Chapter 23. Medicine
Recommended Article : 【Biology】 Biology Index
1. Disease
2. Diagnosis
3. Treatment
1. Disease
⑴ Category 1. Cancer Diseases
⑵ Category 2. Organ-specific Functional Diseases
⑶ Category 3. Immune System Diseases
⑷ 2-1. Respiratory System Diseases
⑸ 2-2. Metabolic Diseases
② Intestinal Diseases
③ Liver Diseases
④ Diabetes Diseases
⑹ 2-3. Skin Diseases
① liver fibrosis
② lung fibrosis
③ idiopathic pulmonary fibrosis
④ scleroderma
⑺ 2-4. Neurodegenerative Diseases
① Brain Diseases
② Neurological Diseases
⑻ 3-1. Infectious Diseases: Viral Diseases, etc.
⑼ 3-2. Inflammatory Diseases
⑽ 3-3. Autoimmune Diseases
⑾ 3-4. Immune System Evasion Diseases: Such as AIDS
2. Diagnosis
⑴ Diagnosis - Histopathology
① Tumor Tissue: Nuclei are larger compared to normal cells.
Figure 1. Tumor Tissue
② Tumor and Gland Tissue
Figure 2. Tumor and Gland Tissue
③ Normal Epithelial Cells
Figure 3. Normal Epithelial Cells
④ Intestinal Metaplasia
Figure 4. Intestinal Metaplasia
⑤ Lymphoid Follicles
Figure 5. Lymphoid Follicles
⑥ Muscularis Mucosa
Figure 6. Muscularis Mucosa
⑦ Peritumoral Muscularis
Figure 7. Peritumoral Muscularis
⑧ Lamina Propria
Figure 8. Lamina Propria
⑨ Blood-Containing Tissue
Figure 9. Blood-Containing Tissue
⑩ Connective Tissue
Figure 10. Connective Tissue
⑪ Immune Clusters: Higher cell density and larger nuclei compared to other cells.
⑵ Diagnosis - Blood Pressure
① Normal: Systolic BP 90-119 mmHg, Diastolic BP 60-79 mmHg
② Prehypertension: Systolic BP 120-139 mmHg, Diastolic BP 80-89 mmHg
③ Hypertension Stage 1: Systolic BP 140-159 mmHg, Diastolic BP 90-99 mmHg
④ Hypertension Stage 2: Systolic BP > 160 mmHg, Diastolic BP > 100 mmHg
⑶ Diagnosis - Pulmonary Function Test (PFT)
① Forced Vital Capacity (FVC): Maximum amount of air that can be exhaled.
② Forced Expiratory Volume in 1 Second (FEV1): Amount of air exhaled in 1 second.
③ % = FEV1 / FVC × 100
④ Normal: % = 70
⑤ Obstructive: % ↓
⑥ Restrictive: % ↑
⑷ Diagnosis - Glomerular Filtration Rate (GFR)
Table 1. GFR Scale
⑸ Assessment - RECIST (Response Evaluation Criteria in Solid Tumors)
① Serves as a biomarker and clinical outcome
② Complete Response (CR)
○ All target and non-target lesions are removed
○ Lymph nodes are reduced to < 10 mm
③ Partial Response (PR)
○ ≥ 30% reduction in target lesions
○ Non-target lesions don’t progress
④ Stable Disease (SD)
○ Indeterminate between PR and PD
⑤ Progressive Disease (PD)
○ ≥ 20% increase in target lesions or new lesions
⑹ Assessment - TNM Staging: Evaluates tumor phase
① Tumor (T): Differentiated by size and relationship to adjacent cells
② Node Metastasis (N): Spread to lymphatic system
③ Distant Metastasis (M): Spread through bloodstream
⑺ Assessment - HAS-BLED Score: Assess bleeding risks.
① Table of score evaluation
| Clinical features | Score (point) |
|---|---|
| H Hypertension: SBP > 160 mmHg | 1 |
| A Abnormal liver function | 1 |
| A Abnormal renal function | 1 |
| S Stroke history | 1 |
| B Prior major bleeding / predisposition to bleeding | 1 |
| L Labile INR on Warfarin | 1 |
| E Elderly; age > 65 years | 1 |
| D Drugs predisposing bleeding: antiplatelet / NSAIDs | 1 |
| D High alcohol consumption | 1 |
| Maximum score | 9 |
Table 2. Table of HAS-BLED score evaluation
② Evaluation: 0 is low risk, 1-2 is moderate risk, 3+ is high risk.
