Gelatin Foam Research Articles

Assessment of the efficacy of a novel adhesive haemostat using real world, case series data collection

BackgroundPost-operative haemorrhage can lead to significant complications and even mortality. These utilise scarce healthcare resources and increase hospital costs, as well as negatively impacting on patient's quality of life. Haemostats that exhibit additional adhesive properties can reduce the rate of bleeding complications. Standard gelatin sponges have been used safely in surgery for over 75 years but have almost no adhesive properties. This article reports the performance of a novel adhesive gelatin patch in human surgery for the first time. MethodsA CE-marked gelatin foam patch (TenaTac®, Selentus Science, UK) has been created through a physical modification of the sponge surface, avoiding the need for the addition of blood-derived components or additional chemicals to stimulate adhesion. Real-world, post-approval clinical evaluations of the device were undertaken, and a structured data form was utilised to collect information on the device's performance during these procedures. ResultsIn total, 63 evaluations were undertaken by 40 surgeons in 13 countries, covering 29 different surgical procedures. When assessing the adherence of TenaTac, 83 % (48/58) of the surgeons assessed the adhesion as very good or excellent. Both “haemostatic effect” and “time to haemostasis” achieved median scores of 4/5 (IQR 4–5), which equated to “very good” on the questionnaire. When surgeons were asked to compare their experience with TenaTac against their usual haemostat, 91.7 % (55/60) rated it as good, very good or excellent. When surgeons were asked if they would recommend the use of TenaTac, 96.5 % (55/57) of the surgeons responded positively to this question. ConclusionReal world evaluation of the novel adhesive patch, TenaTac, has confirmed that it exhibits very good adhesive and haemostatic qualities and could be considered for use by a wide variety of surgical specialities.

An all-protein aerogel with a nanofiber/foam structure for versatile air filtration

Structural design plays a vital role in advancement of multifunctional air filters. We here report a novel design of an all-protein aerogel with a unique hybrid nanofiber/foam structure, demonstrating versatile filtration capabilities, i.e. being able to capture oils & organic chemicals, toxic gaseous molecules, and particulate matter (PM), at a low pressure drop. The aerogel is made from two abundant natural proteins: zein and gelatin, by freeze-drying. The electrospun zein nanofibers dispersed within the hybrid zein/gelatin aerogel provide a large specific surface area and hydrophobicity, enabling high filtration efficiency even under a humid environment. The gelatin foam structure constructs a skeleton of the hybrid aerogel, extending the filtration capacities for capturing air pollutants. In addition, the optimal Z1/G1-3 aerogel sample exhibits high filtration efficiency of 99.24 % for PM2.5 and 95.54 % for PM0.3 at a low pressure drop of 54.76 Pa. More significantly, the Z1/G1-3 air filter presents exceptional filtration performance even when subjected to a high airflow rate of 10 L/min or after a continuous 120-min filtration period. This work proposes a novel air filter design that integrates eco-friendliness and multifunctional filtration features.

Epistaxis Treatment Options: Literature Review.

Epistaxis means bleeding from nostrils, nasal cavity or nasopharynx. To summarize the available epistaxis treatment options. Methods: 61 articles published in the last 20years were included. Duplicate records, irrelevant and inaccessible ones were excluded. Epistaxis can be treated with first aid measures such as external pressure and ice packing and applying topical agents, e.g. oxymetazoline that stops 65-75% of nosebleeds in A&E. Also, with electrocautery which is more effective and has fewer recurrences (14.5% vs. 35.1%) than chemical cauterization and applying tranexamic acid that promotes hemostasis in 78% of patients, versus 35% and 31% respectively in patients treated with oxymetazoline and nasal packing. Furthermore, nasal packing can be applied with non-absorbable materials, e.g. petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, balloons (Rapid-Rhino), absorbable materials, e.g. nasal tampon (Nasopore), and with newer hemostatic materials which are more effective and with fewer complications, e.g. hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan) and fibrin glue. Moreover, epistaxis can be achieved with endoscopic ligation of arteries, mainly SPA, which is more effective than conventional nasal packing (97% vs. 62%), and with endoscopic cauterizationwhich is more effective than ligation. Finally, for intractable cases embolization can be applied using gelatin sponge, foam, PVA and coils with 80% success rate and comparable efficacy and complications to surgical methods. Epistaxis can be dealt with various methods depending on patient's history and available resources. Newer hemostatic agents in combination with endoscopic methods have advantages over traditional methods.

