1. RFA

This method can be used for unresectable liver cancer, but it is still under investigation. The incidence of HCC has been increasing year by year, ranking first among cancer-related causes of death worldwide. Only 20%–30% of liver cancer patients can undergo radical treatments such as early resection or liver transplantation. For patients with unresectable liver cancer, there are currently other options, such as percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE).

1. RFA The procedure involves inserting a specialized electrode directly into the tumor lesion and applying radiofrequency energy to create a high-frequency ablation zone, which encompasses the tumor tissue and the surrounding 1 cm of liver tissue. Recent research shows that for primary liver cancers with diameters of 2–4 cm, the cure rate with RFA is 90%, and the 3-year disease control rate is 80%.

2. TACE If the tumor diameter exceeds 4 cm, this method can be chosen. The liver receives blood supply through the hepatic artery and portal vein, but HCC almost entirely relies on the hepatic artery for blood supply. TACE takes advantage of this fact. During the procedure, a catheter is inserted into the tumor artery, and a mixture of oily contrast agent (iodized oil) and chemotherapeutic drugs (usually doxorubicin) is injected, followed by embolic agents (such as polyvinyl alcohol embolic microspheres). These embolic agents are carried by the bloodstream to the terminal branches of the hepatic artery, where they aggregate and block the vessels, leading to ischemic necrosis of the tumor.

RFA is commonly known as radiofrequency ablation; TACE is commonly known as chemoembolization. Combining the two can improve the survival rate of HCC patients.

June 13, 2008: Cancer association of prostate stem cell antigen (PSCA)

PSCA is a gene highly expressed in prostate cancer, and it has now been proven to have an objective correlation with diffuse gastric cancer, as well as with various other cancer factors.

June 13, 2008: National Comprehensive Cancer Network (NCCN) in the United States

This is the world's most authoritative cancer information resource database, regularly or irregularly publishing the latest diagnostic and treatment information and guidelines for cancer worldwide, prompting immediate responses from medical communities around the globe. For example, when NCCN recently updated the "NCCN Clinical Practice Guidelines for Gastric Cancer," a Chinese expert panel immediately engaged in thorough discussions and communication with NCCN representatives, preliminarily finalizing the Chinese version of the guidelines. The following are the key updates.

① Epidemiology: China accounts for more than 40% of the world's total gastric cancer cases. The main site of gastric cancer in China is the gastric antrum.

② Surgical treatment: the surgical margin should be more than 5 cm away from the tumor. The number of lymph nodes removed should be at least 15, abandoning the previous D0 and D1 standards and advocating for the D2 standard radical surgery.

③ Preoperative adjuvant chemotherapy: paclitaxel or docetaxel combined with radiotherapy can be used, but only as a third-line recommendation.

④ Postoperative chemotherapy: for D2 radical surgery, patients who did not receive preoperative chemotherapy should undergo postoperative chemotherapy; those who received preoperative chemotherapy do not need postoperative chemotherapy.

⑤ Metastatic gastric cancer: the DFC (docetaxel + 5-FU + cisplatin) and DC (docetaxel + cisplatin) chemotherapy regimens are recommended.

June 16, 2008: Stent research in cardiac intervention

Currently, stents used in cardiac intervention include bare-metal stents (BMS) and drug-eluting stents (DES), both of which have seen technological advancements. The latter includes paclitaxel stents and sirolimus stents, among others. In addition, there are new types of stents that promote endothelial healing and biodegradable stents.

June 30, 2008: Hepatolenticular degeneration (HLD)

HLD, also known as Wilson's disease, is an autosomal recessive genetic disorder characterized by copper metabolism dysfunction. The daily copper requirement for healthy individuals is 2 mg, with serum copper levels around 15 μmol/L. Excess copper binds loosely to proteins and accumulates in the liver, brain, kidneys, cornea, and other organs, leading to decreased ceruloplasmin levels and increased urinary copper excretion.

