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Elevation of early-stage gastrointestinal cancer using submucosal injection materials (SIMs) and postoperative wound care with adhesive materials are crucial for preventing complications arising from endoscopic submucosal dissection (ESD). Several types of SIMs have been developed; however, they often provide insufficient tissue elevation and fail to adequately adhere to the defect following the removal of early-stage gastrointestinal cancer. In this study, we present the development of injectable Cat-PBA-ApGltn hydrogels, which are based on catechol group-modified Alaska pollock gelatin (Cat-ApGltn) and phenylboronic acid-modified Alaska pollock gelatin (PBA-ApGltn), serving as multifunctional SIMs. A Cat-ApGltn/PBA-ApGltn mixed solution formed a hydrogel within 3 seconds. The resulting Cat-PBA-ApGltn hydrogels were easily injected manually through a 23 G needle due to their shear-thinning properties. Additionally, 10 w/v% Cat-PBA-ApGltn hydrogels demonstrated a 2.3-fold increase in mucosal elevation (7.2 ± 0.4 mm) compared with a commercially available SIM (3.1 ± 0.7 mm). The 10 w/v% Cat-PBA-ApGltn hydrogel, when adhered to porcine gastric submucosa, exhibited a burst strength 7 times greater than the average human intragastric pressure. Furthermore, the Cat-PBA-ApGltn hydrogels demonstrated biodegradability without inducing severe inflammation upon implantation in rat subcutaneous tissue. These Cat-PBA-ApGltn hydrogels hold promise as multifunctional SIMs, boasting injectability, excellent elevation, adhesion capabilities, and biodegradability. • We present a new type of injectable hydrogel based on hydroxyl group-boronic acid interaction. • The hydrogel comprises catechol group- and phenylboronic acid-modified Alaska pollock gelatin (Cat-ApGltn and PBA-ApGltn). • A Cat-ApGltn/PBA-ApGltn mixed solution formed a hydrogel within 3 seconds. • Due to their shear-thinning properties, the resulting Cat-PBA-ApGltn hydrogels were easily injected through a 23G needle. • Cat-PBA-ApGltn injectable gel demonstrated better mucosal elevation compared with commercially available material. • Cat-PBA-ApGltn injectable gel demonstrated biodegradability without inducing severe inflammation in the rat's back. [ABSTRACT FROM AUTHOR]

The extracellular matrix (ECM), an integral component of all organs, is inherently tissue adhesive and plays a pivotal role in tissue regeneration and remodeling. However, man-made three-dimensional (3D) biomaterials that are designed to mimic ECMs do not intrinsically adhere to moisture-rich environments and often lack an open macroporous architecture required for facilitating cellularization and integration with the host tissue post-implantation. Furthermore, most of these constructs usually entail invasive surgeries and potentially a risk of infection. To address these challenges, we recently engineered biomimetic and macroporous cryogel scaffolds that are syringe injectable while exhibiting unique physical properties, including strong bioadhesive properties to tissues and organs. These biomimetic catechol-containing cryogels were prepared from naturally-derived polymers such as gelatin and hyaluronic acid and were functionalized with mussel-inspired dopamine (DOPA) to impart bioadhesive properties. We found that using glutathione as an antioxidant and incorporating DOPA into cryogels via a PEG spacer arm led to the highest tissue adhesion and improved physical properties overall, whereas DOPA-free cryogels were weakly tissue adhesive. As shown by qualitative and quantitative adhesion tests, DOPA-containing cryogels were able to adhere strongly to several animal tissues and organs such as the heart, small intestine, lung, kidney, and skin. Furthermore, these unoxidized (i.e., browning-free) and bioadhesive cryogels showed negligible cytotoxicity toward murine fibroblasts and prevented the ex vivo activation of primary bone marrow-derived dendritic cells. Finally, in vivo data suggested good tissue integration and a minimal host inflammatory response when subcutaneously injected in rats. Collectively, these minimally invasive, browning-free, and strongly bioadhesive mussel-inspired cryogels show great promise for various biomedical applications, potentially in wound healing, tissue engineering, and regenerative medicine.

Introduction and hypothesis: Articles are getting published on the use of tissue adhesive for vesicovaginal fistula. The objective is to carry out a systematic review on their effectiveness and complications. Methods: A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers screened abstracts and full-text and extracted data independently. A narrative synthesis was conducted given the heterogeneity of studies. Results: A total of 1032 studies were identified after searching the database, and 14 articles were included in this systematic review. Of the 84 women included, 12 (14.3%) presented failure or recurrence of their fistula tract. The mean time of follow-up was 11.46 months. The average size of the fistula was 1.05 (range 0.1 to 3.9) cm. Most fistulas (81) included were vesicovaginal fistulas. Nine papers reported the usage of fibrin glue in which only three (6.5%) women reported recurrence of the fistula in a delay of 2 weeks to 26 months. The other studies used cyanoacrylate (14 women) and autologous fibrin injection from the patients' blood (31 women). No significant complications were reported. Complications reported were urinary tract infections in 3 women (3.6%), hematuria in 2 women (2.4%), overactive bladder symptoms in 6 women (7.2%) and septic pelvic thrombosis in one woman (1.2%). Conclusions: Tissue adhesive appears to be a promising alternative for management of urogenital fistulas without reported important complications. [ABSTRACT FROM AUTHOR]

Simple Summary: The choice of suture material for skin closure can affect the final cosmetic outcome, the risk of wound infection and other complications in companion animals. We assessed two quickly and easily applicable skin closure methods, staples and tissue glue, and compared them to intradermal suturing in dogs, by using cosmetic, clinical, ultrasonographical and histological evaluation. The results indicate that glue had a less favorable outcome and that intradermal suture was the best, however not significantly better than staples, which are applied easier and in significantly less time. The study aimed to monitor the healing process in the canine skin following surgical incision and closure using staples or tissue glue and to compare them with the intradermal suture pattern. Surgically created skin incisions in 10 dogs were apposed with staples, tissue glue (n-butyl cyanoacrylate) and continuous intradermal pattern. The cosmetic appearance of the wounds was blindly evaluated on days 7, 14 and 28 and once a month until the end of the experiment, i.e., one year after the incision. Ultrasonographic and clinical evaluation was performed on days 0–10, 12, 14, 16, 18, 21, 24 and 28, once a week until the end of the 3rd month and once a month until the end of the experiment. Histopathological evaluation was performed on days 7, 14, 28, 180 and 365. The median time required for the performance of each technique differed significantly between techniques; stapling lasted 21 s, glue 2 min 16 s and intradermal 15 min 37 s. Cosmetic appearance with glue was statistically worse than staples and intradermal. The clinical appearance of intradermal was significantly better than glue and staples. No significant differences were found at histological evaluation; however, glue had the worst score throughout the experiment. The overall evaluation of the techniques showed that glue had the worst score compared to intradermal and staples, with the difference being statistically significant in the first postoperative week. Intradermal suture pattern is much better than glue application for skin closure in dogs, whilst is not significantly better than staples. Staples should be preferred when time is an important factor. [ABSTRACT FROM AUTHOR]

