Hidden blood loss and its risk factors in patients undergoing laparoscopy and laparotomy for cervical cancer management.

PURPOSE: Laparoscopy and laparotomy are the two most common surgical options used to treat women with early-stage cervical cancer. This study aimed to examine the volume of hidden blood loss (HBL) between laparoscopy and laparotomy for cervical cancer and to identify its risk factors. METHODS: Sixty-one patients treated with laparotomy and 50 patients treated with laparoscopy were enrolled in this study. Their medical data were collected to calculate the HBL according to the Nadler and Gross formula, and its risk factors were identified by multiple linear regression analysis. RESULTS: The visible blood loss was 574.9 ± 271.6 mL in the laparotomy surgery; however, the HBL was 345.2 ± 258.6 mL, accounting for 38.3 ± 21.4% of true TBL. The visible blood loss in the laparoscopy group was 168.9 ± 121.9 mL, and the HBL was 185.1 ± 130.5 mL (52.3 ± 28.1% of true TBL). The HBL blood loss in laparotomy was more than laparoscopy (p < 0.01). Multiple linear regression analysis suggested that patient age (p = 0.012), surgical time (p = 0.037) and pathological tumour type (p = 0.014) were independent risk factors contributing to HBL in laparotomy. Meanwhile, the following risk factors were positively correlated with HBL in laparoscopy: pre-operative value of Hb (p = 0.002), pre-operative value of Hct (p = 0.003), surgical time (p = 0.035), pathological tumour type (p = 0.036) and diabetes mellitus (p = 0.022). Ten and eight patients had pre-operative anaemia in the laparotomy group and the laparoscopy group, respectively, and 54 and 29 post-operatively. CONCLUSIONS: HBL is seriously underestimated, and accounts for a large percentage of total blood loss both in laparotomy and laparoscopy for cervical cancer. Additionally, age, pathological tumour type, pre-operative value of Hb and Hct, surgical time and diabetes mellitus have the potential to increase HBL. A correct understanding of HBL can ensure patient safety and improve post-operative rehabilitation.

Injectable carboxymethyl chitosan-genipin hydrogels encapsulating tea tree oil for wound healing.

Injectable hydrogel is of interesting for wound healing due to it can be used as carriers of bioactive molecules for the reparation of tissues with minimal invasiveness. However, the integration of lipid-soluble substances into hydrogel network is difficult because of the polarity differences. Here, the tea tree oil (TTO) is encapsulated into the hydrogel network via a previous emulsification process, and a tough and antibacterial injectable hydrogel is synthesized by the Schiff base reaction between carboxymethyl chitosan (CMCS) and genipin (GP). CMCS is served as both an emulsifier and a gel-forming material to construct the heterogeneous hydrogel. The obtained hydrogels present high adhesive strength (∼162.75 kPa), great antibacterial properties (over 90 %) and excellent biocompatibility. Moreover, an anal fistula-like wound healing experiment concluded that the heterogeneous hydrogel has good slow-release properties of TTO for an accelerate healing process, this hydrogel shows great potential for the treatment of complex anal fistula wounds.