The clinical symptoms of this disease are divided into liver and brain manifestations. Liver symptoms include all signs of cirrhosis; brain symptoms involve neurological changes. The lenticular nucleus is located in the basal ganglia of the brain, where copper ion deposition is most severe, causing corresponding liver and brain symptoms such as extrapyramidal symptoms, psychiatric changes, and cirrhosis. Other areas with significant deposition include the cornea, kidneys, and skin, with symptoms such as corneal pigment ring and kidney damage.

Treatment for this disease mainly involves penicillamine and dimercaprol.

July 4, 2008: Recent developments in gastric cancer

Currently, gastric cancer ranks fourth among global cancers in terms of incidence (by commonality) and second in terms of mortality. Gastric cancer can be divided into intestinal type and diffuse type; the former is associated with Hp infection, while the latter is not. The causes of these two types of gastric cancer differ, with the latter seemingly more closely related to genetic factors. As a substance active in PSA, a gene highly expressed in prostate cancer, its relevance to gastric cancer diagnosis is still under study.

The "NCCN Clinical Practice Guidelines for Gastric Cancer" have made some changes in their descriptions of endoscopic ultrasound (EUS) and PET/CT scans. The Chinese version of the clinical practice guidelines has also been revised based on the NCCN guidelines.

1. Mortality rate of Chinese gastric cancer patients: 40.8 per 100,000 for males and 18.6 per 100,000 for females. This mortality rate is 4–8 times higher than in Europe and the United States. Chinese gastric cancer patients account for approximately 40% of the world's gastric cancer cases.

2. Surgical treatment recommends incisions at least 5 cm away from the tumor lesion, with daily lymph node dissection of at least 15 nodes, and combined with positional dissection up to the second station of lymph nodes. The surgical approach should be D2 radical surgery, rather than D0 or D1.

3. There is currently no consensus on the value of preoperative and postoperative chemotherapy. Generally, D2 radical surgery is prioritized, and patients who undergo preoperative chemotherapy are usually not recommended to receive postoperative chemotherapy.

4. For metastatic cancer, the recommended chemotherapy regimen is docetaxel + 5-FU, or doxorubicin + cisplatin + 5-FU.

July 7, 2008: "NCCN Clinical Practice Guidelines for Colorectal Cancer (Chinese Version)"

The most distinctive feature of this guideline is the division of Stage II into II-A (T3N0M0) and II-B (T4N0M0), and the division of Stage III into III-A (T4N1M0), III-B (T3～4N1M0), and III-C (TxN2M0).

According to U.S. epidemiological surveillance statistics, the 5-year survival rates for each stage are as follows: Stage I 93.2%, Stage II-A 84.7%, Stage II-B 72.4%, Stage III-A 83.4%, Stage III-B 64.1%, Stage III-C 44.3%, and Stage IV 8.1%.

The 5-year survival rate for colorectal cancer with liver metastasis is 0%.

The chemotherapy regimen combining bevacizumab with 5-FU is still in the clinical trial phase, and bevacizumab is relatively expensive, making it difficult to popularize domestically.

China's current treatment protocols for colorectal cancer are not yet unified.

July 14, 2008: Report from the 2008 Roche China Oncology Forum

I. Progress in the treatment of advanced colorectal cancer

It has now been confirmed that irinotecan and oxaliplatin are equally effective in treating advanced colorectal cancer. Capecitabine (Xeloda) and irinotecan can be used together without any issues. In the first-line treatment of metastatic colorectal cancer, the XELOX regimen (capecitabine + oxaliplatin) can replace the FOLFOX regimen (oxaliplatin + 5-FU + leucovorin). Both regimens perform equally well in terms of progression-free survival (PFS) and overall survival (OS). The former exhibits less toxicity in terms of neutropenia. Regarding second-line drugs for metastatic cancer: XELOX outperforms FOLFOX in terms of OS. Therefore, in the treatment of advanced colorectal cancer, the XELOX regimen appears to be able to fully replace the FOLFOX regimen. Another view suggests that various chemotherapy regimens for advanced cancers can be combined with bevacizumab; moreover, once initial efficacy is achieved, continued use is possible.

