Endoscopic band ligation or endoscopic tissue adhesive injection in the treatment of gastric varices:Which is better?

The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies.Moreover,the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.

Efficacy of Cyanoacrylate Tissue Adhesive Application in the Management of Corneal Perforations at Preah Ang Duong Hospital in Cambodia

Purpose: The study was to evaluate the efficacy of cyanoacrylate tissue adhesive (CTA) application in corneal perforations. Method: This was a prospective study on 20 patients of corneal perforations who received cyanoacrylate tissue adhesive application as treatment between March 2021 and March 2022 at Preah Ang Duong Hospital. The primary outcome measure was success rate of CTA application, while the secondary outcome was to measure postoperative best-corrected visual acuity (BCVA) and ocular complications. Results: The mean age of patients was 44.15 ± 16.05 years old and 7 (35%) were female. Causes of perforation were microbial infection in 12 patients (60%), trauma in 5 patients (25%), and sterile melting in 3 patients (15%). The perforation of size smaller than 1.5 mm was in 8 patients (40%) while 12 patients (60%) had perforated size between 1.5 mm to 3 mm. The perforation was 60% (12 patients) central, 25% (5 patients) paracentral, and 15% (3 patients) peripherally. Out of 20 patients, 5 patients (25%) received CTA application more than 1 time. The mean glue retention was 57.60 ± 31.84 days. Success rate of glue application (defined as intact globe without surgical intervention regardless of number of CTA applications) was 85%. At the last visit, 7 patients (35%) had BCVA of 6/120 or better. Common complications were uveitis (45%), ocular hypertension (30%), cataract (25%) and neovascularization (20%). No serious complications were found. Conclusion: Cyanoacrylate tissue adhesive is an effective treatment option in sealing corneal perforations with no serious complications. .

Bioactive citrate-based polyurethane tissue adhesive for fast sealing and promoted wound healing

As a superior alternative to sutures,tissue adhesives have been developed significantly in recent years.However,existing tissue adhesives struggle to form fast and stable adhesion between tissue interfaces,bond weakly in wet environments and lack bioactivity.In this study,a degradable and bioactive citrate-based polyurethane adhesive is constructed to achieve rapid and strong tissue adhesion.The hydrophobic layer was created with polycaprolactone to overcome the bonding failure between tissue and adhesion layer in wet environments,which can effectively improve the wet bonding strength.This citrate-based polyurethane adhesive provides rapid,non-invasive,liquid-tight and seamless closure of skin incisions,overcoming the limitations of sutures and commercial tissue adhesives.In addition,it exhibits biocompatibility,biodegradability and hemostatic properties.The degradation product citrate could promote the process of angiogenesis and accelerate wound healing.This study provides a novel approach to the development of a fast-adhering wet tissue adhesive and provides a valuable contribution to the development of polyurethane-based tissue adhesives.

Natural biopolymers derived hydrogels with injectable,self-healing,and tissue adhesive abilities for wound healing

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.

A cuttlefish ink nanoparticle-reinforced biopolymer hydrogel with robust adhesive and immunomodulatory features for treating oral ulcers in diabetes

Oral ulcers can be managed using a variety of biomaterials that deliver drugs or cytokines.However,many patients experience minimal benefits from certain medical treatments because of poor compliance,short retention times in the oral cavity,and inadequate drug efficacy.Herein,we present a novel hydrogel patch(SCE2)composed of a biopolymer matrix(featuring ultraviolet-triggered adhesion properties)loaded with cuttlefish ink nanoparticles(possessing pro-healing functions).Applying a straightforward local method initiates the formation of a hydrogel barrier that adheres to mucosal injuries under the influence of ultraviolet light.SCE2 then demonstrates exceptional capabilities for near-infrared photothermal sterilization and neutralization of reactive oxygen species.These properties contribute to the elimination of bacteria and the management of the oxidation process,thus accelerating the healing phase’s progression from inflammation to proliferation.In studies involving diabetic rats with oral ulcers,the SCE2 adhesive patch significantly quickens recovery by altering the inflamed state of the injured area,facilitating rapid re-epithelialization,and fostering angiogenesis.In conclusion,this light-sensitive hydrogel patch offers a promising path to expedited wound healing,potentially transforming treatment strategies for clinical oral ulcers.

