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Cassano R, Perri P, Scarcello E, Piro P, Sole R, Curcio F, Trombino S. Chitosan Hemostatic Dressings: Properties and Surgical Applications. Polymers (Basel) 2024; 16:1770. [PMID: 39000626 PMCID: PMC11244242 DOI: 10.3390/polym16131770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024] Open
Abstract
Wounds caused by trauma and/or surgery represent a significant challenge in contemporary medical practice, requiring innovative approaches to promote optimal healing and reduce the risk of bleeding and complications resulting from it. In this context, chitosan, a natural polysaccharide derived from chitin, represents an ideal material for the study and application of medical devices, in the form of dressings, in wound management for pre- and/or post-operative wounds due to its ability to induce hemostasis and its high biocompatibility with biological tissues. The aim of this work was to discuss the structural characteristics, properties and application of chitosan-based hemostatic dressings in hemostatic processes resulting from pre- or post-surgical approaches.
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Affiliation(s)
- Roberta Cassano
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, 87036 Rende, Italy; (R.C.); (R.S.)
| | - Paolo Perri
- Department of Vascular and Endovascular Surgery, Annunziata Hospital, 1 Via Migliori, 87100 Cosenza, Italy; (P.P.); (E.S.); (P.P.)
| | - Edoardo Scarcello
- Department of Vascular and Endovascular Surgery, Annunziata Hospital, 1 Via Migliori, 87100 Cosenza, Italy; (P.P.); (E.S.); (P.P.)
| | - Paolo Piro
- Department of Vascular and Endovascular Surgery, Annunziata Hospital, 1 Via Migliori, 87100 Cosenza, Italy; (P.P.); (E.S.); (P.P.)
| | - Roberta Sole
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, 87036 Rende, Italy; (R.C.); (R.S.)
| | - Federica Curcio
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, 87036 Rende, Italy; (R.C.); (R.S.)
| | - Sonia Trombino
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, 87036 Rende, Italy; (R.C.); (R.S.)
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Mousa NA, Soliman SM, Al-Mofty SED. Potential novel role of the human amniotic membrane as a sustainable hemostat. Int J Gynaecol Obstet 2024. [PMID: 38676349 DOI: 10.1002/ijgo.15559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Acute hemorrhage can cause significant morbidity and mortality arising from trauma, bleeding disorders, surgical procedures, or obstetric complications. Surgical hemostasis methods may fail to stop acute bleeding due to the complex bleeding dynamics of each bleeding type. Therefore, developing safe and effective topical hemostatic agents remains crucial. The human amniotic membrane (hAM) has established clinical evidence of effectiveness in promoting wound healing and tissue regeneration. Despite its unique biological and immunologic properties and its structural composition of established hemostatic elements, the hemostatic role of hAM has not been yet explored. The present study aimed to investigate this potential role and to describe the development protocol and characterization of hAM-derived topical hemostat. METHODS Surface electron microscope (SEM) imaging and Fourier transform infrared (FTIR) spectroscopy were used for characterization, and mouse models with induced peritoneal and tail wound bleeding were employed to evaluate the hemostatic effectiveness using physiological studies, in comparison to a chitosan-based combat-scale hemostat. RESULTS The hAM hemostat showed a distinctive composition by SEM and FTIR. Applying equal masses of the hAM hemostat, the commercial hemostat, or a combination reduced peritoneal wound bleeding time to averages of 108.4, 86.2, and 76.8 s, respectively, compared to the control group (300 s). Tail wound bleeding times were similarly reduced with no significant difference between the hAM and the commercial hemostat (P values = 0.29, 0.34 in peritoneal and tail wounds, respectively). Neither hemostat affected coagulation time. CONCLUSION This study describes a simple cost-effective preparation protocol for a hAM-based hemostatic agent. The long-recognized safety, sustainability, and immunotolerance advantages of hAM can establish superiority over commercial hemostats with reported safety concerns. Robust research validation in larger-scale bleeding models is required for wider applications and severe bleeding types.
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Affiliation(s)
- Noha Ahmed Mousa
- Obstetrics and Gynecology, Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Saif El-Din Al-Mofty
- Zewail City of Science and Technology, Cairo, Egypt
- Department of Chemistry, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
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Edwards JV, Prevost NT, Hinchliffe DJ, Nam S, Chang S, Hron RJ, Madison CA, Smith JN, Poffenberger CN, Taylor MM, Martin EJ, Dixon KJ. Preparation and Activity of Hemostatic and Antibacterial Dressings with Greige Cotton/Zeolite Formularies Having Silver and Ascorbic Acid Finishes. Int J Mol Sci 2023; 24:17115. [PMID: 38069435 PMCID: PMC10706952 DOI: 10.3390/ijms242317115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/01/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
The need for prehospital hemostatic dressings that exert an antibacterial effect is of interest for prolonged field care. Here, we consider a series of antibacterial and zeolite formulary treatment approaches applied to a cotton-based dressing. The design of the fabric formulations was based on the hemostatic dressing TACGauze with zeolite Y incorporated as a procoagulant with calcium and pectin to facilitate fiber adherence utilizing silver nanoparticles, and cellulose-crosslinked ascorbic acid to confer antibacterial activity. Infra-red spectra were employed to characterize the chemical modifications on the dressings. Contact angle measurements were employed to document the surface hydrophobicity of the cotton fabric which plays a role in the contact activation of the coagulation cascade. Ammonium Y zeolite-treated dressings initiated fibrin equal to the accepted standard hemorrhage control dressing and showed similar improvement with antibacterial finishes. The antibacterial activity of cotton-based technology utilizing both citrate-linked ascorbate-cellulose conjugate analogs and silver nanoparticle-embedded cotton fibers was observed against Staphylococcus aureus and Klebsiella pneumoniae at a level of 99.99 percent in the AATCC 100 assay. The hydrogen peroxide levels of the ascorbic acid-based fabrics, measured over a time period from zero up to forty-eight hours, were in line with the antibacterial activities.
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Affiliation(s)
- J. Vincent Edwards
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - Nicolette T. Prevost
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - Doug J. Hinchliffe
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - Sunghyun Nam
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - SeChin Chang
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - Rebecca J. Hron
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - Crista A. Madison
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - Jade N. Smith
- Southern Regional Research Center, Agricultural Research Service, United States Department of Agriculture, New Orleans, LA 70124, USA; (N.T.P.); (D.J.H.); (S.N.); (S.C.); (R.J.H.); (C.A.M.); (J.N.S.)
| | - Chelsie N. Poffenberger
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA; (C.N.P.); (M.M.T.); (K.J.D.)
| | - Michelle M. Taylor
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA; (C.N.P.); (M.M.T.); (K.J.D.)
| | - Erika J. Martin
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Kirsty J. Dixon
- Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA; (C.N.P.); (M.M.T.); (K.J.D.)
