When it comes to conducting a literature review on techniques to achieve hemostasis in endoscopic

sinus surgery, one quickly realizes the complexity of the task at hand. Endoscopic sinus surgery is a
specialized field with a vast array of techniques and approaches, each with its nuances and
considerations. As such, compiling and analyzing the existing literature on this topic requires a
significant amount of time, effort, and expertise.

The process begins with identifying relevant sources of information, including peer-reviewed journal
articles, conference papers, textbooks, and clinical guidelines. Once these sources have been
identified, they must be systematically reviewed and synthesized to provide a comprehensive
overview of the current state of knowledge in the field.

One of the challenges of conducting a literature review in this area is the sheer volume of available
literature. Endoscopic sinus surgery is a rapidly evolving field, with new techniques and research
findings emerging regularly. As a result, keeping up-to-date with the latest developments can be a
daunting task.

Furthermore, the quality of the available literature varies widely, ranging from well-designed
randomized controlled trials to anecdotal case reports. Distinguishing between high-quality evidence
and low-quality evidence is essential to ensure that the conclusions drawn from the literature review
are reliable and robust.

Another challenge is synthesizing the findings of multiple studies into a coherent narrative. Each
study may use different methodologies, outcome measures, and terminology, making it challenging
to compare and contrast their findings. Additionally, conflicting results between studies can further
complicate the synthesis process.

Given the challenges involved in conducting a literature review on techniques to achieve hemostasis
in endoscopic sinus surgery, many individuals may find it beneficial to seek assistance from
professional writing services. ⇒ StudyHub.vip ⇔ offers expert literature review writing services,
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Poly(vinyl alcohol) (PVA) was conducive to increasing the swelling degree of the spheres and the
enhanced hemostatic effect. Moreover, it can play an effective role in hemostasis for capillary,
arterioles and venous bleeding ( Tam, Harkins et al., 2014 ). In addition, the Surgicel can lower the
local pH of the wound to acidic, which has a certain antibacterial effect ( Masci, Faillace et al., 2018
). However, the premise of using such hemostatic biomaterials is that the patient must have a
complete coagulation function. Then, after freeze-drying and puffing treatments, the final product is
obtained. These cookies ensure basic functionalities and security features of the website,
anonymously. Hemostatic strategies in biomaterials Optimization of the single hemostatic biomaterial
Various hemostatic materials have been emerging in recent years, but it is still a great challenge to
achieve hemostasis in surgery. Masuhara, Fujii et al. (2012) confirmed the hemostatic effect of
RADA16-I by rabbit abdominal aortic puncture bleeding model, and also tested the safety of
intravenous injection of lower concentration hydrogel. Therefore, developing new hemostatic
biomaterials which can rapid hemostasis is a critical issue to improve hemodynamic stability and
avoid the side effects of blood transfusion. Polysaccharide hemostatic biomaterials Cellulose
Oxidized cellulose (OC) and oxidized regenerated cellulose (ORC) are topical hemostatic
biomaterials that have the appearance and texture of cotton yarns and are bioabsorbable. The other is
to develop new hemostatic polypeptides or proteins with good biocompatibility and hemostatic
effect through gene recombinant technology. Sinus surgery can offer an effective treatment for
severe sinusitis and other sinus problems. It was confirmed that it has good hemostasis through these
aspects ( Figure 2B ): 1) fast-absorbing of plasma within the sponge; 2) concentrating blood on the
sponge surface; 3) activating clotting factors by MMT; 4) accelerating the speed of blood clotting,
totally resulting in an ultrafast hemostasis. Apart from this, Nagamatsu et al. (1997) found in the
study of the formation of neuropathy that the highly acidic environment generated by oxidative
cellulose can cause nerve injury through a diffuse chemical mechanism. The KOD can self-assemble
into three helical nanofibers to further form nanofiber hydrogels, which have been shown to
coagulate whole blood, minimize bleeding, and significantly activate platelets. For example, some
hemostatic biomaterials cannot be injected intravenously in case they cause vascular embolization.
