Hemostasis mechanism and applications of N-alkylated chitosan sponge

Aloesin-loaded chitosan/cellulose-based scaffold promotes skin tissue regeneration

Skin wound healing and regeneration is very challenging across the world as simple or acute wounds can be transformed into chronic wounds or ulcers due to foreign body invasion, or diseases like diabetes or cancer. The study was designed to develop a novel bioactive scaffold, by loading aloesin to chitosan-coated cellulose scaffold, to cure full-thickness skin wounds. The physiochemical characterization of the scaffold was carried out using scanning electron microscopy (SEM) facilitated by energy-dispersive spectrophotometer (EDS), atomic force microscopy (AFM), and Fourier transform infrared spectroscopy (FTIR). The results indicated the successful coating of chitosan and aloesin on cellulose without any physical damage. The drug release kinetics confirmed the sustained release of aloesin by showing a cumulative release of up to 88 % over 24 h. The biocompatibility of the aloesin-loaded chitosan/cellulose (AlCsCFp) scaffold was evaluated by the WST-8 assay that confirmed the significantly increased adherence and proliferation of fibroblasts on the AlCsCFp scaffold. The in vivo wound healing study showed that both 0.05 % and 0.025 % AlCsCFp scaffolds have significantly higher wound closure rates (i.e. 88.2 % and 95.6 % approximately) as compared to other groups. This showed that novel composite scaffold has a wound healing ability. Furthermore, histological and gene expression analysis demonstrated that the scaffold also induced cell migration, angiogenesis, re-epithelialization, collagen deposition, and tissue granulation formation. Thus, it is concluded that the aloesin-loaded chitosan/cellulose-based scaffold has great therapeutic potential for being used in wound healing applications in the clinical setting in the future.

Expansion-clotting chitosan fabrics based on unidirectional fast-absorption fibers for rapid hemorrhage control

The rapid absorption of water from the blood to concentrate erythrocytes and platelets, thus triggering quick closure, is important for hemostasis. Herein, expansion-clotting chitosan fabrics are designed and fabricated by ring spinning of polylactic acid (PLA) filaments as the core layer and highly hydrophilic carboxyethyl chitosan (CECS) fibers as the sheath layer, and subsequent knitting of obtained PLA@CECS core spun yarns. Due to the unidirectional fast-absorption capacity of CECS fibers, the chitosan fabrics can achieve erythrocytes and platelets aggregate quickly by concentrating blood, thus promoting the formation of blood clots. Furthermore, the loop structure of coils formed in the knitted fabric can help them to expand by absorbing water to close their pores, providing effective sealing for bleeding. Besides, They have enough mechanical properties, anti-penetrating ability, and good tissue-adhesion ability in wet conditions, which can form a physical barrier to resist blood pressure during hemostasis and prevent them from falling off the wound, thus enhancing hemostasis synergistically. Therefore, the fabrics exhibit superior hemostatic performance in the rabbit liver, spleen, and femoral artery puncture injury model compared to the gauze group. This chitosan fabric is a promising hemostatic material for hemorrhage control.

Recent advances of chitosan as a hemostatic material: Hemostatic mechanism, material design and prospective application

Uncontrolled hemorrhage arising from surgery or trauma may cause morbidity and even mortality. Therefore, facilitating control of severe bleeding is imperative for health care worldwide. Among diverse hemostatic materials, chitosan (CS) is becoming the most promising material owing to its non-toxic feature, as well as inherently hemostatic performance. However, further enhancing hemostatic property of CS-based materials without compromising more beneficial functions remains a challenge. In this review, representative hemostatic mechanisms of CS-based materials are firstly discussed in detail, mostly including red blood cells (RBCs) aggregation, platelet adherence and aggregation, as well as interaction with plasma proteins. Also, various forms (involving powder/particle, sponge, hydrogel, nanofiber, and other forms) of CS-based hemostatic materials are systematically summarized, mainly focusing on their design and preparation, characteristics, and comparative analysis of various forms. In addition, varied hemostatic applications are described in detail, such as skin wound hemostasis, liver hemostasis, artery hemostasis, and heart hemostasis. Finally, current challenges and future directions of functional design of CS-based hemostatic materials in diverse hemostatic applications are proposed to inspire more intensive researches.