Developing a biocompatible and multifunctional adhesive hydrogel with injectability and self-healing ability for promoting wound healing is highly anticipated in various clinical applications. In this paper, we present a novel natural biopolymer-derived hydrogel based on the aldehyde-modified oxidized guar gum (OGG) and the carboxymethyl chitosan (CMCS) for efficiently improving wound healing with the encapsulation of vascular endothelial growth factor (VEGF). As the hydrogels are synthesized via the dynamically reversible Schiff base linkages, it is imparted with excellent self-healing ability and good shear thinning behavior, which make the hydrogel be easily and conveniently injected through a needle. Besides, the physiochemical properties, including porous structure, mechanical strength and swelling ratio of the hydrogel can be well controlled by regulating the concentrations of the OGG. Moreover, the hydrogel can attain strong adhesion to the tissues at physiological temperature based on the Schiff base between the aldehyde group on the hydrogel and the amino group on the tissue. Based on these features, we have demonstrated that the VEGF encapsulated hydrogel can adhere tightly to the defect tissue and improve wound repair in the rat model of defected skin by promoting cell proliferation, angiogenesis, and collagen secretion. These results indicate that the multifunctional hydrogel is with great scientific significance and broad clinical application prospects. [ABSTRACT FROM AUTHOR]

Adhesions are dense, fibrous bridges that adjoin tissue surfaces due to uncontrolled inflammation following postoperative mesothelial injury. A widely used adhesion barrier material in Seprafilm often fails to prevent transverse scar tissue deposition because of its poor mechanical properties, rapid degradation profile, and difficulty in precise application. Solution blow spinning (SBS), a polymer fiber deposition technique, allows for the placement of in situ tissue-conforming and tissue-adherent scaffolds with exceptional mechanical properties. While biodegradable polymers such as poly(lactic-co-glycolic acid) (PLGA) have desirable strength, they exhibit bulk biodegradation rates and inflammatory profiles that limit their use as adhesion barriers and result in poor tissue adhesion. Here, viscoelastic poly(lactide-co-caprolactone) (PLCL) is used for its pertinent biodegradation mechanism. Because it degrades via surface erosion, spray deposited PLCL fibers can dissolve new connections formed by inflamed tissue, allowing them to function as an effective, durable, and easy-to-apply adhesion barrier. Degradation kinetics are tuned to match adhesion formation through the design of PLCL blends comprised of highly adhesive "low"-molecular weight (LMW) constituents in a mechanically robust "high"-molecular weight (HMW) matrix. In vitro studies demonstrate that blending LMW PLCL (30% w/v) with HMW PLCL (70% w/v) yields an anti-fibrotic yet tissue-adhesive polymer sealant with a 14-day erosion rate countering adhesion formation. PLCL blends additionally exhibit improved wet tissue adhesion strength (~10 kPa) over a 14-day period versus previously explored biodegradable polymer compositions, such as PLGA. In a mouse cecal ligation model, select PLCL blends significantly reduce abdominal adhesions severity versus no treatment and Seprafilm-treated controls. [ABSTRACT FROM AUTHOR]

Introduction: Most postoperative rectal leakages can be successfully treated with minimally invasive procedures. Endoscopic vacuum therapy supported by tissue adhesives or cellular growth stimulants closes even chronic anastomotic fistulas. Aim: To present a treatment strategy for postoperative leakage of rectal anastomoses with noninvasive procedures. Material and methods: From 2015 to 2020, a group of 25 patients with postoperative rectal leakage was enrolled for minimally invasive treatment. The indication for the therapy was anastomotic dehiscence not exceeding 1/2 of the bowel circuit and the absence of severe septic complications. All patients were healed with endoluminal vacuum therapy (EVT) supported by hemostatic clips, tissue adhesives or cellular growth stimulants. Results: Complete drainage and reduction of leakage were achieved in 23 patients. The fistula was totally closed in 21 patients and in 2 of them it was restricted to a slit sinus. Two patients required revision surgery. Endoscopic treatment attempted within 7 days from leakage detection, as well as the size of the dehiscence less than 1/4 of the bowel circuit, increased the chance of full healing. In contrast, ultra low resection and neoadjuvant radiotherapy impaired the healing process, limiting the effectiveness of noninvasive therapy. Conclusions: The minimally invasive approach successfully restricts anastomotic leakage and reduces the diameter of dehiscence. Early initiation of the therapy and the size of rupture determine the final results. The use of complementary endoscopic solutions, such as clips or tissue adhesives, increases the effectiveness of the noninvasive strategy. [ABSTRACT FROM AUTHOR]

Introduction: Traditionally, sutures have been widely used to close intraoral wounds. Various alternatives have been developed amongst which newer tissue adhesives such as N-butyl-2-cyanoacrylate having accepted clinical properties are gaining popularity. The primary purpose of the present study is to evaluate the efficacy of N‑butyl‑2‑cyanoacrylate for intraoral attached mucosal wound closure following alveoloplasty. Materials and Methods: In this prospective split-mouth study, 25 patients requiring alveoloplasty in either maxillary or mandibular arch bilaterally with a total of 50 sites were divided into two equal groups, namely silk suture (Group 1) and cyanoacrylate (Group 2). Each patient was evaluated on the first, third, seventh, 14th and 21st post-operative days. Parameters evaluated were time taken to close incision and to achieve haemostasis, pain, oedema, post-operative wound healing, patient discomfort and possible complications. Results: Time taken to close incision, time taken to achieve haemostasis, post-operative pain and oedema were found to be less in Group 2. Wound healing too was found to be better in Group 2. There was one case of adhesive peel off on the first post‑operative day which was managed by reapplying the tissue adhesive. The incidence of wound dehiscence and wound infection was observed more in Group 1 on the third post-operative day. Suture breakage (16%) and adhesive dislodgement (8%) were reported on the seventh post‑operative day. Discussion: The use of cyanoacrylates’ inherent benefits, such as improved wound seal off in attached mucosa, quick polymerisation and bacteriostatic characteristics can be beneficial when performing minor oral surgical procedures on elderly, young and mentally challenged patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to investigate the histopathological effects of 2-octyl-cyanoacrylate used in facial plastic operations that are applied for the fixation of cartilage graft types and the graft stabilization effect. Methods: In the study, 16 New Zealand-type rabbits weighing between 2250 g and 2500 g, 3-4 months old, were used. Two groups were formed as the study and control groups. Those using 2-octyl-cyanoacrylate for cartilage graft fixation were defined as the study group. Those using suturing were defined as the control group. The operation was planned with cartilage grafts taken from the ears of each rabbit and the study group on the left of the sagittal suture and the control group on the right. Results: Acute inflammation findings were found in 19 (39.6%) of the study group and 6 (14%) of the control group. Acute inflammation levels were found to be higher in the study group than in the control group (P = .006). Mild inflammation was found in 20 (41.7%) of the study group, moderate inflammation in 7 (14.6%), and severe inflammation in 2 (4.2%). Mild inflammation was detected in 10 (23.3%) of the control group. Chronic inflammation levels were higher in the study group than in the control group. Foreign body reaction was detected in 28 (58.3%) of the study group and 14 (32.6%) of the control group. Foreign body reaction levels were found to be higher in the study group than in the control group. Conclusion: We think that the use of 2-octyl-cyanoacrylate in cartilage graft fixation is not correct as it may increase the risk of postoperative complications. [ABSTRACT FROM AUTHOR]

