Puff pastry-like chitosan/konjac glucomannan matrix with thrombin-occupied microporous starch particles as a composite for hemostasis

Interaction mechanism, fabrication strategies, and advanced applications of konjac glucomannan-based mixed polysaccharide systems

Due to its high viscoelasticity and positive health benefits, konjac glucomannan (KGM)-based mixed polysaccharide systems are widely applied in food processing and pharmaceuticals. However, a knowledge gap exists between the relationship between KGM interactions with different polysaccharides and the resulting food processing properties and health benefits. This review elaborately aims to address this research gap by analyzing the literature on the updated KGM-based binary thermodynamic compatibility systems, classified and discussed according to the basic gel models. Further fabrication and tailored strategies for improving gel properties and the resulting changes in food production and processing, nutrient digestion and absorption, and health benefits are explored. The development of future food should combine with structural food theory and colloidal nutrition based on soft condensed matter physics, intersected chemistry, biology, and engineering to achieve technological innovation.

Hyaluronic acid-based ε-polylysine/polyurethane asymmetric sponge for enhanced wound healing

Asymmetric sponge dressings with a hydrophobic surface and a hydrophilic inner layer can prevent bacterial infiltration and ensure efficient absorption of wound exudate. In this work, ε-polylysine/aliphatic polyurethane sponge (EPU) was prepared by prepolymer foaming process, and oxidized hyaluronic acid (OHA) was cross-linked with ε-polylysine (EPL) in EPU through schiff-base reaction to obtain EHPU. Octaisobutyl polyhedral oligomeric silsesquioxane (Oi-POSS) was uniformly sprayed onto the surface of EHPU as the hydrophobic layer, resulting in asymmetric sponge dressings denoted as P-EHPU. These dressings demonstrate capabilities in resisting staining and bacterial invasion, with internal EPL effectively inhibiting bacterial proliferation on the wound surface. The introduction of OHA and EPL leads to a denser and more complete pore structure of the sponge, endowing it with good compression, tensile strength, and hemostatic performance. Wound healing studies indicate that P-EHPU effectively prevents external bacterial infiltration and promotes wound healing.

Chitosan/β-glycerophosphate porous microsphere prepared by facile water-in-water emulsion as a topical hemostatic material

Acute hemorrhage is a major cause of death in many emergency cases. Although many hemostatic materials have been studied in recent years, it is still necessary to develop new hemostatic materials with remarkable efficiency, biosafety, convenient preparation, low cost, and good biodegradability. In this work, novel chitosan (CS)/β-glycerophosphate (β-GP) composite porous microsphere with a uniform size of 210.00 ± 2.14 μm was fabricated through water-in-water (W/W) emulsion via microencapsulation, which can avoid the use of toxic crosslink chemicals and organic solvents to achieve facile and efficient preparation of microspheres. β-GP could promote the formation of microspheres by enhancing the hydrogen-bonding interaction between CS chains, which contributed to the macro-porous structure. Owing to their large pore size (6.0 μm) and high specific surface area (37.8 m2/g), the CS/β-GP microspheres could absorb water quickly and adsorb protein, red blood cells, and platelets through electrostatic forces to promote blood coagulation. Furthermore, the CS/β-GP microspheres achieved a significantly shortened hemostatic time (45 s) and reduced blood loss (0.03 g) in a rat liver injury model. Rat tail amputation test also showed a satisfactory hemostatic effect. Overall, the green and porous CS/β-GP microspheres can be used as a facile and topical rapid hemostatic material.

Konjac glucomannan: A comprehensive review of its extraction, health benefits, and pharmaceutical applications

Konjac glucomannan (KG) is a dietary fiber hydrocolloid derived from Amorphophallus konjac tubers and is widely utilized as a food additive and dietary supplement. As a health-conscious choice, purified KG, along with konjac flour and KG-infused diets, have gained widespread acceptance in Asian and European markets. An overview of the chemical composition and structure of KG is given in this review, along with thorough explanations of the processes used in its extraction, production, and purification. KG has been shown to promote health by reducing glucose, cholesterol, triglyceride levels, and blood pressure, thereby offering significant weight loss advantages. Furthermore, this review delves into the extensive health benefits and pharmaceutical applications of KG and its derivatives, emphasizing its prebiotic, anti-inflammatory, and antitumor activities. This study highlights how these natural polysaccharides can positively influence health, underscoring their potential in various biomedical applications.

