Comparison between air and carbon dioxide insufflation in the endoscopic submucosal excavation of gastrointestinal stromal tumors

AIM:To evaluate the safety and efficacy of CO2 insufflation compared with air insufflation in the endoscopic submucosal excavation(ESE) of gastrointestinal stromal tumors.METHODS:Sixty patients were randomized to undergo endoscopic submucosal excavation,with the CO2 group(n = 30) and the air group(n = 30) undergoingCO2 insufflation and air insufflation in the ESE,respectively.The end-tidal CO2 level(pETCO2) was observed at 4 time points:at the beginning of ESE,at total removal of the tumors,at completed wound management,and 10 min after ESE.Additionally,the patients' experience of pain at 1,3,6 and 24 h after the examination was registered using a visual analog scale(VAS).RESULTS:Both the CO2 group and air group were similar in mean age,sex,body mass index(all P > 0.05).There were no significant differences in PetCO2 values before and after the procedure(P > 0.05).However,the pain scores after the ESE at different time points in the CO2 group decreased significantly compared with the air group(1 h:21.2 ± 3.4 vs 61.5 ± 1.7;3 h:8.5 ± 0.7 vs 42.9 ± 1.3;6 h:4.4 ± 1.6 vs 27.6 ± 1.2;24 h:2.3 ± 0.4 vs 21.4 ± 0.7,P < 0.05).Meanwhile,the percentage of VAS scores of 0 in the CO2 group after 1,3,6 and 24 h was significantly higher than that in the air group(60.7 ± 1.4 vs 18.9 ± 1.5,81.5 ± 2.3 vs 20.6 ± 1.2,89.2 ± 0.7 vs 36.8 ± 0.9,91.3 ± 0.8 vs 63.8 ± 1.3,respectively,P < 0.05).Moreover,the condition of the CO2 group was better than that of the air group with respect to anal exsufflation.CONCLUSION:Insufflation of CO2 in the ESE of gastrointestinal stromal tumors will not cause CO2 retention and it may significantly reduce the level of pain,thus it is safe and effective.

Characteristics of greenhouse gas emission in three full-scale wastewater treatment processes

Three full-scale wastewater treatment processes, Orbal oxidation ditch, anoxic/anaerobic/aerobic （reversed A^2O） and anaerobic/anoxic/aerobic （A^2O）, were selected to investigate the emission characteristics of greenhouse gases （GHG）, including carbon dioxide （CO2）, methane （CH4） and nitrous oxide （N2O）. Results showed that although the processes were different, the units presenting high GHG emission fluxes were remarkably similar, namely the highest CO2 and N2O emission fluxes occurred in the aerobic areas, and the highest CH4 emission fluxes occurred in the grit tanks. The GHG emission amount of each unit can be calculated from its area and GHG emission flux. The calculation results revealed that the maximum emission amounts of CO2, CH4 and N2O in the three wastewater treatment processes appeared in the aerobic areas in all cases. Theoretically, CH4 should be produced in anaerobic conditions, rather than aerobic conditions. However, results in this study showed that the CH4 emission fluxes in the forepart of the aerobic area were distinctly higher than in the anaerobic area. The situation for N2O was similar to that of CH4： the N2O emission flux in the aerobic area was also higher than that in the anoxic area. Through analysis of the GHG mass balance, it was found that the flow of dissolved GHG in the wastewater treatment processes and aerators may be the main reason for this phenomenon. Based on the monitoring and calculation results, GHG emission factors for the three wastewater treatment processes were determined. The A^2O process had the highest CO2 emission factor of 319.3 g CO2/kg CODremoved, and the highest CH4 and N2O emission factors of 3.3 g CH4/kg CODremoved and 3.6 g N2O/kg TNremoved were observed in the Orbal oxidation ditch process.