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Wu W, Liu W, Lin N, Zhao H, Yang J, Ye Z, Yang W, Wang Y, Fang Y. A modified chain-based sponge dressing controls junctional hemorrhage in the tactical combat casualty care simulation of pigs. Scand J Trauma Resusc Emerg Med 2023; 31:75. [PMID: 37946246 PMCID: PMC10636963 DOI: 10.1186/s13049-023-01133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Hemorrhage has always been the focus of battlefield and pre-hospitalization treatment. With the increasing fatality rates associated with junctional bleeding, treatment of bleeding at junctional sites has gradually gained attention in battlefield trauma emergency care. We designed a modified chain-based sponge dressing with a medical polyvinyl alcohol sponge that can be used to treat junctional hemorrhage and tested its hemostatic efficacy and biocompatibility. METHODS Twenty adult Bama miniature pigs were randomly divided into the modified chain-based sponge dressing (MCSD) and standard gauze (SG) groups. The right femoral artery of the pigs was shot at after anesthesia. The Bama miniature pigs were moved to the safety zone immediately to assess the condition according to the MARCH strategy, which evaluates massive hemorrhaging, airway obstruction, respiratory status, circulatory status, head injury & hypothermia. Hemoglobin and coagulation status were checked during the experiment.Among the pigs in which the inguinal hemorrhagic model based on bullet penetrating wounds was successfully established, those in the MCSD group received a disinfected MCSD for hemostasis, while those in the SG group received standard gauze in an imbricate manner to pack the bullet exit and entrance wounds to stop bleeding until the wound was filled, followed by compression for 3 min at sufficient pressure. CT scanning, transmission electron microscopy, and HE staining were conducted after experiment. RESULTS The MCSD group showed lower hemostasis time and blood loss than the gauze group. The MCSD group also showed a higher success rate of treatment,more stable vital signs and hemoglobin level. The CT scanning results showed tighter packing without large gaps in the MCSD group. The histopathological assessments and the transmission electron microscopy and HE staining findings indicated good biocompatibility of the polyvinyl alcohol sponge. CONCLUSION The MCSD met the battlefield's requirements of speedy hemostasis and biosafety for junctional hemorrhage in Bama miniature pigs. Moreover, in comparison with the conventional approach for hemostasis, it showed more stable performance for deep wound hemostasis. These findings provide the theoretical and experimental basis for the application of MCSD in the treatment of hemorrhage in the battlefield in the future.
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Affiliation(s)
- Weihang Wu
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China
| | - Wangwu Liu
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China
| | - Nan Lin
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China
| | - Hu Zhao
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China
| | - Jin Yang
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China
| | - Zhi Ye
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China
| | - Weijin Yang
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China
| | - Yu Wang
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China.
| | - Yongchao Fang
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of Joint Logistics Support Force, PLA, Fuzhou, Fujian, 350025, China.
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Bao L, Zhang Z, Li X, Zhang L, Tian H, Zhao M, Ye T, Cui W. Bacteriosynthetic Degradable Tranexamic Acid-Functionalized Short Fibers for Inhibiting Invisible Hemorrhage. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2303615. [PMID: 37501326 DOI: 10.1002/smll.202303615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Current research on hemostatic materials have focused on the inhibition of visible hemorrhage, however, invisible hemorrhage is the unavoidable internal bleeding that occurs after trauma or surgery, leading directly to a dramatic drop in hemoglobin and then to anemia and even death. In this study, bacterial nanocellulose (BNC) was synthesized and oxidized from the primary alcohols to carboxyl groups, and then grafted with tranexamic acid through amide bonds to construct degradable nanoscale short fibers (OBNC-TXA), which rapidly activated the coagulation response. The hemostatic material is made up of nanoscale short fibers that can be constructed into different forms such as emulsions, gels, powders, and sponges to meet different clinical applications. In the hemostatic experiments in vitro, the composites had significantly superior pro-coagulant properties due to the rapid aggregation of blood cells. In the coagulation experiments with rat tail amputation and liver trauma hemorrhage models, the group treated with OBNC-TXA1 sponge showed low hemorrhage and inhibited invisible hemorrhage in rectus abdominis muscle defect hemorrhage models, with a rapid recovery of hemoglobin values from 128±5.5 to 165±2.6 g L-1 within 4 days. In conclusion, the degradable short fibers constructed from bacterial nano-cellulose achieved inhibition of invisible hemorrhage in vivo.
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Affiliation(s)
- Luhan Bao
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Zhiqiang Zhang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Xiaoxiao Li
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Lei Zhang
- Department of Vascular Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, 200437, P. R. China
| | - Hua Tian
- Department of Orthopedics, Peking University 3rd Hospital, No 49 Huayuan North Road, Haidian district, Beijing, 100191, P. R. China
| | - Minwei Zhao
- Department of Orthopedics, Peking University 3rd Hospital, No 49 Huayuan North Road, Haidian district, Beijing, 100191, P. R. China
| | - Tingjun Ye
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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Shaw J, Zakhary B, Coimbra R, Moore L, Scalea T, Kundi R, Teeter W, Romagnoli A, Moore E, Sauaia A, Dennis B, Brenner M. Use of Tranexamic Acid With Resuscitative Endovascular Balloon Occlusion of the Aorta is Associated With Higher Distal Embolism Rates: Results From the American Association of Surgery for Trauma Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery Trial. Am Surg 2023; 89:4208-4217. [PMID: 37431165 DOI: 10.1177/00031348231177918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Tranexamic acid (TXA) use has been associated with thrombotic complications. OBJECTIVE We aim to investigate outcomes associated with TXA use in the setting of high- (HP) and low-profile (LP) introducer sheaths for resuscitative endovascular balloon occlusion of the aorta (REBOA). PARTICIPANTS The Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery (AORTA) database was queried for patients who underwent REBOA using a low-profile 7 French (LP) or high-profile, 11-14 French (HP) introducer sheaths between 2013 and 2022. Demographics, physiology, and outcomes were examined for patients who survived beyond the index operation. RESULTS 574 patients underwent REBOA (503 LP, 71 HP); 77% were male, mean age was 44 ± 19 and mean injury severity score (ISS) was 35 ± 16. 212 patients received TXA (181 [36%] LP, 31 [43.7%] HP). There were no significant differences in admission vital signs, GCS, age, ISS, SBP at AO, CPR at AO, and duration of AO among LP and HP patients. Overall, mortality was significantly higher in the HP (67.6%) vs the LP group (54.9%; P = .043). Distal embolism was significantly higher in the HP group (20.4%) vs the LP group (3.9%; P < .001). Logistic regression demonstrated that TXA use was associated with a higher rate of distal embolism in both groups (OR = 2.92; P = .021). 2 LP patients (one who received TXA) required an amputation. CONCLUSION Patients who undergo REBOA are profoundly injured and physiologically devastated. Tranexamic acid was associated with a higher rate of distal embolism in those who received REBOA, regardless of access sheath size. For patients receiving TXA, REBOA placement should be accompanied by strict protocols for immediate diagnosis and treatment of thrombotic complications.