II. Current status of targeted therapy for breast cancer

Breast cancer surgery and comprehensive treatment have made considerable progress. In addition to radiation, chemotherapy, and endocrine therapy, biological targeted therapy has become a major focus of attention. The clinical efficacy of trastuzumab (Herceptin) has been recognized by countries in Europe and America. This drug has provided ample evidence of extending disease-free survival (DFS) and overall survival (OS). For patients positive for epidermal growth factor receptor 2 (HER-2), using trastuzumab plus chemotherapy is the standard treatment.

III. Prospects for the treatment of non-small cell lung cancer (NSCLC)

NSCLC has now replaced liver cancer as the leading cause of cancer-related deaths. Vascular endothelial growth factor (VEGF) is closely related to tumor formation. Bevacizumab is a VEGF inhibitor used in NSCLC, and clinical trials have demonstrated that it can extend OS by more than one year. In 2008, the U.S. National Comprehensive Cancer Network (NCCN) conducted a systematic review of erlotinib, affirming its therapeutic efficacy.

July 20, 2008: The long road to treating arrhythmias

In 1989, the CAST study found that after correcting arrhythmias in patients with myocardial infarction, their mortality rate actually increased. Subsequently, many studies confirmed this finding, concluding that the benefits brought by antiarrhythmic drugs were offset by their side effects, and even surpassed them.

In 1996, three classes of antiarrhythmic drugs, including ibutilide, were launched. This drug has a high success rate in converting atrial fibrillation and atrial flutter, with few side effects. However, it can only be administered intravenously, making long-term home use inconvenient. Later, similar drugs such as amiodarone and dofetilide were found to have potential proarrhythmic effects, greatly reducing the use of these drugs.

In 1987, radiofrequency catheter ablation technology began to be applied, quickly gaining popularity due to its high success rate, safety, and minimal invasiveness. Today, radiofrequency catheter ablation has become the primary method for treating supraventricular tachycardia. In 1994, American physician Swarty et al. first applied this method to treat atrial fibrillation and achieved success. In 1998, French physician Mas discovered that 90% of atrial fibrillation cases originate from "foci" located in the pulmonary veins, advocating the use of radiofrequency catheter ablation to eliminate these "foci." With the continuous development of three-dimensional positioning imaging technology, radiofrequency catheter ablation technology has evolved rapidly, playing an extraordinary role not only in treating atrial fibrillation but also in addressing all types of arrhythmias.

In the treatment of chronic arrhythmias, alongside radiofrequency catheter ablation, DDDR-type pacemakers have also advanced. However, in recent years, some internationally authoritative studies have confirmed that the mortality rate and OS of patients implanted with DDDR-type pacemakers are not superior to those of patients without implants.

August 6, 2008: Early intervention for stroke

Early intervention is divided into Phase I intervention and Phase II intervention. The former includes exercise and weight loss, as well as dietary adjustments. The latter mainly focuses on controlling hypertension, high blood viscosity, high blood lipids, high blood sugar, and high uric acid, with particular emphasis on treating the first three conditions. Early, comprehensive, and individualized treatment plans can be adopted.

Medications to reduce blood viscosity include clopidogrel (Plavix), aspirin, and warfarin. Antihypertensive drugs include beta-blockers, calcium channel blockers (CCB), ACE inhibitors, and ARBs. Lipid-modifying drugs include statins.

August 11, 2008: Transient ischemic attack (TIA)

TIA occurs on the basis of cerebrovascular damage, lasting from a few seconds to a few hours, sometimes resulting in fainting or even coma, but often without lasting sequelae afterward. Previously considered to be cerebral vasospasm, it is now referred to as transient ischemic attack. Besides cerebral vasospasm, other causes include microthrombus theory and aggregation theory. Clinical manifestations vary depending on the location of ischemia; for example, TIA in the internal carotid artery system often presents with hemiplegia, hemiparesis, unilateral sensory disturbances, aphasia, etc. TIA in the vertebrobasilar artery system often manifests as transient dizziness, nystagmus, and lower limb weakness.

August 11, 2008: Common medications for treating cerebral infarction

1. Antiplatelet drugs, such as aspirin, dipyridamole, clopidogrel, and prostacyclin.

2. Vasodilators

(1) Betahistine 8 mg, three times daily, orally; or 20 mg, added to 500 mL of 5% glucose injection solution, administered intravenously once daily, for a two-week course.

