Electrospun Nanofibrous Architectures of Thrombin-Loaded Poly(ethylene oxide) for Faster in Vivo Wound Clotting

Alginate based hemostatic materials for bleeding management: A review

Severe bleeding has caused significant financial losses as well as a major risk to the lives and health of military and civilian populations. Under some situations, the natural coagulation mechanism of the body is unable to achieve fast hemostasis without the use of hemostatic drugs. Thus, the development of hemostatic materials and techniques is essential. Improving the quality of life and survival rate of patients and minimizing bodily damage requires fast, efficient hemostasis and prevention of bleeding. Alginate is regarded as an outstanding hemostatic polymer because of its non-immunogenicity, biodegradability, good biocompatibility, simple gelation, non-toxicity, and easy availability. This review summarizes the basics of hemostasis and emphasizes the recent developments regarding alginate-based hemostatic systems. Structural modifications and mixing with other materials have widely been used for the improvement of hemostatic characteristics of alginate and for making multifunctional medical devices that not only prevent uncontrolled bleeding but also have antibacterial characteristics, drug delivery abilities, and curing effects. This review is hoped to prepare critical insights into alginate modifications for better hemostatic properties.

Multi-functional dual-layer nanofibrous membrane for prevention of postoperative pancreatic leakage

Postoperative pancreatic leakage due to pancreatitis in patients is a life-threatening surgical complication. The majority of commercial barriers are unable to meet the demands for pancreatic leakage due to poor adhesiveness, toxicity, and inability to degrade. In this study, we fabricated mitomycin-c and thrombin-loaded multifunctional dual-layer nanofibrous membrane with a combination of alginate, PCL, and gelatin to resolve the leakage due to suture line disruption, promote hemostasis, wound healing, and prevent postoperative tissue adhesion. Electrospinning was used to fabricate the dual-layer system. The study results demonstrated that high gelatin and alginate content in the inner layer decreased the fiber diameter and water contact angle, and crosslinking allowed the membrane to be more hydrophilic, making it highly biodegradable, and adhering firmly to the tissue surfaces. The results of in vitro biocompatibility and hemostatic assay revealed that the dual-layer had a higher cell proliferation and showed effective hemostatic properties. Moreover, the in vivo studies and in silico molecular simulation indicated that the dual layer was covered at the wound site, prevented suture disruption and leakage, inhibited hemorrhage, and reduced postoperative tissue adhesion. Finally, the study results proved that dual-layer multifunctional nanofibrous membrane has a promising therapeutic potential in preventing postoperative pancreatic leakage.

Topical lyophilized thrombin application improves wound healing for posterior spinal surgery

Background

The erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery. However, ESPB might cause more surgical incisional wound exudate and poor wound healing, which might be improved after topical lyophilized thrombin application.

Materials and methods

We performed a retrospective study on patients who received posterior spinal surgery between January 2018 and December 2021. These patients were assigned into three groups: group A (general anesthesia), group B (general anesthesia with ESPB), and group C (general anesthesia with ESPB and topical 1000-unit thrombin application). Postoperative outcomes, including times of dressing changes, duration of suture removal, and incisional wound healing, were compared among these groups.

Results

Our study included 89 patients, with 48, 20, and 21 patients in groups A, B, and C, respectively. Baseline demographics, height, weight, comorbidities, and operation duration were comparable among the three groups. Group B required statistically significantly more dressing changes and had a prolonged duration of suture removal than group A (9.4 ± 4.7 versus 6.5 ± 2.0 times, 16.2 ± 3.7 versus 14.2 ± 1.4 days, respectively), which could be statistically significantly improved after the thrombin application in group C. Group B also had more frequent poor wound healing (25.0 %), which could also be improved after the thrombin application (0.0 %).

Conclusions

ESPB could cause more dressing changes and poor surgical wound healing after posterior spinal surgery, which could be improved by topical lyophilized thrombin powder application.

Sono-responsive smart nanoliposomes for precise and rapid hemostasis application

Massive hemorrhage caused by injuries and surgical procedures is a major challenge in emergency medical scenarios. Conventional means of hemostasis often fail to rapidly and efficiently control bleeding, especially in inaccessible locations. Herein, a type of smart nanoliposome with ultrasonic responsiveness, loaded with thrombin (thrombin@liposome, named TNL) was developed to serve as an efficient and rapid hemostatic agent. Firstly, the hydrophilic cavities of the liposomes were loaded onto the sono-sensitive agent protoporphyrin. Secondly, a singlet oxygen-sensitive chemical bond was connected with the hydrophobic and hydrophilic ends of liposomes in a chemical bond manner. Finally, based on the host guest effect between ultrasound and the sono-sensitizer, singlet oxygen is continuously generated, which breaks the hydrophobic and hydrophilic ends of liposome fragments, causing spatial collapse of the TNL structure, swiftly releases thrombin loaded in the hydrophilic capsule cavity, thereby achieving accurate and rapid local hemostasis (resulted in a reduction of approximately 67% in bleeding in the rat hemorrhage model). More importantly, after thorough assessments of biocompatibility and biodegradability, it has been confirmed that TNL possesses excellent biosafety, providing a new avenue for efficient and precise hemostasis.