Dencichine/palygorskite nanocomposite incorporated chitosan/polyvinylpyrrolidone film for accelerating wound hemostasis

The development of efficient, safe, environmentally friendly, and user-friendly hemostatic dressings remains a great challenge for researchers. A variety of clay minerals and plant extracts have garnered considerable attention due to their outstanding hemostatic efficacy and favorable biosafety. In this study, a facile solution casting strategy was employed to prepare nanocomposite films by incorporating natural nanorod-like palygorskite (Pal) and herb-derived hemostat dencichine (DC) based on chitosan and polyvinylpyrrolidone. The dynamic blood clotting index demonstrated that the nanocomposite film with a DC addition of 1.0 wt% exhibited significantly superior hemostatic properties compared to both pure DC powder or commercial hemostatic agent Yunnan Baiyao. This improvement was primarily attributed to proper blood affinity, increased porosity, enhanced adhesion of platelets and erythrocytes, as well as the accelerated activation of coagulation factors and platelets. Under the synergistic effect of Pal and DC, the nanocomposite film displayed suitable tensile strength (20.58 MPa) and elongation at break (47.29 %), which may be due to the strong intermolecular hydrogen bonding and electrostatic interaction between Pal/DC and macropolymers. Notably, the nanocomposite film exhibited remarkable antibacterial effectiveness and desirable cytocompatibility, as well as the capability of promoting wound healing in vitro. Taken together, the nanocomposite film synergized with Pal and DC is expected to be an efficacious and suitable wound dressing.

Fabrication of yeast β-glucan/sodium alginate/γ-polyglutamic acid composite particles for hemostasis and wound healing

Particles with a porous structure can lead to quick hemostasis and provide a good matrix for cell proliferation during wound healing. Recently, many particle-based wound healing materials have been clinically applied. However, these products show good hemostatic ability but with poor wound healing ability. To solve this problem, this study fabricated APGG composite particles using yeast β-glucan (obtained from Saccharomyces cerevisiae), sodium alginate, and γ-polyglutamic acid as the starting materials. The structure of yeast β-glucan was modified with many carboxymethyl groups to obtain carboxymethylated β-glucan, which could coordinate with Ca2+ ions to form a crosslinked structure. A morphology study indicated that the APGG particles showed an irregular spheroidal structure with a low density (<0.1 g cm-3) and high porosity (>40%). An in vitro study revealed that the particles exhibited a low BCI value, low hemolysis ratio, and good cytocompatibility against L929 cells. The APGG particles could quickly stop bleeding in a mouse liver injury model and exhibited better hemostatic ability than the commercially available product Celox. Furthermore, the APGG particles could accelerate the healing of non-infected wounds, and the expression levels of CD31, α-SMA, and VEGF related to angiogenesis were significantly enhanced.

A Visible Light Cross-Linked Underwater Hydrogel Adhesive with Biodegradation and Hemostatic Ability

Hydrogel adhesives with integrated functionalities are still required to match their ever-expanding practical applications in the field of tissue repair and regeneration. A simple and effective safety strategy is reported, involving an in situ injectable polymer precursor and visible light-induced cross-linking. This strategy enables the preparation of a hydrogel adhesive in a physiological environment, offering wet adhesion to tissue surfaces, molecular flexibility, biodegradability, biocompatibility, efficient hemostatic performance, and the ability to facilitate liver injury repair. The proposed one-step preparation process of this polymer precursor involves the mixing of gelatin methacryloyl (GelMA), poly(thioctic acid) [P(TA)], poly(acrylic acid)/amorphous calcium phosphate (PAAc/ACP, PA) and FDA-approved photoinitiator solution, and a subsequent visible light irradiation after in situ injection into target tissues that resulted in a chemically-physically cross-linked hybrid hydrogel adhesive. Such a combined strategy shows promise for medical scenarios, such as uncontrollable post-traumatic bleeding.