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Affiliation(s)
| | - Bishoy Zakhary
- Riverside University Health System, Department of Surgery, 26520 Cactus Ave, Moreno Valley, CA 92555
| | - Raul Coimbra
- Riverside University Health System, Department of Surgery, 26520 Cactus Ave, Moreno Valley, CA 92555
| | - Laura Moore
- University of Texas Health Science Center at Houston (UTHealth), Department of Surgery, 6431 Fannin Street, Houston TX 77030
| | - Thomas Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| | - Rishi Kundi
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| | - William Teeter
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| | - Anna Romagnoli
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
| | - Ernest Moore
- University of Colorado Anschutz Medical Campus, Department of Surgery, 12631 East 17th Avenue, Aurora, CO 80045
| | - Angela Sauaia
- University of Colorado Anschutz Medical Campus, Department of Surgery, 12631 East 17th Avenue, Aurora, CO 80045
| | - Bradley Dennis
- Vanderbilt University Medical Center, Division of Acute Care Surgery, 1161 21st,Avenue South, Medical Center North, D-5203, Nashville, TN 37232
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Kong C, Chen S, Wang X, Hu C, Li B, Fu R, Zhang J. Hemoadhican, a Tissue Adhesion Hemostatic Material Independent of Blood Coagulation. Adv Healthc Mater 2023; 12:e2300705. [PMID: 37029455 DOI: 10.1002/adhm.202300705] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Uncontrolled hemorrhage is a leading cause of death, emphasizing the need for novel hemostatic agents. Here, a novel hemostatic polysaccharide hemoadhican (HD) is screened out by analyzing the rheological properties of screened material mixed blood sludges, which is prepared by mixing polysaccharide granules and whole blood to mimic the coagulation in vitro. HD is produced by a bacterial isolate Paenibacillus sp.1229, and the repeating units of HD are →)-α-L-Rhap-(1→3)-β-D-Glcp-(1→4)[4,6-ethylidene-α-D-Galp-(1→4)-α-D-Glcp-(1→3)]-α-D-Manp-(1→. Compared to chitosan and celox, HD achieves more effective hemostasis in animal models with mouse and rat femoral arteries, rat carotid arteries, and rabbit femoral arteries. Especially, HD maintains an excellent hemostatic capability in animals with heparin-induced hemorrhage diathesis. In vitro experiments show HD granules can quickly absorb a small amount of blood component to create a hemophobic blood sludge resistant to high pressure. The blood sludge firmly adheres to damaged tissue and efficiently repels blood. In vitro experiments show that HD does not actively trigger blood coagulation cascade and is independent of blood conditions including heparin treatment. In addition, HD moisturizes wounds and accelerates wound healing, exhibiting excellent biodegradability, and hemocompatibility. The results indicate that HD is a promising hemostatic material for treating traumatic hemorrhages and uncontrollable surgical bleeding.
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Affiliation(s)
- Changchang Kong
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Beijing, 210094, China
| | - Shijunyin Chen
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Beijing, 210094, China
| | - Xianjin Wang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Beijing, 210094, China
| | - Chengtao Hu
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Beijing, 210094, China
| | - Bing Li
- Nanjing Southern Element Biotechnology Co., Ltd, Nanjing, 211899, China
| | - Renjie Fu
- Nanjing Southern Element Biotechnology Co., Ltd, Nanjing, 211899, China
| | - Jianfa Zhang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
- Key Laboratory of Metabolic Engineering and Biosynthesis Technology, Ministry of Industry and Information Technology, Beijing, 210094, China
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Liu C, Cui X, Du Y, Wang X, Kim J, Li S, Zhang L, Zhao X, Zhao L, Tian P, Zhang H, Su K, Li X, Pan H. Unusual Surface Coagulation Activation Patterns of Crystalline and Amorphous Silicate-Based Biominerals. Adv Healthc Mater 2023; 12:e2300039. [PMID: 37000691 DOI: 10.1002/adhm.202300039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/17/2023] [Indexed: 04/01/2023]
Abstract
Activation of coagulation cascades, especially FX and prothrombin, prevents blood loss and reduces mortality from hemorrhagic shock. Inorganic salts are efficient but cannot stop bleeding completely in hemorrhagic events, and rebleeding carries a significant mortality risk. The coagulation mechanism of biominerals has been oversimplified in the past two decades, limiting the creation of novel hemostats. Herein, at the interface, the affinity of proteins, the protease activity, fibrinolysis, hydration shell, and dynamic microenvironment are monitored at the protein level. Proteomic analysis reveals that fibrinogen and antithrombin III's affinity for kaolin's interface causes a weak thrombus and rebleeding during hemostasis. Inspiringly, amorphous bioactive glass (BG) with a transient-dynamic ion microenvironment breaches the hydration layer barrier and selectively and slightly captures procoagulant components of kiniogen-1, plasma kallikrein, FXII, and FXI proteins on its interface, concurrently generating a continuous biocatalytic interface to rapidly activate both intrinsic and extrinsic coagulation pathways. Thus, prothrombin complexes are successfully hydrolyzed to thrombin without platelet membrane involvement, speeding production of high-strength clots. This study investigates how the interface of inorganic salts assists in coagulation cascades from a more comprehensive micro-perspective that may help elucidate the clinical application issues of kaolin-gauze and pave the way to new materials for managing hemorrhage.
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Affiliation(s)
- Chunyu Liu
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Xu Cui
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Yunbo Du
- Department of Critical Care Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518000, P. R. China
| | - Xue Wang
- R&D Department, Shenzhen Healthemes Biotechnology Co. Ltd, Shenzhen, 518102, P. R. China
| | - Jua Kim
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Shuaijie Li
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
- Department of orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Liyan Zhang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Xiaoli Zhao
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Limin Zhao
- Department of Critical Care Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518000, P. R. China
| | - Pengfei Tian
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Hao Zhang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Kun Su
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Xian Li
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Haobo Pan
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
- R&D Department, Shenzhen Healthemes Biotechnology Co. Ltd, Shenzhen, 518102, P. R. China
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Latif RK, Clifford SP, Baker JA, Lenhardt R, Haq MZ, Huang J, Farah I, Businger JR. Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med 2023; 31:25. [PMID: 37226264 DOI: 10.1186/s13049-023-01088-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
Trauma is the number one cause of death among Americans between the ages of 1 and 46 years, costing more than $670 billion a year. Following death related to central nervous system injury, hemorrhage accounts for the majority of remaining traumatic fatalities. Among those with severe trauma that reach the hospital alive, many may survive if the hemorrhage and traumatic injuries are diagnosed and adequately treated in a timely fashion. This article aims to review the recent advances in pathophysiology management following a traumatic hemorrhage as well as the role of diagnostic imaging in identifying the source of hemorrhage. The principles of damage control resuscitation and damage control surgery are also discussed. The chain of survival for severe hemorrhage begins with primary prevention; however, once trauma has occurred, prehospital interventions and hospital care with early injury recognition, resuscitation, definitive hemostasis, and achieving endpoints of resuscitation become paramount. An algorithm is proposed for achieving these goals in a timely fashion as the median time from onset of hemorrhagic shock and death is 2 h.
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Affiliation(s)
- Rana K Latif
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA.
- Paris Simulation Center, Office of Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.
- Outcomes Research Consortium, Cleveland, OH, USA.
| | - Sean P Clifford
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Jeffery A Baker
- Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rainer Lenhardt
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Mohammad Z Haq
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
- Department of Cardiovascular & Thoracic Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
- The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, USA
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA
- Division of Infectious Diseases, Department of Medicine, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, USA
| | - Ian Farah
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Jerrad R Businger
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
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10
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Berry C, Gallagher JM, Goodloe JM, Dorlac WC, Dodd J, Fischer PE. Prehospital Hemorrhage Control and Treatment by Clinicians: A Joint Position Statement. PREHOSP EMERG CARE 2023:1-15. [PMID: 36961935 DOI: 10.1080/10903127.2023.2195487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- Cherisse Berry
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | | | - Jeffrey M Goodloe
- Department of Emergency Medicine, University of Oklahoma Health Sciences Center, Tulsa, OK
| | - Warren C Dorlac
- Department of Surgery, University of Colorado Health Loveland, Loveland, CO
| | - Jimm Dodd
- Stop the Bleed, American College of Surgeons, Chicago, IL
| | - Peter E Fischer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
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11
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Zhang Y, Liu Y, Ni G, Xu J, Tian Y, Liu X, Gao J, Gao Q, Shen Y, Yan Z. Sulfated modification, basic characterization, antioxidant and anticoagulant potentials of polysaccharide from Sagittaria trifolia. ARAB J CHEM 2023. [DOI: 10.1016/j.arabjc.2023.104812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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12
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Deng L, Wang L, Li L, Gong Z, Wang R, Fei W, Zhou Y, Wang F. Bioabsorbable Fibrillar Gauze Dressing Based on N-Carboxyethyl Chitosan Gelling Fibers for Fatal Hemorrhage Control. ACS APPLIED BIO MATERIALS 2023; 6:899-907. [PMID: 36691985 DOI: 10.1021/acsabm.2c01089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Death from lethal hemorrhage remains a major problem in various emergency scenarios. There is a continuous interest in the development of absorbable hemostatic dressings that can control hemorrhage rapidly and can be left in the wound site without removal. In this study, we report a hemostatic gauze dressing based on N-carboxyethyl chitosan (CECS) gelling fibers. The CECS fibrillar gauze combines ultra-hydrophilic, cationic chemical property of the fiber components with the fluffy nonwoven material form, exhibiting good conformability for wound filling, high fluid uptaking capacity, and enhanced blood-concentrating effect. In a swine femoral artery injury model, the CECS fibrillar gauze achieves shorter time to hemostasis and less blood loss compared with commercially available hemostatic dressings. This chitosan gelling fiber gauze demonstrates comparable bioabsorbability to clinically used absorbable hemostat and thus may be applied to treat fatal hemorrhage both in emergency medical services and in internal surgical procedures.
