Strain-Programmed Adhesive Patch for Accelerated Photodynamic Wound Healing.

As an alternative to tissue adhesives, photochemical tissue bonding is investigated for advanced wound healing. However, these techniques suffer from relatively slow wound healing with bleeding and bacterial infections. Here, the versatile attributes of afterglow luminescent particles (ALPs) embedded in dopamine-modified hyaluronic acid (HA-DOPA) patches for accelerated wound healing are presented. ALPs enhance the viscoelastic properties of the patches, and the photoluminescence and afterglow luminescence of ALPs maximize singlet oxygen generation and collagen fibrillogenesis for effective healing in the infected wounds. The patches are optimized to achieve the strong and rapid adhesion in the wound sites. In addition, the swelling and shrinking properties of adhesive patches contribute to a nonlinear behavior in the wound recovery, playing an important role as a strain-programmed patch. The protective patch prevents secondary infection and skin adhesion, and the patch seamlessly detaches during wound healing, enabling efficient residue clearance. In vitro, in vivo, and ex vivo model tests confirm the biocompatibility, antibacterial effect, hemostatic capability, and collagen restructuring for the accelerated wound healing. Taken together, this research collectively demonstrates the feasibility of HA-DOPA/ALP patches as a versatile and promoting solution for advanced accelerated wound healing, particularly in scenarios involving bleeding and bacterial infections.

The effect of preoperative use of anticoagulants on the hemostatic effect of intravenous application of tranexamic acid in PLIF: a case control study.

Intravenous application of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) can effectively reduce blood loss without affecting coagulation function. However, it has not been reported whether preoperative use of anticoagulants may affect the efficacy of TXA in PLIF. The purpose of this study is to observe the effect of preoperative use of anticoagulants on coagulation indicators and blood loss after PLIF receiving intravenous unit dose TXA. A retrospective analysis was conducted on data from 53 patients with PLIF between 2020.11 and 2022.9, who received intravenous application of a unit dose of TXA (1 g/100 mL) 15 min before the skin incision after general anesthesia. Those who used anticoagulants within one week before surgery were recorded as the observation group, while those who did not use anticoagulants were recorded as the control group. The main observation indicators include surgical time, intraoperative blood loss, postoperative drainage volume, blood transfusion, and red blood cell (RBC), hemoglobin (HB), and hematocrit (HCT) measured on the 1st, 4th, 7th, and last-test postoperative days. Secondary observation indicators included postoperative incision healing, deep vein thrombosis of lower limbs, postoperative hospital stay, and activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), and platelets (PLT) on the 1st and 4th days after surgery. The operation was successfully completed in both groups, the incision healed well after operation, and no lower limb deep vein thrombosis occurred. There was no significant difference in surgical time, intraoperative blood loss, postoperative drainage volume, and blood transfusion between the two groups (p > 0.05). There was no significant difference in the RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days between the two groups (p > 0.05). There was no statistically significant difference in APTT, PT, TT, FIB and PLT between the two groups on the 1st and 4th postoperative days (p > 0.05). There was no significant difference in postoperative hospital stay between the two groups (p > 0.05). The use of anticoagulants within one week before surgery does not affect the hemostatic effect of intravenous unit dose TXA in PLIF.

Platelet-rich fibrin ensures hemostasis after single-tooth removal under factor Xa inhibitors - a clinical prospective randomized split-mouth study.

OBJECTIVES: In this prospective, double-blinded, randomized split-mouth study, the local hemostatic effect of platelet-rich fibrin (PRF) inserted into the extraction socket in patients taking factor Xa (FXa) inhibitors (apixaban, rivaroxaban, edoxaban) was compared to a hemostatic gelatine sponge (GS) as the "therapeutic gold standard" without withdrawal of oral anticoagulant therapy. MATERIALS AND METHODS: Single-tooth extraction was conducted under local anesthesia in n = 21 patients using a split-mouth design (42 teeth). Using a double-blind approach, the extraction socket on one side of the jaw was filled with PRF and on the other with a GS. Bleeding was assessed immediately after surgery, in 30 min, 1 h, 1.5 h, and on follow-up appointments in 24 h and on the 7th day. RESULTS: In 67% of cases, mild postoperative oozing could be stopped 30-90 min after tooth extraction via gauze pressure without any delayed bleeding. Concerning bleeding events, there was no difference among the PRF and GS groups and no significant difference among rivaroxaban, apixaban, and edoxaban (all p > 0.15). CONCLUSION: PRF and GS are reliable hemostatic methods in postextraction sockets of patients taking FXa inhibitors. CLINICAL RELEVANCE: Consequently, there is no need to discontinue FXa inhibitors because of a single-tooth removal, eliminating the risk of thrombus formation.

