Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical...Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.展开更多
The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Base...The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.展开更多
INTRODUCTION Great changes have taken place in modern neurosurgery in the past decades.Contrasting models of management for complex neurosurgical patients have been developed in China as the specialty evolving,thus ar...INTRODUCTION Great changes have taken place in modern neurosurgery in the past decades.Contrasting models of management for complex neurosurgical patients have been developed in China as the specialty evolving,thus arise many controversies.Clinical demand calls for an expert consensus on neurosurgical inpatients management,especially for the subspecialty of neurosciences critical care （NCC）.展开更多
IntroductionMore than 1.0 million patients worldwide are diagnosed with space-occupying lesions in the liver every year, with the number approaching 0.5 million per year in China, and only 20% of the lesions are resec...IntroductionMore than 1.0 million patients worldwide are diagnosed with space-occupying lesions in the liver every year, with the number approaching 0.5 million per year in China, and only 20% of the lesions are resectable Due to a lack of available donors, only a limited number of patients underwent allogeneic liver transplantation, the remaining patients simply receive palliative care. Therefore, discovering new options for treating these patients is a high priority. Liver autotransplantation （LAT） is a surgical technique that adopts liver transplantation skills to radically treat spaceoccupying hepatic lesions, benign or malignant,展开更多
Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination...Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion.This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence,aiming to provide general guidance on appropriate imaging examination selection,comprehensive and accurate imaging assessment for early orthodontic treatment patients.展开更多
The research and development of new traditional Chinese medicine(TCM)drugs have progressively established a novel system founded on the integration of TCM theory,human experience,and clinical trials(termed the“Three ...The research and development of new traditional Chinese medicine(TCM)drugs have progressively established a novel system founded on the integration of TCM theory,human experience,and clinical trials(termed the“Three Combinations”).However,considering TCM's distinctive features of“syndrome differentiation and treatment”and“multicomponent formulations and complex mechanisms”,current TCM drug development faces challenges such as insufficient understanding of the material basis and the overall mechanism of action and an incomplete evidence chain system.Moreover,significant obstacles persist in gathering human experience data,evaluating clinical efficacy,and controlling the quality of active ingredients,which impede the innovation process in TCM drug development.Network pharmacology,centered on the“network targets”theory,transcends the limitations of the conventional“single target”reductionist research model.It emphasizes the comprehensive effects of disease or syndrome biological networks as targets to elucidate the overall regulatory mechanism of TCM prescriptions.This approach aligns with the holistic perspective of TCM,offering a novel method consistent with TCM's holistic view for investigating the complex mechanisms of TCM and developing new TCM drugs.It is internationally recognized as a“next-generation drug research model”.To advance the research of new tools,methods,and standards for TCM evaluation and to overcome fundamental,critical,and cutting-edge technical challenges in TCM regulation,this consensus aims to explore the characteristics,progress,challenges,applicable pathways,and specific applications of network pharmacology as a new theory,method,and tool in TCM drug development.The goal is to enhance the quality of TCM drug research and development and accelerate the efficiency of developing new TCM products.展开更多
Primary liver cancer,often referred to as hepatocellular carcinoma(HCC),is the fourth most common malignant tumor and the second leading cause of cancer-related deaths in China[1].Each year,39.0%-53.6%of newly diagnos...Primary liver cancer,often referred to as hepatocellular carcinoma(HCC),is the fourth most common malignant tumor and the second leading cause of cancer-related deaths in China[1].Each year,39.0%-53.6%of newly diagnosed liver cancer are identified at an advanced stage,marked by short survival and a refractory clinical condition[2].However,current guidelines for diagnosing and treating liver cancer broadly classify the advanced stage,advocating a singular strategy without considering individual patient treatment options.Therefore,it is urgent to establish a comprehensive and practical expert consensus specifically for China to enhance early diagnosis and treatment of liver cancer.Using the Delphi method,an expert team has,for the first time,refined the classification criteria for Chinese liver cancer patients and developed corresponding optimal treatment regimen recommendations[3].This consensus is intended to provide a more detailed,scientific,and reasonable reference basis for the selection of individualized diagnosis and treatment plans.展开更多
