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The construction of elderly care needs assessment system is conducive to realize the reasonable matching between care services and needs of the elderly， and to promote the effective allocation of pension resources. It is the basis and premise of the development of long-term care insurance system. Questions such as "Who is responsible for the assessment？ Who can apply for the assessment？ What is the assess tool？ How to pay the assessment fee？" are the core issues that need to be addressed in the construction of the evaluation system. This study compared the current situation of the elderly care needs assessment systems in China， the Netherlands， Germany， Japan and the United States from four aspects： assessment subject， assessment object， assessment cost source， and assessment tools’ dimensions. It has been a trend to entrust a third party for the evaluation work in pilot cities in China. Compared with foreign countries， domestic appraisers’ discipline and professional background are simpler. In foreign countries， the evaluation objects of elderly care needs are more extensive； the legal and financial support system of needs evaluation is more mature； and the evaluation dimensions are more objective and comprehensive. Based on this study， we suggest China to establish a national unified elderly care needs assessment system， cultivate professional assessment teams， expand the coverage of care needs assessment objects， improve the standards of assessment objects and assessment dimensions， and improve the law and financial support regulations related to needs assessment.
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Objective:To explore the clinical efficacy ofendoscopic retrograde cholangiopancreatography (ERCP) plus percutaneous transhepatic cholangiodrainage (PTCD) of biliary reunion in the treatment of biliary occlusion after liver transplantation.Methods:From May 2018 to August 2019, clinical data were retrospectively analyzed for 9 patients with biliary tract occlusion after an initial liver transplantation. All of them underwent biliary reunion. An endoscopist performed ERCP while an interventional physician completed PTCD with bilateral guide wire under the same anesthetic period so that bilateral guide wire completed a reunion at biliary occlusion for re-opening biliary tract or establishing a new bile duct outflow path. Postoperative follow-ups were performed for observing the treatment outcomes and various factors of biliary stricture factors analyzed.Results:All of them received PTCD or T-tube sinus angiography and interventional treatment. The diagnosis of complete biliary occlusion was definite. After treatment, 7 cases of biliary tract reunion were successful. During operation, three reunion types of guide wire biliary, intestinal cavity and intra-abdominal cavity were employed. Two failed cases received continuous PTCD drainage after operation. The influencing factors of biliary tract stenosis were retrospectively analyzed after operation. Among them, there were non-anastomotic stenosis ( n=2), biliary leakage ( n=2) and anastomotic stenosis and long tortuous biliary tract ( n=5). Conclusions:Rapid, mini-invasive and safe, ERCP plus PTCD biliary tract reunion may be employed as a first choice for biliary occlusion after liver transplantation.
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Objective To analyze the expression of activated T cell nuclear factor (NFAT) in hepatoeellular carcinoma (HCC) tissues and its correlation with clinicopathological factors.Methods Data of 105 patients including 87 males and 18 females,aged 55.1 ± 10.8 years old,diagnosed with HCC who underwent hepatectomy in hepatobiliary surgery department of the first central hospital of Tianjin from September 2014 to December 2016 were retrospectively analyzed,Immunohistochemical staining was used to detect the expression of NFAT subtypes in HCC tissues and adjacent normal liver tissues,and the differences in expression of NFAT subtypes and related factors were analyzed.Results HCC tissues had higher expression of NFAT4 and lower expression of NFAT1 compared to adjacent tissues (P＜0.05).NFAT1 positive group had higher HBV infected rate (93.1％ vs.78.7％) and lower microvascular invasion rate than that in NFAT1 negative group (24.1％ vs.46.8％) (P＜ 0.05).NFAT3 positive group had more younger patients (≤ 60 years old) (80.0％ vs.60.0％) and higher microvascular invasion rate (46.2％ vs.15.0％) (P＜0.05).NFAT4 positive group had higher microvascular invasion rate (43.3％ vs.22.2％) (P＜0.05).Conclusion HCC tissues had different expressions of NFATs.The expressions of NFAT1,NFAT3 and NFAT4 are related to microvascular invasion.