Study Objective: The peripheral intravenous catheter (IV) is the most common and painful invasive medical device in acute care settings. Our objective was to determine whether adding skin glue to secure IVs reduced catheter failure rate in children., Methods: We conducted a randomized controlled trial in a tertiary-care pediatric emergency department (ED). ED patients younger than 18 years old with an IV who were anticipated to be admitted to hospital were eligible for enrollment. Children were randomized to receive standard IV securement with cloth-bordered transparent polyurethane dressing (control) or application of cyanoacrylate glue at the catheter insertion site in addition to standard securement (intervention). Participants were followed until device removal due to failure or physician order. The primary outcome was IV failure before the intended treatment course was complete. Patients who were randomized with primary outcome data were included in the intention-to-treat analysis., Results: Of the 557 participants enrolled between December 2020 and April 2023, 278 (50%) and 279 (50%) were allocated to the glue and control groups, respectively. A total of 527 participants were included in the intention-to-treat analysis. Intravenous failure rates in the glue and control groups were 83 of 265 (31.3%) and 82 of 262 (31.3%), respectively. The odds of intravenous catheter failure were not different between groups (adjusted odds ratio 0.98; 95% confidence interval, 0.67 to 1.42). Time to device failure was similar between groups (hazard ratio 0.99; 95% confidence interval, 0.73 to 1.35)., Conclusions: This study found no benefit in using skin glue to secure IVs in the ED in children., (Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: It remains unclear whether the addition of non-selective beta-blockers (NSBB) provides further benefit after combined use of tissue adhesive and endoscopic variceal ligation for bleeding gastroesophageal varices., Objective: This is the first cohort study comparing the secondary prophylactic efficacy of adding NSBB to combined endoscopic treatment in cirrhotic patients with gastric varices (without inclusion of isolated gastric varices [IGVs], which are rare in patients with cirrhosis without splanchnic thrombosis)., Methods: We retrospectively analyzed two matched large cohorts of cirrhotic patients with gastric varices who received combined endoscopic treatment and were assigned to receive NSBB treatment or not as secondary prophylaxis. Further sub-analyses were performed. The 5-year overall survival and rebleeding rates were compared., Results: A total of 490 patients were enrolled, 130 of whom took NSBB. After propensity score matching (PSM), both groups comprised 130 patients. No significant difference between the NSBB and non-NSBB groups was observed regarding 5-year survival (87.40% vs. 83.64%, HR 0.62, 95% CI 0.33-1.17), while NSBB decreased the 5-year rebleeding rate from 45.7% to 30.64% (HR 0.57, 95% CI 0.39-0.82). The same was true when comparing the 2 groups after PSM. NSBB (HR 0.54, 95% CI 0.37-0.79) and splenectomy (HR 0.65, 95% CI 0.44-0.96) independently reduced rebleeding but did not affect survival. In patients without splenectomy, NSBB treatment improved survival (HR 0.43, 95% CI 0.21-0.89) and reduced rebleeding (HR 0.52, 95% CI 0.34-0.78)., Conclusion: We show for the first time that adding NSBB to combined endoscopic therapy significantly reduced recurrent variceal bleeding in cirrhotic patients but did not improve overall survival, except for patients without splenectomy. The addition of NSBB for patients receiving combined endoscopic treatment of gastroesophageal varices provides benefits but does not prolong overall survival., (© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)

Endoscopic submucosal dissection (ESD) is a widely used procedure for the treatment of early and precancerous gastrointestinal lesions and has become the standard treatment. In this procedure, the commonly used materials have a short retention time and a limited lifting capacity, which will prolong the duration of the ESD procedure. Furthermore, these liquids tend to diffuse after ESD surgery, failing to adequately protect the wound. Therefore, we designed and developed injectable hydrogels based on hyaluronic acid. A series of oxidized hyaluronic acid (OHA) and hydrazide hyaluronic acid (AHA) were synthesized, and 16 kinds of injectable hydrogels were fabricated to investigate the effects of molecular structures on the properties of the hydrogels. Among these, the O1A3 hydrogel exhibited a suitable injection performance, gelation time, and mechanical properties, along with good blood and cell compatibility in vitro . Subsequently, in a porcine model of the ESD procedure, the results demonstrated that the O1A3 hydrogel exhibited a good retention time and lifting performance while also significantly reducing the operation time from 1-2 h to ∼10 min. Furthermore, the adhesive property of the O1A3 hydrogel on small bleeding spots and wounds could be observed, which was beneficial in protecting the wound from the complex environment of the gastrointestinal tract. The present work of injectable hyaluronic acid-based hydrogels could be promising to improve the efficiency of ESD surgery.

Objective: The aim of this study is evaluating in vivo degradation of photocrosslinkable hyaluronic acid (HA)-based dural sealant (HA photosealant) using magnetic resonance imaging (MRI) and histopathological analysis to assess its biodegradability and effectiveness in preventing cerebrospinal fluid (CSF) leakage., Methods: HA photosealants were applied to the incised dura in a rat craniectomy and durotomy. The HA photosealant quickly seal the wound upon low-energy visible light exposure (405 nm, < 5 s, < 1 J/cm2). The degradation of HA photosealants was tracked through serial MRI scans at 1, 2, and 4 weeks post-application. The remaining area of HA photosealants on the dura was measured using image processing program for volumetric analysis. Additionally, histopathological analyses were performed to evaluate the biocompatibility and effectiveness of the dural repair., Results: The MRI and histopathological analyses showed that the HA photosealants achieved progressive degradation while successfully preventing CSF leakage without any adverse tissue reactions. The residual area of HA photosealants measured at 2 weeks ranged from 41.36% to 94.88%, with an average of 66.57%. At 4 weeks, a more distinct degradation pattern was observed compared to 2 weeks, showing a residual area of 10.28% to 56.12%. The HA photosealants maintained structural integrity until dural regeneration was complete., Conclusion: HA photosealant showed gradual degradation in vivo while maintaining mechanical strength until the dura was repaired for preventing CSF leakage without inflammation and toxicity. HA photosealant has great potentials for clinical application for dural repair with biodegradable properties and biocompatibility.

Background: Suture removal in infants and children operated for cleft lip is one of the cumbersome task for the surgeons because of missing compliance. For this reason, tissue adhesives have gained popularity among the surgeons as well as the patients over the past two decades for skin wound closure. Although there are several published reports of case series using tissue adhesive for skin closure during cleft lip repair, very few have established its advantage over conventional suture technique. Objective: The objective of this study was to compare the esthetic outcome of skin closure in cleft lip repair with suture technique and tissue adhesive, with respect to the quality of scar. Methodology: A retrospective observational study was conducted by analyzing the photographic records of patients who underwent surgical repair of cleft lip between January 2015 and December 2017. The patients were divided into two groups, one for whom skin closure performed with 5-0 monofilament polyamide suture and the other with tissue adhesive. Esthetic outcome in terms of the quality of scar was assessed using a 5 point Likert's scale by 10 independent observers who remained blind of the surgeon performed the surgery, to reduce the assessor-related bias to minimum. The statistical analysis was performed using the SPSS version 27.0 and the difference between mean scores of both the groups was calculated. Results: A total of 70 patients were included in this study with 35 in each group. The mean follow-up period of adhesive and the suture group was 13.97 and 17.85 months, respectively. Overall mean of the total scores of the entire patient population was 3.92 (+/‒0.38). For the tissue adhesive group, the mean score was 3.88 (+/‒0.367) and for the suture group, the mean score was 3.96 (+/‒0.401). The difference between mean scores of individual parameters of both the groups as well as the difference between the overall mean scores of both the groups was not found to be statistically significant. Conclusion: The use of tissue adhesive for the closure of skin during cleft lip repair is as good as sutures, with respect to esthetic outcome of scar. Hence, any of these two techniques can be used for this purpose depending on the surgeon's preference.

