Chinese Expert Consensus Research Articles

Chinese expert consensus on home management of oral anticoagulants(2024 edition)

Oral anticoagulants are widely used in the home care of patients who require prevention and treatment of thromboembolic diseases. The irrational use of anticoagulants may cause thrombosis and hemorrhage. Currently, there are no national or international guidelines or consensus providing recommendations for home management of oral anticoagulants. Therefore, the Hospital Pharmacy Professional Committee of the Chinese Pharmaceutical Association organized domestic experts in the fields of clinical pharmacy, cardiovascular surgery, cardiovascular medicine, vascular surgery, respiratory medicine and laboratory science to sort out the relevant issues and compile the expert consensus on the home management of oral anticoagulants. The main contents of this consensus include pharmacological monitoring of oral anticoagulants, the process and precautions of carrying out home management of oral anticoagulants, and treatment of some special conditions during home management, with the aim of enhancing the safety and effectiveness of oral anticoagulants' usage and reducing the adverse events.

Chinese Expert Consensus on the Standardized Diagnosis and Treatment of Non‑small Cell Lung Cancer with EGFR Exon 20 Insertion Mutations (2024 Edition)

The standard clinical practice of managing the non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion (ex20ins) mutations was elaborated in Chinese expert consensus on non‑small cell lung cancer with EGFR exon 20 insertion mutations (2023 edition), and this rare subset has gradually attracted attention recently. With the deepening of treatment area exploration and the approval of new targeted drugs, there are more options for the diagnosis and treatment of EGFR ex20ins positive NSCLC patients. Therefore, based on the previous version of consensus, the expert panel has updated this consensus on the standardized clinical diagnosis and treatment of EGFR ex20ins mutation NSCLC through reference to literature and clinical data, and combined with the experts' own clinical experience. The updated recommendations includes disease congnition, testing methods, therapy and recent relevant clinical trials for NSCLC patients with EGFR ex20ins mutation, in order to provide better medication reference for clinical physicians. .

Erratum: Chinese expert consensus on day surgery management of lung cancer (2024 edition).

This corrects the article DOI: 10.3779/j.issn.1009-3419.2024.102.24.

Chinese expert consensus on off-label use of Tocilizumab in rheumatic diseases

The interleukin-6 (IL-6) pathway plays a crucial role in various rheumatic diseases. Tocilizumab, a biologic targeting IL-6 receptor, has been widely used in clinical practice, though it's officially approved in China for only three indications. To address clinical challenges associated with the off-label use of tocilizumab in treating rheumatic diseases, the Committee of Chinese Primary Health Care Foundation for Rheumatologists and Immunologists engaged multidisciplinary experts and highlight 12 related clinical issues. We aggregated the drug specifications, the guidelines for clinical management of rheumatic diseases and the evidence from clinical research. Recommendations were formed through voting with the consensus conference method incorporating the Oxford evidence-based medicine criteria to evaluate the strength of evidence and recommendations. We have formulated 10 recommendations for off-label use of tocilizumab related to giant cell arteritis, polymyalgia rheumatica, Takayasu arteritis, systemic sclerosis, adult-onset Still's disease, rheumatoid arthritis, and juvenile idiopathic arthritis. This consensus aims to provide references for the rational use of tocilizumab in clinical practice and enhance pharmacovigilance monitoring.

2024 Chinese Expert Consensus Guidelines on the Diagnosis and Treatment of Atrial Fibrillation in the Elderly, Endorsed by Geriatric Society of Chinese Medical Association (Cardiovascular Group) and Chinese Society of Geriatric Health Medicine (Cardiovascular Branch): Executive Summary.

The consensus guidelines of the Geriatric Society of Chinese Medical Association on the management of atrial fibrillation (AF) in the elderly was first published in 2011 and updated in 2016, with endorsement by Chinese Society of Geriatric Health Medicine. Since then, many important studies regarding the screening and treatment in the elderly population have been reported, necessitating this updated expert consensus guideline. The writing committee members comprehensively reviewed updated evidence pertaining to elderly patients with AF, and formulated this 2024 update. The highlighted issues focused on the following: screening for AF, geriatric comprehensive assessment, use of the Atrial fibrillation Better Care (ABC) pathway for the elderly patients, and special clinical settings related to elderly patients with AF. New recommendations addressing smart technology facilitated AF screening, ABC pathway based management, and optimal anticoagulation were developed, with a focus on the elderly.

Interpretation of Chinese Expert Consensus on the Diagnosis and Management Strategy of Patients with Statin Intolerance: A guiding file for helping to lipid management for Chinese population.