Development of Composite Sponge Scaffolds Based on Carrageenan (CRG) and Cerium Oxide Nanoparticles (CeO2 NPs) for Hemostatic Applications.

In this study, a novel absorbable hemostatic agent was developed using carrageenan (CRG) as a natural polymer and cerium oxide nanoparticles (CeO2 NPs). CRG-CeO2-0.5 and CRG-CeO2-1 composites were prepared by compositing CeO2 to CRG + CeO2 at a weight ratio of 0.5:100 and 1:100, respectively. The physicochemical and structural properties of these compounds were studied and compared with pristine CRG. Upon incorporation of CeO2 nanoparticles into the CRG matrix, significant reductions in hydrogel degradation were observed. In addition, it was noted that CRG-CeO2 exhibited better antibacterial and hemostatic properties than CRG hydrogel without CeO2 NPs. The biocompatibility of the materials was tested using the NIH 3T3 cell line, and all samples were found to be nontoxic. Particularly, CRG-CeO2-1 demonstrated superior hemostatic effects, biocompatibility, and a lower degradation rate since more CeO2 NPs were present in the CRG matrix. Therefore, CRG-CeO2-1 has the potential to be used as a hemostatic agent and wound dressing.

An improved blood hemorrhaging treatment using diatoms frustules, by alternating Ca and light levels in cultures.

Hemorrhage control requires hemostatic materials that are both effective and biocompatible. Among these, diatom biosilica (DBs) could significantly improve hemorrhage control, but it induces hemolysis (the hemolysis rate > 5%). Thus, the purpose of this study was to explore the influence of Ca2+ biomineralization on DBs for developing fast hemostatic materials with a low hemolysis rate. Here, CaCl2 was added to the diatom medium under high light (cool white, fluorescent lamps, 67.5 µmol m-2 s-1), producing Ca-DBs-3 with a particle size of 40-50 µm and a Ca2+ content of Ca-DBs-3 obtained from the higher concentration CaCl2 group (6.7 mmol L-1) of 0.16%. The liquid absorption capacity of Ca-DBs-3 was 30.43 ± 0.57 times its dry weight; the in vitro clotting time was comparable to QuikClot® zeolite; the hemostatic time and blood loss using the rat tail amputation model were 36.40 ± 2.52 s and 0.39 ± 0.12 g, which were 40.72% and 19.50% of QuikClot® zeolite, respectively. Ca-DBs-3 showed no apparent toxicity to L929 cells (cell viability > 80%) and was non-hemolysis (the hemolysis rate < 2%). This study prepared Ca-DBs-3 with a rapid hemostatic effect and good biocompatibility, providing a path to develop diatom biosilica hemostatic materials. Supplementary Information: The online version contains supplementary material available at 10.1007/s42995-023-00180-3.

Identifying the active ingredients of carbonized Typhae Pollen by spectrum-effect relationship combined with MBPLS, PLS, and SVM algorithms.

