ObjectiveThe clinical characteristics and the possible risk factors were explored for the low triiodothyronine syndrome （LTS） in elderly patients with chronic heart failure （CHF）， and the risk prediction model of LTS was established. MethodsFor this research， 291 elderly patients with CHF were selected as sample and retrospectively reviewed was used as analytical method. According to the thyroid function of admission patients， two groups including LTS group （n=107） and normal thyroid function group （n=184） were divided. The general information and biochemical indicators of patients were collected and recorded， and the risk factors for LTS were assigned scores， in which numerical variables （except age） were grouped by median. The chi-squared test was used for statistical analysis of each variable， and multivariate regression model was used to analyze the independent risk factors of LTS in elderly patients with CHF， then the nomogram model for LTS was established based on the results from the final regression analysis. Furthermore， the prediction model was evaluated using C-index， calibration curve and receiver operating characteristic （ROC） curve. ResultSerum creatinine （Scr）， C-reactive protein （CRP）， interleukin-6 （IL-6） and the cardiac functional grading according to the New York Heart Association （NYHA） were positively correlated with LTS （OR values were 1.893， 2.356， 1.021 and 1.815， respectively， P < 0.05）， serum Albumin （Alb） was negatively correlated with LTS （OR = 0.412， P < 0.05）. This means that， the LTS was easily occurred as the serum Alb level declined. When introduce the above statistically significant variables into nomogram obtained the C index with 0.807 ［95% CI = （0.757， 0.856）］. The calibration curve verified by internal verification showed that the calibration degree of this prediction model was well calibrated. ROC curve analysis showed that the prediction model was well differentiated. ConclusionThe Scr， CRP， IL-6， Alb and cardiac functional grading in elderly CHF patients may be risk factors for incidence of LTS， while serum Alb may be a protective factor for LTS. Based on the above risk factors， the nomogram model for predicting the occurrence of LTS in elderly CHF patients had good differentiation and accuracy， and can provide guidance for clinical individualized prevention and treatment.

Objective To investigate new methods of osteonecrosis of femoral head (ONFH) with retrospective analysis of the clinical cases with technique of rotary cutting pressure-relief,impacted graft,and tantalum rod supporting treatment of early-stage femoral head necrosis.Methods From June 2010 to June 2014,32 cases (38 hips,23 males and 9 females) with ONFH were treated with technique of rotary cutting pressure-relief,impacted graft,and tantalum rod supporting,with the mean age of 24 ～ 52 (36.2 ± 3.8) years old.According to the Association Research Circulation Osseous (ARCO) classification,there were 11 hips on Ⅱ A stage,12 hips Ⅱ B,8 hips Ⅱ c,7 hips Ⅲ A.The averaged Harris score of all cases was 65 ～ 81 (72.5 ± 5.8) points.All cases were cured with minimally invasive technique,rotary cutter pressure-relief in femoral head,thoroughly remove sequestrum and implant allogeneic bone.Postoperative patients laid in bed for 1 month,after 1 month hold crutch gradually began to functional training.Postoperative 1 month,X ray film was reviewed every 3 months.According to the clinical symptoms,imaging findings,Harris scoring system was graded to evaluate the effectiveness.Results All the cases were followed up for average of 12 ～32 (20.2 ± 2.6) months,31 hips Kept hips succeed,hips pain; lame line symptoms were reduced or disappeared; x-ray showed femoral head necrosis area formed new bone,Harris scoring was upgraded to 75 ～ 95 (87.7 ± 6.4) points ; and seven hips failed with operation of total hip arthroplasty.The overall good rate was promoted from 26.3％ to 84.2％.Conclusions The technique treating for early-stagefemoral head necrosis with minimally invasive,rotary cutting pressure-relief,impacted graft,and tantalum rod supporting had a good short-term effects.