It is well-known that elevated low-density lipoprotein cholesterol (LDL-C) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD), statins are cornerstone drugs for the cause-based treatment of ASCVD, which has created a new era for ASCVD therapy. However, statin intolerance is not clinically uncommon, which there are several issues with confusion and misunderstandings. Hence, a file named Chinese Expert Consensus on the Diagnosis and Management Strategy of Patients With Statin Intolerance, like a navigator, has recently been published written by a team of experts from the Cardiovascular Metabolic Medicine Professional Committee, Expert Committee of the National Center for Cardiovascular Diseases aiming to enhance the standardized clinical application of statins and improve the prevention and clinical outcome. In this article, author briefly summarized the key points of above consensus in order to helping to comprehending the content of the consensus suggestions.

Chinese expert consensus on radiofrequency therapy for gastroesophageal reflux disease 2024

ObjectiveRadiofrequency (RF) therapy is a minimally invasive procedure used to treat gastroesophageal reflux disease (GERD). During the procedure, electrodes are meticulously inserted into the lower esophageal sphincter and cardiac muscle through a gastroscope. By applying heat at various layers and sites around the gastroesophageal junction, the treatment intends to augment the junction's pressure and reduce tissue compliance. This process may also desensitize the esophagus, thereby preventing reflux and relieving symptoms. RF therapy boasts a high success rate and a low risk of adverse effects, making it an increasingly popular choice. However, there is a lack of consensus regarding its indications, contraindications, and the evaluation processes for pre- and postoperative care. To enhance the precision of patient selection and the technical execution of RF therapy, it is imperative to consolidate and standardize its clinical application in China. This will ensure the therapy's safety and efficacy are optimized. MethodsBetween December 2022 and April 2024, a group of 25 Chinese endoscopists, each with experience in over 50 radiotherapy procedures, engaged in six rounds of consensus discussions. The discussions focused on several key aspects of the procedure. During these discussions, each item was put to a vote among the experts. A consensus was reached when an item received agreement from at least 80 ​% of the participants. ResultsThe expert group, comprising 25 specialists from 22 different institutions, had an average experience of over 50 RF procedures. These experts engaged in comprehensive discussions on a total of eight critical items, covering the full spectrum of the procedure, including indications, contraindications, basic working conditions and preparation, preoperative preparation, surgical process and technical skills, postoperative management, therapeutic effects, complications and prevention. The group successfully reached a consensus on all these items, ensuring a standardized approach to RF procedures. ConclusionThis consensus summarized and standardized the clinical application of anti-reflux RF therapy in China. Adoption of this consensus will improve the precision of patient selection and technical implementation, thereby enhancing the safety and effectiveness of anti-reflux radiofrequency therapy.

Chinese expert consensus on perioperative nutritional support for elderly surgical patients (2024)

The increasing aging population in China leads to an increase in the number of elderly patients undergoing surgical procedures. Elderly patients are characterized with conditions such as multiple comorbidities, high nutritional risk, frailty, decreased organ function, etc. Nutritional support is one of the most significant elements in the perioperative period of elderly surgical patients. Currently, there is a lack of guidelines or expert consensus on nutritional support. To promote the standardized development of clinical work in this field, the Geriatric Surgery Professional Committee of the Chinese Research Hospital Association gathered experts and formulated relevant recommendations for perioperative nutritional therapy for elderly surgical patients based on existing research evidence. This consensus included several parts: preoperative nutritional assessment, indications, goals, ingredients and approaches of perioperative nutritional support, nutritional complications and management, nutritional intervention for surgical complications, and nutritional follow-up. It is expected to provide valuable suggestions for standardizing nutritional support for elderly surgical patients.

Chinese expert consensus on the guidance of anti-tumor drugs for patients with tumor combined chronic kidney disease (2024 edition)

The incidence of malignant tumors has steadily increased year by year in China in recent decades. The emergence of innovative anti-cancer drugs has bolstered the prognosis of cancer patients, making it a chronic disease. Kidney injuries are frequent complications of cancer treatment clinically manifested as acute kidney injury (AKI), chronic kidney disease (CKD), proteinuria, and electrolyte disorders, etc. Although kidney injuries affect up to 50% of the patients, there is a lack of professional management guidance for anti-cancer drug dosage adjustment. The clinical pharmacology branch of the Chinese Medical Association has initiated the "Chinese expert consensus on the guidance of anti-tumor drugs for patients with tumor combined chronic kidney disease (2024 edition)". We unified national multidisciplinary experts to analyze clinical evidence with the Delphi method, and conducted expert interviews and seminars focusing on kidney function assessment, anti-tumor drug dosage adjustment for kidney disease patients. We make recommendations on selection and dose adjustment of anti-tumor drugs (chemotherapy, small molecules and antibodies) according to chemotherapeutic drug classifications, providing practical and feasible scientific guidance for clinicians.

Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition)

To alleviate the medical burden of lung cancer surgery and facilitate the implementation of the national hierarchical diagnosis and treatment policy, it is imperative to establish a hierarchical diagnosis and treatment system for day surgery of lung cancer. Identifying key quality control checkpoints in day surgery of lung cancer is essential to enhance medical quality, ensure safety, and improve the efficiency of medical services. These efforts aim to uphold a safe and well-structured progression of day surgery practices in China. The Chinese Expert Consensus Group on Day Surgery Management of Lung Cancer has convened national experts in relevant fields and integrated the latest research findings from both domestic and international sources to craft the Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition). This consensus is founded on the principles of holistic management of lung cancer surgery and comprehensive patient care throughout their medical journey. It encompasses preoperative assessments, anesthesia protocols, surgical procedures, postoperative care, hospital-community collaboration initiatives, and emergency response strategies. The primary objective of this expert consensus is to furnish research assistance and clinical recommendations to advance the practice of day surgery for lung cancer patients in China. .

Chinese expert consensus on implementation and management of brain-computer interface clinical research in neurological diseases

The development of brain-computer interface (BCI) technology and its preliminary research results show great clinical application prospects. In particular, the application of BCI technologyis a hot research topic in the field of nervous system diseases at present, but the current BCI technology is still in the stage of experimental exploration, needing systematic and standardized clinical research validation. For this purpose, the consensus is led by the Society of Neurosurgery of Chinese Medical Association and Society of Cerebrovascular Surgery of Chinese Stroke Association. Based on the in-depth discussion of multidisciplinary experts and the vote of the Delphi Method, the guidelines and principles are proposed for pre-clinical qualification review, clinical research implementation and management, and long-term effect tracking and evaluation, so as to standardize research ethics and clinical research procedures and further promote the extensive application and in-depth development of BCI technology in the treatment of nervous system diseases.

The role and responsibility of clinical neuroscience in brain-computer interface clinical research

Brain-computer interface (BCI) constructs the direct communication between human brain and external devices, which has been extensively applied in clinical research of the diagnosis and treatment of nervous system diseases, and plays a crucial role in functional evaluation, communication control, reconstruction, rehabilitation training, and neural regulation. This paper summarizes the different forms of BCI technology, the progress of clinical research on BCI for neurological diseases, and the importance of developing appropriate clinical trial standards and ethical norms. Further emphasis is placed on the interpretation of the scope of BCI clinical research in neurological diseases, the ethical principles of BCI clinical research in neurological diseases, and the key points of BCI clinical research implementation and management summarized in the Chinese expert Consensus on the implementation and management of BCI clinical research in Neurological diseases. Finally, the role and responsibility of clinical neuroscience in BCI clinical trials are put forward, emphasizing interdisciplinary cooperation in clinical research to better promote the clinical transformation of BCI technology.

Chinese expert consensus on the diagnosis and treatment of acute graft-versus-host disease after hematopoietic stem cell transplantation (2024)

Despite the continuous improvement in the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT), acute graft-versus-host disease (GVHD) remains a major complication and cause of death. In recent years, with the emergence of new drugs for the prevention and treatment of acute GVHD and the update of a series of clinical studies, there have been varying degrees of changes in the routine prevention and treatment regimens for acute GVHD. Based on the main research achievements and the accumulation of clinical experience in this field in recent years, this consensus further updates the "The Consensus on Allogeneic Hematopoietic Stem Cell Transplantation for Hematological Diseases in China-Acute Graft-Versus-Host Disease (2020) .

Chinese expert consensus on minimal residual disease detection in multiple myeloma based on bone marrow samples (2024)

Multiple myeloma (MM) is the second most common hematologic malignant tumor. Standard holistic treatment model and new drug-based regimens have greatly improved the survival of patients with MM; however, minimal residual disease (MRD) causes relapse in most patients. Therefore, combining MRD testing on the basis of traditional serological efficacy evaluation is necessary to achieve a more accurate assessment of the patient's disease status. At present, next-generation flow cytometry (NGF) and next-generation sequencing (NGS) are the mainstream technologies for detecting MRD based on bone marrow samples. To standardize and normalize MRD detection, the expert group discussed and formulated Chinese expert consensus on the application of NGF and NGS technology for bone marrow MRD detection in patients with MM.

Chinese expert consensus on the clinical applications of bronchial provocation test (2024 edition)

The bronchial provocation test (BPT) is an important clinical examination to detect airway hyperresponsiveness, primarily in diagnosing asthma with FEV1≥70% of predicted value, including typical asthma and atypical asthma such as cough variant asthma and chest tightness variant asthma. BPT is a valuable tool in differentiating asthma from other chronic airway diseases and assessing the efficacy of asthma treatment. Despite its clinical significance, BPT remains largely underused in clinical practice, primarily due to limited knowledge of its importance and inadequate availability of medical professionals, equipment and medications in primary care settings. In response to this gap, the China Asthma Group of Chinese Thoracic Society has drafted this expert consensus to enhance knowledge and application of BPT among clinical practitioners. This expert consensus specifically focuses on the classic direct provocation agent methacholine, covering general principles and classification of BPT; indications, contraindications, and clinical applications; result interpretation; analyzing potential reasons and coping strategies for false positive and false negative test results; and finally, providing safety precautions and emergency measures. The aim of this expert consensus is to promote the standardized application of BPT.