(2) Puerarin 500 mg, added to 500 mL of 5% glucose injection solution, administered intravenously once daily.

(3) Ginkgo biloba capsules 80 mg, three times daily, orally.

(4) Nicotinic acid zinteno 300–900 mg, added to 500 mL of 5% glucose injection solution, administered intravenously once daily.

3. Calcium channel blockers, such as nimodipine and flunarizine.

4. Thrombolytic drugs, such as urokinase (400 mg, three times daily, orally) and viper antithrombotic enzyme.

5. External counterpulsation therapy.

6. Surgical treatments, such as carotid endarterectomy and extracranial-intracranial arterial bypass surgery.

7. Reducing blood viscosity, such as compound Danshen plus low-molecular-weight dextran.

8. Eliminating cerebral edema, such as 10% magnesium sulfate, 20% mannitol, 30% urea, 40% urotropin, and 50% glucose.

August 11, 2008: Treatment of cerebral hemorrhage

1. Traditional Chinese medicines include Angong Niuhuang Wan, Shengbao Dan, Suhexiang Wan, Xingnaojing injection, and Qingkailing injection.

2. Maintain quiet, administer oxygen, monitor electrocardiogram, and provide intravenous fluids.

3. Administer mannitol intravenously 1–4 times, slowly, over 30 minutes.

4. If blood pressure remains high, appropriately lower it by administering sodium nitroprusside 20 mg intravenously, but avoid lowering it too much; if blood pressure is slightly elevated, no special treatment is usually necessary.

5. Patients without cardiovascular disease can consider hibernation therapy.

August 13, 2008: Hyperlipidemia

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Hyperlipidemia can be classified into four types: ① TC (cholesterol) > 5.72 mmol/L, which is hypercholesterolemia. ② TG (triglycerides) > 1.70 mmol/L, which is hypertriglyceridemia. ③ TC > 5.72 mmol/L and TG > 1.70 mmol/L, which is mixed hyperlipidemia. ④ HDL (high-density lipoprotein) < 0.7 mmol/L, which is low high-density lipoprotein cholesterol.

On August 25, 2008, the Asia-Pacific Association for the Study of the Liver (APASL) proposed the concept of acute-on-chronic liver failure (ACLF).

The APASL proposed ACLF. This disease is defined as an acute exacerbation occurring on the basis of chronic liver disease, clinically manifested by liver function impairment and jaundice, often accompanied by ascites and hepatic encephalopathy within 4 weeks. The disease can be divided into three types: Type A (previously good liver function), Type B (previously poor liver function, compensated cirrhosis), and Type C (previously poor liver function, decompensated cirrhosis).

Acute-on-chronic liver failure (ACLF) is essentially what was previously referred to as chronic severe hepatitis.

August 25, 2008: Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) refers to hydatidiform mole, malignant hydatidiform mole, and choriocarcinoma. Hydatidiform mole is a low-risk type of gestational trophoblastic disease; malignant hydatidiform mole is a high-risk type. Diagnosis of GTD: history of amenorrhea + vaginal bleeding + ultrasound, CT, MRI examination. There is also the term gestational trophoblastic neoplasm (GTN), which is similar to GTD, because hydatidiform mole, malignant hydatidiform mole, and choriocarcinoma are all tumors. The treatment of these tumors traditionally involves herbal medicine and chemotherapy, with methotrexate and actinomycin D being the most commonly used, and their combined use is also frequent.

August 25, 2008 Chronic Myeloid Leukemia New Treatment Concepts for Chronic Phase (CML-CP)

Traditional drugs for treating CML, such as busulfan and hydroxyurea, have shown good efficacy, and interferon is also effective; when interferon treatment fails, imatinib (imatinib mesylate) can be selected.

October 27, 2008: Effective Formulas for Deafness and Tinnitus

Formula 1: Cinnabar 2g, Shenqu 10g, Turtle Shell 15g, Schisandra 3g, Magnetite 30g, Rehmannia 12g, Cornus 10g, Chinese Yam 10g, Moutan Bark 6g, Poria 12g, Alisma 10g. Take one dose daily, decocted in water and taken orally.