Bridging anticoagulation aims to reduce patients’ risk of developing blood clots, such as stroke, but
may also increase patients’ risk of developing potentially serious bleeding complications after
surgery. For example, it was reported that CEGP-003 ( Bang, Lee et al., 2018 ) is a mixture of EGF
and hydroxyethylcellulose. Advertisement cookies are used to provide visitors with relevant ads and
marketing campaigns. A systematic review and meta-analysis of 11 studies involving 4,596 patients
found that a DOAC interruption period of 2-4 days was associated with a lower risk of bleeding
compared to shorter or longer interruption periods. There are limited data regarding its safety in
pediatric patients, and thus, no recommendation could be made based on the literature review. In
recent years, a variety of hemostatic biological materials and products have been developed, mainly
divided into natural biological materials and synthetic biological materials. Prophylaxis is safer and
more effective than generally held while the toll of venous thromboembolism (VTE) without
prophylaxis is usually significantly underestimated. One type of hemostatic biomaterial that creates a
nanometer or micron-sized pore size, such as zeolites, mesoporous silica, etc. ( Ellis-Behnke, Liang et
al., 2006; Laurenti, Zazeri et al., 2017 ), and biopolymer materials such as gelatin and starch, which
accelerates the initiation of physiological hemostasis by concentrating certain components of the
blood under physical or chemical action and accelerating the activation of coagulation factors to stop
bleeding. The SEM images of (Middle) mCHA-C, (Right) mCHA zeolite on cotton. (B) In vivo
hemostatic capacity evaluation of hemostats. The ENTtoday summaries below include the
Background and Best Practice sections of the original article. We offer first-class post-procedure
recovery suites so you can wake up peacefully refreshed and get home quickly. Therefore, the
stability of the expression product is usually improved by fusing RADA-16 with other proteins.
Chitosan porous materials mainly include porous microspheres, porous fibers, porous sponges, or a
combination of the above several types of hemostatic materials ( Huang, Sun et al., 2015 ), the
porous structure of which facilitates the discharge of secretion from the wound and tissue healing.
However, the application of these hemostatic biomaterials is often limited by many factors, such as
the amount of bleeding, bleeding sites, and different hemostatic effects of the biomaterials, etc.
Because of this, the researchers not only designed various types of self-assembled short peptides, but
also fused other peptides or proteins with RADA to obtain new hemostatic biomaterials. However,
such hemostatic materials can lead to vascular embolization and release toxic substances such as
cyanide and formaldehyde in the degradation process, which may induce inflammation and tissue
necrosis around the injection site ( Farooq and Wong 2005 ).
Therefore, there are some insurmountable shortcomings ( Wang, Wang et al., 2019 ): 1) With the
decrease in the number of functional sequence amino acids, the function of the active protein was
greatly reduced. Importantly, the formed gel material will not adhere to the operative cavity and is
conducive to repairing nasal mucosa epithelium. This is an option for people with ongoing and
recurrent sinus infections, for people with abnormal sinus structure, or abnormal growths in the sinus.
In addition, a hemostatic liquid sealant made of the tetra-succinimidyl -derivatized PEG and tetra-
thiol-derivatized PEG could stop bleeding by crosslinking with tissue and sealing the hemorrhagic
spot ( Overby and Feldman 2018 ). Esophagus Band Ligation of Actively Bleeding
Gastroesophageal Varices. In the coagulation cascade, activation of coagulation factor X affects
thrombin generation, which directly determines the blood clotting. The decision to use bridging
therapy should be based on an individualized assessment of the risks and benefits for each patient.
Contact us today with any questions or to schedule your consultation. To prepare hemostatic
biomaterials that can meet the needs of patients with hemorrhage, it is necessary to modify the
properties of the materials. The results of AFM ( Wang et al., 2012 ) showed that RADA16-1 could
form long self-assembled nanofibers ranging with hundred nanometers in a stable and repeatable
manner ( Figure 3D ). Additionally, successful employment of VTE prophylaxis avoids the concern
for much higher and longer dosage of therapeutic anticoagulation should a VTE occur. To take full
advantage of the PVA and chitosan, the Chitosan-PVA spheres ( Chen, Liu et al., 2017 ) were
prepared through electrospraying and ionotropic gelation, which effectively reduced thromboembolic
