Objective: The present study aimed to investigate the clinical application of a hemostatic chitinous sponge for intraoperative hemorrhage and abdominal organ injury with hemostatic problems. Subjects and Methods: General anesthesia was induced in 20 male Wistar rats ≥ 10 weeks old using diethyl ether and maintained with intraperitoneal injection of sodium pentobarbital and intermittent diethyl ether inhalation. The liver was exposed through midline laparotomy and a penetrating wound 3mm in diameter was made 5mm from the left lateral liver lobe margin to create a liver injury model. Surgical cotton and chitinous sponge used to pack the wound cavity was removed after 2, 3 or 5min and the hemostatic status of the wound surface was inspected. If hemorrhage persisted, time and hemorrhage weight until complete hemostasis were measured while using special rapid absorption paper to remove blood from the wound cavity every 30s. Rates of hemostasis achieved with no packing or surgical cotton, chitinous sponge or commercial bovine atelocollagen were also compared. Tissue samples were prepared from the injury site posthemostasis with surgical cotton and chitinous sponge.
Results: No packing tended to result in greater hemorrhage weight than 3-min packing with surgical cotton, but no difference was observed between both conditions with regard to time. Median time until hemostasis was shorter with chitinous sponge than with surgical cotton after 2, 3 and 5min of packing (6.5, 7.5 and 8.0min vs. 14.5, 11.0 and 10.8min) or with bovine atelocollagen after 3 and 5min of packing (8.0 and 7.5min vs. 12.0 and 11.0min) respectively. Median hemorrhage weight was smaller with chitinous sponge than with surgical cotton after 3min of packing (0.6g vs. 1.2g) or with bovine atelocollagen after 3 and 5min of packing (0.6 and 1.6g vs. 1.8 and 1.9g), respectively. No signs of fibrin precipitation were seen aside from blood clots in tissue samples obtained after chitinous sponge hemostasis. Conclusion: Use of chitinous sponge may promote primary thrombus (platelet thrombus) formation. In a rat liver injury model comprising a penetrating wound, chitinous sponge achieved hemostasis more rapidly than surgical cotton or bovine atelocollagen, indicating the clinical applicability of chitinous sponge.

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We conducted a survey of 178 firefighters dispatched from other regions to areas affected by the Great East Japan Earthquake of March 11, 2011. From the survey conducted in August 2011, we aimed to evaluate the critical incident stress (CIS) and mental health of the firefighters by using the Impact of Event Scale-revised (IES-R) and other questionnaires. Completed responses were received from 126 subjects (all men; mean age, 40.9 years [range, 22-58 years]), of whom 85 were engaged in the rescue operation of disaster victims, and 41 were engaged in logistics support. The survey results showed that the firefighters were dispatched at an average of 1.6 times (range, 1-6 times) to disaster affected areas, that their IES-R score was 4.0 ± 4.9 (range, 0-21), and that no team member recorded a score of ≥ 25, which is the score considered to show high risk of post-traumatic stress disorder (PTSD). We considered that the reason for none of the firefighters showing risk of PTSD might have been because after they completed their duties, they returned to their home where they were no longer exposed to CIS of this disaster. Considering the various CIS factors of this disaster, the survey results suggest that risk factors for mental health of firefighters dispatched for disaster were “the number of times that they were dispatched,”“participation on the day when a disaster happened,”“rescue operation of disaster victims,” and“staying for long periods in an area affected by a terrible disaster.”

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