Hemostatic Characteristics Research Articles

Janus-Structured Microgel Barrier with Tissue Adhesive and Hemostatic Characteristics for Efficient Prevention of Postoperative Adhesion.

Postoperative adhesion (POA) is a common and serious complication following various types of surgery. Current physical barriers either have a short residence time at the surgical site with a low tissue attachment capacity or are prone to undesired adhesion formation owing to the double-sided adhesive property, which limits the POA prevention efficacy of the barriers. In this study, Janus-structured microgels (Janus-MGs) with asymmetric tissue adhesion capabilities are fabricated using a novel bio-friendly gas-shearing microfluidic platform. The anti-adhesive side of Janus-MGs, which consists of alginate, hyaluronic acid, and derivatives, endows the material with separation, lubrication, and adhesion prevention properties. The adhesive side provided Janus-MGs with tissue attachment and retention capability through catechol-based adhesion, thereby enhancing the in situ adhesion prevention effect. In addition, Janus-MGs significantly reduced blood loss and shortened the hemostatic time in rats, further reducing adhesion formation. Three commonly used rat POA models with different tissue structures and motion patterns are established in this study, namely peritoneal adhesion, intrauterine adhesion, and peritendinous adhesion models, and the results showed that Janus-MGs effectively prevented the occurrence of POA in all the models. The fabrication of Janus-MGs offers a reliable strategy and a promising paradigm for preventing POA following diverse surgical procedures.

3D Electrospun Nanofiber Sponges of Insect Chitosan/Pullulan/Citric Acid Embedded with ZnMOF in situ for Enhanced Healing of MRSA-Infected Wounds

In biomedicine, one of the major challenges is effectively promoting wound healing of bacterial infections. Current wound dressings (e.g., gauze and bandages) are far from meeting the needs of the population as they lack various bioactivities to promote wound healing (including hemostasis, antimicrobial, anti-inflammatory, promotion of tissue regeneration, etc.) and are not biodegradable. In this study, we prepared an insect chitosan/pullulan/citric acid three-dimensional, layered electrospun nanofiber sponge embedded with ZnMOF in situ (3D-ZnMOF) and used it to promote MRSA-infected wound healing. The fabrication method and physicochemical characteristics of 2D nanofiber membranes and 3D nanofiber sponges were thoroughly assessed. SEM-EDS, XPS, XRD, and FT-IR were used to characterize the 3D-ZnMOF sponges, and the release behavior of zinc ions was examined. Experiments conducted both in vitro and in vivo demonstrated the hemostatic characteristics, biocompatibility, and antibacterial activity of 3D-ZnMOF sponges. 3D-ZnMOF sponges showed the ability to promote wound contraction, accelerate collagen deposition, inhibit inflammatory factors, and promote angiogenesis in an MRSA-infected rat whole-skin wound model. Consequently, 3D-ZnMOF nanofiber sponges offer a great deal of promise for accelerating the healing of wounds infected with drug-resistant bacteria.

Synthesis of hemostatic aerogel of TEMPO-oxidized cellulose nanofibers/collagen/chitosan and in vivo/vitro evaluation

The treatment of internal hemorrhage remains challenging due to the current limited antibacterial capability, hemostatic efficacy, and biocompatibility of hemostatic materials. The TEMPO-oxidized cellulose nanofibers/collagen/chitosan (TCNF/COL/CS) hemostatic aerogel was developed in this work by physically encasing COL in a sandwich structure and electrostatically self-assembling polyanionic TCNF with polycationic CS. In vitro coagulation experiments revealed the favorable procoagulant properties of TCNF/COL/CS along with high adhesion to erythrocytes and platelets. TCNF/COL/CS significantly increased the hemostatic efficacy by 59.8 % and decreased blood loss by 62.2 % in the liver injury model when compared to Surgicel®, the most frequently used hemostatic material. Furthermore, it demonstrated outstanding biodegradability both in vitro and in vivo, and a substantial increase in resistance (96.8 % against E. coli and 95.4 % against S. aureus) compared to TCNF. The significant hemostatic and biodegradable characteristics of TCNF/COL/CS can be ascribed to its interconnected porous structure, increased porosity, and efficient water absorption, along with the synergistic effect of the three constituents. The TCNF/COL/CS aerogel shows significant potential to control internal bleeding. A novel plant-derived nanocellulose composite aerogel has been described here for the first time; it has outstanding antibacterial characteristics, higher biocompatibility, and outstanding hemostatic characteristics in vivo.

