Objective:To investigate the clinical efficacy of liver transplantation for intra-hepatic cholangiocarcinoma.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 22 patients with intrahepatic cholangiocarcinoma who underwent liver trans-plantation in the 5 medical centers, including First Hospital of Jilin University, et al, from September 2005 to December 2021 were collected. There were 18 males and 4 females, aged 57(range, 38?71)years. Observing indicators: (1) clinicopathological characteristics of patients with intrahepatic cholangiocarcinoma; (2) follow-up; (3) prognosis. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. The Kaplan-Meier method was used to draw survival curves. The Log-Rank test was used for survival analysis. Results:(1) Clinicopathological characteristics of patients with intrahepatic cholangio-carcinoma. Of the 22 patients, 20 cases were diagnosed as intrahepatic cholangiocarcinoma before liver transplantation, 7 cases had viral hepatitis type B, 1 case had primary sclerosing cholangitis, 7 cases had tumor treatment before liver transplantation, 7 cases, 6 cases and 9 cases were classified as grade A, grade B and grade C of the Child-Pugh classification, 16 cases had preoperative CA19-9 >40 U/mL, 14 cases had single tumor, 11 cases with tumor located at right lobe of liver, 6 cases with tumor located at both left and right lobe of liver, 5 cases with tumor located at left lobe of liver, 9 cases with tumor vascular invasion. All 22 patients were diagnosed as moderate-poor differentiated tumor. There were 9 cases with liver cirrhosis, 4 cases with tumor lymph node metastasis, 10 cases with tumor burden within Milan criteria. The tumor diameter of 22 patients was 4.5(range, 1.5?8.0)cm. (2) Follow-up. All 22 patients were followed up for 15(range, 3?207)months. Of the 22 patients, 9 cases had tumor recurrence and 8 cases died. (3) Prognosis. The 1-year overall survival rate and 1-year disease-free survival rate of the 22 patients was 72.73% and 68.18%, respectively. Results of subgroup analysis showed there were significant differences in overall survival and disease-free survival between the 10 patients with tumor burden within Milan criteria and the 12 patients with tumor burden beyond Milan criteria who underwent liver transplantation ( hazard ratio=0.13, 0.26, 95% confidence interval as 0.03?0.53, 0.08?0.82, P<0.05). Results of further analysis of the 12 patients with tumor burden beyond Milan criteria showed there were significant differences in overall survival and disease-free survival between the 5 patients with preoperative tumor down-staging treatment and the 7 patients without preoperative tumor down-staging treatment ( hazard ratio=0.18, 0.14, 95% confidence interval as 0.04?0.76, 0.04?0.58, P<0.05). Conclusions:Intrahepatic cholangiocarcinoma patients with tumor burden within Milan criteria have a better prognosis than patients with tumor burden beyond Milan criteria after liver transplantation. For patients with tumor burden beyond Milan criteria, active tumor down-staging treatment before liver transplantation can improve the prognosis.

Intrahepatic cholangiocarcinoma (ICC) is a complex malignant tumor with poor prognosis. Historically, the prognosis of ICC patients after liver transplantation is poor, which led to that it is once regarded as a contraindication of liver transplantation. However, in recent years, results of multiple studies challenge the above view. These emerging studies demonstrate that under the condition of reasonable selection of recipients or combined with neoadjuvant therapy, liver trans-plantation has achieved considerable prognosis in patients with ICC. In addition, compared with surgical resection and other treatments, liver transplantation can improve the prognosis of patients with ICC. The factors related to the prognosis of ICC patients who underwent liver transplantation include neoadjuvant therapy, overall tumor burden, tumor biological behavior and comprehensive treatment after transplantation, et al. Based on the results from currently existing clinical studies, the authors make a deep elaboration on the prognosis of ICC patients after liver transplantation, prognosis comparison between liver transplantation and other treatment measures for ICC, factors related to the prognosis of ICC patients who underwent liver transplantation, and the selection strategy of recipient of liver transplantation for ICC, and advance and challenge of liver transplantation for ICC.