Effect of Starch Type and Pre-Treatment on the Properties of Gelatin-Starch Foams Produced by Mechanical Foaming.

Incorporating biopolymers in packaging foams can contribute to a more circular packaging system, utilizing renewable and compostable materials. Gelatin, with its favorable physicochemical properties, allows for producing gelatin foams via mechanical foaming, a well-established and low-investment process. To improve foam properties, starch can be added to the gelatin formulation. However, the variability in the properties of starch powders can impact the polymer blend and, consequently, the properties of the dry foam. This study aimed to investigate the impact of different starch powders from different botanical origins (tapioca and corn) and treatments (native or pregelatinized) on the properties of gelatin-starch foams produced by mechanical foaming. The study successfully produced foams with densities of approximately 45-50 kg/m3 and compression properties comparable to EPS (expanded polystyrene) foams. The starch type and pre-treatment significantly influenced the properties of the foam. Pregelatinized starches exhibited slightly higher densities due to lower foamability caused by higher viscosity. Using starch exhibiting total loss of birefringence led to denser foams with greater compression properties than those with starch with a certain degree of crystallinity remaining. Therefore, selecting the appropriate starch type is crucial when developing starch-based materials to ensure optimal material and processing properties align with application requirements.

TMIC-50. AN INNOVATIVE THREE-DIMENSIONAL GELATIN FOAM CULTURE SYSTEM FOR IMPROVED STUDY OF GLIOBLASTOMA STEM CELL BEHAVIOR

Abstract Three-dimensional (3-D) tissue engineered constructs provide a platform for examining how the local extracellular matrix contributes to the malignancy of various cancers, including human glioblastoma multiforme. Here, we describe a simple and innovative 3-D culture environment and assess its potential for use with glioblastoma stem cells (GSCs) to examine the diversification inside the cell mass in the 3-D culture system. The dissociated human GSCs were cultured using gelatin foam. These cells were subsequently identified by immunohistochemical staining, reverse transcriptase-polymerase chain reaction, and Western blot assay. We demonstrate that the gelatin foam provides a suitable microenvironment, as a 3-D culture system, for GSCs to maintain their stemness. The gelatin foam culture system contributes a simplified assessment of cell blocks for immunohistochemistry assay. We show that the significant transcription activity of hypoxia and the protein expression of inflammatory responses are detected at the inside of the cell mass in vitro, while robust expression of PROM1/CD133 and hypoxia-induced factor-1 alpha are detected at the xenografted tumor in vivo. We also examine the common clinical trials under this culture platform and characterized a significant difference of drug resistance. The 3-D gelatin foam culture system can provide a more realistic microenvironmentthrough which to study the in vivo behavior of GSCs to evaluate the role that biophysical factors play in the hypoxia, inflammatory responses and subsequent drug resistance.

Optimization of the modular reinforced bone scaffold for customized alveolar bone defects

A modular reinforced bone scaffold with enhanced mechanical properties has recently been developed by our group. It includes: 1) A load-bearing module: a skeleton which is made of a slowly degradable material, undertaking mechanical necessities of the scaffold, and 2) A bio-reactive module: a porous and biodegradable component undertaking biological necessities of the scaffold. The load-bearing module is placed into the bio-reactive module to reinforce it. This paper is dedicated to optimizing the load-bearing module for a certain customized alveolar bone defect. More specifically, a 3D-printed skeleton, made of polycaprolactone (PCL), is optimized based on the boundary conditions of the defect shape using the finite element method (FEM) to minimize the weight (to minimize the amount of PCL) and maximize the mechanical properties and porosity of the skeleton. Gelatin foam has been incorporated into the optimized skeleton through the aminolysis process to form the bio-reactive module. The mechanical characterization confirmed that the optimized load-bearing module has a bridge-like shape and can significantly improve the mechanical properties of the scaffold. Also, in vitro studies showed that the fabricated scaffold can improve cell proliferation and osteogenesis. This kind of scaffold can be useful for the treatment of critical-sized defects.

