Search Results (142)

(1) Background: Impaired diabetic wound healing stems from systemic dysregulation of the wound-healing cascade under hyperglycemic conditions, producing a disordered microenvironment marked by sustained inflammation, defective angiogenesis, and aberrant extracellular matrix remodeling, multifactorial, multistage pathological interactions demanding multi-target intervention. (2) Methods: We constructed a multifunctional nanocomposite hydrogel dressing (PGAs@CDV) based on a “drug-carrier integration” strategy, targeting the dysregulated hemostasis, inflammation, and proliferation phases of diabetic wound healing. An amphiphilic micelle carrier (PNO-GA) was synthesized by covalently conjugating Panax notoginseng oligosaccharide with gallic acid, loaded with Anemoside B4 to yield drug-loaded nanomicelles (PGAs), embedded into a carboxymethyl chitosan-dopamine-vanillin hydrogel (CDV) matrix to form PGAs@CDV. We then examined how PGAs@CDV affected diabetic wound healing. (3) Results: In vitro, PGAs@CDV enhanced cell migration and angiogenic capacity, exhibited potent antioxidant activity, and promoted M1-to-M2 macrophage polarization. We tested PGAs@CDV in a streptozotocin-induced diabetic mouse wound model. Wounds treated with PGAs@CDV closed faster than those treated with the control, CDV, PNO@CDV, and AB4@CDV. Four readouts tracked this difference: hemostasis was quicker, inflammation was lower, more blood vessels formed, and collagen deposition was higher. At the pathway level, PGAs@CDV suppressed NF-κB signaling and activated PI3K/AKT/HIF-1α. These two arms map onto the anti-inflammatory and pro-angiogenic effects observed above. (4) Conclusions: This nanocomposite hydrogel integrates a bioactive carrier with a therapeutic payload to enable coordinated intervention across multiple phases of diabetic wound repair. By combining structural support with sustained pharmacological activity, it offers a promising strategy for the treatment of chronic diabetic wounds. Full article

Neonatal thromboembolic (TE) disease is an increasingly recognized clinical entity, driven by the physiological uniqueness of developmental hemostasis, improved survival of preterm infants, and the widespread use of invasive supportive technologies. Most neonatal thrombotic events are associated with central venous and arterial catheterization which are considered the most significant modifiable risk factors. The clinical spectrum encompasses catheter-related thrombosis, perinatal stroke and site-specific entities such as renal vein and portal vein thrombosis. Each condition presents distinct challenges such as neurological complications, chronic organ dysfunction and portal hypertension. Diagnosis relies primarily on Doppler ultrasonography, though its sensitivity is limited in deep-vessel scenarios, often requiring advanced modalities like magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA). Therapeutic interventions remain controversial due to a lack of high-quality evidence, with current guidelines largely based on observational data. Ultimately, managing neonatal TE requires a nuanced, individualized approach that balances the risk of thrombus extension against the inherent hemorrhagic vulnerability of the neonate. This review aims to provide a comprehensive and up-to-date overview of neonatal TE, emphasizing major clinical entities and diagnostic strategies. It highlights current evidence gaps and outlines future directions, including the need for standardized management protocols and high-quality prospective research. Full article

Fibrinogen is an essential component of hemostasis and clot formation that stabilizes the platelet-dependent primary hemostatic process. Low fibrinogen levels can be primary (congenital) or secondary (acquired). Acquired hypofibrinogenemia may result from chronic diseases (e.g., liver, autoimmune diseases, and malignancies) or major hemorrhage (e.g., trauma, surgery). Low fibrinogen levels are both a symptom and a precipitating factor for coagulopathy and ongoing bleeding. Fibrinogen repletion with fibrinogen-containing products is important for managing coagulopathic bleeding with suspected or documented hypofibrinogenemia. Different available fibrinogen sources include fibrinogen concentrate, cryoprecipitate, and frozen plasma and vary based on multiple factors including fibrinogen content, purity, other clotting or non-clotting proteins (e.g., immunomodulating proteins or proteins of unknown function), preparation time, safety, volumes, and availability. Fibrinogen replacement strategies have been studied in trauma but also in patients undergoing spine, cytoreductive, and cardiac surgery. In this review, we discuss the physiological actions of fibrinogen, strategies for control of coagulopathic bleeding related to hypofibrinogenemia, and the therapeutic, logistical, and economic factors that influence treatment decisions. In addition, current guidelines and clinical studies were considered regarding the formation of evidence-based treatment strategies that can be individualized at the patient’s bedside. Full article

