Development and metastasis of NSCLC are closely related to angiogenesis.Several distinct groups of vascular-targeted therapies have evolved:anti-VEGF monoclonal antibody,small molecules inhibitors,vascular disrupting agents,endothelial cell growth inhibitors,et al.Antiangiogenic treatment could make longer survival than conventional treatment.The strategy of anti-angiogenic drugs combined conventional treatment is being studied.

Objective:To investigate the efficacy of stereotactic body radiation therapy with gamma-knife (γ-SBRT) combined with targeted drug sorafenib and hyperthermia for the treatment of recurrent and metastatic hepatocellular carcinoma. Methods:A total of 71 patients with recurrent and metastatic hepatocellular carcinoma were admitted from August 2007 to December 2009. Among these patients, 39 were treated with γ-SBRT and hyperthermia (group 1); 19 were treated with γ-SBRT combined with sorafenib and hyperthermia (group 2). Results: The total efficacy rate after a three-month treatment was 83.1% (59/71). In group 1, the following results were obtained:one-and three-year local control rates of 41.0%(16/39) and 18%(7/39), respectively;one-and three-year overall survival (OS) rates of 41.2% and 17.9%, respectively; and one- and three-year progression-free survival (PFS) rates of 38.4% and 15.4%, respectively. In group 2, the following results were obtained:one-and three-year local rates of 56.3%(18/32) and 28.1%(9/32), respectively;one-and three-year OS rates of 62.5%and 28.1%, respectively;and one-and three-year PFS rates of 59.4%and 25.0%, respectively. Significant differences in OS and PFS were observed between the two groups. Conclusion:The combination ofγ-SBRT with targeted drug sorafenib and hyperthermia can be used effectively to treat recurrent and metastatic hepatocellular carcinoma. Adverse reactions are mild, and patients can tolerate this treatment.

Objective: To evaluate the clinical efficacy and adverse events of recombinant human interleukin-11(rhIL-11) in the prevention of thrombocytopenia induced by craniospinal irradiation. Methods: In this randomized control study, 100 patients were randomly divided into A (rhIL-11 group, n=50) and B groups (control group, n=50). In the A group, subcutaneous injection of rhIL-11 was delivered at a dose of 50 μg/kg/d, once daily when the platelet count was< 100×10⁹/L during radiotherapy or decreased by> 50% compared with the baseline level. The administration of rhIL-11 was terminated when the platelet count was ≥ 200×10⁹/L. In the B group, the same protocol was conducted when the platelet count was< 50×10⁹/L and terminated until the platelet count was ≥ 100×10⁹/L. The clinical efficacy was assessed in 92 patients. Subcutaneous injection of rhIL-11 could significantly elevate the minimal platelet count during craniospinal irradiation (P<0.01), considerably shorten the duration of thrombocytopenia (P<0.01) and effectively shorten the duration of radiotherapy (P<0.01). Main adverse events included mild pain at the injection site, sclerosis, redness and fatigue, etc. Conclusions Injection of rhIL-11 can significantly enhance the platelet count, effectively reduce the incidence of thrombocytopenia throughout craniospinal irradiation, guarantee the success of radiotherapy and yield mild adverse events.

Objective The aim of this study was to evaluate the safety and efficacy of 135 cm Corsair microcatheter inpercutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) with antegrade approach via radial artery. Methods From June 2010 to February 2014, a total of 81 patients with CTO lesions treated with 135cm Corsair microcatheter (Asahi Intec Co, Japan) and transradial antegrade approach was enrolled in this study. The success rate of CTO-PCI, the rate of Corsair microcatheter crossing the CTO lesions and the number of balloon catheters utilization were retrospectively analyzed. Unique complications related to the Corsair microcatheter were also documented. Results Success recanalization of CTO were achieved in 73 (90.1%) patients. Crossing the CTO body with Corsair microcatheter was found in 56(84.8%) patients. The number of balloon utilized after Corsair microcatheter crossing the CTO was much lower than that of patients who Corsair microcatheter failed to cross (1.3±0.6 per patient versus 2.8±1.2per patient, P < 0.05). The success recanalization rate of combined using Fielder XT guidewire with Corsair microcatheter was 51.5%. There was no complications related to Corsair microcatheter during the index procedure, no major adverse cardiac events during in-hospital clinical follow-up. Conclusions Corsair microcatheter was safe and effective in the recanalization for CTO with transradialantegrade approach. It can simplify the CTO-PCI procedure and reduce the number of balloon catheters.