Unconventional luminescent CS-PEC-based composite hemostasis sponge with antibacterial activity and visual monitoring for wound healing

Multifunctional wound dressings are promising medical materials for various applications. Among them, dressings with antimicrobial activity, high biosafety, and real-time monitoring have attracted considerable research interest. Herein, a biodegradable hemostatic sponge comprising a chitosan skeleton and polyelectrolyte-surfactant complex (CS-PEC) was developed as a versatile wound dressing for wound pH monitoring and inhibition of bacterial infection. CS-PEC sponge with high porosity exhibited satisfactory fluid absorption capacity and biocompatibility, along with antibacterial properties against E. coli and S. aureus. In vivo experiments in rat liver trauma model revealed that wounds treated with the CS-PEC sponge recorded less blood loss (97.1 mg) and shorter hemostasis time (27.2 s) than those treated with commercial gelatin sponge (309.1 mg and 163.5 s, respectively). Furthermore, PECs based on unconventional luminescent molecules (L-C16-Hyp) were used as pH fluorescent indicators, which endowed the sponge with fluorescence-responsive behavior to wound pH changes in the range of 5.0-8.5. Visual images can be captured using a smartphone and converted to RGB color mode values for on-site assessment of wound status. This study sheds light on the design and application of unconventional luminescent materials in wound dressing and provides a smart and effective solution for wound management.

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.

Preparation and application of hemostatic microspheres containing biological macromolecules and others

Bleeding from uncontrollable wounds can be fatal, and the body's clotting mechanisms are unable to control bleeding in a timely and effective manner in emergencies such as battlefields and traffic accidents. For irregular and inaccessible wounds, hemostatic materials are needed to intervene to stop bleeding. Hemostatic microspheres are promising for hemostasis, as their unique structural features can promote coagulation. There is a wide choice of materials for the preparation of microspheres, and the modification of natural macromolecular materials such as chitosan to enhance the hemostatic properties and make up for the deficiencies of synthetic macromolecular materials makes the hemostatic microspheres multifunctional and expands the application fields of hemostatic microspheres. Here, we focus on the hemostatic mechanism of different materials and the preparation methods of microspheres, and introduce the modification methods, related properties and applications (in cancer therapy) for the structural characteristics of hemostatic microspheres. Finally, we discuss the future trends of hemostatic microspheres and research opportunities for developing the next generation of hemostatic microsphere materials.

A sandwich-like silk fibroin/polysaccharide composite dressing with continual biofluid draining for wound exudate management

Optimal wound healing requires a wet microenvironment without over-hydration. Inspired by capillarity and transpiration, we have developed a sandwich-like fibers/sponge dressing with continuous exudate drainage to maintain appropriate wound moisture. This dressing is prepared by integrating a three-layer structure using the freeze-drying method. Layer I, as the side that contacts with the skin directly, consists of a hydrophobic silk fibroin membrane; Layer II, providing the pumping action, is made of superabsorbent chitosan-konjac glucomannan sponge; Layer III, accelerating evaporation sixfold compared to natural evaporation, is constructed with a graphene oxide soaked hydrophilic cellulose acetate membrane. Animal experiments showed that the composite dressing had superior wound-healing characteristics, with wounds decreasing to 24.8% of their original size compared to 28.5% for the commercial dressing and 43.2% for the control. The enhanced wound healing can be ascribed to the hierarchical porous structure serves as the fluid-driving factor in this effort; the hydrophilicity of a membrane composed of silk fibroin nanofibers is adjustable to regulate fluid-transporting capacity; and the photothermal effect of graphene oxide guarantees exudates that have migrated to the top layer to evaporate continuously. These findings indicate the unidirectional wicking dressing has the potential to become the next generation of clinical dressings.

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.

