Objective To explore the iodine status of pregnant women after 17 years of salt iodization in rural areas of Shijiazhuang City.Methods Probability proportionate to size sampling was employed in which 30 towns were selected from the 211 towns in the rural areas of Shijiazhuang City.In each town selected,40 pregnant women were randomly selected to collect their spot urine samples,edible salt samples and drinking water samples from their households to measure iodine content.The iodine content of salt was determined quantitatively using a titration method (GB/F 13025.7-2012).The urinary iodine content was determined using the method of ammonium persulfate digestion arsenic cerium catalytic spectrophotometry (WS/T 107-2006).The iodine content in drinking water was determined by the method of standard test for drinking water.Results A total of 1 200 salt samples was collected from the pregnant women's households in 30 towns,with the overall median iodine content being 27.2 mg/kg.The median salt iodine content in 30 towns varied from 23.4 to 32.6 mg/kg.A total of 478 water samples were collected,with a median of 5.3 μg/L.The median urinary iodine content (UIC) of 1 200 pregnant women in 30 towns was 146.4 μg/L.The median UIC in the first (≤ 13 weeks),second (14 ～ 26 weeks) and third (≥27 weeks) trimesters was 166.3,145.1 and 133.5 μg/L,respectively.The median UIC in the first trimester was significantly higher than that in the third trimester (Mann-Whitney Test,U =18 265,P ＜ 0.05).Except for the 9-20 and 37-40 weeks period of pregnancy,the median UIC was lower than the WHO criteria (150 μg/L).Tested by linear correlation,the pregnant women's median UIC did not correlate with median salt iodine (r =0.725,P ＞ 0.05).Conclusion Under the current universal salt iodization,the pregnant women's iodine intake could almost meet their requirement in the rural areas of Shijiazhuang City,however,mild iodine deficiency has existed in the third trimester.Alternative measures of iodine supplement could be implemented.

Objective To analyze the prevention and treatment of postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 142 patients undergoing pancreaticoduedenectomy from Jan 1995 to Dec 2008 were retrospectively analyzed. Results The incidence of postoperative hemorrhage was 14.1% (20/142), the mortality caused by this complication was 35% (7/20). Among these patients, intra-abdominal hemorrhage occurred in seven cases, and gastrointestinal hemorrhage occurred in 14 cases, with one case suffering both. There were three and four cases of early and delayed intra-abdominal hemorrhage respectively. Early and delayed gastrointestinal hemorrhage occurred in three and eleven cases respectively. Univariate analysis showed that operative blood loss, blood transfusion, infection and pancreatic fistula were significantly associated with postoperative hemorrhage. Multivariate analysis using Logistic regression identified two variables as independent factors associated with postoperative hemorrhage, namely, infection(OR=6.918) and pancreatic fistula(OR=3.948). Conclusions The incidence and mortality of hemorrhage after pancreaticoduodenectomy is still high. Skillful operation and prevention of pancreatic fistula, infection and stress ulcer are the key paints for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset and severity of hemorrhage.

Objective To investigate the way to accurately delineate gross tumor volume (GTV) of high grade gliomas(HGG) for intensity modulated radiation therapy (IMRT) by using computed tomography (CT) and magnetic resonance imaging (MRI) image fusion technique. Methods CT and MRI images were fused from 19 patients. The GTV of each patient were independently delineated by one chief doctor and one resident doctor on CT and MRI image. The GTV contoured on CT (GTVCT), MRI (GTVMRI) were measured, and composite volumes (GTVCT+MRI) were the sum of CT-defined GTV and MRI-defined GTV. The differences of these volumes were compared. Results Whether chief or resident doctors delineated, all were GTVMRI ＞GTVCT(P ＜0.050). The percentages of GTVMRI on GTVCT+MRI were (98.57±7.00)% by chief doctors, and (97.84±10.00)% by resident doctors. Compared the difference between GTVCT and GTVMRI in postoperative patients and preoperative patients, P =0.046, and the difference between chief doctors and resident doctors was statistically significant for GTV defined by CT (P =0.020), but not by MRI and composite image (P ＞0.050).Conclusion The GTV of HGG patients must be delineated on both CT image and MRI image, including using CT and MRI image fusion. But the composite volumes(GTVCT+MRI) should be the sum of CT-defined GTV and MRI-defined GTV. Especially for the postoperative patients,delineating GTV should be taken more attention. And the GTV should be delineated by doctors with full experiences.

