Objective To assess compliance in liver transplant recipients,ascertain related factors,and help clinical nunrses take measures to improve compliance. Methods Questionnaires including social demo-graphic variables and questionnaire about compliance after liver transplant,were used to investigate 54 liver transplant recipients whose post transplant time>6 months.Results Liver transplant recipients had good compliance to immunosuppressive medication,scored(3.67±0.51),and health lifestyle,scored(3.30±0.44),but relatively poor compliance to follow-up.scored(3.05±0.89)and self-monitoring,scored(2.00±0.89).The main factors influencing the compliance were average monthly per capita family income(P<0.01)and post trans-plant time(P<0.01).Conclusions The importance of compliance to follow-up and self-monitoring should be emphasized in health education to the recipients and more attention should be paid to those re-cipients with lower income or longer post transplant time.

Objective To study the expression and the clinical significance of Wnt signal pathway regulation factor Pygo2 in human renal cell carcinoma.Methods Using RFQ-PCR and immunohistochemical SP methods to detect Pygo2 mRNA and protein expression in 42 cases renal clear cell carcinoma and their own normal kidney tissue specimens.All specimens had a definite diagnosis by pathologic.All were renal clear cell carcinoma.The tumor diameter was 1.2-15.5 cm.The average was 7.2 cm.Among all patients,there were 7 cases with diameter ＜ 4.0 cm,9 cases 4.0-7.0 cm,26 cases ＞ 7.0 cm.Fuhrman classification:grade Ⅰ 6 cases,grade Ⅱ 17 cases,grade Ⅲ 17 cases,grade Ⅳ 2 cases.AJCC TNM stages:stage Ⅰ 16 cases,stage Ⅱ 7 cases,stage Ⅲ 7 cases,stage Ⅳ 12 cases.Statistics was done to analyze the expression difference of pygo2 between normal kidney and renal cell carcinoma,and among renal cell carcinoma within each group.Results There was higher expression of Pygo2 in renal cell carcinoma,and in the adjacent lower expression.The pygo2 mRNA expression were 2.88 ± 1.26 and 1.00 ± 0.00 in respective specimens (P ＜ 0.0001).The pygo2 protein expression were 45.53 + 24.54 and 11.02 + 1.39 in respective specimens (P ＜ 0.0001).Pygo2 expression in grading and staging were statistically significant (P ＜0.0001),but in gender,age was not statistically significant (P ＞ 0.05).Conclusions High expression of Pygo2 was found in Fuhrman high grade,high clinical staging,lympho-metastasized renal clear cell carcinoma.Pygo2 might play an important role in the occurrence and development process in renal clear cell carcinoma.

Objective To evaluate living-related liver transplantation (LRLT) for the treatment of Wilson′s disease. MethodsBetween Jan. 2001 and Oct. 2003,LRLT was performed in 20 patients (mean age 11.1 years) of late staged Wilson′s disease. Among them emergency transplantation was performed in 3 patients. Donor livers were all from patient′s parents. ResultsSurgery was successful in all donors and recipients, liver function test and serum ceruloplasmin reached normal level one month after transplantation. One patient died of severe rejection. Discharged patients were followed up from 2～33 months (mean 18.9 months). [WT5”HZ]ConclusionsLiving related liver transplantation is an effective treatment for Wilson′s disease complicated with hepatic dysfunction.

Objective To evaluate the selection standard of donors of living related liver transplantation (LRLT). Methods From Jan. 1995 to Jul. 2003, 28 LRLT were performed. The preoperative examination, selection standard, postoperative complication were reviewed. Results There was no mortality for donors. Raw surface bleeding and biliary fistula occurred in one each case, and the complications were cured conservativery.Conclusions The key for LRLTlies in the safety of the donor. Living related liver transplantation is safe, while performed by a surgical team with well qualified expertise.

This article reported a case of malignant insulinoma which recurred as liver metastasis 12 years after the initial pancreatic insulinoma resection. The patient was a 48-year-old woman who was firstly diagnosed as pancreatic insulinoma in 2006 and underwent the surgery involved complete resection of a 1.9 cm×1.3 cm tumor located in pancreas. No signs of either invasion or metastasis was detected according to preoperative imaging examination and intraoperative exploration. The tumor was diagnosed as a benign insulinoma according to histopathological results. The patient had no hypoglycemia and the fasting blood glucose was normal during the subsequent 12 years. The patient underwent a fasting blood glucose of 2.8 mmol/L in 2018, and gradually experienced palpitation and cold sweats, which was relieved by eating. She was hospitalized in May 2018 with blood glucose of 1.73 mmol/L and insulin of 1 128 pmol/L. CT and MRI revealed morphologic changes of postoperative pancreas and abnormal liver signal, the liver tumor was finally identified as insulinoma by modified selective intra-arterial calcium stimulated venous sampling (ASVS). Partial liver resection was performed and the histopathological result was neuroendocrine tumor. Therefore, the disease was diagnosed as liver metastatic malignant insulinoma.