Objective:To evaluate the methods and effects of mini-invasive treatment of non-dilated common bile duct stones.Methods:From Oct 2015 to Dec 2018, clinical data of 230 cases of cholecystolithiasis combined with non-dilated common bile duct stones (choledochal diameter ≤8 mm) at our hospital were analyzed. The treatment methods included endoscopic retrograde cholangiopancreatography (ERCP)+ synchronous LC, ERCP+ nonsynchronous LC, laparoscopic transcyctic duct common bile duct exploration(LTCBDE).Results:In 69 out of 70 patients in the ERCP+ synchronous LC group stones were successfully extracted. In 118(118/120) cases out of the ERCP+ nonsynchronous LC group common bile duct stones were successfully removed, LTCBDE was performed in 38(38/40) cases and stones were successfully removed. There was no significant difference in the success rate among the three methods ( P>0.05), while patients in LTCBDE group had the shortest mean postoperative hospitalization time ( F=243.22, P=0.000) , the least average hospitalization cost ( F=300.40, P=0.000) and with lower incidence of complications (10.00%, P<0.05). Conclusions:It is of great importance to adopt the appropriate procedures for the mini-invasive treatment of non-dilated extrahepatic common bile duct stones. LTCBDE is the most suitable procedures for this purpose.

目的:探讨腹膜后平滑肌肉瘤的临床特点、影像学表现及治疗策略,以期对类似病例的诊治提供参考.方法:回顾性分析收治的1例腹膜后平滑肌肉瘤患者临床资料,并复习相关文献.结果:患者腹部胀痛伴贫血,影像学提示中下腹部恶性肿瘤伴出血,早期行液体复苏,进一步介入栓塞,超声引导下穿刺引流,避免腹腔隔室综合征的发生;复查待瘤体缩小,贫血纠正,行完整切除肿瘤,病理诊断为平滑肌肉瘤.术后随访16个月,患者恢复良好.结论:腹膜后平滑肌肉瘤是一种罕见的恶性肿瘤,起病隐匿,易复发和转移,手术完整切除是其主要治疗方式,配合以化疗、放疗等手段综合治疗,可改善患者预后.

BACKGROUND:Geriatric Nutritional Risk Index (GNRI) has been widely used to assess the nutritional status in a variety of human pathological conditions, but the prognostic value of the GNRI in malignancies has not been evinced.METHODS:Relevant studies updated on Jul 27, 2019, were retrieved in available databases, including PubMed, Web of Science, Cochrane library, Chinese CNKI, and Chinese Wan-fang. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted and pooled by using STATA 14.RESULTS:A total of 15 studies involving 8,046 subjects were included in this meta-analysis. Meta-analysis results evinced that low GNRI was associated with poor OS (HR = 1.95, 95% CI: 1.49-2.56, p ≤ 0.001), poor CSS (HR = 1.81, 95% CI: 1.49-2.19, p ≤ 0.001), poor DFS (HR = 1.67, 95% CI: 1.28-2.17, p ≤ 0.001), and poor PFS (HR = 1.68, 95% CI: 1.28-2.21, p ≤ 0.001), and the correlation of GNRI with OS was not changed when stratified by possible confounding factors, suggesting that malignancy patients with low GNRI would suffer from reduced survival rate and increased recurrence rate. Moreover, low GNRI was also associated with postoperative complications in malignancies.CONCLUSIONS:In summary, GNRI is associated poor prognosis in human malignancies, and GNRI should be used as a predictive indicator of adverse outcomes during malignancy treatment.

Objective To analyze the risk factors of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC),and to establish a preoperative prediction model for MVI.Methods The clinical data of 159 patients with HCC from the First Hospital of Jilin University treated from January 2012 to December 2014 were retrospectively analyzed.There were 128 males and 31 females.Univariate and multivariate logistic regression analysis of factors influencing the presence of MVI in HCC patients were carried out.Independent risk factors were scored based on the β values of multivariate analysis.Receiver operating characteristics (ROC) curves were used to evaluate the predictive value of the scores for the risk factor for MVI.Results Univariate and multivariate logistic regression analyses showed that age ≥ 60 years (OR=0.263,95％ CI:0.112 ～ 0.614),tumor diameter ≥5 cm (OR=3.902,95％ CI:1.784 ～ 8.583),neutrophil to lymphocyte ratio (NLR) ≥ 1.83 (OR=2.414,95％ CI:1.065～5.472) and platelet to lymphocyte ratio (PLR) ≥ 72.30 (OR =2.578,95％ CI:1.068～ 6.223) were the influencing factors of MVI in patients with HCC (P＜0.05).The preoperative prediction model of MVI was established using the MVI independent risk factor scores.The area under the ROC curve was 0.793 (95％ CI:0.723～ 0.862).The optimal cutoff value for the presence of MVI was 2.75 points,and the sensitivity was 0.72 and the specificity was 0.78.The MVI positive rates of patients with risk scores of 0 to 1.5,2.0 to 3.5,and 4.0 to 5.0 were 18.6％,42.9％,and 78.3％,respectively.Conclusion Age,tumor diameter,NLR,and PLR were independent factors influencing MVI in patients with HCC.The preoperative model based on the independent risk factor scores can be used to predict the presence of MVI in HCC patients.