Rapid hemostasis assessment is essential for managing acute coagulopathy, guiding anticoagulant therapy, and monitoring cardiac surgery patients. Although viscoelastic testing provides valuable guidance for early intervention, its widespread adoption is constrained by large blood usage (~2 mL), prolonged turnaround times (several hours), long assay durations (~25–40 min), and high costs. To overcome these limitations, we developed an innovative, all-in-one magnetoelastic (ME) sensing chip that enables systematic coagulation kinetics monitoring using only 46 μL of whole blood within 15 min. Featuring prepackaged lyophilized reagents and pumpless blood loading, this user-friendly chip is highly cost-effective for disposable use. The experimental results demonstrated good reproducibility for on-chip extrinsic coagulation activation, with clotting parameters maintaining coefficients of variation under 10%. Furthermore, clotting parameters derived from heparin monitoring results exhibited a strong linear correlation that compares favorably with the clinical standard (r = 0.986). Finally, sensitivity evaluation toward various blood components validated the sensor’s dual-mode characterization strategy for identifying coagulation factors and fibrin-related coagulopathies. The proposed ME sensing chip holds promise for bedside testing and flexible, on-demand coagulation monitoring across diverse clinical scenarios. Full article

Background/Objectives: ADAMTS13 is a plasma metalloprotease that cleaves von Willebrand Factor (vWF), a multimeric glycoprotein involved in platelet recruitment during primary hemostasis. Inhibition of ADAMTS13 activity by autoantibodies causes immune thrombotic thrombocytopenic purpura (iTTP). Growing evidence has established allostery as a key contributor to iTTP pathophysiology. This review summarizes the current understanding of how ADAMTS13 structure contributes to its function and regulation and examines anti-ADAMTS13 antibodies as pathological allosteric modulators in iTTP and their associated allosteric mechanisms. Methods: We searched the published literature investigating the role of allostery in iTTP, with special emphasis on studies that satisfy the functional definition of allostery, which addresses how a ligand binding to a protein influences a second ligand-binding event at a distinct site. Results: Anti-ADAMTS13 antibodies primarily affect catalytic turnover as opposed to substrate binding affinity, consistent with their characterization as V-type allosteric ligands. Biophysical studies have revealed extensive and distal structural changes upon antibody binding, including near the enzyme’s active site. However, more recent work utilizing full-length Immunoglobulin G (IgG) molecules and polyclonal iTTP patient plasma suggests that the mechanistic complexity is greater than initially appreciated, with multiple mechanisms likely coexisting. Conclusions: While significant progress has been made to understand allostery in ADAMTS13 and iTTP, many questions remain unresolved. Further elucidation of these underlying mechanisms could help inform the development of diagnostic strategies and targeted therapies for this potentially fatal disorder. Full article