⑻ Prediction - HER-2 Grading System
① Predicts effectiveness of HER-2 targeted treatment by assessing HER-2 expression
| HER-2 grade | Explanation | Interpretation |
|---|---|---|
| 0 | No reactivity or membranous reactivity in < 10% of tumor cells. | Negative |
| 1 | Faint / barely perceptible membranous reactivity is detected in > 10% of tumor cells. | Negative |
| The cells are immunoreactive only in part of the membrane. | ||
| 2 | Weak to moderate complete membranous reactivity is seen in > 10% of tumor cells. | Borderline reactivity |
| 3 | Strong complete reactivity is seen in > 10% of tumor cells. | Positive |
Table 3. HER-2 grading system
⑼ Prognosis - Gleason’s Pattern Scale
3. Treatment
⑴ Method 1. Surgery
① Tumor Resection
⑵ Method 2. Chemotherapy
⑶ Method 3. Radiotherapy
① Type 1. External Beam Radiotherapy
○ IMRT: Current standard
○ 3D CRT: Shape-conforming, but lacks intensity modulation
② Type 2. Brachytherapy
⑷ Method 4. Immunotherapy
① Overview: Immunotherapies unfortunately work in only about 12.5% of cancer patients.
② Type 1. Cancer Vaccine
③ 1-1. Preventive Cancer Vaccine: HPV, hepatitis B, only two FDA-approved
○ Voretigene Neparvovec (Luxturna): AAV2-based, expresses RPE65 gene
○ Onasemnogene Abeparvovec (Zolgensma): AAV9-based, encodes survival motor neuron (SMN) protein
④ 1-2. Sipuleucel-T: Therapeutic cancer vaccine
○ 1st. Antigen-presenting cells (APCs) extracted from patient
○ 2nd. Antigens exposed to APCs in vitro
○ 3rd. Trained APCs reinfused into patient
○ Used in prostate cancer treatment, offers personalized therapy
⑤ Type 2. CAR (Chimeric Antigen Receptor)-T Cell Therapy
○ 1st. T cells extracted from patient’s blood
○ 2nd. T cells engineered with viral vectors to express CAR
○ 3rd. Expanded to millions of cells
○ 4th. Infused back into patient for cancer treatment
○ Effective in blood cancers, less so in solid tumors due to tumor microenvironment
⑥ Type 3. Cytokine: IL-2, interferon-alpha, etc.
⑦ Type 4. ICI (Immune Checkpoint Inhibitor), also known as ICB (Immune Checkpoint Blockade)
○ Principle
Figure. 11. The principle of ICI
○ PD-1: Expressed in T cells
○ CTLA-4: Expressed in T cells
○ PD-L1: Expressed in macrophages or tumor cells
○ VISTA: Expressed in T cells, TAM (tumor-associated macrophages), dendritic cells, and other immune cells
○ Siglec: The Siglec family in immune cells binds to sialylated glycans on cancer cells, acting as an immune checkpoint
○ MYC: Overexpression of MYC is involved in immune suppression
○ Type 1. PD-1 inhibitor
○ nivolumab (Opdivo)
○ pembrolizumab (Keytruda, approved for TNBC patients)
○ cemiplimab (Libtayo)
○ Type 2. PD-L1 inhibitor
○ atezolizumab (Tecentriq, approved for TNBC patients)
○ avelumab (Bavencio)
○ durvalumab (Imfinzi)
○ atezolizumab
○ Type 3. CTLA-4 inhibitor
○ ipilimumab (the first ICI discovered)
○ Advantages
○ Universally applicable regardless of cancer type
○ Received FDA approval for mutation burden: This universality was a first
○ Disadvantages
○ Immune-related adverse effect: Can cause autoimmune diseases
○ Shows a response rate of approximately 20-40%: Attempts targeted therapy using mutation burden and other biomarkers
○ Ineffective for cold tumors like glioblastoma
○ Expensive
○ PD-L1 sensitivity may continuously change during treatment
○ Treatment
○ Better treated with anti-PD1/L1 therapy than with anti-CTLA-4 therapy → Anti-PD1, anti-PDL1 drugs are dominating
○ FDA approval condition: Prescribed for solid tumors when specific conditions such as MSI-H (microsatellite instability), MMR (mismatch-repair gene) are met.
⑸ Method 5. Photodynamic Therapy
① PS (Photosensitizer)
② Type I Reaction: PS → 1PS* (singlet state) → 3PS* (triplet state)
○ 1PS* and 3PS* generate radicals, causing tissue damage
③ Type II Reaction: 3PS* + O2 → PS + 1O2*
○ 1O2* (singlet oxygen) causes tissue damage
④ Drawbacks include low oxygen efficiency in type II reaction, toxicity of PS, and sensitivity to light
⑤ PS in the skin can be damaged by sunlight, light penetration is an issue
Input: 2022-05-05 11:32
Last Revised: 2023-06-04 17:50