Objective:To summarize the experience of surgical treatment of primary liver cancer.Methods:The clinical data of 10 966 surgically managed cases with primary liver cancer, from January 1986 to December 2019 at Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The life table method was used to calculate the survival rate and postoperative recurrence rate. Log‐rank test was used to compare the survival process of different groups, and the Cox regression model was used for multivariate analysis. In addition, 2 884 cases of hepatocellular carcinoma(HCC) with more detailed follow‐up data from 2009 to 2019 were selected for survival analysis. Among 2 549 patients treated with hepatectomy, there were 2 107 males and 442 females, with an age of (56.6±11.1) years (range: 20 to 86 years). Among 335 patients treated with liver transplantation, there were 292 males and 43 females, with an age of (51.0±9.7) years (range: 21 to 73 years). The outcomes of hepatectomy versus liver transplantation, anatomic versus non-anatomic hepatectomy were compared, respectively.Results:Of the 10 966 patients with primary liver cancer, 10 331 patients underwent hepatectomy and 635 patients underwent liver transplantation. Patients with liver resection were categorized into three groups: 1986－1995(712 cases), 1996－2008(3 988 cases), 2009?2019(5 631 cases). The 5‐year overall survival rate was 32.9% in the first group(1986－1995). The 5‐year overall survival rate of resected primary liver cancer was 51.7% in the third group(2009‐2019), among which the 5‐year overal survival rates of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer were 57.4%, 26.6% and 50.6%, respectively. Further analysis was performed on 2 549 HCC patients with primary hepatectomy. The 1‐, 3‐, 5‐, and 10‐year overall survival rates were 88.1%, 71.9%, 60.0%, and 41.0%, respectively, and the perioperative mortality rate was 1.0%. Two hundred and forty‐seven HCC patients underwent primary liver transplantation, with 1‐, 3‐, 5‐, and 10‐year overall survival rates of 84.0%, 64.8%, 61.9%, and 57.6%, respectively. Eighty‐eight HCC patients underwent salvage liver transplantation, with the 1‐, 3‐, 5‐, and 10‐year overall survival rates of 86.8%, 65.2%, 52.5%, and 52.5%, respectively. There was no significant difference in survival rates between the two groups with liver transplantation ( P>0.05). Comparing the overall survival rates and recurrence rates of primary hepatectomy (2 549 cases) with primary liver transplantation (247 cases), the 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients within Milan criteria treated with hepatectomy and transplantation were 96.3%, 87.1%, 76.9%, 54.7%, and 95.4%, 79.4%, 77.4%, 71.7%, respectively ( P=0.754). The 1‐, 3‐, 5‐year recurrence rates were 16.3%, 35.9%, 47.6% and 8.1%, 11.7%, 13.9%, respectively( P<0.01). The 1‐, 3‐, 5‐, 10‐year overall survival rates in patients with no large vessels invasion beyond the Milan criteria treated with liver resection and transplantation were 87.2%, 65.9%, 53.0%, 33.0% and 87.6%, 71.8%, 71.8%, 69.3%, respectively( P=0.003); the 1‐, 3‐, 5‐year recurrence rate were 39.2%, 57.8%, 69.7% and 29.7%, 36.7%, 36.7%, respectively ( P<0.01). The 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients with large vessels invasion treated with liver resection and transplantation were 62.1%, 36.1%, 22.2%, 15.0% and 62.9%, 31.8%,19.9%, 0, respectively ( P=0.387); the 1‐, 3‐, 5‐year recurrence rates were 61.5%, 74.7%, 80.8% and 59.7%, 82.9%, 87.2%, respectively( P=0.909). Independent prognostic factors for both overall survival and recurrence‐free survival rates of HCC patients treated with liver resection included gender, neoadjuvant therapy, symptoms, AST, intraoperative or postoperative blood transfusion, tumor number, tumor size, cirrhosis, macrovascular invasion, microvascular invasion, and pathological differentiation. Propensity score matching analysis of 443 pairs further showed that there was no significant difference in overall survival rate between anatomical liver resection and non‐anatomical liver resection( P=0.895), but the recurrence rate of non‐anatomical liver resection was higher than that of anatomical liver resection( P=0.035). Conclusions:In the past decade, the overall survival rate of HCC undergoing surgical treatment is significantly higher than before. For HCC patients with good liver function reservation, surgical resection can be performed first, and salvage liver transplantation can be performed after recurrence. The effect of salvage liver transplantation is comparable to that of primary liver transplantation. As for the choice of liver resection approaches, non‐anatomical resection can reserve more liver tissue and can be selected as long as the negative margin is guaranteed.