Advancing Bioactive Material for Mandibular Bone Regeneration: Transformation of Fibrous Mat into 3D Matrix Cotton for Enhanced Shape Retention and Rapid Hemostasis.

Transformation of a fibrous mat into a three-dimensional (3D) scaffold opens up abundant innovative prospects in biomedical research, particularly for studying both soft as well as hard tissues. Electrospun nanofibers, which mimic the extracellular matrix have attracted significant attention in various studies. This research focuses on rapidly converting a fibrous mat made of polycaprolactone (PCL)/pluronic F-127 (PF-127) with different percentages of monetite calcium phosphate (MCP) into desirable 3D matrix cotton using a unique gas foaming technology. These matrix cottons possess biomimetic properties and have oriented porous structures. Using this innovative technique, various shapes of 3D matrix cotton, such as squares, hollow tubes, and other customizable forms, were successfully produced. Importantly, these 3D matrix cottons showed a consistent distribution of monetite particles with total porosity ranging from 90% to 98%. The structure of the 3D matrix cotton, its water/blood absorption capacity, the potential for causing non-hemolysis, and rapid hemostatic properties were thoroughly investigated. Additionally, periodontal cells were cultured on the 3D matrix cotton to assess their viability and morphology, revealing promising results. Furthermore, a coculture study involving NIH-3T3 and MG-63 cells on the 3D matrix cotton showed spheroidal formation within 24 h. Notably, in vitro assessments indicated that the matrix cotton containing 15% monetite (PCL-MMC15%) exhibited superior absorbent capabilities, excellent cell viability, and rapid hemostatic characteristics. Subsequently, the effectiveness of PCL-MMC15% in promoting mandibular bone regeneration was evaluated through an in vivo study on rabbits using a mandibular injury model. The results demonstrated that PCL-MMC15% facilitated the resolution of defects in the mandibular region by initiating new bone formation. Therefore, the presented 3D matrix cotton (PCL-MMC15%) shows significant promise for applications in both mandibular bone regeneration and hemostasis.

Activities of polysaccharide fractions from corn silk: Hemostatic, immune, and anti-lung cancer potentials

Corn silk is the stigma and style of corn and is rich in polysaccharides. Despite the extensive research on its polysaccharides, the hemostatic characteristics of effective parts and the related activities remain insufficiently explored. Corn silk polysaccharide (CSP) was extracted with hot water and purified using a diethylaminoethyl cellulose membrane. Then, it was separated with sephadex G-150 to obtain five fractions. These fractions were investigated for their potential in hemostasis, antioxidant, immune response, and anti-lung cancer activities. CSP-2, CSP-3, and CSP-4 significantly affected the coagulation indicators activated partial thromboplastin time (APTT) and thrombin time (TT) at 125–500 μg/mL. Corn silk flavonoids and saponins at 32.25 μg/mL significantly prolonged APTT, TT, and prothrombin time (PT). CSP-2, with potent antioxidant ability, approaches Vitamin C. At 25 μg/mL, CSPs nearly reached the phagocytosis of neutral red of lipopolysaccharides. The five fractions promoted the proliferation of RAW264.7 cells at 25–800 μg/mL and stimulated NO secretion at 25–100 μg/mL. CSP-2 also showed an 86 % inhibition rate effect on A549 at 200 μg/mL. These results indicate that CSP not only has hemostatic effects but also has immune and anti-lung cancer activities. Thus, it is a potential candidate compound with immune activity for managing bleeding in cancer.

