2. Malignant Lymphoma ML

2. Malignant Lymphoma (ML) The median age of onset for ML is older than for CD, with a difference of about 10 years. The median duration of ML is significantly shorter than that of CD. Perianal lesions in CD are highly specific, such as a tendency to develop intestinal obstruction and fistulas. ML commonly presents with abdominal masses and fluid accumulation; CD rarely does.

September 17, 2007: New Therapy for Helicobacter pylori

An Italian scholar proposed a 10-day sequential therapy: for the first 5 days, use proton pump inhibitors such as omeprazole, pantoprazole, and rabeprazole (10 mg each time, three times a day), combined with amoxicillin (1000 mg each time, three times a day); for the next 5 days, continue using proton pump inhibitors as before, combined with clarithromycin (500 mg each time, twice a day) and tinidazole (500 mg each time, twice a day).

October 15, 2007: Insulin Resistance in Hypertensive Patients

Hypertensive patients often have hyperlipidemia and insulin resistance, collectively known as metabolic syndrome. In China, among people aged 35–64, metabolic syndrome affects 10%–20% of the population; while among those aged 60–95, the proportion rises to 20%–40%. Metabolic syndrome is the foundation for the development of cardiovascular disease and diabetes, increasing the incidence of the former by 2–4 times and the latter by 5–9 times. Recent research has found that angiotensin II receptor blockers like micardis (telmisartan) have the effects of lowering blood pressure, reducing lipids, and lowering blood sugar, making them ideal drugs for preventing and treating metabolic syndrome.

October 15, 2007: Application of Angiotensin II Receptor Blockers (ARBs) in Chronic Kidney Disease

All hypertensive patients with kidney disease should prioritize ACEI or ARBs as their first-line medication. It should be noted that the usage of these two types of drugs should differ, because the renin-angiotensin system (RAS) in the body is divided into circulating RAS and organ-local RAS. Ang II in kidney tissue is 60–100 times more concentrated in circulation, because 85% of it is produced by the kidney itself, while only 15% comes from circulation. Therefore, when treating hypertension in kidney disease, using the usual dosage often fails to provide protective effects, and suddenly increasing the dosage may also be intolerable for patients. Thus, it is advisable to gradually increase the dosage from a small amount to a larger one, sometimes using ARBs up to 8–12 tablets per day for more than six years.

October 19, 2007: The Latest Concept of Uremia

Ultimately, kidney failure leads to uremia, at which point urea nitrogen can reach 21 mmol/L, creatinine 700 μmol/L, and glomerular filtration rate only about 7% of normal levels.

Treatment options include dialysis and kidney transplantation. Dialysis can solve the problem of urea but not that of solutes (amines, indoles, phenols, furans, etc.). The so-called solute problem is also known as residual syndrome (fatigue, loss of appetite, nausea, convulsions, spasms, decreased body temperature). Kidney transplantation, on the other hand, can solve both the urea problem and the residual problem, but donor availability is limited and it is difficult to promote. With dialysis 2–3 times a week, some patients can survive for more than 10 years, but due to factors such as infection, the 5-year survival rate remains quite low. Rejection after kidney transplantation is still a major issue. Recently, clinical practice has adopted a combination of mycophenolate mofetil, hormones, and tacrolimus, which can greatly reduce transplant rejection.

October 22, 2007: Glomerular Filtration Rate

Glomerular filtration rate refers to the amount of urine filtered by the kidneys per minute, with normal adults ranging from 80–125 mL/min. This value is equal to the absolute value of endogenous creatinine clearance, so the normal adult range for endogenous creatinine clearance is also 80–125 mL/min.