Chemical modification of chitosan for developing of new hemostatic materials: A review

Uncontrolled bleeding that occurs during surgery, trauma, and in combat conditions is critical and require immediate action. Chitosan is a polysaccharide, obtained from natural sources with unique biological properties. It is often used as basis for local hemostatic agents (LHA). We summarized the data on hemostatic properties of chitosan, commercially available chitosan-based products with focus in the field of chemical modification of chitosan. Various approaches are used to enhance hemostatic activity of chitosan-based materials. The approach with chemical modification of chitosan allows changing the properties of the polymer in order to obtain an active macromolecule that contributes to hemostasis. Ongoing research on the mechanism of interaction with blood components in the case of different chitosan derivatives will make it possible to identify promising directions for chemical modification to obtain an effective LHA.

Strategy of targeting the tumor microenvironment via inhibition of fibroblast/fibrosis remodeling new era to cancer chemo-immunotherapy resistance

The use of repurposing drugs that may have neoplastic and anticancer effects increases the efficiency and decrease resistance to chemotherapy drugs through a biochemical and mechanical transduction mechanisms through modulation of fibroblast/fibrosis remodeling in tumor microenvironment (TME). Interestingly, fibroblast/fibrosis remodeling plays a vital role in mediating cancer metastasis and drug resistance after immune chemotherapy. The most essential hypothesis for induction of chemo-immunotherapy resistance is via activation of fibroblast/fibrosis remodeling and preventing the infiltration of T cells after is mainly due to the interference between cytoskeleton, mechanical, biochemical, metabolic, vascular, and remodeling signaling pathways in TME. The structural components of the tumor that can be targeted in the fibroblast/fibrosis remodeling include the depletion of the TME components, targeting the cancer-associated fibroblasts and tumor associated macrophages, alleviating the mechanical stress within the ECM, and normalizing the blood vessels. It has also been found that during immune-chemotherapy, TME injury and fibroblast/fibrosis remodeling causes the up-regulation of inhibitory signals and down-regulation of activated signals, which results in immune escape or chemo-resistance of the tumor. In this regard, repurposing or neo-adjuvant drugs with various transduction signaling mechanisms, including anti-fibrotic effects, are used to target the TME and fibroblast/fibrosis signaling pathway such as angiotensin 2, transforming growth factor-beta, physical barriers of the TME, cytokines and metabolic factors which finally led to the reverse of the chemo-resistance. Consistent to many repurposing drugs such as pirfenidone, metformin, losartan, tranilast, dexamethasone and pentoxifylline are used to decrease immune-suppression by abrogation of TME inhibitory signal that stimulates the immune system and increases efficiency and reduces resistance to chemotherapy drugs. To overcome immunosuppression based on fibroblast/fibrosis remodeling, in this review, we focus on inhibitory signal transduction, which is the physical barrier, alleviates mechanical stress and prevents mechano-metabolic activation.

Rational Design of Bioactive Materials for Bone Hemostasis and Defect Repair

Everyday unnatural events such as trauma, accidents, military conflict, disasters, and even medical malpractice create open wounds and massive blood loss, which can be life-threatening. Fractures and large bone defects are among the most common types of injuries. Traditional treatment methods usually involve rapid hemostasis and wound closure, which are convenient and fast but may result in various complications such as nerve injury, deep infection, vascular injury, and deep hematomas. To address these complications, various studies have been conducted on new materials that can be degraded in the body and reduce inflammation and abscesses in the surgical area. This review presents the latest research progress in biomaterials for bone hemostasis and repair. The mechanisms of bone hemostasis and bone healing are first introduced and then principles for rational design of biomaterials are summarized. After providing representative examples of hemostatic biomaterials for bone repair, future challenges and opportunities in the field are proposed.