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Affiliation(s)
- Lili Deng
- Department of Critical Care Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201620, China
| | - Liu Wang
- Department of Critical Care Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201620, China
| | - Li Li
- Department of Orthopaedics and Traumatology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Zuguang Gong
- College of Materials Science and Engineering and Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, China
| | - Ruilan Wang
- Department of Critical Care Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201620, China
| | - Wendi Fei
- Department of Orthopaedics and Traumatology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
| | - Yingshan Zhou
- College of Materials Science and Engineering and Key Laboratory of Green Processing and Functional Textiles of New Textile Materials, Ministry of Education, Wuhan Textile University, Wuhan 430073, China
| | - Fang Wang
- Department of Orthopaedics and Traumatology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China
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13
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Zhao P, Feng Y, Zhou Y, Tan C, Liu M. Gold@Halloysite nanotubes-chitin composite hydrogel with antibacterial and hemostatic activity for wound healing. Bioact Mater 2023; 20:355-367. [PMID: 35784635 PMCID: PMC9207301 DOI: 10.1016/j.bioactmat.2022.05.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/13/2023] Open
Abstract
Infection and healing of wounds after injury has always been an unavoidable problem in daily life, so design of a biomaterial with antibacterial and good wound healing properties is highly needed. Herein, a wound healing hydrogel dressing with halloysite clay and chitin as the main components was prepared, which combines the advantages of the biomacromolecule and clay. Halloysite nanotubes (HNTs) are extremely biocompatible clay materials with a hollow tubular structure, and the inner and outer surfaces of HNTs are composed of SiOx and AlOx layers with different charges. Au nanoparticles with diameter in 5-10 nm were filled into the HNTs' lumen to endow photothermal effect of the clay materials. Au@HNTs was then mixed with chitin solution to prepare flexible composite hydrogel by crosslinking by epichlorohydrin. The antibacterial properties, biocompatibility and hemostatic properties of the hydrogel material were investigated by antibacterial experiments, cell experiments, mouse liver and tail hemostatic experiments. After infecting the back wound of mice with Staphylococcus aureus, the hydrogel was applied to the wound to further verify the killing effect on bacteria and wound healing effect of the hydrogel material in vivo. The Au@HNTs-chitin composite hydrogel exhibits high antibacterial and hemostatic activity as well as promoting wound healing function with low cytotoxicity. This study is significant for the development of high-performance wound dressings based on two commonly used biocompatible materials, which shows promising application in wound sterilization and healing.
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Affiliation(s)
- Puxiang Zhao
- Department of Materials Science and Engineering, Jinan University, Guangzhou, 510632, China
- Engineering Research Center of Artificial Organs and Materials, Ministry of Education, Guangzhou, 510632, China
| | - Yue Feng
- Department of Materials Science and Engineering, Jinan University, Guangzhou, 510632, China
- Engineering Research Center of Artificial Organs and Materials, Ministry of Education, Guangzhou, 510632, China
| | - Youquan Zhou
- Department of Materials Science and Engineering, Jinan University, Guangzhou, 510632, China
- Engineering Research Center of Artificial Organs and Materials, Ministry of Education, Guangzhou, 510632, China
| | - Cuiying Tan
- Department of Materials Science and Engineering, Jinan University, Guangzhou, 510632, China
- Engineering Research Center of Artificial Organs and Materials, Ministry of Education, Guangzhou, 510632, China
| | - Mingxian Liu
- Department of Materials Science and Engineering, Jinan University, Guangzhou, 510632, China
- Engineering Research Center of Artificial Organs and Materials, Ministry of Education, Guangzhou, 510632, China
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14
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Feng Y, He Y, Lin X, Xie M, Liu M, Lvov Y. Assembly of Clay Nanotubes on Cotton Fibers Mediated by Biopolymer for Robust and High-Performance Hemostatic Dressing. Adv Healthc Mater 2023; 12:e2202265. [PMID: 36314398 DOI: 10.1002/adhm.202202265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/20/2022] [Indexed: 02/03/2023]
Abstract
Uncontrollable bleeding from military conflicts, accidents, and surgical procedures is a major life-threatening factor. Rapid, safe, and convenient hemostasis is critical to the survival of bleeding patients in prehospital care. However, the peel-off of hemostats such as kaolinite sheets from the cotton fibers often poses a risk of distal thrombosis. Here, an efficient clay hemostat of halloysite nanotubes is tightly bound onto commercial cotton fibers, which is capillary mediated by biopolymer alginate with Ca2+ crosslinking. The robust clay nanotube dressing materials maintain high procoagulant activity after harsh water treatment, and only a few residuals of halloysite exist in the wound area. Compared with commercial hemostat QuikClot Combat gauze, halloysite-alginate-cotton composite dressing exhibits hemostatic properties both in vivo and in vitro with high safety. The hemostatic mechanism of the dressing is attributed to activating platelets, locally concentrating clotting components in the nanoclay, halloysite coagulation factors, and alginate cross-linked with Ca2+ . This work inspires robust self-assembly of clay nanotubes on textile fibers and offers a hemostatic material with balanced high hemostatic activity, minimal ingredient loss, and biocompatibility. The robust dressing based on halloysite tightly bounded cotton shows great potential for military, medical, and civil bleeding control with low health risks.