Management of Symptomatic Vascularized Retained Products of Conception by Proximal Uterine Artery Embolization with Gelatin Sponge Torpedoes

PurposeTo evaluate the effectiveness and safety of temporary proximal uterine artery embolization (UAE) for the treatment of highly vascularized retained products of conception (RPOCs). Materials and MethodsThis retrospective analysis included women who underwent treatment for vaginal bleeding after abortion, miscarriage, or delivery, with highly vascularized RPOCs detected by Doppler ultrasound (US) (ie, presence of an enhanced myometrial vascularity, a low resistance index of <0.5, and a peak systolic velocity of ≥0.7 m/s). A unilateral or bilateral embolization with torpedoes of gelatin foam was performed. From November 2017 to January 2021, 24 women with a median age of 30 years (interquartile range, 26.0–34.5 years) with symptomatic highly vascularized RPOCs were included. Clinical success was defined as bleeding arrest between the UAE and 1-month follow-up. Technical success was defined as the complete obstruction of at least 1 uterine artery supplying vascular abnormalities. The safety of the procedure according to the classification of the Society of Interventional Radiology and evolution of lesions on US were also reported. ResultsTechnical success was achieved in all 24 (100%) patients, with bilateral arterial embolization in 19 (79%) patients and unilateral embolization in 5 (21%) patients. Clinical success was achieved in all 24 (100%) patients. Five patients still had uterine retention at the 1-month follow-up, including 2 patients with highly vascularized RPOCs. Two patients benefited from hysteroscopy, and 3 had noninvasive management. Four minor adverse events were reported (1 patient had infectious endometritis and 3 patients had a postembolization syndrome). ConclusionsProximal UAE with torpedoes of gelatin foam is safe and effective for the management of symptomatic highly vascularized RPOCs.

Emerging Polymer Materials in Trackable Endovascular Embolization and Cell Delivery: From Hype to Hope.

Minimally invasive endovascular embolization is a widely used clinical technique used for the occlusion of blood vessels to treat various diseases. Different occlusive agents ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) (PVA) have been commercially used for embolization. However, these agents have some drawbacks, such as undesired toxicity and unintended and uncontrolled occlusion. To overcome these issues, several polymer-based embolic systems are under investigation including biocompatible and biodegradable microspheres, gelling liquid embolic with controlled occlusive features, and trackable microspheres with enhanced safety profiles. This review aims to summarize recent advances in current and emerging polymeric materials as embolization agents with varying material architectures. Furthermore, this review also explores the potential of combining injectable embolic agents and cell therapy to achieve more effective embolization with the promise of outstanding results in treating various devastating diseases. Finally, limitations and challenges in developing next-generation multifunctional embolic agents are discussed to promote advancement in this emerging field.

Pi-induced in-situ aggregation of sevelamer nanoparticles for vascular embolization

Decades have witnessed rapid progress of polymeric materials for vascular embolic or chemoembolic applications. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. In this paper, we proposed a concept of ‘responsive embolization’. Sevelamer, clinically proved as an inorganic phosphate binder, was ground into nanoparticles. Sevelamer nanoparticle is highly mobile and capable of swelling and aggregating in the presence of endogenous inorganic phosphate, thereby effectively occluding blood flow in the vessel as it was administered as an embolic agent for interventional therapy. Moreover, citrated sevelamer nanoparticles delayed the aggregation, preferable to penetrate deeply into the capillary system. On the rabbit VX2 liver cancer model, both sevelamer particles aggregates occlude the tumor feeding artery, but backflow was found for the pristine one, thereby citrate passivation of sevelamer nanoparticles endows it have potential from ‘bench to bedside’ as a new type of vascular embolic.