Alkylated chitosan-attapulgite composite sponge for rapid hemostasis

This study reported the development of a composite sponge (ACATS) based on alkylated chitosan (AC) and attapulgite (AT) for rapid hemostasis. The well-designed ACATS, with an optimal AC N-alkylation of 5.9 % and an optimal AC/AT mass ratio of 3:1, exhibited a hierarchical porous structure with a favorable biocompatibility. The ACATS can effectively and rapidly stop the uncontrolled bleeding in 235 ± 64 s with a total blood loss of 8.4 ± 4.0 g in comparison with those of Celox as a positive control (602 ± 101 s and 22.3 ± 2.4 g, respectively) using rabbit carotid artery injury model in vivo. ACATS could rapidly interact with blood and its components, including platelets (PLs), red blood cells (RBCs), and coagulation factors, resulting in these blood components rapidly accumulation and the following thrombus formation and coagulation factors activation.

An aminocaproic acid-grafted chitosan derivative with superior antibacterial and hemostatic properties for the prevention of secondary bleeding

Uncontrolled bleeding is one of the leading causes of human mortality. Existing hemostatic materials or techniques cannot meet the clinical requirements for safe and effective hemostasis. The development of novel hemostatic materials has always been of great interest. Chitosan hydrochloride (CSH), a derivative of chitin, is extensively used on wounds as an antibacterial and hemostatic agent. However, the formation of intra- or intermolecular hydrogen bonds between hydroxyl and amino groups limits its water solubility and dissolution rate and affects its effectiveness in promoting coagulation. Herein, we covalently grafted aminocaproic acid (AA) to the hydroxyl and amino groups of CSH via ester and amide bonds, respectively. The solubility of CSH in water (25 °C) was 11.39 ± 0.98 % (w/v), whereas the AA-grafted CSH (CSH-AA) reached 32.34 ± 1.23 % (w/v). Moreover, the dissolution rate of CSH-AA in water was 6.46 times higher than that of CSH. Subsequent studies proved that CSH-AA is non-toxic, biodegradable, and has superior antibacterial and hemostatic properties to CSH. Additionally, anti-plasmin activity can be exerted by the dissociated AA from the CSH-AA backbone, which can help to lessen secondary bleeding.

Advances in haemostatic sponges: Characteristics and the underlying mechanisms for rapid haemostasis

In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk of complications and surgical failure. High expansion sponges are effective clinical practice for the treatment of wound bleeding (irregular/deep/narrow) that are caused by capillaries, veins and even arterioles as they possess a high liquid absorption ratio so can absorb blood platelets easily in comparison with traditional haemostasis treatments, which involve compression, ligation, or electrical coagulation etc. When in contact with blood, haemostatic sponges can cause platelet adhesion, aggregation, and thrombosis, preventing blood from flowing out from wounds, triggering the release of coagulation factors, causing the blood to form a stable polymerized fibre protein, forming blood clots, and achieving the goal of wound bleeding control. Haemostatic sponges are found in a variety of shapes and sizes. The aim of this review is to facilitate an overview of recent research around haemostatic sponge materials, products, and technology. This paper reviews the synthesis, properties, and characteristics of haemostatic sponges, together with the haemostasis mechanisms of haemostatic sponges (composite materials), such as chitosan, cellulose, gelatin, starch, graphene oxide, hyaluronic acid, alginate, polyethylene glycol, silk fibroin, synthetic polymers silver nanoparticles, zinc oxide nanoparticles, mesoporous silica nanoparticles, and silica nanoparticles. Also, this paper reviews commercial sponges and their properties. In addition to this, we discuss various in-vitro/in-vivo approaches for the evaluation of the effect of sponges on haemostasis.

