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Deng J, Zhao Z, Yeo XY, Yang C, Yang J, Ferhan AR, Jin B, Oh C, Jung S, Suresh S, Cho NJ. Plant-Based Shape Memory Cryogel for Hemorrhage Control. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2311684. [PMID: 39011812 DOI: 10.1002/adma.202311684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 06/24/2024] [Indexed: 07/17/2024]
Abstract
The escalating global demand for sustainable manufacturing, motivated by concerns over energy conservation and carbon footprints, encounters challenges due to insufficient renewable materials and arduous fabrication procedures to fulfill specific requirements in medical and healthcare systems. Here, biosafe pollen cryogel is engineered as effective hemostats without additional harmful crosslinkers to treat deep noncompressible wounds. A straightforward and low-energy approach is involved in forming stable macroporous cryogel, benefiting from the unique micro-hierarchical structures and chemical components of non-allergenic plant pollen. It is demonstrated that the pollen cryogel exhibits rapid water/blood-triggered shape-memory properties within 2 s. Owing to their inherent nano/micro hierarchical structure and abundant chemical functional groups on the pollen surface, the pollen cryogel shows effective hemostatic performance in a mouse liver penetration model, which is easily removed after usage. Overall, the self-crosslinking pollen cryogel in this work pioneers a framework of potential clinical applications for the first-hand treatment on deep noncompressible wounds.
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Affiliation(s)
- J Deng
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Centre for Cross Economy, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Z Zhao
- Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Engineering Center of Natural Polymers-based Medical Materials, School of Resource and Environmental Science, Wuhan University, Wuhan, 430079, China
| | - X Y Yeo
- Department of Medical Science, College of Medicine, CHA University, Gyeonggi-do, 13488, Republic of Korea
| | - C Yang
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - J Yang
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - A R Ferhan
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Centre for Cross Economy, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - B Jin
- Department of Medical Science, College of Medicine, CHA University, Gyeonggi-do, 13488, Republic of Korea
| | - C Oh
- Department of Medical Science, College of Medicine, CHA University, Gyeonggi-do, 13488, Republic of Korea
| | - S Jung
- Department of Medical Science, College of Medicine, CHA University, Gyeonggi-do, 13488, Republic of Korea
| | - S Suresh
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - N-J Cho
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
- Centre for Cross Economy, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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Malik A, Rehman FU, Shah KU, Naz SS, Qaisar S. Hemostatic strategies for uncontrolled bleeding: A comprehensive update. J Biomed Mater Res B Appl Biomater 2021; 109:1465-1477. [PMID: 33511753 DOI: 10.1002/jbm.b.34806] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022]
Abstract
Uncontrolled bleeding remains the leading cause of morbidity and mortality across the entire macrocosm. It refers to excessive loss of blood that occurs inside of body, due to unsuccessful platelet plug formation at the injury site. It is not only limited to the battlefield, but remains the second leading cause of death amongst the civilians, as a result of traumatic injury. Startlingly, there are no effective treatments currently available, to cater the issue of internal bleeding, even though early intervention is of utmost significance in minimizing the mortality rates associated with it. The fatal issue of uncontrolled bleeding is ineffectively being dealt with the use of pressure dressings, tourniquet, and surgical procedures. This is not a practical approach in combat arenas or in emergency situations, where the traumatic injury inflicted is deep inside the body, and cannot be addressed externally, by the application of topical dressings. This review focuses on the traditional hemostatic agents that are used to augment the process of hemostasis, such as mineral zeolites, chitosan based products, biologically active agents, anti-fibrinolytics, absorbable agents, and albumin and glutaraldehyde, as well as the micro- and nano-based hemostatic agents such as synthocytes, thromboerythrocytes, thrombosomes, and the synthetic platelets.
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Affiliation(s)
- Annum Malik
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Fiza Ur Rehman
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Syeda Sohaila Naz
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
| | - Sara Qaisar
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
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Khoshmohabat H, Paydar S, Makarem A, Karami MY, Dastgheib N, Zahraei SAH, Rezaei R, Mahmoudi Nezhad GS. A review of the application of cellulose hemostatic agent on trauma injuries. Open Access Emerg Med 2019; 11:171-177. [PMID: 31534375 PMCID: PMC6682168 DOI: 10.2147/oaem.s205006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Planning for management of bleeding in trauma injuries is very important. The initial purpose in emergency situations should be immediate establishment of an efficient hemostasis, principally in its topical application. In this study, we aimed to review the major relevant articles in the case of application of cellulose hemostatic agent on trauma injuries. Methods We searched the online databases such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, and Scopus. Two reviewers independently searched and assessed the titles and abstracts of all articles. Results Upon screening the titles and abstracts, 24 studies were identified for full-text review. The oxidized cellulose had the best clotting times, while it demonstrated low absorption ability. Surgical and thermosensitive chitosan hemostatic could be valuable for managing hemorrhage from liver injuries in trauma patients. Conclusion Recently, the application of cellulose hemostatic agents has been one of the main improvements obtained for controlling bleeding in trauma injuries. However, generally according to the literature review, the decision about using each agent should be made on a case-by-case basis. However, it can be mentioned that the perfect hemostatic agent has not been still identified.
