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目的 研究以年龄、血压、临床特征、症状持续时间、糖尿病、双重TIA和影像（age，blood pressure，clinical features，duration，diabetes，double transient ischemic attack，image；ABCD3-I）评分联合血清组织蛋白酶L（cathepsin L，CatL）水平预测TIA患者短期发生脑梗死的价值。 方法 回顾性连续收集2019年10月—2022年6月西北大学第一医院收治的TIA患者资料，根据发病后90 d是否发生急性脑梗死分为脑梗死组和对照组。比较两组患者的ABCD3-I评分、血清CatL水平及其他临床资料的差异，采用多因素logistic回归分析TIA患者90 d发生脑梗死的独立危险因素，采用ROC曲线分析ABCD3-I评分、血清CatL水平对TIA患者短期发生脑梗死的预测价值。 结果 共纳入115例TIA患者，脑梗死组22例，对照组93例。脑梗死组的ABCD3-I评分[7.0（6.0～7.0）分 vs. 5.0（4.5～6.0）分，P＜0.001]、血清CatL水平[（6.1±0.9）μg/L vs.（4.8±0.9）μg/L，P＜0.001]及LDL-C水平[（3.6±0.5）mmol/L vs.（3.4±0.6）mmol/L，P=0.039]均高于对照组。多因素logistic回归分析显示，ABCD3-I评分高（OR 4.843，95%CI 2.301～10.193，P＜0.001）、血清CatL水平升高（OR 2.099，95%CI 1.332～3.308，P=0.001）是TIA患者发生急性脑梗死的独立危险因素。ROC曲线分析显示，ABCD3-I评分、血清CatL水平预测TIA患者发生急性脑梗死的AUC值分别为0.829（95%CI 0.749～0.909）和0.867（95%CI 0.796～0.938），对应截断值分别为7.0分和5.3 μg/L，两者联合预测的AUC值提升至0.911（95%CI 0.848～0.974）。 结论 ABCD3-I评分联合血清CatL水平对TIA患者短期发生急性脑梗死具有较好的预测价值。 Abstract: Objective To study the value of age, blood pressure, clinical features, duration, diabetes, double transient ischemic attack, image (ABCD3-I) score combined with serum cathepsin L (CatL) level in predicting the short-term cerebral infarction in patients with TIA. Methods The data of TIA patients admitted to the Northwest University First Hospital from October 2019 to June 2022 were retrospectively and continuously collected. The patients were divided into the cerebral infarction group and the control group according to whether acute cerebral infarction occurred at 90 d follow-up. The differences in ABCD3-I score, serum CatL level, and clinical data between two groups of patients were compared. The independent influencing factors of short-term cerebral infarction in TIA patients were analyzed by multivariate logistic regression. The predictive value of ABCD3-I score and serum CatL level on the occurrence of short-term cerebral infarction in TIA patients was analyzed by the ROC curve. Results A total of 115 patients with TIA were enrolled, including 22 patients in the cerebral infarction group and 93 patients in the control group. The ABCD3-I score [7.0 (6.0-7.0) points vs. 5.0 (4.5-6.0) points, P＜0.001], serum CatL level [(6.1±0.9) μg/L vs. (4.8±0.9) μg/L, P＜0.001], and LDL-C level [(3.6±0.5) mmol/L vs. (3.4±0.6) mmol/L, P=0.039] of the cerebral infarction group were higher than those of the control group. Multivariate logistic regression analysis showed that the elevated ABCD3-I score (OR 4.843, 95%CI 2.301-10.193, P＜0.001) and the elevated serum CatL level (OR 2.099, 95%CI 1.332-3.308, P=0.001) were independent risk factors for the occurrence of acute cerebral infarction in TIA patients. ROC curve analysis showed that the AUC value of ABCD3-I score and serum CatL level in predicting acute cerebral infarction of TIA patients were 0.829 (95%CI 0.749-0.909) and 0.867 (95%CI 0.796-0.938), respectively, and the corresponding cutoff value were 7.0 points and 5.3 μg/L, respectively. The AUC value of the combination of the two indicators was 0.911(95%CI 0.848-0.974). Conclusions The combination of ABCD3-I score and serum CatL level has good predictive value on the occurrence of short-term cerebral infarction in TIA patients.

Objective: To investigate the safety and efficacy of hepatic resection for those patients with large/multinodular hepatocellular carcinoma (HCC) or those involving macrovascular invasion (MVI)., Methods: PubMed was systematically searched for studies examining the safety and efficacy of hepatic resection for treatment of HCC involving a single large tumor (>5 cm) or multiple tumors (>2), or those involving MVI., Results: The identified 52 studies involving 14 922 patients that investigated the use of hepatic resection for large/multinodular HCC, and 25 studies with 4 412 patients that investigated hepatic resection for HCC with MVI. Median in-hospital mortality of patients with either type of HCC was significantly lower in Asian studies (2.7%) than in non-Asian studies (7.3%, P<0.001). Median overall survival rate was significantly higher for all Asian patients with large/multinodular HCC than for all non-Asian patients both at the time of 1 year (81% vs 65%, P<0.001) and 5 years (42% vs 32%, P<0.001). However, median overall survival rate was similar for Asian and non-Asian patients with HCC involving MVI at the time of 1 year (50% vs 52%, P=0.46) and 5 years (18% vs 15%, P=0.95). There was an increasing trend in 5-year overall survival in patients with either type of HCC., Conclusions: Hepatic resection is reasonably safe and effective for the treatment of large/multinodular HCC and HCC with MVI. The available evidence argues for expanding the indications for hepatic resection in official treatment guidelines.