formation in stopping the bleeding from the femoral artery. The researchers have been working on
improving the hemostatic properties of zeolite by various methods and have found results. Another
systematic review and meta-analysis of 23 studies involving 16,834 patients found that a DOAC
interruption period of 3-5 days was associated with a lower risk of bleeding compared to shorter or
longer interruption periods. The hemostasis was assessed upon manual pressure on the rabbit lethal
femoral artery injury with cotton (left), CG (mid), or mCHA-C (right). It was reported that the
negatively charged surface of alginate can induce coagulation initiating via the auto-activation of
coagulation factor XII ( Sperling, Fischer et al., 2009 ), while the positively charged surface on the
chitosan can adhere to platelets via charge interaction. There is temporary, mild discomfort after
surgery. The balloon is guided gently to dilate open the natural sinus drainage pathways. Based on
the biomaterials of montmorillonite and kaolin, the corresponding hemostatic products were
developed, namely Wound stat and Combat Gauze. The fact that zeolite does not contain any
biological components has some advantages, such as stability, ease of use, no biological toxicity and
no disease transmission ( Li, Cao et al., 2013 ). The hemostatic mechanism of fibrin glue is that
thrombin cleaves the fibrinogen into fibrin, which causes blood coagulation, while aprotinin inhibits
the dissolution of blood clots, making blood clots more stable on the wound, thereby achieving
hemostasis. Kumar, Taylor et al. (2014) designed a mimetic peptide of collagen named KOD
((PKG)4(P-Hyp-G)4(D-Hyp-G)4), consisting of 36 amino acids. We offer first-class post-procedure
recovery suites so you can wake up peacefully refreshed and get home quickly. Hence, complete
debridement should be conducted before wound closure. Periprocedural management of patients
receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or
surgery. Westrich demonstrated that intermittent pneumatic compression (IPC) devices in total knee
replacement surgery were more effective than low molecular weight heparin (LMWH) and far more
effective than aspirin alone in reducing both DVT and pulmonary embolism. The role of mechanical
and similar adjuncts in prophylaxis against VTE verifies their use. Use of the Internet or email is for
your convenience only, and by using them, you assume the risk of unauthorized use. Nowadays,
cross-linking techniques are commonly used to change the physical properties of collagen. The first
procedure may have been inadequate for the severity of the sinus disease, or the initial procedure was
done incorrectly. FIGURE 2 FIGURE 2. Naturally derived biomaterials are applied in hemostasis.
(A) Schematic representation of the preparation route and the microstructure of the GMCS.
These cookies ensure basic functionalities and security features of the website, anonymously. The
SEM images of (Middle) mCHA-C, (Right) mCHA zeolite on cotton. (B) In vivo hemostatic
capacity evaluation of hemostats. Duodenum - Bleeding Ulcer Treated with Thermal Therapy,
Perforation Closed with Hemoclips. In major surgery, doctors need to help patients to minimize
blood loss. Author. Functional cookies help to perform certain functionalities like sharing the content
of the website on social media platforms, collect feedbacks, and other third-party features. Our
group constructed a new hemostatic sponge of HLC-RADA by fusing human-like collagen with
RADA16, then lyophilizing the fusion protein, which showed effective hemostasis in a hemostatic
model of rabbit liver. Chitosan hydrogel can achieve better and more effective contact with the
wound, and provide a moist environment to promote wound healing ( Ono, Ishihara et al., 2001 ).
Mi, Shyu et al. (2001) prepared a novel asymmetric chitosan film consisting of a surface with a
macroporous sponge-like sub-layer, which can control water loss, has excellent oxygen permeability,
and promotes fluid excretion. A Septoplasty is a minimally invasive procedure done through the
natural nostril openings using an endoscope and small instruments to repair the deviated septum. In
this clinical scenario, it is generally not advised to perform elective surgery. It was reported ( Seon,
Lee et al., 2018 ) that an efficacious hemostatic agent made of chitosan-based non-woven dressing
with recombinant batroxobin (rBat), which has a synergetic effect on blood coagulation. Although
all commercial hemostatic products conform to the basic criteria for hemostatic biomaterials, their
different hemostatic mechanisms affect the choice and application of hemostatic biomaterials in
bleeding patients. In particular, the 96ELP-RADA sponge film showed a good hemostatic effect.