A soft tissue adhesive based on aldehyde-sodium alginate and amino-carboxymethyl chitosan preparation through the Schiff reaction

Sodium alginate and carboxymethyl chitosan have been extensively applied in tissue engineering and other relative fields due to their low price and excellent biocompatibility. In this paper, we oxidized sodium alginate with sodium periodate to convert 1,2-hydroxyl groups into aldehyde groups to get aldehyde-sodium alginate （A- SA）. Carboxymethyl chitosan was modified with ethylenediamine （ED） in the presence of water-soluble N-（3-Dimethylaminopropyl）-N＇-ethylcarbodiimide hydrochloride （EDC） to introduce additional amino groups to get amino-carboxymethyl chitosan （A-CS）. Upon mixing the A-SA and A-CS aqueous solutions together, a gel rapidly formed based on the Schiff＇s base reaction between aldehyde groups in A-SA and amino groups in A-CS. FTIR analysis confirmed the characteristic peak of Schiff＇s base group in the hydrogel. It was confirmed that the gelation time be dependent on the aldehyde group content in A-SA and amino group content in A-CS. The fasted hydrogel formation takes place within 10 min. The data of bonding strength and cytotoxicity measurement also showed that the hydrogel had good adhesion and biocompatibility. All these results support that this gel has the potential as soft tissue adhesive.

Bridging wounds:tissue adhesives’essential mechanisms,synthesis and characterization,bioinspired adhesives and future perspectives

Bioadhesives act as a bridge in wound closure by forming an effective interface to protect against liquid and gas leakage and aid the stoppage of bleeding.To their credit,tissue adhesives have made an indelible impact on almost all wound-related surgeries.Their unique properties include minimal damage to tissues,low chance of infection,ease of use and short wound-closure time.In contrast,classic closures,like suturing and stapling,exhibit potential additional complications with long operation times and undesirable inflammatory responses.Although tremendous progress has been made in the development of tissue adhesives,they are not yet ideal.Therefore,highlighting and summarizing existing adhesive designs and synthesis,and comparing the different products will contribute to future development.This review first provides a summary of current commercial traditional tissue adhesives.Then,based on adhesion interaction mechanisms,the tissue adhesives are categorized into three main types:adhesive patches that bind molecularly with tissue,tissuestitching adhesives based on pre-polymer or precursor solutions,and bioinspired or biomimetic tissue adhesives.Their specific adhesion mechanisms,properties and related applications are discussed.The adhesion mechanisms of commercial traditional adhesives as well as their limitations and shortcomings are also reviewed.Finally,we also discuss the future perspectives of tissue adhesives.

Activating proper inflammation for wound-healing acceleration via mesoporous silica nanoparticle tissue adhesive

Efficient initiation and resolution of inflammation are crucial for wound repair.However,with using tissue adhesives for wound repair,patients occasionally suffered from delayed healing process because slow elimination of those exogenous adhesives generally leads to chronic inflammation.As the demand for minimal invasive therapy continues to rise,desire for adhesive materials that can effectively reconnect surgical gaps and promote wound regeneration becomes increasingly urgent.Herein,by exploiting the inherent porous structure and performance of adhesion to tissue of mesoporous silica nanoparticles(MSNs),we demonstrate a tissue adhesive that can elicit acute inflammatory response and get eliminated after tissue reformation.With formation of nanocomposites in wound gaps,the injured tissues can get reconnected conveniently.The resultant accelerated healing process verifty that the strategy of exploiting unique properties of nanomaterials can effectively promote inflammation resolution and wound repair.This design strategy will inspire more innovative tissue adhesives for clinical applications.