The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening syste...The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening systems have been established.It is of great significance to build a high-quality gastric cancerscreening system adaptive to China's national conditions.Due to the large number of people at risk ofgastric cancer and the uneven distribution of medical resources,it is still difficult for China to carry out anationwide gastroscopy screening program for gastric cancer.Gastric oral contrast ultrasonography(OCUS)is a promising,non-invasive tool for initial gastric cancer screening,offering a painless,radiationfreealternative.Based on two 2020 OCUS consensuses,this document analyzes national gastric cancerscreening strategies and challenges to elaborate on the necessity,feasibility,and current problems ofpreliminary ultrasound screening in China.It details the key aspects of OCUS,including indications,contraindications,operator requirements,contrast agent standards,and essential scanning protocols.Italso introduces the standardized ultrasound sections and the Stomach Ultrasound Report and Data System(Su-RADS)and proposes the relevant consensus opinions.After several rounds of discussions and voting byexperts from multiple societies,a total of 17 consensus opinions have been formed on OCUS as a preliminary screening technique for gastric cancer,with the aim of standardizing the popularization ofOCUS.In addition,the consensus calls for conducting nationwide multicenter prospective studies toimprove the level of evidence and provide big data support for the construction of a preliminary gastriccancer ultrasound screening system that is in line with China's national conditions.展开更多
Objective:To develop an expert consensus on subcutaneous injection for allergen-specific immunotherapy.Methods:Relevant domestic and international literature was reviewed,and nursing experts experienced in subcutaneou...Objective:To develop an expert consensus on subcutaneous injection for allergen-specific immunotherapy.Methods:Relevant domestic and international literature was reviewed,and nursing experts experienced in subcutaneous injection of allergen-specific immunotherapy were interviewed to form the initial draft of the consensus.A total of 85 experts from 42 hospitals nationwide were invited to participate the discussions.Through two rounds of expert consultations,adjustments,revisions,and improvements to the initial draft,an online meeting was held to form the final version of the consensus.The content approved by more than 75%of the expert group is retained.Results:The expert consensus includes operational standards for subcutaneous injection of allergen-specific immunotherapy,identification and management of adverse reactions,and health education.Conclusion:The consensus demonstrates strong scientific rigor and practicality,providing guidance for nursing practices in the field of clinical allergology.展开更多
Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associa...Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.展开更多
Objective:To establish consensus on Chinese Herbal Medicine(CHM)for rheumatoid arthritis(RA)among 21 Singaporean experts,this study addressed the lack of CHM clinical practice guidelines(CPGs)in Singapore.Despite adva...Objective:To establish consensus on Chinese Herbal Medicine(CHM)for rheumatoid arthritis(RA)among 21 Singaporean experts,this study addressed the lack of CHM clinical practice guidelines(CPGs)in Singapore.Despite advancements in RA therapies,the disease's progressive nature and high costs of novel treatments worsen disparities in management and outcomes.The initiative aimed to bridge this gap by developing expert-backed recommendations for CHM use in RA care.Methods:The group of experts conducted two rounds of Delphi surveys containing 29 items identified from a literature review.Consensus was defined as≥75%of votes in dichotomized ratings on a fivepoint ordinal scale for recognition.Items that did not reach consensus were discussed in a focus group with four selected experts.Results:Nineteen experts completed both rounds of Delphi surveys.A consensus was reached for 27 items,which encompassed Chinese medicine rationale,pattern differentiation,management,CHM prescription,and co-effectiveness with pharmacological therapy.Collective expert opinions were formed for the two remaining items.All items received a recognition score>3.5.Conclusions:The consensus derived from this study provides a foundation for CHM CPGs for RA in Singapore.However,the findings are limited by the demographic composition of the experts and the representativeness of the patient pool.展开更多
With the growing emphasis on maternal and child oral health,the significance of managing oral health across preconception,pregnancy,and infancy stages has become increasingly apparent.Oral health challenges extend bey...With the growing emphasis on maternal and child oral health,the significance of managing oral health across preconception,pregnancy,and infancy stages has become increasingly apparent.Oral health challenges extend beyond affecting maternal wellbeing,exerting profound influences on fetal and neonatal oral development as well as immune system maturation.This expert consensus paper,developed using a modified Delphi method,reviews current research and provides recommendations on maternal and child oral health management.It underscores the critical role of comprehensive oral assessments prior to conception,diligent oral health management throughout pregnancy,and meticulous oral hygiene practices during infancy.Effective strategies should be seamlessly integrated across the life course,encompassing preconception oral assessments,systematic dental care during pregnancy,and routine infant oral hygiene.Collaborative efforts among pediatric dentists,maternal and child health workers,and obstetricians are crucial to improving outcomes and fostering clinical research,contributing to evidence-based health management strategies.展开更多
Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health,function,and aesthetics,ensuring both patient satisfaction and long-term stability.Managing ...Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health,function,and aesthetics,ensuring both patient satisfaction and long-term stability.Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues,especially in severe cases.Therefore,close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment,along with diligent patient compliance throughout the entire process,is crucial for achieving favorable treatment outcomes.Moreover,long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success.This expert consensus,informed by the latest clinical research and practical experience,addresses clinical considerations for orthodontic treatment of periodontal patients,delineating indications,objectives,procedures,and principles with the aim of providing clear and practical guidance for clinical practitioners.展开更多
Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common den...Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture,primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography(CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis,differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.展开更多
Artificial intelligence(AI)is increasingly recognized as a transformative force in the field of solid organ transplantation.From enhancing donor-recipient matching to predicting clinical risks and tailoring immunosupp...Artificial intelligence(AI)is increasingly recognized as a transformative force in the field of solid organ transplantation.From enhancing donor-recipient matching to predicting clinical risks and tailoring immunosuppressive therapy,AI has the potential to improve both operational efficiency and patient outcomes.Despite these advancements,the perspectives of transplant professionals-those at the forefront of critical decision-making-remain insufficiently explored.To address this gap,this study utilizes a multi-round electronic Delphi approach to gather and analyses insights from global experts involved in organ transplantation.Participants are invited to complete structured surveys capturing demographic data,professional roles,institutional practices,and prior exposure to AI technologies.The survey also explores perceptions of AI’s potential benefits.Quantitative responses are analyzed using descriptive statistics,while open-ended qualitative responses undergo thematic analysis.Preliminary findings indicate a generally positive outlook on AI’s role in enhancing transplantation processes,particularly in areas such as donor matching and post-operative care.These mixed views reflect both optimism and caution among professionals tasked with integrating new technologies into high-stakes clinical workflows.By capturing a wide range of expert opinions,the findings will inform future policy development,regulatory considerations,and institutional readiness frameworks for the integration of AI into organ transplantation.展开更多
Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of...Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of < 6 mo. However, over the past three decades, an integrated treatment strategy of cytoreductive surgery(CRS) + hyperthermic intraperitoneal chemotherapy(HIPEC) has been developed by the pioneering oncologists, with proved efficacy and safety in selected patients. Supported by several lines of clinical evidence from phases Ⅰ, Ⅱ and Ⅲ clinical trials, CRS + HIPEC has been regarded as the standard treatment for selected patients with PC in many established cancer centers worldwide. In China, an expert consensus on CRS + HIPEC has been reached by the leading surgical and medical oncologists, under the framework of the China Anti-Cancer Association. This expert consensus has summarized the progress in PC clinical studies and systematically evaluated the CRS + HIPEC procedures in China as well as across the world, so as to lay the foundation for formulating PC treatment guidelines specific to the national conditions of China.展开更多
Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first e...Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.展开更多
Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation ...Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.展开更多
Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis an...Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.展开更多
Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Ca...Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Care Medicine Committee of Chinese People’s Liberation Army(PLA)worked with Chinese Society of Laboratory Medicine,Chinese Medical Association to develop this consensus to provide guidance for clinical practice.The consensus includes five sections and 27 items:the definition of thrombocytopenia,etiology and pathophysiology,diagnosis and differential diagnosis,treatment and prevention.展开更多
文摘Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.