October 22, 2007: Primary Biliary Cirrhosis

As early as the 20th century, primary biliary cirrhosis (PBC) was classified as an autoimmune-related disease, mainly affecting middle-aged women. In the United States, the incidence is 1%–4%, while in China there are no complete statistics on its occurrence yet. Fatigue and skin itching are the earliest subjective symptoms of this disease. Ultrasound examination reveals signs of cirrhosis. Anti-nuclear antibodies (ANA) and anti-mitochondrial antibodies (AMA) are often positive. In advanced stages, jaundice, ascites, and skin pigmentation may appear. PBC can be divided into four stages histologically: portal inflammation stage, hepatic parenchymal inflammation stage, interstitial or bridging fibrosis stage, and cirrhosis with regenerative nodules stage. The median survival time for patients with this disease is 10 years. In recent years, treatment with ursodeoxycholic acid has proven effective, potentially extending survival. Anti-mitochondrial antibodies (AMA) can also be positive in non-biliary cirrhosis patients, but the positivity is non-specific.

October 22, 2007: Monoclonal Antibodies

Monoclonal antibodies are commonly known as “biological missiles,” referring to antibodies produced by specific antigenic determinants acting on specific sites. Targeted therapeutic drugs frequently used in clinical practice, such as rituximab, imatinib mesylate, herceptin, and erlotinib, all belong to this category.

October 26, 2007: Top Ten Medication Errors

In July 2007, the annual meeting of the American Pharmacists Association was held in Atlanta, where common medication errors in clinical practice were discussed. The top ten included: ① Insulin: dosage. ② Anticoagulants: timing. ③ Amoxicillin: misuse. ④ Aspirin: timing. ⑤ Co-trimoxazole: stomach irritation. ⑥ Acetaminophen (paracetamol): stomach irritation. ⑦ Ibuprofen: stomach irritation. ⑧ Hydrocodone (acetylcodine)/acetaminophen: stomach irritation. ⑨ Cefalexin: misuse. ⑩ Penicillin: misuse.

October 26, 2007: Salbutamol

Salbutamol (albuterol sulfate) is currently the drug of choice for treating bronchial asthma or asthmatic bronchitis. The tablet dosage is 2 mg, 1–2 tablets each time, three times a day; the aerosol dosage is 0.1 mg, three to four sprays each time, three to four times a day.

October 22, 2007: Anti-Smooth Muscle Antibodies (Anti-SMA)

During acute and chronic liver diseases, hepatocytes die, muscle fibers contract, and proteins are released into the bloodstream, producing anti-SMA antibodies. In autoimmune hepatitis (primary biliary cirrhosis), the positive rate of these antibodies is relatively high; in acute viral hepatitis, the SMA positive rate can reach 80%, often appearing within the first week of illness.

November 29, 2007: Interferon

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Interferon (IFN) is an activated cytokine produced by monocytes and lymphocytes, composed of polypeptides. Based on differences in origin and structure, IFNs can be classified into three types: IFN-α, IFN-β, and IFN-γ. The former has more than 20 subtypes, while the latter two each have only one subtype. IFN-α is produced by leukocytes, IFN-β by fibroblasts, and IFN-γ by lymphocytes. Its functions include inhibiting viruses, suppressing cell proliferation, and regulating immunity.

Given this, interferons are currently used to treat three categories of diseases: ① viral infections: hepatitis B, hepatitis C, shingles, and various warts. ② leukemia, lymphoma, and malignant tumors. ③ autoimmune diseases (due to their significant side effects, they are now rarely used).

Side effects of IFN: ① fever and flu-like symptoms. ② suppression of bone marrow hematopoiesis. ③ psychiatric symptoms, such as irritability, insomnia, and palpitations. In very rare cases, patients may experience cardiovascular disease and liver damage.

IFN preparations: ① IFNα-1b (Saifujin). ② IFNα-2a (Luo Rourou). ③ IFNα-2b (Anfulong, Andafen). ④ Compound interferon: its efficacy exceeds that of ordinary interferons by five times, available in 9μg and 15μg specifications. ⑤ Long-acting interferons: polyethylene glycol interferon α-2b (Peile Neng), polyethylene glycol interferon α-2a (Pai Luoxin), with the former being superior to the latter. Long-acting interferons have longer-lasting effects and fewer side effects compared to short-acting ones.

