional perfusion significantly reduced the development of tissue edema. ConclusionOur perfused PMHS model with circulating arterial and venous flow appears to be a feasible method for the training of multiple bleeding control techniques. Regional arteriovenous flow successfully reduces tissue edema and increases the durability of the model. Further research should focus on reducing edema and enhancing the durability of the model.