Objective To investigate the risk factors for early complications after liver transplantation and to improve the prognosis .Methods The clinical data of 147 patients who underwent orthotopic liver transplantation in the Hepatic Transplantation Center of The First Hos - pital of Jilin University from September 2011 to April 2017 were retrospectively analyzed.According to the presence or absence of early com - plications after surgery, these patients were divided into non -complication group (n =11) and complication group (n =136).The possible factors associated with early complications after surgery were collected , including donor factors (age and whether the blood type of the donor matches that of the recipient), recipient factors (sex, age, primary disease, Model for End -Stage Liver Disease [MELD] score, aspartate aminotransferase [AST], alanine aminotransferase[ALT], albumin [Alb], platelet [PLT], hemoglobin [Hb], fibrinogen, total bilirubin,creatinine, PLT/Alb ratio [PAR], and neutrophil /lymphocyte ratio [NLR]), intraoperative factors (cold ischemia time, warm ischemia time, intraoperative blood loss, and duration of anhepatic phase), and postoperative factors (AST and ALT immediately and 12, 24, 48,and 72 hours after operation).The clinical data were analyzed to investigate the association between these factors and early complications .The t test was used for comparison of normally distributed continuous data ; the Mann -Whitney U test was used for comparison of non -normally distributed continuous data.The chi -square test was used for comparison of categorical data .Backward logistic regression was used for multivariate analysis.Results MELD score (t =-3.86,P =0.002), Alb (t =2.19,P =0.049), PLT (Z =467.00,P =0.039),PAR (Z =500.00,P =0.068), fibrinogen (t =1.80,P =0.096), TBil (Z =-1.98,P =0.047), preoperative AST (Z =417.00,P =0.015), and preoperative ALT (Z =501.50,P =0.070) were associated with postoperative complications .PAR and preoperative AST were independent risk factors for early complications (odds ratio [OR] =3.84, 95% confidence interval [CI]: 1.03 -14.34, P <0.05; OR =0.25, 95% CI: 0.07 -0.94, P <0.05).The 147 patients were divided into high -PAR group (PAR ≥3 ×109 /g; n =55) and low - PAR group (PAR <3 ×109 /g; n =92); PAR was associated with postoperative vascular and biliary complications (χ2 =2.87, P =0.090;χ2 =3.54,P =0.060).The 147 patients were divided into normal preoperative AST group (AST <40 U/L; n =93) and abnormal preoperative AST group (AST ≥40 U/L; n =54); preoperative AST level was associated with postoperative pleural effusion (χ2 =3.03,P =0.082).Conclusion Fibrinogen, PLT, Alb, TBil, PAR, MELD score, and preoperative AST and ALT are associated with the develop -ment of early complications after liver transplantation , and PAR and preoperative AST are independent risk factors for early complications . To improve the prognosis and postoperative survival , these factors, particularly PAR, should be fully assessed for the liver transplantation re - cipient before operation, and specific interventions should be provided accordingly .

Purpose: Our meta-analysis aims to investigate the prognostic role of pretreatment albumin to globulin ratio (AGR) in human cancers. Methods: Available databases were searched up to Sept 25th, 2017. Pooled hazard ratios (HRs) and risk ratio (RRs) with their corresponding 95% confidence intervals (CIs) were used to assess the prognostic impact of AGR on overall survival (OS)/disease-free survival (DFS)/progression-free survival (PFS) and 5-year mortality respectively. Results: Totally, 28 studies with 15 356 cancer patients were included. Our results demonstrated that low pretreatment AGR is associated with poor OS (HR = 2.08, 95%CI:1.78-2.44, univariate results; HR = 1.75, 95%CI:1.56-1.97, multivariate results), poor DFS (HR = 1.96, 95%CI:1.48-2.59, univariate results; HR = 1.64, 95%CI:1.26-2.14, multivariate results) and poor PFS (HR = 1.89, 95%CI:1.61-2.22, univariate results; HR = 1.66, 95%CI:1.32-2.0, multivariate results). Meanwhile, low pretreatment AGR is also associated with increased 5-year mortality (RR = 2.12, 95%CI:1.48-3.03). Moreover, this significant correlation was not altered by stratified analysis according to publication times, sample sizes, patient origins, AGR cutoff values, cancer systems, treatment methods or HR sources. Conclusion: Low pretreatment AGR is associated with poor prognosis in human cancers, and AGR should be used as a prognostic marker during cancer therapy.