Electrospun Nanofiber Membranes with Various Structures for Wound Dressing

Electrospun nanofiber membranes (NFMs) have high porosity and a large specific surface area, which provide a suitable environment for the complex and dynamic wound healing process and a large number of sites for carrying wound healing factors. Further, the design of the nanofiber structure can imitate the structure of the human dermis, similar to the natural extracellular matrix, which better promotes the hemostasis, anti-inflammatory and healing of wounds. Therefore, it has been widely studied in the field of wound dressing. This review article overviews the development of electrospinning technology and the application of electrospun nanofibers in wound dressings. It begins with an introduction to the history, working principles, and transformation of electrospinning, with a focus on the selection of electrospun nanofiber materials, incorporation of functional therapeutic factors, and structural design of nanofibers and nanofiber membranes. Moreover, the wide application of electrospun NFMs containing therapeutic factors in wound healing is classified based on their special functions, such as hemostasis, antibacterial and cell proliferation promotion. This article also highlights the structural design of electrospun nanofibers in wound dressing, including porous structures, bead structures, core-shell structures, ordered structures, and multilayer nanofiber membrane structures. Finally, their advantages and limitations are discussed, and the challenges faced in their application for wound dressings are analyzed to promote further research in this field.

Multilayered nanofibrous scaffold of Polyvinyl alcohol/gelatin/poly (lactic-co-glycolic acid) enriched with hemostatic/antibacterial agents for rapid acute hemostatic wound healing

Electrospun nanofibers scaffolds show promising potential in wound healing applications. This work aims to fabricate nanofibrous wound dressing as a novel approach for a topical drug delivery system. Herein, the electrospinning technique is used to design and fabricate bioabsorbable nanofibrous scaffolds of Polyvinyl alcohol/gelatin/poly (lactic-co-glycolic acid) enriched with thrombin (TMB) as hemostatic agent and vancomycin (VCM) as anti-bacterial agent for a multifunctional platform to control excessive blood loss, inhibit bacterial growth and enhance wound healing. SEM, FTIR, XRD, in vitro drug release, antimicrobial studies, biofilm, cell viability assay, and in vivo study in a rat model were used to assess nanofiber's structural, mechanical, and biological aspects. SEM images confirms the diameter of nanofibers which falls within the range from 150 to 300 nm for all the batches. Excellent swelling index data makes it suitable to absorb wound exudates. In-vitro drug release data shows sustained release behavior of nanofiber. Nanofibers scaffolds showed biomimetic behavior and excellent biocompatibility. Moreover, scaffolds exhibited excellent antimicrobial and biofilm activity against Staphylococcus aureus. Nanofibrous scaffolds showed less bleeding time, rapid blood coagulation, and excellent wound closure in a rat model. ELISA study demonstrated the decreasing level of inflammatory markers, such as TNF-α, IL1β, and IL-6, making formulation promising for hemostatic wound healing applications. Finally, the study concludes that nanofibrous scaffolds loaded with TMB and VCM have promising potential as a dressing material for hemostatic wound healing applications.

Nanofibrous hemostatic materials: Structural design, fabrication methods, and hemostatic mechanisms

Development of rapid and effective hemostatic materials has always been the focus of research in the healthcare field. Nanofibrous materials which recapitulate the delicate nano-topography feature of fibrin fibers produced during natural hemostatic process, offer large length-to-diameter ratio and surface area, tunable porous structure, and precise control in architecture, showing great potential for staunching bleeding. Here we present a comprehensive review of advances in nanofibrous hemostatic materials, focusing on the following three important parts: structural design, fabrication methods, and hemostatic mechanisms. This review begins with an introduction to the physiological hemostatic mechanism and current commercial hemostatic agents. Then, it focuses on recent progress in electrospun nanofibrous hemostatic materials in terms of composition and structure control, surface modification, and in-situ deposition. The article emphasizes the development of three-dimensional (3D) electrospun nanofibrous materials and their emerging evolution for improving hemostatic function. Next, it discusses the fabrication of self-assembling peptide or protein-mimetic peptide nanofibers, co-assembling supramolecular nanofibers, as well as other nanofibrous hemostatic agents. Further, the article highlights the external and intracavitary hemostatic management based on various nanofiber aggregates. In the end, this review concludes with the current challenges and future perspectives of nanofibrous hemostatic materials. STATEMENT OF SIGNIFICANCE: This article reviews recent advances in nanofibrous hemostatic materials including fabrication methods, composition and structural control, performance improvement, and hemostatic mechanisms. A variety of methods including electrospinning, self-assembly, grinding and refining, template synthesis, and chemical vapor deposition, have been developed to prepare nanofibrous materials. These methods provide robustness in control of the nanofiber architecture in the forms of hydrogels, two-dimensional (2D) membranes, 3D sponges, or composites, showing promising potential in the external and intracavitary hemostasis and wound healing applications. This review will be of great interest to the broad readers in the field of hemostatic materials and multifunctional biomaterials.

Nanofibrous Membrane with Encapsulated Glucose Oxidase for Self-Sustained Antimicrobial Applications

Polyvinyl alcohol (PVA) nanofibrous membrane, consisting of separately encapsulated glucose oxidase (GOx) and glucose (Glu) nanofibers, was prepared via simultaneously electrospinning PVA/GOx and PVA/Glu dopes. The as-prepared pristine membrane could self-sustainably generate hydrogen peroxide (H2O2) only in contact with an aqueous solution. The H2O2 production level was well maintained even after storing the dry membrane at room temperature for 7 days. Cross-linking the membrane via reaction with glutaraldehyde (GA) vapor could not only prevent the nanofibrous membrane from dissolving in water but also prolonged the release of H2O2. The sustained release of H2O2 from the membrane achieved antimicrobial capability equivalent to that of 1% H2O2 against both Escherichia coli and Staphylococcus aureus. Gram(+) S. aureus cells were more susceptible to H2O2 than Gram(-) E. coli and >99% of S. aureus were killed after 1 h incubation with the membrane. Pristine and GA-crosslinked nanofibrous membrane with in situ production of H2O2 were self-sterilized in which no microorganism contamination on the membrane could be detected after 2 weeks incubation on an agar plate. The GOx/Glu membrane may find potential application as versatile antimicrobial materials in the field of biomedicine, in the food and health industries, and especially challenges related to wound healing in diabetic patients.