Catechol-chitosan/carboxymethylated cotton-based Janus hemostatic patch for rapid hemostasis in coagulopathy

Uncontrolled bleeding is the leading cause of death, and the death risk of bleeding from coagulopathy is even higher. By infusing the relevant coagulation factors, bleeding in patients with coagulopathy can be clinically treated. However, there are not many emergency hemostatic products accessible for coagulopathy patients. In response, a Janus hemostatic patch (PCMC/CCS) with a two-layer structure of partly carboxymethylated cotton (PCMC) and catechol-grafted chitosan (CCS) was developed. Ultra-high blood absorption (4000 %) and excellent tissue adhesion (60 kPa) were both displayed by PCMC/CCS. The proteomic analysis revealed that PCMC/CCS has significantly contributed to the creative generation of FV, FIX, and FX, as well as to the substantial enrichment of FVII and FXIII, re-paving the initially blocked coagulation pathway of coagulopathy to promote hemostasis. The in vivo bleeding model of coagulopathy demonstrated that PCMC/CCS was substantially more effective than gauze and commercial gelatin sponge at achieving hemostasis in just 1 min. The study provides one of the first investigations on procoagulant mechanisms in anticoagulant blood conditions. Rapid hemostasis in coagulopathy will be significantly affected by the results of this experiment.

Preparation and Hemostatic Effect of Micro-Nanograded Porous Particles Doped with Dopamine-Based Water-Triggered Intelligent Composite Adhesives

The wet environment of water or tissue in bleeding wounds poses significant challenges to the adhesion performance of existing hemostatic adhesives. An intelligent composite adhesive prepared by doping starch-based silicate micro-nanograded porous particles (MBC@CMS) with dopamine-hyperbranched polymers (HPD, 7800 Mw) synthesized by the Michael addition reaction could be triggered by water to form a glue (MBC@CMS-HPD). The results indicated that MBC@CMS-HPD could still have adhesion properties under running water washing and water immersion and could effectively seal the water outlet. The results of the glue-forming mechanism showed that MBC@CMS-HPD had better wettability than water, which could eliminate water molecules at the wet adhesive surface. When contacted with water, the agglomeration of the HPD hydrophobic chain increases the exposure of the catechol group, and the relative atomic mass of the N element on the surface increases from 2.8 to 4.8%. The adhesion of MBC@CMS-HPD was enhanced and stable. MBC@CMS-HPD showed significant hemostasis effects in five injury bleeding models of Sprague-Dawley (SD) rats and New Zealand rabbits. Especially in the fatal femoral artery bleeding model of New Zealand rabbits, MBC@CMS-HPD reduced the amount of bleeding by 75% and shortened the bleeding time by 78% compared with the a-cyanoacrylate adhesives. The results of the coagulation mechanism showed that compared with HPD, MBC@CMS-HPD could activate both endogenous and exogenous coagulation pathways. Among them, after contact with blood, HPD formed a gel to close the blood outlet, and MBC@CMS entered the wound to activate the internal and external coagulation pathways. In addition, HPD and MBC@CMS had good histocompatibility and degradability, which has the potential to be applied to different wounds.

A quaternized chitosan and carboxylated cellulose nanofiber-based sponge with a microchannel structure for rapid hemostasis and wound healing

A hemostatic sponge should perform rapid hemostasis and exhibit antibacterial properties, whilst being non-toxic, breathable, and degradable. This study prepared a hemostatic sponge (CQTC) with microchannels, specifically a microchannel structure based on quaternized chitosan (QCS) and carboxylated cellulose nanofibers (CCNF) obtained by using tannic acid and Cu²⁺ complex (crosslinking agent). The sponge had low density and high porosity, while being degradable. The combination of microchannels and three-dimensional porous structure of CQTC leads to excellent liquid absorption and hemostasis ability, based on a liquid absorption rate test and in vitro hemostasis experiment. In addition, CQTC exhibited excellent antibacterial activity against both gram-negative and gram-positive bacteria, and it promoted wound healing. In conclusion, this porous and microchannel hemostatic sponge has broad application prospects as a clinical wound hemostatic material.