Objective:To explore the accuracy of intelligent calculation (IC) method for risk assessment of hospitalization for patients, aiming to build a more advantageous risk assessment system.Methods:The "Search Engine" program was developed based on hospital information system (HIS) of the Fifth Center Hospital in Tianjin, which automatically captured patient information and generated nutritional risk screening 2002 (NRS 2002) score, Caprini thrombosis risk assessment model and Padua thrombosis risk assessment model for venous thromboembolism (VTE), the CHA 2DS 2-VASc for predicting stroke risk stratification in atrial fibrillation and the HAS-BLED for predicting bleeding risk in anticoagulated patients with atrial fibrillation. A randomized controlled trial was conducted. According to the applicable conditions of each risk assessment, 100 risk scores from "Search Engine" program belonged to each risk assessment were randomly selected, defined as the IC group. Manual scoring with the data of the same case at the same time, defined as the traditional calculation (TC) group, compared the consistency of the scores and the difference in time-consuming between the two groups. Results:The Bland-Altman plots showed that the 95% limits of agreement (95% LoA) of NRS 2002 score, Caprini score, Padua score, CHA 2DS 2-VASc score and HAS-BLED score was -0.46 to 0.41, -0.49 to 0.52, -0.50 to 0.41, -0.67 to 0.60, -0.44 to 0.43, respectively, all P > 0.05. In this study, the Bland-Altman plot showed that 95%, 96%, 97%, 97%, 95% plots fell within the 95% LoA in NRS 2002 score, Caprini score, Padua score, wwCHA 2DS 2-VASc score and HAS-BLED score by the two methods, respectively. The all plots of 95% LoA were within the clinically acceptable range (-0.5 to 0.5 scores). The time-consuming of NRS 2002 score, Caprini score, Padua score, CHA 2DS 2-VASc score and HAS-BLED score in IC group were significantly shorter than those in TC group [0.72 (0.71, 0.73) seconds vs. 361.02 (322.41, 361.02) seconds, 0.72 (0.72, 0.73) seconds vs. 196.68 (179.99, 291.20) seconds, 0.72 (0.72, 0.73) seconds vs. 105.75 (92.32, 114.70) seconds, 0.72 (0.71, 0.72) seconds vs. 72.66 (56.24, 84.20) seconds, 0.72 (0.71, 0.72) seconds vs. 51.30 (38.88, 57.15) seconds, respectively, all P < 0.001]. Conclusion:For the above five risk assessments, the TC method and IC method has good consistency in scores, and the IC method is faster, which has good application prospect for clinical application.

Objective:To explore the evaluation value of sequential organ failure assessment (SOFA) score at different time points in the prognosis of patients with severe pneumonia combined with acute respiratory distress syndrome (ARDS).Methods:A retrospective cohort study method was conducted, including patients with severe pneumonia and ARDS admitted to the emergency intensive care unit (ICU) of General Hospital of Ningxia Medical University from January 2015 to December 2019. General clinical data such as gender, age, and the SOFA scores at 1, 2, 3, and 7 days after admission were recorded. According to the diagnostic test, the prognostic evaluation value of SOFA score in patients with severe pneumonia combined with ARDS at different time points and different ages was analyzed.Results:A total of 88 cases were included in this study, eventually, 42 cases were survived and 46 cases died, the mortality was 52.27%. The age of the death group was significantly older than the survival group (years old: 60.67±14.66 vs. 51.91±15.97), the SOFA score at each time point were significantly higher than those in the survival group (9.83±3.50 vs. 7.54±2.67, 9.98±3.75 vs. 7.48±2.92, 10.84±4.14 vs. 7.23±2.94, 11.71±4.03 vs. 6.51±3.22, respectively at 1, 2, 3, 7 days after admission, all P < 0.01). The receiver operator characteristic curve (ROC curve) showed that the SOFA score at 1, 2, 3, and 7 days after admission had a certain predictive value for the prognosis of patients with severe pneumonia combined with ARDS (all P < 0.01), and with the prolong of ICU stay, the area under ROC curve (AUC) of SOFA score had gradually increased. On the 7th day after admission, the SOFA score had the highest sensitivity in predicting severe pneumonia combined with ARDS patients, which was 92.86%, and the specificity was the highest on the 3rd day after admission, which was 88.10%. The AUC in day 7 was significantly higher than day 2 (0.85 vs. 0.72) , there was no statistically significant difference of AUC at other time points. After stratifying by age, the diagnostic of sensitivity, specificity, accuracy, and AUC of SOFA score for the prognosis had gradually increased, and the predictive value was better. However, only on day 3 after admission, the AUC of SOFA score was significantly higher than day 1 (0.80 vs. 0.77, P < 0.05), and there was no significant difference in AUC at other time points. In patients older than 60 years old, the AUC of the SOFA score predicting the prognosis of patients was relatively small on day 1 and day 2 (0.67, 0.68, respectively), the ability was poor. There was no statistically significant difference in the AUC of SOFA scores at each time point in evaluating the prognosis of patients. The trends over time of patients at different ages and time points showed that regardless of age, the SOFA scores of the patients in the death group showed an upward trend, while showed a downward trend in the survival group, the difference reached the largest on the 7th day after admission, and the death group was significantly higher than the survival group (age < 60 years old: 12.50 vs. 6.69; age≥60 years old: 11.58 vs. 6.21). Conclusion:The initial SOFA score has a certain value in the evaluation of prognosis of severe pneumonia patients combined with ARDS, but the effect is poor for elderly patients.