A double cross-linked anisotropic quaternized chitosan/sodium alginate-based wound dressing for rapid drainage of biofluids

Excessive biofluid around wounds can cause infection and prevent healing. In this study, an anisotropic quaternized chitosan (QC)/sodium alginate (AL)-based aerogel wound dressing was prepared via a directional freeze-drying technique inspired by the channel structure used for water transport in trees. The aligned channels provided the dressing with self-pumping ability, allowing it to rapidly and completely remove biofluids and absorb biofluids up to 1292.5 % of its own weight. To enhance the strength of the dressing, a double cross-linked network was constructed based on the QC-AL electrostatic attraction and AL-Ca2+ chelation interaction. The axial compressive strength of the double cross-linked dressing reached 207.3 kPa (ε = 50 %). In addition, the dressing exhibited strong conductive properties (conductivity = 13.0 S/m), antioxidant activities [reactive oxygen species (ROS) scavenging ability = 88.0 %], and hemostatic characteristics (blood coagulation index = 1.8 %). The dressing also exhibited powerful antibacterial performance, exhibiting over 98.0 % inhibition of E. coli and S. aureus. Experiments on diabetic mouse models revealed that the dressing considerably promoted wound healing. On day 3, the wound healing rate was 96.7 % faster in the QAC group than in the gauze group. Therefore, the developed dressing may have great potential for chronic wound care.

CLINICAL-EXPERIMENTAL ЕVALUATION OF THE TOPICAL HEMOSTATIC EFFECT CAPROFER IN THE PRACTICE OF ORAL SURGERY

Sufficient hemostasis during oral surgical procedures is crucial for successful outcomes, can play a key role in establishing hemostasis and to reduce healthcare resource utilization. The search for a topical hemostatic drug that gives the desired effects has led to the need to develop a new substance based on a chemical compound with excellent hemostatic properties. This study is aimed at experimental and clinical evaluation of effectiveness as a topical hemostatic Caprofer and their impact on ease of operation in clinical dental practice. Based on the obtained clinical and experimental material, it is possible to come to an objectively justified conclusion about the high therapeutic efficacy topical hemostatic Caprofer which allows its widespread use as a therapeutic and prophylactic agent for bleeding and inflammation of the maxillofacial region. Caprofer, which has a hemostatic action, is used as in prophylactic, as well as in medical purposes in case of post-surgical bleeding in the oral cavity, creates favorable conditions for wound healing characteristics, characterized by a pronounced advantage over hemostatic amy analogous local action, expressed in instantly developing hemo static effect after its application to a bleeding wound. Along with distinct hemostatic characteristics, there were so, that the caprofer favorably differs and its high antimicrobial, antioxidant and anti-inflammatory action. Based on сlinical-experimental studies, we present the possibility of confirm these properties of the drug.

The hemostatic profile of cold-stored whole blood from non-greyhound and greyhound dogs over 42 days

To compare the hemostatic characteristics of cold-stored whole blood (CSWB) from non-greyhound dogs (NGD) and greyhound dogs (GD) over 42 days of storage, notably, platelet closure time (PCT) (NGD only), manual platelet count (PLT) (GD only), ellagic acid (INTEM) and tissue factor activated (EXTEM) rotational thromboelastometry, prothrombin (PT) and activated partial thromboplastin time (aPTT), fibrinogen concentration (FIB), and the activities of factors (F) FII, FV, FVII, FVIII, FIX, FX, FXIII antigen (FXIII:Ag), and von Willebrand factor antigen (vWF:Ag). Whole blood from 10 NGD and 10 GD, was refrigerated in CPD blood bags at 4°C for 42 days. Blood was analyzed before refrigeration (day 0) and at day 1 (d1), 3, 5, 7, 10, 14, 17, 21, 24, 28, 31, 35, 38, and 42. Multivariate linear mixed effects models were created to evaluate coagulation parameters over time and compare NGD and GD. Data are summarized as estimated marginal means with 95% confidence intervals. Significance was set at P < 0.05. The PCT for all NGD CSWB was above the device limit by d7. The PLT for GD CSWB did not change during storage. The mean alpha-angle for INTEM and EXTEM decreased to <50% of baseline at d38 and d31 for NGD, and d31 and d17 for GD CSWB. The mean maximum clot firmness (MCF) for INTEM and EXTEM reduced to <50% of baseline at d42 and d28 for both GD and NGD. PT and aPTT for NGD and GD increased over time. For NGD CSWB, the mean FVIII and vWF:Ag activities decreased to <50% of baseline at d7 and d28, respectively, and FIB reached 0.982 g/dL by d24. For GD CSWB, FVIII, FXIII:Ag and FV activities decreased to <50% of baseline by d3, d38, and d38, respectively, and FIB was 0.982 g/dL at baseline. Alpha-angle and MCF for both INTEM and EXTEM, and activities for FII, FV, FIX, FXIII:Ag were significantly lower, and vWF:Ag was significantly higher overall in GD CSWB compared with NGD. A significant difference in the pattern of change over time was detected between NGD and GD in EXTEM alpha-angle, INTEM and EXTEM MCF, FII, and FVIII activities. The in vitro viscoelastic parameters of GD and NGD CSWB declines over 42 days, but numerous hemostatic parameters (INTEM and EXTEM alpha-angle and MCF, activity of FII, FV, FV, FVII, FIX, FX, FXIII:Ag, vWF:Ag, and FIB) remain within 50% of baseline for more than 14 days. CSWB from GD compared to NGD has reduced hemostatic activity overall, but a similar pattern of decline for most parameters over time.