Pancreatic leakage is severe and life-threatening when happening pancreatitis or conducting pancreatectomy on patients, which easily induces bleeding, infection and even death. Commercial tissue adhesives cannot meet the demands for pancreatic leakage sealing due to the weak adhesiveness, potential toxicity and inability to degrade. Few reports have been feasibly paid attention to pancreas sealants due to the complicated conditions such as enzymatic microenvironments, mechanical dynamics and pre-infections. Herein, we prepared a rapid high-adhesion, antibacterial, biodegradable and injectable bioadhesive based on the FDA-approved polyethylene glycol to seal the pancreatic leakage for clinical translations and commercial applications. The tetra-armed poly(ethylene glycol) succinimidyl glutarate (PEG-SG), tetra-armed poly(ethylene glycol) amine (PEG-NH2) and tannic acid (TA) were integrated to rapidly form the adhesive hydrogel (gelling time < 5 seconds) for convenient operations, while this bioadhesive achieved tough tissue adhesion (∼ 30 kPa), robust antibacterial activity (∼ 95% efficiency) and biocompatibility, revealing the excellent performances for pancreatic wound closure. In the established pre-clinical pancreatectomy using Bama miniature pig model, the bioadhesive presented efficient outcomes on pancreatic leakage, and this indicated the promising feasibility of the bioadhesive for clinical trials and translations.

Objective: To analyze the effect of endoscopic titanium clips combined with tissue adhesive in treating GOV2 (Type 2 Gastroesophageal Varices) patients. Methods: One-hundred-and-seventeen GOV2 patients from June 2018 to June 2020 were divided into the observation group (n = 5 9) and control group (n = 5 8). The observation group was treated with endoscopic titanium clip combined with the tissue adhesive, while controls were treated with tissue adhesive alone. The clinical effects were compared at 1, 6, and 24 months. Results: Overall response rates of the observation group at 1, 6, and 24 months were 98.31%, 96.61%, and 91.53%, respectively, vs. 81.03%, 76.27%, and 55.17% in controls (P < 0. 0 5). The number, diameters, red color sign proportion of varicose veins, and incidence of bleeding in the observation group were lower than the control group, and the GQOL-74 (Generic Quality of Life Inventory 74) score was higher at 1, 6, and 24 months (P < 0. 0 5). There was no significant difference in complications, mortality at 6 and 24 months, and recurrence rate at 6 months (P > 0. 0 5); however, the recurrence rate at 24 months after treatment was lower in the observation group (6.78% vs. 20.69%) (P < 0. 0 5). Conclusions: Endoscopic titanium clips combined with tissue adhesive can be applied to treat GOV2 patients. [ABSTRACT FROM AUTHOR]

This study proposes a method to prepare autologous bio-based fibrin glue (FG) for use in ophthalmic surgery. FGs containing three fibrinogen concentrations and a thrombin concentrate were prepared using human blood from five donors (FG1: physiological fibrinogen concentration; FG2 and FG3: concentrated fibrinogen). The adhesion strength was tested, and the clinical safety and efficacy were studied in rabbit eyes in conjunctival surgery. A commercial FG was used as a control. From each donor, 2 mL of FG was prepared, containing 1 mL of 3.49 ± 0.78 (FG1), 17.74 ± 4.66 (FG2), or 47.46 ± 9.36 mg/mL (FG3) of fibrinogen and 1 mL of 2248.12 ± 604.20 UI/mL of thrombin. The average adhesion strength increased with the fibrinogen concentration, from 1.49 ± 0.39 kPa (FG1) to 3.14 ± 1.09 kPa (FG3). FG1 showed poor results when used for autograft adhesion. In contrast, the conjunctival autografts were successfully grafted using FG2 and FG3, revealing equivalent adhesion properties compared with commercial FG, but with less inflammation. In conclusion, FGs could be prepared on demand within minutes from small volumes of human blood, using a method that results in FGs which exhibit good adhesion capacity and are also safe and effective in a preclinical study. [ABSTRACT FROM AUTHOR]

Background: Previous meta-analyses examining skin closure methods for all surgical wounds have found suture to have significantly decreased rates of wound dehiscence compared to tissue adhesive; however, this was not specific to laparoscopic wounds alone. This study aims to determine the best method of skin closure in patients undergoing laparoscopic abdominopelvic surgery in order to minimize wound complications and pain, while maximize cosmesis, time and cost efficiency. Methods: A comprehensive search of EMBASE, Medline, Pubmed, and CENTRAL was conducted from inception to 1st May 2020 for randomized controlled trials (RCTs). Two independent reviewers extracted data and assessed risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to describe the quality of evidence. Meta-analysis was performed using a random-effects model. A summary relative risk (RR) was calculated for dichotomous outcomes where data could be pooled. (Prospero registration number: CRD42019122639). Results: The literature search identified 11,628 potentially eligible studies. Twelve RCTs met inclusion criteria. There was no difference in wound complications (infection, dehiscence, and drainage) between sutures, tissue adhesives nor adhesive papertape. Low-quality evidence found transcutaneous suture had lower rates of wound complications compared with subcuticular sutures (RR 0.22, 95%: CI 0.05–0.98). There was no evidence of a difference in patient-evaluated cosmesis, prolonged pain, or patient satisfaction between the three groups. Closure with tissue adhesive and adhesive papertape was faster and cheaper than suture. Conclusion: Tissue adhesive and adhesive papertape offer safe, cost and time-saving alternatives to closure of laparoscopic port sites compared to suture. [ABSTRACT FROM AUTHOR]

Whey proteins are mainly a group of small globular proteins. Their structures can be modified by physical, chemical, and other means to improve their functionality. The objectives of this study are to investigate the effect of radiation on protein–protein interaction, microstructure, and microbiological properties of whey protein–water solutions for a novel biomaterial tissue adhesive. Whey protein isolate solutions (10%, 27%, 30%, 33%, and 36% protein) were treated by different intensities (10–35 kGy) of gamma radiation. The protein solutions were analyzed for viscosity, turbidity, soluble nitrogen, total plate count, and yeast and mold counts. The interactions between whey proteins were also analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis and scanning electron microscopy. The viscosity of protein solution (27%, w/w) was increased by the treatment of gamma radiation and by the storage at 23 °C. The 35 kGy intensity irradiated soluble nitrogen (10%, w/w) was reduced to about half of the sample treated by 0 kGy gamma radiation. The effects of gamma radiation and storage time can significantly increase the viscosity of whey protein solutions (p < 0.05). Radiation treatment had significant impact on soluble nitrogen of whey protein solutions (p < 0.05). SDS-PAGE results show that the extent of oligomerization of whey protein isolate solutions are increased by the enhancement in gamma radiation intensity. Photographs of SEM also indicate that protein–protein interactions are induced by gamma radiation in the model system. Consistent with above results, the bonding strength increases by the addition of extent of gamma radiation and the concentration of glutaraldehyde. Our results revealed that the combination of gamma-irradiated whey protein isolate solutions and glutaraldehyde can be used as a novel biomaterial tissue adhesive. [ABSTRACT FROM AUTHOR]

Tough hydrogel adhesives that consist of a robust gel network and can strongly adhere to wet tissues have shown great promise as the next generation of bioadhesives. While a variety of chemistries can be utilized to construct the tough gel network, the covalent conjugation methods for tissue adhesion are still limited. Here we report, for the first time, the use of side product-free amine-thiolactone chemistry which initiates a double crosslinking adhesion mechanism to develop tough gel adhesives. Thiolactone groups can conjugate with tissue-surface amines via a ring-opening reaction. The resultant thiol end groups can be further crosslinked into disulfide linkages, enabling the formation of a robust and stable adhesion layer. The thiolactone-bearing tough hydrogel composed of methacrylate-modified gelatin, acrylic acid, and thiolacone acrylamide exhibited good biocompatibility and mechanical properties, and strong adhesion to various types of engineering solids and tissues. We also demonstrated its ability to function as a tissue sealant and drug depot. The novel adhesion mechanism will diversify future design of bioadhesives for hemostasis, drug delivery, tissue repair, and other applications. Tough hydrogel adhesives with excellent tissue-adhesive and mechanical properties have demonstrated tremendous promise for hemostasis, tissue repair, and drug delivery applications. However, the covalent chemistry for tissue adhesion has been limited, which narrows the choice of materials for the design of bioadhesives and may pose a safety concern. Here, for the first time, we report the use of side product-free amine-thiolactone chemistry, which involves a double crosslinking adhesion mechanism, for developing tough hydrogel adhesives. We demonstrate that thiolactone-bearing tough hydrogels exhibit favorable biocompatibility and mechanical properties, and superior adhesion to both engineering solids and tissues. Our new adhesion technology will greatly facilitate future development of advanced bioadhesives for numerous biomedical applications. [Display omitted] [ABSTRACT FROM AUTHOR]