文摘The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
文摘INTRODUCTION Great changes have taken place in modern neurosurgery in the past decades.Contrasting models of management for complex neurosurgical patients have been developed in China as the specialty evolving,thus arise many controversies.Clinical demand calls for an expert consensus on neurosurgical inpatients management,especially for the subspecialty of neurosciences critical care （NCC）.
基金supported by the National Natural Science Foundation of China:United Foundation with Xinjiang(U1403222)National Natural Science Foundation of China(81570079)
文摘IntroductionMore than 1.0 million patients worldwide are diagnosed with space-occupying lesions in the liver every year, with the number approaching 0.5 million per year in China, and only 20% of the lesions are resectable Due to a lack of available donors, only a limited number of patients underwent allogeneic liver transplantation, the remaining patients simply receive palliative care. Therefore, discovering new options for treating these patients is a high priority. Liver autotransplantation （LAT） is a surgical technique that adopts liver transplantation skills to radically treat spaceoccupying hepatic lesions, benign or malignant,
基金supports by the National Natural Science Foundation of China(Nos.82201135)"2015"Cultivation Program for Reserve Talents for Academic Leaders of Nanjing Stomatological School,Medical School of Nanjing University(No.0223A204).
文摘Early correction of childhood malocclusion is timely managing morphological,structural,and functional abnormalities at different dentomaxillofacial developmental stages.The selection of appropriate imaging examination and comprehensive radiological diagnosis and analysis play an important role in early correction of childhood malocclusion.This expert consensus is a collaborative effort by multidisciplinary experts in dentistry across the nation based on the current clinical evidence,aiming to provide general guidance on appropriate imaging examination selection,comprehensive and accurate imaging assessment for early orthodontic treatment patients.
基金supported by the National Medical Products Administration Commissioned Research Project (No.20211440216)the National Administration of Traditional Chinese Medicine Science and Technology Project (No.GZY-KJS-2024-03)+3 种基金the State Key Laboratory of Drug Regulatory Science Project (No.2023SKLDRS0104)the Basic Research Program Natural Science Fund-Frontier Leading Technology Basic Research Special Project of Jiangsu Province (No.BK20232014)the Programs Foundation for Leading Talents in National Administration of Traditional Chinese Medicine of China“Qihuang scholars”Projectthe Tianjin Administration for Market Regulation Science and Technology Key Projects (No.2022-W35)。
文摘The research and development of new traditional Chinese medicine(TCM)drugs have progressively established a novel system founded on the integration of TCM theory,human experience,and clinical trials(termed the“Three Combinations”).However,considering TCM's distinctive features of“syndrome differentiation and treatment”and“multicomponent formulations and complex mechanisms”,current TCM drug development faces challenges such as insufficient understanding of the material basis and the overall mechanism of action and an incomplete evidence chain system.Moreover,significant obstacles persist in gathering human experience data,evaluating clinical efficacy,and controlling the quality of active ingredients,which impede the innovation process in TCM drug development.Network pharmacology,centered on the“network targets”theory,transcends the limitations of the conventional“single target”reductionist research model.It emphasizes the comprehensive effects of disease or syndrome biological networks as targets to elucidate the overall regulatory mechanism of TCM prescriptions.This approach aligns with the holistic perspective of TCM,offering a novel method consistent with TCM's holistic view for investigating the complex mechanisms of TCM and developing new TCM drugs.It is internationally recognized as a“next-generation drug research model”.To advance the research of new tools,methods,and standards for TCM evaluation and to overcome fundamental,critical,and cutting-edge technical challenges in TCM regulation,this consensus aims to explore the characteristics,progress,challenges,applicable pathways,and specific applications of network pharmacology as a new theory,method,and tool in TCM drug development.The goal is to enhance the quality of TCM drug research and development and accelerate the efficiency of developing new TCM products.