Interpenetrating network expansion sponge based on chitosan and plasma for ultrafast hemostasis of arterial bleeding wounds

Preventing arterial hemorrhage by intervening within the first few minutes is critical to the patient's life. Hemostatic materials have been developed over the last decades to address this issue, nevertheless these materials alone do not contribute to improve the survival effects in many extreme conditions, which is usually caused by penetrating arterial bleeding wounds that are incompressible and deep arterial bleeding with irregularly shapes. It is well known that, after calcium ion stimulation, many intriguing changes occurred in the major components of plasma, including the activation of several coagulation factors, such as the conversion of fibrinogen to fibrin, prothrombin to thrombin, and so on. Therefore, we constructed an expansion sponge with interpenetrating network based on chitosan and plasma, while various activated coagulation factors in plasma were also loaded into the pore structure of chitosan sponges. The prepared CS-PG sponge is capable of providing a simpler and more efficient method for treating high-pressure arterial bleeding wounds, which includes three steps: Rapid sealing and adhension, Thrombin catalysis and Activated autocoagulation. As the next generation bioactive materials, compared to conventional hemostatic materials, CS-PG sponge demonstrated superior hemostatic characteristics in both rabbit femoral artery damage and rat liver injury models.

Physiological features of platelet hemostasis in calves during the phase of plant nutrition, kept in the ecological conditions of central Russia

During the final phase of early ontogenesis in calves, there is a low activity of lipid peroxidation, pronounced antioxidant protection of platelets, an increase in the intensity of the actin-myosin complex, a significant content of adenosine phosphates in their granules and their intensive secretion under conditions of platelet activation. In calves during the phase of plant nutrition, there was a tendency to increase the hemostatic capacity of platelets, assessed in vitro and in vivo. A certain increase in platelet aggregation and secretion found in calves during the phase of plant nutrition is apparently caused by regular age-related changes in the implementation of post-receptor processes in their platelets, which ensure an increase in their hemostatic characteristics in the conditions of completion of growth and development of their body.

A look into hemostatic characteristics during pediatric liver transplantation using the thromboelastometry (ROTEM® ) test.

There is a paucity of evidence about the coagulation profile regarding the complexity of children undergoing liver transplantation (LT). This study aimed to investigate intraoperative hemostatic changes during pediatric LT according to the etiology for LT and examine the ability of rotational thromboelastometry (ROTEM® , TEM International GmbH, Munich, Germany) as a point-of-care monitoring method. We evaluated 106 patients aged 3months to 17years undergoing LT for acute liver failure (ALF) and chronic liver disease, which consists of patients with cholestatic disease, metabolic/genetic disease, and cancer. A total of 731 ROTEM® measurements, including 301 ellagic acid to initiate clotting via the intrinsic pathway, 172 tissue factor to initiate the extrinsic clotting cascade (EXTEM), and 258 cytochalasin D to inhibit platelet activity reflecting fibrinogen (FIBTEM), were analyzed at predetermined time points (the preanhepatic, anhepatic, and postreperfusion phases). We simultaneously conducted conventional coagulation tests. In children with ALF, preanhepatic measurements of conventional coagulation tests and ROTEM® showed a more hypocoagulable state than other diseases. During LT, the coagulation profile was deranged, with a prolonged clotting time and reduced clot firmness, changes that were more profound in the cholestatic disease group. Maximum clot firmness (MCF) on EXTEM and FIBTEM were well correlated with the platelet count and fibrinogen concentration (r=0.830, p<0.001 and r=0.739, p<0.001, respectively). On the EXTEM, MCF with 30mm predicted a platelet count <30,000/mm3 (area under the curve, 0.985), and 6mm predicted a fibrinogen concentration <100mg/dl on the FIBTEM (area under the curve, 0.876). However, the activated partial thromboplastin time and prothrombin time were significant but only weakly correlated with the clotting time on the ROTEM® . In children undergoing LT, coagulation profiles depend on the etiology for LT. During LT, ROTEM® parameters could help detect thrombocytopenia and hypofibrinogenemia and guide transfusion therapy as a point-of-care monitoring method.