Objective To summarize clinical results of 29 cases of multi-vessel coronary disease treated by hybrid revascularization.Methods A total of 29 consecutive patients(all male,aged 62.8?9.7 years) with coronary artery disease(two-vessel,n=10;three-vessel,n=19) were treated with minimally invasive direct coronary artery bypass(MIDCAB)(left internal mammary artery to left anterior descending artery,LIMA-to-LAD) and percutaneous coronary intervention(PCI) between January 2000 and April 2005.The left ventricular ejection fraction(LVEF) was 0.576?0.108.Concomitant diseases included hypertension in 23 patients,insulin-dependent diabetes mellitus in 5 patients,chronic obstructive pulmonary disease in 2 patients,and old myocardial infarction in 14 patients.Results The 29 patients received 33 grafts(LIMA: 27 grafts;great saphenous vein: 6 grafts).Balloon angioplasty was carried out in 41 coronary lesions,usually following surgery.The mean number of revascularization was 2.5 per patient.There was no surgery-related complications and mortality.The blood flow in the LIMA was 45?14 ml/min.The chest drainage volume was 274?197 ml.Blood transfusion was required in 2 patients(6.9%).The length of ICU stay was 1.9?0.1 d and the length of hospital stay was 4~11 d(mean,7.5 d).Follow-up for 2.2?0.9 years showed no late death and myocardial infarction.Postoperative New York Heart Association(NYHA) Classification showed Class Ⅰ in 25 patients and Class Ⅱ in 4 patients.Repeated angiography was conducted in 4 patients,which found great saphenous vein graft occluded in 1 patient and stent re-stenosis in 2 patients.Conclusions The midterm results of hybrid techniques for coronary artery disease are satisfactory.Hybrid procedure is beneficial to high-risk patients.The long-term results need further investigation.

ObjectiveTo determine the prevalence of avian influenza viruses in the external environment of poultry in Anqing City， Anhui Province， and provide scientific evidence for prevention and control of animal-derived influenza in humans. MethodsA total of 28 farmers’ markets/farms in 10 counties （cities， districts） of Anqing City， Anhui Province， were selected as surveillance sites by simple random sampling strategy. Poultry faeces and other related samples were collected for 6 consecutive weeks. Real-time fluorescence quantitative PCR was used to examine the nucleic acids of influenza A virus. Subtypes H5， H7， and H9 of avian influenza virus were further tested in the positive samples. ResultsA total of 426 specimens were collected， among which 113 tested positive with a positive rate of 26.53%. Among the positive specimens， 104 were determined to be subtype H9， accounting for 92.04%. It did not significantly differ in the positive rate between the main and non-main urban areas （χ²<0.01， P>0.05） or among the specimens collected in different weeks （χ²=7.57， P>0.05）. However， it significantly differed in the positive rate among the specimens collected in the third week and other weeks （χ²=6.89， P<0.05）. Furthermore， among the different sampling sites， farms had the highest positive rate of 46.67%. Among the specimens from different sources， the surface-coated specimens from poultry cages had the highest positive rate of 34.78%. ConclusionAvian influenza viruses are prevalent in the external environment of poultry in Anqing City. It warrants strengthening the surveillance and risk assessment to reduce the virus transmission in the external environment and risk of human infection with animal-derived influenza.

AIM: To investigate the therapeutic effect and safety of ranibizumab and conbercept on macular edema secondary to non-ischemic retinal vein occlusion.

METHODS: Totally 80 cases(80 macular edema eyes)with macular edema secondary to non-ischemic retinal vein occlusion patients enrolled into our hospital from March 2014 to May 2018 were collected into our study and randomly divided into the group A(40 cases)and the group B(40 cases). The patients in the group A and group B underwent ranibizumab and conbercept intravitreal injections, respectively. The intraocular pressure, central macular thickness(CMT), best corrected visual acuity(BCVA)and central macular volume(CMV), the number of injections and the occurrence of ocular complications before and after treatment of 2 groups were recorded and compared.