Achieving fast and secure wound closure without ocular foreign body sensation is highly desired in ophthalmologic surgery. Sutureless approaches using tissue adhesives are gaining popularity, but their practical use is limited by the difficulty in controlling adhesion time and satisfying safety standards without compromising adhesive performance. Herein, we report user‐demand hydrogel‐forming ocular glues based on multilength photo‐crosslinkable hyaluronic acid (HA), achieving firm tissue adhesion under wet and dynamic conditions and possessing cornea‐like optical transparency. The HA‐based photocurable glue (HA photoglue) quickly seals wounds upon nontoxic low‐energy light exposure (320–500 nm, < 5 s, < 1 J cm−2), and its mechanical and adhesive properties are improved by introducing short and long crosslinkable moieties into HA through one‐step synthesis, forming multilength networks. Furthermore, the HA photoglue provides stable sealing in wet environments like ocular mucous surface, a clear vision with a light transmittance of more than 95% over the entire visible range, and a lubricating surface with minimal ocular sensation (generating less than 10% frictional force than suture groups). In a rabbit corneal incision model, the HA photoglue showed improved wound healing efficacy based on histological evaluation compared to control groups. [ABSTRACT FROM AUTHOR]

Hydrogel-based bioadhesives have emerged as alternatives for sutureless wound closure, since they can mimic the composition and physicochemical properties of the extracellular matrix. However, they are often associated with poor mechanical properties, low adhesion to native tissues, and lack of antimicrobial properties. Herein, a new sprayable, elastic, and biocompatible composite hydrogel, with broad-spectrum antimicrobial activity, for the treatment of chronic wounds is reported. The composite hydrogels were engineered using two ECM-derived biopolymers, gelatin methacryloyl (GelMA) and methacryloyl-substituted recombinant human tropoelastin (MeTro). MeTro/GelMA composite hydrogel adhesives were formed via visible light-induced crosslinking. Additionally, the antimicrobial peptide Tet213 was conjugated to the hydrogels, instilling antimicrobial activity against Gram (+) and (-) bacteria. The physical properties (e.g. porosity, degradability, swellability, mechanical, and adhesive properties) of the engineered hydrogel could be fine-tuned by varying the ratio of MeTro/GelMA and the final polymer concentration. The hydrogels supported in vitro mammalian cellular growth in both two-dimensional and three dimensional cultures. The subcutaneous implantation of the hydrogels in rats confirmed their biocompatibility and biodegradation in vivo. The engineered MeTro/GelMA-Tet213 hydrogels can be used for sutureless wound closure strategies to prevent infection and promote healing of chronic wounds.

Background: The labial frenulum may be associated with traction on the marginal gingiva of the incisors with resulting gingival recession, a condition known as “pull syndrome”. In this case, performing a frenulectomy at least 6 months before root covering surgery is necessary. Recently, tissue adhesives have been studied as a good alternative to conventional sutures. Methods: A 34-year-old female affected by pull syndrome of the central lower incisors underwent frenulectomy, and an n-hexyl-cyanoacrylate tissue adhesive was used to ensure wound closure. Results: The patient was instructed in hygiene maneuvers and rinsed with 0.12% chlorhexidine-based mouthwash for 15 days. The glue was partially removed at 7 days, and for the remaining, natural disposal time was expected. The wound healing process was complete after 15 days with minimal postoperative discomfort. Conclusion: This n-hexyl-cyanoacrylate surgical glue could be proposed as a viable alternative to conventional sutures during surgical procedures involving wide flaps with the impossibility of first-intention healing. Moreover, it could be indicated to reduce operative time and patients’ discomfort, even if these hypotheses should be confirmed by future clinical studies.

The development of tissue adhesives with good biocompatibility and potent antimicrobial properties is crucial for addressing the high incidence of surgical site infections in emergency and clinical settings. Herein, an injectable hydrogel adhesive composed of chitosan biguanidine (CSG), oxidized dextran (ODex) and tannin (TA) was synthesized primarily through Schiff-base reactions, hydrogen bonding, and electrostatic interactions. TA was introduced into the CSG/ODex hydrogel to prepare a physicochemically double cross-linked hydrogel. The hydrogel formulation incorporating 2 wt% TA (CSG/ODex-TA2) exhibited rapid gelation, moderate mechanical properties, good tissue adhesion, and sustained release behavior of TA. Both in vitro and in vivo studies demonstrated that CSG/ODex-TA2 showed significantly enhanced adhesion and antibacterial effectiveness compared to the CSG/ODex hydrogel and commercial fibrin glue. Leveraging the positive charge of CSG, the CSG/ODex-TA2 hydrogel demonstrated a strong contact antibacterial effect, while the sustained release of TA provided diffusion antibacterial capabilities. By integrating contact and diffusion antibacterial mechanisms into the hydrogel, a promising approach was developed to boost antibacterial efficiency and accelerate the healing of wounds infected with methicillin-resistant Staphylococcus aureus (MRSA). The CSG/ODex-TA2 hydrogel has excellent biocompatibility, hemostatic properties, and antibacterial capabilities, making it a promising candidate for improving in vivo wound care and combating bacterial infections. [Display omitted] [ABSTRACT FROM AUTHOR]

In situ forming hydrogels with strong adhesive strength and antibacterial activity are of great interest to serve as tissue adhesive in fields like wound dressing and mass hemorrhage. In this study, hybrid hydrogel (GOHA) based on gelatin and oxidized hyaluronic acid was developed and endowed with excellent mechanical strength and tissue adhesion. According to our results, GOHA hydrogel exhibits a fast gelation time of around 60 s, robust compression strength of 223.43 ± 24.28 kPa, and strong adhesion of 14.33 ± 0.78 kPa to porcine skin, which is much higher than that of commercial fibrin glue (around 1.00 kPa). Meanwhile, through the loading of levofloxacin, obvious antibacterial activity can be obtained for wider applications. Notably, it would not compromise the hemocompatibility and cytocompatibility in vitro. In summary, this kind of hybrid hydrogel shows great potential as tissue adhesive in biomedical fields. [ABSTRACT FROM AUTHOR]