Background: Postoperative bleeding remains an important source of morbidity following Bentall procedures despite numerous technical refinements aimed at improving hemostasis. We evaluated whether a modified hybrid cardioplegia strategy incorporating intermittent blood cardioplegia during aortic root reconstruction could reduce bleeding-related complications compared with a conventional double-dose del Nido strategy. Methods: A total of 103 consecutive patients who underwent Bentall procedures were retrospectively analyzed. Patients were divided according to the myocardial protection strategy employed: conventional double-dose del Nido cardioplegia (Group 1, n = 46) and a modified hybrid strategy consisting of initial del Nido cardioplegia followed by intermittent blood cardioplegia during root reconstruction (Group 2, n = 57). The primary endpoint was postoperative re-exploration for bleeding during the index hospitalization. Additional bleeding-related outcomes included 24 h drainage volume and blood product transfusion requirements. Secondary endpoints were intensive care unit (ICU) stay, hospital stay, and in-hospital mortality. Results: Baseline characteristics, cardiopulmonary bypass times, and aortic cross-clamp durations were comparable between groups. Group 2 demonstrated significantly lower 24 h postoperative drainage volumes compared with Group 1 (450 [350–550] mL vs. 550 [400–650] mL, p = 0.005). Postoperative re-exploration for bleeding occurred significantly less frequently in Group 2 than in Group 1 (3.5% vs. 19.6%, p = 0.011). No significant differences were observed in red blood cell transfusion (p = 0.112), fresh frozen plasma transfusion (p = 0.339), or platelet transfusion requirements (p = 0.147). Mechanical ventilation duration (p = 0.423), intensive care unit stay (p = 0.342), and hospital stay (p = 0.103) were similar between groups. In-hospital mortality did not differ significantly between the groups (4.3% vs. 3.5%, p = 1.000); however, the study was not powered to detect differences in mortality because of the low number of events. Conclusions: In patients undergoing Bentall procedures, a modified hybrid cardioplegia strategy incorporating intermittent blood cardioplegia during aortic root reconstruction was associated with lower postoperative drainage volumes and fewer re-explorations for bleeding compared with a conventional double-dose del Nido strategy. These findings suggest that cardioplegia delivery may contribute to intraoperative hemostatic optimization beyond its traditional role in myocardial protection. Larger prospective studies are warranted to validate these observations. Full article

Background: Despite modern technology of energy instruments, secure arterial vessel sealing remains a surgical challenge. Particularly in cases of fragile vessel walls or limited visibility, additional reinforcement techniques are potentially desirable. TachoSil^®, a collagen-based, fibrin-coated fleece, is routinely employed in clinical practice for hemostasis and suture support. Whether its external use in terms of collagen augmentation improves the burst strength of bipolarly sealed arteries is to be examined. Objective: To investigate the influence of a TachoSil^® cuff on sealing quality and burst pressures after bipolar vessel sealing in a standardized ex vivo model. Materials and Methods: Porcine carotid arteries (outer diameter 5–7 mm) were examined in two groups: native vessels (group A, n = 12) and vessels with TachoSil^® cuffs (group B, n = 12). Sealing was performed with marSeal^® 5 plus and maXium^® sealer. Burst pressures were measured by continuously increasing intraluminal pressure. Histological analyses were performed. Results: Mean burst pressures were significantly reduced in group B (805 ± 78 mbar) as compared to group A (1452 ± 275 mbar; p < 0.001). Histologically, no structural fusion between vessel walls and collagen fleece was observed. Conclusions: External collagen augmentation using TachoSil^® leads to a significant reduction in the burst strength of bipolarly sealed arteries, despite unaltered sealing duration. The combination of collagen fleece and energy sealing does not have a synergistic effect and should not be used in planned vessel sealing. Further studies are needed to evaluate the underlying mechanisms and possible alternative augmentation strategies. Full article

To address the challenges associated with prolonged inflammatory phases and delayed healing in clinically infected wounds, this research developed a multifunctional PB@GC@OD hydrogel integrating self-healing properties, injectability, and photothermal antibacterial efficacy. The hydrogel was constructed using oxidized dextran (OD) and glycol chitosan (GC) as the matrix, which were dynamically cross-linked via a Schiff-base reaction to form the GC@OD hydrogel. Subsequently, the photothermal agent prussian blue (PB) was incorporated to fabricate the PB@GC@OD hydrogel. The resulting PB@GC@OD hydrogel demonstrated robust self-healing capabilities and excellent injectability. Upon exposure to 808 nm near-infrared (NIR) irradiation, the hydrogel achieved efficient photothermal conversion, rapidly inducing localized hyperthermia that effectively eliminated Staphylococcus aureus, Escherichia coli, and methicillin-resistant Staphylococcus aureus (MRSA). In a mouse model of MRSA-infected wounds, the hydrogel not only maintained a moist wound microenvironment but also eradicated pathogenic bacteria via photothermal therapy, thereby significantly accelerating the healing process. Moreover, the hydrogel demonstrated favorable biocompatibility and long-term safety. Therefore, the PB@GC@OD hydrogel integrates photothermal sterilization, self-healing, injectability, hemostasis, and biocompatibility into a single platform, presenting a promising strategy for synergistic therapy and tissue regeneration in bacterially infected wounds. Full article

