AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sph...AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sphincter of Oddi manometry （ESOM）, and to assess the postendoscopic sphincterotomy （EST） outcome. METHODS： We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy （QHBS）, and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary type Ⅰ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic＇ cholecystectomized volunteers （attended to our hospital for general cardiovascular screening） completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain （frequency and intensity） was assessed with a visual analogue scale （VAS）. In 40 of 80 patients having definite SOD （i.e. patients with SOD biliary type Ⅰ and those with elevated SO basal pressure on ESOM）, an EST was performed just afl：er ERCP. In these patients repeated questionnaires were filled at each follow-up visit （at 3 and 6 too） and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS： The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre-and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 （43%） patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION： Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST.展开更多
Addressing concerns about mitigating greenhouse gas （GHG） emissions while maintaining high grain yield requires improved management practices that achieve sustainable intensification of cereal production systems. In...Addressing concerns about mitigating greenhouse gas （GHG） emissions while maintaining high grain yield requires improved management practices that achieve sustainable intensification of cereal production systems. In the North China Plain, a field experiment was conducted to measure nitrous oxide （N2O） and methane （CH4） fluxes during the maize （Zea mays L.） season under various agricultural management regimes including conventional treatment （CONT） with high N fertilizer application at a rate of 300 kg N ha-1 and overuse of groundwater by flood irrigation, optimal fertilization 1 treatment （OPTIT）, optimal fertilization 2 treatment （OPT2T）, and controlled-release urea treatment （CRUT） with reduced N fertilizer application and irrigation, and a control （CK） with no N fertilizer. In contrast to CONT, balanced N fertilization treatments （OPT1T, OPT2T, and CRUT） and CK demonstrated a significant drop in cumulative N20 emission （1.70 v.s. 0.43-1.07 kg N ha-l）, indicating that balanced N fertilization substantially reduced N20 emission. The vMues of the N20 emission factor were 0.42%, 0.29%, 0.32%, and 0.27% for CONT, OPTIT, OPT2T, and CRUT, respectively. Global warming potentials, which were predominantly determined by N20 emission, were estimated to be 188 kg CO2-eq ha-1 for CK and 419-765 kg CO2-eq ha-1 for the N fertilization treatments. Global warming potential intensity calculated by considering maize yield was significantly lower for OPT1T, OPT2T, CRUT, and CK than for CONT. Therefore, OPTIT, OPT2T, and CRUT were recommended as promising management practices for sustaining maize yield and reducing GHG emissions in the North China Plain.展开更多
文摘AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sphincter of Oddi manometry （ESOM）, and to assess the postendoscopic sphincterotomy （EST） outcome. METHODS： We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy （QHBS）, and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary type Ⅰ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic＇ cholecystectomized volunteers （attended to our hospital for general cardiovascular screening） completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain （frequency and intensity） was assessed with a visual analogue scale （VAS）. In 40 of 80 patients having definite SOD （i.e. patients with SOD biliary type Ⅰ and those with elevated SO basal pressure on ESOM）, an EST was performed just afl：er ERCP. In these patients repeated questionnaires were filled at each follow-up visit （at 3 and 6 too） and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS： The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre-and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 （43%） patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION： Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST.
基金Supported by the National Natural Science Foundation of China(Nos.30870414 and 31170489)the Special Fund for Agroscientific Research in the Public Interest of China(No.201103039)
文摘Addressing concerns about mitigating greenhouse gas （GHG） emissions while maintaining high grain yield requires improved management practices that achieve sustainable intensification of cereal production systems. In the North China Plain, a field experiment was conducted to measure nitrous oxide （N2O） and methane （CH4） fluxes during the maize （Zea mays L.） season under various agricultural management regimes including conventional treatment （CONT） with high N fertilizer application at a rate of 300 kg N ha-1 and overuse of groundwater by flood irrigation, optimal fertilization 1 treatment （OPTIT）, optimal fertilization 2 treatment （OPT2T）, and controlled-release urea treatment （CRUT） with reduced N fertilizer application and irrigation, and a control （CK） with no N fertilizer. In contrast to CONT, balanced N fertilization treatments （OPT1T, OPT2T, and CRUT） and CK demonstrated a significant drop in cumulative N20 emission （1.70 v.s. 0.43-1.07 kg N ha-l）, indicating that balanced N fertilization substantially reduced N20 emission. The vMues of the N20 emission factor were 0.42%, 0.29%, 0.32%, and 0.27% for CONT, OPTIT, OPT2T, and CRUT, respectively. Global warming potentials, which were predominantly determined by N20 emission, were estimated to be 188 kg CO2-eq ha-1 for CK and 419-765 kg CO2-eq ha-1 for the N fertilization treatments. Global warming potential intensity calculated by considering maize yield was significantly lower for OPT1T, OPT2T, CRUT, and CK than for CONT. Therefore, OPTIT, OPT2T, and CRUT were recommended as promising management practices for sustaining maize yield and reducing GHG emissions in the North China Plain.
