Treatment: Interventional procedures, surgery, and conservative medical treatment.

Treatment: Interventional procedures, surgery, and conservative medical treatment.

2011.11.31 Metastatic Colorectal Cancer

Metastatic colorectal cancer refers to cancer that has spread beyond the original colorectal tumor mass, with the most common sites of metastasis being lymph nodes, liver, lungs, and peritoneum. Chemotherapy is one of the standard treatment options for metastatic colorectal cancer. Below is a comparison of commonly used chemotherapy regimens for this condition.

① 5-FU, overall survival (OS) 12 months. ② 5-FU + oxaliplatin, OS 16 months. ③ Bevacizumab + 5-FU + oxaliplatin, OS 24 months.

It is evident that triple-drug combinations are superior to dual-drug regimens, but the toxicity is difficult to tolerate and OS gains are hard to achieve.

2011.12.4 Four Major Characteristics of Female Lung Cancer

① Younger age. ② High proportion of adenocarcinoma. ③ Easy to metastasize. ④ Easy to misdiagnose.

Mnemonic: One "big," one "small," two "easy."

In 2012, I resolved to keep learning throughout my life, believing that reading could extend my lifespan. Whenever I gained new insights, I would jot them down, finding joy in keeping my desk always well-stocked with books. (April 2012)

2012.1.5 Chronic Myelogenous Leukemia (CML)

This is a common disease characterized by hyperproliferation of granulocytes, accompanied by extreme leukocytosis, splenomegaly, and anemia. The primary pathogenesis involves chromosomal translocations between chromosome 9 and chromosome 22, resulting in the formation of the BCR-ABL fusion gene. Treatment for this condition aims to inhibit the BCR-ABL fusion gene. Current therapeutic drugs include: busulfan → hydroxyurea → interferon → allogeneic hematopoietic stem cell transplantation → targeted therapy (imatinib).

① Busulfan: 2 mg each time, taken orally three times daily, takes effect after two weeks, has the effect of suppressing bone marrow hematopoiesis. It is an alkylating agent that primarily affects hematopoietic progenitor cells. ② Hydroxyurea: 20 mg/kg each time, taken orally twice a week, acts quickly, takes effect rapidly, has few side effects, but is prone to relapse. This drug primarily targets S-phase cells. ③ Interferon: Has significant side effects. ④ Allogeneic hematopoietic stem cell transplantation: Overall efficacy is not as good as imatinib. ⑤ Imatinib: 400 mg each time, taken once daily, preferably during meals, common adverse reactions include neutropenia, thrombocytopenia, anemia, headache, indigestion, edema, muscle cramps, diarrhea, rash, etc.

2012.1.6 Tigecycline and Rapamycin

Tigecycline is a newly developed broad-spectrum antibiotic effective against drug-resistant superbugs. Rapamycin (siro-mo-si) is a recently developed potent immunosuppressant, stronger than cyclosporine, tacrolimus, and steroids!

2012.1.14 Biexie Fenqing Yin and Biexie Shengshi Tang

Biexie Fenqing Yin: Biexie 10 g, wu yao 10 g, yi zhi 10 g, shi chang pu 10 g, poria mushroom 12 g, licorice root 6 g.

Biexie Shengshi Tang: Red poria mushroom 10 g, ze xie 10 g, coix seed 20 g, phellodendron bark 6 g, dan pi 6 g, talc 10 g, mu tong 6 g.

The former is used to treat cold-dampness-related urinary turbidity, frequent urination, and senile urethritis; the latter is used to treat urinary tract infections caused by damp-heat descending.

2012.1.18 Progressive Muscular Dystrophy

This is a genetic disorder commonly seen in adolescents aged 10 to 30. Muscular dystrophy primarily affects muscles near the shoulder and hip girdles, manifesting as muscle atrophy, pain, and functional impairment. Laboratory tests for this condition often show elevated creatine kinase, creatine kinase isoenzymes, and lactate dehydrogenase. Hormonal Western medicines are ineffective for treating this condition; using galantamine hydrobromide, vitamin B1, vitamin B2, and vitamin B12 yields only minor effects; using Zhang Xichun’s Zhenwei Tang, Pei’s Zhenwei Tang, Sancai Fengsui Dan, and Hu Qian Wan also produces limited results.