Typhae Pollen (TP) and its carbonized product (carbonized Typhae Pollen, CTP), as cut-and-dried herbal drugs, have been widely used in the form of slices in clinical settings. However, the two drugs exhibit a great difference in terms of their clinical efficacy, for TP boasts an effect of removing blood stasis and promoting blood circulation, while CTP typically presents a hemostatic function. Since the active ingredients of CTP, so far, still remain unclear, this study aimed at identifying the active ingredients of CTP by spectrum-effect relationship approach coupled with multi-block partial least squares (MBPLS), partial least squares (PLS), and support vector machine (SVM) algorithms. In this study, the chemical profiles of a series of CTP samples which were stir-fried for different duration (denoted as CTP0∼CTP9) were firstly characterized by UHPLC-QE-Orbitrap MS. Then the hemostatic effect of the CTP samples was evaluated from the perspective of multiple parameters-APTT, PT, TT, FIB, TXB2, 6-keto-PGF1α, PAI-1 and t-PA-using established rat models with functional uterine bleeding. Subsequently, MBPLS, PLS and SVM were combined to perform spectrum-effect relationship analysis to identify the active ingredients of CTP, followed by an in vitro hemostatic bioactivity test for verification. As a result, a total of 77 chemical ingredients were preliminarily identified from the CTP samples, and the variations occurred in these ingredients were also analyzed during the carbonizing process. The study revealed that all the CTP samples, to a varying degree, showed a hemostatic effect, among which CTP6 and CTP7 were superior to the others in terms of the hemostatic effect. The block importance in the projection (BIP) indexes of MBPLS model indicated that flavonoids and organic acids made more contributions to the hemostatic effect of CTP in comparison to other ingredients. Consequently, 9 bioactive ingredients, including quercetin-3-O-glucoside, kaempferol-3-O-rutinoside, quercetin, kaempferol, isorhamnetin, 2-methylenebutanedioic acid, pentanedioic acid, benzoic acid and 3-hydroxybenzoic acid, were further identified as the potential active ingredients based on PLS and SVM models as well as the in vitro verification. This study successfully revealed the bioactive ingredients of CTP associated with its hemostatic effect, and also provided a scientific basis for further understanding the mechanism of TP processing. In addition, it proposed a novel path to identify the active ingredients for Chinese herbal medicines.

Antibacterial chitosan-based composite sponge with synergistic hemostatic effect for massive haemorrhage.

Uncontrollable acute bleeding and wound infection pose significant challenges in emergency treatment and surgical operations. Therefore, the research and development of highly efficient antibacterial hemostatic agents are of great importance in reducing the mortality rate among patients with massive hemorrhage. In this study, we utilized hydrophobically modified chitosan (HM-CS) and gallic acid chitosan (GA-CS) to create a composite sponge (HM/GA-CS) that exhibits complementary advantages. The composite sponge combines the alkyl chain and polyphenol structure, allowing it to adsorb blood cells and plasma proteins simultaneously. This synergistic effect was confirmed through various tests, including blood cell adhesion, plasma protein barrier behavior, and in vitro hemostatic testing. Furthermore, experiments conducted on a rat liver injury model demonstrated that the composite sponge achieved rapid coagulation within 52 s, resulting in significantly lower bleeding volume compared with traditional gauze. In addition, the incorporation of GA-CS into HM-CS enhanced the antibacterial properties of the composite sponge. The antibacterial rate of the composite sponge against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) reached 100 % and 98.2 %, respectively. To evaluate its biocompatibility, the composite sponge underwent blood compatibility and cell activity tests, confirming its suitability. The HM/GA-CS sponge holds promising applications in managing cases of massive hemorrhage.

A Biodegradable Flexible Micro/Nano-Structured Porous Hemostatic Dental Sponge.

A biodegradable micro/nano-structured porous hemostatic gelatin-based sponge as a dentistry surgery foam was prepared using a freeze-drying method. In vitro function evaluation tests were performed to ensure its hemostatic effect. Biocompatibility tests were also performed to show the compatibility of the sponge on human fetal foreskin fibroblasts (HFFF2) cells and red blood cells (RBCs). Then, 10 patients who required the extraction of two teeth were selected, and after teeth extraction, for dressing, the produced sponge was placed in one of the extracavities while a commercial sponge was placed in the cavity in the other tooth as a control. The total weight of the absorbed blood in each group was compared. The results showed a porous structure with micrometric and nanometric pores, flexibility, a two-week range for degradation, and an ability to absorb blood 35 times its weight in vitro. The prepared sponge showed lower blood clotting times (BCTs) (243.33 ± 2.35 s) and a lower blood clotting index (BCI) (10.67 ± 0.004%) compared to two commercial sponges that displayed its ability for faster coagulation and good hemostatic function. It also had no toxic effects on the HFFF2 cells and RBCs. The clinical assessment showed a better ability of blood absorption for the produced sponge (p-value = 0.0015). The sponge is recommended for use in dental surgeries because of its outstanding abilities.