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Objective To classify the ischemic-type of biliary lesions (TTBL) after liver transplantation based on the imaging findings and the severity of the clinical manifestations,and analyze the relationship between the grading and prognosis of ITBL.Methods 886 liver transplantation recipients were divided into 2 groups:ITBL group (124 cases),and non-ITBL group (762 cases).The prognosis of the recipients was compared between the two groups.According to the severity of ITBL,ITBL patients were divided into three grades,and the prognosis was compared among the three grades.Results The survival rate,graft survival rate and adverse prognosis rate between ITBL group and non-ITBL group were statistically significant (P＜0.001).There was no significant difference in survival rate among mild,moderate and severe ITBL groups.There was very significant difference in graft survival between mild and moderate group versus severe group (P＜0.05).There was no significant difference between mild and moderate groups in graft survival.There was significant difference in the incidence of adverse outcomes between mild group versus moderate and severe groups (P＜0.04),but there was no significant difference between the moderate and severe groups.Conclusion The ITBL classification based on the imaging severity of the biliary tract and the level of bilirubin can predict the prognosis of ITBL.
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Objective Toidentify factors contributing to posthepatectomy liver dysfunction (PHLD),focusing on the Functional remnant liver volume to spleen volume ratio (FreLSVR).Methods The clinical data of 74 patients undergoing precise liver resection from January 2016 to October 2017 were retrospectively analyzed.IQQA liver system was used to reconstruct the liver and spleen 3D image by using patients' preoperative abdominal CT image data.Tumor volume,3D estimated functional residual liver volume,spleen volume and FreLSVR were measured and calculated.Preoperative and postoperative liver function test,blood coagulation function test,operation time,intraoperative blood loss,and the volume of daily postoperative abdominal drainage were recorded.Correlations between multiple parameters and PHLD were analyzed.Results PHLD occurred in 16 (21.6％).Single factor analysis revealed that the standardized residual liver volume ratio (P＜0.05),FreLSVR (P＜0.05) and preoperative AST value (P＜0.05) were correlated with postoperative hepatic insufficiency.Multivariate regression analysis showed that FreLSVR (OR=0.535,95％CI=0.305～0.936,P＜0.05) was the only independent factor of PHLD.In the ROC curve analysis for FreLSVR,a cut-off value of 2.56 (AUC=0.824,Sensitivity 81.1％,specificity 71.7％.) was the appropriate value for predicting the risk of PHLD according to Youden index.Then the patients were regrouped according to this cut-off value.Compared with the FreLSVR＞2.56 group (53 cases),the highest postoperative INR value (1.46± 0.19 to 1.29± 0.29,t=-2.405,P＜0.05) was higher that of FreLSVR≤2.56 group,and the amount of average daily abdominal drainage in one and two weeks after operation was higher,(188.0(79.2 ～ 375.1)ml to 96.0(46.5 ～ 179.3)ml,P＜0.05) and (207.2(125.6 ～ 827.1)ml to71.8(14.0 ～ 179.8) ml,P＜0.05),respectively.Conclusion FreLSVR has significant correlation with postoperative hepatic dysfunction,and provides guidance for the safety of liver resection in the future.
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Liver transplantation is an important clinical treatment for primary liver cancer,but the high rate of recurrence and metastasis has a serious impact on the efficacy of HCC treatment,among which extrahepatic metastasis is the most common.Up to now,there is still lack of effective methods to prevent postoperative recurrence and metastasis.Therefore,how to prevent the recurrence and metastasis of liver cancer after liver transplantation is of great significance.This paper summarized the prevention and evaluation of recurrent lung metastasis after liver transplantation for liver cancer from three aspects:before transplantation,among transplantation and after transplantation.
