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Objective: To investigate the safety and efficacy of embedding the stump of gastroduodenal artery between the left lateral lobe of the liver and the left caudate lobe to prevent bleeding after laparoscopic pancreaticoduodenectomy. Methods: The clinical data of 41 patients who underwent laparoscopic pancreaticoduodenectomy at the second Hospital of Hebei Medical University from October 2021 to April 2022 were analyzed retrospectively.There were 27 males and 14 females, aged (63.0±9.2)years (range: 48 to 78 years), and the body mass index was (24.1±3.2)kg/m2 (range: 15.4 to 31.6 kg/m2). After routine laparoscopic pancreaticoduodenectomy, the stump of gastroduodenal artery was embedded between the left lateral lobe and the left caudate lobe of the liver, and the hepatic parenchyma of the left lateral lobe and the left caudate lobe were sutured with absorbable sutures.The occurrence and recovery of postoperative complications (pancreatic fistula, biliary fistula, postoperative abdominal bleeding, abdominal infection, liver abscess) were observed. Results: All the operations of 41 patients were completed successfully.The operation time was (277.5±52.0) minutes (range: 192 to 360 minutes). The entrapment time of gastroduodenal artery stump was (3.1±0.6) minutes (range: 2.3 to 4.2 minutes), and the intraoperative blood loss (M(IQR)) was 300 (200) ml (range: 50 to 800 ml).The results of ultrasound examination of hepatic artery on the first day after operation showed that the blood flows of hepatic artery were unobstructed.Postoperative pancreatic fistula occurred in 3 cases, including grade B pancreatic fistula in 2 cases (1 case with abdominal infection) and biochemical leakage in 1 case. Three patients with pancreatic fistula were discharged successfully after continuous abdominal drainage. There was no biliary fistula, abdominal bleeding, abdominal infection, liver abscess or postoperative liver dysfunction. Conclusion: The encasement of the gastroduodenal artery stump by the left outer and left caudate lobes of the liver may be an effective way to prevent bleeding from the rupture of the gastroduodenal artery stump after laparoscopic pancreatoduodenectomy, which is easy and safe to perform.
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Feminino , Masculino , Humanos , Artéria Hepática , Pancreaticoduodenectomia , Fístula Pancreática , Estudos Retrospectivos , Laparoscopia , Abscesso Hepático , Infecções Intra-Abdominais , Hemorragia Pós-Operatória/prevenção & controleRESUMO
Objective To observe the effects of casein on iodine metabolism in blood,urine and thyroid of mice under excessive iodine.Methods A 2 by 3 factorial design was used in the experiment.The levels of iodine and casein were 50 and 600 μg/L in drinking water and 0( Ⅰ ),10％( Ⅱ ),20％( m ) in food,respectively.After six and twelve months,iodine content in serum,thyroid gland and urine was determined by arsenic-cerium catalyzed spectrophotometry.Results In six months,the levels of serum iodine in 50 Ⅰ,50 Ⅱ,50Ⅲ,600 Ⅰ,600 Ⅱ,and 600Ⅲ groups were (85.59 ± 8.78),(64.59 ± 9.06),(72.53 ± 11.69),(110.04 ± 9.37),(81.06 ± 9.94),(86.63 ± 19.59)μg/L,respectively; the levels of iodine content in thyroid gland were (0.21 ± 0.09),(0.29 ±0.08),(0.24 ± 0.05),(0.50 ± 0.10),(0.37 ± 0.13),(0.42 ± 0.12)g/kg,respectively; the levels of urinary iodine median were 87.5,68.1,105.5,746.5,828.3,1014.2 μg/L,respectively.The variance analysis results of factorial design showed iodine and casein significantly influenced the serum iodine level(F =27.95,18.52,all P ＜0.05),however,there was no interaction between the two(F =0.81,P ＞ 0.05); iodine significantly influenced the iodine content in thyroid gland(F =31.35,P ＜ 0.05),the presence of iodine interacted with casein(F =3.34,P ＜0.05).In twelve months,the levels of serum iodine were (88.54 ± 12.33),(72.45 ± 7.73),(72.93 ± 13.61),( 106.26 ± 12.00),(90.03 ± 7.90),( 104.88 ± 11.67)μg/L,respectively; the levels of iodine content in thyroid gland were (0.58 ± 0.12),(0.40 ± 0.14),(0.69 ± 0.16),(0.84 ± 0.13),(0.89 ± 0.13),(1.02 ± 0.11 )g/kg,respectively;the levels of urinary iodine median were 104.8,121.5,102.7,829.1,1080.8,895.2 μg/L,respectively.The variance analysis results of factorial design showed iodine and casein significantly influenced the iodine content in serum and thyroid gland (F =42.78,7.42 and 66.62,7.90,all P ＜ 0.05),however,there was no interaction between the two(F =1.93,2.31,all P ＞ 0.05).Conclusions Long-term intake of iodine can significantly increase the iodine content in serum,thyroid gland and urine,but casein may accelerate iodine excretion and partly reduce the effect.