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Affiliation(s)
- Hadi Khoshmohabat
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shahram Paydar
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Makarem
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Yasin Karami
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Dastgheib
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Rohallah Rezaei
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Khoshmohabat H, Paydar S, Kazemi HM, Dalfardi B. Overview of Agents Used for Emergency Hemostasis. Trauma Mon 2016; 21:e26023. [PMID: 27218055 PMCID: PMC4869418 DOI: 10.5812/traumamon.26023] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/19/2015] [Accepted: 05/25/2015] [Indexed: 12/12/2022] Open
Abstract
CONTEXT In today's modern world, despite the multiple advances made in the field of medicine, hemorrhagic shock is still the main cause of battlefield mortality and the second most prevalent cause of mortality in civilian trauma. Hemostatic agents can play a key role in establishing hemostasis in prehospital situations and preventing hemorrhage-associated death. In this respect, this article aims to review different aspects of known hemostatic agents. EVIDENCE ACQUISITION A comprehensive search of the academic scientific databases for relevant keywords was conducted; relevant articles were compiled and assessed. RESULTS Hemostatic agents can establish hemostasis by means of different mechanisms, including concentrating coagulation factors, adhesion to the tissues, in which traumatic hemorrhage occurred, and delivering procoagulant factors to the hemorrhage site. Presently, these hemostatics have been significantly improved with regard to efficacy and in adverse consequences, resulting from their use. Several hemostatic dressings have been developed to the degree that they have received FDA approval and are being used practically on the battlefield. In addition, there are currently several case reports on the use of such hemostatics in the hospital setting, in conditions where commonly known approaches fail to stop life-threatening bleeding. CONCLUSIONS The use of hemostatic dressings and agents is one of the main advancements achieved in recent decades. However, it can be claimed that the ideal hemostatic has not been recognized yet; therefore, this topic needs to be brought into focus and further addressed.
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Affiliation(s)
- Hadi Khoshmohabat
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Department of General Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Behnam Dalfardi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Behnam Dalfardi, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-9132483359, Fax: +98-7136254206, E-mail:
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Study on preparation of fibrinogen-loaded poly (L-lactic) acid nano-fabrics and its haemostatic performance in swine traumatic haemorrhage models. Blood Coagul Fibrinolysis 2015; 25:486-91. [PMID: 24509325 DOI: 10.1097/mbc.0000000000000090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Haemorrhage is the major cause of death in civilian trauma and the leading cause of preventable death in military trauma. It is very important to develop a haemostatic material with definite haemostatic effects. In this study, a nano-fabric membrane containing fibrinogen (Fbg) (2.5%, w/v) was successfully prepared by electrospinning as a haemostatic dressing. The average fibre diameter was 400 nm by scanning electron microscope (SEM), and it was indicated that fibrinogen and fibrin possessed excellent compatibility with poly (L-lactic)-acid (PLLA) from X-ray diffraction (XRD). Swine traumatic haemorrhage models including spleen haemorrhage, liver haemorrhage and femoral arteriovenous fistula haemorrhage were developed to detect haemostatic effects of this dressing. The results showed that the Fbg-loaded PLLA nano-fibre can significantly decrease the bleeding time, blood loss and mortality rate, which suggested that Fbg-loaded PLLA nano-fibre was efficacious on the models of traumatic uncontrolled haemorrhage, and further study of this dressing would be warranted to determine its potential in first aid and field trauma care.
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Aboushwareb T, Eberli D, Ward C, Broda C, Holcomb J, Atala A, Van Dyke M. A keratin biomaterial gel hemostat derived from human hair: evaluation in a rabbit model of lethal liver injury. J Biomed Mater Res B Appl Biomater 2009; 90:45-54. [PMID: 18988274 DOI: 10.1002/jbm.b.31251] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Effective hemostatic dressings that are compatible with tissues are needed. Keratins are a class of biomaterials that can be derived by extraction of proteins from human hair. We have recently discovered that keratin biomaterials have hemostatic characteristics and hypothesize that a keratin hydrogel having the ability to absorb fluid and bind cells may be an effective hemostat. The goal of this study was to test a keratin hydrogel and evaluate it compared to current hemostats. Thirty-two New Zealand white rabbits received a lethal liver injury. Eight animals each were assigned to negative control, QuickClot, HemCon bandage, and keratin treatment groups. Vital stats and other data were recorded during surgery and all surviving animals were sacrificed after 72 h. Histology was conducted on all surviving animals. Twenty-four-hour survival rates were 0%, 62.5%, 62.5%, and 75% for the negative control, QuickClot, HemCon, and keratin groups, respectively. Other outcomes included blood loss, mean arterial pressure, heart rate, shock index, and liver histology. All of the hemostats were statistically better than the negative control group at late operative time points. The keratin group consistently performed as well as, or better than, the commercial hemostats. Histology showed an interesting healing response at the hemostat-liver interface in the keratin group.