Objective To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.Methods Clinical data of 351 patients who underwent pancreaticoduodenectomy in our hospital from Jan 2001 to Dec 2015 were retrospectively analyzed.Results The overall incidence of pancreatic fistula was 20.2％ (71/351),with grade A in 34 (9.7％) patients,grade B in 25 (7.1％),and grade C in 12 (3.4％).Postoperative hospital stay was significantly prolonged in patients with grade B and C pancreatic fistula.Multivariate analysis using Logistic regression identified three variables as independent factors associated with pancreatic fistula,namely,BMI (OR =2.281),preoperative total bilirubin level (OR =2.180) and soft pancreatic texture (OR =3.653).Preoperative total bilirubin level (OR =2.684),soft pancreatic texture (OR =5.128) and postoperative hemorrhage (OR =9.030) were independent risk factors of grade B and C pancreatic fistula after pancreaticoduodenectomy.Conclusions The incidence of pancreatic fistula after pancreaticoduodenectomy is still high.Pancreatic fistula prolongs the postoperative hospital stay significantly.The incidence of grade B and C pancreatic fistula could be reduced by avoiding postoperative hemorrhage.

Objective To investigate the significance of tumor markers CEA and CA19-9 in predicting the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.Methods A retrospective analysis of 110 cases with primary duodenal carcinoma treated in our hospital from January 1999 to December 2016 was conducted.ROC analysis,univariate and multivariate analysiswere performed to investigate the relationship between CEA,CA19-9 and the clinicopathologic characteristics of primary duodenal carcinoma.Kaplain-Meier method was used to analyze the relationship between CEA and CA19-9 and the prognosis of primary duodenal carcinoma.Results CEA level was of value for predicting the depth of infiltration,lymphatic involvement,metastasis and TNM stage.The receiver operating characteristic was 0.629,0.672,0.749,0.692 respectively.Univariate analysis showed serum CA19-9 lever was related to the depth of infiltration and serum CEA lever were related to tumor differentiation,lymphatic invasion,metastasis and TNM stage.Logistic analysis showed that CEA value was only associated with metastasis (OR:9.853,P ＜ 0.01).Patients with elevated serum CEA level had a significant worse prognosis than patients with normal serum CEA level (P ＜ 0.05).Conclusion Serum CEA level was closely associated with the clinicopathologic characteristics and prognosis of primary duodenal carcinoma.

Primary hepatic lymphoma (PHL) is an extremely rare disease without any unified diagnostic criterion.The symptoms are usually nonspecific.Liver biopsy remains the most valuable tool for diagnosis of PHL.The predominant histology of PHL is diffuse large B-cell lymphoma.The therapeutic modalities are variable,including surgery,chemotherapy,radiotherapy,or combination of the various processes.This article described a 33-year-old man with diffuse large B-cell PHL who was treated at the Affiliated Cancer Hospital of Shanxi Medical Univeitity Blood Disease Diagnosis and Treatment Center in February 2014.The patient benefited from eight-cycle chemotherapy.At present,the patient is disease-free and undergoes regular follow-up.