我国人体器官移植事业在几代器官移植工作者的积极探索和实践下,尤其是2000年以后发展迅速,已取得了显著成绩.2007年,国务院颁布了我国首部器官移植条例——《人体器官移植条例》,使我国的器官移植事业走上法治化道路,揭开了我国器官移植事业改革的序幕.2014年12月3日,我国宣布自2015年1月1日起停用死囚器官,公民自愿器官捐献为唯一合法器官来源,实现了中国公民逝世后器官来源的转型[1].截至2017年12月10日,中国大陆已累计实现公民逝世后器官捐献14 861例,捐献大器官4.1万个,器官捐献者志愿捐献登记人数超过36万人,预计2020年成为世界第一移植大国[2].

目的 探讨单发肝细胞癌(SHCC)发生微血管侵犯的影响因素及患者预后情况.方法 回顾性分析2012年1月-2014年12月吉林大学第一医院收治的138例行肝癌根治术SHCC患者的临床病理资料.根据中性粒细胞、PLT、纤维蛋白原、中性粒细胞与淋巴细胞比值、PLT与淋巴细胞比值、纤维蛋白原与Alb比值和是否发生微血管侵犯绘制受试者工作特征曲线,依据约登指数确定各指标的临界值.应用logistic回归模型行单因素和多因素分析,比值比(0R)和95％可信区间(95％CI)评价联系的紧密性.对微血管侵犯阳性与阴性患者应用Kaplan-Meier法计算无瘤生存率,并绘制生存曲线,采用log-rank检验进行比较.结果 单因素分析显示,与SHCC微血管侵犯相关的因素有性别(OR =0.400,95％CI:0.162 ～0.985,P=0.046)、肿瘤直径(OR=5.902,95％CI:2.813 ～12.382,P＜0.001)、AFP(OR =2.635,95％ CI:1.286 ～5.398,P=0.008)、中性粒细胞(OR =3.019,95％CI:1.353～6.736,P=0.007)、PLT(OR=2.255,95％CI:1.116～4.555,P=0.023)、纤维蛋白原(OR=3.483,95％CI:1.687 ～7.190,P=0.00l)、GGT(OR=2.115,95％CI:1.069 ～4.182,P=0.031)、中性粒细胞与淋巴细胞比值(OR=3.662,95％CI:1.803 ～7.436,P＜0.001)、PLT与淋巴细胞比值(OR=3.734,95％CI:1.649 ～ 8.455,P=0.002)、纤维蛋白原与Alb比值(OR=3.014,95％CI:1.497～6.070,P=0.002).多因素分析显示,肿瘤直径(OR=5.423,95％CI:2.555 ～11.511,P＜0.001)和AFP(OR =2.195,95％CI:1.010 ～4.774,P=0.047)是微血管侵犯的独立相关因素.预后研究结果表明,有微血管侵犯组患者l、3年无瘤生存率为66.4％、52.8％,无微血管侵犯组患者l、3年无瘤生存率为90.6％、71.5％,2组患者1、3年无瘤生存率比较差异有统计学意义(x2值分别为10.929、4.043,P值均＜0.05).2组无瘤生存曲线比较,差异亦有统计学意义(x2=7.860,P=0.005).结论 肿瘤直径、术前AFP水平是SHCC发生微血管侵犯的独立相关因素,SHCC伴有微血管侵犯者预后较差.