Sevelamer arsenite nanoparticle as a Pi-responsive drug carrier and embolic agent for chemoembolization

Arsenic trioxide (As2O3, ATO) has limited therapeutic benefit to treat solid tumors, whether used alone or in combination. Nanoscale drug delivery vehicles have great potential to overcome the limitation of the utility of ATO by rapid renal clearance and dose-limiting toxicity. Polymeric materials ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) were developed for vascular embolic or chemoembolic applications. Recently, we have introduced sevelamer, an oral phosphate binder, as a new polymeric embolic for vascular interventional therapy. In this paper, sevelamer arsenite nanoparticle with a polygonal shape and a size of 50–300 nm, synthesized by anionic exchange from sevelamer chloride, was developed as a Pi-responsive bifunctional drug carrier and embolic agent for chemoembolization therapy. At the same arsenic dosage, sevelamer arsenite-induced severer tumor necrosis than ATO on the VX2 cancer model. In vitro tests evidenced that Pi deprivation by sevelamer could enhance ATO’s anticancer effect. The results showed that ATO in Pi starvation reduced cell viability, induced more apoptosis, and diminished the mitochondrial membrane potential (Δψm) of cells since Pi starvation helps ATO to further down-regulate Bcl-2 expression, up-regulate Bax expression, enhance the activation of caspase-3 and increase the release of cytochrome c, and the production of excessive reactive oxygen species (ROS). Sevelamer arsenite not only plays a Pi-activated nano-drug delivery system but also integrated anticancer drug with embolic for interventional therapy. Therefore, our results presented a new administration route of ATO as well as an alternative chemoembolization therapy.

Development of a modular reinforced bone tissue engineering scaffold with enhanced mechanical properties

A modular design composed of 3D-printed polycaprolactone (PCL) as the load-bearing module, and dual porosity gelatin foam as the bio-reactive module, was developed and characterized in this study. Surface treatment of the PCL module through aminolysis-aldehyde process was found to yield a stronger interface bonding compared to NaOH hydrolysis, and therefore was used in the fabrication procedure. The modular scaffold was shown to significantly improve the mechanical properties of the gelatin foam. Both compressive modulus and ultimate strength was found to increase over 10 times when the modular design was employed. The bio-reactive module i.e., gelatin foam, presented a dual porosity network of 100–300 µm primary and < 10 µm secondary pores. SEM images revealed excellent attachment of DPSCs to the bio-reactive module.

P.101: Safety and Efficacy of a Percutaneous Intraportal Islet Transplantation Procedure Using Tract Embolization With Gelatine Foam Pledgets

Introduction: Intraportal pancreatic islet transplantation is a minimally invasive procedure to treat patients with diabetes mellitus and unstable glycemic control despite optimal medical treatment. We analysed the safety and efficacy of percutaneous transhepatic intraportal islet transplantation procedures using embolization of the hepatic puncture tract with gelatin foam pledgets. Methods: This was a retrospective, single center study including all allogeneic islet transplantations between 2007 and 2019 at the Leiden University Medical Center. Under local anaesthesia, islets were infused into the main portal vein using a right-sided transhepatic approach. Tract embolization was performed in 51/62 procedures using the Hunter Biopsy Sealing Device. Complications were assessed according to CTCAEv5.0. Stimulated C-peptide during a mixed meal test was measured after 3 months to evaluate efficacy. Results: A total of 62 islet transplants in 38 recipients (female 39.5%; median age 53.2 (IQR 40.8 – 64.0) years) were included. 11 complications occurred in 62 procedures: no CTCAE grade 4 or 5 complications occurred. Bleeding occurred in 3/11 (27.3%) of procedures without tract embolization, compared to 2/51 (3.9%) with tract embolization (p=0.01). 3 of these bleeding episodes comprised grade 3 complications which could be managed conservatively, and 2 bleeding episodes were grade 1 that did not require intervention. More than one puncture attempt was a positive predictor for bleeding (p=0.001) and pain (p=0.002). No portal vein thromboses were encountered.1 biliary puncture (grade 1) and 5 episodes of pain (grade 1 (n=3) and grade 2 (n=2)) occurred. Three months after infusion, stimulated C-peptide was >0.17 nmol/L in 60/62 (97%) transplant recipients. Conclusion: A percutaneous transhepatic procedure using gelatine foam pledgets is a safe and efficacious method to transplant islets into the portal vein. Complications were either self-limiting or could be managed with non-invasive treatment. The vast majority of patients gained endogenous insulin production.