A wet-adhesive carboxymethylated yeast β-glucan sponge with radical scavenging, bacteriostasis and anti-inflammatory functions for rapid hemostasis

Local hemostats still face obstacles to efficiently achieving hemostasis and promoting wound healing. Herein, a series of multifunctional well-degradable hemostatic sponges based-on carboxymethylated yeast β-glucan (CMYG) were fabricated by lyophilization. The porous CMYG sponge not only could absorb blood quickly (44.12 g/g), but also possessed unexpected tissue adhesion (∼30 kPa), and it represented good biocompatibility in vitro on fibroblasts and red blood cells. Notably, compared with the commercial Celox™, the CMYG sponge achieved more rapid hemostasis and significantly reduced blood loss in liver injury rat models by rapid wound block. Interestingly, the developed sponge showed an outstanding effect on antioxidant, anti-infection, anti-inflammatory, and cell proliferation, which are beneficial for further wound repair. Overall, these results suggest that the CMYG sponge is a promising candidate for the clinical management of uncontrollable hemorrhage and the further development of wound dressing materials throughout skin defect repair.

Poly β-Cyclodextrin/Quaternary Ammoniated Chitosan Cryogel with a Porous Structure for Effective Hemostasis

Uncontrolled bleeding is one of the most important causes threatening human health, but quick hemostasis remains a challenge. We prepared porous cryogels with poly β-cyclodextrin (Pβ-CD) and quaternary ammoniated chitosan (QCs). Pβ-CD acts as a "water-grabbing agent" to assist QCs' ability to absorb and concentrate blood rapidly. The rat-tail amputation model and liver injury model exhibited that cryogels had excellent hemostatic performance. Moreover, cryogels showed good antibacterial activity and biocompatibility. Therefore, these cryogels can be used as potential hemostatic materials.

Biomembrane-Based Nanostructure- and Microstructure-Loaded Hydrogels for Promoting Chronic Wound Healing

Wound healing is a complex and dynamic process, and metabolic disturbances in the microenvironment of chronic wounds and the severe symptoms they cause remain major challenges to be addressed. The inherent properties of hydrogels make them promising wound dressings. In addition, biomembrane-based nanostructures and microstructures (such as liposomes, exosomes, membrane-coated nanostructures, bacteria and algae) have significant advantages in the promotion of wound healing, including special biological activities, flexible drug loading and targeting. Therefore, biomembrane-based nanostructure- and microstructure-loaded hydrogels can compensate for their respective disadvantages and combine the advantages of both to significantly promote chronic wound healing. In this review, we outline the loading strategies, mechanisms of action and applications of different types of biomembrane-based nanostructure- and microstructure-loaded hydrogels in chronic wound healing.

Microcluster colloidosomes for hemostat delivery into complex wounds: A platform inspired by the attack action of torpedoes

Complex yet lethal wounds with uncontrollable bleeding hinder conventional hemostats from clotting blood at the source or deep sites of injury vasculature, thereby causing massive blood loss and significantly increased mortality. Inspired by the attack action of torpedoes, we synthesized microcluster (MC) colloidosomes equipped with magnetic-mediated navigation and "blast" systems to deliver hemostats into the cavity of vase-type wounds. CaCO₃/Fe₂O₃ (CF) microparticles functionalized with Arg-Gly-Asp (RGD) modified polyelectrolyte multilayers were co-assembled with oppositely charged zwitterionic carbon dots (CDs) to form MC colloidosomes, which were loaded with thrombin and protonated tranexamic acid (TXA-NH₃ ⁺). The composite microparticles moved against blood flow under magnetic mediation and simultaneously disassembled for the burst release of thrombin stimulated by TXA-NH₃ ⁺. The CO₂ bubbles generated during disassembly produced a "blast" that propelled thrombin into the wound cavity. Severe bleeding in a vase-type hemorrhage model in the rabbit liver was rapidly controlled within ∼60 s. Furthermore, in vivo subcutaneous muscle and liver implantation models demonstrated excellent biodegradability of MC colloidosomes. This study is the first to propose a novel strategy based on the principle of torpedoes for transporting hemostats into vase-type wounds to achieve rapid hemostasis, creating a new paradigm for combating trauma treatment.