Chinese expert consensus on diagnosis and treatment of immune checkpoint inhibitor-related skin adverse reactions (2024 edition)

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.

Chinese expert consensus on the diagnosis and management of severe asthma (2024 edition)

Severe asthma is the main cause of disability and death in patients with asthma, with a high risk of future disease, but also caused serious social and economic burden. The pathophysiological mechanisms such as obvious heterogeneity of airway inflammation, severe airway remodeling, influence of genetic factors, decreased glucocorticoid responsiveness, and many factors affecting asthma control make the treatment of severe asthma particularly difficult. In recent years, with the deepening of the understanding of the pathogenesis of asthma, especially the development of biologics targeting type 2 inflammation, a new approach has been opened up for the treatment of patients with severe asthma. How to correctly diagnose and evaluate severe asthma patients and how to choose treatment are still the perplexity and challenge in clinical practice. This expert consensus is based on the "Chinese Expert Consensus on the Diagnosis and Management of Severe Asthma" published in 2017 and combined with the latest research progress at home and abroad, and is updated on the definition, pathogenesis, diagnosis and evaluation, and treatment of severe asthma, especially the treatment recommendation for type 2 inflammatory biologics, so as to provide reference for the individualized diagnosis and treatment of severe asthma.

Chinese expert consensus on surgical continuous quality improvement goals in esophageal cancer and esophagogastric junction cancer (2024 edition)

Improving the quality and efficiency of surgical diagnosis and treatment guarantees the outcome for most patients with esophageal cancer and esophagogastric junction cancer, and the continuous quality improvement mechanism oriented to the "textbook outcome" is the best choice. To ensure the successful implementation of the "Quality Control Indicators for Standardized Diagnosis and Treatment of Esophageal Cancer in China (2022 Version)" aligning with it more effectively is crucial. The Expert Committee on Quality Control of Esophageal Cancer at the National Cancer Center leads work teams comprised of multidisciplinary experts, particularly those in thoracic surgery, to establish a consensus. The current consensus comprises eight "textbook outcomes" to standardize, promote, and consolidate surgical quality management and continuously improve the surgical quality of esophageal cancer and esophagogastric junction cancer.

Chinese expert consensus on clinical practice of daytime hip arthroplasty

Daytime hip arthroplasty refers to a medical procedure where a patient undergoes admission, surgery, and discharge all within a single day (24 hours). The establishment of daytime hip arthroplasty centers signifies a significant paradigm shift in the development model of modern hospitals. While numerous nationally accredited large medical institutions are undertaking daytime hip arthroplasty in various forms and scales, there remains a lack of standardized system processes and criteria. In this context, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Bone and Joint Specialty Committee of the China Ambulatory Surgery Alliance, Joint Surgery Branch of the Chinese Orthopedic Association, and Osteoarthritis Study Group of the Chinese Association of Orthopedic Surgeons have collaboratively organized experts in the relevant field domestically. Leveraging international experiences in daytime hip arthroplasty and integrating them with the clinical practices of well-established medical institutions conducting daytime surgeries in China, they have arrived at consensus recommendations. These recommendations cover the establishment of daytime hip arthroplasty centers, policies, procedures, and perioperative management. The ultimate goal is to provide reference points and guidance for the standardized implementation of daytime hip arthroplasty.

Chinese expert consensus on diagnosis and treatment of high risk multiple myeloma (2024)

High-risk multiple myeloma (HRMM) refers to patients with multiple myeloma whose overall survival time is less than 2-3 years under current standardized diagnosis and treatment. By combining various static and dynamic prognostic factors, risk stratification is performed to identify HRMM patients early and treat patients with personalized strategies, with the aim of significantly improving adverse survival outcomes in HRMM patients. Although the clinical value of HRMM has reached a consensus domestically in recent years, there still exist confusions and ambiguities in the definition, high-risk factors, risk stratification, and treatment of HRMM, necessitating standardization. In order to enhance the diagnostic and treatment capabilities of Chinese physicians in HRMM, the Professional Committee of Hematologic Malignancies of the Chinese Anti-Cancer Association (CACA) and the Multiple Myeloma Expert Committee of the Chinese Society of Clinical Oncology (CSCO) have organized relevant experts to develop this consensus. This consensus aims to clarify the definition of HRMM, high-risk factors, and risk stratification system, and provide treatment recommendations for HRMM, thereby improving the quality of life and prognosis of Chinese HRMM patients.