Ultralong Organic Phosphorescent Foams with High Mechanical Strength.

Ultralong organic phosphorescence (UOP) has aroused enormous interest in recent years. UOP materials are mainly limited to crystals or rigid host-guest systems. Their poor processability and mechanical properties critically hamper practical applications. Here, we reported a series of ultralong phosphorescent foams with high mechanical strength. Phosphorescence lifetime of the foam can reach up to 485.8 ms at room temperature. Impressively, lightweight gelatin foam can bear a compressive pressure of 4.44 MPa. Moreover, phosphorescence emission of polymer foam can be tuned from blue to orange through varying the excitation wavelength. Experimental data and theoretical calculations revealed that ultralong phosphorescence was ascribed to the fixation of multiple hydrogen bonds to the clusters of carbonyl groups. These results will allow for expanding the scope of luminescent foams, providing an ideal platform for developing ultralong phosphorescent materials with high mechanical strength.

Cell Block Optimization: A Comparative Study of Quality Variables in 4 Different Cell Block Methods

Objective: The cell block (CB) is an important adjunct to cytological preparations in diagnostic cytopathology. Optimizing cellular material in the CB is essential to the success of ancillary studies such as immunohistochemistry (IHC) and molecular studies (MS). Our aim was to identify which CB method was most suitable in a variety of specimen types and levels of cellularity. Study Design: We assessed 4 different CB methods, thrombin clot method (TCM), MD Anderson method (MDAM), gelatin foam method (GFM), and agar method (AM), with descriptive observations and ranking of the methods based on quantity of cells and morphological features. Results: TCM performed best in ranking for both quantity of cells and morphological features, followed by MDAM, GFM, and AM. Lack of adjuvant in the MDAM resulted in some unique morphological advantages which, however, also resulted in inconsistent performance. In low cellularity cases insufficient cells were frequently identified on slides from MDAM and AM CBs. Technique touch time was similar for all methods, with total processing time being shortest for TCM followed by MDAM, GFM, and AM. Conclusions: TCM was the most robust CB technique, retaining high scores for ranking of quantity and morphology in a variety of specimen cellularities and specimen types.

Managing Anticoagulant Patients Undergoing Dental Extraction by using Hemostatic Agent: Tranexamic Acid Mouthrinse.

Background:Patient who is on antiplatelet therapy had an impaired fibrin formation which leads to fibrinolysis which is the main reason behind postextraction bleeding.Objectives:The aim of the study is to manage anticoagulated patient who has to undergo dental extraction by using hemostatic agent and the objective is to rule out potential risk factor which may trigger bleeding.Methods:One hundred patients with anticoagulant and antiplatelet therapy and having International Normalized Ratio (INR) in-between 1.9 and 3.5 were selected. Postextraction instruction use 5 ml of 10% tranexamic acid mouthrinse four times a day for next 7 days was suggested. All demographic data, history of anticoagulant and antiplatelet therapy, details of bleeding, and treatment requirement were recorded to identify potential risk factor.Results:Of 100 subjects, 16 were reported postextraction bleeding on days 1 and 2 which was controlled by tranexamic acid pressure pack. Bleeding from extraction socket of 10 patients was stopped by gelatin foam. No life-threatening risk was observed. In patients with age group of 41–60 years whose INR value was ≥2.5, the number of teeth undergoing extraction, whose bleeding time was increased, and were on long duration of antiplatelet and anticoagulation therapy might increase the risk of bleeding.Conclusion:Use of tranexamic acid mouthrinse after extraction is an effective way to control bleeding on patients who are under antiplatelet therapy with at therapeutic INR level is a secure and allowable method of minimizing postextraction oozing.