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Affiliation(s)
- Yue Feng
- Department of Materials Science and Engineering, College of Chemistry and Materials Science, Jinan University, Guangzhou, 511443, P. R. China
| | - Yunqing He
- Department of Materials Science and Engineering, College of Chemistry and Materials Science, Jinan University, Guangzhou, 511443, P. R. China
| | - Xiaoying Lin
- Department of Materials Science and Engineering, College of Chemistry and Materials Science, Jinan University, Guangzhou, 511443, P. R. China
| | - Mingyang Xie
- Department of Materials Science and Engineering, College of Chemistry and Materials Science, Jinan University, Guangzhou, 511443, P. R. China
| | - Mingxian Liu
- Department of Materials Science and Engineering, College of Chemistry and Materials Science, Jinan University, Guangzhou, 511443, P. R. China.,Engineering Research Center of Artificial Organs and Materials, Ministry of Education, Guangzhou, 510632, P. R. China
| | - Yuri Lvov
- Institute for Micromanufacturing, Louisiana Tech University, Ruston, LA, 71272, USA
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15
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Patil G, Pawar R, Jadhav S, Ghormade V. A chitosan based multimodal “soft” hydrogel for rapid hemostasis of non-compressible hemorrhages and its mode of action. CARBOHYDRATE POLYMER TECHNOLOGIES AND APPLICATIONS 2022. [DOI: 10.1016/j.carpta.2022.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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A Narrative Review of Different Hemostatic Materials in Emergency Treatment of Trauma. Emerg Med Int 2022; 2022:6023261. [PMID: 36311483 PMCID: PMC9616665 DOI: 10.1155/2022/6023261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 11/23/2022] Open
Abstract
Hemostatic materials are very important for the treatment of a large number of bleeding trauma patients in battlefield and disaster environments. Different types of hemostatic materials need to be used for emergency hemostasis according to different injury parts and severity. At present, the first-aid hemostatic materials have been well applied to the bleeding of body surface wounds, limbs, and junctions, but there are still no ideal hemostatic materials in the early treatment of first aid for the deep and incompressible bleeding of thoracoabdominal cavity and visceral organs. This paper reviews the classification and mechanism of hemostatic materials, as well as the application and research progress in trauma emergency, so as to provide reference for the application of hemostatic materials in early first-aid emergency.
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17
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Ngoepe MP, Battison A, Mufamadi S. Nano-Enabled Chronic Wound Healing Strategies: Burn and Diabetic Ulcer Wounds. J Biomed Nanotechnol 2022. [DOI: 10.1166/jbn.2022.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The human skin serves as the body’s first line of defense against the environment. Diabetes mellitus (DM) and 2nd–4th degree burns, on the other hand, affect the skin’s protective barrier features. Burn wounds, hypermetabolic state, and hyperglycemia compromise the
immune system leading to chronic wound healing. Unlike acute wound healing processes, chronic wounds are affected by reinfections which can lead to limb amputation or death. The conventional wound dressing techniques used to protect the wound and provide an optimal environment for repair have
their limitations. Various nanomaterials have been produced that exhibit distinct features to tackle issues affecting wound repair mechanisms. This review discusses the emerging technologies that have been designed to improve wound care upon skin injury. To ensure rapid healing and possibly
prevent scarring, different nanomaterials can be applied at different stages of healing (hemostasis, inflammation, proliferation, remodeling).
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Affiliation(s)
- Mpho Phehello Ngoepe
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
| | - Aidan Battison
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
| | - Steven Mufamadi
- DSI-Mandela Nanomedicine Platform, Nelson Mandela University, Gqeberha, 6001, Eastern Cape, South Africa
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18
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Wang L, Hao F, Tian S, Dong H, Nie J, Ma G. Targeting polysaccharides such as chitosan, cellulose, alginate and starch for designing hemostatic dressings. Carbohydr Polym 2022; 291:119574. [DOI: 10.1016/j.carbpol.2022.119574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 12/21/2022]
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19
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Zhou M, Liao J, Li G, Yu Z, Xie D, Zhou H, Wang F, Ren Y, Xu R, Dai Y, Wang J, Huang J, Zhang R. Expandable carboxymethyl chitosan/cellulose nanofiber composite sponge for traumatic hemostasis. Carbohydr Polym 2022; 294:119805. [DOI: 10.1016/j.carbpol.2022.119805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022]
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20
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Biswas S, Bhunia BK, Janani G, Mandal BB. Silk Fibroin Based Formulations as Potential Hemostatic Agents. ACS Biomater Sci Eng 2022; 8:2654-2663. [PMID: 35616246 DOI: 10.1021/acsbiomaterials.2c00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Effective hemorrhage control is indispensable for life-threatening emergencies in defense fields and civilian trauma. During major injuries, hemostatic agents are applied externally to mimic and accelerate the natural hemostasis process. Commercially available topical hemostatic agents are associated with several limitations, e.g., burning sensation, necrosis, futile in severe injuries, and high costs of the products. In the present study, we developed silk fibroin fiber-based formulations and evaluated their use as a cost-effective potential hemostatic agent with shortened clotting time. Silk fiber-based powder was produced following the alkaline hydrolysis process, wherein Bombyx mori silk fibroin fibers were treated with sodium hydroxide (NaOH) solution that randomly chopped the silk microfibers. Physicochemical reaction parameters, e.g., reaction temperature, molarity of NaOH solution, and incubation time, were optimized to achieve the maximum yield of microfibers. The surface properties of alkaline hydrolyzed silk microfibers (AHSMf) were analyzed by field emission scanning electron microscopy and energy dispersive X-ray studies. The water uptake capacity of AHSMf and the change in pH and temperature (∼30 °C) during blood clotting were analyzed. Further, the hemostatic potential of AHSMf was evaluated by an in vitro whole blood clotting assay using both goat and human blood. The in vitro studies demonstrated a reduced blood clotting time (CT = 20-30 s), prothrombin time (PT = ∼27%), and activated partial thromboplastin time (APTT = ∼14%) in the presence of AHSMf when compared to silk hydrogel powder (devoid of NaOH). Thus, the developed AHSMf could be a promising material to serve as a potential hemostatic agent.
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Affiliation(s)
- Saptarshi Biswas
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781 039, India
| | - Bibhas K Bhunia
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781 039, India
| | - G Janani
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781 039, India
| | - Biman B Mandal
- Biomaterials and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781 039, India.,Centre for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati 781 039, India.,School of Health Sciences and Technology, Indian Institute of Technology Guwahati, Guwahati 781 039, India
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21
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Sultan MT, Hong H, Lee OJ, Ajiteru O, Lee YJ, Lee JS, Lee H, Kim SH, Park CH. Silk Fibroin-Based Biomaterials for Hemostatic Applications. Biomolecules 2022; 12:biom12050660. [PMID: 35625588 PMCID: PMC9138874 DOI: 10.3390/biom12050660] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/15/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
Hemostasis plays an essential role in all surgical procedures. Uncontrolled hemorrhage is the primary cause of death during surgeries, and effective blood loss control can significantly reduce mortality. For modern surgeons to select the right agent at the right time, they must understand the mechanisms of action, the effectiveness, and the possible adverse effects of each agent. Over the past decade, various hemostatic agents have grown intensely. These agents vary from absorbable topical hemostats, including collagen, gelatins, microfibrillar, and regenerated oxidized cellulose, to biologically active topical hemostats such as thrombin, biological adhesives, and other combined agents. Commercially available products have since expanded to include topical hemostats, surgical sealants, and adhesives. Silk is a natural protein consisting of fibroin and sericin. Silk fibroin (SF), derived from silkworm Bombyx mori, is a fibrous protein that has been used mostly in fashion textiles and surgical sutures. Additionally, SF has been widely applied as a potential biomaterial in several biomedical and biotechnological fields. Furthermore, SF has been employed as a hemostatic agent in several studies. In this review, we summarize the several morphologic forms of SF and the latest technological advances on the use of SF-based hemostatic agents.
