Chinese Experts Research Articles

Chinese Expert Consensus on ovarian function and fertility preservation of cervical cancer in pregnancy (2023).

Cervical cancer in pregnancy (CCIP) refers to cervical cancer diagnosed during pregnancy, the most common gynecological malignant tumor. Because of the special physiological changes of CCIP, although preserving ovarian function and fertility is very important, the methods are very limited. There is no guideline or consensus on the preservation methods of ovarian function and fertility in this special period. Therefore, the Committee of Fertility Protection and Preservation of China Association for the Promotion of Health Science and Technology, combined with the Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology, Society Endocrinology Branch of Beijing Institute of Obstetrics & Gynecology, combined with Society on Fertility Preservation affiliated with the Chinese Preventive Medicine Association, organized relevant experts from different disciplines to formulate this consensus, in order to guide ovarian function and fertility preservation of CCIP patients.

Chinese expert consensus on multidisciplinary discussion of interstitial lung disease

Interstitial lung disease (ILD) is a group of heterogeneous diseases characterized by interstitial lung inflammation and fibrosis. Its causes are diverse, symptoms can be non-specific, and the associated imaging and pathologic patterns can vary widely. The diagnosis and management of these conditions often require input from multiple medical disciplines. Over the past few decades, the importance of multidisciplinary discussion (MDD) in the management of ILD has grown internationally, and MDD has gradually become a part of the gold standard for ILD diagnosis and an essential reference for disease management. Recognizing this, the Chinese Medical Association-Chinese Thoracic Society and the Chinese Association of Chest Physicians have collaborated with experts to standardize the ILD-MDD process in China.Key recommendations:1. Formation of teams: ILD centers should establish multidisciplinary teams (MDT) and integrate MDD into the ILD patient care process. (strong recommendation)2. Patient preparation: Prior to ILD-MDD, patients should undergo as thorough an ILD assessment as possible, including medical history, diagnostic tests, and functional evaluations. (strong recommendation)3. MDD frequency & logistics:(1) The frequency, duration and number of cases to be discussed in ILD-MDD should be based on the clinical needs of each center, but should be held at least monthly. (2) Consistent timing and location of ILD-MDD is recommended to improve attendance. (medium recommendation)4. Team composition: The MDT should include experts from a range of disciplines with experience of ILD. These should include specialists in Pulmonary and Critical Care Medicine, Radiology, and Pathology. Where appropriate, experts in Rheumatology, Hematology, Thoracic Surgery, and Respiratory Care and Rehabilitation should also be involved. (strong recommendation)5. Case presentation & goals:(1) The physician in charge should present clinical information, preferably using standardized slides. Real-time imaging and pathology data are encouraged. (2) The primary goals of ILD-MDD discussions should be disease diagnosis and management. (strong recommendation)6. Operational leadership: Assign a dedicated professional to manage the ILD-MDD operations and maintain the information discussed. (strong recommendation)7. Specific conditions:(1) Suspected idiopathic pulmonary fibrosis should be diagnosed by a standardized MDD process. (2) Suspected idiopathic interstitial pneumonia (IIP) should be classified by MDD. If IIP is indicated by imaging or pathology, prioritize identifying potential underlying causes such as connective tissue diseases (CTDs), certain medications, or aspiration.(3) Suspected hypersensitivity pneumonitis should also be diagnosed by MDD. (4) If an ILD patient shows signs suggestive of CTDs, the diagnosis should be made by ILD-MDD with the involvement of rheumatologists. (strong recommendation)8. Unclassifiable ILD: For ILD patients who cannot be clearly classified, create a tailored management plan based on the patient's specific disease features. (strong recommendation)9. Progressive pulmonary fibrosis: Use ILD-MDD to determine whether an ILD patient meets the criteria for progressive pulmonary fibrosis and to discuss a personalized care plan. (strong recommendation).

Chinese expert consensus on treatment of malignant pleural effusion (2023 Edition)

Malignant pleural effusion (MPE) is a pleural effusion that is caused by a malignant tumor originating in the pleura or by a metastatic malignant tumor from another site that has invaded the pleura. MPE is associated with poor prognosis. Members of the Pleural and Mediastinal Diseases Working Group (preparatory) of Chinese Thoracic Society and some external experts selected clinical issues related to the management of MPE and conducted rigorous evidence retrieval and evaluation. After several meetings and revisions of the manuscript, recommendations were made. This consensus applies to patients aged≥18 years old with MPE caused by various malignancies except for pleural mesothelioma. It included four chapters: pathogenesis of MPE, prognostic evaluation of MPE, local thoracic treatment, and systemic anticancer therapy for MPE.The main recommendations of this consensus are as follows:1. Prognosis evaluation of MPE was valuable in formulating treatment options. It is suggested to comprehensively evaluate the patient's prognosis by combining the patient's performance status, tumor type, and laboratory examination.2. It is recommended that in patients with symptomatic MPE, therapeutic thoracentesis could be used as the initial therapeutic option. Evaluate whether the lung is expandable after thoracentesis and drainage, and then develop a therapeutic regimen.3. In patients with MPE and known expandable or nonexpandable lung, an indwelling pleural catheter (IPC) is recommended as a first-line pleural management. Daily IPC drainages are recommended. In patients with MPE and expandable lung, talc pleurodesis by talc poudrage or talc slurry is recommended if the drug is accessible. Other pleurodesis agents include povidone iodine, bleomycin, and doxycycline.4. After drainage, it is suggested to consider the option of intrapleural use of recombinant human endostatin or bevacizumab alone or in combination with intrapleural chemotherapy. Intrapleural intervention including electrocautery, argon knife, cryotherapy, laser and radiofrequency ablation, is recommended for use in patients who have undergone rigorous evaluation in eligible hospitals. The use of intrapleural urokinase or streptokinase via pleural catheter is recommended for patients with symptomatic MPE and loculated effusion.5. For patients with good performance status and metastatic malignancies, systemic anti-cancer treatment is recommended as standard of care.