2012.1.29 Application of Gene Types in Clinical Practice

Gene categories reflect genetic polymorphism, influencing various aspects of human physiology, pathology, and disease. For example, hepatitis C virus has four genotypes, with Type I and Type IV being more common, while Type II and Type III are rarer. Treatment for Type I requires a longer course of PEGIFN, usually 48 weeks, whereas Type IV requires a shorter course, typically 24 weeks. Professor Shao Jianyong at the Sun Yat-sen University Cancer Prevention and Treatment Center has identified seven genes associated with the survival prognosis of nasopharyngeal carcinoma patients, enabling prediction of recurrence risk and survival prognosis, thus guiding clinicians to implement more effective treatment plans.

2012.1.29 New Drug for Rheumatoid Arthritis (RA) Launched

China’s fully independently owned intellectual property new drug for rheumatoid arthritis—ailamode (trade name “Aideshin”)—is a small-molecule drug for treating rheumatoid arthritis (RA). Phase III clinical trials of this drug show that Aideshin begins to take effect from the 4th to 6th week of use; after 24 weeks of medication, according to the American College of Rheumatology’s standard of 20% improvement, Aideshin achieves an effectiveness rate of 63.8% at 50 mg/day, with significant reductions in RF and IgA, IgG, and IgM antibodies. Compared with methotrexate, this drug has significantly fewer side effects.

2012.1.29 Idiopathic Membranous Nephropathy

This type of kidney disease is also called rheumatic immune kidney disease or membranous nephropathy. In fact, all primary glomerular nephropathies are caused by antigen-antibody complexes depositing on the basement membrane of glomerular capillaries, triggering an allergic reaction—classified as Type III hypersensitivity—and can all be termed membranous nephropathy, with IgA nephropathy being the most typical representative. Secondary nephropathies such as lupus nephritis, allergic purpura nephritis, diabetic nephropathy, and uric acid nephropathy are treated separately.

2012.1.31 Cytomegalovirus Infection

This virus is also known as inclusion body virus and belongs to the herpesvirus family, abbreviated as CMV in English. It most easily infects infants and young children, but elderly and frail individuals can also be infected. Newborns can contract this virus during the perinatal period, leading to multi-organ dysfunction, affecting systems such as respiration, digestion, reproduction, and blood.

2012.2.1 Clostridium difficile and Colon Cancer

Clostridium difficile infection is currently believed to be correlated with the incidence of colon cancer, as the detection rate of Clostridium difficile in the intestines of colon cancer patients is 20 to 100 times higher than in healthy individuals. Hepatitis B virus and liver cancer, Helicobacter pylori and gastric cancer, Clostridium difficile and colon cancer—all show that before cancer develops, there is invariably an infection by a pathogenic microorganism. The relationship between cancer and pathogenic microorganisms is indeed quite close!

Some have come up with a novel approach to treating Clostridium difficile infection—fecal transplantation—which initial trials suggest is effective.

2012.2.2 Hot Topics in the Field of Leukemia

1. Chronic Lymphocytic Leukemia (CLL) Microenvironment and targeted therapy. Clinically, CXCR4 antagonists and small-molecule inhibitors of B-cell receptor-associated kinases are the latest drugs targeting CLL cells and their microenvironment.

2. Chronic Myelogenous Leukemia (CML) Deep remission and long-term suppression. Over the past ten years, imatinib (mesylate imatinib) has revolutionized the treatment of CML. Recently, a more promising BCR-ABL fusion gene inhibitor—oral ponatinib—has shown stronger activity against the T315I mutation.

3. Acute Myeloid Leukemia (AML) and Myelodysplastic Syndromes (MDS) DNA methylation research is leading the trend. An increasing number of studies show that gene mutations and karyotype can predict the prognosis of AML and provide important evidence for personalized treatment. Some once estimated that advances in molecular biology would bring rapid progress to targeted therapies for malignant tumors, but this has not been the case; many promising drugs have failed to deliver the expected results.

DNA methylation plays a crucial role in regulating gene proliferation in myeloid hematologic malignancies, a discovery that has changed our understanding of the pathogenesis of AML and introduced new treatment concepts. Gene mutations are the fundamental cause of malignant tumors, while DNA methylation is key to regulating cell proliferation.