Engineered Hemostatic Biomaterials for Sealing Wounds

Hemostatic biomaterials show great promise in wound control for the treatment of uncontrolled bleeding associated with damaged tissues, traumatic wounds, and surgical incisions. A surge of interest has been directed at boosting hemostatic properties of bioactive materials via mechanisms triggering the coagulation cascade. A wide variety of biocompatible and biodegradable materials has been applied to the design of hemostatic platforms for rapid blood coagulation. Recent trends in the design of hemostatic agents emphasize chemical conjugation of charged moieties to biomacromolecules, physical incorporation of blood-coagulating agents in biomaterials systems, and superabsorbing materials in either dry (foams) or wet (hydrogel) states. In addition, tough bioadhesives are emerging for efficient and physical sealing of incisions. In this Review, we highlight the biomacromolecular design approaches adopted to develop hemostatic bioactive materials. We discuss the mechanistic pathways of hemostasis along with the current standard experimental procedures for characterization of the hemostasis efficacy. Finally, we discuss the potential for clinical translation of hemostatic technologies, future trends, and research opportunities for the development of next-generation surgical materials with hemostatic properties for wound management.

Dual-Driven Hemostats Featured with Puncturing Erythrocytes for Severe Bleeding in Complex Wounds

Achieving rapid hemostasis in complex and deep wounds with secluded hemorrhagic sites is still a challenge because of the difficulty in delivering hemostats to these sites. In this study, a Janus particle, SEC-Fe@CaT with dual-driven forces, bubble-driving, and magnetic field– (MF–) mediated driving, was prepared via in situ loading of Fe₃O₄ on a sunflower sporopollenin exine capsule (SEC), and followed by growth of flower-shaped CaCO₃ clusters. The bubble-driving forces enabled SEC-Fe@CaT to self-diffuse in the blood to eliminate agglomeration, and the MF-mediated driving force facilitated the SEC-Fe@CaT countercurrent against blood to access deep bleeding sites in the wounds. During the movement in blood flow, the meteor hammer-like SEC from SEC-Fe@CaT can puncture red blood cells (RBCs) to release procoagulants, thus promoting activation of platelet and rapid hemostasis. Animal tests suggested that SEC-Fe@CaT stopped bleeding in as short as 30 and 45 s in femoral artery and liver hemorrhage models, respectively. In contrast, the similar commercial product Celox™ required approximately 70 s to stop the bleeding in both bleeding modes. This study demonstrates a new hemostat platform for rapid hemostasis in deep and complex wounds. It was the first attempt integrating geometric structure of sunflower pollen with dual-driven movement in hemostasis.

Injectable hydrogel based on dodecyl-modified N-carboxyethyl chitosan/oxidized konjac glucomannan effectively prevents bleeding and postoperative adhesions after partial hepatectomy

Hemostasis and prevention of postoperative adhesions after hepatectomy are still challenges. In this work, we chose chitosan, a competitive candidate hemostatic material, as the backbone, and konjac glucomannan as the functional moieties, to form an injectable hydrogel. The hydrogel was prepared by the Schiff base reaction of dodecyl-modified N-carboxyethyl chitosan (DCEC) and oxidized konjac glucomannan (OKGM), which could effectively prevent bleeding and postoperative adhesions. The resultant hydrogel possessed self-healing and tissue adhesive capability, and combined the unique bioactivities of two polysaccharides: DCEC endowed the hydrogel with excellent antibacterial and hemostatic ability by the electrostatic and hydrophobic interactions between the cell membrane and amine/dodecyl groups, and OKGM imparted hydrogel anti-inflammatory action by activating macrophages. Moreover, the notable hemostatic efficacy of the hydrogel was confirmed in a rat hepatectomy model. The hydrogel could prevent postoperative adhesions and down-regulate the inflammatory factor TNF-α and the pro-fibrotic factor TGF-β₁ in situ, which might be caused by the combination of the barrier function of hydrogel and instinct bioactivities of DCEC and OKGM. Thus, this multifunctional injectable hydrogel is potentially valuable for preventing bleeding and postoperative adhesions after hepatectomy.

Preparation and evaluation of chitosan/polyvinylpyrrolidone/zein composite hemostatic sponges

Trauma-related excessive bleeding is one of the leading causes of death. Chitosan (CS) sponges have unique advantages in the treatment of massive bleeding, but their application is limited by poor stability and toxic crosslinking agent. In this work, chitosan/polyvinylpyrrolidone/zein (CS/PVP/Zein) sponges with macroporous structure were prepared, which exhibited rapid water absorption capacity and water-triggered expanding property with low cytotoxicity and low hemolysis ratio. In vitro blood coagulation experiments showed that CS/PVP/Zein sponges could clot blood significantly faster than commercial surgical gauze. Further investigation of the hemostatic mechanism suggested that the CS/PVP/Zein sponges could accelerate coagulation by promoting attachment of erythrocytes, activation of platelets, and rapid plasma protein absorption. Prepared sponges were also found effective in the rat femoral artery transection model to control bleeding. Overall, the CS/PVP/Zein sponges exhibited the potential to control trauma-related hemorrhage.

Antibacterial porous sponge fabricated with capric acid-grafted chitosan and oxidized dextran as a novel hemostatic dressing

This work aims to fabricate multifunctional hemostatic sponges (C-ODs). Porous C-ODs were first constructed by using capric acid-modified chitosan (CSCA) and oxidized dextrans (ODs) with different oxidation degrees. Batches of experiments showed that (i) CSCA (33.39% of grafting degree), ODs, and C-ODs (100-200 μm in pore size) were synthesized, evidenced by FT-IR, ¹H NMR, elemental analysis, hydroxylamine hydrochloride titration, and SEM results; (ii) among C-ODs, C-OD₂ had appropriate porosity (85.0%), swelling (20 times its dry weight), absorption, water retention, water vapor transmission, and mechanical properties; (iii) C-OD₂ possessed low toxicity (relative cell viability > 86%), low hemolysis rate (0.65%), suitable tissue adhesion (4.74 kPa), and strong antibacterial efficacy (five strains); and (iv) C-OD₂'s dynamic blood clotting was within 30 s. In three animal injury models, C-OD₂'s hemostasis time and blood loss were fairly lower than commercial gelatin sponge. Totally, C-OD₂ might serve as an ideal hemostatic dressing.

Hydrogel Adhesive Formed via Multiple Chemical Interactions: From Persistent Wet Adhesion to Rapid Hemostasis

Thus far, robust and durable adhesion capability of hydrogel adhesive in wet environment remains a huge challenge. Here, a chemically-physically double-network cross-linked hydrogel matrix was prepared by first mixing acrylic...

Recent advances in materials for hemostatic management

Traumatic hemorrhage can be a fatal event, particularly when large quantities of blood are lost in a short period of time. Therefore, hemostasis has become a crucial part of emergency treatment. For small wounds, hemostasis can be achieved intrinsically depending on the body's own blood coagulation mechanism; however, for large-area wounds, particularly battlefield and complex wounds, materials delivering rapid and effective hemostasis are required. In parallel with the constant progress in science, technology, and society, advances in hemostatic materials have also undergone various iterations by integrating new ideas with old concepts. There are various natural and synthetic hemostatic materials, including hemostatic powders, adhesives, hydrogels, and tourniquets, for the treatment of severe external trauma. This review covers the differences among the currently available hemostatic materials and comprehensively describes the hemostatic effects of different materials based on the underlying mechanisms. Finally, solutions for current issues related to trauma bleeding are discussed, and the prospects of hemostatic materials are proposed.

Hemostatic Efficacy and Biocompatibility Evaluation of a Novel Absorbable Porous Starch Hemostat

BACKGROUND

A novel absorbable porous starch hemostat (APSH) based on calcium ion-exchange crosslinked porous starch microparticles (Ca²⁺CPSM) was developed to improve hemostasis during surgeries for irregular cuts. The aim of this study was to compare its hemostatic efficacy and biocompatibility in a standard rat liver injury model relatively to Arista AH, Quickclean, and crosslinked porous starch microparticles (CPSM, without calcium ion).