Post-Covid-19 Hemostatic Characteristics of Convalescent Patients: The Bergamo Experience

Introduction: Severe COVID-19 patients present with a hypercoagulable state, complement activation and endothelial perturbation, which result from an excessive inflammatory response. Thromboinflammation is one important mechanism underlying the COVID-19-associated coagulopathy and the increased risk of thrombosis. Bergamo city is one of the first and most affected area by SARS-CoV-2 infection in the world. For this reason, since the beginning we were actively involved in recruiting convalescent COVID-19 patients, in a program of selection of candidates for convalescent plasma donation. In a large cohort of convalescent COVID-19 patients, we aimed to characterize markers of coagulation activation and endothelial perturbation, in order to explore whether the COVID-19-related hemostasis activation might persist afterwards and evaluate its possible association with the degree of severity of the previous infection, and/or with demographic characteristics, or anti-SARS-CoV-2 antibody levels.Methods: In 392 convalescent COVID-19 patients (216M/176F, median age: 46 years) plasma levels of fibrinogen, protein C, protein S, factor V, factor VIII, factor XIII, D-dimer, von Willebrand factor (vWF), prothrombin fragment F1+2 were measured at the recruitment, i.e. 1-5 months from recovery. Samples were tested for the anti-SARS-CoV-2 antibodies, including anti-S IgG (Anti-S Ab) and anti-N IgG (Anti-N Ab) antibodies at enrollment and at each scheduled subsequent visits.Results: Levels of fibrinogen, D-dimer, von Willebrand factor, protein S and protein C were significantly higher (p<0.05) in patients who were hospitalized for severe COVID-19 as compared to patients who were treated at home. There was no correlation between levels of coagulation biomarkers and days from end of symptoms. Male gender, age > 40 years, and severe form of COVID-19 were identified as independent predictors of high levels of both anti-S and anti-N Ab (p<0.001). Among hemostatic biomarkers, fibrinogen (p<0.01) and vWF (p<0.05) independently predict high levels of anti-S Ab. In particular, vWF levels positively correlated with anti-S Ab levels (vWF-antigen r=0.188; vWF-activity r=0.241 and vWF-RiCof r=0.223, p<0.01). Evaluation of anti-SARS-CoV2 antibody levels at different time points during follow up revealed that 30% of patients displayed high levels of anti-S Ab until more than 8 months from the end of symptoms.Conclusions: Convalescent patients, with a history of severe COVID-19 had a persistent endothelium activation, despite of disease clinical remission even after 9 months from end of symptoms. Furthermore, fibrinogen and vWF levels predicted high levels of Anti-S Ab. Among demographic characteristics, gender, age and severe disease can be predictors of increased antibody response. These findings suggest that inflammation, coagulation and endothelial dysfunction may persist after recovery and may explain the findings of persistent clinical symptoms reported in these patients after healing from COVID-19. DisclosuresFalanga: Bayer: Honoraria; Leo Pharma: Honoraria; Pfizer: Honoraria; Sanofi: Honoraria.