Objective:To summarize the experience of surgical treatment of primary liver cancer.Methods:The clinical data of 10 966 surgically managed cases with primary liver cancer, from January 1986 to December 2019 at Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The life table method was used to calculate the survival rate and postoperative recurrence rate. Log‐rank test was used to compare the survival process of different groups, and the Cox regression model was used for multivariate analysis. In addition, 2 884 cases of hepatocellular carcinoma(HCC) with more detailed follow‐up data from 2009 to 2019 were selected for survival analysis. Among 2 549 patients treated with hepatectomy, there were 2 107 males and 442 females, with an age of (56.6±11.1) years (range: 20 to 86 years). Among 335 patients treated with liver transplantation, there were 292 males and 43 females, with an age of (51.0±9.7) years (range: 21 to 73 years). The outcomes of hepatectomy versus liver transplantation, anatomic versus non-anatomic hepatectomy were compared, respectively.Results:Of the 10 966 patients with primary liver cancer, 10 331 patients underwent hepatectomy and 635 patients underwent liver transplantation. Patients with liver resection were categorized into three groups: 1986－1995(712 cases), 1996－2008(3 988 cases), 2009?2019(5 631 cases). The 5‐year overall survival rate was 32.9% in the first group(1986－1995). The 5‐year overall survival rate of resected primary liver cancer was 51.7% in the third group(2009‐2019), among which the 5‐year overal survival rates of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer were 57.4%, 26.6% and 50.6%, respectively. Further analysis was performed on 2 549 HCC patients with primary hepatectomy. The 1‐, 3‐, 5‐, and 10‐year overall survival rates were 88.1%, 71.9%, 60.0%, and 41.0%, respectively, and the perioperative mortality rate was 1.0%. Two hundred and forty‐seven HCC patients underwent primary liver transplantation, with 1‐, 3‐, 5‐, and 10‐year overall survival rates of 84.0%, 64.8%, 61.9%, and 57.6%, respectively. Eighty‐eight HCC patients underwent salvage liver transplantation, with the 1‐, 3‐, 5‐, and 10‐year overall survival rates of 86.8%, 65.2%, 52.5%, and 52.5%, respectively. There was no significant difference in survival rates between the two groups with liver transplantation ( P>0.05). Comparing the overall survival rates and recurrence rates of primary hepatectomy (2 549 cases) with primary liver transplantation (247 cases), the 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients within Milan criteria treated with hepatectomy and transplantation were 96.3%, 87.1%, 76.9%, 54.7%, and 95.4%, 79.4%, 77.4%, 71.7%, respectively ( P=0.754). The 1‐, 3‐, 5‐year recurrence rates were 16.3%, 35.9%, 47.6% and 8.1%, 11.7%, 13.9%, respectively( P<0.01). The 1‐, 3‐, 5‐, 10‐year overall survival rates in patients with no large vessels invasion beyond the Milan criteria treated with liver resection and transplantation were 87.2%, 65.9%, 53.0%, 33.0% and 87.6%, 71.8%, 71.8%, 69.3%, respectively( P=0.003); the 1‐, 3‐, 5‐year recurrence rate were 39.2%, 57.8%, 69.7% and 29.7%, 36.7%, 36.7%, respectively ( P<0.01). The 1‐, 3‐, 5‐, and 10‐year overall survival rates in patients with large vessels invasion treated with liver resection and transplantation were 62.1%, 36.1%, 22.2%, 15.0% and 62.9%, 31.8%,19.9%, 0, respectively ( P=0.387); the 1‐, 3‐, 5‐year recurrence rates were 61.5%, 74.7%, 80.8% and 59.7%, 82.9%, 87.2%, respectively( P=0.909). Independent prognostic factors for both overall survival and recurrence‐free survival rates of HCC patients treated with liver resection included gender, neoadjuvant therapy, symptoms, AST, intraoperative or postoperative blood transfusion, tumor number, tumor size, cirrhosis, macrovascular invasion, microvascular invasion, and pathological differentiation. Propensity score matching analysis of 443 pairs further showed that there was no significant difference in overall survival rate between anatomical liver resection and non‐anatomical liver resection( P=0.895), but the recurrence rate of non‐anatomical liver resection was higher than that of anatomical liver resection( P=0.035). Conclusions:In the past decade, the overall survival rate of HCC undergoing surgical treatment is significantly higher than before. For HCC patients with good liver function reservation, surgical resection can be performed first, and salvage liver transplantation can be performed after recurrence. The effect of salvage liver transplantation is comparable to that of primary liver transplantation. As for the choice of liver resection approaches, non‐anatomical resection can reserve more liver tissue and can be selected as long as the negative margin is guaranteed.