Optimization of Oligomer Chitosan/Polyvinylpyrrolidone Coating for Enhancing Antibacterial, Hemostatic Effects and Biocompatibility of Nanofibrous Wound Dressing.

A synergistic multilayer membrane design is necessary to satisfy a multitude of requirements of an ideal wound dressing. In this study, trilayer dressings with asymmetric wettability, composed of electrospun polycaprolactone (PCL) base membranes coated with oligomer chitosan (COS) in various concentrations of polyvinylpyrrolidone (PVP), are fabricated for wound dressing application. The membranes are expected to synergize the hygroscopic, antibacterial, hemostatic, and biocompatible properties of PCL and COS. The wound dressing was coated by spraying the solution of 3% COS and 6% PVP on the PCL base membrane (PVP6-3) three times, which shows good interaction with biological subjects, including bacterial strains and blood components. PVP6-3 samples confirm the diameter of inhibition zones of 20.0 ± 2.5 and 17.9 ± 2.5 mm against Pseudomonas aeruginosa and Staphylococcus aureus, respectively. The membrane induces hemostasis with a blood clotting index of 74% after 5 min of contact. In the mice model, wounds treated with PVP6-3 closed 95% of the area after 10 days. Histological study determines the progression of skin regeneration with the construction of granulation tissue, new vascular systems, and hair follicles. Furthermore, the newly-growth skin shares structural resemblances to that of native tissue. This study suggests a simple approach to a multi-purpose wound dressing for clinical treatment.

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

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

A novel gene recombinant collagen hemostatic sponge with excellent biocompatibility and hemostatic effect.

Effect and biosafety are the most noteworthy aspect of the hemostatic materials for trauma treatment. In this work, we evaluated the biocompatibility and hemostatic effect of a novel recombinant collagen hemostatic sponge according to ISO 10993. In addition, the interaction between the recombinant collagen hemostatic sponge and blood cells was observed by scanning electron microscopy, moreover, the hemostatic effect was evaluated by blood clotting assay in vitro and liver hemorrhage models in vivo. As the results, the novel recombinant collagen hemostatic sponge enables to be biodegradable completely in vivo, without stimulation, sensitization, acute toxicity, hematolysis or obvious immune rejection. The procoagulant effect of recombinant hemostatic sponge in vitro is significantly more excellent than that of natural collagen sponge due to the more promotive capacity of blood cell adhesion. Meanwhile, the liver hemorrhage models showed that the hemostatic time of recombinant collagen sponge was 19.33 ± 4.64 s, which was significantly better than that of natural collagen sponge (hemostatic time 31.62 ± 5.63 s). Therefore, the novel recombinant collagen hemostatic sponge with satisfactory biocompatibility and significant hemostatic effect can be performed as a potential novel type of clinical hemostatic products for research and development.

Hemostatic Effect of Palliative Radiation Therapy in Preventing Blood Transfusions from Bleeding Occurring within Advanced Gastric Cancer.

Purpose: To report the hemostatic effects of palliative radiation therapy (RT) for the prevention of blood transfusions (BT) in patients with advanced gastric cancer (AGC). Methods and Materials: Twenty-eight patients who received palliative three-dimensional conformal RT for hemostasis of gastric bleeding were retrospectively assessed in a study conducted in Japan. The median follow-up was 143.5 days. Changes in hemoglobin (Hb) levels were compared at the beginning of RT and four weeks later. Blood transfusion-free survival (BTFS) and overall survival (OS) were measured from the beginning of RT. Treatment toxicity was evaluated within 60 days of RT initiation. Results: No statistically significant decrease in Hb level was observed four weeks after RT. Twenty-eight patients did not receive BT within a month after RT, of whom three died within a month; 6/28 patients (21%) received BT at a median interval of 99.5 days following RT. The one-year BTFS and OS rates for all patients were 69% and 12%, respectively. The one-year BTFS was statistically significantly higher in 17 patients treated with a biologically effective dose (BED)10 of 39 Gy (30 Gy in 10 fractions) (78%) compared with six patients treated with a BED10 of 48 Gy (40 Gy in 20 fractions) (25%). Grade 1 and 2 nausea (n = 11) and a Grade 2 increase in alanine aminotransferase (n = 1) were observed. One patient died of Grade 5 hemorrhage. Conclusions: Palliative RT is an effective treatment to prevent BT for bleeding occurring within AGC. Specifically, a fractionation regimen of 30 Gy in 10 fractions (a BED10 of 39 Gy) has a more durable hemostatic effect and thus should be considered for better prognosis.