Risk factors for death in hospitalized COVID-19 patients in Africa: A systematic review and meta-analysis

BACKGROUND

The coronavirus disease 2019 has quickly spread worldwide since it first appeared in Wuhan, China, in late 2019. The most affected country in Africa was South Africa. This study aimed to identify the risk factors for death in hospitalized COVID-19 patients in Africa.

METHODS

We conducted a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched articles from the following database: PubMed, Embase, Cochrane Library, Medline, and COVID-19 Research Database. We used Google Scholar for gray literature. The language used in this article was English. The last search was conducted on January 15, 2023. Pooled HRs, or ORs, and 95% confidence intervals, were calculated separately to identify the risk factors for death in hospitalized COVID-19 patients. Heterogeneity was assessed by Cochran's Q statistic and the I2 test. The Egger test was used to assess publication bias. Subgroup analysis was performed to determine the source of heterogeneity. Data analysis was performed using Stata version 17. A P value < .05 was considered significant.

RESULTS

A total of 16,600 articles were obtained from the database search; finally, 16 articles met the inclusion criteria and were eligible for data extraction. The analysis revealed that the pooled prevalence of mortality in hospitalized COVID-19 patients was 13.9%. Advanced age was a significant risk factor for death in hospitalized COVID-19 patients, with the pooled coronavirus mortality HR and OR being 3.73 (95% CI: 2.27-5.19) and 1.04 (95% CI: 1.02-1.06), respectively. In addition, male gender (pOR 1.23; 95% CI: 1.07-1.40), patients with diabetes mellitus (DM) (pOR 1.26; 95% CI: 1.01-1.51), hypertension (HTN) (pOR 1.56; 95% CI: 1.27-1.85), chronic kidney disease (CKD) (pHR 5.43; 95% CI: 0.18-10.67), severe or critical conditions (pOR 9.04; 95% CI: 3.14-14.94) had a significantly increased risk of coronavirus-related mortality. The main limitations of the present study stem from the predominant use of published studies, which could introduce publication bias.

CONCLUSION

According to this study, advanced age, male gender, hypertension, diabetes mellitus, chronic kidney disease, and severe or critical condition were clinical risk factors associated with death outcomes in hospitalized COVID-19 patients in Africa.

Silk composite interfacial layer eliminates rebleeding with chitosan-based hemostats

Chitosan foams are among the approved hemostats for pre-hospital hemorrhagic control but suffer from drawbacks related to mucoadhesiveness and rebleeding. Herein, we have developed a designer bilayered hemostatic foam consisting of a bioactive layer composed of silica particles (≈300 nm) and silk fibroin to serve as the tissue interfacing component on a chitosan foam. The foam composition was optimized based on the in vitro clotting behavior and cytocompatibility of individual components. In vivo analysis in a rat model demonstrated that the developed hemostat could achieve rapid clotting (31 ± 4 s), similar to a chitosan-based hemostat, but the former had significantly lower blood loss. Notably, removal of the bilayered hemostat prevented rebleeding, unlike the chitosan foam, which was associated with markedly higher incidences of rebleeding (50 %) and left behind material residue. Thus, the designer bilayered foam presented here is a potent inducer of blood clotting whilst affording easy removal with minimal rebleeding.

Chitosan-based hemostatic sponges as new generation hemostatic materials for uncontrolled bleeding emergency: Modification, composition, and applications

The choice of hemostatic technique is a curial concern for surgery and as first-aid treatment in combat. To treat uncontrolled bleeding in complex wound environments, chitosan-based hemostatic sponges have attracted significant attention in recent years because of the excellent biocompatibility, degradability, hemostasis and antibacterial properties of chitosan and their unique sponge-like morphology for high fluid absorption rate and priority aggregation of blood cells/platelets to achieve rapid hemostasis. In this review, we provide a historical perspective on the use of chitosan hemostatic sponges as the new generation of hemostatic materials for uncontrolled bleeding emergencies in complex wounds. We summarize the modification of chitosan, review the current status of preparation protocols of chitosan sponges based on various composite systems, and highlight the recent achievements on the detailed breakdown of the existing chitosan sponges to present the relationship between their composition, physical properties, and hemostatic capacity. Finally, the future opportunities and challenges of chitosan hemostatic sponges are also proposed.