Postoperative adhesion is a serious and frequent complication, but there is currently no reliable anti-adhesive barrier available due to low tissue adhesiveness, undesirable chemical reactions, and poor operability. To overcome these problems, we report a single-syringe hotmelt tissue adhesive that dissolves upon warming over 40 °C and coheres at 37 °C as a postoperative barrier. Tendon-derived gelatin was conjugated with the ureidopyrimidinone unit to supramolecularly control the sol-gel transition behavior. This functionalization improved bulk mechanical strength, tissue-adhesive properties, and stability under physiological conditions through the augmentation of intermolecular hydrogen bonding by ureidopyrimidinone unit. This biocompatible adhesive prevented postoperative adhesion between cecum and abdominal wall in adhesion models of rats. This hotmelt tissue adhesive has enormous potential to prevent postoperative complications and may contribute to minimally invasive surgery. There is a strong need to develop medical tissue adhesives with high biocompatibility, tissue adhesiveness, and operatability to prevent postoperative complications. In this report, single syringe, hotmelt-type tissue adhesive was developed by controlling sol-gel transition behavior of gelatin through supramolecular approach. The functionalization of gelatin with quadruple hydrogen bonding improved key features necessary for anti-adhesive barrier including bulk mechanical strength, tissue adhesive property, stability under physiological conditions, and anti-adhesive property. The hotmelt tissue adhesive can be used for a sealant, hemostatic reagent, and wound dressing to prevent postoperative complications including delayed bleeding, perforation, and inflammation and contribute to minimally invasive surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to analyze the biomechanical characteristics of a novel cyanoacrylate-based tissue adhesive (CTA) for soft-tissue closure of the (non-) tooth-bearing alveolar process and around dental implants. Materials and methods: Halves of porcine mandibles (n = 21) were randomly divided into three experimental intraoral wound closure groups (A–C) with three different mucoperiosteal flap types (F1–3, n = 7 each): F1, crestal incision between the last incisor and the canine with a mesial and distal vestibular relief; F2, crestal double-T-shaped incision and dental implant placement between the canine and the first premolar; and F3, trapezoidal incision on the second premolar. F1–3 were respectively closed using (A) monofil non-resorbable sutures, (B) CTA, and (C) a combination of both. Tensile strength (TS) and elasticity (E) measurements were performed for biomechanical analysis. Results: In F1, CTA showed a significantly reduced TS compared to A (p < 0.001) and C (p < 0.01). In F2, an increased TS of C compared to A (p < 0.01) and B (p < 0.001) was found. Here, E was significantly increased in C compared to B (p < 0.02). In F3, TS was significantly decreased in B compared to A (p < 0.01) and C (p < 0.001). The E in group C was significantly increased compared to B (p < 0.01). Conclusions: Different biomechanical characteristics between CTA and sutures were found. CTA could be a possible alternative to sutures for intraoral wound closure in special conditions. Clinical relevance: A combination of both, suturing and CTA, could be a promising option in critical soft-tissue wounds requiring high functional stability and elasticity. [ABSTRACT FROM AUTHOR]

Polysaccharides are extracted from Ornithogalum by maceration using different ultrasound (US) treatment times (0%US, 50%US, 100%US), and under optimized extraction conditions (OP%US). The total carbohydrates content (TCC) and proteins content of the extracts were determined. Data show that the extraction parameters significantly influence the extracts composition. Rheological measurements allowed determining the liquid, intermediate and gel states of the extract's solutions. The adhesion strength of the solutions was evaluated on paper and polylactide (PLA) substrates to evaluate their potential as environmentally friendly adhesive. OP%US presents the highest adhesion strength (1418.3 kPa) on paper, and is further tested on pork skin substrates. The adhesion strength is higher on skin/paper (870 kPa) than on skin/skin (411 kPa) substrate due to the capillary force of paper which allows penetration of adhesive into the micropores of paper. The correlation between rheological properties and adhesion strength indicates that the adhesion strength strongly depends on the state of adhesives and the substrate type. SEM analyses show that higher adhesion strength (intermediate and gel states) involves both cohesive and adhesive failure, whereas only adhesive failure is observed in liquid state on PLA substrates. Therefore, these polysaccharides extracts could be very promising as tissue adhesive in medical applications. [ABSTRACT FROM AUTHOR]

In the past decade, cyanoacrylate glue has been progressively introduced into the clinical practice of venous access devices used for different purposes. Glue has been used to increase device stabilisation (to reduce the risk of catheter dislodgement), to seal the exit site (to both reduce local bleeding and decrease the risk of bacterial contamination) and to close skin incisions required for the insertion of tunnelled catheters or totally implanted venous ports. For many of these purposes, the efficacy and cost-effectiveness of cyanoacrylate glue has been demonstrated, while some indications are still controversial. This article reports on 10 years of clinical experience with cyanoacrylate glue in a large university hospital, and provides a narrative review of the scientific evidence on the benefits of glue in venous access that has been accumulating over the past decade. [ABSTRACT FROM AUTHOR]

Abstract Background One of the most serious complications of extracorporeal membrane oxygenation (ECMO) therapy is ECMO cannulae infection, which can occur at quadruple the rate of central venous catheter infections, and significantly impact morbidity and paediatric mortality. The objective of this in vitro observational study was to assess antimicrobial properties of two n-butyl-2-octyl cyanoacrylate tissue adhesive (TA) formulations for bacterial inhibition at peripheral ECMO cannulae insertion sites. Methods Antimicrobial properties were assessed using modified agar disk-diffusion (n = 3) and simulated agar cannulation insertion site (n = 20) models. Both assays used Staphylococcus epidermidis which was seeded at the edge of the TA or dressing. Microorganism inhibition was visually inspected and evidenced by the presence or absence of a TA bacterial inhibition zone at 24 and 72 h. Results Both TAs provided effective barriers to bacterial migration under cannula dressings, to cannula insertion sites and down cannula tunnels. Additionally, both TAs demonstrated distinct zones of inhibition produced when left to polymerise onto agar plates seeded with S. epidermidis. Conclusions N-Butyl-2-octyl cyanoacrylate TA appears to inhibit bacterial growth and migration of S. epidermidis. Application of TA to cannulae insertion sites may therefore be a potential bedside strategy for infection prevention in ECMO cannulae, but requires further testing before being used clinically for this purpose.

Abstract Background The increase in the incidence of pulmonary nodules has made computed tomography (CT) screening a requirement for diagnosis and treatment. Small pulmonary nodule detection during video‐assisted thoracoscopic surgery (VATS) or thoracotomy is frequently challenging; however, accurate and efficient localization of nodules is critical for precise resection. Herein, we introduce and evaluate the feasibility and safety of a novel technique for preoperative pulmonary nodule localization. Methods From March 2018 to December 2019, 140 patients with 153 pulmonary nodules measuring

Abstract Background Extracorporeal membrane oxygenation (ECMO), an invasive mechanical therapy, provides cardio-respiratory support to critically ill patients when maximal conventional support has failed. ECMO is delivered via large-bore cannulae which must be effectively secured to avoid complications including cannula migration, dislodgement and accidental decannulation. Growing evidence suggests tissue adhesive (TA) may be a practical and safe method to secure vascular access devices, but little evidence exists pertaining to securement of ECMO cannulae. The aim of this study was to determine the safety and efficacy of two TA formulations (2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate) for use in peripherally inserted ECMO cannula securement, and compare TA securement to ‘standard’ securement methods. Methods This in vitro project assessed: (1) the tensile strength and flexibility of TA formulations compared to ‘standard’ ECMO cannula securement using a porcine skin model, and (2) the chemical resistance of the polyurethane ECMO cannulae to TA. An Instron 5567 Universal Testing System was used for strength testing in both experiments. Results Securement with sutures and n-butyl-2-octyl cyanoacrylate both significantly increased the force required to dislodge the cannula compared to a transparent polyurethane dressing (p = 0.006 and p = 0.003, respectively) and 2-octyl cyanoacrylate (p = 0.023 and p = 0.013, respectively). Suture securement provided increased flexibility compared to TA securement (p