基金funded by the National Natural Science Foundation of China(grant number:82272956)Beijing Municipal Science&Technology(No.Z231100004823030).
文摘Primary liver cancer,often referred to as hepatocellular carcinoma(HCC),is the fourth most common malignant tumor and the second leading cause of cancer-related deaths in China[1].Each year,39.0%-53.6%of newly diagnosed liver cancer are identified at an advanced stage,marked by short survival and a refractory clinical condition[2].However,current guidelines for diagnosing and treating liver cancer broadly classify the advanced stage,advocating a singular strategy without considering individual patient treatment options.Therefore,it is urgent to establish a comprehensive and practical expert consensus specifically for China to enhance early diagnosis and treatment of liver cancer.Using the Delphi method,an expert team has,for the first time,refined the classification criteria for Chinese liver cancer patients and developed corresponding optimal treatment regimen recommendations[3].This consensus is intended to provide a more detailed,scientific,and reasonable reference basis for the selection of individualized diagnosis and treatment plans.
基金supported by the CAMS Innovation Fund for Medical Sciences(2023-I2M-C&T-B-016)lthe National High Level Hospital Clinical Research Funding(2022-PUMCH-C-048)l the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0520600).
文摘The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening systems have been established.It is of great significance to build a high-quality gastric cancerscreening system adaptive to China's national conditions.Due to the large number of people at risk ofgastric cancer and the uneven distribution of medical resources,it is still difficult for China to carry out anationwide gastroscopy screening program for gastric cancer.Gastric oral contrast ultrasonography(OCUS)is a promising,non-invasive tool for initial gastric cancer screening,offering a painless,radiationfreealternative.Based on two 2020 OCUS consensuses,this document analyzes national gastric cancerscreening strategies and challenges to elaborate on the necessity,feasibility,and current problems ofpreliminary ultrasound screening in China.It details the key aspects of OCUS,including indications,contraindications,operator requirements,contrast agent standards,and essential scanning protocols.Italso introduces the standardized ultrasound sections and the Stomach Ultrasound Report and Data System(Su-RADS)and proposes the relevant consensus opinions.After several rounds of discussions and voting byexperts from multiple societies,a total of 17 consensus opinions have been formed on OCUS as a preliminary screening technique for gastric cancer,with the aim of standardizing the popularization ofOCUS.In addition,the consensus calls for conducting nationwide multicenter prospective studies toimprove the level of evidence and provide big data support for the construction of a preliminary gastriccancer ultrasound screening system that is in line with China's national conditions.
基金supported by the Peking Union Medical College Hospital Central High-Level Hospital Clinical Research Fund(2022-PUMCH-B-130).
文摘Objective:To develop an expert consensus on subcutaneous injection for allergen-specific immunotherapy.Methods:Relevant domestic and international literature was reviewed,and nursing experts experienced in subcutaneous injection of allergen-specific immunotherapy were interviewed to form the initial draft of the consensus.A total of 85 experts from 42 hospitals nationwide were invited to participate the discussions.Through two rounds of expert consultations,adjustments,revisions,and improvements to the initial draft,an online meeting was held to form the final version of the consensus.The content approved by more than 75%of the expert group is retained.Results:The expert consensus includes operational standards for subcutaneous injection of allergen-specific immunotherapy,identification and management of adverse reactions,and health education.Conclusion:The consensus demonstrates strong scientific rigor and practicality,providing guidance for nursing practices in the field of clinical allergology.
