AIM： To describe characteristics of a poorly expandable （PE） common bile duct （CBD） with stones on en- doscopic retrograde cholangiography.METHODS： APE bile duct was characterized by a rigid and relatively narro...AIM： To describe characteristics of a poorly expandable （PE） common bile duct （CBD） with stones on en- doscopic retrograde cholangiography.METHODS： APE bile duct was characterized by a rigid and relatively narrowed distal CBD with retro- grade dilatation of the non-PE segment. Between 2003 and 2006, endoscopic retrograde cholangiography （ERC） images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Centerin Chang Gung Memoria acteristic PE bile duct on Hospital. Patients with char ERC were identified from the database. Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS： A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study. The median patient age was 45 years （range, 20 to 92 years）; 66.7% of the patients were men. The di ameters of the widest non-PE CBD segment, the PE segment, and the largest stone were 14.3 ± 4.9 mm, 5.8±1.6 mm, and 11.2±4.7 mm, respectively. The length of the PE segment was 39.7±15.4 mm （range, 12.3 mm to 70.9 mm）. To remove the CBD stone（s） completely, mechanical lithotripsy was required in 25 （83.3%） patients even though the stone size was not as large as were the difficult stones that have been described in the literature. The stone size and stone/ PE segment diameter ratio were associated with the need for lithotripsy. Post-ERC complications occurred in 4 cases： pancreatitis in 1, cholangitis in 2, and an im- pacted Dormia basket with cholangitis in 1. Two （6.7%） of the 28 patients developed recurrent CBD stones at follow-up （50±14 mo） and were successfully managed with therapeutic ERC.CONCLUSION： Patients with a PE duct frequently require mechanical lithotripsy for stones extraction, To retrieve stones successfully and avoid complications, these patients should be identified during ERC,展开更多
Gross ecosystem product(GEP) is the gross value of all ecosystem products and services provided by ecosystems for human society. In practice, GEP measures the ecosystems’ contributions to human well-being and constit...Gross ecosystem product(GEP) is the gross value of all ecosystem products and services provided by ecosystems for human society. In practice, GEP measures the ecosystems’ contributions to human well-being and constitutes one of the core issues in the construction of ecological civilization systems. Currently, GEP accounting faces a series of problems, such as the inconsistency of accounting subjects and a lack of accounting standards,the result of which is the non-reproducibility and weak applicability of accounting results. In this paper, mainstream models for ecosystem service valuation are summarized in a systematic manner. On this basis, eight basic principles are established for screening accounting indicators: biological productivity, human benefits, production territoriality, current increment, actual effectiveness, physical metrizability, data availability, and harmlessness. Next, a series of ecosystem service subjects are identified that need to be excluded from accounting, and the detailed reasons for their exclusion are presented. Finally, three ideas for improving GEP accounting are offered from the perspectives of the relationship between biological production and human production, the circulation-transport relationship and spatial differences, and harms to the ecosystem carrying capacity. The purpose is to provide positive considerations aimed at promoting the socio-economic applications of accounting and to contribute to the scientific quantification of the values of ecological products.展开更多
文摘AIM： To describe characteristics of a poorly expandable （PE） common bile duct （CBD） with stones on en- doscopic retrograde cholangiography.METHODS： APE bile duct was characterized by a rigid and relatively narrowed distal CBD with retro- grade dilatation of the non-PE segment. Between 2003 and 2006, endoscopic retrograde cholangiography （ERC） images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Centerin Chang Gung Memoria acteristic PE bile duct on Hospital. Patients with char ERC were identified from the database. Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS： A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study. The median patient age was 45 years （range, 20 to 92 years）; 66.7% of the patients were men. The di ameters of the widest non-PE CBD segment, the PE segment, and the largest stone were 14.3 ± 4.9 mm, 5.8±1.6 mm, and 11.2±4.7 mm, respectively. The length of the PE segment was 39.7±15.4 mm （range, 12.3 mm to 70.9 mm）. To remove the CBD stone（s） completely, mechanical lithotripsy was required in 25 （83.3%） patients even though the stone size was not as large as were the difficult stones that have been described in the literature. The stone size and stone/ PE segment diameter ratio were associated with the need for lithotripsy. Post-ERC complications occurred in 4 cases： pancreatitis in 1, cholangitis in 2, and an im- pacted Dormia basket with cholangitis in 1. Two （6.7%） of the 28 patients developed recurrent CBD stones at follow-up （50±14 mo） and were successfully managed with therapeutic ERC.CONCLUSION： Patients with a PE duct frequently require mechanical lithotripsy for stones extraction, To retrieve stones successfully and avoid complications, these patients should be identified during ERC,
基金The Projects of Shandong Social Science Planning(21CGLJ19)The Fundamental Research Funds of Shandong University(2020GN107).
文摘Gross ecosystem product(GEP) is the gross value of all ecosystem products and services provided by ecosystems for human society. In practice, GEP measures the ecosystems’ contributions to human well-being and constitutes one of the core issues in the construction of ecological civilization systems. Currently, GEP accounting faces a series of problems, such as the inconsistency of accounting subjects and a lack of accounting standards,the result of which is the non-reproducibility and weak applicability of accounting results. In this paper, mainstream models for ecosystem service valuation are summarized in a systematic manner. On this basis, eight basic principles are established for screening accounting indicators: biological productivity, human benefits, production territoriality, current increment, actual effectiveness, physical metrizability, data availability, and harmlessness. Next, a series of ecosystem service subjects are identified that need to be excluded from accounting, and the detailed reasons for their exclusion are presented. Finally, three ideas for improving GEP accounting are offered from the perspectives of the relationship between biological production and human production, the circulation-transport relationship and spatial differences, and harms to the ecosystem carrying capacity. The purpose is to provide positive considerations aimed at promoting the socio-economic applications of accounting and to contribute to the scientific quantification of the values of ecological products.
