ObjectiveTo study the diagnosis and trea tm ent of bilateral renal angiomyolipomas.MethodsThe clin ic data of 13 cases of bilateral renal angiomyolipoms were reviewed.There were 2 male and 11 female patients with an average age of 42.Preoperative ultrasonogra phy and CT scanning have been undertaken in all.Renal angiomyolipoma was diagnos ed in 11 and cancer nodules could not be ruled out in the other 2.Unilateral and bilateral renal sparing surgerys were carried out in 5 and 8 cases respectively .ResultsAll cases were examined with rapid frozen sect ion analysis at operations.The renal function of all the patients except 1 was n ormal after operation except 1 with a temporary rise in Scr (350 ?mol/L).The pa tients have been followed up 1 to 4 years after discharging from hospital and th e renal function became normal in all.No recurrence was found.Conc lusionsUltrasonography and CT are important methods to diagnose ang iomyolipoma with specific manifestations.Rapid frozen section analysis at operat ions is helpful to diagnose and to choose the correct surgical technique.Attenti on should be paid to reserve the renal tissues as much as possible and renal fun ction should be protected properly.

eiving Solifenacin 5.8% compared to those recei-ving Tolterodine 10.4%(P<0.05). Conclusion Solifenacin could be the safer and effective drug in the treatment of OAB patients with main complaints of urinary urgency and urgy incontinence.

Objective To systematically review reports dealing with the efficacy of pulmonary rehabilitation for patients with acute exacerbation of chronic obstructive pulmonary disease.Methods The PubMed,EMbase,China National Knowledge Infrastructure,VIP and Wan Fang databases were searched to collect reports of randomized and controlled trials of pulmonary rehabilitation for patients with acute exacerbation of chronic obstructive pulmonary disease.The search covered from each database's inception to August 1,2016.Two reviewers screened the literature independently,extracted data and assessed the risk of bias for the studies eventually included.A meta-analysis was performed using version 5.3 of the RevMan software.Results After the initial selection,a total of 7 reports covering 486 patients were included in the meta-analysis.The results of the meta-analysis showed that the average mMRC score,the 6-minute walk distance and Borg score in the pulmonary rehabilitation group were all significantly higher than in the control group.There was,however,no significant difference between the two groups' average pulmonary function values.Conclusion Pulmonary rehabilitation is safe for patients experiencing an acute exacerbation of chronic obstructive pulmonary disease.It can effectively improve their exercise tolerance,expiratory dyspnea and daily living ability.

Objective:To explore the clinical efficacy and safety of different surgical procedures of Mayo level Ⅳ inferior vena cava tumor thrombus(IVC-TT).Methods:The clinical and pathological data of 36 patients with Mayo level Ⅳ tumor thrombus were collected in three large clinical centers in China, including 18 cases in PLA General Hospital, 7 cases in Nanfang Hospital, and 11 cases in Renji Hospital. There were 25 males and 11 females.The median age was 56.5 years (53-67 years old). The average body mass index was 24.18±2.55 kg/m 2. The average diameter of renal tumors was 8.24±3.25 cm. The average length of inferior vena cava tumor thrombus was 12.89±2.50 cm. Mayo level Ⅳ tumor thrombus were divided into level Ⅳa and level Ⅳb (301 classification) based on the criterion of whether the proximal end of the thrombus has invaded the right atrium. Among them, level Ⅳa patients underwent robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass(CPB-free group, 6 cases). Level Ⅳb patients underwent robot-assisted inferior vena cava thrombectomy with cardiopulmonary bypass(CPB group, 12 cases) or cardiopulmonary bypass with deep hypothermic circulatory arrest assisted inferior vena cava thrombectomy(CPB/DHCA group, 18 cases). The baseline data of the three groups of patients were comparable. The perioperative results and long-term survival data after surgery were compared with different surgical methods for grade Ⅳcancer thrombosis. Results:All operations were successfully completed. Compared with the CPB group, the CPB-free group had a shorter first portal blocking time[17.5(15-36)min vs. 36.5(12-102)min, P=0.044], less intraoperative bleeding [2 350(1 000-3 000)ml vs. 3 500 (1 500-12 000)ml, P=0.043] and a lower allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 185(700-5 800)ml, P=0.049]. Compared with the CPB/DHCA group, the CPB-free group had an advantage in reducing intraoperative allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 700(1 200-10 000)ml, P=0.003]. There were no significant differences between groups in terms of duration of surgery and postoperative hospital stay. Among the 36 patients in this group, 23(64%) developed major complications (level Ⅲ or above), including 9 (25%) grade Ⅲ, 12 (33%) grade Ⅳ, and 2 (6%) grade Ⅴ. The CPB-free group had a relatively low complication rate of grade Ⅳ or above [ 17% (1/6) vs.42% (5/12) vs.44% (8/18)]. There were no statistical differences in median progression-free survival (16.4 vs.12.3 vs.18.0 months, P=0.695) and overall survival (30.1 vs.30.2 vs.37.7 months, P=0.674) between the groups. Conclusions:Robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass has the advantages of short ischemia time of organs, less intraoperative bleeding, and low incidence of major complications, which can be used as a safe and feasible surgical strategy for selected level Ⅳ tumor thrombus.