Application of epinephrine saline rinsing solution in hemostasis of cleft palate repair / 中华医学美学美容杂志

Objective:To investigate the hemostatic effect of epinephrine saline rinse solution in cleft palate repair.Methods:A total of 100 children who underwent cleft palate repair in the operating room of the Second Affiliated Hospital of Shantou University Medical College from 2018 to 2020 were selected, Among them, 51 were males and 49 females, aged from 6 months to 12 years, with an average (2.5±2.49) years. The patients were divided into two groups according to whether to use epinephrine saline flushing fluid: in group A, 43 cases were treated with adrenaline saline irrigation solution to wash the incision during the operation; gauze soaked in rinse solution was used to fill the oral cavity before endotracheal intubation and extubation after operation; in B group of 57 cases, no intraoperative rinses were used. The intraoperative blood loss and operation duration were compared between the two groups.Results:Intraoperative use in group A after adrenaline saline rinses showed that the intraoperative blood loss of children (16.23±4.88) ml was significantly lower than that of group B (19.26±4.13) ml. The duration of operation in group A (109.79±40.27) min was significantly shorter than that in group B (137.16±50.47) min, The difference was statistically significant ( t=2.92, P<0.05). Conclusions:The incision is rinsed with epinephrine saline solution during cleft palate repair. In addition, before endotracheal intubation and extubation after operation, gauze soaked in rinsing solution is used to fill the oral cavity, which could significantly reduce the amount of bleeding and shorten the operation time.

The effect of Moutan cortex carbonisata nano-components on the blood-cooling and hemostatic / 药学学报

At present, the research of Moutan cortex carbonisata (MCC) mainly focuses on the changes of chemical composition before and after charcoal production, and there is a lack of material basic research directly related to the efficacy at home and abroad. In this study, Moutan cortex, as a precursor, and was calcined to MCC at high temperature. The Moutan cortex carbonisata nano-components (MCC-NCs) were extracted and separated from MCC to explore its cooling-blood and hemostatic effects. In the experiment, the MCC was calcined at a high temperature in a muffle furnace (350 ℃, 1 h), and then MCC-NCs were extracted for MCC, and characterized by transmission electron microscopy and UV-vis absorption spectroscopy, fluorescence spectroscopy, Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. In addition, the study evaluated the blood-cooling and hemostatic effects of MCC-NCs. The results showed that MCC-NCs have a size distribution of 0.80-2.8 nm, a lattice spacing of 0.26 nm. MCC-NCs are mainly composed of C, O and N elements and have abundant surface functional groups such as OH, C=O, C-N and C=C. The fluorescence yield of MCC-NCs was 7.18%. The experiments complied with the Animal Ethics Committee of Beijing University of Chinese Medicine. The result indicated that pretreatment MCC-NCs can significantly (P < 0.05) reduce the high, medium, and low viscosity of whole blood and plasma viscosity, and reduce hematocrit, red blood cell distribution width, hemoglobin and red blood cell level. In addition, MCC-NCs significantly reduced the levels of activated partial thromboplastin time, thrombin time and fibrinogen (P < 0.05). The pathological examination results showed that MCC-NCs can significantly reduce lung tissue damage, reduce bleeding and inflammatory cell infiltration. At the same time, it can also significantly reduce the symptoms of gastric mucosal bleeding. In conclusion, the results indicated that MCC-NCs has significantly the effect of blood cooling and hemostasis, and its hemostatic effect is mainly related to the activation of endogenous coagulation pathway or fibrinogen system, which provided a novel strategy for exploring the material basis of traditional Chinese medicine for hemostasis.

Platelet Protease Activated Receptor 1 Is Involved in the Hemostatic Effect of 20(S)-Protopanaxadiol by Regulating Calcium Signaling.