In this work, fungal mushroom-derived carboxymethyl chitosan-polydopamine hydrogels (FCMCS-PDA) with multifunctionality (tissue adhesive, hemostasis, self-healing, and antibacterial properties) were developed for wound dressing applications. The hydrogel is obtained through dynamic Schiff base cross-linking and hydrogen bonds between FCMCS-PDA and covalently cross-linked polyacrylamide (PAM) networks. The FCMCS-PDA-PAM hydrogels have a good swelling ratio, biodegradable properties, excellent mechanical properties, and a highly interconnected porous structure with PDA microfibrils. Interestingly, the PDA microfibrils were formed along with FCMCS fibers in the hydrogel networks, which has a high impact on the biological performance of hydrogels. The maximum adhesion strength of the hydrogel to porcine skin was achieved at about 29.6 ± 2.9 kPa. The hydrogel had good self-healing and recoverable properties. The PDA-containing hydrogels show good antibacterial properties on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria. Moreover, the adhesive hydrogels depicted good viability and attachment of skin fibroblasts and keratinocyte cells. Importantly, FCMCS and PDA combined resulted in fast blood coagulation within 60 s. Hence, the adhesive hydrogel with multifunctionality has excellent potential as a wound dressing material for infected wounds. [ABSTRACT FROM AUTHOR]

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Localization of tumors during laparoscopic surgery is generally performed by locally injecting India ink into the submucosal layer of the gastrointestinal tract using endoscopy. However, the location of the tumor is obscured because of the black-stained surgical field and the blurring caused by India ink. To solve this problem, in this study, we developed a tissue-adhesive porphyrin with polycations consisting of quaternary ammonium salt groups. To evaluate the ability of tissue-adhesive porphyrin in vivo, low-molecular-weight hematoporphyrin and tissue-adhesive porphyrin were injected into the anterior wall of the exposed stomach in rats. Local injection of low-molecular-weight hematoporphyrin into the anterior wall of the stomach was not visible even after 1 day because of its rapid diffusion. In contrast, the red fluorescence of the tissue-adhesive porphyrin was visible even after 7 days due to the electrostatic interactions between the positively-charged moieties of the polycation in the tissue-adhesive porphyrin and the negatively-charged molecules in the tissue. In addition, intraperitoneal injection of tissue-adhesive porphyrin in rats did not cause adverse effects such as weight loss, hepatic or renal dysfunction, or organ adhesion in the abdominal cavity. These results indicate that tissue-adhesive porphyrin is a promising fluorescent tissue-marking agent. [ABSTRACT FROM AUTHOR]

Objective: To compare scar quality associated with metal staples or tissue adhesive for closure of the skin incision at repeat cesarean delivery (CD).Study Design: Single-center Randomized Controlled Trial (ClinicalTrial.gov ID: NCT04302597), including women undergoing repeat CD using metal staples or 2- octylcyanoacrylate for closure of the skin incision. Patients were randomized to have skin closure following CD with either staples or tissue adhesive. Scar quality was evaluated 2 and 6 months postoperatively using the Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale (POSAS), and a visual analog scale.Results: Of the 66 patients who were recruited, 55 successfully completed the study. The duration of surgery was comparable in both groups. A partial wound dehiscence occurred in one patient who had tissue adhesive closure. No difference in subjective and objective scar cosmesis rating was found between tissue adhesive and staples groups at either 2 months or 6 months.Conclusions: In women undergoing CD, stapled wounds and those closed with tissue adhesive result in equivalent cosmetic appearance of the scar. [ABSTRACT FROM AUTHOR]

Background: Tissue adhesives (TAs) represent a promising alternative or augmentation method to conventional tissue repair techniques. In sports medicine, TA use has been suggested and implemented in the treatment of meniscal tears. The aim of this review was to present and discuss the current evidence and base of knowledge regarding the clinical usage of TAs for meniscal repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search was performed using the PubMed, Embase, and Cochrane Library databases for studies reporting on clinical outcomes of TA usage for meniscal repair in humans in the English language published before January 2020. Results: Ten studies were eligible for review and included 352 meniscal repairs: 94 (27%) were TA-based repairs and 258 (73%) were combined suture and TA repairs. Concomitant anterior cruciate ligament reconstruction was performed in 224 repairs (64%). All included studies utilized fibrin-based TA. Of the 10 studies, 9 were evidence level 4 (case series), and 8 reported on a cohort of ≤40 meniscal repairs. Rates of meniscal healing were evaluated in 9 of 10 studies, with repair failure seen in 39 repairs (11%). Conclusion: The use of TAs, specifically fibrin-based TAs, for meniscal repair shows good results as either an augmentation or primary repair of various configurations of meniscal tears. However, this review reveals an absence of comparative high-quality evidence supporting the routine use of TAs for meniscal repair and emphasizes the lack of an ideal TA designed for that purpose. Further high-quality research, basic science and clinical, will facilitate the development of new materials and enable testing their suitability for use in meniscal repair. [ABSTRACT FROM AUTHOR]

Spontaneously formed hydrogels are attracting increasing interest as injectable or wound dressing materials because they do not require additional reactions or toxic crosslinking reagents. Highly valuable properties such as low viscosity before external application, adequate filmogenic capacity, rapid gelation and tissue adhesion are required in order to use them for those therapeutic applications. In addition, biocompatibility and biodegradability are also mandatory. Accordingly, biopolymers, such as hyaluronic acid (HA) and chitosan (CHI), that have shown great potential for wound healing applications are excellent candidates due to their unique physiochemical and biological properties, such as moisturizing and antimicrobial ability, respectively. In this study, both biopolymers were modified by covalent anchoring of catechol groups, and the obtained hydrogels were characterized by studying, in particular, their tissue adhesiveness and film forming capacity for potential skin wound healing applications. Tissue adhesiveness was related to o-quinone formation over time and monitored by visible spectroscopy. Consequently, an opposite effect was observed for both polysaccharides. As gelation advances for HA-CA, it becomes more adhesive, while competitive reactions of quinone in CHI-CA slow down tissue adhesiveness and induce a detriment of the filmogenic properties. [ABSTRACT FROM AUTHOR]

Xiangpeng Kong,1 Minzhi Yang,1,2 Renwen Guo,1 Jiying Chen,1 Wei Chai,1 Yan Wang1 1Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People’s Republic of China ; 2Nankai University, Tianjin, People’s Republic of ChinaCorrespondence: Wei Chai; Yan Wang Email chaiweiguanjie@sina.com; wangyanguanjie@sina.comBackground: The study focusing on the tissue adhesive in total knee arthroplasty (TKA) was rare. This study aimed to evaluate the clinical outcomes and economic costs of tissue adhesive when acting as the adjunct to standard incision closure in TKA.Patients and Methods: From September 2019 to November 2019, we prospectively enrolled the consecutive patients who underwent simultaneous bilateral TKA in our institute. The allocation using the tissue adhesive was done after the subcuticular suture in right knee first and another method was applied in the left knee automatically. The patients’ demographics, length of stay (LOS), times of dressing changes and incision-related cost, range of motion (ROM), incision-related complications and incision evaluation scores were recorded.Results: Thirty-two patients were enrolled in this study and followed at two months after surgery. In the knees of tissue adhesive, the times of dressing change and patient scar assessment scores (PSAS) were significantly less than those standard skin closure (p=0.000; p=0.003). Although there were no significant differences of the delayed discharge, incision-related cost, ROM, incision-related complications and Vancouver scar score (VSS) between two groups, 65.6% (21/32) patients preferred the tissue adhesive and only 15.6% (5/32) patients preferred the standard incision closure.Conclusion: Tissue adhesive could effectively reduce postoperative wound drainage and improve patients’ satisfaction rate with no difference in medical costs and ROM in TKA. The application of tissue adhesive and subcuticular sutures might be one safe and convenient method of skin closure in TKA.Chinese Clinical Trial Registry: ChiCTR1900025730; Registered 6 September 2019.Keywords: total knee arthroplasty, tissue adhesive, incision closure, dressing change