TABLE 2 TABLE 2. The summary of composite hemostatic biomaterials. Because gelatin fiber has
strong adsorption, and can adhere to the wound surface, it has a more obvious hemostatic effect than
a gelatin sponge in the deep part of the body. Platelet activation affects the formation of a
hemostatic plug, it also activates prothrombin to achieve blood clotting. Therefore, the quality and
biocompatibility of collagen hemostatic sponge prepared with chemical cross-linkers are often
unsatisfactory. And it is proven that they are non-toxic, non-carcinogenic, and have good
histocompatibility and significant hemostasis. However, questions arise regarding the safety profile
of such potent vasoconstriction and possible systemic effects, especially in light of patients with
preexisting cardiovascular comorbidities. Hemostatic strategies in biomaterials Optimization of the
single hemostatic biomaterial Various hemostatic materials have been emerging in recent years, but it
is still a great challenge to achieve hemostasis in surgery. In the meantime, clinical experts have
suggested a risk classification scheme to help identify which patients may or may not need bridging
( Table ), but much work needs to be done. Meta-analysis: anticoagulant prophylaxis to prevent
symptomatic venous thromboembolism in hospitalized medical patients. Proteins, called clotting
factors, interact to form a fibrin mesh to hold the platelets in place. However, the proteins expressed
by genetic recombination can overcome the above shortcomings, and can also realize large-scale
production of proteins at a low price. If you are interested in more information regarding endoscopic
sinus surgery, call (823) 720-NOSE or email us. The procedure is performed endoscopically, with no
visible cuts, incisions or changes in appearance. The fact that zeolite does not contain any biological
components has some advantages, such as stability, ease of use, no biological toxicity and no disease
transmission ( Li, Cao et al., 2013 ). The hemostatic mechanism of fibrin glue is that thrombin
cleaves the fibrinogen into fibrin, which causes blood coagulation, while aprotinin inhibits the
dissolution of blood clots, making blood clots more stable on the wound, thereby achieving
hemostasis. However, due to the limited effect of hemostasis of chitosan, it is not very satisfactory in
the wound with extensive bleeding. Therefore, the stability of the expression product is usually
improved by fusing RADA-16 with other proteins. Based on the above, a new styptic sponge was
prepared by cross-linking human-like collagen with glutamine transaminase and a two-step freezing
method ( Jiang, Wang et al., 2017 ), which has good biocompatibility and a significant hemostatic
effect in the ear artery model and liver injury model. Case report: BCR-ABL-positive acute
lymphoblastic leukemia with bone.
It has the properties of hygroscopicity, gelation, good biocompatibility, and the ability to ignite and
shield electromagnetics. For example, it was reported that CEGP-003 ( Bang, Lee et al., 2018 ) is a
mixture of EGF and hydroxyethylcellulose. Kumar, Taylor et al. (2014) designed a mimetic peptide
of collagen named KOD ((PKG)4(P-Hyp-G)4(D-Hyp-G)4), consisting of 36 amino acids. This is an
open-access article distributed under the terms of the Creative Commons Attribution License (CC
BY). You also have the option to opt-out of these cookies. Some dentists allow patients to continue
warfarin (especially if there are concerns about stopping it), so long as they take a special mouthwash
called tranexamic acid (Amicar) just before and 3 times daily for 1 to 2 days after the dental
procedure, to help prevent bleeding. Optimal timing for resumption of direct oral anticoagulants in
patients undergoing elective surgery: a systematic review and meta-analysis. JAMA Surg.
2021;156(5):e210682. This becomes important when treating disease processes near the brain or eye.
The choice of thromboprophylaxis depends on various factors such as the type of surgery, patient
characteristics, and bleeding risk. Hemostasis is necessary to relieve pain and reduce mortality in
these accidents. The development of cross-linking technology is also very important. Literature
review and expert opinion on the treatment of high-risk acute. Determining the predictive impact of
donor parity on the outcomes of human. In this clinical scenario, it is generally not advised to
perform elective surgery. Effective surgery depends upon adequate identification of anatomic
structures, and even a small amount of mucosal oozing can limit visualization. Bhandarkar, MD,
Maie A. St. John, MD, PhD, James N. After modifying the tilapia skin collagen sponge through
chemical cross-linking methods ( Verissimo, et al., 2010; Xie, Yi et al., 2018 ), the sponge has shown
more excellent performances, such as mechanical properties, the elongation at break, and the
collagenase degradation. For example, some hemostatic biomaterials cannot be injected
intravenously in case they cause vascular embolization. In addition, the hemostatic biomaterials
achieved the purpose of hemostasis by more than one mechanism, such as collagen, gelatin. The
quantitative analysis of hemostatic time (left) and blood loss (middle) in the rabbit femoral artery
injury model. However, due to the limited effect of hemostasis of chitosan, it is not very satisfactory
in the wound with extensive bleeding. Any product that may be evaluated in this article, or claim
that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Platelet
activation affects the formation of a hemostatic plug, it also activates prothrombin to achieve blood
clotting. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral
anticoagulant requiring an elective procedure or surgery. The role of mechanical and similar adjuncts
in prophylaxis against VTE verifies their use. The most commonly used topical vasoconstrictors
include cocaine, oxymetazoline, and epinephrine, with oxymetazoline having the most well-studied
safety profile. It is also recommended to thoroughly wring out pledgets before use, as inadvertent
application to upper airway mucosa may lead to increased systemic effects. A double-layer
hemostatic biomaterial ( Harrison and Spada 2018 ), which was fabricated by combining silk fibroin
and gelatin, has been reported. Thus, it was an ideal medical hemostatic material with
biocompatibility. Both of them are effective in stopping bleeding, but they have some disadvantages,
such as compression hemostasis being only suitable for vascular bleeding, and drug hemostasis can
just be used as auxiliary means.