Rapid Whole Blood Clot Retraction Assay on Quartz Crystal Microbalance

This letter demonstrates, for the first time, a novel, rapid automated whole blood clot retraction assay utilizing quartz crystal microbalance resonant frequency monitoring. Tissue factor is selected to initiate coagulation. The test turnaround time is 10–20 min, during which a real-time coagulation trace is recorded in parallel with a reference coagulation trace. The reference sample is the same blood sample that is treated by platelet aggregation inhibitor, and the difference between the two traces indicates the quantitative platelet effect on clotting. This differential approach enables determination of a hematocrit-independent parameter characterizing the intensity of clot retraction. In the case of samples with normal hemostatic characteristics, the intensity of retraction is a linear function of platelet count, whereas the retraction is reduced in the case of platelet hypofunction. Moreover, in combination with a clotting time parameter derived from the same coagulation trace, the method allows primary differentiation between three groups of bleeding disorders of various etiology, including platelet disorders, defects in plasma factors, and hypofibrinogenaemia.

The immune potential of ex vivo stored platelets: a review.

Platelets are now acknowledged as key regulators of the immune system, as they are capable of mediating inflammation, leucocyte recruitment and activation. This activity is facilitated through platelet activation, which induces significant changes in the surface receptor profile and triggers the release of a range of soluble biological response modifiers (BRMs). In the field of transfusion medicine, the immune function of platelets has gained considerable attention as this may be linked to the development of adverse transfusion reactions. Further, component manufacturing and storage methodologies may impact the immunoregulatory role of platelets, and an understanding of this impact is crucial and should be considered alongside their haemostatic characteristics. This review highlights the key interactions between platelets and traditional immune modulators. Further, the potential impact of current and novel component storage methodologies, such as refrigeration and cryopreservation, on this functional capacity is examined, highlighting why further knowledge in this area would be of benefit.

Hemostatic characteristics of thawed, pooled cryoprecipitate stored for 35 days at refrigerated and room temperatures.

Cryoprecipitate's shelf life is limited due to concerns over decreased clotting factor activity and contamination with extended storage. Hemostatic characteristics of thawed cryoprecipitate stored up to 35 days at refrigerated and room temperatures were assessed. Pooled cryoprecipitate was thawed and aliquoted for storage at 1-6°C or 21-24°C. Samples were tested immediately after thawing and at 4 h, 24 h, 72 h, and weekly for 35 days. At each time point fibrinogen, factor VIII (FVIII), and von Willebrand factor (vWF) were assessed. Thrombin generation and rotational thromboelastometry (ROTEM) were also performed. Further, packed red cells, platelet concentrates, frozen plasma, and stored cryoprecipitate were combined (1:1:1:1) to simulate massive transfusion and analyzed by ROTEM. Day 35 samples were cultured for bacterial contamination. Precipitation was observed in refrigerated samples; however, these aggregates were easily resuspended upon warming in a 37°C water bath. No significant changes were observed in fibrinogen concentration or ROTEM at either temperature. FVIII and vWF declined significantly during storage. vWF, clot time, and thrombin generation were significantly better preserved with refrigeration. With simulated massive transfusion, fibrinogen function remained at or above the established range for whole blood at both storage temperatures. Bacterial contamination was not observed in cold stored or room temperature cryoprecipitate. The fibrinogen concentration and function of cryoprecipitate at extended storage durations are adequate for fibrinogen replacement in critical bleeding. These results support extension of the shelf life of cryoprecipitate when used for fibrinogen replacement.

Expanding Hydrophobically Modified Chitosan Foam for Internal Surgical Hemostasis: Safety Evaluation in a Murine Model

BackgroundA novel injectable expanding foam based on hydrophobically modified chitosan (HM-CS) was developed to improve hemostasis during surgeries. HM-CS is an amphiphilic derivative of the natural biopolymer chitosan (CS); HM-CS has been shown to improve the natural hemostatic characteristics of CS, but its internal safety has not been systematically evaluated. The goal of this study was to compare the long-term in vivo safety of HM-CS relative to a commonly used fibrin sealant (FS), TISSEEL (Baxter). MethodsSixty-four Sprague–Dawley rats (275-325 g obtained from Charles River Laboratories) were randomly assigned to control (n = 16) or experimental (n = 48) groups. Samples of the test materials (HM-CS [n = 16], CS [n = 16], and FS [n = 16]) applied to a nonlethal liver excision (0.4 ± 0.3 g of the medial lobe) in rats were left inside the abdomen to degrade. Animals were observed daily for signs of morbidity and mortality. Surviving animals were sacrificed at 1 and 6 wk; the explanted injury sites were microscopically assessed. ResultsAll animals (64/64) survived both the 1- and 6-wk time points without signs of morbidity. Histological examination showed a comparable pattern of degradation for the various test materials. FS remnants and significant adhesions to neighboring tissues were observed at 6 wk. Residual CS and HM-CS were observed at the 6 wk with fatty deposits at the site of injury. Minimal adhesions were observed for CS and HM-CS. ConclusionsThe internal safety observed in the HM-CS test group after abdominal implantation indicates that injectable HM-CS expanding foam may be an appropriate internal use hemostatic candidate.