Panax notoginseng (Burk.) F.H. Chen has long been used to stop bleeding for hundreds of years in China. At present, only dencichine, notoginsenoside Ft1, and 20(S)-protopanaxadiol (PPD) showed hemostatic effect. However, the molecular mechanism of PPD on the platelet aggragetion needs to be further investigated. The study aims to evaluate the hemostatic effect of PPD and reveal its interacting targets using a series of experiments. In this study, the bleeding time was measured in mouse tail amputation and liver scratch models to evaluate hemostatic effect of PPD. The routine blood and plasma coagulation parameters in NS, HC, and PPD (2, 4, and 8 mg/kg) groups were measured using a blood analyzer. Platelet aggregation rate and ATP release were analyzed by a platelet aggregometer. Subsequently, the degranulation marker CD62P and PAC-1, and the concentrations of cytosolic Ca2+ ([Ca2+]i), cAMP, cGMP, and PAC-1 expressions were also assessed. We found that PPD shorted the bleeding time on the mouse tail amputation and liver scratch models and mainly increased blood platelet count in the rats after subcutaneous injection for 4 h. Meanwhile, PPD decreased APTT, increased FIB content, and directly induced platelet aggregation in vitro. In the absence of Ca2+, PPD induced the increase of [Ca2+]i and slightly increased the levels of CD62P and PAC-1. After the addition of 1 mM Ca2+, PPD treatment markedly promoted platelet activation by promoting ATP level, releasing CD62P and increasing PAC-1 binding in washed platelets. Excitingly, PPD-induced changes including platelet aggregation, decreased cAMP content, and the increases of CD62P and PAC-1 were significantly reversed by protease-activated receptor 1 (PAR-1) antagonist, vorapaxar, which showed similar function as thrombin. In addition, molecular docking analysis and ELISA assay demonstrated that PPD had a promising docking score with -6.6 kcal/mol and increased PAR-1 expression in human platelets, which indicated that PAR-1 is involved in PPD-induced platelet aggregation by regulating calcium signaling. Collectively, our study could provide the new insights of PPD as an essential hemostatic ingredient in Panax notoginseng for the treatment of hemorrhagic disease.

Better Treatment Values in Local Application of Tranexamic Acid (TXA) than Intravenous Application with the Same Dose in Total Hip Arthroplasty.

INTRODUCTION: The aim of our study was to investigate the hemostatic effect of local and intravenously administered tranexamic acid (TXA) at the same dose in total hip arthroplasty. METHODS: The prospective study included 72 patients who underwent total hip arthroplasty in our hospital between March 2018 and March 2019. The patients enrolled in the study were randomly divided into two groups: the observation group (36 patients were injected with 2.0 g TXA in 10 mL 0.9% NaCl using the joint cavity drainage tube after suturing the joint capsule) and the control group (36 patients were given an intravenous infusion of 2 g TXA in 200 mL 0.9% NaCl 30 min before the operation). In each patient, apparent blood loss, hidden blood loss, average blood transfusion, and the number of cases receiving blood transfusion were compared between the two groups after treatment. Hematocrit (Hct) and hemoglobin (Hb) levels were recorded at postoperative day (POD) 1, 2, 3, 7, and 10. We also recorded the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) before the operation and 12 h postoperative and POD 1, 3, 7, and 10. The incidence of deep venous thrombosis and pulmonary embolism was also taken into account. RESULTS: In the observation group, apparent blood loss, hidden blood loss, average blood transfusion volume, and the number of patients receiving blood transfusion were lower compared than the control group (P < 0.001). The levels of Hct and Hb were compared between the two groups at POD 1, 2, 3, 7, and 10, and the observation group reported higher levels of Hct and Hb (P < 0.001). The levels of CRP and IL-6 were compared between the two groups at POD 1, 3, 7, and 10, and the observation group reported lower levels of CRP and IL-6 than the control group (P < 0.001). On POD 7, there was no pulmonary embolism in both groups, and no significant difference was observed in the incidence of deep venous thrombosis between the two groups (P > 0.05). CONCLUSIONS: Local and intravenous applications of TXA at the same dose are effective approaches in terms of reducing bleeding and inflammatory reaction with a good safety profile; however, the effect of local application had superior therapeutic values.

Hemostatic action of lotus leaf charcoal is probably due to transformation of flavonol aglycons from flavonol glycosides in traditional Chinses medicine.