文摘Over the past three decades,there has been increasing interest in miniaturized percutaneous nephrolithotomy(mPCNL)techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL(sPCNL).However,despite this growing acceptance and recognition of its benefits,unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks.In response to these challenges,an international panel comprising experts from the International Alliance of Urolithiasis(IAU)took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice.This endeavor involved conducting a systematic literature review to identify research gaps(RGs),which formed the foundation for developing a structured questionnaire survey.Subsequently,a two-round modified Delphi survey was implemented,culminating in a group meeting to generate final evidence-based comments.All 64 experts completed the second-round survey,resulting in a response rate of 100.0%.Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains,including general information(13 questions),preoperative work-up(13 questions),procedural tips and tricks(19 questions),and postoperative evaluation and follow-up(13 questions).Additionally,9 questions evaluated the experts’experience with PCNLs.Consensus was reached on 30 questions after the second-round survey,while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting.mPCNL,characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique,has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics.It offers several advantages over sPCNL including reduced bleeding,fewer requirements for nephrostomy tubes,decreased pain,and shorter hospital stays.The series of detailed techniques presented here serve as a comprehensive guide for urologists,aiming to improve their procedural understanding and optimize patient outcomes.
基金supported by the Nanyang Technological University Start-Up Grant(#022387‒00001).
文摘Objective:To establish consensus on Chinese Herbal Medicine(CHM)for rheumatoid arthritis(RA)among 21 Singaporean experts,this study addressed the lack of CHM clinical practice guidelines(CPGs)in Singapore.Despite advancements in RA therapies,the disease's progressive nature and high costs of novel treatments worsen disparities in management and outcomes.The initiative aimed to bridge this gap by developing expert-backed recommendations for CHM use in RA care.Methods:The group of experts conducted two rounds of Delphi surveys containing 29 items identified from a literature review.Consensus was defined as≥75%of votes in dichotomized ratings on a fivepoint ordinal scale for recognition.Items that did not reach consensus were discussed in a focus group with four selected experts.Results:Nineteen experts completed both rounds of Delphi surveys.A consensus was reached for 27 items,which encompassed Chinese medicine rationale,pattern differentiation,management,CHM prescription,and co-effectiveness with pharmacological therapy.Collective expert opinions were formed for the two remaining items.All items received a recognition score>3.5.Conclusions:The consensus derived from this study provides a foundation for CHM CPGs for RA in Singapore.However,the findings are limited by the demographic composition of the experts and the representativeness of the patient pool.
基金supported by grants from the National Natural Science Foundation of China(82270958)the Major Science and Technology Projects in Yunnan Province(202302AA310038)the National Key Clinical Specialty Development Project of Pediatric Dentistry Division of China(20230610)。
文摘With the growing emphasis on maternal and child oral health,the significance of managing oral health across preconception,pregnancy,and infancy stages has become increasingly apparent.Oral health challenges extend beyond affecting maternal wellbeing,exerting profound influences on fetal and neonatal oral development as well as immune system maturation.This expert consensus paper,developed using a modified Delphi method,reviews current research and provides recommendations on maternal and child oral health management.It underscores the critical role of comprehensive oral assessments prior to conception,diligent oral health management throughout pregnancy,and meticulous oral hygiene practices during infancy.Effective strategies should be seamlessly integrated across the life course,encompassing preconception oral assessments,systematic dental care during pregnancy,and routine infant oral hygiene.Collaborative efforts among pediatric dentists,maternal and child health workers,and obstetricians are crucial to improving outcomes and fostering clinical research,contributing to evidence-based health management strategies.
基金supported by the National Key R&D Program of China(2022YFC2504200)Chongqing Young and Middle-aged Medical Excellence Team ProjectJiangsu Province Key Research and Development Program(BE2022670)。
文摘Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health,function,and aesthetics,ensuring both patient satisfaction and long-term stability.Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues,especially in severe cases.Therefore,close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment,along with diligent patient compliance throughout the entire process,is crucial for achieving favorable treatment outcomes.Moreover,long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success.This expert consensus,informed by the latest clinical research and practical experience,addresses clinical considerations for orthodontic treatment of periodontal patients,delineating indications,objectives,procedures,and principles with the aim of providing clear and practical guidance for clinical practitioners.