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Affiliation(s)
- Md. Tipu Sultan
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Heesun Hong
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Ok Joo Lee
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Olatunji Ajiteru
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Young Jin Lee
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Ji Seung Lee
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Hanna Lee
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Soon Hee Kim
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
| | - Chan Hum Park
- Nano-Bio Regenerative Medical Institute (NBRM), Hallym University, Chuncheon 24252, Korea; (M.T.S.); (H.H.); (O.J.L.); (O.A.); (Y.J.L.); (J.S.L.); (H.L.); (S.H.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea
- Correspondence:
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22
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Hao Y, Yuan C, Deng J, Zheng W, Ji Y, Zhou Q. Injectable Self-Healing First-Aid Tissue Adhesives with Outstanding Hemostatic and Antibacterial Performances for Trauma Emergency Care. ACS APPLIED MATERIALS & INTERFACES 2022; 14:16006-16017. [PMID: 35378035 DOI: 10.1021/acsami.2c00877] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Soft-tissue trauma emergency caused by natural disasters and traffic accidents is highly prevalent, which can result in massive bleeding, pathogen infection, and even death. Although numerous tissue adhesives can bind to tissue surfaces and cover wounds, most of them still have several deficiencies, including long gelation time, poor adhesive strength, and anti-infection, making them inappropriate for use as first-aid bandages. Herein, injectable and self-healing four-arm-PEG-CHO/polyethyleneimine (PEI) tissue adhesives as liquid first-aid supplies are developed via the dynamic Schiff base reaction for trauma emergency. It is found that the prepared hydrogel adhesives exhibit short and controlled gelation time (9∼88 s), strong adhesive strength, and excellent antibacterial ability. Their hemostatic and antimicrobial performances can be tailored by the mass ratio of four-arm-PEG-CHO/PEI. Moreover, in vitro biological assays display that the developed tissue adhesives possess satisfactory cyto/hemocompatibility. Importantly, in vivo the designed adhesives show fast hemostatic capacity and excellent anti-infection as compared to commercial Prontosan gel. Thus, this work indicates that the four-arm-PEG-CHO/PEI first-aid tissue adhesives display great potential for wound emergency management.
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Affiliation(s)
- Yuanping Hao
- Department of Stomatology, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Changqing Yuan
- Department of Stomatology, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
- School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Jing Deng
- Department of Stomatology, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
- School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Weiping Zheng
- Department of Stomatology, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
- School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Yanjing Ji
- Department of Stomatology, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
- School of Stomatology, Qingdao University, Qingdao 266003, China
| | - Qihui Zhou
- Department of Stomatology, Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
- School of Stomatology, Qingdao University, Qingdao 266003, China
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23
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Viscoelastic Hemostatic Assays: A Primer on Legacy and New Generation Devices. J Clin Med 2022; 11:jcm11030860. [PMID: 35160311 PMCID: PMC8836477 DOI: 10.3390/jcm11030860] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 02/06/2023] Open
Abstract
Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG® 5000) and rotational thromboelastometry (ROTEM® delta), have been supplanted not only by cartridge systems (TEG® 6S and ROTEM® sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot®, Quantra®, and ClotPro®). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy.
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A review of treatments for non-compressible torso hemorrhage (NCTH) and internal bleeding. Biomaterials 2022; 283:121432. [DOI: 10.1016/j.biomaterials.2022.121432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/26/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
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Ghimire S, Sarkar P, Rigby K, Maan A, Mukherjee S, Crawford KE, Mukhopadhyay K. Polymeric Materials for Hemostatic Wound Healing. Pharmaceutics 2021; 13:2127. [PMID: 34959408 PMCID: PMC8708336 DOI: 10.3390/pharmaceutics13122127] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 02/04/2023] Open
Abstract
Hemorrhage is one of the greatest threats to life on the battlefield, accounting for 50% of total deaths. Nearly 86% of combat deaths occur within the first 30 min after wounding. While external wound injuries can be treated mostly using visual inspection, abdominal or internal hemorrhages are more challenging to treat with regular hemostatic dressings because of deep wounds and points of injury that cannot be located properly. The need to treat trauma wounds from limbs, abdomen, liver, stomach, colon, spleen, arterial, venous, and/or parenchymal hemorrhage accompanied by severe bleeding requires an immediate solution that the first responders can apply to reduce rapid exsanguinations from external wounds, including in military operations. This necessitates the development of a unique, easy-to-use, FDA-approved hemostatic treatment that can deliver the agent in less than 30 s and stop bleeding within the first 1 to 2 min at the point of injury without application of manual pressure on the wounded area.
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Affiliation(s)
- Suvash Ghimire
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Pritha Sarkar
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Kasey Rigby
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Aditya Maan
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
- Department of Chemistry, University of Central Florida, Orlando, FL 32816, USA
| | - Santanu Mukherjee
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Kaitlyn E. Crawford
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
- Department of Chemistry, University of Central Florida, Orlando, FL 32816, USA
- NanoScience Technology Center, University of Central Florida, Orlando, FL 32816, USA
- Biionix Cluster, University of Central Florida, Orlando, FL 32816, USA
| | - Kausik Mukhopadhyay
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
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Song X, Zhao Y, Liu Y, Zhang W, Yuan X, Xu L, Zhang J. Effects of degree of deacetylation on hemostatic performance of partially deacetylated chitin sponges. Carbohydr Polym 2021; 273:118615. [PMID: 34561013 DOI: 10.1016/j.carbpol.2021.118615] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/07/2021] [Accepted: 08/24/2021] [Indexed: 01/08/2023]
Abstract
Chitin/chitosan hemostatic materials have long been studied for uncontrolled hemorrhage, an urgent clinical problem due to severe blood-vessel damage or hemophilia. As one of the basic structural parameters of chitin, the degree of deacetylation (DD) significantly affects the material's physical, chemical, as well as biological properties. In this study, partially deacetylated chitins with a wide range of DD (23-81%) were prepared by homogeneous deacetylation, and sponges with these various chitins were fabricated by freeze-drying to study the effects of DD on their hemostatic properties. Among all sponge samples, the chitosan sponge with a DD of 48% showed the highest water absorption, whole blood adsorption, RBC adsorption rate, and the best hemostatic performance in an uncontrolled bleeding model of the rat femoral artery, demonstrating that a certain proportion of acetyl amino and amino groups could also activate the coagulation system and promote the adhesion of platelet and erythrocyte.
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Affiliation(s)
- Xiaoqiang Song
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, PR China; School of Materials science and Engineering, University of Science and Technology of China, Hefei, Anhui 230026, PR China
| | - Yan Zhao
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, PR China.
| | - Yunen Liu
- Department of Emergency Medicine, The General Hospital of Northern Theater Command, Shenyang 110016, PR China
| | - Wenchang Zhang
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, PR China
| | - Xiaoxue Yuan
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, PR China; School of Materials science and Engineering, University of Science and Technology of China, Hefei, Anhui 230026, PR China
| | - Lei Xu
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, PR China
| | - Jinsong Zhang
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, PR China.
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Sun N, Jia Y, Wang C, Xia J, Dai L, Li J. Dopamine-Mediated Biomineralization of Calcium Phosphate as a Strategy to Facilely Synthesize Functionalized Hybrids. J Phys Chem Lett 2021; 12:10235-10241. [PMID: 34647744 DOI: 10.1021/acs.jpclett.1c02748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Organic-inorganic hybrid materials have been considered to be promising carriers or immobilization matrixes for biomolecules due to their high efficiency and significantly enhanced activities and stabilities of biomolecules. Here, the well-defined dopamine/calcium phosphate organic-inorganic hybrids (DACaPMFs) are fabricated via one-pot dopamine-mediated biomineralization, and their structure and properties are also characterized. Direct stochastic optical reconstruction microscopy (dSTORM) is first used to probe the distribution of organic components in these hybrids. Combined with spectroscopic data, the direct observation of dopamine in the hybrids helps to understand the formation of a physical chemistry mechanism of the biomineralization. The obtained DACaPMFs with multiple-level pores allow the loading of doxorubicin with a high loading efficiency and a pH-responsive property. Furthermore, thrombin is entrapped by the hybrids to prove the controlled release. It is expected that such organic-inorganic hybrid materials may hold great promise for application in drug delivery as well as scaffold materials in bone tissue engineering and hemostatic material.