Evaluation of hydrogels for soft tissue adhesives in vitro and in vivo analyses

In this study, natural materials （sodium alginate, dextran, gelatin and carboxymethyl chitosan） were modified to get aldehyde components and amino components. Upon mixing the two-component solutions together, four kinds of Schiff base hydrogels formed successfully within 5-300 s and could seal the wound tissue. The cytotoxicity tests of hydrogel extraction solution confirmed that the hydrogels are nontoxic materials. The adhesive ability was evaluated in vivo by measuring the adhesive strength after sealing the skin incisions on the back of rats. All the hydrogels showed higher adhesive strength than that of commercial fibrin glue and the blank control. The histological staining observation by hematoxylin and eosin staining （HE） and Masson＇s trichrome staining （MTC） methods suggested that the hydrogels had good biocompatibility and biodegradation in vivo. They have only normal initial inflammation to skin tissue and could improve the formation of new collagen in the incision section. So, the prepared hydrogels were both safe and effective tissue adhesive, which had the great potentials to be used as skin tissue adhesive.

Enlisting a Traditional Chinese Medicine to tune the gelation kinetics of a bioactive tissue adhesive for fast hemostasis or minimally invasive therapy

Gelation kinetics is important in tailoring chemically crosslinked hydrogel-based injectable adhesives for different applications.However,the regulation of gelation rate is usually limited to varying the gel precursor and/or crosslinker concentration,which cannot reach a fine level and inevitably alters the physical properties of hydrogels.Amidation reactions are widely used to synthesize hydrogel adhesives.In this work,we propose a traditional Chinese medicine(Borax)-input strategy to tune the gelation rate of amidation reaction triggered systems.Borax provides an initial basic buffer environment to promote the deprotonation process of amino groups and accelerate this reaction.By using a tissue adhesive model PEG-lysozyme(PEG-LZM),the gelation time can be modulated from seconds to minutes with varying Borax concentrations,while the physical properties remain constant.Moreover,the antibacterial ability can be improved due to the bioactivity of Borax.The hydrogel precursors can be regulated to solidify instantly to close the bleeding wound at emergency.Meanwhile,they can also be customized to match the flowing time in the catheter,thereby facilitating minimally invasive tissue sealing.Because this method is easily operated,we envision Borax adjusted amidation-type hydrogel has a promising prospect in clinical application.

Evaluation of the efficacy and safety of endoscopic band ligation in the treatment of bleeding from mild to moderate gastric varices type 1

BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONCLUSION For mild to moderate GOV1,patients with EBL had a greater one-time varix eradication rate,a greater 6-wk operation-related ulcer healing rate,a lower delayed rebleeding rate and a lower cost than patients with TAI.

Endoscopic treatment of bleeding gastric ulcer causing gastric wall necrosis:A case report

BACKGROUND Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer,which may exacerbate the patient’s condition once it occurs and may even require surgical intervention for treatment.CASE SUMMARY A 59-year-old man was admitted to our department with melena.Endoscopy revealed a giant ulcer in the gastric antrum with a visible vessel in its center,which was treated with sclerosants and tissue glue injection and resulted in necrosis of the gastric wall.CONCLUSION Injection of sclerosants and tissue glue may lead to gastric wall necrosis,which is a serious complication.Therefore,before administering this treatment to patients,we should consider other more effective methods of hemostasis to avoid gastric wall necrosis.

Benefits of laparoscopy-assisted ileostomy in colorectal cancer patients with bowel obstruction

BACKGROUND Ileostomies are commonly performed after colon and rectal surgeries.Laparoscopy-assisted ileostomy with adhesion lysis may have potential benefits over conventional open surgery.AIM To compare the outcomes of laparoscopy-assisted and conventional ileostomies.METHODS Data from 48 consecutive patients who underwent ileostomy at our institution between May 2021 and May 2022 were retrospectively analyzed.The groups comprised 26 and 22 patients who underwent laparoscopic ileostomy(laparoscopic group)and conventional ileostomy(conventional group),respectively,performed by a single surgeon.Patient demographics,operative characteristics,postoperative outcomes,and 30-d morbidities and mortality rates were analyzed.RESULTS The two groups had comparable mean ages,sex distributions,American Society of Anesthesiologists scores,and body mass indices.However,the laparoscopic group showed similar operative time,better visualization for adhesion lysis,and lower visual analog scale scores than the conventional group.CONCLUSION Laparoscopy-assisted ileostomy is a safe and efficient method that produces lower visual analog scale scores,better intraoperative visualization for effective adhesion lysis,and similar operative time compared with conventional ileostomy.