Uncontrolled hemorrhage remains a major challenge in trauma care and surgical interventions, where rapid hemostasis and wound sealing are essential for improving patient survival. Natural polymer-based hydrogels have emerged as promising hemostatic materials owing to their excellent biocompatibility, biodegradability, and biomimetic properties. However, their clinical translation remains limited by insufficient mechanical robustness, wet adhesion, and functional responsiveness. To address these challenges, considerable progress has been achieved through rational material design and structural engineering strategies. Representative natural polymers, particularly polysaccharides and proteins, exhibit distinct physicochemical and biological characteristics that determine their hemostatic mechanisms and design strategies. Based on these material platforms, molecular modification strategies, including charge regulation, hydrophobic modification, and bioactive functionalization, have been widely employed to modulate interfacial interactions, platelet adhesion, coagulation activation, and tissue adhesion. In parallel, advanced structural architectures, such as porous, particulate, fibrous, multicrosslinked/multinetwork, and nanocomposite systems, have significantly enhanced fluid absorption, mechanical resilience, stress dissipation, and hemorrhage sealing efficiency. Beyond conventional hemostasis, increasing efforts have focused on integrating multifunctional properties, including antibacterial activity, inflammatory regulation, oxidative stress modulation, tissue regeneration, dynamic monitoring, and stimuli-responsive behaviors. This review systematically summarizes recent advances in natural polymer-based hemostatic hydrogels from the perspectives of advanced material modification strategies, structural engineering approaches, and functional integration, with particular emphasis on the relationships among material characteristics, interfacial behavior, structural organization, and hemostatic performance. Finally, current challenges and future perspectives for clinical translation are discussed, aiming to provide valuable insights for the rational design and clinical implementation of next-generation hemostatic biomaterials. Full article

Background/Objectives: Ischemic stroke remains a major global health challenge, yet therapeutic options are severely restricted by narrow treatment windows and the risk of hemorrhagic transformation. Natural small molecules represent a valuable reservoir for discovering novel neuroprotective leads with favorable safety profiles. Cinchonidine, a natural quinoline alkaloid, has shown anti-inflammatory and cytoprotective properties, but its potential in treating ischemic stroke is largely unexplored. This study aimed to evaluate the neurovascular protective effects and hemostatic safety of cinchonidine in preclinical stroke models. Methods: We evaluated cinchonidine using a mouse model of middle cerebral artery occlusion (MCAO) and in vitro oxygen–glucose deprivation (OGD) models in cerebral endothelial cells (CECs) and Neuro2A cells. Infarct volume, brain edema, and neurological recovery were assessed. Blood–brain barrier (BBB) integrity was measured via Evans blue extravasation. Mechanistic markers, including microglial activation, pro-inflammatory mediators (iNOS, COX-2), and apoptosis-related signaling, were examined. Additionally, cinchonidine’s effect on platelet aggregation was also tested. Results: Cinchonidine significantly reduced infarct volume and brain edema while improving neurological functional recovery. It effectively preserved BBB integrity and enhanced cell viability under OGD conditions. Furthermore, cinchonidine suppressed microglial activation and decreased the expression of pro-inflammatory mediators. These protective effects were associated with the modulation of apoptotic signaling pathways. These protective effects were accompanied by reduced p53-associated stress signaling in endothelial cells and ischemic brain tissue. Importantly, cinchonidine did not significantly interfere with platelet aggregation, suggesting a potentially favorable hemostatic profile. Conclusions: Cinchonidine attenuates ischemic brain injury and is associated with endothelial protection, preservation of BBB integrity, and modulation of inflammatory and apoptotic responses. As a natural lead compound that does not compromise hemostasis, cinchonidine represents a promising lead compound for further development as a neurovascular protective strategy in ischemic stroke. Full article