Objective:To explore the characteristics of the changes in risk score for intensive care unit (ICU) patients during hospitalization by the intelligent calculation method, and to provide evidence for the risk prevention.Methods:In this retrospective study, ICU patients of the Fifth Central Hospital in Tianjin from November 3, 2021 to March 28, 2022 were enrolled and divided into ≥ 14 days group, 10-13 days group, 7-9 days group, and 3-6 days group according to the ICU length of stay. Risk scores assessed by the intelligent calculation method of the ICU patients were collected, including nutritional risk screening 2002 (NRS 2002), Caprini score and Padua score. NRS 2002 score for all patients, Caprini score for surgical patients and Padua score for internal medicine patients were selected. Trends in change of each score were compared between patients admitted to ICU 1, 3, 7 (if necessary), 10 (if necessary), and 14 days (if necessary).Results:A total of 138 patients were involved, including 79 males and 59 females, with an average age of (61.71±18.86) years and an average hospital stay of [6.00 (4.00, 9.25)] days. ① in the group with ICU length of stay ≥ 14 days (21 cases): there was no significant change in the NRS 2002 scores of the patients within 10 days, but the NRS 2002 score was significantly decreased in 14 days as compared with 1 day [3.00 (2.50, 3.50) vs. 4.00 (3.00, 5.00), P < 0.05]; both Caprini and Padua score were increased with prolonged hospital stay and compared with 1 day, the scores at the other time points were significantly increased, especially at 14 days [Caprini score: 5.00 (3.25, 7.00) vs. 2.50 (1.25, 5.50), Padua score: 6.00 (6.00, 7.00) vs. 3.00 (1.00, 3.00), both P < 0.05].② in the group with ICU length of stay from 10-13 days (15 cases): with the prolonged hospital stay, there was no significant change in NRS 2002 score, but both Caprini and Padua score were increased at 3, 7, 10 days, especially at 10 days [Caprini score: 3.00 (2.00, 4.75) vs. 2.00 (0.25, 2.75), Padua score: 5.00 (3.50, 6.00) vs. 2.00 (0.50, 4.00), both P < 0.05].③ in the group with ICU length of stay from 7-9 days (23 cases): compared with 1 day, the NRS 2002 score at 3 days and7 days were decreased, but the Caprini and Padua score were increased, especially at 7 days [NRS 2002 score: 2.00 (1.00, 4.00) vs. 2.00 (2.00, 4.00), Caprini score: 3.00 (2.00, 5.50) vs. 2.00 (0.25, 3.00), Padua score: 5.00 (4.00, 6.00) vs. 2.00 (0, 2.00), all P < 0.05]. ④ in the group with ICU length of stay from 3-6 days (79 cases): compared with 1 day, the NRS 2002 score at 3 days was decreased [NRS 2002 score: 2.00 (1.00, 3.00) vs. 2.00 (1.00, 3.00), P < 0.05], Caprini and Padua score were significantly increased [Caprini score: 3.00 (2.00, 4.00) vs. 2.00 (1.00, 3.00), Padua score: 5.00 (4.00, 5.00) vs. 2.00 (1.00, 3.00), both P < 0.05]. Conclusion:Based on dynamic assessment of intelligent calculation methods, the risk of thrombosis in ICU patients increased with hospital length of stay, and the nutritional risk was generally flat or reducing in different hospitalization periods.