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Objective To evaluate the impact of intraoperative administration of S-adenosy-methionine on early remnant liver function and regeneration after left lobe resection.Methods 60 cases undergoing left lobe resection were randomly divided into two groups (30 cases in each group).While postop therapies were the same.Patients in the experimental group received intraoperatively intravenous injection of S-adenosy-methionine 1 000 mg.Postoperatively the two groups were injected with S-adenosy-methionine 1 000 mg/d daily for successive 5 days.Results Liver function injury was markedly alleviated in experimental group after hepatectomy,Level of ALT,AST,TBiL,IBiL index were lower than the control group,the difference was statistically significant (P ＜ 0.05);the LRR and the expression of IL-22 was significantly higher than the control group and the difference was statistically significant (P ＜ 0.05),which indicated improved liver regeneration.Conclusion The intraoperative pretreatment of S-adenosy-methionine can reduce the damage of remnant liver function,promote the restoration of remnant liver function and liver regeneration.
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Objective To study the clinical treatment and prognosis of de novo liver cancer following renal transplantation.Methods The clinical data of 15 patients who developed de novo liver cancer after renal transplantation carried out prior to treatment of liver cancer at the First Center Hospital of Tianjin between June 2006 and June 2016 were retrospectively studied.These patients were diagnosed to have liver cancer ranging from 23 to 98 months after renal transplantations,with an average of (42.5 ± 29.7) months.Two patients were diagnosed within 2 years,7 within 5 years,and 6 over 5 years after renal transplantation.Results Three patients underwent transcatheter arterial chemoembolization (TACE) and 12 patients underwent surgical resection which included right/left hemihepatectomy (n =5),hepatic segment resection (n =4),and tumor enucleation (n =3).Postoperative histopathology confirmed hepatocellular carcinoma in 8 patients,cholangiocarcinoma in 1 patient,and mixed liver cancer in 3 patients.Among the 12 patients who initially underwent'curative'surgery,3 patients died from recurrent cancer 8,16,25 months after surgery,respectively.The remaining 9 patients were still alive with a follow-up which ranged from 0.6 to 65-month.The 3 patients who underwent TACE were alive for 4,7 and 13 months,respectively.Conclusions De novo liver cancer were usually asymptomatic and had a rapid onset.The optimal clinical management which includes early diagnosis,appropriate therapy with immunosuppression and renal function preservation can result in good long-term survival.
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Objective To investigate the role of interferon regulatory factor-1 (IRF-1) in liver ischemia/reperfusion (IR) injury and its underlying mechanism,and identify effective managements in alleviating liver IR injury.Methods Three groups of mice models with liver IR injury were well established,including control group (S),warm liver IR injury group (IR) and recombinant IRF-1 group (IRF-1).The levels of mRNA and protein,liver function and pathological changes of liver tissue were detected in group S and group IR.Additionally,the marker of IRF-1,p-Stat1,p-P38,PARP1 and Caspase-3 were measured and PCNA expression was determined in group IR and group IRF-1 mice with 6-hour liver IR injury.Results IRF-1 mRNA and protein and the levels expression of proteins were significantly elevated with peak occurred after 6-hour IR injury,which was statistic difference compare to the group S (t2h =-3.512,t6h =-4.247,t12h =-4.088,t24h =-3.851;P ＜ 0.05).Serum ALT and AST of mice detected in group IR were higher than group S at all endpoints (tALT =4.931,4.592,4.277,4.809;tAST =4.980,4.617,4.336,4.915;P ＜ 0.05).Furthermore,pathological damage change was more distinct compared with group S.The elevated levels of IRF-1,p-Statl,p-P38,PARP1 and Caspase-3 and decreased PCNA expression were determined in mice models with recombinant IRF-1 intervention.Conclusion IRF-1 expression could be closely correlated with liver IR injury,and its underlying mechanism may be attributed to activation of JNK MAPK protein and inhibition of PCNA expression.