Background: Venous closure devices (VCDs) are being increasingly used after femoral venous access to facilitate recovery, but their comparative efficacy and safety versus manual compression or figure-of-eight suture remain uncertain. Because femoral venous access management is influenced by patient-related and procedural factors, VCDs may contribute to a more personalized postprocedural recovery strategy. Objective: Evaluation of the impact of VCDs on procedural recovery and vascular complications in patients undergoing cardiac procedures via femoral venous access. Methods: We systematically searched PubMed, Embase, and CENTRAL through to April 2025 for randomized controlled trials (RCTs) comparing VCDs with manual compression and/or figure-of-eight suture. Primary efficacy outcomes were time to hemostasis (TTH), time to ambulation (TTA), time to discharge (TTD), and time to discharge eligibility (TTDe). Safety outcomes were major and minor vascular complications. Risk of bias was assessed with RoB 2, and certainty of evidence assessed with GRADE. Random-effects models were used to pool standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results: Seven RCTs (n = 948) were included. VCDs use significantly reduced TTH (SMD: −1.00; 95% CI: −1.57 to −0.42) and TTA (SMD: −1.50; 95% CI: −2.42 to −0.58). TTD showed a non-significant trend favoring VCDs (SMD: −0.99; 95% CI: −2.13 to 0.15), while TTDe was consistently shorter with VCDs across three trials. Major vascular complications were rare and similar between groups (RR: 0.41; 95% CI: 0.09–1.89). Minor vascular complications were significantly reduced with VCDs (RR: 0.42; 95% CI: 0.22–0.79). Conclusions: In patients requiring femoral venous access for interventional cardiology procedures, VCDs improve time to hemostasis and ambulation and reduce minor vascular complications without increasing major events. These findings support VCDs as an effective and safe strategy for venous closure. Full article

Impaired wound healing arises from interacting biological and material challenges, including persistent infection, biofilm formation, oxidative stress, unresolved inflammation, impaired angiogenesis, defective epithelialization, hemorrhage, and insufficient real-time assessment of wound status. Quantum dot (QD) and nanodot nanosystems have emerged as a versatile class of bioactive wound interfaces capable of addressing these barriers through functions that extend beyond passive coverage. This review synthesizes the design rationale, material composition, validation strategies, functional outcomes, mechanistic interpretation, and translational relevance of QD-enabled platforms for precision wound repair. Across the reviewed literature, carbon dots, graphene QDs, black phosphorus QDs, metal and metal oxide QDs, transition-metal nanodots, and hybrid nanocomposites were incorporated into hydrogels, films, sponges, nanofibers, microneedles, scaffolds, membranes, sprays, and injectable matrices. Their major precision-enabling attributes include localized antimicrobial and antibiofilm activity, redox-adaptive behavior, photothermal and photodynamic activation, inflammatory and macrophage modulation, hemostasis, controlled therapeutic delivery, angiogenic and epithelial support, and fluorescence-based monitoring. The strongest conceptual advance is the transition from static wound dressings toward adaptive biointerfaces that can sense, respond to, or compensate for local wound state abnormalities. Nevertheless, the field remains largely preclinical, with important gaps in long-term safety, standardized characterization, clinically predictive models, manufacturing reproducibility, regulatory alignment, and human validation. Future progress will depend on rationally simplified multifunctional platforms, rigorous comparative testing, wound state-specific evaluation frameworks, and translation-oriented safety and usability studies. QD nanosystems therefore represent a promising foundation for precision wound repair, provided that their multifunctionality is matched by equally rigorous evidence of safety, reproducibility, and clinical relevance. Full article