Abstract Background Cyanoacrylate alone or in combination with other interventions, can be used to achieve variable rates of success in preventing rebleeding. Our study aims to assess the pooled risk of gastric and esophageal varices rebleeding after an initial treatment with cyanoacrylate alone and/or in combination with other treatments, by a systematic review of the literature and pooled analysis. Methods PubMed, EMBASE, SCOPUS, and the Cochrane library were searched for studies that reported the risk of rebleeding during the follow-up period after treatment of gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. Standard error, upper and lower confidence intervals at 95% confidence interval for the risk were obtained using STATA Version 15 which was also used to generate forest plots for pooled analysis. The random or fixed effect model was applied depending on the heterogeneity (I2). Results A total of 39 studies were found to report treatment of either gastric or esophageal varices with either cyanoacrylate alone or in combination with other treatments. When gastric varices are treated with cyanoacrylate alone, the risk of rebleeding during the follow-up period is 0.15(Confidence Interval: 0.11–0.18). When combined with lipiodol; polidocanol or sclerotherapy the rebleeding risks are 0.13 (CI:0.03–0.22), 0.10(CI:0.02–0.19), and 0.10(CI:0.05–0.18), respectively. When combined with percutaneous transhepatic variceal embolization; percutaneous transhepatic variceal embolization; endoscopic ultrasound guided coils; or with ethanolamine, the rebleeding risk are 0.10(CI:0.03–0.17), 0.10(CI:0.03–0.17), 0.07(CI:0.03–0.11) and 0.08(CI:0.02–0.14), respectively. When esophageal varices are treated with cyanoacrylate alone, the risk of rebleeding is 0.29(CI:0.11–0.47). When combined with percutaneous transhepatic variceal embolization; sclerotherapy; or band ligation, the risks of rebleeding are 0.16(CI:0.10–0.22), 0.12(CI:0.04–0.20) and 0.10(CI:0.04–0.24), respectively. When combined with a transjugular intrahepatic portosystemic shunt; or ethanolamine, the risks of rebleeding are 0.06(CI: − 0.01-0.12) and 0.02 (CI: − 0.02-0.05), respectively. Conclusion In treating both gastric and esophageal varices, cyanoacrylate produces better results in terms of lower risk of rebleeding when combined with other treatments than when used alone. The combination of cyanoacrylate with ethanolamine or with endoscopic ultrasound guided coils produces the lowest risk of rebleeding in esophageal and gastric varices, respectively. We call upon randomized trials to test these hypotheses.

Abstract Background We aimed to present our experience of adopting tissue adhesive as adjunct to standard wound closure in total hip arthroplasty (THA) and evaluate its performance. Methods From September 2019 to November 2019, we prospectively enrolled consecutive patients who underwent simultaneous bilateral THA in this randomized and controlled study. Standard wound closure was applied on one side of hip while additional tissue adhesive was applied on the other side at random. We collected and analyzed patients’ information, including age, gender, body mass index (BMI), diagnosis, postoperative length of stay (LOS), dressing changes, wound evaluation scores, wound-related cost and complications. Results Thirty patients with simultaneous bilateral THA were enrolled in this study. During the hospital stay, the times of dressing change in hips with tissue adhesive was significantly less than that in the other hips (p = 0.000). However, the wound-related cost in hips with tissue adhesive was significantly higher (p = 0.000). According to patients’ feedback at one-month follow-up, wound evaluation of hips with tissue adhesive was significantly better than the other hips (p = 0.004). Seventeen patients preferred tissue adhesive and only five patients preferred standard wound closure. Conclusions Tissue adhesive could significantly reduce wound drainage and increase patients’ satisfaction, which can be an ideal adjunct to standard wound closure in enhanced-recovery THA. Trial registration Chinese Clinical Trial Registry; ChiCTR1900025730 ; Registered 6 September 2019.

This study aimed to develop hydrogels for tissue adhesion that are biocompatible, antioxidant, and antibacterial. We achieved this by using tannic acid (TA) and fungal-derived carboxymethyl chitosan (FCMCS) incorporated in a polyacrylamide (PAM) network using free-radical polymerization. The concentration of TA greatly influenced the physicochemical and biological properties of the hydrogels. Scanning electron microscopy showed that the nanoporous structure of the FCMCS hydrogel was retained with the addition of TA, resulting in a nanoporous surface structure. Equilibrium-swelling experiments revealed that increasing the concentration of TA significantly improved water uptake capacity. Antioxidant radical-scavenging assays and porcine skin adhesion tests confirmed the excellent adhesive properties of the hydrogels, with adhesion strengths of up to 39.8 ± 1.2 kPa for 1.0TA-FCMCS due to the presence of abundant phenolic groups on TA. The hydrogels were also found to be biocompatible with skin fibroblast cells. Furthermore, the presence of TA significantly enhanced the antibacterial properties of the hydrogels against both Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria. Therefore, the developed drug-free antibacterial and tissue-adhesive hydrogels can potentially be used as wound dressings for infected wounds.

Competing Interests: Conflicts of interest None disclosed.

Purpose: To assess the effects of different curing stages of 4-META/MMA-TBB resin on osteoblasts and gingival keratinocytes. Materials and Methods: The MC3T3-E1 murine pre-osteoblastic cell line and GE-1 murine gingival epithelial cell line were cultured with mixtures of Super-Bond C&B at different curing stages, and the cell viability was assessed. The alkaline phosphatase (ALP) activity of the MC3T3-E1 cells was also assessed. Results: The majority of the MC3T3-E1 cells died and showed no ALP activity when cultured with 4-META/MMA-TBB resin during the initial curing phase (1 min of curing). A later curing phase of the 4-META/MMA-TBB resin (7 min of curing) showed cytotoxicity at day 1, but the toxic effect was temporary and the proliferative capacity and ALP activity in the cells were similar to control cells at day 7. Completely cured 4-META/MMA-TBB resin (after 1 or 12 h of curing) did not affect the cell viability or ALP activity of the MC3T3-E1 cells. In contrast, 4-META/MMA-TBB resin showed no effect on the GE-1 cells at any stage of curing. Conclusion: Although 4-META/MMA-TBB resin during the initial curing phase shows toxic effects on MC3T3-E1 cells, that cytotoxicity is minimal at later curing phases. In contrast, neither the uncured nor cured resins affected the GE-1 cells. [ABSTRACT FROM AUTHOR]

Extracellular matrix (ECM) is playing a critical role which is component of mammalian tissue that provide structural support to cells. In addition, ECM act as a local depot for growth factors that control cell phenotype and differentiation. In this regard, scaffold that mimicking the ECM structure is important to growth or wound healing process. Gelatin is natural polymer and derived from collagen which is a major component of ECM. Using gelatin as an ECM mimicking structure has advantage of providing three-dimensional growth or supporting to regulate the cell behavior, proliferation, migration, cell survival, and differentiation. In this study, we developed enzyme-mediated crosslinking gelatin-based hydrogels with robust mechanical property to mimicking ECM and effectively attach to the surrounding tissue with high adhesive property. The effect of different concentration of graphene oxide (GO) on the physico-chemical properties of gelatin hydrogels were investigated, particularly tissue adhesion strength. In vitro proteolytic degradation behavior and human dermal fibroblast proliferation study confirmed the hydrogels were biodegradable and promote cell proliferation. Overall, we suggest that GO incorporated gelatin hydrogels with additional interfacial interactions, showing a promising potential as an injectable tissue adhesive. • We fabricated ECM mimicking gelatin hydrogel by HRP/H 2 O 2 catalized crosslinking reaction. • We confirmed that addition of GO into hydrogel increasing mechanical properties. • Fabricated hydrogel have biodegradability and excellent biocompatibility. • This hydrogel can promote fibroblast proliferation. • The potential use of biomedical application. [ABSTRACT FROM AUTHOR]