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Affiliation(s)
- Nan Sun
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Laboratory of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yi Jia
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Laboratory of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Chenlei Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Jiarui Xia
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Laboratory of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Luru Dai
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Junbai Li
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Laboratory of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
- University of Chinese Academy of Sciences, Beijing 100049, China
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Peng HT, Rhind SG, Devine D, Jenkins C, Beckett A. Ex vivo hemostatic and immuno-inflammatory profiles of freeze-dried plasma. Transfusion 2021; 61 Suppl 1:S119-S130. [PMID: 34269465 DOI: 10.1111/trf.16502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hemorrhage is a leading cause of preventable death in civilian and military trauma. Freeze-dried plasma is promising for hemostatic resuscitation in remote prehospital settings, given its potential benefits in reducing blood loss and mortality, long storage at ambient temperatures, high portability, and rapid reconstitution for transfusion in austere environments. Here we assess the ex vivo characteristics of a novel Terumo's freeze-dried plasma product (TFDP). STUDY DESIGN AND METHODS Rotational thromboelastometry (ROTEM) tests (INTEM, EXTEM, and FIBTEM) were conducted on plasma samples at 37°C with a ROTEM delta-machine using standard reagents and procedures. The following samples were analyzed: pooled plasma to produce TFDP, TFDP reconstituted, and stored immediately at -80°C, reconstituted TFDP stored at 4°C for 24 h and room temperature (RT) for 4 h before freezing at -80°C. Analysis of plasma concentrations of selected cytokines, chemokines, and vascular molecules was performed using a multiplex immunoassay system. One-way ANOVA with post hoc tests assessed differences in hemostatic and inflammatory properties. RESULTS No significant differences in ROTEM variables (coagulation time [CT], clot formation time, α-angle, maximum clot firmness, and lysis index 30) between the TFDP-producing plasma and reconstituted TFDP samples were observed. Compared to control plasma, reconstituted TFDP stored at 4°C for 24 h or RT for 4 h showed a longer INTEM CT. Levels of immuno-inflammatory mediators were similar between frozen plasma and TFDP. CONCLUSIONS TFDP is equivalent to frozen plasma with respect to global hemostatic and immuno-inflammatory mediator profiles. Further investigations of TFDP in trauma-induced coagulopathy models and bleeding patients are warranted.
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Affiliation(s)
- Henry T Peng
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, Ontario, Canada
| | - Dana Devine
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Andrew Beckett
- St. Michael's Hospital, Toronto, Ontario, Canada.,Royal Canadian Medical Services, Ottawa, Ontario, Canada
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Wang Y, Wang P, Ji H, Ji G, Wang M, Wang X. Analysis of Safety and Effectiveness of Sodium Alginate/Poly(γ-glutamic acid) Microspheres for Rapid Hemostasis. ACS APPLIED BIO MATERIALS 2021; 4:6539-6548. [PMID: 35006904 DOI: 10.1021/acsabm.1c00671] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Most preventable deaths after trauma are related to hemorrhage and occur early after injury. Timely hemostatic treatment is essential to minimize blood loss and improve survival. Among the various treatment methods, the most economical and effective is to use a hemostatic agent. A powdered hemostatic agent can be used for wounds of any shape or depth with high compactness and excellent accumulation effect. Herein, we chose the natural, hydrophilic polymer poly(γ-glutamic acid) (γ-PGA) to form composite hemostatic microspheres with sodium alginate (SA), which show good biocompatibility, water absorptivity, and viscosity. The morphology and structure of the hemostatic microspheres were determined using Fourier transform infrared spectroscopy and scanning electron microscopy. The overall safety, hemolysis, pyrogenic, and intradermal irritation tests were examined. The relationship between hemostatic pressure and hemostatic time during microsphere use was also measured. The hemostatic effect was analyzed with a liver, spleen, and femoral artery bleeding model. The composite microspheres were well tolerated in vivo and exhibited better hemostatic effects in animal experiments than a microporous polysaccharide powder compound. Research results showed that SA/γ-PGA microspheres are materials with good hemostatic effect, high safety, and great potential in clinical applications.
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Affiliation(s)
- Yun Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Pei Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Haoran Ji
- Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
| | - Xiansong Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China.,Department of Thoracic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, People's Republic of China
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Roman P, Rodriguez-Alvarez A, Bertini-Perez D, Ropero-Padilla C, Martin-Ibañez L, Rodriguez-Arrastia M. Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review. J Clin Nurs 2021. [PMID: 33969561 DOI: 10.1111/jocn.15834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use. BACKGROUND Trauma-related haemorrhage constitutes one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery. DESIGN AND METHODS An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines. RESULTS A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement. CONCLUSIONS Commercial tourniquets such as Combat Application Tourniquet or Emergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use. RELEVANCE TO CLINICAL PRACTICE Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.
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Affiliation(s)
- Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
- Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain
- Health Research Centre, University of Almeria, Almeria, Spain
| | | | | | - Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain
- Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
| | - Luis Martin-Ibañez
- Field Artillery Group, Light Infantry Brigade "King Alfonso XIII" II of the Legion, Almeria, Spain
| | - Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain
- Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
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Elsabahy M, Hamad MA. Design and Preclinical Evaluation of Chitosan/Kaolin Nanocomposites with Enhanced Hemostatic Efficiency. Mar Drugs 2021; 19:md19020050. [PMID: 33499020 PMCID: PMC7911196 DOI: 10.3390/md19020050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
In the current study, hemostatic compositions including a combination of chitosan and kaolin have been developed. Chitosan is a marine polysaccharide derived from chitins, a structural component in the shells of crustaceans. Both chitosan and kaolin have the ability to mediate a quick and efficient hemostatic effect following immediate application to injury sites, and thus they have been widely exploited in manufacturing of hemostatic composites. By combining more than one hemostatic agent (i.e., chitosan and kaolin) that act via more than one mechanism, and by utilizing different nanotechnology-based approaches to enhance the surface areas, the capability of the dressing to control bleeding was improved, in terms of amount of blood loss and time to hemostasis. The nanotechnology-based approaches utilized to enhance the effective surface area of the hemostatic agents included the use of Pluronic nanoparticles, and deposition of chitosan micro- and nano-fibers onto the carrier. The developed composites effectively controlled bleeding and significantly improved hemostasis and survival rates in two animal models, rats and rabbits, compared to conventional dressings and QuikClot® Combat Gauze. The composites were well-tolerated as demonstrated by their in vivo biocompatibility and absence of clinical and biochemical changes in the laboratory animals after application of the dressings.
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Affiliation(s)
- Mahmoud Elsabahy
- Science Academy, Badr University in Cairo (BUC), Cairo 11829, Egypt
- Science Park, Misr University for Science and Technology, Giza 12566, Egypt
- Correspondence: (M.E.); (M.A.H.); Tel.: +20-1000607466 (M.E.); +20-1222438186 (M.A.H.)
| | - Mostafa A. Hamad
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Correspondence: (M.E.); (M.A.H.); Tel.: +20-1000607466 (M.E.); +20-1222438186 (M.A.H.)