A novel bioactive polyurethane with controlled degradation and L-Arg release used as strong adhesive tissue patch for hemostasis and promoting wound healing

Effective strategy of hemostasis and promoting angiogenesis are becoming increasingly urgent in modern medicine due to millions of deaths caused by tissue damage and inflammation. The tissue adhesive has been favored as an optimistic and efficient path to stop bleeding, while, current adhesive presents limitations on wound care or potential degradation safety in clinical practice. Therefore, it is of great clinical significance to construct multifunctional wound adhesive to address the issues. Based on pro-angiogenic property of L-Arginine (L-Arg), in this study, the novel tissue adhesive (G-DLPUs) constructed by L-Arg-based degradable polyurethane (DLPU) and GelMA were prepared for wound care. After systematic characterization, we found that the G-DLPUs were endowed with excellent capability in shape-adaptive adhesion. Moreover, the L-Arg released and the generation of NO during degradation were verified which would enhance wound healing. Following the in vivo biocompatibility was verified, the hemostatic effect of the damaged organ was tested using a rat liver hemor-rhage model, from which reveals that the G-DLPUs can reduce liver bleeding by nearly 75% and no obvious inflammatory cells observed around the tissue. Moreover, the wound care effect was confirmed in a mouse full-thickness skin defect model, showing that the hydrogel adhesive significantly improves the thickness of newly formed dermis and enhance vascularization (CD31 staining). In summary, the G-DLPUs are promising candidate to act as multifunctional wound care adhesive for both damaged organ and trauma.

Gastroesophageal varices in a patient presenting with essential thrombocythemia:A case report

BACKGROUND Gastroesophageal varices are a rare complication of essential thrombocythemia(ET).ET is a chronic myeloproliferative neoplasm(MPN)characterized by an increased number of blood platelets.CASE SUMMARY A 46-year-old woman,who denied a history of liver disease,was admitted to our hospital on presentation of hematemesis.Laboratory examination revealed a hemoglobin level of 83 g/L,and a platelet count of 397×109/L.The appearance of gastric and esophageal varices with red colored signs as displayed by an urgent endoscopy was followed by endoscopic variceal ligation and endoscopic tissue adhesive.Abdominal computed tomography revealed cirrhosis,marked splenomegaly,portal vein thrombosis and portal hypertension.In addition,bone marrow biopsy and evidence of mutated Janus kinase 2,substantiated the onset of ET.The patient was asymptomatic with regular routine blood testing during the 6-mo follow-up period.Therefore,in this case,gastroesophageal varices were induced by ET.CONCLUSION MPN should be given considerable attention when performing differential diagnoses in patients with gastroesophageal varices.An integrated approach such as laboratory tests,radiological examination,and pathological biopsy,should be included to allow optimal decisions and management.

Is there an alternative therapy to cyanoacrylate injection for safe and effective obliteration of bleeding gastric varices?

TO THE EDITORWe read with interest the article entitled ＂Bleeding gastric varices： Results of endoscopic injection with cyanoacrylate at King Chulalongkorn Memorial Hospital＂ by Noophun et al. They performed n-butyl-2-cyanoacrylate （CA） injection therapy for bleeding gastric varices in twentyfour patients, and hemostasis was achieved in seventeen （71%） patients. They concluded that CA injection therapy was effective and safe for bleeding gastric varices. However, we disagreed with the author＇s conclusion.