National experts consensus on clinical application of collagen-based wound biomaterials (2018 version)

Collagen, as the main structural protein in human body, plays an important role in the wound healing process. Due to their inherent hemostatic characteristics, good biocompatibility, low immunogenicity, as well as controllable biodegradability, collagen-based materials have attracted much attention. In this article, we mainly introduce the characteristics of collagen-based wound biomaterials and the application mechanism as scaffold and wound dressing. And the standard and unified experts' consensus formed on the clinical indications, recommended applications, contraindications, and matters needing attention. The consensus wound help clinicians and patients to recognize collagen-based wound biomaterials correctly and use them rationally.

National experts consensus on clinical application of collagen-based wound biomaterials (2018 version)

Collagen, as the main structural protein in human body, plays an important role in the wound healing process. Due to their inherent hemostatic characteristics, good biocompatibility, low immunogenicity, as well as controllable biodegradability, collagen-based materials have attracted much attention. In this article, we mainly introduce the characteristics of collagen-based wound biomaterials and the application mechanism as scaffold and wound dressing. And the standard and unified experts' consensus formed on the clinical indications, recommended applications, contraindications, and matters needing attention. The consensus wound help clinicians and patients to recognize collagen-based wound biomaterials correctly and use them rationally.

Transpapillary endopancreatic surgery: decompression of duct system and comparison of greenlight laser with monopolar electrosurgical device in ex vivo and in vivo animal models.

Endopancreatic surgery (EPS) is an experimental minimally invasive technique for resection of pancreatic tissue from inside the pancreatic duct, accessed via the duodenum and papilla. It is proposed as an alternative to duodenum-preserving pancreatic head resection in benign diseases such as chronic pancreatitis (CP). This study evaluated the use of EPS for resection of pancreatic duct stenoses. Moreover, greenlight laser (GLL) and monopolar electrosurgical device (MES) were compared as resection tools for EPS. The suitability of EPS for resection of stenoses was evaluated in ex vivo bovine pancreas (n = 8). Artificially created stenoses in the pancreatic head were accessed via the duodenal papilla and resected from inside the organ with MES through a rigid endoscope. Furthermore, standardized pancreatic resections were performed in an in vivo porcine model using either GLL (n = 18) or MES (n = 18) to compare blood loss, operating time, and complications. Thermal damage to the surrounding tissue was assessed using a standardized histological classification. Stenosis resection by EPS was feasible in 8/8 bovine pancreases, with a procedure time of 17 (12-24) min. No perforation of the organ occurred. Resection by GLL was associated with reduced blood loss [median 1.7 (interquartile range 0.6-2.6) ml vs. 5.1 (3.8-13.2) ml; p < 0.01] and shorter operating time [109 (81-127) s vs. 390 (337-555) s; p < 0.01] compared with MES. The zone of thermal tissue damage was more extensive when using GLL than with MES [4.12 (3.48-4.89) mm vs. 1.33 (1.09-1.48) mm; p < 0.01]. Transduodenal-transpapillary EPS can be used to resect stenoses and decompress the pancreatic duct system. Both GLL and MES are feasible resection methods for EPS. However, GLL showed better hemostatic characteristics than MES in an in vivo porcine model. Safety measures such as temperature control and image-guided navigation should be employed to monitor the resection and tissue heating.

317 - Clinical and Hemostatic Characteristics of Patients With Ventricular Assist Device Thrombosis

317 - Clinical and Hemostatic Characteristics of Patients With Ventricular Assist Device Thrombosis