2016年 · 第55卷第01期

thyroid microcarcinoma is an old topic of the endocrine system. In recent years, due to the rapid update of examination methods and the increasing frequency of health examinations, the discovery rate of thyroid microcarcinoma has increased significantly, resulting in a certain degree of "cancer-phobic" epidemic; American scholars even vividly compare the increase of thyroid microcarcinoma to "tsunami". The following introduces the relevant progress in the field of diagnosis and treatment of thyroid microcarcinoma from the aspects of epidemiology, clinical characteristics and treatment.

"precision medicine"^[1]The medical model is different from "personalized medicine". The former emphasizes the fine classification and treatment of diseases based on traditional clinical discovery and examination, combined with genetic or molecular mechanisms. From traditional medicine to evidence-based medicine (standardized protocols intervene in typical patients), from individualized treatment to precision medicine, the medical model is constantly evolving with scientific and technological progress. The core of personalized medicine focuses on individual conditions, while precision medicine tends to be accurate for a small number of specific people suffering from specific diseases, paying more attention to the deep characteristics of "disease" and the high accuracy of "medicine"; It is based on personal genome information, combined with proteome, metabolome and other relevant internal environmental information, to tailor the best treatment plan for patients. It is a high-level medical treatment formed on the basis of in-depth understanding of people, diseases and drugs. At present, the exploration of the implementation of precision medicine plans will focus first on the fields of malignant tumors and diabetes.

[Website] http: / /www.cell.com/trends/endocrinology-metabolism/home

[Website] http: / /www.endosociety.com/

The patient was an 85-year-old male. Twenty years ago, I often had cough and expectoration after catching a cold and catching a cold. I coughed a lot of yellow purulent sputum with bright red blood in the sputum, and I was admitted to hospital for many times. Bronchial lipiodol angiography showed "bronchiectasis", and the diagnosis was "bronchiectasis with infection", which could be improved by anti-infection and hemostasis. In the past 3 years, the patient had chest tightness and asthma after light physical activity, which could be relieved after rest. After catching a cold 5 days before admission, he developed paroxysmal cough, which was difficult to cough up. He coughed up a small amount of gray-brown sputum, accompanied by chills and fever, and his body temperature was as high as 39.0℃. He felt that chest tightness and asthma were worse than usual. He was admitted to the emergency department of our hospital. Blood white blood cells 10.5×10⁹/L, neutral 0.79, Hb 95 g/L, platelets 233×10⁹/L, was admitted to hospital on 1 December 2014 as "bronchiectasis with infection".

"Consensus Opinions on Screening, Diagnosis and Treatment of Early Colorectal Cancer and Precancerous Lesions in China (Chongqing, November 2014)" (Chinese Journal of Internal Medicine, Issue 4, 2015) has played a good role in guiding doctors' clinical practice, but some problems have also been found. On the basis of listening to the opinions of all parties and following further in-depth discussion by the members of the consensus group, the following corrections are made:

In November 2015,Lancet Diabetes EndocrinolProf. Jia Weiping of the Sixth Affiliated People's Hospital of Shanghai Jiao Tong University and Prof. Tong Nanwei of West China Hospital of Sichuan University published a critical article: "Diabetes Prevention and Control and Ongoing Medical Reform in China" [Jia W, Tong N. Diabetes prevention and continuing health-care reform in China. Lancet Diabetes Endocrinol, 2015, 3 (11): 840-842.].

June 2015J Clin Endocrinol MetabA clinical study jointly led by Professor Li Xiaoying of Ruijin Hospital affiliated to Shanghai Jiao Tong University and Professor Zhu Dalong of Gulou Hospital affiliated to Nanjing University was published: "Comparison of the efficacy of urinary follicle-stimulating hormone (FSH) /human chorionic gonadotropin (hCG) sequential therapy and traditional therapy in male idiopathic hypogonadotropic hypogonadism patients" [Zhang M, Tong G, Liu Y, et al. Sequential versus continuous purified urinary FSH/hCG in men with idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab, 2015, 100 (6): 2449-2455]. The study was a prospective, multicenter, open, randomized, parallel-controlled, non-inferiority study.

The sellar region is a general term for the sella turcica and the surrounding anatomical areas. The sella turcica is a saddle-like structure in the middle of the middle cranial fossa and the upper part of the sphenoid body. The pituitary gland is located in the pituitary fossa between the anterior and posterior clinoid processes, and the pituitary stem connects to the hypothalamus through the septum sellar above. Both sides of the pituitary fossa are cavernous sinuses, which are passed by important cranial nerves and internal carotid arteries, so whether it is intrasellar, suprasellar or parasellar lesions can lead to corresponding clinical manifestations. Differential diagnosis and treatment of sellary lesions have become difficult points in endocrinology and neurosurgery because of their deep location and complex nature.

