Erratum: Chinese expert consensus on imaging assessment of pancreatic ductal adenocarcinoma (PDAC) resectability

Biopsy has been used to diagnose thoracic diseases for more than a century. Percutaneous needle biopsy plays a crucial role in the diagnosis, staging, and treatment planning for tumors in the lungs, thoracic wall, hilum, and mediastinum. With the continuous improvement in imaging techniques, the range of clinical applications for percutaneous needle biopsy is also expanding. It has become important to improve Chinese professionals’ and technicians’ understanding of percutaneous transthoracic needle biopsy (PTNB) in order to standardize operating procedures and to strengthen perioperative management. However, there is currently no Chinese expert consensus that provides systematic standardization and guidance for PTNB in clinical practice. The Committee of Chinese Society of Interventional Oncology (CSIO) of the Chinese Anti‐Cancer Association (CACA) initiated a Chinese multidisciplinary expert consensus on PTNB. The consensus includes image‐guided methods, indications, contraindications, multidisciplinary team recommendations, biopsy procedures, daytime/outpatient biopsy, complications, pathological examination, and management of negative results.

Evaluation of pancreatic ductal adenocarcinoma (PDAC) resectability plays an important role in the workflow of diagnosis and treatment of PDAC including the decision of surgery or not, the selection of surgery methods, evaluation of the adopting of neoadjuvant therapy or not. Imaging examination is an important tool to evaluate the resectability of PDAC, and various imaging examination should be used rationally and appropriately. This expert consensus summarized and discussed the key issues in imaging assessment of the resectability of PDAC, such as the selection of examination methods, key points of imaging assessment, and the application of new technologies, in order to better serve and guide the diagnosis and treatment of PDAC patients.

Although there are still controversies over the efficiency and safety of minimally invasive radical surgery for pancreatic ductal adenocarcinoma (PDAC), most available studies have suggested a promising application of minimally invasive radical surgery. This consensus, referring to Chinese expert opinions and worldwide researches, aimed to discuss the related issues on minimally invasive radical surgery for PDAC to ensure the perioperative and oncological outcomes. Quality of evidence and strength of recommendations were evaluated based on the GRADE approach. The 15 recommendations covered 5 topics: oncological outcomes and patient safety of laparoscopic and robotic pancreatoduodenectomy, left-side pancreatectomy for PDAC, learning curve, safety of neoadjuvant therapy, and vascular resection in minimally invasive radical surgery for PDAC. This consensus gives reference and guidance to surgeons on the use of minimally invasive radical surgery for PDAC. Although this consensus is not sufficient to answer all the questions about minimally invasive radical surgery for PDAC, it represents the current consensus on the application of the techniques in the treatment of PDAC on the Chinese mainland.

Various types of minimally invasive pancreatic surgery have been carried out in the last decades with promising outcomes reported by early explorers. Nevertheless, there are still controversies on oncologic outcomes and safety in the use of minimally invasive radical surgery for pancreatic ductal adenocarcinoma (PDAC). This consensus, referring to Chinese expert opinions and worldwide researches, aimed to discuss the related issues on minimally invasive radical surgery for PDAC to ensure the perioperative and oncological outcomes. Quality of evidence and strength of recommendations were evaluated based on the GRADE approach. The 15 recommendations covered 5 topics: oncological outcomes and patient safety of laparoscopic and robotic pancreatoduodenectomy, left-side pancreatectomy for PDAC, learning curve, safety of neoadjuvant therapy, and vascular resection in minimally invasive radical surgery for PDAC. This consensus gives reference and guidance to surgeons on the use of minimally invasive radical surgery for PDAC. Although this consensus is not sufficient to answer all the questions about minimally invasive radical surgery for PDAC, it represents the current consensus on the application of the techniques in the treatment of PDAC on the Chinese mainland.

Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies in China. Most HCC patients are first diagnosed at an advanced stage, and systemic treatments are the mainstay of treatment. Summary: In recent years, immune checkpoint inhibitors have made a breakthrough in the systemic treatment of middle-advanced HCC, breaking the single therapeutic pattern of molecular-targeted agents. To better guide the clinical treatment for effective and safe use of immunotherapeutic drugs, the Chinese Association of Liver Cancer and Chinese Medical Doctor Association has gathered multidisciplinary experts and scholars in relevant fields to formulate the “Chinese Clinical Expert Consensus on Immunotherapy for Hepatocellular Carcinoma (2021)” based on current clinical studies and clinical medication experience for reference in China. Key Messages: The consensus contained 17 recommendations, including the preferred regimen for first- and second-line immunotherapy, evaluation and monitoring before/during/after treatment, management of complications, precautions for special patients, and potential population for immunotherapy.

