Objective To study the diagnosis and treatment of spontaneous perirenal hemorrhage(SPH). Methods The clinical data of 31 cases of SPH were reviewed retrospectively.In the 31 cases,flank pain,flank mass,shock,gross hematuria,abdominal bleeding occured in 31,10,8,3 and 3 cases,respectively.The final diagnosis was established on CT scan,B-ultrasonography and IVU were 18,22 and 7 cases. Results In 31 cases,nephrectomy were performed in 18,radical nephrectomy in 1 case,nephron spare surgery in 4,renal artery embolization in 2,inspiration and drainage of hemorrage in 1 and careful watching in 5 cases.There were 11 cases of angiomyolipoma,6 renal cyst,4 of renal cell carcinoma,3 infectious diseases,2 aneurysm of renal artery and 2 hydronephrosis. Conclusions The clinical presentation may vary greatly depending on the degree and duration of bleeding,and the severe pain in the upper abdomen of abrupt onset is the common sign and symptom.The spontaneous rupture of renal cell carcinoma and angiomyolipoma are the most common cause of SPH.CT scan and B-ultrasonography are the most valuable in the diagnosis of SPH.It is demanded that management of SPH depends on the histopathology and the degree of bleeding.

Objective To evaluate the role of nephron sparing surgery in patients with renal cell carcinoma. Methods Retrospectively analyzed a total of 17 patients with renal cell carcinoma treated with nephron sparing surgery between September 1997 and September 2002.Among these patients,2 cases were bilateral asynchronous and multicentric tumor,15 cases were unifocal tumor.2 cases were in imperative indications,6 cases in relative indications,and 9 cases in elective indications.The tumor diameter ranged from 2 cm to 6 cm,all tumor were in T 1 (1997 TNM staging system).15 cases underwent tumor enucleation at 1 cm apart from surgical margin,1 case underwent upper polar nephrectomy,1 case underwent wedged resection.Selected 20 patients matched for age, tumor location and stage who underwent radical nephrectomy at same period for comparison with an average follow-up of 36.4 months. Results The patients were followed up for an average period of 35.2 months (range,3 to 63 months),no surgical complication or local recurrence has been observed,and its long-term cancer-free survival was comparable to that after radical nephrectomy. Conclusions Nephron sparing surgery is safe and effective for the treatment of renal cell carcinoma and indicated for patients with small,localized,often incidental tumors and a normal contra-lateral kidney.

Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.

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 feasibility and safty of robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy in treatment of Ⅳa grade tumor thrombus without cardiopulmonary bypass and thoracotomy.Methods:The clinical data of 4 patients with renal cell carcinoma and Ⅳa grade tumor thrombus by robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy from January 2013 to June 2019 were retrospectively analyzed. The median age was 53.5 (53-70) years. The average body mass index was 23.25 (20.7-26.3) kg/m 2. The tumors were located on the right side in 2 cases. The average maximum diameter of the tumor was 8.1 (3.6-11.2) cm.Preoperative tumor thrombus of all patients was classified as Ⅳa. The average preoperative length of tumor thrombus in vena cava was 12.3 (11.8-18.0) cm. All the operations were performed under multidisciplinary cooperation of urology, hepatobiliary, cardiovascular, ultrasound and anesthesiologist team. Surgical procedure: Robot assisted liver mobilization was used to expose the inferior vena cava. Under the guidance of intraoperative ultrasound, the central tendon and pericardium of diaphragm were dissected until the inferior vena cava and right atrium in the superior pericardium were exposed. The first porta hepatis and inferior vena cava were blocked in turn.The vena cava thrombectomy and inferior vena cava reconstruction were performed. Results:All the operations were completed without conversion. The median operation time was 553.5 (338-642) minutes, and the median time of the first porta hepatis occlusion was 18.1 (14-32)minutes. The median blood loss was 1 900(1 000-2 600)ml. All patients were transferred to ICU after operation. The median length of stay in ICU was 7(4-8) days, and the median time of indwelling drainage tube was 8(4-12) days. The average postoperative hospital stay was 13(11-20) days. There were 1 case of grade Ⅱ and 3 cases of grade Ⅲ complications (Clavien classification). One case had paroxysmal supraventricular tachycardia, one case had lymphatic fistula, one case had pleural effusion with atelectasis, and one case had hepatic and renal insufficiency and lymphatic fistula. The complications were improved after treatment. There was no perioperative death.Conclusions:Robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy is an alternative method for the treatment of Ⅳa grade inferior vena cava tumor thrombus. Using this method, Ⅳa grade tumor thrombus can be treated without cardiopulmonary bypass and thoracotomy, with controllable complications and zero perioperative mortality.

Objective    To investigate the effect of different administration methods of tranexamic acid on postoperative pulmonary inflammation response during cardiopulmonary bypass (CPB). Methods    A total of 64 SD rats were included in the study. They were randomly divided into eight different groups. CPB model was established for the operation groups. The rats in the operation groups were given tranexamic acid at low (25 mg/kg), medium (50 mg/kg) or high (100 mg/kg) concentrations before or after the CPB. Blood cells count and coagulation function were assessed 1 hour after surgery. The concentration of interleukin (IL)-1β、IL-6 and tumor necrosis factor (TNF)-α in blood and lung lavage fluid were measured. The infiltration of inflammatory cells in lungs was observed by hematoxylin-eosin (HE) staining. Results    The concentration of inflammatory cells in the operation groups was higher than that in the control group (P<0.05). The use of tranexamic acid inhibited the increase of IL-6 and TNF-α in whole blood and lung lavage fluid due to CPB (P<0.05), but there was no significant difference among the experimental groups (P>0.05). Tranexamic acid could reduce the exudation of inflammatory cells in the lungs. Conclusion    The use of tranexamic acid can effectively reduce the release of inflammatory factors and reduce acute lung injury caused by CPB in rat models. But simply increasing the dose or changing the timing of administration is not more effective in reducing the intensity of the inflammatory response.

【Objective】 To statistically analyze the relationship between homologous recombination repair deficiency (HRD) score and clinicopathological characteristics, genomic mutations in patients with high-risk and metastatic hormone-sensitive prostate cancer (mHSPC) and the prognostic predictive value in mHSPC. 【Methods】 A total of 127 patients diagnosed with high-risk prostate cancer and mHSPC, treated at the Department of Urology of Chinese PLA General Hospital during Dec.2021 and Nov.2023 were enrolled.Homologous recombination repair (HRR) gene sequencing was performed, and the genomic scar score (GSS) algorithm were conducted to calculate the HRD score.The relationship between HRD scores and clinicopathological features, genomic alterations, and prognosis were analyzed. 【Results】 The median HRD score was 1.6(0.8, 5.2), 30(23.6%) patients’ HRD scores ≥10, and 11(8.7%) patients’ HRD scores ≥20.Clinicopathological features, including ISUP classification ≥4 (P=0.044) and metastatic status (P=0.008) were associated with high HRD score.Patients with mutations in the BRCA, TP53 and MYC systems had significantly higher HRD score than those with wild-type genes (P<0.05).In mHSPC, the risk of biochemical recurrence was 12.836 times higher in patients with HRD score ≥20 than in those with <20 [OR:12.836 (1.332-124.623), P=0.028]. 【Conclusion】 Baseline HRD score was lower in patients with high-risk prostate cancer and mHSPC.Patients with high HRD score may have higher histological grading (ISUP≥4) and later clinical stage.Further investigation is needed to determine the threshold of HRD scores as biochemical markers suggestive of a poor prognosis.