Drainless Day Case Superficial Parotidectomy with ARTISS [Solutions for Sealant]

Aims: Superficial parotidectomy (SP) is a commonly performed procedure which traditionally requires a drain and overnight hospital stay. This series aimed to show the safety and efficacy of drainless day case parotidectomy using ARTISS [Solution for Sealant] fibrin glue. Materials and Methods: Patients with a superficial parotid lump with benign preoperative sampling underwent an SP. We initially used both ARTISS and a drain, which was removed when output was <40 mls. ARTISS without drain was then introduced and once confident patients were sent home the same day. Objectives: We prospectively collected data and divided groups into ARTISS alone and ARTISS with a drain to compare patients’ length of stay and complication rates. Results: 88 patients were included;52 ARTISS alone, 22 as a day case. 42.3% of patients where ARTISS alone was used were discharged within 24 hours, with the remainder between 24 - 48 hours. Comparatively, no ARTISS and drain patients were discharged within 24 hours and 86.1% were discharged between 24 - 48 hours with the remainder over 48 hours. There were 3 postoperative haematomas and none in the drainless group;a statistically significant difference (p = 0.034). Of the 6 recorded salivary leaks, 4 were in the drain group and 2 in the ARTISS alone group (p > 0.05). Conclusions: Comparable complication rates and reduced length of stay suggest that ARTISS in SP is safe and effective. These findings stand to benefit both patients and the NHS by improving the patient journey and reducing overall costs.

Is anoplasty superior to scar revision surgery for posthemorrhoidectomy anal stenosis?Six years of experience

BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy.The severity of anal stenosis can be classified into three categories:mild,moderate,and severe.There are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different severities.AIM To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.METHODS Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared.The severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson retractor.The explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point scale.Patients underwent proctologic follow-up examinations one,two,and four weeks after surgery.RESULTS We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;P<0.001).The average of length of hospital stay was also significantly shorter after scar revision surgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;P<0.001).Postoperative satisfaction was categorized into four groups:45 patients(75%)reported excellent satisfaction(scores of 8-10),13(21.7%)reported good satisfaction(scores of 6-7),two(3.3%)had no change in satisfaction(scores of 3-5),and none(0%)had scores indicating poor satisfaction(1-2).As such,most patients were satisfied with their quality of life after surgery other than the two who noticed no difference due owing to the fact that they experienced recurrences.CONCLUSION Scar revision surgery may be preferable for mild anal stenosis upon conservative treatment failure.Anoplasty is unavoidable for moderate or severe stenosis,where cicatrized tissue is extensive.

natural polymer-based bilayer adhesive skin substitute for infected burned wound healing

Thermal wounds are complex and lethal with irregular shapes, risk of infection, slow healing, and large surface area. The mortality rate in patients with infected burns is twice that of non-infected burns. Developing multifunctional skin substitutes to augment the healing rate of infected burns is vital. Herein, we 3D printed a hydrogel scaffold comprising carboxymethyl chitosan (CMCs) and oxidized alginate grafted catechol (O-AlgCat) on a hydrophobic electrospun layer, forming a bilayer skin substitute (BSS). The functional layer (FL) was fabricated by physiochemical crosslinking to ensure favorable biodegradability. The gallium-containing hydrophobic electrospun layer or backing layer (BL) could mimic the epidermis of skin, avoiding fluid penetration and offering antibacterial activity. 3D printed FL contains catechol, gallium, and biologically active platelet rich fibrin (PRF) to adhere to both tissue and BL, show antibacterial activity, encourage angiogenesis, cell growth, and migration. The fabricated bioactive BSS exhibited noticeable adhesive properties (P ≤ 0.05), significant antibacterial activity (P ≤ 0.05), faster clot formation, and the potential to promote proliferation (P ≤ 0.05) and migration (P ≤ 0.05) of L929 cells. Furthermore, the angiogenesis was significantly higher (P ≤ 0.05) when evaluated in vivo and in ovo. The BSS-covered wounds healed faster due to low inflammation and high collagen density. Based on the obtained results, the fabricated bioactive BSS could be an effective treatment for infected burn wounds.