Background/Objectives: Type II endoleaks (T2ELs) remain one of the most frequent causes of aneurysm sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR). While embolization may be effective in typical T2ELs with a clearly identifiable feeding vessel, management becomes more challenging when no visible communication with a side branch can be demonstrated. Emerging evidence suggests that hypertrophic vasa vasorum may contribute to aneurysm sac expansion in these atypical cases. We present a case of refractory atypical T2EL treated by open conversion and discuss the potential role of the vasa vasorum network in its pathophysiology. Case Presentation: A 77-year-old man presented with lumbar pain ten years after EVAR for a symptomatic abdominal aortic aneurysm. Computed tomography angiography demonstrated progressive aneurysm sac enlargement to 8.5 cm despite three previous translumbar embolization procedures. Multiple areas of contrast pooling were identified within the aneurysm sac, but no clear communication with a feeding side branch was observed. Owing to persistent sac expansion and symptoms, open conversion was performed with partial endograft explantation and reconstruction using a bifurcated PTFE graft. Results: After opening the aneurysm sac and evacuating the thrombus, diffuse bleeding was observed from numerous small vascular orifices distributed throughout the inner sac surface. These findings were considered consistent with a prominent vasa vasorum network. Hemostasis was achieved using a combination of figure-of-eight sutures and electrocautery. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Follow-up imaging demonstrated normal graft patency without complications. Conclusions: This case supports the hypothesis that an extensive vasa vasorum network may contribute to aneurysm sac expansion in atypical T2ELs and possibly endotension after EVAR. In patients with refractory sac enlargement, open conversion remains a definitive treatment option. Further research is needed to clarify the underlying mechanisms and to explore targeted therapeutic strategies aimed at modulating angiogenesis and vascular remodeling. Full article

This review systematically illustrates the application and research progress of endoscopically delivered hydrogels as a novel strategy in the endoscopic treatment of early-stage gastrointestinal tumors. It focuses on analyzing the unique physicochemical properties, biological functions, and clinical value of hydrogels as submucosal injection materials, and delves into their core roles in achieving sustained mucosal lifting, effective hemostasis, and wound repair during endoscopic submucosal dissection (ESD). Representative hydrogel materials, such as chitosan, hyaluronic acid, and sodium alginate, are driving the evolution of ESD technology from a mere “resection” procedure toward an integrated “lift-resect-repair” therapeutic model, owing to their excellent biocompatibility, injectability, and controllable degradability. Although challenges in clinical translation remain, including long-term safety, precise control of degradation rates, and scalable production, the field is poised for further breakthroughs with the development of smart responsive hydrogels and their deep integration with emerging technologies. Full article

Raw lacquer, a natural polymer derived from the bast of lacquer trees (Toxicodendron vernicifluum), is renowned as the “King of Coatings” due to its exceptional film-forming properties, abrasion resistance, corrosion resistance, and biocompatibility. However, its inherent limitations—including stringent drying conditions, slow curing rates, deep coloration, and difficult application—have severely restricted its modernization and widespread adoption. This review systematically summarizes recent research advances in the modification and application of raw lacquer, focusing on four major modification strategies: (1) Nanocomposite modification—incorporating functional nanofillers such as Al₂O₃, cellulose nanofibrils (CNF), polydopamine (PDA) melanin-like nanoparticles, and SiO₂ to significantly enhance film hardness, compactness, UV-aging resistance, and drying kinetics. (2) Chemical structure modification—employing molecular design strategies including aminoanthraquinone grafting, tung oil blending, water-based emulsification, and terpene/allyl group functionalization to improve hydrophobicity, flexibility, fast-drying properties, and achieve dual photo/oxygen curing. (3) Biomass synergistic composites—utilizing natural polymers such as chitosan and lignin, along with bio-inspired adhesion mechanisms (e.g., PDA), to confer advanced functionalities including antibacterial and antifouling properties. (4) Curing behavior regulation—precisely controlling drying kinetics through inorganic salt ion microenvironment engineering, nonionic surfactants, and salicylaldehyde Schiff base-based driers. Building upon these foundations, this review further expands on the emerging high-value applications of modified lacquer in preventive conservation of cultural heritage, advanced functional coatings (anti-corrosion, super-hydrophobicity, flame retardancy), biomedical materials (hemostasis, antibacterial activity, drug-controlled release, water treatment adsorption), and intelligent responsive flexible electronics. Finally, addressing challenges including weak fundamental research, bottlenecks in green industrialization, and lack of standardization, future development directions are proposed encompassing interdisciplinary innovation, sustainable modification strategies, integration of multifunctional intelligent systems, and big data-driven research paradigms, aiming to provide theoretical guidance and technical references for the high-value utilization and modernization of lacquer resources. Full article