2012.2.4 Research Progress on Non-Hodgkin Lymphoma (NHL)

The Eastern Cooperative Oncology Group (ECOG) in the United States analyzed the overall survival (OS) and progression-free survival (PFS) of diffuse large B-cell lymphoma (DLBCL) patients using paraffin-embedded tissue sections preserved for many years, and selected six genes with predictive value, discovering that gene mutations are the main reason for NHL heterogeneity. By comparing the efficacy of different R-CHOP chemotherapy regimens (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone) among patients, it was found that the main reason for differences in efficacy is gene polymorphism.

2012.2.4 Preventing Chemotherapy-Induced Nausea and Vomiting

Before the 1990s, preventing chemotherapy-induced nausea and vomiting relied solely on metoclopramide and chlorpromazine; starting in 1998, 5-HT receptor antagonists were combined with dexamethasone; by 2003, neurokinin-1 (NK-1) receptor antagonists were launched, significantly improving efficacy, yet still not entirely satisfactory. Recently, aprepitant has made breakthroughs in treating chemotherapy-induced nausea and vomiting.

2012.2.8 Three Highlights of Cardiovascular Events in 2012

1. Three New Drugs Dabigatran etexilate, rivaroxaban, and apixaban are expected to replace warfarin in the treatment of atrial fibrillation patients. Atrial fibrillation patients are most prone to forming emboli, which, if dislodged, can lead to cerebral embolism; warfarin’s anticoagulant effect can prevent such occurrences.

2. Lipid Management Initially, people only focused on managing cholesterol (TC) and triglycerides (TG); later, they realized that controlling low-density lipoprotein (LDL-C) is the key to treating hyperlipidemia. Normal individuals should have LDL-C < 3.12 mmol/L. Recently, more effort has been put into researching high-density lipoprotein (HDL-C), though no major breakthroughs have been made yet.

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3. Myocardial Regeneration Research on myocardial regeneration using pluripotent stem cells is another highlight in the treatment of cardiac diseases.

2012.2.8 Saxagliptin

DPP-4 inhibitor. DPP-4 stands for dipeptidyl peptidase. The combination of saxagliptin with metformin significantly enhances therapeutic efficacy. This drug also demonstrates notable efficacy in patients with type 2 diabetes complicated by renal impairment. While lowering blood glucose, it can also reduce triglycerides. Its effect on cholesterol (TC) is still under investigation.

2012.2.8 Liraglutide

Liraglutide, also known as NovoRapid, is a newly approved FDA drug and is a human glucagon-like peptide-1 (GLP-1) analog. GLP-1 is a peptide hormone secreted by intestinal L-cells upon food intake, classified as an incretin, which acts on the pancreas and cardiovascular system, capable of lowering blood sugar, protecting the cardiovascular system, reducing blood pressure, and aiding weight loss.

2012.2.9 Several Discussions on Liver Cancer Treatment

Currently, liver cancer treatment still mainly relies on surgery, interventional therapy, chemotherapy, and transplantation. For small liver cancers (single tumor diameter <5cm, or multiple tumors each less than 3cm), surgical resection is the most effective. Larger liver cancers can undergo interventional therapy first to shrink the tumor before surgery, commonly referred to as staged surgery.

Surgical therapies include minimally invasive surgery and resection surgery; the former includes gamma knife, X-knife, argon-helium knife, microwave ablation, radiofrequency ablation, etc. In addition, there are also laser ablation, cryotherapy, and anhydrous alcohol injection therapies.

In liver cancer interventional therapy, there is a portal vein (particle) stent implantation procedure, which is designed for liver cancer patients whose main portal vein is blocked due to tumor thrombus formation. A stent is placed as a bridge across the diseased narrowed segment. A "particle stent" is implanted at the site of the portal vein trunk tumor thrombus, and this stent "carries" iodine-125 radioactive particles. While opening up the portal vein to improve liver function, it also provides continuous close-range radiation therapy to inhibit tumor thrombus growth, truly achieving "killing two birds with one stone."

The one-year survival rate for liver transplant patients reaches as high as 90%, and the five-year survival rate reaches 60%.

Recently, there have been reports that the "Da Vinci" surgical robot has been applied to liver cancer surgery, reportedly with efficacy comparable to conventional procedures.

2012.2.10 Effective Prescriptions for Treating Renal Failure

Renal failure is divided into acute and chronic types. The former is caused by burns, trauma, severe acute infections, blood transfusions, etc.; the latter is true renal failure, often referred to as chronic renal failure. Traditional Chinese medicine has the following prescriptions that are effective in treating renal failure.