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Shi P, Zhou D, Zhu Y, Peng B, Shao N, Zan X. Thrombin-Loaded TA-CaCO 3 Microspheres as a Budget, Adaptable, and Highly Efficient Hemostatic. ACS APPLIED BIO MATERIALS 2021. [DOI: 10.1021/acsabm.0c01475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Pengzhong Shi
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang Province 325001, P.R. China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, P.R. China
| | - Daozhen Zhou
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, P.R. China
| | - Yaxin Zhu
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang Province 325001, P.R. China
| | - Bo Peng
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang Province 325001, P.R. China
| | - Nannan Shao
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang Province 325001, P.R. China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, P.R. China
| | - Xingjie Zan
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang Province 325001, P.R. China
- School of Ophthalmology and Optometry, Eye Hospital, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang Province 325035, P.R. China
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Saunders D, Rose L. Regenerative rehabilitation of catastrophic extremity injury in military conflicts and a review of recent developmental efforts. Connect Tissue Res 2021; 62:83-98. [PMID: 32552156 DOI: 10.1080/03008207.2020.1776707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM OF THE REVIEW This review aims to describe the current state of regenerative rehabilitation of severe military extremity injuries, and promising new therapies on the horizon. DISCUSSION The nature of warfare is rapidly shifting with information operations, autonomous weapons, and the threat of full-scale peer adversary conflicts threatening to create contested environments with delayed medical evacuation to definitive care. More destructive weapons will lead to more devastating injuries, creating new challenges for limb repair and restoration. Current paradigms of delayed rehabilitation following initial stabilization, damage control surgery, and prolonged antibiotic therapy will need to shift. Advances in regenerative medicine technologies offer the possibility of treatment along the continuum of care. Regenerative rehabilitation will begin at the point of injury and require a holistic, organ-systems approach. CONCLUSIONS Both technological improvements and a rapidly advancing understanding of injury pathophysiology will contribute to improved limb-salvage outcomes, and shift the calculus away from early limb amputation.
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Affiliation(s)
- David Saunders
- US Army Medical Material Development Activity, Fort Detrick, MD , USA
| | - Lloyd Rose
- US Army Medical Material Development Activity, Fort Detrick, MD , USA
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Lamm RJ, Pichon TJ, Huyan F, Wang X, Prossnitz AN, Manner KT, White NJ, Pun SH. Optimizing the Polymer Chemistry and Synthesis Method of PolySTAT, an Injectable Hemostat. ACS Biomater Sci Eng 2020; 6:7011-7020. [PMID: 33320636 DOI: 10.1021/acsbiomaterials.0c01189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is a lack of prehospital hemostatic agents, especially for noncompressible hemorrhage. We previously reported PolySTAT, a unimeric, injectable hemostatic agent, that physically cross-links fibrin to strengthen clots. In this work, we sought to improve the water-solubility and synthesis yield of PolySTAT to increase the likelihood of clinical translation, reduce cost, and facilitate future mass production. First, we focused on side-chain engineering of the carrier polymer backbone to improve water-solubility. We found that substitution of the 2-hydroxyethyl methacrylate (HEMA) monomer with glycerol monomethacrylate (GmMA) significantly improved the water-solubility of PolySTAT without compromising efficacy. Both materials increased clot firmness and decreased lysis as measured by rotational thromboelastometry (ROTEM). Additionally, we confirmed the in vivo activity of GmMA-based PolySTAT by improving rat survival in a femoral artery bleed model. Second, to reduce waste, we evaluated PolySTAT synthesis via direct polymerization of peptide monomers. Methacrylamide and methacrylate peptide-monomers were synthesized and polymerized via reversible addition-fragmentation chain transfer (RAFT) polymerization. This approach markedly improved the yield of PolySTAT synthesis while maintaining its biological activity in ROTEM. This work demonstrates the flexibility of PolySTAT to a variety of comonomers and synthetic routes and establishes direct RAFT polymerization of peptide monomers as a potential route of mass production.
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Affiliation(s)
- Robert J Lamm
- Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, Washington 98195, United States
| | - Trey J Pichon
- Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, Washington 98195, United States
| | - Frederick Huyan
- Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, Washington 98195, United States
| | - Xu Wang
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington 98195, United States
| | - Alexander N Prossnitz
- Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, Washington 98195, United States
| | - Karl T Manner
- Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, Washington 98195, United States
| | - Nathan J White
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington 98195, United States
| | - Suzie H Pun
- Department of Bioengineering and Molecular Engineering and Sciences Institute, University of Washington, 3720 15th Avenue NE, Box 355061, Seattle, Washington 98195, United States
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Watkins RJ, Hsu JM. The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures. Front Surg 2020; 7:58. [PMID: 32984402 PMCID: PMC7493634 DOI: 10.3389/fsurg.2020.00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
Management of haemodynamically unstable pelvic ring injuries has been simplified into treatment algorithms to streamline care and emergent decision making in order to improve patient outcomes whilst decreasing mortality and morbidity. Pelvic ring injuries are most commonly a result of high-velocity and energy forces that exert trauma to the pelvic bones causing not only damage to the bone but the surrounding soft-tissue, organs, and other structures and are usually accompanied by injuries to other parts of the body resulting in a polytraumatised patient. Open pelvic fractures are a rare subset of pelvic ring fractures that are on the more severe end of the pelvic fracture continuum and usually produce uncontrolled haemorrhage from fractured bone, retroperitoneal haematomas, intraabdominal bleeding from bowel injury, soft tissue injuries to the anus, perineum, and genitals, fractures of the pelvic bones, causing bleeding from cancellous bone, venous, and arterial injuries combined with bleeding from concomitant injuries. This is a very complex and challenging clinical situation and timely and appropriate decisions and action are paramount for a positive outcome. Consequently, open pelvic fractures have an extremely high rate of mortality and morbidity and outcomes remain poor, despite evidence-based improvements in treatment, knowledge, and identification of haemorrhage; in the pre-hospital, critical care, and operative settings. In the future utilisation of haemostatic drugs, dressings, devices, and procedures may aid in the time to haemorrhage control.
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Affiliation(s)
| | - Jeremy M Hsu
- Trauma Service, Westmead Hospital, Westmead, NSW, Australia.,Discipline of Surgery, University of Sydney, Sydney, NSW, Australia
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Gao Y, Sarode A, Kokoroskos N, Ukidve A, Zhao Z, Guo S, Flaumenhaft R, Gupta AS, Saillant N, Mitragotri S. A polymer-based systemic hemostatic agent. SCIENCE ADVANCES 2020; 6:eaba0588. [PMID: 32775633 PMCID: PMC7394519 DOI: 10.1126/sciadv.aba0588] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/18/2020] [Indexed: 05/21/2023]
Abstract
Uncontrolled noncompressible hemorrhage is a major cause of mortality following traumatic injuries in civilian and military populations. An injectable hemostat for point-of-care treatment of noncompressible hemorrhage represents an urgent medical need. Here, we describe an injectable hemostatic agent via polymer peptide interfusion (HAPPI), a hyaluronic acid conjugate with a collagen-binding peptide and a von Willebrand factor-binding peptide. HAPPI exhibited selective binding to activated platelets and promoted their accumulation at the wound site in vitro. In vivo studies in mouse tail vein laceration model demonstrated a reduction of >97% in both bleeding time and blood loss. A 284% improvement in the survival time was observed in the rat inferior vena cava traumatic model. Lyophilized HAPPI could be stably stored at room temperature for several months and reconstituted during therapeutic intervention. HAPPI provides a potentially clinically translatable intravenous hemostat.
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Affiliation(s)
- Yongsheng Gao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Apoorva Sarode
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Nikolaos Kokoroskos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anvay Ukidve
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Zongmin Zhao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Shihui Guo
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Robert Flaumenhaft
- Division of Hemostasis and Thrombosis, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Anirban Sen Gupta
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Samir Mitragotri
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA 02115, USA
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