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Affiliation(s)
- Tamer Aboushwareb
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina 27157, USA
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Fan Y, Sun H, Pei G, Ruan C. Haemostatic efficacy of an ethyl-2-cyanoacrylate-based aerosol in combination with tourniquet application in a large wound model with an arterial injury. Injury 2008; 39:61-6. [PMID: 18155219 DOI: 10.1016/j.injury.2007.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 09/19/2007] [Accepted: 10/03/2007] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tourniquet application is the standard method for the control of severe trauma haemorrhage. However, it may result in severe ischaemic injuries when used for a long time. In this study, we developed a modified ethyl-2-cyanoacrylate-based aerosol (ECA) aerosol spray and determined its efficacy for short-time control of bleeding of large wounds in pigs when used in combination with tourniquet application. METHODS A large wound model with a femoral arterial injury was made in the middle of either thigh of the pig. Thirty white female hybrid pigs were divided evenly and randomly into three groups, including tourniquet application only group (group A), tourniquet-ECA group (group B, a combination of ECA with tourniquet application) and tourniquet-ECA with wound cleaning group (group C, a combination of ECA with tourniquet application plus wound cleaning). RESULTS The success rates of haemostasis were 0%, 30%and 90% in groups A, B and C, respectively (P<0.05). The incidence of haematoma and the membrane forming time were 100% and 20%, and 5.9+/-1.0min and 8.3+/-1.1min, respectively, in groups B and C (both P<0.05). The haemostatic time and the thickness of membrane were 11.9+/-1.8min and 10.2+/-1.4min, and 0.68+/-0.29mm and 0.79+/-0.25mm, respectively, in the two groups (P>0.05, both). CONCLUSION The ECA spray achieves haemostasis within a very short time when it is used in combination with tourniquet application in a large wound model with an arterial injury. It may effectively prevent the wound from bleeding without the need for any long-term pressure bandage to wrap the wound, and it is easy to be disposed in debridement. Therefore, it may serve as an optimal choice for the first aid of large wounds with an arterial injury.
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Affiliation(s)
- Yueguang Fan
- Department of Orthopaedic Surgery, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, No. 16 Ji Chang Road, Guangzhou 510405, PR China.
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Hemostatic Efficacy of a Recombinant Thrombin-Coated Polyglycolic Acid Sheet Coupled With Liquid Fibrinogen, Evaluated in a Canine Model of Pulmonary Arterial Hemorrhage. ACTA ACUST UNITED AC 2007; 63:783-7; discussion 787. [DOI: 10.1097/ta.0b013e318151ffdc] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Janvikul W, Uppanan P, Thavornyutikarn B, Krewraing J, Prateepasen R. In vitro comparative hemostatic studies of chitin, chitosan, and their derivatives. J Appl Polym Sci 2006. [DOI: 10.1002/app.24192] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rothwell SW, Reid TJ, Dorsey J, Flournoy WS, Bodo M, Janmey PA, Sawyer E. A Salmon Thrombin-Fibrin Bandage Controls Arterial Bleeding in a Swine Aortotomy Model. ACTA ACUST UNITED AC 2005; 59:143-9. [PMID: 16096554 DOI: 10.1097/01.ta.0000171528.43746.53] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recently, a wide variety of bandages have been formulated to attempt to improve the effectiveness of emergency intervention in situations of uncontrolled bleeding. The best of these dressings contain a mixture of human thrombin and fibrinogen. The presence of human components in these bandages, although effective, increases the cost of the dressing and raises questions of availability of raw materials and transmission of pathogens. The purpose of this study was to investigate the efficacy of dressings composed of salmon thrombin and fibrinogen in a swine aortotomy model. METHODS A 4.4-mm aortotomy was produced in the abdominal aorta of 19 anesthetized, splenectomized swine. The United States Army standard field gauze was applied to 8 animals, and the salmon thrombin-fibrin dressing (SFD) was applied to 11 animals. Survival, blood loss, and other parameters were measured over a 60-minute period. RESULTS All 11 animals that received the SFD survived the aortotomy injury, and bleeding stopped within 7.5 +/- 1.5 min. Seven of 8 animals in the control group were killed when bleeding continued and blood pressures decreased to the cutoff values as outlined in the animal protocol. Bleeding was significantly less in the SFD group compared with the gauze group (241 +/- 65.3 vs. 932.7 +/- 142.4 mL). CONCLUSION Fibrin dressing using salmon-derived thrombin and fibrinogen is effective in controlling severe, uncontrolled bleeding. This dressing may offer an alternative to dressings composed of human coagulation proteins.
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Affiliation(s)
- Stephen W Rothwell
- Department of Blood Research, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910-7500, USA.
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Effect of propyl gallate on activity of cyclooxygenase 1 and 2 in mice’s peritoneal macrophages. Chin J Integr Med 2004. [DOI: 10.1007/bf02836411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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