Synthesis and characterization of mussel-inspired nanocomposites based on dopamine-chitosan-iron oxide for wound healing: In vitro study

There are many challenges faced the soft tissue adhesives in the medical application field. For example, there is a limited effective binding between the medical adhesive and different types of soft tissues. Chitosan (CS) and dopamine (DA) were used as structural units for synthesizing nanocomposites utilized as a wet tissue adhesive. To produce dopamine-chitosan-iron oxide nanocomposites (DA-CS-Fe₃O₄ NCs), DA was loaded onto chitosan-iron oxide nanocomposites. The nanocomposites have been prepared using ionic gelation method under vigorous homogenization and characterized by different techniques. Fourier-transform infrared spectroscopy (FTIR) have shown that DA-CS- Fe₃O₄ NCs could attach to the tissue through two possible functional groups, namely, the catechol and amine groups. The results of in vitro scratch wound-healing assay suggested that the prepared DA-CS- Fe₃O₄ NCs facilitate cell migration (the wound-closure percentage reached 96% at 72 h). All experimental results confirm that DA-CS- Fe₃O₄ NCs are strongly recommended for use as a soft medical tissue adhesive in wound healing and surgeries such as vascular surgery. In addition, the results of the whole blood clotting, antibacterial assessment, live and dead assay, cytotoxicity test, and wound-healing assay indicate that DA-CS-Fe₃O₄ NCs can be used as a multifunctional biomedical adhesive.

Antibacterial quaternary ammonium chitosan/carboxymethyl starch/alginate sponges with enhanced hemostatic property for the prevention of dry socket

Tooth extraction commonly leads to postoperative wound bleeding, bacterial infection, and even the occurrence of dry socket. Therefore, developing a biomedical material with favorable antibacterial and excellent hemostatic properties to prevent the post-extraction dry socket is necessary. Herein, quaternary ammonium chitosan/ carboxymethyl starch/alginate (ACQ) sponges are developed via Ca²⁺ cross-linking, electrostatic interaction, and lyophilization methods. The results show that the bio-multifunctional sponges exhibit interconnected porous structures with significant fluid absorption rates and suitable water vapor transmission rates. In vitro cellular and hemolysis experiments indicate that the developed sponges have acceptable biocompatibility. Notably, the constructed sponges effectively inhibit the growth of E. coli, S. aureus, and C. albicans, as well as achieve rapid hemostasis in the mouse liver injury and mini-pig tooth extraction models by absorbing blood and promoting red blood cell adhesion. Thus, the created bio-multifunctional sponges show tremendous promise as a hemostatic material for wound management after tooth extraction.

Design of biopolymer-based hemostatic material: Starting from molecular structures and forms

Uncontrolled bleeding remains as a leading cause of death in surgical, traumatic, and emergency situations. Management of the hemorrhage and development of hemostatic materials are paramount for patient survival. Owing to their inherent biocompatibility, biodegradability and bioactivity, biopolymers such as polysaccharides and polypeptides have been extensively researched and become a focus for the development of next-generation hemostatic materials. The construction of novel hemostatic materials requires in-depth understanding of the physiological hemostatic process, fundamental hemostatic mechanisms, and the effects of material chemistry/physics. Herein, we have recapitulated the common hemostatic strategies and development status of biopolymer-based hemostatic materials. Furthermore, the hemostatic mechanisms of various molecular structures (components and chemical modifications) are summarized from a microscopic perspective, and the design based on them are introduced. From a macroscopic perspective, the design of various forms of hemostatic materials, e.g., powder, sponge, hydrogel and gauze, is summarized and compared, which may provide an enlightenment for the optimization of hemostat design. It has also highlighted current challenges to the development of biopolymer-based hemostatic materials and proposed future directions in chemistry design, advanced form and clinical application.

