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Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

World Journal of Gastroenterology 2008年第32期14卷 5032-5038页

作者： Jaap Jacob Kloek Otto Marinus van Delden Deha Erdogan Fibo Jan ten Kate Erik Anthoni Rauws Olivier Robert Busch dirk joan gouma Thomas Mathijs van Gulik Department of Surgery Academic Medical Center University of Amsterdam Department of Radiology Academic Medical Center University of Amsterdam Department of Pathology Academic Medical Center University of Amsterdam Department of Gastroenterology Academic Medical Centre University of Amsterdam

AIM: To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These fi ndings were analyzed to obtain the fi nal diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, groupⅡ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰvs 60% group Ⅱ P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰcompared to group Ⅱ The various imaging modalities showed vascular involvement exclusively in the malignant group (36%,P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

关键词： Biliary stricture Hilar cholangiocarcinoma Benign Radiological Vascular involvement cholangio

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White (Trifolium repensL.) and Arrowleaf (Trifolium vesiculosumSavi) Clover Emergence in Varying Loblolly Pine (Pinus taedaL.) Tree Alley Spacings

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American Journal of Plant Sciences 2019年第4期10卷 659-669页

作者： Taylor C.Adams dirk Philipp David M.Burner John Jennings Becky Mc Peake Amanda J.Ashworth Daniel H.Pote joan M.Burke Robert Rhein Department of Poultry Science University of ArkansasFayettevilleARUSA Animal Science Department University of ArkansasFayettevilleARUSA Retired US Department of AgricultureDale Bumpers Small Farms Research CenterBoonevilleARUSA Cooperative Extension Service University of ArkansasLittle RockARUSA US Department of Agriculture Poultry Production and Product Safety Research UnitFayettevilleARUSA US Department of Agriculture Dale Bumpers Small Farms Research CenterBoonevilleARUSA

Agroforestry systems have the potential to provide year-long income opportunities via the integrated forage or crop, timber, and livestock. Legumes are an attractive alternative option during the growing season when more traditional forages may not be as productive. The objective of this study was to test the establishment of arrowleaf and white clover grown under varying pine tree alley widths. In 2011, existing forage was removed in 15-yr old loblolly pine tree row alleys of different widths (3.7, 4.9, 7.3, and 9.8 m), including an open area. Arrowleaf, as an annual, was replanted in 2012. Seedlings were counted twice/year, while dry matter was measured three times/year. Photosynthetically active radiation (PAR) was measured in all alley widths to compare light penetration through the canopy. Hot and dry conditions occurred throughout 2012, affecting results. In 2012 and 2013, the greatest PAR for most treatments was observed in June. Seedling counts for all treatments were greatest immediately after establishment, and gradually declined throughout the course of the study. Dry matter yields increased throughout the growing season, and were greatest in arrowleaf clover in the open area on all measurement dates;however, increased weed pressure and repeated flooding affected yields. This study demonstrated that clover establishment in shady wooded areas is possible, but only under suitable environmental conditions.

关键词： White Clover Arrowleaf Clover Dry Matter Yield Seedling Count Agroforestry

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