Use of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery

BackgroundChronic rhinosinusitis with nasal polyps recurs frequently after functional endoscopic sinus surgery (FESS), with resultant poor quality of life with persistence of nasal obstruction, sinus aches, and discharge as well anosmia and dysgysia; revision FESS is usually the treatment of choice referred to relief patients’ suffering, yet it is not always the case, patients preference as well as fitness for general hypotensive anesthesia, patients age, cardiopulmonary status, and concurrent bronchial asthma might render unfit for an elective procedure. The aim of this study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery.ResultsThirty patients suffering from recurrent sinonasal polyposis after single or multiple FESS procedures were selected; all patients were subjected to intranasal application of gelfoam soaked with triamcinolone as a conservative medical office procedure using triamcinolone-soaked absorbable gelatin foam (gelfoam) weekly for a period of 8 weeks followed by intranasal steroid nasal spray for maintenance and as anti-recurrence measure. Patients were followed up for 4 months post-intervention; Meltzer Clinical Scoring System was used to analyze the patients’ pre- and post-intervention via office endoscopy (0° 4-mm Hopkins endoscope). All patients tolerated the procedure well. The study group showed no statistical significance pre-intervention which comprised 17 (56.7%) patients with grade 4 sinonasal polyposis extent and 13 (43.3%) patients with grade 3 sinonasal polyposis extent (P=0.795), denoting no difference between patients pending treatment option. Post-treatment, both groups showed a significant reduction in the extent of polyposis (P<0.001) where post-treatment showed 21 (70%) patients with grades 0 no polyps and 9 (30%) patients with grade 1 sinonasal polyposis extent.ConclusionTriamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent sinonasal polyposis after FESS. Intervention contributed to a successful result, decreased the need for surgery in poor candidates for hypotensive anesthesia, and could be used as a sole treatment of recurrent sinonasal polypsis in elderly patients whose general condition could not tolerate invasive procedures.

Evaluation of bone regeneration in mandible large defect using undifferentiated adipose stem cells loaded on gelatin carrier: An animal model case study

Background. Large mandibular defects are considered difficult reconstructive challenges for oral and maxillofacial surgeons. Cell therapy, as an alternative technique, might increase the speed of bone regeneration. This study aimed to investigate bone regeneration in large defects of dog mandibles using allogenic adipose-derived stem cells on gelatin foam as a cell carrier. Methods. The tissue engineering phase consisted of the sampling of adult dogs’ adipose tissue that can easily be isolated from adipose stem cells (ASCs) of the dogs, ASCs were cultured in Dulbecco’s Modified Eagle’s Medium (DMEM, Gibco, USA) with low glucose, containing 10% fetal bovine serum (FBS) (Sigma, USA) and 1% penicillin-streptomycin (Gibco, USA), with the characterization of dog ASCs and gelatin-transplanted ASCs. Six dogs were included in this experimental study in the next step and randomly assigned to the treatment and control groups. The samples in both groups underwent surgery under general anesthesia to create uniform 3-cm bony defects. The samples in both groups were reconstructed with titanium reconstruction plates and screws. A large bone gap filled with ASCs (5×106 ) was seeded on gelatin (ASCs) in the treatment group. In the control group, bony defects were filled with a cell delivery carrier without ASCs. Six months after transplantation, the animals’ mandibles were evaluated by CT scan imaging, and the results were quantified through the Hounsfield unit (HU). The data were analyzed with t-test. Results. Before transplantation, the nature of the stem cells was confirmed by the expression of CD44 and CD105 cell markers at 71.9% and 89.3%, respectively, and a lack of the CD45 cell marker expression at 2.2%. Evaluation of CT scan images showed significantly higher bone repair in the ASCs group (920.25±572.92 HU) than in the control group (-94.746± 08.42). Conclusion. The bone regeneration of the ASCs group was significantly higher than that in the control group.