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Biopolymers possess sound biocompatibility, biodegradability and bioactivity for the design of hemostatic materials.

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Molecular structure designs including component and chemical modification are summarized from a microscopic perspective.

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Design of various forms of hemostatic materials is discussed and compared synthetically from a macroscopic perspective.

Progress in Research of Chitosan Chemical Modification Technologies and Their Applications

Chitosan, which is derived from chitin, is the only known natural alkaline cationic polymer. Chitosan is a biological material that can significantly improve the living standard of the country. It has excellent properties such as good biodegradability, biocompatibility, and cell affinity, and has excellent biological activities such as antibacterial, antioxidant, and hemostasis. In recent years, the demand has increased significantly in many fields and has huge application potential. Due to the poor water solubility of chitosan, its wide application is limited. However, chemical modification of the chitosan matrix structure can improve its solubility and biological activity, thereby expanding its application range. The review covers the period from 1996 to 2022 and was elaborated by searching Google Scholar, PubMed, Elsevier, ACS publications, MDPI, Web of Science, Springer, and other databases. The various chemical modification methods of chitosan and its main activities and application research progress were reviewed. In general, the modification of chitosan and the application of its derivatives have had great progress, such as various reactions, optimization of conditions, new synthetic routes, and synthesis of various novel multifunctional chitosan derivatives. The chemical properties of modified chitosan are usually better than those of unmodified chitosan, so chitosan derivatives have been widely used and have more promising prospects. This paper aims to explore the latest progress in chitosan chemical modification technologies and analyze the application of chitosan and its derivatives in various fields, including pharmaceuticals and textiles, thus providing a basis for further development and utilization of chitosan.

Graphene-ophicalcite heterogeneous composite sponge for rapid hemostasis

Synergistic functionalization of interface coagulation stimulation and liquid absorption capacity is the key to improve the hemostatic efficiency of hemostats. Herein, we prepared a graphene-ophicalcite (OPH) heterogeneous composite sponge (GOCS) by using the heterogeneous gradient composite strategy. The sponge took cross-linked graphene sponge (CGS) as the main skeleton, allowing the OPH to be controllably positioned on the surface of GOCS. The heterogeneous strategy gave full play to the advantages of the material. On the one hand, GOCS had excellent liquid absorption ability, which enriched blood cells and other coagulation components at the wound interface after contacting blood. On the other hand, the OPH at the interface obviously activated platelets and rapidly triggered coagulation cascade reactions, exhibiting fast response and feedback characteristics for coagulation signals. Under the synergistic effects, the blood clotting index value of GOCS was reduced to 33.87 ± 9.97%, which was significantly lower than those of OPH (46.33 ± 16.85%) and CGS (67.53 ± 5.35%). Importantly, GOCS rapidly stopped bleeding within 51 s in the rat femoral artery model, suggesting its great potential in the field of hemostasis. Therefore, this study provides a new idea for the design and preparation of hemostatic materials via heterogeneous strategy.

Biomaterials for Hemostasis

Uncontrolled bleeding is a major problem in trauma and emergency medicine. While materials for trauma applications would certainly find utility in traditional surgical settings, the unique environment of emergency medicine introduces additional design considerations, including the need for materials that are easily deployed in austere environments. Ideally, these materials would be available off the shelf, could be easily transported, and would be able to be stored at room temperature for some amount of time. Both natural and synthetic materials have been explored for the development of hemostatic materials. This review article provides an overview of classes of materials used for topical hemostats and newer developments in the area of injectable hemostats for use in emergency medicine. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

An anticoagulant/hemostatic indwelling needle for oral glucose tolerance test

Anticoagulant/hemostatic indwelling needles developed by polydopamine co-deposition and underwater hyperbranched polymer adhesive priming monitor changes in blood glucose concentration in diabetic rats.

