2018年 · 第98卷第16期

In 2015, the United States announced a new project in the field of life sciences-the Precision Medicine Plan, and then the Chinese government also launched the Precision Medicine Plan. It should be said that precision medicine is an individualized medical model developed based on empirical medicine model and evidence-based medicine model. Tumors are polygenic diseases and are the best objects for precision medicine research. Precision medicine of tumors includes accurate early diagnosis, molecular typing, efficacy prediction and monitoring, metastasis and recurrence monitoring, and prognosis judgment. Classification treatment under the guidance of molecular typing of breast cancer is the representative of precision medicine.

It is the deepening understanding and effective treatment of benign paroxysmal positional vertigo (BPPV) that promotes the upsurge of diagnosis and treatment of dizziness/vertigo at home and abroad. At present, the domestic situation is that on the one hand, there is insufficient understanding of BPPV, and on the other hand, there is generalization of BPPV diagnosis and treatment, which will affect the sustainable development of dizziness/vertigo diagnosis, treatment and research or may lead to misdiagnosis and mistreatment. It is urgent to clarify some key issues and standardize the clinical diagnosis and treatment of benign paroxysmal positional vertigo.

The Chinese Society of Clinical Oncology (CSCO) "Guidelines for the Diagnosis and Treatment of Breast Cancer" is a clinical diagnosis and treatment guide based on evidence-based medical evidence and the basic principles of precision medicine, combined with the cutting-edge medical progress at home and abroad, and taking into account China's medical status and resource availability. Scientific and practical are the two main principles of consideration in the guide. The diagnosis and treatment suggestions of each clinical problem are divided into two parts: basic strategy and optional strategy. The basic strategy belongs to universal diagnosis and treatment measures with good accessibility, and the value of tumor treatment is relatively stable; Most alternative strategies belong to drugs or treatment measures with high-level evidence, but poor accessibility or potency ratio beyond the affordability of Chinese people. In order to better complete the update of the 2018 edition of the guidelines, this paper analyzes and discusses the important research progress in the field of breast cancer in the past year, for the reference of the expert committee in updating the guidelines.

Vestibular function examination is indispensable in the clinical practice of diagnosis and treatment of vertigo. Vestibular function examination can achieve the following goals: confirm clinical judgment, and there will be a preliminary clinical diagnosis through medical history and clinical examination. The examination further confirms the state of vestibular function, whether it is unilateral weakening, bilateral decline, or normal vestibular function; Quantitative detection of the extent and degree of vestibular function impairment (semicircular canal, otolithic apparatus, complete and partial loss of function); Vestibular physiological evidence of functional compensation after vestibular impairment, and objective evidence of functional vertigo. Vestibular function tests include vestibular-ocular reflex function tests and vestibular-spinal reflex tests, which are used to evaluate semicircular canal (cold-hot test, shake-head nystagmus, swivel chair and cephalic pulse test), otolithic function (cervicogenic and ophthalmic vestibular-evoked myogenic potentials) and balance function, respectively.

The etiology of vertigo/dizziness is complex and involves multiple disciplines. From the general outpatient department of primary hospitals to the relevant specialty outpatient and emergency department of tertiary hospitals, a large number of vertigo/dizziness patients are admitted every year. Clinicians at all levels are required to have comprehensive knowledge of vertigo/dizziness related disciplines, excellent medical history inquiry skills, basic skills of physical examination, and the ability to reasonably select and correctly interpret auxiliary examinations, so as to be able to diagnose and treat correctly under different diagnosis and treatment conditions (emergency rooms, outpatient clinics or wards of different levels of hospitals). Today, with the high development of imaging technology, clinicians' dependence on auxiliary examination has obviously increased. However, physical examination, as a basic technology of doctors, is an indispensable means of disease diagnosis, and it is also the embodiment of good clinical thinking mode. Therefore, vertigo physical examination (hereinafter referred to as vertigo physical examination) as the basic skill of vertigo/dizziness diagnosis and treatment needs to be repeatedly emphasized and standardized training.

Patient 1Male, 16 years old, was admitted to the Department of Rheumatology and Immunology of the First Affiliated Hospital of Zhengzhou University on August 10, 2016 due to "intermittent fever and cough for more than 6 months". The patient developed fever on February 2, 2016, with a maximum body temperature of 40 ℃, accompanied by muscle pain in the chest, back and calf, cough and cough a small amount of yellow phlegm, and was admitted to the local hospital. Blood test routine: white blood cells 27.6×10⁹/L, neutrophil ratio 77.8%, neutrophil number 21.34×10⁹/L; Bone marrow cytology: no abnormalities. "Azithromycin, ribavirin, levofloxacin" was given, but the effect was poor. Past history: The stool has not formed in the past 5 years. In the past 1 year, bilateral chewing muscles have repeated pain, inability to chew hard food, and intermittent dizziness. Physical examination after admission: body temperature 38.5 ℃, blood pressure: 123/67 mmHg on the right side (1 mmHg =0.133 kPa), 117/62 mmHg on the left side, and blow-like vascular murmur could be heard in bilateral neck vessels. Blood routine: white blood cells 20.2×10⁹/L, hemoglobin 105 g/L; Erythrocyte sedimentation rate 29 mm/1 h, CRP 69.47 mg/L; Ultrasound: Intima-media thickening of bilateral common carotid arteries, approximately 3.3 mm in the left total neck thicker area and 1.7 mm in the right total neck thicker area, Takayasu arteritis (TA) considered; PET-CT: Diffuse metabolism of the colon is active, and multiple enlarged lymph nodes around the intestine and retroperitoneum are metabolically active. Inflammatory lesions are more considered, and endoscopy is recommended. Colonoscopy: ileocecal, ascending colon, hepatic flexure of colon, transverse colon, splenic flexure of colon, descending colon, sigmoid colon, and rectal mucosa were granular, with unclear vascular texture, diffuse small ulcers, covered with purulent coating, scattered erosion, polyp formation, diagnosis: ulcerative colitis (UC). Descending colon pathology: chronic active inflammation of the mucosa with lymphoid tissue hyperplasia. Diagnosis: TA, UC. He was given methylprednisolone, sulfasalazine enteric-coated tablets and other drugs, and his condition was stable after regular follow-up in out-of-hospital clinic.