METHODS

72 Wistar rats (220g-240 g) were randomly assigned to six groups (Arista, Quickclean, CPSM, Ca²⁺CPSM, native potato starch, and untreated control group, n =12 per group). 30 mg of each hemostatic agent was applied to a standard circular liver excision (8 mm in diameter and 3 mm deep) in rats. Following their hemostatic efficacy, in vivo biocompatiblity evaluation was examined. The native potato starch (NPS) group was used as the negative group.

RESULTS

Ca²⁺CPSM had almost the same hemostatic efficacy compared with Arista; meanwhile, all the 4 hemostatic agents had good blood compatibility. In terms of in vivo tissue compatibility, Ca²⁺CPSM had relatively fast degradation and absorption rate with good histocompatibility. As the morphological, anatomic observation and H&E staining of liver defects after implantation, Ca²⁺CPSM was almost completely absorbed by liver tissue after 14 days.

CONCLUSION

According to our study, Ca²⁺CPSM could effectively achieve hemostasis in the standard rat liver injury model and exhibited good blood compatibility and in vivo tissue compatibility. These finding suggested that Ca²⁺CPSM as a new kind of APSH had its extensive clinical application value.

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.

Polysaccharides-modified chitosan as improved and rapid hemostasis foam sponges

Serial hemostatic sponges consisting of polysaccharides-modified chitosan foam sponges were prepared by Schiff base crosslinking reaction between the deacetylated chitosan and oxidized dialdehyde cellulose. Such composite foam sponges were characterized by scanning electron microscopy and Fourier-transform infrared spectroscopy to confirm their morphology and compositions. Then the coagulation process was evaluated in vitro by thrombus elasticity meters. Furthermore, the hemostasis experiments on mouse tail vein and rabbit femoral artery were also performed in vivo. The results strongly indicated that such synergistic cellulose-modified chitosan foam sponges showed comprehensively excellent water-absorbing quality, improved mechanical performance, low hemolysis rates, benign cytotoxicity, good resilience ability after repeated compression, and superior hemostasis capability both in vitro and in vivo. Furthermore, the hemostatic mechanism is via adhering/activating the red blood cell/platelet to form robust blood clots through the endogenous coagulation pathway, which serves as a good candidate for emergency trauma treatment in daily civilian and military hemostasis.

Study on hemostatic effect and mechanism of starch-based nano-microporous particles

The powdered hemostatic particles have broad application prospects in large open wounds, internal organ injuries and penetrating injuries of the body. In this study, nanoscale mescoporous and macroporous silica (MMSN), nanoscale mescoporous and macroporous bioactive glass (MBG), micron-scale cross-linked corn starch porous microspheres (CMS), MMSN@CMS and MBG@CMS starch-based nano-microporous particles were synthesized and their hemostatic effect and hemostatic mechanism were studied. The results showed that comparted with the single particle of CMS, the combination particles MBG@CMS and MMSN@CMS significantly increased the water absorption rate, activated both internal and external coagulation pathways, significantly shortened CBT, as well as the improved hemostatic effects in vitro. The immediately released Ca²⁺ from MBG@CMS in the blood to participate in the coagulation pathway, and MMSN@CMS activated platelets by concentrating blood coagulation factors, might be the main hemostatic mechanisms for the starch-based nano-microporous particles. Furthermore, the hemostatic efficacy of particles, both in the model of tail-amputation and liver injury in SD rats, showed the starch-based nano-microporous particles, especial MBG@CMS, could significantly reduce the weight of blood loss and shorten the bleeding time. Our research work stated that the starch-based nano-microporous particles MBG@CMS might be a hemostasis biomaterial with the potential applications for the emergency bleeding.

Research status and development potential of composite hemostatic materials

Through the discussion of the coagulation mechanism of compositehemostatic materials, the future development potential of hemostatic materials is proposed.