Chestnut-like macro-acanthosphere triggered hemostasis: a featured mechanism based on puncturing red blood cells

Acute hemorrhage that occurs after trauma is a life-threatening condition. Hence, to halt massive bleeding, there is a critical need to develop a suitable therapy. In this study, we developed self-propelling chestnut-like particles (Pro-MAS) comprising a macro-acanthosphere (MAS) coated with calcium carbonate and protonated tranexamic acid to puncture red blood cells (RBCs) and thus activate hemostasis. In vitro assessments revealed that Pro-MAS was biocompatible, biodegradable, and nontoxic; furthermore, it was capable of puncturing RBCs to release procoagulants and activate platelet aggregation for hemostasis. Animal tests showed that self-propelling Pro-MAS effectively traveled through blood flow to the deep ends of wounds; hemorrhage was controlled within 90 s and 4 min in the injured liver and bleeding femoral artery, respectively. Compared with a commercial hemostat, superior hemostasis was achieved with Pro-MAS, which could be ascribed to its functional and structural features. Overall, traveling Pro-MAS possessed sufficient impact force to puncture RBCs and sufficient momentum to reach the targeted bleeding sites. The present study demonstrated the ability of a novel platform, self-propelling MAS particles, to trigger hemostasis by puncturing RBCs. To the best of our knowledge, this is the first trial in which the release of endogenous procoagulants is promoted without the addition of exogenous procoagulants for severe hemorrhage control.

Application status and technical analysis of chitosan-based medical dressings: a review

Chitosan has wide applications in the field of medical dressings due to its good biomedical properties. This review provides the application status and technical analysis of chitosan medical dressings. First, we introduce the source and chemical structure of chitosan. Then, we investigate the mechanism of chitosan showing different medical properties. We also show the application of supramolecular chitosan-based hydrogels in the dressing field and the formulation optimization and the preparation technology of chitosan dressings for fabricating chitosan-based dressings with various morphologies and medical functions. After that, we introduce the research process of the modification method of chitosan dressings including single modification, blending modification, crosslinking modification, etc. Finally, based on the study of the medical effects of chitosan dressings, we analyze the existing problems in the preparation process and propose corresponding solutions from the aspects of the morphology, clinical feedback effect, and future development trends. This paper can provide a reference for further studies of skin tissue engineering and the development of new chitosan medical dressings.

Chitosan has wide applications in the field of medical dressings due to its good biomedical properties.

A Randomized Controlled Trial of Thermo-Sensitive Sol-Gel Anti-Adhesion Agent after Gynecologic Surgery

Postoperative abdominal adhesions can lead to several adverse consequences such as pelvic pain, bowel obstruction, and infertility. We aimed to explore the anti-adhesion efficacy and safety of a thermo-sensitive sol-gel agent in patients who receive abdominopelvic surgery for benign gynecologic disease. This study was a randomized, controlled, single-blind clinical trial of women undergoing benign gynecologic surgery between January 2017 and December 2017. The patients were randomly assigned to three groups with a 1:1:1 ratio: experimental group (received the thermo-sensitive sol-gel agent), control group (untreated), and comparator group (received 4% icodextrin). Patients were followed for 4 weeks postoperatively, and efficacy was evaluated by performing the visceral slide test to identify adhesion formation. In total, 183 patients were enrolled in the study, and 178 (97.3%) completed the trial. The incidence rate of abdominal adhesion formation was significantly lower in the experimental group than in the control group (7.9% vs. 21.1%, p = 0.040); however, it was similar between the experimental and comparator groups (7.9% vs. 13.8%. p = 0.299). At 4 weeks, no differences in adhesion-related symptoms were observed between the experimental and control groups. Adverse events were mostly mild and did not differ significantly among the three groups (p = 0.375). In conclusion, use of a thermo-sensitive sol-gel agent was safe and effective to prevent abdominal adhesions after benign gynecologic surgeries.