In recent years, professional societies in China including the Chinese Medical Doctor Association Anorectal Branch have issued many clinical practice guidelines and expert consensus on constipation, which played a positive role in the standardization of diagnosis and surgical treatment of chronic constipation in China. However, the diagnosis and treatment of outlet obstructive constipation (OOC) remain controversial. OOC, the most common subtype of functional constipation, is featured by various clinical symptoms, complex pelvic floor anatomy, functional and psychological aspects. We need a gold standard supported by high-level clinical research evidence. To standardize the diagnosis and treatment process of OOC in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee, and jointly sponsored by Professional Committee on Anorectal Diseases of Chinese Society of Integrated Traditional Chinese and Western Medicine, Anorectal Disease Committee of Chinese Medical Women's Association and Chinese Constipation Medical Association, and the Chinese Journal of Gastrointestinal Surgery organized and summoned a Chinese expert taskforce to focus on OOC diagnosis, classification, examination, evaluation, and various treatments (e.g. diet modification, medication, biofeedback therapy, pelvic floor function training, psychological intervention, traditional Chinese medicine and surgical treatment). Based on the latest relevant evidence in China and abroad and experts' clinical experience, the taskforce produced the " Chinese expert consensus on the diagnosis and treatment of outlet obstructive constipation (2022 edition)" after rounds of discussion and revision. The aim is to help anorectal surgeons make clinical decisions, standardize the process of diagnosis and treatment, reduce complications and improve clinical efficacy in OOC.

Percutaneous endoscopic gastrostomy / jejunostomy (PEG/J) is a relatively safe and effective minimally invasive surgical approach to establish long-term enteral nutrition (EN) channels. Due to the good compliance and the reduced incidence of reflux and aspiration pneumonia, PEG/J is the preferred way for long-term EN and has been widely used in clinical applications. However, few technical guidelines or expert consensus guiding the clinical practice of PEG/J have been published. The formation of "Chinese expert consensus on clinical application of percutaneous endoscopic gastrostomy / jejunostomy (2024 edition)" is led by the Committee of Parenteral and Enteral Nutrition, Chinese Research Hospital Association. This consensus is based on the latest clinical evidence as well as the clinical experience of Chinese experts. This consensus is divided into PEG/J indications and contraindication, perioperative management, operational techniques, prevention, and treatment of related complications and other issues. All recommendations and their strengths were carried out by expert-voting method and presented as the basic framework of "Recommended Opinions (level of evidence and strength of recommendation) and Summary of Evidence". This consensus is registered on the International Practice Guide Registration Platform (IPGRP-2022CN329).

The publication of Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition) has widely accelerated the standardization and homogenization on the surgical treatment of adenocarcinoma of esophagogastric junction (AEG). In China, the surgical outcomes of AEG, the universality and practicability of this consensus has also been affirmed after the clinical practice during the past 5 years. Due to the persistent increasing incidence of AEG, the specificity on anatomic site, clinicopathological characteristics, molecular biological characteristics, AEG had been always the hotspot of many clinical trials and more clinical evidences had been published. However, its definition, classification, staging, surgical approach, resection pattern, extent of lymphadenectomy, and the digestive tract reconstruction etc. remain controversial. In light of the above, it is necessary to update the 2018 edition of consensus. The Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2024 edition) is generated based on the currently available and best clinical evidence, the latest global guidelines or consensuses, and the opinions from the Chinese expert panel. The present consensus focuses on the key points of surgical treatment and issues in dispute, and provides scientific recommendations. The goal of this expert consensus was to improve the homogeneity in understanding and practice between Chinese thoracic and gastrointestinal surgeons, and to further standardize surgical treatment of AEG. Those pending issues in this consensus need high-quality clinical research to further investigate.

Organ transplantation is the most effective treatment for end stage organ failure,and voluntary donation after citizen's death is the only source of transplanted organ in China.Clinically,transplantation organ protection technology plays a critical role in improving the quality of transplantation organs and the prognosis of recipients.On the basis of domestic and worldwide basic research and clinical practice and according to the Oxford evidence classification and GRADE system,the experts organized by Organ Transplantation Doctor Branch of Chinese Medical Doctor Association,Organ Transplantation Group in Surgery Branch of Chinese Medical Association and China Liver Transplant Registry Scientific Committee had compiled and published the Chinese Expert Consensus on Organ Protection of Transplantation(2016 edition) for liver,kidney,pancreas,small intestine,heart,lung transplantation organs.With the support of China Liver Transplant Registry,National Center for Healthcare Quality Management in Liver Transplant,National Quality Control Center for Donated Organ Procurement,National Clinical Research Center for Orthopedics & Sports Medicine & Rehabilitation and National Trauma Medical Organ Protection Committee and combined with recent domestic and worldwide clinical practice and research progress for organ transplantation and organ protection,the Chinese Expert Consensus on Organ Protection of Transplantation(2022 edition)(hereinafter referred to as the consensus) has been formulated in 2022.This edition of the consensus focuses on updating the technical progress and evidence-based medicine of organ procurement,organ preservation,organ transport,and quality evaluation in clinical practice.Additionally,protection of composite tissue for transplantation,mainly including limb graft,has also been included.The organ protection strategy recommended in this consensus aims to promote scientific and standardize clinical organ transplantation work.