Formula One: Eighteen Guan Zei Decoction

Stone fern 10g, fenugreek 10g, polygonatum 10g, horsetail herb 10g, butterfly bush 6g, houttuynia 20g, silkworm pupa 6g, cistanche 10g, rhubarb 10g, morinda root 10g, gardenia fruit 10g, raw rehmannia 12g, angelica 10g, bupleurum 10g, epimedium 10g, polygonum multiflorum 10g, astragalus 20g, deer antler glue 10g, mulberry 10g, leech 10g (to be taken in divided doses), panax notoginseng 3g (to be taken in divided doses), oyster powder 30g (to be taken in divided doses).

Formula Two: Compound Kidney-Nourishing Decoction

Raw rehmannia 12g, cornelian cherry 6g, Chinese yam 10g, moutan bark 6g, poria 10g, alisma 10g, cinnamon twig 10g, aconite slice 6g, angelica 10g, chuanxiong 10g, red peony root 10g, peach kernel 10g, safflower 6g, motherwort 20g, salvia 20g, honeysuckle 15g, forsythia 15g, dandelion 15g, indigofera 20g, perilla leaf 10g, cicada slough 6g, panax notoginseng 3g (to be taken in divided doses), leech 10g (to be taken in divided doses).

Formula Three: Four-Component Mixture

Motherwort 20g, plantain seed 10g, honeysuckle 15g, white snake tongue grass 15g, rhubarb 10g, aconite slice 6g, astragalus 20g, salvia 20g, cornelian cherry 20g, goji berry 10g, mulberry 10g, leech 10g (to be taken in divided doses), angelica 10g, chuanxiong 6g, red peony root 10g, peach kernel 10g, safflower 6g, forsythia 20g, dandelion 20g, indigofera 20g, cicada slough 6g, panax notoginseng 3g (to be taken in divided doses), perilla leaf 20g.

Formula Four: Astragalus-Oyster Mixture

Astragalus 30g, evodia 10g, rhubarb 20g (added later), aconite slice 6g, oyster 30g (to be taken in divided doses).

Formula Five: Yi-Dan-Chi-Guo Decoction

Motherwort 30g, salvia 20g, red peony root 10g, cardamom 10g, astragalus 30g, evodia 10g, rhubarb 20g, aconite slice 6g, oyster powder 30g (to be taken in divided doses).

2012.2.13 Talking About Radiation

There are seven visible light colors: red, orange, yellow, green, cyan, blue, and violet, with wavelengths gradually decreasing from red to violet. Before red lies infrared, and after violet lies ultraviolet. Infrared includes microwaves, and before microwaves lie radio waves. After violet comes ultraviolet, followed by X-rays and gamma rays.

Wavelengths sorted from long to short: radio waves > microwaves > infrared > red light > orange light > yellow light > green light > cyan light > blue light > violet light > ultraviolet > X-rays > gamma rays.

From left to right, wavelengths become shorter, amplitudes increase, and penetrative power strengthens. Radio waves and microwaves are used clinically because their penetrative power is relatively weak, so they can only be called radiofrequency ablation. X-rays and gamma rays, due to their strong penetrating power, are therefore referred to as "knives."

Alpha and beta rays do not belong to the category of electromagnetic waves. Alpha rays have weaker penetrating power than beta rays but stronger ionizing ability; they are heavier and penetrate poorly, with a range of only a few centimeters in air. Beta rays have stronger penetrating power but weaker ionizing effects.

2012.2.14 Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy includes lesions of sensory and motor nerve endings, plexus lesions, nerve root lesions, and cranial nerve lesions. The clinical manifestations of these lesions are diverse; patients may experience sensory abnormalities such as burning sensation, cold sensation, numbness, eventually leading to local malnutrition and resulting in ulcers and necrosis. Recently, pregabalin has been recommended as a more ideal drug for treating diabetic peripheral neuropathy.

2012.2.14 Serological Diagnosis of Transient Ischemic Attack (TIA)

A professor at the University of Pennsylvania Hospital in the United States pointed out that nine tests—lipoprotein-associated phospholipase A2 (Lp-PLA2), C-reactive protein (CRP), D-dimer (DD), B-type natriuretic peptide (BNP), matrix metalloproteinases, and others—can clarify the cause of TIA and assess the prognosis.

2012.2.17 Contrast-Induced Nephropathy