Objective To analyze the risk factors for delayed gastric emptying (DGE) after pancreaticoduodenectomy.Methods Clinical data of 213 patients who underwent pancreaticoduodenectomy at our hospital from January 1996 to December 2011 was retrospectively analyzed.Results The overall incidence of DGE was 40.8％ (87/213).The incidence of grade A,grade B and grade C DGE was 14.1％ (30/213),14.5 ％ (31/213) and 12.2％ (31/213) respectively.Median postoperative hospital stay was significantly prolonged in patients with DGE:30.5,32 and 61 days for grade A,B and C respectively versus 21 days in patients without DGE (x2 =66.171,P =0.000).Univariate analysis showed that operation time (≥420 min),intraoperative blood loss (≥ 1000 ml),Child alimentary reconstruction and pancreatic fistula were risk factors for postoperative DGE.Multivariate analysis using Logistic regression identified three variables as independent risk factors associated with postoperative DGE,namely,Child alimentary reconstruction (OR =2.098),intraoperative blood loss (≥ 1000 ml) (OR =2.525) and pancreatic fistula (OR =4.821).Grade C DGE was more frequently seen in patients suffering from postoperative pancreatic fistula.Conclusions The incidence of DGE after pancreaticoduodenectomy is still high.DGE prolongs the postoperative hospital stay significantly.The incidence of DGE could be reduced by Roux-en-Y reconstruction and reducing intraoperative blood loss.Postoperative pancreatic fistula is significantly associated with DGE,especially grade C DGE.

Objective:To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma(SHCC).Methods:Sixty five SHCC patients with intact clinical data, treated in the Center of Hepatobiliary Surgery, Peking University People's Hospital between Feb 2005 and Aug 2012, were enrolled in this study. Among them, 30 patients were treated by MWA, and the other 35 by hepatectomy. Follow-up was conducted from Mar 2013 to Feb 2021. The differences in long-term survival, intraoperative blood loss, operative time, postoperative complications, performance status (PS), and postoperative hospital stay were compared between the two groups.Results:The survival probability at 1, 3, 5 and 10 years was 93.2%, 82.5%, 55.6% and 41.2%, respectively, in the MWA group, and 97.1%, 82.6%, 67.2% and 48.3%, in the resection group ( P=0.347). The MWA group had less perioperative complications, less blood loss, shorter operation time, better PS score and better hospital stay than the surgical resection group (all P<0.001).There was no statistically significant difference in the survival rate between BCLC stage 0~A1 and A2~A4 patients( P=0.773, 0.536). Conclusions:Microwave ablation in the treatment of small hepatocellular carcinoma can achieve similar results as hepatectomy with less traumatic,better postoperative PS score and shorter postoperative hospital stay.

Objective To investigate the diagnosis and treatment of upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension.Methods The clinical diagnosis and follow-up data of 13 patients with upper gastrointestinal hemorrhage caused by pancreatic segmental portal hypertension from Jan 2010 to Dec 2017 were retrospectively analyzed.Results Of the 13 patients,5 had pancreatic pseudocysts and 8 had chronic pancreatitis.All of them had a history of hematemesis or (and) tarry feces,and 2 of them had a history of hemorrhagic shock.13 patients had isolated gastric varices,and 5 of them had varicose veins in the lower esophagus.13 patients had splenomegaly and hypersplenism,and all patients underwent splenectomy.All patients were followed up,and the varicose veins were significantly improved or disappeared.During 1 year to 8 years of follow-up,there was no rebleeding.Conclusion Splenectomy cures upper gastrointestinal hemorrhage caused by rupture of the varicose veins in patients of pancreatic segmental portal hypertension.Preoperative interventional spleen artery embolization can reduce the difficulty of spleen resection.

Objective To investigate the complication and risk factors in elderly patients undergoing pancreaticoduodenectomy (PD).Methods From Jan 2005 to Dec 2016,358 consecutive patients undergoing PD were divided into ≥ 70 years group (98 cases) and ＜ 70 years group (260patients).Perioperative complications were compared and risk factors explored between the two groups.Results There were differences in coronary heart disease between the two groups in the preoperative medical comorbidities (P =0.008),and that of albumin,alanine aminotransferase,alkaline phosphatase and creatinine (all P ＜ 0.05).Perioperative mortality was higher in the elderly group than in the younger group (P =0.038),probably related to higher systemic complications (P =0.001).The independent risk factors influencing the postoperative medical complications were preoperative total bilirubin ≥ 171 μmol/L and intraoperative blood loss ≥ 1 000 ml.Conclusions Patients over 70 years old have a comparatively higher perioperative mortality rate after pancreaticoduodenectomy,which were probably derived from a higher postoperative vital organ dysfunction.