ObjectiveTo investigate the predictive value of thyroid transcription factor-1 (TTF-1) in the treatment of advanced lung adenocarcinoma with different chemotherapy regimens.MethodsA total of 126 patients with advanced lung cancer were divided into three groups according to the chemotherapy regimen, namely a pemetrexed+nedaplatin group (PEM+NDP group), a pemetrexed+cisplatin/carboplatin group (PEM+DDP/CBP group) and a third-generation (3G) chemotherapy+cisplatin/carboplatin group (3G agent+DDP/CBP group). The predictive value of TTF-1 in the above three treatment regimens was analyzed. The patients were followed up by telephone or outpatient visit until April 2017.ResultsThere were no significant differences in disease control rate or objective response rate between the three different chemotherapy regimens (all P>0.05). The survival rate of PEM+NDP group was significantly higher than that of PEM+DDP/CBP group and 3G agent+DDP/CBP group (9.68%vs. 5.56% and 6.80%, both P<0.05). ECOG score and brain metastasis were independent risk factors for the prognosis of chemotherapy regimens. TTF-1 was an independent risk factor for PEM+NDP therapy.ConclusionTTF-1 is an independent risk factor for PEM+NDP chemotherapy, but not for 3G agent + DDP/CBP or PEM+DDP/CBP regimens.
Objective To estimate the feasibility and efficacy of respiratory function score ( RFS)guided ventilator weaning in mechanical ventilated patients with respiratory failure. Methods By a prospective control study,136 patients with acute respiratory failure who had received endotracheal intubation and mechanical ventilation from January 2010 to May 2012 were randomly divided into three group, ie. a RFS-guided 3-4 group ( n=60) , a RFS-guided 5-6 group ( n = 51) , and a traditional group ( n =25) . TheRFS-guided groups underwent ventilator weaning by guidance of RFS 3-4 and 5-6 respectively. The traditional group underwent ventilator weaning by ordinary way. The ventilation and oxygenation index, RFS,direct weaning success rate, total weaning success rate, total mechanical ventilation time, re-intubation rate,and ventilator-associated pneumonia ( VAP) incidence rate were observed.Results The direct weaning success rate in the RFS-guided 3-4 group, the RFS-guided 5-6 group, and the traditional group was 98. 3%( 59/60) , 82. 4% ( 42 /51) , and 100% ( 25 /25) , respectively. The total duration of mechanical ventilation was ( 5. 2 ±2. 5) days, ( 5. 0 ±3. 0) days, and( 7. 5 ±3. 5) days, respectively. the re-intubation rate was 0( 0 /60) , 1. 9% ( 1 /51) , and 0 ( 0/25) , respectively. VAP incidence rate was 11. 7% ( 7/60) , 13. 7%( 7 /51) and 24% ( 6 /25) , respectively. Compared with the traditional group, the direct weaning success rate and total weaning success rate in the RFS-guided 3-4 group were not significant different( P gt;0. 05) , while the total mechanical ventilation time and VAP incidence rate were significantly lower ( P lt; 0. 05) . Compared with the traditional group, the direct weaning success rate and total mechanical ventilation time in the RFSguided 5-6 group were significantly lower ( P lt;0. 05) , but the total weaning success rate was not significantly different ( P gt;0. 05) . Compared with the RFS-guided 5-6 group, the directweaning success rate in the RFSguided 3-4 group was significantly increased. Conclusions Mechanical ventilator weaning of patients with respiratory failure under RFS guidance is safe and feasible. RFS 3-4 guided ventilator weaning can significantly improve the therapeutic effect.
ObjectiveTo investigate the effectiveness of the modified great toe fibular flap using the distal artery pedicle as reflux vein for repairing distal phalanx finger wound.MethodsBetween June 2018 and January 2020, 15 patients who suffered tissue defect of the distal phalanx finger were treated, including 12 males and 3 females, the average age was 40.2 years (range, 24-56 years). All of them were caused by machine crush injury. There were 2 cases of thumb, 6 cases of index finger, 3 cases of middle finger, 3 cases of ring finger, and 1 case of little finger. The defects ranged from 1.7 cm×1.3 cm to 3.0 cm×2.0 cm. The time from injury to admission was 0.6-4 hours, with an average of 2.3 hours. The medial fibular proper digital artery was further dissociated to the distal end and anastomosed with the recipient vein as the reflux vein. The area of flaps ranged from 2.0 cm×1.5 cm to 3.2 cm×2.2 cm.ResultsAll the flaps survived without vascular crisis, and the wounds healed by first intention. Except for 1 case that the suture was too tight, the incision was partially split after the stitches were removed, and it healed spontaneously after dressing change, the other patients had good healing of the donor site incision and normal foot function. All 15 patients were followed up 3-18 months, with an average of 9.3 months. The appearance of finger pulps were satisfactory with full and threaded. The color, texture, and elasticity of the flaps were good, and the two-point discrimination was 6-8 mm at last follow-up. The flexion and extension of fingers were normal. At last follow-up, hand function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society, and the results were 13 cases of excellent and 2 cases of good.ConclusionModified great toe fibular flap using the distal arterial pedicle as a reflux vein can improve the venous drainage of the flap and contribute to increase the success rate of the flap without additional injury.