RESULTS: After treatment 2wk to 3mo, compared with the group A, the CMT, BCVA, CMV and the cases of intravitreal injections had decreased(P<0.05), meanwhile the visual acuity had increased in the group B(65% vs 38%, P<0.05), however, there was no significant difference in the incidence of complications between the two groups(5% vs 0%, P=0.999).

CONCLUSION: Compared with the ranibizumab, the conbercept has advantage in treatment of macular edema secondary to non-ischemic retinal vein occlusion by improving the visual acuity, reducing the CMT, CMV and the times of intravitreal injections.

Objective    To evaluate the efficacy of thoracoscopic complex segmentectomy for stageⅠnon-small cell lung cancer (NSCLC). Methods    We retrospectively reviewed the perioperative clinical data of patients with stageⅠNSCLC who underwent thoracoscopic complex segmentectomy (n=58) or simple segmentectomy (n=33) between January 2017 and March 2020 in our hospital. There were 36 males and 55 females with a median age of 57 years (range: 50-66 years). The clinical data of the two groups were compared. Results    There were no significant differences between the two groups in characteristics including age, sex, weight, comorbidities, preoperative pulmonary function, dominant composition of tumor, tumor histology and size, overall complications, estimated blood loss, prolonged air leakage, length of hospital stay, length of drainage, surgical margin distance or number of dissected lymph nodes. Only the operation time and number of staples for making intersegmental plane were significantly different between the two groups (P<0.05). There was no perioperative death in both groups. Conclusion    Thoracoscopic complex segmentectomy is a feasible and safe technique for stageⅠNSCLC.

Objective The aim of this study is to review the experience of using non-transplantation procedure treating ischemic heart disease. Methods Between Jan of 2000 and Jan of 2008, 74 patients with ischemic heart disease comprised the study group, including 66 males and 8 females. The age of the group ranged from 36-79 years, mean 63.3 ±9.28years. The patients underwent non-transplantation procedure according to the preoperative tests. To evaluate the aimed vessels and the survival myocardial viability, coronary angiography, echocardiography, radioisotope scanning and dobutamine-stress echo-test were used. The cardiac function data were analyzed before and after operation. Results Seventy-one cases underwent coronary artery bypass [mean (3.26 ± 1.14) grafts/case], containing 54 arterial grafts and 177 veinuos grafts. The mechanical assistance was applied in 51 cases including 1ABP 50 cases(67.6% ), IABP and ECMO 1 case(1.4%). Postoperative complication contained re-thoracotomy for bleeding 1 case ( 1.4% ), wound infection 3 cases (4.1%), renal dysfunction 3 cases(4.1%), low cardiac output 11 cases(14.9 %). The in-hospital mortality was 10.8% ( 8 cases ). The follow-up time ranged from 17 to 107 months, mean (47.47±24.51 ) months. The follow-up mortality rate was 3.0%. The re-hospitalization for cardiovascular events taken place in 6 cases(9.1% ). The cardiac function improved postoperatively. EF increased from preoperative 0.33 to postoperative 0.47. The diameter of the left ventricular decreased markedly. The left ventricular end-systolic diamension decreased from preoperative 47.6 mm to postoperative 43.4 mm. Conclusion Selected patients with ischemic heart disease, potentially eligible for transplantation, can be managed by the non-transplantation surgery. In those patients post-operative quality of life is satisfactory, with comparable survival and low risk of re-hospitalization.

