Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and C...Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBD calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi to<5 mm size and clear the same during ERCP.Complete clearance of the CBD was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.展开更多
The analysis of environmental impact effects on forest ecosystems has a theoretical and practical nature. Many methods have been developed to determine characteristics and intensity of this impact. Methodologically, t...The analysis of environmental impact effects on forest ecosystems has a theoretical and practical nature. Many methods have been developed to determine characteristics and intensity of this impact. Methodologically, they can be divided into three groups： environmental parameter, bioindicative and combined methods. To evaluate the environmental impact a combined method was used in this study, it was based on trees as the bioindicators and their response reactions, and environmental parameter analysis. In this study the bioindicator was Norway spruce （Picea abies （L.） Karst.）, whose response reaction was used to explain total impact volumes of environmental factors in different places in the region of Kurzeme and try to interpret the causes of these differences. As the bioindicators criterion was used response reaction of Norway spruce during a period of 20 years, which was expressed with cumulative and annual additional volume increment, and was depending on the location of the stand and its morphometric characteristics. The empirical material was collected in Kurzeme region in 28 sample plots that are located on two transects and in one reference stand. For the evaluation the widths of the last 40 year growth rings were measured. To express the environmental impact in Kurzeme region a multiple regression model was developed, which explains the environmental impact in the volume of 68.2%, the rest part can be explained by the local conditions of each stand. It must be noted that methodology used in this study is very sensitive, thus, each of the nuances in the dynamics of volume＇s annual reduced additional increments has biological and ecological cause.展开更多
Wastewater from the production of cellulosic ethanol was treated by the processes of internal micro-electrolysis method ＋ABR＋UASB ＋MBR. The results of running indicated that, when COD is 12000 mg/L and HRT of UASB ...Wastewater from the production of cellulosic ethanol was treated by the processes of internal micro-electrolysis method ＋ABR＋UASB ＋MBR. The results of running indicated that, when COD is 12000 mg/L and HRT of UASB is 48 h, the COD removal rate reaches 72% and HRT of MBR is 20 h, COD removal rate is between 80.8% and 87.5%. The effluent COD concentration stabilized at 301- 537 mg/L, it indicates that the MBR system has a strong ability to resist impact load.展开更多
文摘Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBD calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi to<5 mm size and clear the same during ERCP.Complete clearance of the CBD was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.
文摘The analysis of environmental impact effects on forest ecosystems has a theoretical and practical nature. Many methods have been developed to determine characteristics and intensity of this impact. Methodologically, they can be divided into three groups： environmental parameter, bioindicative and combined methods. To evaluate the environmental impact a combined method was used in this study, it was based on trees as the bioindicators and their response reactions, and environmental parameter analysis. In this study the bioindicator was Norway spruce （Picea abies （L.） Karst.）, whose response reaction was used to explain total impact volumes of environmental factors in different places in the region of Kurzeme and try to interpret the causes of these differences. As the bioindicators criterion was used response reaction of Norway spruce during a period of 20 years, which was expressed with cumulative and annual additional volume increment, and was depending on the location of the stand and its morphometric characteristics. The empirical material was collected in Kurzeme region in 28 sample plots that are located on two transects and in one reference stand. For the evaluation the widths of the last 40 year growth rings were measured. To express the environmental impact in Kurzeme region a multiple regression model was developed, which explains the environmental impact in the volume of 68.2%, the rest part can be explained by the local conditions of each stand. It must be noted that methodology used in this study is very sensitive, thus, each of the nuances in the dynamics of volume＇s annual reduced additional increments has biological and ecological cause.
文摘Wastewater from the production of cellulosic ethanol was treated by the processes of internal micro-electrolysis method ＋ABR＋UASB ＋MBR. The results of running indicated that, when COD is 12000 mg/L and HRT of UASB is 48 h, the COD removal rate reaches 72% and HRT of MBR is 20 h, COD removal rate is between 80.8% and 87.5%. The effluent COD concentration stabilized at 301- 537 mg/L, it indicates that the MBR system has a strong ability to resist impact load.