基金supported by the National Natural Science Foundation of China(no. 82320108004)the Construction Engineering Special Fund of “Taishan Scholars” of Shandong Province (ts20190975)the National Clinical Key Specialty(Periodontology) Construction Project。
文摘Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture,primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography(CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis,differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
文摘Artificial intelligence(AI)is increasingly recognized as a transformative force in the field of solid organ transplantation.From enhancing donor-recipient matching to predicting clinical risks and tailoring immunosuppressive therapy,AI has the potential to improve both operational efficiency and patient outcomes.Despite these advancements,the perspectives of transplant professionals-those at the forefront of critical decision-making-remain insufficiently explored.To address this gap,this study utilizes a multi-round electronic Delphi approach to gather and analyses insights from global experts involved in organ transplantation.Participants are invited to complete structured surveys capturing demographic data,professional roles,institutional practices,and prior exposure to AI technologies.The survey also explores perceptions of AI’s potential benefits.Quantitative responses are analyzed using descriptive statistics,while open-ended qualitative responses undergo thematic analysis.Preliminary findings indicate a generally positive outlook on AI’s role in enhancing transplantation processes,particularly in areas such as donor matching and post-operative care.These mixed views reflect both optimism and caution among professionals tasked with integrating new technologies into high-stakes clinical workflows.By capturing a wide range of expert opinions,the findings will inform future policy development,regulatory considerations,and institutional readiness frameworks for the integration of AI into organ transplantation.
基金Supported by Key Project of the National Natural Science Foundation of China,No.81230031
文摘Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of < 6 mo. However, over the past three decades, an integrated treatment strategy of cytoreductive surgery(CRS) + hyperthermic intraperitoneal chemotherapy(HIPEC) has been developed by the pioneering oncologists, with proved efficacy and safety in selected patients. Supported by several lines of clinical evidence from phases Ⅰ, Ⅱ and Ⅲ clinical trials, CRS + HIPEC has been regarded as the standard treatment for selected patients with PC in many established cancer centers worldwide. In China, an expert consensus on CRS + HIPEC has been reached by the leading surgical and medical oncologists, under the framework of the China Anti-Cancer Association. This expert consensus has summarized the progress in PC clinical studies and systematically evaluated the CRS + HIPEC procedures in China as well as across the world, so as to lay the foundation for formulating PC treatment guidelines specific to the national conditions of China.
文摘Heat stroke(HS)is a fatal disease caused by thermal damage in the body,and it has a very high mortality rate.In 2015,the People’s Liberation Army Professional Committee of Critical Care Medicine published the first expert consensus on HS in China,Expert consensus on standardized diagnosis and treatment for heat stroke.With an increased understanding of HS and new issues that emerged during the HS treatment in China in recent years,the 2015 consensus no longer meet the requirements for HS prevention and treatment.It is necessary to update the consensus to include the latest research evidence and establish a new consensus that has broader coverage,is more practical and is more in line with China’s national conditions.This new expert consensus includes new concept of HS,recommendations for laboratory tests and auxiliary examinations,new understanding of diagnosis and differential diagnosis,On-site emergency treatment and In-hospital treatment,translocation of HS patients and prevention of HS.
文摘Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.
文摘Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.
文摘Thrombocytopenia is a common complication of critical care patients.The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia.Therefore,the Critical Care Medicine Committee of Chinese People’s Liberation Army(PLA)worked with Chinese Society of Laboratory Medicine,Chinese Medical Association to develop this consensus to provide guidance for clinical practice.The consensus includes five sections and 27 items:the definition of thrombocytopenia,etiology and pathophysiology,diagnosis and differential diagnosis,treatment and prevention.
