Gallstones occur in about one third of the patients having liver cirrhosis.Pigment gallstones are the most frequent type,while cholesterol stones represent about15%of all stones in cirrhotics.Increased secretion of un...Gallstones occur in about one third of the patients having liver cirrhosis.Pigment gallstones are the most frequent type,while cholesterol stones represent about15%of all stones in cirrhotics.Increased secretion of unconjugated bilirubin,increased hydrolysis of conjugated bilirubin in the bile,reduced secretion of bile acids and phospholipds in bile favor pigment lithogenesis in cirrhotics.Gallbladder hypomotility also contributes to lithogenesis.The most recent data regarding risk factors for gallstones are presented.Gallstone prevalence increases with age,with a ratio male/female higher than in the general population.Chronic alcoholism,viral C cirrhosis,and non-alcoholic fatty liver disease are the underlying liver diseases most often associated with gallstones.Gallstones are often asymptomatic,and discovered incidentally.If asymptomatic,expectant management is recommended,as for asymptomatic gallstones in the general population.However,a closer follow-up of these patients is necessary in order to earlier treat symptoms or complications.For symptomatic stones,laparoscopic cholecystectomy has become the therapy of choice.Child-Pugh class and MELD score are the best predictors of outcome after cholecystectomy.Patients with severe liver disease are at highest surgical risk,therefore gallstone complications should be treated using noninvasive or minimally invasive procedures,until stabilization of the patient condition.展开更多
Zircon LA-ICP-MS U-Pb dating reveals that the Baimashan Pluton is composed mainly of late Indosinian (204.5±2.8 Ma-209.2±3.8 Ma) biotite granodiorites/monzonitic granites (LIGs) and early Yanshanian (176.7&#...Zircon LA-ICP-MS U-Pb dating reveals that the Baimashan Pluton is composed mainly of late Indosinian (204.5±2.8 Ma-209.2±3.8 Ma) biotite granodiorites/monzonitic granites (LIGs) and early Yanshanian (176.7±1.7 Ma) two-micas monzonitic granites (EYGs), and the coeval (203.2±4.5 Ma-205.1±3.9 Ma) mafic microgranular enclaves (MMEs) are generally found in the former. In addition, the ages of cores within zircons from LIGs and MMEs ranging from 221.4±4.0 Ma to 226.5±4.1Ma provide evidence of multistage magma intrusion during Indosinian in the study area. Measured 3010±20.6 Ma of inherited zircon age suggests that there may be recycling Archaean curstal material in existence in this area. LIGs and EYGs share some similar geochemical features: subalkaline and peraluminous granites, enrichment of Th, U, K, Ta, Zr, Hf and LREE but depletion of Ba, Nb, P, Ti and Eu, low εNd(t) values but high (87Sr/86Sr)i ratios, and old T2DM (ca. 1.9-2.0 Ga). The behaviors of incompatible elements and REE are mainly dominated by fractional crystallization of plagioclase, K-feldspar, ilmenite and apatite, but that of Sr isotope mainly controlled by EC-AFC. They are crust-sourced and derived from partial melting of paleo-Proterozoic metagreywackes and related to biotite dehydration melting. LIGs are formed in post-collisional tectonic setting as crustal local extension and thinning during late Indosinian. But EYGs may be evolved products of congeneric granitic magma with LIGs formed in late Indoinian, which were emplaced again when crust underwent extensive thinning and extension in post-orogenic tectonic setting during Yanshanian in SC after undergoing EC-AFC. MMEs should be cognate enclaves and derived from liquid immiscibility of host magma.展开更多
文摘Gallstones occur in about one third of the patients having liver cirrhosis.Pigment gallstones are the most frequent type,while cholesterol stones represent about15%of all stones in cirrhotics.Increased secretion of unconjugated bilirubin,increased hydrolysis of conjugated bilirubin in the bile,reduced secretion of bile acids and phospholipds in bile favor pigment lithogenesis in cirrhotics.Gallbladder hypomotility also contributes to lithogenesis.The most recent data regarding risk factors for gallstones are presented.Gallstone prevalence increases with age,with a ratio male/female higher than in the general population.Chronic alcoholism,viral C cirrhosis,and non-alcoholic fatty liver disease are the underlying liver diseases most often associated with gallstones.Gallstones are often asymptomatic,and discovered incidentally.If asymptomatic,expectant management is recommended,as for asymptomatic gallstones in the general population.However,a closer follow-up of these patients is necessary in order to earlier treat symptoms or complications.For symptomatic stones,laparoscopic cholecystectomy has become the therapy of choice.Child-Pugh class and MELD score are the best predictors of outcome after cholecystectomy.Patients with severe liver disease are at highest surgical risk,therefore gallstone complications should be treated using noninvasive or minimally invasive procedures,until stabilization of the patient condition.
基金Supported by the National Natural Science Foundation of China (Grant No. 40372036)the Key Project of Ministry of Education of China (Grant No. 306007)
文摘Zircon LA-ICP-MS U-Pb dating reveals that the Baimashan Pluton is composed mainly of late Indosinian (204.5±2.8 Ma-209.2±3.8 Ma) biotite granodiorites/monzonitic granites (LIGs) and early Yanshanian (176.7±1.7 Ma) two-micas monzonitic granites (EYGs), and the coeval (203.2±4.5 Ma-205.1±3.9 Ma) mafic microgranular enclaves (MMEs) are generally found in the former. In addition, the ages of cores within zircons from LIGs and MMEs ranging from 221.4±4.0 Ma to 226.5±4.1Ma provide evidence of multistage magma intrusion during Indosinian in the study area. Measured 3010±20.6 Ma of inherited zircon age suggests that there may be recycling Archaean curstal material in existence in this area. LIGs and EYGs share some similar geochemical features: subalkaline and peraluminous granites, enrichment of Th, U, K, Ta, Zr, Hf and LREE but depletion of Ba, Nb, P, Ti and Eu, low εNd(t) values but high (87Sr/86Sr)i ratios, and old T2DM (ca. 1.9-2.0 Ga). The behaviors of incompatible elements and REE are mainly dominated by fractional crystallization of plagioclase, K-feldspar, ilmenite and apatite, but that of Sr isotope mainly controlled by EC-AFC. They are crust-sourced and derived from partial melting of paleo-Proterozoic metagreywackes and related to biotite dehydration melting. LIGs are formed in post-collisional tectonic setting as crustal local extension and thinning during late Indosinian. But EYGs may be evolved products of congeneric granitic magma with LIGs formed in late Indoinian, which were emplaced again when crust underwent extensive thinning and extension in post-orogenic tectonic setting during Yanshanian in SC after undergoing EC-AFC. MMEs should be cognate enclaves and derived from liquid immiscibility of host magma.
