Iodine monitoring models contribute to avoid adverse birth outcomes related more than adequate iodine intake.

BACKGROUND: Iodine plays an important role in pregnancy. How to maintain adequate iodine intake amongst pregnant women in each trimester of pregnancy to prevent adverse birth outcomes in central China is a challenge for clinical practice. METHODS: 870 pregnant women and their infants were enrolled in the study. Urinary iodine concentration (UIC) was measured using an inductively coupled plasma mass spectrometry (ICP-MS). Maternal and newborn information were obtained during follow-up. Multinomial logistic regression models were established. RESULTS: Median UIC of pregnant women was 172 ± 135 µg/L which is currently considered to be sufficient. Multivitamin supplements containing iodine, iodized salt intake and frequent milk intake were significantly associated with higher UIC. Multivariate logistic regression analysis showed that multivitamin supplements containing iodine and milk consumption were risk factors for more than adequate iodine (UIC ≥ 250 µg/L). Iodine-rich diet was significantly related to heavier birthweight, larger head circumference and longer femur length of the newborns while more than adequate iodine intake (UIC ≥ 250 µg/L) was a risk factor for macrosomia. Logistic regression models based on potential risk factors involving iodine containing supplements and iodine-rich diet were established to predict and screen pregnant women with high risk of more than adequate iodine intake among local pregnant women in different trimesters and guide them to supplement iodine reasonably to prevent the risk. CONCLUSIONS: Multivitamin supplements containing iodine and milk consumption were risk factors for maternal UIC ≥ 250 µg/L which was a risk factor for macrosomia. Iodine monitoring models were established to provide guidance for pregnant women to reduce the risk of more than adequate iodine intake, thereby contributing to reduce the risk of having a macrosomia.

Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy.

OBJECTIVES: Anastomotic leakage is a major cause of mortality in oesophageal surgery. Whether omentoplasty after oesophagogastrostomy could reduce anastomotic leakage is still controversial. The aim of this study is to investigate the function of omentoplasty to reinforce cervical oesophagogastrostomy after radical oesophagectomy with three-field lymphadenectomy. METHODS: A total of 184 patients who underwent radical oesophagectomy with three-field lymphadenectomy took part in this prospective study. Patients were randomized to receive either the omentoplasty or non-omentoplasty. In the omentoplasty group, the omentum was wrapped around the oesophagogastric anastomosis after oesophagogastrostomy. Age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease, peripheral vascular disease and performance of omentoplasty were recorded. The anastomotic leakage and stricture and recurrence site were followed up for three years after the operation. RESULTS: The two groups were comparable in terms of age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease and peripheral vascular disease (P > 0.05). In contrast to the non-omentoplasty group with a postoperative anastomotic leakage rate of 9.8%, the omentoplasty subjects demonstrated a significantly lower rate of 3.3% (P < 0.05). No lethal leakage was found in the omentoplasty group, while two non-omentoplasty patients developed incurable empyema and mediastinitis due to leakage and ultimately died. The rate of incidence of anastomotic stricture in the omentoplasty and non-omentoplasty groups were 4.3% and 2.2% respectively. Of the five cases of death during the hospital stay, two were found in the omentoplasty group and three in non-omentoplasty. There was no significant difference of lethal leakage, stricture and death rate between the two groups (P > 0.05). The hospital stay was significantly longer for non-omentoplasty patients, compared with that for the omentoplasty subjects (P < 0.05). Tumour recurrence in lymphatic- or haematogenous metastasis was similar in both groups (P > 0.05). CONCLUSION: Omentoplasty may prevent anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy.