Rheumatology Department

Rheumatology Department

1.Member institution of International Network of Scleroderma Clinical Care and Research (InSCAR)

2.TCM key specialty institution of Hebei Province
3.Clinical and Research Base for Rheumatism and Immune Diseases of Chinese Medical Association.

1. Introduction

Rheumatology and Autoimmune Diseases Department of Hebei Yiling Hospital, is a member institution of International Network of Scleroderma Clinical and Research (InSCAR), key TCM specialty department of Hebei Province, the Clinical and Research Base of Rheumatoid and Autoimmune Diseases of Chinese Medical Association, and the largest and earliest established scleroderma treatment center in China. With over twenty years of development, the department has become a significant characteristic specialty both at home and abroad, and developed 34 TCM preparations which have been approved by Hebei Food and Drugs Administration, and mainly treated scleroderma, multiple myositis, ankylosing spondylitis, rheumatoid diseases, Sjögren's syndrome, Behcet's syndrome, etc. Particularly, the department is in a leading position for treating scleroderma, and has the largest number of inpatients with scleroderma throughout the world with over 12000 cases of scleroderma.

On the basis of fully tapping TCM traditional theories, the department established for scleroderma and its complications a scleroderma research lab which has innovated many treatment theories and methods, such as diagnosis and treatment from the perspective of collateral pathology, softening scleroderma with TCM medication in three phases, treating scleroderma pulmonary fibrosis with three differentiations and three combinations according to different phases, treating systematic scleroderma with the combination of TCM and thoracic duct drainage, and also conducted clinical researches on treating systematic scleroderma esophageal lesion with Shenzhe Zhuyun mixture, treating scleroderma pulmonary fibrosis with combination of Shenmai Kaifei powder and pirfenidone and treating scleroderma with mesenchymal stem cell, etc.

While conducting substantial clinical practice, the department has also attached the same importance to scientific research, carried out cooperation on scleroderma with medical institutions like UT Health, Fudan University, Shanghai Huashan Hospital, taken on one international cooperation project (NIH-UO1) of the National Institution of Health of the United States, one special international cooperation project of the Ministry of Science and Technology, one project of the National Natural Science Foundation of China and four project of provincial science and research, published over 20 professional papers on scleroderma, and related research results have been shared many times at professional conferences both at home and abroad. The clinical efficacy and research competence of the department has been highly appreciated by the general patients and professionals both at home and abroad.

New techniques or grading of liver tumors

Adenoma is a rare liver tumor, in which a specific part of the adenoma will be transformed into malignant tumors, recently from the Vienna Medical University researchers use a new type of nuclear magnetic resonance technology, the patient is not invasive tissue sampling Detection of the premise can be effective on the classification of adenomas, related research published in the international journal Radiology.
 
At present, adenoma patients must undergo tissue biopsy to determine whether hepatocellular adenomas are benign or potentially malignant, and the researchers have developed a new imaging technique that allows the use of liver-specific magnetic resonance contrast agents Classification of hepatocellular adenomas;
 
Adenoma in the liver is very rare, it will develop in many ways, the current identified three adenoma subtypes, namely, benign, inflammatory and precancerous lesions, in addition to the fourth unclassified subtype, the fourth Types of adenomas tend to cause different clinical manifestations and potentially worsen.
 
In this paper, researchers can use the new type of nuclear magnetic resonance imaging technology can be a special classification of adenomas, and gadolinium acid called liver special contrast agent, which can target the role of bile in the organic anion transport peptide, but also target To the role of adenoma cells and normal liver cells in the multi-drug-related proteins, then the researchers will use magnetic resonance imaging of the adenoma surface transporter ratio of normal dirty cells compared to the progress of the adenoma Classification (grading).
 
The researchers, Ahmed Ba-Ssalamah, point out that this new imaging technique can evaluate the characteristics of adenomas in patients without intrusive sampling, which is useful for later understanding of the biological characteristics of adenomas and other liver tumors, Therapy or technology to effectively inhibit the development of adenoma provides a new clue and ideas.

Immune system kill cancer cells is a positive solution

Cancer cells usually use camouflage techniques to escape the immune system attacks. But scientists have developed, can now stripped of cancer cell camouflage, with the immune system to fight cancer cells.
 
In the human immune system, there is a regulatory T cells that regulate the immune system and prevent it from overreacting. Under normal circumstances, the immune system will automatically identify and attack bacteria, viruses and other foreign intruders, but also inevitably have made mistakes. When the immune system to determine the mistakes, began to attack the body itself, the regulatory T cells will act as a security guard role, to prevent the "oolong event" occurred.
 
However, this function of regulatory T cells is used by cancer cells. In order to escape the immune system attacks, cancer cells will usually be involved in the regulation of T cells around, so that the immune system is difficult to identify and attack the "sheep" sheep.
 
In the treatment of cancer, it has long been known that the important role of regulatory T cells, but close the regulatory T cells or take them away from the cancer cells is a problem, because the regulatory T cells and immune cells are very similar to the use of drugs Close the regulation of T cells is prone to accidental injury, but affect the immune cells on cancer cells resistance.
 
Researchers at the Helmholtz Infection Research Center in Germany, however, have now found a way to quickly identify and shut down regulatory T cells in blood or tumor tissue. Experiments show that in a gene implanted in the experimental mice, the experimental mice in the regulatory T cells will stop working, so that the original cancer cells exposed. Then the immune system began to attack cancer cells, the tumor has been formed significantly reduced.

Four advantages of proton therapy

Proton therapy is currently the most popular topic in medical circles, as one of the most advanced and most sophisticated treatment technology, has successfully treated many patients with tumor, radiotherapy is twentieth Century methodology a qualitative leap. There are a large number of authoritative medical journals made a special report on it, there are also many countries pay the manpower and material resources for research and technology transfer, in the end it has what magic, exactly what is the significance of it in tumor circles, what are the advantages compared to other treatment techniques?
1 cure rate is extremely high
Deep traditional radiation therapy in ray with body tissue, energy gradually decay, and the proton as positively charged ions, into the body at high speed, occurred in vivo and normal tissues or cells of the opportunity is very low, when the specific parts to cancer cells, reduce speed and stop suddenly, the biggest release energy, produce Bragg peak, kill cancer cells.
2 side effects
At present, although radiation therapy in the treatment of cancer has achieved remarkable curative effect, but due to X - ray or gamma ray attenuation is in the form of index, the range cannot be controlled, so the normal tissue and tumor tissue after superficial injury and proton therapy when the tumor is large; the front end of the tissue was only minimal exposure to the back side of the tumor and normal tissue irradiation is zero, almost no damage to the normal tissue.
3 high accuracy
Because of the high quality proton scattering in the material, less in the irradiated area around only a small penumbra, reduces the irradiation dose of the surrounding normal tissue, thus providing the accuracy of tumor therapy. The traditional radiotherapy can not control range, and proton beam can use automation technology that the energy release control direction, position and range, the Bragg peak in the control of tumor target boundaries, to achieve directional blasting".
4 make up for deficiencies in other treatments
For tumors with an important tissue and organ, other therapies are at a loss, and proton therapy shows great advantages. There was no recurrence of glioma in the target area after proton therapy.

5A biological immunotherapy safe green anti tumor

The World Cancer Report has a surprising figure: the number of Chinese malignancies in 2012 was 3.065 million, accounting for about one fifth of the global incidence; the number of deaths from malignant tumors was 2.25 million, accounting for about four percent of global cancer deaths One by one. China's malignant tumor incidence and death situation is very grim.
 
Early detection, early treatment is the key to reducing the mortality of cancer patients
 
Beijing armed police two hospital tumor biology center Wen Hongze director said: early prevention, early detection, early treatment, is to reduce the incidence of malignant tumors and mortality of the key. "Malignant tumors can be found in the early and after scientific treatment, the patient's 5-year survival rate can reach 80% to 90%." Wen said. But in fact, many patients wait until there are obvious symptoms to the hospital when they often have to the disease in the late, lost the best surgical opportunities, so the director of the temperature to remind you to establish early anti-cancer awareness, regular physical examination, concerned about the body issued Some unusual signal.
 
Early surgical treatment of the main surgery
 
For the early detection of malignant tumor patients, the temperature director suggested surgery as far as possible surgery, "but in order to prevent surgical resection is not clean, recurrence and metastasis, it is recommended to cooperate with biological immunotherapy to remove postoperative small cancer cells, improve the success rate of surgery "Wen said the director.
 
5A biological immunotherapy - safe green anti-tumor
 
Wen Hongze Director, 5A biological immunotherapy is the latest generation of tumor biotherapy technology. It is a specific immune cell load tumor stem cell antigen, tumor stem cells as a target, combined with a variety of anti-cancer immune cells, the elimination of cancer stem cells, to achieve tumor-free proliferation and differentiation ability, so that the tumor gradually degenerative atrophy, and ultimately achieve the goal of real cure
The following are the same as the "
"5A biological immunotherapy can be used with traditional surgery and radiotherapy, chemotherapy and other conventional means used in addition to its removal of residual microcell cells, to prevent recurrence and metastasis, but also to reduce the side effects of chemotherapy and enhance the treatment effect. Wen Hongze director, the most important is the 5A tumor biotherapy without side effects, safe and reliable, can improve the patient's own immune system, even the constitution is relatively weak patients can also bear.
 
Biological immunotherapy, new hope for cancer patients
 
"Biological immunotherapy is known as the fourth largest cancer treatment, with surgery, radiotherapy and chemotherapy and other traditional therapies in combination, become a modern clinical standardization of cancer is an indispensable means." Wen said.
 
Biological immunotherapy through the regulation and enhancement of the body's immune defense mechanism, the tumor cells and other non-proliferative tumor cells have significant killing effect, at the same time, can improve the body's own immune system, so as to effectively remove the patient's residual tumor cells , To prevent tumor metastasis and recurrence. In 2013, the United States "Science" magazine will tumor immunotherapy as "annual breakthrough" one of its clinical treatment of cancer in the safety and effectiveness of the international medical community has been highly recognized.

The early symptoms of cancer is what 8 anti cancer food has a magic

In recent years, the incidence of cancer is increasing in China due to many reasons. At the same time, with the improvement of living standards and the improvement of medical conditions, people's awareness of prevention and health care is gradually increasing. More and more attention has been paid to the health examination of tumors, one of which is that some tumor markers have been included in the health examination program.
Tumor markers appear to be responsible for tumor production
Refers to the occurrence of tumor markers and proliferation in the process of malignant tumor, the expression of tumor cells by gene synthesis and secretion, or by the body of tumor response and abnormalities, reflect the tumor presence and growth of a class of substances. Generally speaking, this kind of substance should not exist or should not exist in a healthy adult body, when these substances appear or abnormal increase, it means that there may be a tumor.
At present, tumor markers found are: alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 15-3 (CA15-3), cancer antigen 19-9 (CA19-9), cancer antigen 72-4 (CA72-4), non-small cell lung cancer associated antigen (CYFRA 21-1), a small fine cell lung cancer associated antigen (neuron specific enolase, NSE), squamous cell carcinoma antigen (SCC), total prostate specific antigen (TPSA).
Tumor markers are valuable in the diagnosis, differential diagnosis, observation of curative effect, monitoring of recurrence and prognosis evaluation. For example, AFP is the diagnosis of primary liver cancer is sensitive and specific index, if the adult blood AFP value (AFP = >300ug/L) and viral hepatitis, liver cirrhosis, except in pregnant women with genital gland and embryonal tumors, liver cancer may have said.
In recent years, found that bee royal jelly contains special lactic acid, effective prevention and treatment of malignant tumor.
Tea contains catechins, can clear the body of radioactive substances. Radiotherapy patients often drink tea beneficial to rehabilitation. Tea can also prevent dental caries.
Many studies have confirmed that garlic has anti-cancer ability of garlic in the fat soluble volatile oil can activate macrophages, enhance the body's ability to fight, also contains a sulfur compound, also can kill tumor cells.
Honey can promote metabolism, enhance body resistance, improve hematopoietic function and tissue repair.
Almonds can improve the body's immune function, inhibit cell canceration. It can relieve the symptoms such as dry mouth, but oral inflammation, ulcers and bleeding in patients with inappropriate eating.
Milk calcium and vitamin D in the intestine combined with carcinogenic substances, eliminate its harmful effects.
Yogurt inhibits tumor cell growth.
Containing polysaccharide material and interferon inducer, can inhibit tumor. Letinous edodes has a certain effect on gastric cancer, esophageal cancer, lung cancer and cervical cancer.

Adoptive transfer of immune cells in the face of challenges in the clinical treatment of cancer

Recently, with the great progress of acute B CAR-T for recurrent lymphocytic leukemia, and the protection of T cells in vivo PD-1 monoclonal antibody in clinical trials have certain curative effect, has attracted many international well-known pharmaceutical companies on the capital market and to the field of cancer immunotherapy. People began to realize the immune therapy especially the adoptive transfer of immune cells has great prospects in the treatment of cancer. Although immunotherapy suddenly heat up, work in the field of scientists brought development opportunities for always; but on the other hand, we must remain sober minded, adoptive transfer of immune cells of the objective face in the clinical treatment of cancer challenge.
The complexity of tumor immunotherapy
The treatment of solid tumors is a combination of surgery (including a variety of minimally invasive surgery), chemotherapy, radiotherapy, biological immunotherapy, traditional Chinese medicine, psychotherapy, nutrition and metabolism in one of the integrated treatment. In order to get the benefits of biological immunotherapy, we should first pay attention to the top-level design of the overall treatment plan for each patient's first visit. The choice of means of treatment of local lesions, immune therapy, time, how will the adoptive transfer of immune cells and targeting antibodies with the application, how to use chemotherapy or immunosuppressive antibody reduces factors (including Treg) have an impact on the efficacy of immunotherapy. According to our experience, the adoptive transfer of immune cells should begin in the perioperative period, through the postoperative course. In order to achieve long-term survival, we should continue to monitor the immune function, so as to strengthen immunization if necessary. Therefore, the adoptive transfer of immune cells is responsible for the implementation of the treatment of physicians, should have a complete understanding of all aspects of the comprehensive treatment of the tumor, and to propose solutions for the specific circumstances of the patient.
In the course of immune cell therapy, we found that the cells were prepared using a unified culture system, and the cells of each patient responded differently, including the number and phenotype. This is closely related to the factors such as the disease of the tumor, the staging of the disease, the combination of other viral infections, the treatment of other cells, the initial treatment of the immune cells or the subsequent treatment, as well as the psychological status and other factors. Therefore, on the one hand, we need to analyze and grasp from the clinical point of view, on the other hand, we need to adjust the cell culture conditions of different patients in the process of cell preparation.
Targeting of tumor immune cell therapy
The solution of adoptive tumor immune cell transfer therapy targeting or specific problems mainly depends on the load of tumor antigen DC in vivo or in vitro induced induction and amplification of specific cytotoxic T cells (CTL), directly from the tumor infiltrating lymphocytes (TIL) or draining lymph node lymphocytes (TDLN) was CTL the construction of CAR-T, and T cell receptor engineered T cell gene engineering technology (TCRT). The treatment of acute B lymphocytic leukemia relapse obtained complete remission rate was 90%, the treatment of chronic B lymphocytic leukemia also obtained complete remission rate was 87%, which shows that the modified CAR-T has a strong and persistent tumor killing effect. However, the molecular markers of CD19 and CD20 are the surface markers of human normal B lymphocytes. This means that the goal of the treatment is to remove all B cells in the blood, even in the bone marrow, including lymphoma cells. The substance of the treatment is equivalent to that of the pulp. Of course, the important physiological functions of B lymphocytes can be partially replaced by exogenous supplementary immunoglobulin for a long time. However, for solid tumors, they lack specific targets with universal significance. Some of the related antigen epitopes found in solid tumor cells are different from normal cells. The CAR-T has a low expression level of target normal tissue cells attack will have a "Miss" effect, the side effect is very serious. Of particular note is a highly heterogeneous solid tumor cells (including different dry or different degree of differentiation of tumor cells, tumor growth may support the alienation of mesenchymal cells and vascular endothelial cells), biological characteristics, genetic changes in the immune pressure self modulation, the treatment of anti single target in clinical on a wide range of difficult work. Therefore, the author thinks that: 1) from the source specific immune antigen presenting cells (such as DC) breakthrough, break the immune tolerance and immune surveillance function returned to normal and the precise start and activation of autologous T cells, is still an integral part of anti tumor immunotherapy. 2) the combination therapy of non potent multi-target tumor associated antigen specific T cells may be safer and more effective. 3. It is important to develop a DC vaccine targeting the cancer stem / progenitor cells or to induce and amplify the target CTL.

Persistence of tumor immunotherapy

Studies have shown that both in vivo and in vitro can induce the individual CTL, but there is a problem of how to improve the survival of CTL in vivo, which is a long-term role in vivo. Once the tumor is constructed in a suitable microenvironment for its growth, it will release a series of inhibitory factors, prevent T cells from entering the tumor region or induce T cell apoptosis. Studies have shown that blockade of CO inhibitory pathway molecules (PD-1 and PDL-1, CTLA4) and / or activation of costimulatory molecules (4-1BB, D28, OX4) and so on, help to improve the survival and function of CTL in vivo. Although the anti CTLA-4 antibody is known to have a positive effect on immune suppression, the side effects are very obvious. Clinical trials of anti PD-1 antibody showed a certain effect, but the effectiveness of most of the initial test is still relatively low, and there is a big gap between clinical expectations. How will the treatment combination transfer PD-1 antibody and anti PDL-1 antibody and T cell adoptive, obtain better curative effect, the urgent need to carry out pre clinical and clinical trials. The research team is working on this aspect.
Other factors affecting the therapeutic effect of immune cells
The neuro immune endocrine system is a whole, and they interact and regulate each other. The effects of mental or psychological changes on immune system can be clearly observed in clinical treatment. A significant proportion of patients with cancer have depression or depression, can directly affect the effect of immunotherapy. Therefore, it is very important to improve the efficacy of immunotherapy. It is also important for clinicians to provide psychological counseling for tumor patients.
The effect of immune cell therapy also depends on the improvement of the systemic environment. Patients with cancer are often associated with other metabolic disorders, including lipid metabolic disorders, diabetes, and an imbalance in nutrient intake. Doctors are required to provide the necessary dietary and nutritional guidance. It is very important to improve the immune function of patients with advanced cancer or chemotherapy.
Traditional Chinese medicine believes that the human body is a highly developed ecological system which is closed and closely linked with the outside world. The body of any abnormal changes from the outside or inside, can be adjusted through their own ecological conditioning system, and ultimately achieve the balance of yin and Yang human needs. For cancer patients, Chinese medicine focuses on the human body rather than the tumor. Its goal is to promote the process of self adjustment and self harmony, and ultimately become a "flat" (yin and yang balance and harmony of people). Chinese medicine in the treatment process through the analysis of the appearance of disease function imbalance human nature, and then through the whole function of the adjustment, repair and stimulate the defensive system and self-healing system itself, the coexistence of state so that the resistance and pathogens themselves to live in peace. The neuro immune endocrine regulatory system is the embodiment of the overall concept of Western medicine, but also a bridge between traditional Chinese medicine and Western medicine. Adoptive transfer of immune cell therapy is the only western medicine has four major anticancer therapies in the overall consideration and "health" the efficacy of therapy. But due to the tumor patients with evil factors of poison, phlegm, dampness and stagnation of pathogenic factors, adoptive immune cells transferred to the human body, such as in these diseases do not get rid of, the overall environment does not improve, but also can not fully play a role and can not be sustained, unable to repair and reconstruction of its anti tumor immune function. The combination of Chinese medicine and immune cell technology, Chinese medicine can be obtained faster "health" effect, the comprehensive effect of Chinese medicine on multiple targets and effect on regulation of whole environment can strengthen the immune cell therapy. The two complement each other, may play a synergistic role in 1+1>2, and to restore the ability of anti tumor reconstruction patients themselves, improve life quality and prolong the survival in patients with malignant tumor, even tumor patients were cured.