Epidural steroid injection (ESI), the injection of local anesthetics or glucocorticoids (GCS) into the epidural space, is the most commonly performed procedure for the treatment of spinal pain worldwide. The epidural approach is most often used to optimize the local, anti-inflammatory effects of corticosteroid at the nerve root level. An additional warning emphasized that epidural injections of steroids may cause spinal cord infarction, paraplegia, quadriplegia, cortical blindness and stroke, spoken by USA Food and Drug Administration in 2014 for ESI. Application of glucocorticoids in minimally invasive interventional treatment for pain (Chinese expert consensus) also suggested that this procedure should be done by trained physicians. This paper summarized the literatures in order to interpret the Chinese expert consensus about the untoward effects and its prevention during the manipulation of ESI in detail. Key words: Glucocorticoids; Injections, epidural; Adverse reaction

Immune checkpoint inhibitors (ICIs) have emerged as crucial therapeutic agents for various malignancies by activating the host immune system against tumor cells. However, many different types of skin adverse reactions may occur during its use, including eruption, pruritus, blistering, hypopigmentation, alopecia, and even severe cases, Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). These cutaneous immune-related adverse events (cirAEs) had a high incidence, which seriously affected patients' quality of life and antitumor treatment decisions. Some severe cutaneous adverse reactions (SCARs) even endanger patients' lives. Therefore, the Chinese Society of Dermatology, the Chinese Dermatologist Association of the Chinese Medical Doctor Association, the Dermatology Division of the Chinese Geriatrics Society, and other relevant experts jointly discussed and formulated the 'Chinese Expert Consensus on the Diagnosis and Treatment of Immune Checkpoint Inhibitor-Related Cutaneous Adverse Reactions'. This consensus covers the name, epidemiology, pathogenesis, clinical features, classification and grading of cirAEs, principles of management and the re-initiation of ICIs. It aims to provide a more scientific and authoritative reference for the diagnosis and treatment of cirAEs in China in the future.

China has stepped into an aging society. Hypertension is an independent risk factor of cardio-cerebrovascular diseases and related to mortality and disability of the elderly. Compared to middle-aged and young patients with similar blood pressure elevation, the risks of cardiovascular and cerebrovascular events significantly increase in the elderly. Since the Chinese expert consensus on the diagnosis and treatment of hypertension in the elderly(2008, 2011 version) were published, many guidelines have been accordingly updated, which further improved the prevention and control strategy of hypertension. In this article, Chinese expert consensus on the diagnosis and treatment of hypertension in the elderly(2017) is revised as to facilitate the prevention and treatment of hypertension in Chinese elderly. The consensus is composed of eight parts, including definition, epidemiology, characteristics, evidence, treatment objectives and measurements of elderly hypertension. The purpose of the consensus is to provide guidance for management of elderly hypertensive patients.

Chinese Expert Consensus on Enhanced Recovery After Hepatectomy (Version 2017)

D-dimer is a degradation product deriving from the plasmin-mediated degradation of cross-linked fibrin. It serves as a biomarker for the activation of coagulation and fibrinolysis, and has been extensively utilized in the diagnosis and treatment of various diseases. However, in recent years, issues related to D-dimer laboratory testing and its clinical application have become increasingly prominent. The lack of standardization in reports has led to confusion in both laboratory testing and clinical application. To address this, the Chinese Society on Thrombosis and Hemostasis brought together experts in the field of thrombosis and hemostasis in China to discuss and develop the 'Chinese Expert Consensus on D-Dimer Laboratory Testing and Clinical Application'. This consensus focuses on laboratory testing methods, quality requirements, performance evaluation, sample processing, analysis interference, result reports, and clinical application of D-dimer. Its aim is to optimize the key issues related to D-dimer testing in laboratories and provide guidance for the appropriate use and accurate interpretation of D-dimer in clinical settings.

With the significant increase in the use of extracorporeal membrane oxygenation in patients with severe respiratory failure, cardiogenic shock, and cardiopulmonary resuscitation, complications related to extracorporeal membrane oxygenation are increasingly being taken seriously. Cerebral injury is one of the most serious complications during extracorporeal membrane oxygenation treatment, and is an important factor affecting the hospital mortality rate and long-term quality of life. Due to the use of analgesics, sedatives, and muscle relaxants interfering with neurological physical examination results, cerebral injury that occurs during extracorporeal membrane oxygenation therapy is not easily detected in a timely manner. Therefore, bedside cerebral monitoring has important value in quickly detecting cerebral injury in patients with extracorporeal membrane oxygenation and providing early intervention guidance. Therefore, Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association organized relevant experts across the country to develop the"Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation", this expert consensus is based on the pathological and physiological mechanisms of cerebral injury in patients with extracorporeal membrane oxygenation. It is based on the current application status of cerebral monitoring technologies such as neurological physical examination, plasma brain injury biomarkers, brain imaging, intracranial pressure, cerebral blood flow, brain oxygen, electroencephalogram, and somatosensory evoked potential. Combining the special clinical application scenarios of extracorporeal membrane oxygenation and integrating the latest evidence-based medical evidence, we have formed 15 consensus recommendations which can be referenced by professionals in critical care medicine, neurology, cardiovascular disease, respiratory and critical care, emergency medicine, and other fields. Given the particularity, complexity, and individual differences of critically ill patients, the recommendations formed by this expert consensus need to implement personalized strategies.