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Objective To study the effects of different levels of iodine concentration on insulin-like growth factors Ⅰ (IGF-1) mRNA expression of thyroid and breast in lactating rats. Methods Thirty Wistar female rats, having been weaned for 1 month, were randomly divided into three groups according to their body weights, i. e. :low iodine(LI) group,adequate iodine(AI) group, high iodine(HI) group, 10 rats in each group. Synthetic fodder and deionized water containing iodine of 0,150,3000 μg/L was respectively fed to these rats. After fed for 3 months, the rats mated and had offspring. Their mammary glands, thyroids and serum were sampled at lactation day 5. The serum iodine of lactating rats were determined by moderate acid digestion method, level of T3 and T4 were determined by radioimmunoassay method, and the expressions of IGF-1 mRNA of mammary glands and thyroids were determined by real-time fluorescence quantitative PCR assay. Results The value of serum iodine of LI group [(17.38±3.27) μg/L] was lower than that of AI group [(43.42±6.92) μg/L, P<0.05], and the value of serum iodine of HI group[(350.10±38.46)μg/L] was higher than that of AI group (P<0.05). The level of T3 of LI group and HI group[ (1.11±0.25), (1.61±0.33)μg/L] reduced obviously compared with that of AI group[(2.18±0.46) μg/L, P<0.05]. The mean of T4 of LI group and HI group[(33.40±11.11),(56.54±10.38)μg/L] had no statistical significance compared with AI group(44.02±12.51)μg/L, P>0.05), but the level of T4 of LI group was lower than that of HI group(P<0.05). The level of IGF-1 mRNA expression of thyroid in LI group and HI group (0.34±0.08, 0.23±0.08) was higher than that of AI group(0.15±0.03, P<0.05). The level of IGF-1 mRNA expression of lactating mammary in LI group(0.59±0.18) was higher than that of AI group(0.40±0.10, P<0.05). The level of IGF-1 mRNA expression of thyroid was lower than that of breast between the same group(t=3.54, 6.44,2.62, all P<0.05). Conclusion Iodine could affect IGF-1 mRNA expression of thyroid and lactating mammary, and IGF-1 mRNA expression of lactating mammary was stronger than that of the thyroid.