Fibroblast growth factor 21 (FGF21) is a special member of the fibroblast growth factor family. It was first discovered by Japanese scientists in 2000. Unlike most other FGFs, FGF21 does not promote cell division, but can enter the circulatory system to play a hormone-like function, and play an important role in regulating glucose and lipid metabolism and maintaining energy homeostasis^[1,2]。 The liver is an important organ for maintaining various metabolic homeostasis in human body, and it is also the main place for secreting FGF21. When faced with conditions such as glucose and lipid metabolism imbalance, liver fat accumulation, viral infection and even hepatocyte carcinogenesis, the liver enters a stress state. At this time, the metabolic homeostasis of the liver is broken, and metabolites such as hepatocyte factors and fatty acids will also change accordingly. In recent years, it has been found that FGF21 is related to liver diseases such as fatty liver, viral hepatitis and hepatocellular carcinoma. The following reviews the changes of FGF21 in several liver pathologies and their underlying mechanisms.

Parkinson's disease (PD) is a movement disorder. At the same time, PD can also cause many non-movement symptoms, such as constipation, hyposmell, sleep disorders, blood pressure regulation disorders, drowsiness, etc. These non-motor symptoms influence anti-PD therapy and are sometimes even more prominent than motor symptoms. Prominent non-motor symptoms of PD with hypertension are dysregulation of blood pressure, including orthostatic hypotension (OH), supine hypertension (SH), and postprandial hypotension. The presence of dysregulation of blood pressure in PD patients is associated with age, the disease itself, and the use of anti-PD and antihypertensive drugs. When choosing drugs for the treatment of PD combined with hypertension, the occurrence of SH should be avoided as much as possible, and the aggravation of OH and postprandial hypotension should be avoided.

Portal hypertension refers to a group of clinical syndromes caused by increased pressure in the portal system caused by various reasons, and its most common disease is cirrhosis caused by various reasons. The basic pathophysiological characteristics of portal hypertension are obstruction and/or increase of blood flow in the portal system, increase of static pressure in the portal vein and its branches and formation of collateral circulation. The clinical manifestations are mainly ascites, gastroesophageal varices (GOV), esophagogastric variceal bleeding (EVB) and hepatic encephalopathy, among which EVB has a high mortality rate and is one of the most common digestive emergencies. In order to standardize the prevention, diagnosis and treatment of EVB in cirrhosis and portal hypertension, the Hepatology Branch, Gastroenterology Branch and Digestive Endoscopy Branch of Chinese Medical Association organized relevant domestic experts to formulate the Consensus on Prevention and Treatment of Esophagogastric Variceal Bleeding in Cirrhosis and Portal Hypertension in 2008^[1]。 In the past seven years, the clinical research on EVB in cirrhosis and portal hypertension has made some progress at home and abroad. Many randomized controlled studies have updated the treatment of EVB, publishing 2008 Scottish Intercollegiate Guidelines Network (SIGN), 2012 National Institute of Health and Clinical Optimization (NICE) guidelines and 2015 UK guidelines and Baveno VI^[2]Etc. In addition, the influence of patient education, basic treatment, how to reduce the rate of rebleeding after endoscopic treatment, and preoperative and postoperative assessment (including liver function, portal hypertension and collateral circulation) on the choice of treatment options are also prominent clinical problems.

As one of the malignant tumors with high incidence rate, esophageal cancer has been paid more and more attention. Its incidence rate ranks 8th among malignant tumors in the world, 5th among all kinds of tumors in mainland China, and its mortality rate ranks 6th among malignant tumors in the world and 4th in mainland China^[1,2]。 esophageal squamous cell carcinoma (ESCC) is the main esophageal cancer in China, accounting for more than 90% of esophageal cancer, followed by esophageal adenocarcinoma (EAC). Since the 1970s, the incidence of esophageal adenocarcinoma in western countries has gradually increased, surpassing squamous cell carcinoma and becoming the main type of esophageal cancer; However, esophageal squamous cell carcinoma has always been the main in China, and the incidence of adenocarcinoma has not increased significantly^[2]。 There are obvious regional differences in the incidence of esophageal squamous cell carcinoma in China. The absolute high incidence in certain areas and the relatively low incidence in surrounding areas constitute the most typical epidemiological characteristics of esophageal squamous cell carcinoma in China.

Time flies, and in a blink of an eye it is the New Year again. In 2016, we will adhere to the original intention of serving the majority of physicians, carefully plan, actively compose manuscripts, improve communication methods, and strive to present wonderful content to readers in various ways. Continue to build a communication platform for internal medicine clinicians to understand the progress of the discipline and improve the level of diagnosis and treatment.