December 10, 2007: Ambroxol Syrup

This drug, also known as Mucosolvan, is a commonly used expectorant and cough suppressant today. Typically administered orally as syrup, adults take 90mg/day, three times daily; once improvement is observed, the dosage can be reduced to 60mg/day, three times daily, with an average treatment course of one week. According to research by Boehringer Ingelheim in Germany, this drug’s expectorant and cough-suppressing effects rank first among current similar medications.

December 10, 2007: Continuous Renal Replacement Therapy (CRRT) for Acute Renal Failure (ARF)

This therapy has been practiced in Western countries for nearly 20 years, but has only just begun in China. The principle behind this method is to use the pressure difference between arteries and veins as the driving force for extracorporeal circulation, continuously and slowly removing excess fluid from the blood; and to remove uremic substances and inflammatory mediators from solutes through convection. Previously, acute renal failure (ARF) was defined as kidney failure caused by poisoning, burns, severe trauma, and infections. However, nowadays multi-organ failure (MOF) and multiple organ dysfunction syndrome (MODS) are frequently seen clinically, often accompanied by ARF, so the current definition remains inconsistent.

December 15, 2007: Several Current Hospital Devices

1. The JF-800A hemoperfusion machine integrates extracorporeal blood circulation equipment, automatic anticoagulant infusion device, blood warming device, and pressure/bubble monitoring functions, used for blood purification and all emergency treatments requiring extracorporeal circulation, such as acute renal failure caused by pesticide poisoning, trauma of various causes, burns, and sepsis.

2. The HA300 resin hemoperfusion device is specifically designed and manufactured for poisoned patients, particularly suitable for treating poisoning caused by large or medium molecules, or drugs bound to plasma. This device directly removes toxins through the strong adsorption effect of the resin. Such a device can also be used for stubborn skin diseases, hepatic encephalopathy, nephrotic syndrome, and systemic lupus erythematosus.

3. Continuous blood purification equipment is ideal for emergency blood purification, suitable for both acute and chronic renal failure, as well as for rescuing patients from various types of poisoning.

December 21, 2007: The 58th American Liver Disease Academic Conference

This conference focused on the significance of non-alcoholic fatty liver disease (NAFLD), considering it a product of metabolic syndrome. Metabolic syndrome is a group of serious middle-aged and elderly diseases starting with diabetes and hypertension. Therefore, people at high risk for these diseases should pay attention to changes in liver function indicators in their daily lives.

Recently, the United States has launched a new anti-HCV drug—polyethylene glycol interferon α-2a—which shows better efficacy than previous interferons, but increasing the dose does not further enhance effectiveness. Some suggest that interferon treatment for liver diseases should be individualized, adopting personalized therapy.

Telaprevir (VX-950) is an oral serine protease inhibitor targeting HCV NS3-4A, which can greatly reduce dependence on interferon therapy and the rebound effect after discontinuation. R1626 is a prodrug of a nucleoside analog inhibitor of HCV RNA polymerase, whose efficacy still requires further clinical observation.

2008

January 10, 2008: The First Critical Infection and AIM China Tour Summit Conference

At this conference, David G. Paterson from the University of Queensland in Australia delivered a speech on “Management of Febrile Patients with Neutropenia.” He pointed out that in such cases, empirical antibiotic treatment should be initiated immediately rather than waiting for bacterial culture results. The American Society of Infectious Diseases recommends using third-generation cephalosporins such as imipenem and meropenem as single-agent therapies. However, according to Professor Paterson’s experience, ticarcillin/clavulanate is not ideal, while meropenem and piperacillin/sulbactam work better. Analysis in The Lancet also indicates that third-generation cephalosporins do not offer superior efficacy and have higher mortality rates compared to other antibiotics. From the perspective of bacterial species, Pseudomonas aeruginosa is the most common cause of febrile neutropenia in recent years.

