2016年 · 第55卷第10期

The incidence of vertigo/dizziness has been increasing year by year in recent years. Because of its large patient population, many causes, and involving multiple clinical disciplines (otology, neurology, general internal medicine, orthopedics and geriatrics, etc.), it brings many challenges to clinical diagnosis and treatment, and has become a common concern of experts and scholars in various fields at present. At present, many domestic clinicians have weak basic knowledge of vestibular system in interdisciplinary disciplines, and lack of overall thinking of clinical diagnosis and treatment, which hinders their in-depth development in this field. Therefore, consolidating basic knowledge, cultivating solid clinical basic skills, and establishing clinical thinking of vertigo diagnosis and treatment are the fundamentals to promote the standardized development and improve the level of vertigo/dizziness diagnosis and treatment. In the past, the traditional diagnosis and treatment idea of vertigo/dizziness in China was to take the "nature of symptoms" as the starting point, and guide the follow-up diagnosis and treatment by distinguishing the types of vertigo/dizziness in patients. However, this method has certain limitations in actual diagnosis and treatment work, which is not conducive to rapid preliminary diagnosis and symptomatic treatment. From 2009 to 2015, the framework structure and some definitions and standards of the International Classification of Vestibular Diseases (ICVD) were introduced one after another, and the final complete version of ICVD will be officially released in the 11th edition of the International Classification of Diseases (ICD-11) in 2017. The use of the ICVD classification method improves the practicality and ease of operation for clinicians in the diagnostic analysis of vertigo. Therefore, our journal invited experts from many disciplines with profound attainments in this field to jointly write the clinical diagnosis and treatment thinking and treatment principles of vertigo disease in the direction of ICVD, as well as the clinical diagnosis and treatment of acute vestibular syndrome, paroxysmal vestibular syndrome and chronic vestibular syndrome, which were published in the special written talk column of this issue. Welcome to read.

The incidence of vertigo/dizziness has been increasing year by year in recent years, and it is very common in outpatient clinics of hospitals at all levels. Because of its large patient population, many causes, and involvement of multiple clinical disciplines, it brings many challenges to clinical diagnosis and treatment, and has become a common concern of experts and scholars in various fields. It is an important task to gradually improve the understanding level of vertigo/dizziness disease and standardize its diagnosis and treatment.

In the face of vertigo/dizziness patients, it is the basic skill of clinicians to master medical history collection, bedside physical examination and necessary auxiliary examination, and it is the basis of positioning and qualitative diagnosis. It is the correct way of clinical diagnosis to collect as detailed clinical data as possible through the history of vertigo, physical examination of vertigo and necessary auxiliary examinations, and then carry out comprehensive analysis.

acute vestibular syndrome (AVS) is a group of clinical syndromes with acute onset, persistent vertigo/dizziness or instability as the main symptoms, lasting from days to weeks, and usually with progressive vestibular system dysfunction. It is characterized by a single phase lasting for a certain time^[1]。 Diseases that can appear in the form of AVS mainly include vestibular neuritis, acute labyrinthitis, traumatic vestibular disease, demyelinating disease, and structural damage of the central or peripheral vestibular system caused by stroke. The common etiology of AVS is mainly perivestibular disease, but acute vertigo caused by stroke has the most serious consequences, which needs to be highly paid attention to and prioritized identification.

episodic vestibular syndrome (EVS) is a group of syndromes with transient episodes of vertigo, dizziness, and unsteady standing as the main symptoms, lasting for several seconds to several hours, occasionally several days, and usually including some temporary and transient vestibular system dysfunction (such as nystagmus, fall attacks). There are also symptoms and signs that suggest cochlear or central nervous system dysfunction. EVS are often characterized by multiple recurrent episodes (induced or spontaneous) caused by paroxysmal disease, but may also be the first manifestation after the first event. Disorders manifesting as EVS include benign paroxysmal positional vertigo (BPPV), Meniere disease (MD), vestibular migraine (VM), Convulsive seizures, hypoglycemia, and structural damage to the central or peripheral vestibular system caused by transient ischemic attack (TIA)^[1]。

chronic vestibular syndrome (CVS) is a group of clinical syndromes with chronic vertigo/dizziness or instability as the main symptom, lasting from months to years, usually with persistent vestibular system dysfunction (visual oscillation, nystagmus, gait instability)^[1]There are also some symptoms and signs that suggest cochlear or central nervous system dysfunction. CVS usually exhibits a progressive, worsening process and sometimes includes a stable state of incomplete recovery after acute vestibular disease or a state of persistent symptomatic presence between episodic vestibular disorders. Disorders with such symptoms include unilateral vestibulopathy that cannot be compensated, chronic bilateral vestibulopathy, cerebellar degenerative disease, posterior fossa tumors, and mental or behavioral disorders with prominent vestibular symptoms.