1病例资料患者男性,47岁,因"右上腹胀痛2个月,发现腹部包块1个月"于2016年12月22日入院;近2个月内体质量下降4 kg左右,睡眠及饮食正常,二便正常,无发热,无肝硬化。既往:体健,无高血压、糖尿病、冠心病史,无肝炎等传染病史,无特殊药物接触及服用史,无家族遗传病。饮酒25年,白酒100 g/d;吸烟25年,20支/d。查体可见患者右上腹膨隆,包块较左侧平面高出3 cm左右;可触及肝区巨大质软肿物,压痛明显,无波动感;可叩及实音;无明显血管杂音。实验室检查示肝功能:

胆囊癌是消化系统常见肿瘤之一,发病率位于第6位 [1] ,占我国同期胆道疾病的0.4%~3.8% [2] 。胆囊癌恶性程度高,且临床表现缺乏特异性,病人就诊时多已晚期,预后极差。以往认为5年生存率不足5% [3] 。基于TNM分期的根治性手术是胆囊癌病人可能治愈的唯一方法 [4-6] 。接受R0切除的病人5年

Background: The most common hepatic artery complications after Liver Transplantation (LT) are hepatic artery stenosis, thrombosis and pseudoaneurysm, which can all cause ischemia in the grafted liver. As one of the main complications, the Hepatic Artery Pseudoaneurysm (HAP) is rare with the incidence of about 2%, but its consequence may be most devastating or even fatal. Methods: Here, we presented a 57 y old male patient, who underwent LT due to Hepatocellular Carcinoma (HCC), with previous history of several times of Transhepatic Arterial Chemoembolization (TACE). This patient suffered from grafted liver ischemia on the 3rd postoperative day. Initially, this case was misdiagnosed as hepatic artery thrombosis, as the hepatic arterial blood flow could not be found by Doppler ultrasound or the hepatic angiography. Subsequently, thrombolysis was adopted, which leaded to abdominal haemorrhage rather than recanalization. Immediately, the laparotomy was exploited, which showed that the ischemia was caused by HAP rather than hepatic artery thrombosis. Finally, the HAP was surgically removed and the LT was successful. Conclusion: For patients after LT, HAP should be considered when the hepatic blood flow is very low or even hardly be detected by ultrasound in particular after angiogram. Besides, HAP should also be suspected when the haemorrhage occurred during the thrombolysis but the hepatic arterial blood flow remained unimproved, especially for patient with TACE history.

本文采用总线技术对建筑物内电梯群监控系统进行了分析.提出了电梯群控并联调配新算法.在硬件设计方面,采用单片机和CAN总线控制器作为主要控制部分,以实现整个过程控制.在软件设计方面,利用Delphi软件完成系统登录、电梯故障报警和电梯维护等功能.

Uterine fibroids are the most common benign tumor of female genital organs.Recently,there are many treatments to this disease.The objective of this article is to discuss the selection of surgical indications and surgery scope,in order to avoid excessive or insufficient treatment.

由"毒奶粉事件"引发的三聚氰胺案件对我国侵权法提出了新的挑战,因果关系确定问题成为此类案件中受害人获取损害赔偿的最大障碍。在与此类似的DES案件中,美国部分州法院为适应社会需要而确立了市场份额规则,对受害人进行救济。我国现有的法律体系中没有相应的法律规则可以替代市场份额规则。将市场份额规则与共同危险责任规则协调起来,可以为我国有害物质致损案件提供有效的救济途径。

Since the 20th century,the traditional tort law faces with unprecedented crisis with the arising of social security system,insurance of the third party's liability,and no-fault liability. Thus,Anglo-American tort theories face with severe problem. The justification of result liability as the basis of tort law could have two approaches:one is to find proper theoretical basis through economic analysis and corrective justice,the other is prove its justification in the perspective of social practice analyzing socialized security system. In the study of the failure of New Zealand's social practice,the function of tort law safeguarding freedom and justice could be affirmed.

管理规约是规定业主在物业管理中的权利、义务及其相关责任的自治规则。管理规约具有集团契约的特征,其功效反映了私法社会本位化的明显趋势。管理规约对于物业管理方式的转变及业主共同体性质的变迁具有重要作用。通过经济分析的方法可以深刻地揭示管理规约的功效。管理规约功效的实现必须在法律的实现过程中达致。

Pure economic loss is a framed right like the right of general personality in German law and a concept which is hollowed after it came out.The birth of the concept of pure economic loss and the formulation of the rule that pure economic loss in negligence is not remedied are accidental.How to address pure economic loss shows that the remedies in private laws are grounded on the law tradition and the legislation mechanisms of the respective countries.

The contribution of real estate and relevant industry’s development to the economic growth is obvious to all. But the conflict of the right in the sale of apartments is inevitable, there is a puzzledom in the sale of apartments. We should construct balancing mechanism to adjust the benefits. The system of priority rights accords with the law of our country, but it has a limit, too.