Objective To evaluate the clinical application and midterm result of mitral valve repair with multiple techniques for patients with complex mitral valve regurgitation. Methods From January, 2000 to July, 2006, 34 patients with complex mitral regurgitation, including 24 males and 10 females, aged 23 - 65 years [ average (42.8 ± 11.7) years ], comprised the study group. The data of the cardiac function (NYHA/EF), the diameter of left ventricular, left atria and the degree of mitral regurgitation were analyzed before and after operation. Results There was no mortality or major morbidity or reoporatien. Patients were followed up from 1 to 54 months [ average (31.2 ± 19.4) months]. The degree of mitral valve regurgitation decreased significantly after operation. The mean degree of pre-operatien mitral regurgitation was 3.62 ± 0.49, and follow-up degree was 1.18 ± 0.99 ( P ＜ 0.05) respectively.The diameters of left ventricular and left atria reduced. The postoperative cardiac function improved apparently. EF increased from 0.55 ± 0.11 preoperatively to 0.57 ± 0.10 postoperatively ( P = 0.06). Conclusion The comprehensive application of multiple techniques in repairing complex mitral valve regurgitation may be effective, and with a satisfying midterm results.

Objective    To explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy. Methods    The clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed, including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years. The data including lung nodule number, benign or malignant, preoperative location by Hookwire, preoperative planning and actual implementation, operation time, intraoperative blood loss, postoperative drainage volume and time of drainage tube removal, postoperative hospital stay and complications were collected and analyzed. Results    Among the 90 patients, 38 were preoperatively positioned by Hook-wire, 52 were directly operated on; 87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery, and 3 were converted to thoracotomy among whom 1 underwent lobectomy. Operation time was 198.58±56.42 min, intraoperative blood loss was 129.78±67.51 mL, lymph node samples were 6.43±1.41, drainage time was 2.98±1.25 d, the amount of postoperation drainage was 480.00±262.00 mL, hospital stay was 7.60±2.38 d. In all patients, 73 had single nodules and 17 had multiple nodules. Totally 113 pulmonary nodules were resected, 14 (12.39%) were benign nodules and 99 (87.61%) were malignant nodules. There was no perioperative death or serious complications. Conclusion    For those pulmonary parenchymal nodules which meet the  indications, it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography (3D-CTBA) reconstruction results. Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.

Objective To compare the clinical application of empirical thoracoscopic segmentectomy and precise segmentectomy planned by artificial intelligence software, and to provide some reference for clinical segmentectomy. Methods A retrospective analysis was performed on the patients who underwent thoracoscopic segmentectomy in our department from 2019 to 2022. The patients receiving empirical thoracoscopic segmentectomy from January 2019 to September 2021 were selected as a group A, and the patients receiving precise segmentectomy from October 2021 to December 2022 were selected as a group B. The number of preoperative Hookwire positioning needle, proportion of patients meeting oncology criteria, surgical time, intraoperative blood loss, postoperative chest drainage time, postoperative hospital stay, and number of patients converted to thoracotomy between the two groups were compared. Results A total of 322 patients were collected. There were 158 patients in the group A, including 56 males and 102 females with a mean age of 56.86±8.82 years, and 164 patients in the group B, including 55 males and 109 females with a mean age of 56.69±9.05 years. All patients successfully underwent thoracoscopic segmentectomy, and patients whose resection margin did not meet the oncology criteria were further treated with extended resection or even lobectomy. There was no perioperative death. The number of positioning needles used for segmentectomy in the group A was more than that in the group B [47 (29.7%) vs. 9 (5.5%), P<0.001]. There was no statistical difference in the number of positioning needles used for wedge resection between the two groups during the same period (P=0.572). In the group A, the nodule could not be found in the resection target segment in 3 patients, and the resection margin was insufficient in 10 patients. While in the group B, the nodule could not be found in 1 patient, and the resection margin was insufficient in 3 patients. There was a statistical difference between the two groups [13 (8.2%) vs. 4 (2.4%), P=0.020]. There was no statistical difference between the two groups in terms of surgical time, intraoperative blood loss, duration of postoperative thoracic drainage, postoperative hospital stay, or conversion to open chest surgery (P＞0.05). Conclusion Preoperative surgical planning performed with the help of artificial intelligence software can effectively guide the completion of thoracoscopic anatomical segmentectomy. It can effectively ensure the resection margin of pulmonary nodules meeting the oncological requirements and significantly reduce the number of positioning needles of pulmonary nodules.