ETHNOPHARMACOLOGICAL RELEVANCE: Nelumbo nucifera Gaertn (lotus) leaves were empirically carbonized to enhance the hemostatic effect in traditional Chinese medicines. The mechanism of this application remains unclear. AIM OF THE STUDY: The present study aims at exploring the transformation of phytochemical compounds in lotus leaves after heating and figuring out the phytochemical mechanism of the application of charcoal hemostatic styptics. METHODS AND RESULTS: Raw lotus leaves were heated at 150 °C and 220 °C, respectively, and the transformation of the phytochemicals was studied. Flavonol glycosides in raw lotus leaves were found to be degraded to their corresponding aglycons in 150 °C lotus leaf charcoals (LLC) and the subsequent degradation products of aglycons in 220 °C LLC. 150 °C LLC exhibited the most desirable hemostatic effect in mice on reducing both bleeding time (BT) and clotting time (CT) by more than 30% as compared to the untreated group (P < 0.05). The extracts of 150 °C LLC were further separated by using different solvents. Ethyl acetate fraction which contained much flavonol aglycons displayed the most desirable hemostatic effect. On the contrary, petroleum ether fraction contains poor flavonoid and much alkaloid thus prolonged BT and CT. N-butanol extracts which contained only flavonol glycoside failed to shorten CT. In rats, quercetin (aglycon) standard promoted blood coagulation by shortening APTT (activated partial thromboplastin time) and increasing fibrinogen (P < 0.05). Hyperoside (glycoside) increased fibrinogen and platelet count (P < 0.05). Nuciferine was shown to prolong APTT and TT (thrombin time) and decrease fibrinogen (P > 0.05). CONCLUSION: Degradation of flavonoids and alkaloids in lotus leaves was suggested to enhance the hemostatic effect of LLC. Flavonol aglycons were found to be more effective on blood clotting compared with their corresponding glycosides. Nuciferine, a typical alkaloid in lotus leaves which was degraded in LLC showed anticoagulation effect in rats. The content of flavonoid aglycon can be regarded as a criterion to qualify LLC.

[Research on hemostatic effect and mechanism of carbonized Scutellariae Radix on rats of uterine bleeding].

The aim of this paper was to investigate the hemostatic effect and mechanism of carbonized Scutellariae Radix on uterine bleeding in the rats caused by early pregnancy termination. Eight unpregnant female rats were selected as normal group. Forty female rats conceived on the same day received mifepristone(11. 4 mg·kg-1) and misoprostol(125 µg·kg-1) to induce model of incomplete abortion in early pregnancy. Abortion models were randomly divided into model group,carbonized Scutellariae Radix water extract low dose group(0. 55 g·kg-1),medium group(1. 10 g·kg-1),high dose group(2. 20 g·kg-1) and positive control group(0. 45 g·kg-1).The uterine bleeding volume was detected by ultraviolet spectrophotometry. The pathological changes of endometrium were detected by HE(hematixylin-eosin) staining. The levels of interleukin(IL-1ß),IL-6 and tumor necrosis factor(TNF-α) in the plasma of rats were determined by ELISA. The expression levels of IL-1ß,IL-6 and TNF-α mRNA in the uterus of rats were determined by RT-PCR.The protein expression levels of VEGF,MMP-2 and MMP-9 were determined by Western blot. As compared with the normal group,the uterine bleeding volume and histopathological score were increased significantly; microvessel density of endometrial tissues was decreased significantly; the contents of TNF-α,IL-1ß and the levels of TNF-α mRNA and IL-1ß mRNA in the plasma were increased,while the content of IL-6 and level of IL-6 mRNA were decreased significantly. The protein expression levels of VEGF,MMP-2 and MMP-9 in the uterine tissues were also decreased. As compared with the model group,the uterine bleeding volume was decreased significantly in the carbonized Scutellariae Radix medium dose and high dose groups; endometrial repair was promoted,and the microvessel density of endometrial tissues was increased significantly; the contents of IL-1ß and TNF-α in the plasma of rats were decreased significantly,while the content of IL-6 in the plasma of rats was increased significantly; the expression levels of IL-1ß and TNF-α mRNA in the uterus of rats were decreased and the expression level of IL-6 mRNA showed an increase; the protein expressions of VEGF,MMP-2 and MMP-9 were decreased significantly in carbonized Scutellariae Radix medium and high dose groups. In conclusion,carbonized Scutellariae Radix showed good hemostatic effect,and its mechanism may be related to the repair of endometrium and inhibition of inflammatory reaction.