From microporous to mesoporous mineral frameworks: An alliance between zeolite and chitosan

Microporous and mesoporous minerals are key elements of advanced technological cycles nowadays. Nature-driven microporous materials are known for biocompatibility and renewability. Zeolite is known as an eminent microporous hydrated aluminosilicate mineral containing alkali metals. It is commercially available as adsorbent and catalyst. However, the large quantity of water uptake occupies active sites of zeolite making it less efficient. The widely-used chitosan polysaccharide has also been used in miscellaneous applications, particularly in medicine. However, inferior mechanical properties hampered its usage. Chitosan-modified zeolite composites exhibit superior properties compared to parent materials for innumerable requests. The alliance between a microporous and a biocompatible material with the accompaniment of negative and positive charges, micro/nanopores and proper mechanical properties proposes promising platforms for different uses. In this review, chitosan-modified zeolite composites and their applications have been overviewed.

Fluorescent chitosan hydrogel for highly and selectively sensing of p-nitrophenol and 2, 4, 6-trinitrophenol

Nitroaromatic compounds, especially 2, 4, 6-trinitrophenol, have strong biological toxicity and explosive risks, so the detection of 2, 4, 6-trinitrophenol exhibit importantly practical and scientific significance. In this work, three fluorescence functionalized chitosan CNS 3, CNS 4 and CNS 5 were prepared using chitosan as matrix. When 2, 4, 6-trinitrophenol (TNP) and/or p-nitrophenol (4-NP) was present in spot, these fluorescent chitosan sensors produced notable fluorescence quenching. It renders the chitosan sensing ability to detect TNP and 4-NP selectively and sensitively. The sensing mechanism is investigated as well. When introduced electron-rich moieties to the fluorescent chitosan, the sensitive detecting ability could be obtained. Excellent recognition ability could reach as low as 0.28 μM. The fluorescence fictionalization cause slight influence to the gel performance of chitosan.

Application of Chitosan in Bone and Dental Engineering

Chitosan is a deacetylated polysaccharide from chitin, the natural biopolymer primarily found in shells of marine crustaceans and fungi cell walls. Upon deacetylation, the protonation of free amino groups of the d-glucosamine residues of chitosan turns it into a polycation, which can easily interact with DNA, proteins, lipids, or negatively charged synthetic polymers. This positive-charged characteristic of chitosan not only increases its solubility, biodegradability, and biocompatibility, but also directly contributes to the muco-adhesion, hemostasis, and antimicrobial properties of chitosan. Combined with its low-cost and economic nature, chitosan has been extensively studied and widely used in biopharmaceutical and biomedical applications for several decades. In this review, we summarize the current chitosan-based applications for bone and dental engineering. Combining chitosan-based scaffolds with other nature or synthetic polymers and biomaterials induces their mechanical properties and bioactivities, as well as promoting osteogenesis. Incorporating the bioactive molecules into these biocomposite scaffolds accelerates new bone regeneration and enhances neovascularization in vivo.

Chitosan-Based Composite Materials for Prospective Hemostatic Applications

Effective hemostasis is vital to reduce the pain and mortality of patients, and the research and development of hemostatic materials are prerequisite for effective hemostasis. Chitosan (CS), with good biodegradability, biocompatibility and non-toxicity, has been widely applied in bio-medicine, the chemical industry, the food industry and cosmetics. The excellent hemostatic properties of CS have been extensively studied. As a result, chitosan-based composite hemostatic materials have been emerging. In this review, the hemostatic mechanism of chitosan is briefly discussed, and then the progress of research on chitosan-based composite hemostatic materials with multiple forms such as films, sponges, hydrogels, particles and fibers are introduced. Finally, future perspectives of chitosan-based composite hemostatic materials are given. The objective of this review is to provide a reference for further research and development of effective hemostatic materials.