Among empirical treatments, meropenem’s efficacy is lower than that of imipenem. Piperacillin/sulbactam is effective against febrile neutropenia caused by Pseudomonas aeruginosa because the combination of the two drugs can significantly inhibit the β-lactamase within the bacterium. Meropenem and imipenem belong to the same class of drugs; in China, meropenem is marketed under the name “Taineng.” Initial antibiotic treatment differs from the conventional approach of observing first and patiently waiting for antimicrobial susceptibility reports.

January 21, 2008: The trough-to-peak ratio is an important indicator for assessing the condition of hypertensive patients.

The highest blood pressure value within 24 hours is called the peak, and the lowest is called the trough; trough refers to T, peak refers to P, and the trough-to-peak ratio (T/P) is the term used to describe this. A T/P ratio greater than 70% is considered normal, while in hypertension the trough-to-peak ratio is usually below this level. When prescribing medication, the size of the T/P ratio is also an important criterion for evaluating drug efficacy. Currently, long-acting calcium channel blockers are regarded as the best among antihypertensive drugs, with the advantage of not only lowering blood pressure but also increasing the T/P ratio.

January 22, 2008: Six Major Trends in Medical Research in 2008

1. Increased use of targeted drug therapy

Currently, targeted drugs are still under development, with some already in clinical use, such as Iressa, Herceptin, imatinib mesylate, and rituximab. These targeted drugs fall into two categories: monoclonal antibodies against epidermal growth factor and monoclonal antibodies against vascular endothelial growth factor.

2. The prevalence of diabetes has entered a plateau phase

Basu, director of the Department of Endocrinology and a diabetes expert at the University of North Carolina at Chapel Hill, predicts that the prevalence of diabetes in 2008 has entered a plateau phase because obesity, the underlying cause of diabetes, is receiving increasing attention. Studies show that long-term use of rosiglitazone carries a risk of cardiovascular disease, so its use may gradually decrease in the future.

3. Obesity is the root of all diseases

It is important to maintain a healthy weight from childhood to prevent obesity, thereby reducing the risk of hypertension, diabetes, and cardiovascular and cerebrovascular diseases.

4. Stroke and coronary heart disease are determined by common risk factors

Professor Bhatt at the Cleveland Clinic in Ohio believes that drugs used to treat coronary heart disease can also treat cerebral infarction.

5. New rheumatoid arthritis drugs are about to be launched

The new rheumatoid arthritis drug tocilizumab can inhibit IL-6, thereby alleviating joint inflammation.

6. Return of hormone replacement therapy for cardiovascular diseases

Hormone replacement therapy (HRT) for menopause has been discontinued for several years due to its association with cardiovascular events, but it may make a comeback in the coming year.

March 3, 2008: Top Ten U.S. Medical News of 2007

1. A new source of stem cells—amniotic fluid. Research results show that pluripotent stem cells can be isolated from amniotic fluid. Previously, the main sources of human pluripotent stem cells were blood, bone marrow, and morula embryos. This study provides a third pathway for isolating stem cells.

2. Recent research by the American Heart Association shows that strengthening medication alone does not differ significantly in long-term efficacy from combined drug and cardiac intervention therapy, thus raising questions about PCI and shaking the authority of PCI (percutaneous coronary intervention) and PTCA (percutaneous transluminal coronary angioplasty).

3. Stem cell therapy can treat type 1 diabetes. On April 11, 2008, Brazilian researchers discovered that autologous non-bone-marrow hematopoietic stem cell transplantation combined with high-dose immunosuppressants can, within certain limits, treat type 1 diabetes, enabling a certain degree of recovery of pancreatic beta cells in the vast majority of type 1 diabetic patients.

4. The safety of rosiglitazone (Avandia) has sparked controversy. A U.S. research report suggests that Avandia can lead to cardiovascular disease, prompting widespread patient skepticism about the drug.

5. Gene therapy can treat Parkinson’s disease. U.S. scholars have confirmed through Phase III clinical trials that using adeno-associated virus (AAV) as a vector to deliver the gene for glutamic acid decarboxylase (GAD) into the subthalamic nucleus can treat Parkinson’s disease with good safety. Among trial patients, 20%–30% showed improved motor function after three months of treatment.