Thermal damage width and hemostatic effect of bipolar electrocoagulation, LigaSure, and Ultracision techniques on goat mesenteric vessels and optimal power for bipolar electrocoagulation.

BACKGROUND: We aimed to determine the optimal bipolar electrocoagulation power for laparoscopic surgery and to investigate which method, bipolar electrocoagulation, advanced bipolar, or ultrasonic technique was more reliable. METHODS: Goat mesenteric vessels (210 in vivo samples) with diameters of 3.03-5.44 mm were selected. Bipolar electrocoagulation with 80 W, 75 W, 70 W, 65 W, 60 W, 55 W, and 50 W, and advanced bipolar and ultrasonic techniques were performed on mesenteric vessels. The thermal damage width, hemostatic effect, and burst pressure of these tissues were recorded. SPSS version 13.0 was used for all data analysis. RESULTS: The results showed that 60 W was the optimal for bipolar electrocoagulation based on the thermal damage width, hemostatic effect, and burst pressure. In contrast, the thermal damage width of advanced bipolar and ultrasonic techniques was smaller than that of bipolar electrocoagulation, and advanced bipolartechnique had the highest successful rate for hemostasis and highest burst pressure. CONCLUSIONS: Bipolar electrocoagulation was optimally performed with 60 W of power. Compared with ultrasonic and bipolar electrocoagulation techniques, advanced bipolar use was more reliable for mesenteric vessels in laparoscopic surgery; however, bipolar electrocoagulation with optimal power can be used for its simplicity of operation and low cost.

Research on hemostatic effect and mechanism of carbonized Scutellariae Radix on rats of uterine bleeding / 中国中药杂志

The aim of this paper was to investigate the hemostatic effect and mechanism of carbonized Scutellariae Radix on uterine bleeding in the rats caused by early pregnancy termination. Eight unpregnant female rats were selected as normal group. Forty female rats conceived on the same day received mifepristone(11. 4 mg·kg-1) and misoprostol(125 μg·kg-1) to induce model of incomplete abortion in early pregnancy. Abortion models were randomly divided into model group,carbonized Scutellariae Radix water extract low dose group(0. 55 g·kg-1),medium group(1. 10 g·kg-1),high dose group(2. 20 g·kg-1) and positive control group(0. 45 g·kg-1).The uterine bleeding volume was detected by ultraviolet spectrophotometry. The pathological changes of endometrium were detected by HE(hematixylin-eosin) staining. The levels of interleukin(IL-1β),IL-6 and tumor necrosis factor(TNF-α) in the plasma of rats were determined by ELISA. The expression levels of IL-1β,IL-6 and TNF-α mRNA in the uterus of rats were determined by RT-PCR.The protein expression levels of VEGF,MMP-2 and MMP-9 were determined by Western blot. As compared with the normal group,the uterine bleeding volume and histopathological score were increased significantly; microvessel density of endometrial tissues was decreased significantly; the contents of TNF-α,IL-1β and the levels of TNF-α mRNA and IL-1β mRNA in the plasma were increased,while the content of IL-6 and level of IL-6 mRNA were decreased significantly. The protein expression levels of VEGF,MMP-2 and MMP-9 in the uterine tissues were also decreased. As compared with the model group,the uterine bleeding volume was decreased significantly in the carbonized Scutellariae Radix medium dose and high dose groups; endometrial repair was promoted,and the microvessel density of endometrial tissues was increased significantly; the contents of IL-1β and TNF-α in the plasma of rats were decreased significantly,while the content of IL-6 in the plasma of rats was increased significantly; the expression levels of IL-1β and TNF-α mRNA in the uterus of rats were decreased and the expression level of IL-6 mRNA showed an increase; the protein expressions of VEGF,MMP-2 and MMP-9 were decreased significantly in carbonized Scutellariae Radix medium and high dose groups. In conclusion,carbonized Scutellariae Radix showed good hemostatic effect,and its mechanism may be related to the repair of endometrium and inhibition of inflammatory reaction.