The results of AFM ( Wang et al., 2012 ) showed that RADA16-1 could form long self-assembled
nanofibers ranging with hundred nanometers in a stable and repeatable manner ( Figure 3D ). The
quantitative analysis of hemostatic time (left) and blood loss (middle) in the rabbit femoral artery
injury model. One is to combine two or more hemostatic biomaterials to simultaneously obtain the
multifunctional biomaterials. Because gelatin fiber has strong adsorption, and can adhere to the
wound surface, it has a more obvious hemostatic effect than a gelatin sponge in the deep part of the
body. Moreover, fibrin glue also has some disadvantages, such as the high cost, the potential for
infecting human or animal hematogenous diseases ( Valeri 2006 ), and the low efficiency of
hemostasis for great vessels, limiting its application range. All rights reserved. 7041 Koll Center
Parkway, Suite 160, Pleasanton, CA 94566, USA. For example, since natural collagen is mostly
extracted from animals, it has the potential of pathogenic transmission and the disadvantage of
batch-batch instability. Mechanical prophylaxis, pharmacological prophylaxis, and combination
prophylaxis are some of the options available. However, sources for whole blood and its components
are limited. It is also recommended to thoroughly wring out pledgets before use, as inadvertent
application to upper airway mucosa may lead to increased systemic effects. Case 6-2024: A 21-Year-
Old Man with Fatigue and Night Sweats CD19 CAR T-Cell Therapy in Autoimmune Disease — A
Case Series with. Then, after freeze-drying and puffing treatments, the final product is obtained.
Thus, the key to successful hemostasis is consisted by two parts: one is coagulation cascade, the
other is platelet activation. Reproduced from ( Wang et al., 2012 ) with permission from Copyright
2012. (D) AFM images of RADA16-I nanofibers at various points in time after sonication.
Polysaccharide hemostatic biomaterials Cellulose Oxidized cellulose (OC) and oxidized regenerated
cellulose (ORC) are topical hemostatic biomaterials that have the appearance and texture of cotton
yarns and are bioabsorbable. Sinuses are lined with cilia, which are very fine hair-like cells. The role
of mechanical and similar adjuncts in prophylaxis against VTE verifies their use. A systematic
review and meta-analysis published in the Annals of Internal Medicine in 2013 found that bridging
therapy was associated with a higher risk of major bleeding complications, but no significant
reduction in thromboembolic events. For instance, the poor mechanical properties of collagen and
gelatin can be improved by the cross-linking technology to adapt to hemodynamics and adhere to the
tissues. Thus, it was an ideal medical hemostatic material with biocompatibility. The coagulation
mechanism of chitosan is independent of blood clotting factors and platelets, so it can be used in
patients with coagulopathy. The study found no significant difference in the rate of thromboembolic
events between the two groups, but a higher rate of major bleeding complications in the bridging
therapy group. In the absence of coagulation factors, the role of such hemostatic biomaterials in
activating platelets is significantly weakened. Only when the short peptide hydrogel closely fits the
wound can it better withstand the vascular pulse and exert the maximum hemostatic effect. 5) The
degradation products of self-assembling peptide hydrogels are natural L amino acids that can be
absorbed by surrounding tissues for repair. Hemostatic strategies in biomaterials Optimization of the
single hemostatic biomaterial Various hemostatic materials have been emerging in recent years, but it
is still a great challenge to achieve hemostasis in surgery. These cookies ensure basic functionalities
and security features of the website, anonymously. Bhandarkar, MD, Maie A. St. John, MD, PhD,
James N. Chitosan powder can be combined with gauze or made into a spray, which is suitable for
emergency treatment with large-area skin damage but small blood loss ( Muzzarelli, Morganti et al.,
2007 ). Chitosan fiber not only has good cell compatibility and cell adhesion ( Pillai, Paul et al., 2009
), but also contributes to the regeneration of skin tissue and the inhibition of scar formation. The
2018 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist
oral anticoagulants in patients with atrial fibrillation. The endoscope is inserted into the nose to reach
the openings of the sinuses.