Endovascular management of recurrent hemarthrosis of the knee: a case series

BackgroundRecurrent hemarthrosis of the knee is an uncommon but potentially debilitating occurrence with multiple etiologies, including previous total knee replacement. The purpose of this study is to present data of a group of patients undergoing angiography and embolization for recurrent hemarthrosis of the knee. Patient characteristics, angiographic findings, safety and efficacy of the procedure are reported.MethodsA retrospective single centre review of patients undergoing angiography and embolization at a tertiary referral centre in Sydney, Australia from March 2006 to April 2018 was performed. A total of 25 patients undergoing a total of 29 procedures were identified (20 female, 5 male; mean age 67), the majority of which (23/25, 92%) had a history of total knee arthroplasty. Embolization was performed in 28 of the 29 procedures (97%). The embolic agent used was either polyvinyl alcohol particles (23/28), gelatin foam (3/28), detachable microcoils (1/28) or a combination of particles and coils (1/28).ResultsThe most commonly identified dominant vascular abnormality was periarticular synovial hypervascularity (23/25, 92%). A pseudoaneurysm was demonstrated in two patients (8%). Technical success (elimination of angiographic abnormalities) was achieved in 27 of 29 procedures (93%). There were 6 episodes of recurrence (25%) following a single embolization procedure, three of which were managed successfully with repeat embolization. There were no complications relating to skin or periarticular ischemia.ConclusionAngiography and embolization is a safe and effective tool for the management of recurrent hemarthrosis of the knee following arthroplasty and should be considered first line treatment following failure of conservative management.Level of evidenceLevel 4, Case Series.

The Effect of Triamcinolone-Soaked Gelfoam in Patients with Polypoid Mucosal Change after Endoscopic Sinus Surgery

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) recurs frequently after endoscopic sinus surgery (ESS). The aim of study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurred polypoid changes after ESS.Subjects and Method: A total of 35 patients and 57 nasal cavities was retrospectively reviewed. All patients underwent triamcinolone- infused gelfoam packing for 1 week under nasal endoscopic guidance. Endoscopic scores were evaluated at 1 week, 1 month, and 3 months. We analyzed clinical characteristics between success and failure groups.Results: Endoscopic scores were significantly improved after triamcinolone-soaked gelfoam packing, and the effects were maintained at 3-month follow-up (1.85±0.61 vs. 0.82±0.77, p＜0.001). Duration between surgery and gelfoam packing was shorter in the success group compared to the failure group (8.2±6.9 vs. 13.7±8.4 weeks, p=0.033). Serum eosinophil cationic protein and tissue eosinophil counts were significantly higher in the failure group (p=0.025 and p=0.010, respectively).Conclusion: Triamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent polypoid change in patients with CRSwNP after ESS. Early intervention contributed to a successful result, and eosinophilic inflammation was associated with poor outcomes.

Poly(lactic acid)/gelatin foams by non-solvent induced phase separation for biomedical applications

Poly (lactic acid)/gelatin foams with porous structures have been prepared by thermally impacted non-solvent induced phase separation. Gelatin, being hydrophilic and biocompatible but non-foamable independently, has been employed as an additive to generate porous patterning in a mechanically stable poly (lactic acid) matrix. The amount of gelatin has been found to influence the crystallinity, which in turn affected the degradation rate of the foams. The presence of gelatin and the porosity within the matrix, generated in situ, have been found to facilitate the controlled release of a hydrophilic drug (metformin hydrochloride). The gelatin modified matrix has also been observed to possess a high degree of biodegradability and cell-viability which makes it ideal for different biomedical applications.