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Objective To investigate the effects of different hepatic perfusion procedures for small-for-size liver transplantation in rats. Methods A total of 156 rats were randomly divided into two groups: portal vein perfusion group (groupⅠ, n=78) and abdominal aorta perfusion group (groupⅡ, n=78). After harvesting graft, the left lobe of the liver and the middle lobe were resected and the remaining approximately 30%volumes of the liver were transplanted in groupⅠand groupⅡ. The body weights of donor and acceptor, the weight of graft, the time of operating in donor, the cold ischemia time, anhepatic phase, the blocking time of inferior hepatic vena cava and the time of operating in receptor were recorded in two groups. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), pathological HE staining and 7-day survival rate in 6 h, 1 d, 3 d and 7 d after operation were compared between two groups. Results The serum levels of ALT and AST were decreased gradually in two groups, but the levels decreased slowly in groupⅠ. The serum levels of ALT and AST were significantly higher in groupⅠthan those of groupⅡ(P<0.05). HE staining showed greater damage of mi-crostructure of liver tissue at early stage in group Ⅰthan that in groupⅡ. The 7-day survival rate was lower in group Ⅰthan that of groupⅡ(χ2=4.050,P=0.044). Conclusion There is a higher survival rate and mild liver damage in small-for-size liver transplantation in rats using perfusion by abdominal aorta.
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Objective To investigate the differential expression of hepatocyte growth factor activator (HGFA) and its inhibitors (HAI-1,HAI-2) during cirrhotic and normal liver regeneration after partial hepatectomy,and to explore the causes of the delayed liver regeneration after partial hepatectomy in cirrhotic rat model.Methods We used 40％ CCl4 subcutaneous injection to establish the cirrhotic rat model,and then performed 70％ liver resection for the experimental group together with no operation for the healthy rats as control group.Rats in each group after 3 hours,6 hours,12 hours,24 hours and 48 hours were randomly sacrificed and specimens were collected.The serum HGFA was detected by enzyme-linked immunosorbent assay (ELISA),and we used RT-PCR to detect the mRNA expressions of HAI-1 and HAI-2 in splenic tissue.Results The serum HGFA level in cirrhotic rats at each time point was all significantly lower than that in the control group (P ＜0.05).The expression of HAI-1 mRNA in cirrhotic rats was sustained at a higher level than that in the control group (P ＜ 0.05),but there was no significant difference on the HAI-2 mRNA expression between the two groups (P ＞ 0.05).Conclusions The synthesis of HGFA during the liver regeneration after partial hepatectomy in cirrhosis rats is lower compared with healthy rats,which may lead to the insufficient activation of HGF precursor,eventually causing the slow liver regeneration.HAI-2 may not be involved in the healing process of liver.
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BACKGROUND:Studies have shown that the reason of the slower liver regeneration in individuals of cirrhotic liver after partial hepatectomy compared with healthy liver may be related to the delayed synthesis and secretion of hepatocyte growth factor during liver regeneration, but the cause of this phenomenon is not clear. The hepatocyte growth factor activator inhibitor found in recent years can indirectly inhibit the activation of hepatocyte growth factor, but there is little research to explore the expression of hepatocyte growth factor activator inhibitor in the regeneration process after partial hepatectomy in cirrhotic liver and its relationship with the liver regeneration. OBJECTIVE:To investigate the expression of hepatocyte growth factor activator inhibitors (HAI-1, HAI-2) during cirrhotic and normal liver regeneration after partial hepatectomy through establishing the cirrhotic rat model, and to explore the biological effects of HAI-1, HAI-2 in cirrhotic liver during the liver regeneration after partial hepatectomy. METHODS:We used 40%CCl4 subcutaneous injection to establish the cirrhotic rat model, then we performed 70%liver resection for the experimental group. The rats in the control group only received ordinary water feeding and 70%liver resection. Rats in each group were randomly sacrificed before surgery and at 3 hours, 6 hours, 12 hours, 24 hours and 48 hours after surgery, and samples were col ected. We used RT-PCR technology to detect the expression of HAI-1 mRNA, HAI-2 mRNA in splenic tissue. RESULTS AND CONCLUSION:The expression levels of HAI-1 mRNA of two groups after partial hepatectomy were increased firstly and then decreased. The expression of HAI-1 mRNA in cirrhotic rats was sustained higher than that of the control group (P0.05). The expression of HAI-1 mRNA in liver cirrhosis rats after resection was consistently higher than that in healthy rats, which may lead to the insufficient synthesis and secretion of hepatocyte growth factor activator in cirrhotic rats, then hepatocyte growth factor precursor may not be activated enough, eventual y leading to slow liver regeneration. HAI-2 may not be involved in the wound repair process of liver.