Clinically, sulfasalazine is mainly used for the treatment of inflammatory bowel disease, rheumatoid arthritis and ankylosing spondylitis. Adverse reactions were drug eruption, neutropenia or deficiency, thrombocytopenia and aplastic anemia, hemolytic anemia and hemoglobinuria, occasionally liver and kidney function impairment and digestive tract symptoms. A case of severe agranulocytosis combined with perianal abscess and septic shock due to the application of sulfasalazine in the treatment of psoriatic arthritis is reported. The treatment process is summarized and discussed in combination with domestic and foreign literatures, in order to be helpful to clinicians.

Good's syndrome is a primary immunodeficiency disease characterized by thymoma, hypogammaglobulinemia, and peripheral blood B lymphocyte reduction or absence. More than adults, the clinical manifestations are repeated chronic respiratory tract infection or diarrhea. 1954 Good^[1]First reported, this type of disease was later called Good's syndrome. In the late 1990s, researchers found that this type of patient had disturbance of B lymphocyte differentiation and low T lymphocyte function. Good's syndrome is rare, with 281 cases currently in the literature^[2]Reports. According to statistics in the United States, the incidence rate of thymoma is 0.15/1 million, and about 6% ~11% of thymoma patients are complicated with hypogammaglobulinemia^[3]。 A systematic review of 152 patients diagnosed with Good's syndrome revealed that thymoma was diagnosed earlier than immunodeficiency in 42% of patients, both were diagnosed almost simultaneously (within 2 months) in 38% of patients, immunodeficiency followed by thymoma diagnosis in 10% of patients, and a further 10% of thymoma was diagnosed later than immunodeficiency^[4]。 A case of Good's syndrome is reported.

February 2016Neurobiol AgingA comprehensive clinical basic study "Analysis of MATR3 gene mutation in Chinese patients with sporadic amyotrophic lateral sclerosis" by Professor Fan Dongsheng's research group of Department of Neurology, Peking University Third Hospital (Xu L, Li J, Tang L, et al. MATR3 mutation analysis in a Chinese cohort with sporadic amyotrophic lateral sclerosis. Neurobiol Aging, 2016, 38:218.e3-4.), to clarify the variation of the MATR3 gene in Chinese patients with sporadic amyotrophic lateral sclerosis (ALS). This is the first time that the MATR3 gene mutation status has been obtained in the Han population in mainland China, and it has enriched the global genetic information resource database of ALS patients.

hyperglycemic hyperosmolar syndrome (HHS) is an emergency characterized by severe hyperglycemia, hyperosmolarity, dehydration, and no obvious ketosis, often accompanied by disturbance of consciousness or coma of varying degrees. Although HHS usually occurs in older adults, it may also develop in children and young people^[1,2]。 HHS can be complicated by other critical diseases such as myocardial infarction, stroke, seizures, cerebral edema, and central pontine myelinolysis. The mortality rate of HHS is higher than that of diabetic ketoacidosis, and the overall mortality rate is nearly 20%, which is 10 times that of diabetic ketoacidosis^[3,4,5]。 The following is a summary of the diagnosis and treatment of HHS combined with the diagnosis and treatment of a patient with HHS.

Achalasia is an esophageal motility disorder, which is mainly characterized by dysphagia, chest pain, reflux, vomiting and weight loss. Its pathophysiological changes are mainly lower esophageal sphincter (LES) relaxation disorder and ineffective contraction of the esophageal body^[1]。 Achalasia is an incurable chronic disease, which seriously affects the quality of life of patients. A Canadian survey showed that 74% of patients with achalasia had lifestyle restrictions due to this disease, 37% suffered from work distress, and an average absence of 10.2 days every 6 months^[2]。 Achalasia is sporadic worldwide and its prevalence is on the rise^[3]Its etiology and pathogenesis are still unknown. The research progress of the pathogenesis of achalasia is reviewed.

Mechanical ventilation is an important treatment for critically ill patients. Inappropriate mechanical ventilation setting can not only lead to ventilator-induced lung injury (VILI) in patients with acute respiratory distress syndrome (ARDS), but also lead to lung injury in non-ARDS patients, and further ARDS, which affects the prognosis of patients^[1]。 Studies have shown that protective ventilation strategies, including low tidal volume ventilation and open lung strategies, can avoid lung injury in non-ARDS patients, reduce pulmonary and systemic complications, prevent ARDS from occurring, and ultimately improve patient prognosis. Therefore, the role of protective ventilation strategy in non-ARDS patients is equally important. The progress of the application of protective mechanical ventilation strategy in non-ARDS patients is reviewed below.

Antithrombotic therapy has become the cornerstone of drug therapy for acute coronary syndrome (ACS). For ACS and its patients undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT, aspirin plus P2Y₁₂Receptor inhibitors) can significantly reduce the incidence of early and long-term adverse cardiovascular events. At the same time, the use of anticoagulants in the acute phase of ACS and during PCI can further reduce the occurrence of thrombotic events^[1,2,3,4,5]。 However, various hemorrhagic complications associated with antithrombotic therapy are also increasing.