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Objective To investigate the occurrence of new cretinism cases and the prevalence of endemic goiter, and the reason of lower coverage rate of iodized salt in the iodine deficiency disorders(IDD) high-risk areas of China, so as to put forward target prevention measures for these areas. Methods A hundred and one counties from 11 provinces(autonomous regions, municipality), such as Tibet, Qinghai, Xinjiang, Gansu, Ningxia, Sichuan, Hainan, Chongqing, Yunnan, Guangxi, Inner Mongolia, were chosen into the survey by simple random sampling. In the counties of high risk, typical sampling principle was used. In the selected townships, searching for new cretinism cases were carried out in the children under 10 years old, the thyroid volume of children aged 8-10 years old were determined by B-ultrasonography methods and their urinary iodine (UI) were determined by As3-Ce<'4+> catalytic spectrophotometry, the intelligence quotient(IQ) values of children aged 8-10 years old were measured by the combined Raven Test in China. In the household survey, the housewives were asked to fill in the questionnaire, the iodized salt coverage rates and the UI levels of child-bearing age women were investigated, the salt iodine content was determined using self-quantitative kit. Epi Info software was used to analyze the determination results. Results In the 101 high-risk counties, 249 were diagnosed as new cretinism cases from 4122 suspected cases searched. The goiter rate of children aged 8-10 years old by B-ultrasound was 8.28% (4434/53 541), 44 counties had goiter rates in the range of 5%-20%, 5 counties had goiter rates in the range of 20%-30%, and 3 counties had goiter rates of 30%. The mean IQ of children was 85.44, and the percentage of IQ value less than 70 was 16.52%(8713/52 745). The median urinary iodine(MUI) of children was 154.69 μg/L, the percentage of UI less than 50 μg/L was 17.26% (9069/52 558). Twenty-five counties had a MUI of children less than 100 μg/L. The MUI of housewives was 107.14 μg/L, the percentage of UI less than 50 μg/L was 27.50% (3722/13 534). MUI of housewives in 46 counties were less than 100.0 μg/L. The coverage rate of iodized salt at household level was 77.85%(13 150/16 891). The coverage rate of iodized salt was 52.80%(1585/3002), 44.72% (631/1411) and 72.82% (1850/2506) in Tibet, Hainan and Qinghai, respectively. More than 10% residents of Tibet, Sichuan, Hainan, Gansu and Qinghai complained that iodized salt was not convenient to buy. There were 71.39%(7652/10 719) of observed people ate crude salt. The average price of crude salt price(0.30-1.20 Yuan/kg) was lower than iodized salt(1.20-3.00 Yuan/kg). Conclusions In these IDD high-risk areas, the risk of endemic goiter and cretinism prevalence is threatening. The IDD monitoring should be carried out successively in these high-risk areas. The prevention measures, increasing iodized salt coverage rate and establishing the sustainable mechanism for eliminating IDD should be strengthened. Emergent iodine fortification measure for high risk region people should be implemented as soon as possible, a long term effective mechanism of eliminating IDD should be established.
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Objective To explore the effects of different vitamin A(VA) levels on thyroid cells apoptosis and its gene expression of mice taking excessive iodine. Methods Kunming mice were randomly divided into 6 groups according to body weight 3 weeks after born: normal control(NI) group, high iodine(HI) group, low vitamin (LVA) group, high iodine plus low vitamin A(HI+LVA) group, high iodine plus vitamin A1 (HI+VA1) group, high iodine plus vitamin A2(HI+VA2) group. The VA was given in food(4000,4000,0,0,8000,16 000 U/kg), and the iodine was given as potassium iodate in water (I-:50,3000,50,3000,3000,3000 μg/L). The apoptosis was tested using in situ end labehng(TUNEL) method. Reverse transcription polymerase chain reaction (RT-PCR) were used to measure the level of mRNA of apoptosis gene(Fas, FasL, Bcl-2) in tissues. Results Apoptotic index measured by TUNEL method was rising along with the mice age. Compared to NI group[(14.09±5.68)%], apoptotic index was significantly increased in HI[(20.91±9.57)%], HI+LVA[(20.29±9.90)%]and HI+VA2 [(19.51±8.25)%]groups in the three months(P < 0.05). Compared to NI group[(16.80±9.90)%], apoptotic index was significantly increased(P < 0.05) in HI[(23.22±8.58)%],LVA[(22.56±6.17)%],HI+LVA [(25.99±9.62)%],HI+VA1 [(21.65±7.74)%]groups in the six months. Compared with the NI group(Fas: 1.29±0.25,1.27±0.26; FasL: 1.60±0.13,1.65±0.13), the mRNA levels of Fas and FasL in HI group(Fas: 1.57±0.36,1.49±0.35; FasL: 1.85±0.46,1.84±0.32) were increased, but the differences were not remarkable(P > 0.05) in the three and six months. Compared with the HI group, the mRNA levels of Fas in HI+ VA1, HI+VA2(1.33±0.35, 1.30±0.26) groups were decreased to the level in NI group in the six months. The mRNA levels of Fas and FasL were not different (P > 0.05) between HI+LVA(I.60±0.27,1.88±0.46) and HI groups in the three months. The mRNA levels of Bcl-2 were not remarkably differences in the three months (1.05±0.19,0.96±0.33,0.95±0.26,1.18±0.27,1.10±0.19,0.98±0.36, all P > 0.05), and in the six months (1.35±0.28,1.60±0.25,1.48±0.18,1.71±0.26,1.66±0.29,1.56±0.35, all P > 0.05). Conclusions Excessive iodine can cause thyroid cells apoptosis in mice. Supplementation of suitable amount of VA can regulate the levels of the apoptosis-related genes expression, and partly antagonize the apoptosis caused by high iodine.
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Objective To observe the effects of casein and excessive iodine on histomorphalogY and ultrastructure of mouse thymicL Methods Based on 2 × 3 factorial design,the experimental mice were divided into 6 groupg Animal models were estabhshed by feeding the mice with different levels of iodine water and casein food.The levels of iodine were 50,600 μg/L in drinking water and 0(Ⅰ),10%(Ⅱ),20%(Ⅲ)of casein in food respectively.After 12 months,the thyroid weight was measured and the morphology of thyroid was observed under optical and electron microscope.Results Factorial analysis showed that iodine factors obviously affected the thyroid absolute and relative weiights of mice(F=16.23,9.47,P＜0.01),and there was interaction between casein and iodine(F=5.29,4.68,P＜0.01 or＜0.05).Compared wiht 150Ⅰ[(5.91±0.82)rag,(117.0±22.2)mg/kg]and 50Ⅲ[(4.90±0.63)rag,(106.1±13.3)mg/kg]groups.thyroid absolute and relative weights of the mice increased in 600 Ⅰ[(7.60±2.40)mg,(143.3±43.2)mg/kg]and 600Ⅲ[(8.63±1.88)mg,(166.2±39.4)mg/kg]groups(P＜0.05 or＜0.01),respectively.But compared with 600 Ⅰ and 600Ⅲ groups.they were reduced obviously in 600Ⅱ[(5.76±1.13)mg,(109.8±16.5)mg/kg]group(P＜0.05 or＜O.01).Colloid goiter,lymphocyte infiltration were found,some of the follicles epithelial cells appeared active under light and electron microscope in iodine excels group,which,however,decreased obviously along with the increase of casein dose.Conclusions Long-term excessive iodine may cause colloid goiter and inflammation injury of mice,possibly leading the development of thyroiditis in mice,which may be partly reduced by casein.
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Objective In order to compare the iodine deficiency disorders(IDD)prevalent slatus in Chun'an County between 2006 and 2007,and to provide the science information for iodine supplementation in different regions.Methods Three schools of Wangzhai,Pingmen and Wenchang which the goiter prevalenee was the most severe were selected in Chun'an County;and from each school,90 pupils aged 8-10 years were randomly selected.B-ultrasound examination of thyroids,urine iodine and salt iodine were measured.Results The goiter rate in B-ultrasound were 7.5%(20/267),median of urine iodine was 247.5 μg/L,mean of salt iodine was 32.7 ms/ks in 2006;and the goiter rate in B-uhrasound were 3.7%(10/271),median of urine iodine was 383.4 μg/L,mean of salt iodine was 33.5 mg/kg in 2007.The goiter prevalence in Wangzhai,Pingrnen and Wenehang township were 15.2%(14/92),6.0%(5/83)and 2.2%(2/92),respectively,and median of urine iodine were 360.1.211.3,189.3μg/L,respectively,in 2006;The goiter prevalence were 6.6%(6/91),3.3%(3/90)and 1.1%(1/90),respectively.and median of urine iodine were 388.6,41 1.5,327.8μg/L,respectively,in 2007.Family ineome of Wangzhai,Pingmen and Wenchang township were 1000,2000,3000 yuan,respectively.Conclusions Goiter prevalence was correlated with urinary iodine,nutritional state and economic condition,high urinary iodine contents and poor nutritional status lcad to a high goiter rate.