Intercultural dialogue and the mobilisation of aural skills

ABSTRACTA model for incorporating diverse musical content into the core conservatory aural skills curriculum is presented. We position the contemporary conservatory as a solid institution providing Western musicians with a sense of stability and heritage in an age of anxiety (Bauman’s ‘liquid modernity’). Despite these benefits, we argue that the conservatory education leaves graduates ill-equipped for the society in which they will build their careers. We therefore advocate for diversification as a means of producing more versatile graduates. Two aural perception classroom workshops were led by a Chinese pipa expert. A range of Chinese notation systems were introduced, before students were led through interactive practical activities engaging these systems. Reflecting on the success of our workshops alongside student feedback, we conclude that intercultural musical experiences encourage students to critically examine their existing skillsets. Intercultural dialogue presents an opportunity to mobilise these skills and recognise their diverse potential.

Integrating China in the International Consortium for Personalized Medicine: A Position Paper on Personalized Medicine in Sustainable Healthcare

Introduction: Over the last decade, the emergence and spread of personalized medicine (PM) have defined a substantial revolution in healthcare. In principle, healthcare system sustainability is challenged by the investments required for research and development, as well as the adoption of PM techniques in routine clinical care. The “Integrating China in the International Consortium for Personalized Medicine” (IC2PerMed) EU-funded project aims to integrate China into the “International Consortium for Personalized Medicine” (ICPerMed). IC2PerMed aims to align the EU and China’s research agendas in this field to enable a swift development of approaches in the EU and China with strong leverage upon EU-Chinese collaborations. Methods: Within this project, we first mapped relevant policies on PM in both the EU and China, and then we involved European and Chinese experts in PM in workshops and Delphi surveys in order to identify relevant priorities for the implementation of PM in sustainable healthcare. Results: As a result of this process, we identified nine overarching priorities, each addressing specific aspects of the sustainability of healthcare systems and PM implementation, with the main goal of supporting policymakers in integrating PM approaches in the EU and China. Discussion/conclusion: The implementation of PM in health systems is appealing in terms of improved accuracy in diagnostics, treatment, and prevention of disease, as well as reduction of the side effects resulting from inefficient use of drugs. Research, development, and implementation of needed techniques require time and resources that can slow the adoption of PM in healthcare systems. The nine priorities we identified address some of the most critical points, trying to lay the foundations for a comprehensive approach.

Chinese expert consensus on the prevention and treatment of postoperative delirium of cardiovascular surgery

Postoperative delirium of cardiovascular surgery occurs in up to 26%-52% of patients after cardiovascular surgery and is associated with adverse outcomes, including increased hospital length of stay, higher cost of care, higher rates of readmission. The combination of multiple factors leads to postoperative delirium of cardiovascular surgery, including preoperative (previous psychiatric conditions and cognitive disfunction, cerebrovascular disease, age, cardiac insufficiency, and so on), intraoperative (duration of surgery>5 h, emergency surgery, anesthetic drugs, direct myocardial injury, and so on) and postoperative (pain, sleep disturbance, Deep sedation, duration of mechanical ventilation>72 h) risk factors. On the basis of the latest literature at home and abroad and the clinical experience of many experts, the Cardiac Critical Care Branch of China International Exchange and Promotive Association for Medical and Health sought to develop a consensus document"Chinese expert consensus on the prevention and treatment of postoperative delirium of cardiovascular surgery", in order to standardize the management of postoperative delirium of cardiovascular surgery and improve the prognosis of patients.

Expert consensus on emergency open wound irrigation

Wound irrigation is one of the most effective means to prevent open wound infection after injury. Wound irrigation can reduce the risk of wound infection and promote wound healing by removing the cell fragments, surface bacteria, dressings residues, residual foreign body and wound exudates loosely attached to the wound. The effect of wound irrigation mainly depends on the pressure of irrigation, the direction of fluid flow, the type of liquid, temperature and volume/amount of irrigation fluid. In response to the phenomenon that emergency open wounds are not irrigated in a standardized manner in China, the Posttraumatic Special Infections and Biting Injury Study Group of the Trauma Surgeons Branch of the Chinese Medical Doctor Association and the Animal Injury Treatment Branch of China Association for Disaster and Emergency Rescue Medicine organized domestic experts in the fields of emergency department and trauma treatment centers to collect the latest clinical evidence of emergency open wound irrigation, and wrote this consensus with reference to relevant guidelines, consensus and the clinical experience of Chinese experts. The consensus summarized the important factors affecting wound irrigation and put forward 10 recommendations to improve the knowledge and skills of trauma emergency medical personnel in wound irrigation.

Academic characteristics of contemporary famous traditional Chinese medicine experts and schools in treatment of chronic renal failure based on SrTO

According to the systematic review of text and opinion(SrTO) developed by the Joanna Briggs Institute(JBI), this study integrated the evidence of the medical cases, papers, medical experience, and other related research of famous experts and schools on the treatment of chronic renal failure in the field of traditional Chinese medicine(TCM) nephropathy, analyzed the academic characteristics and influencing factors from the aspects of the principle, method, recipe, and medicines, and explored the internal logic and law of inheritance and innovation in TCM nephropathy. A total of 36 famous TCM experts and 4 schools were included. The work areas are concentrated in North and South China. 94.0% of the famous TCM experts have experienced master-disciple teaching. 27.8% have studied TCM through family succession. 38.9% have been taught by multiple famous teachers. And 5.6% have not experienced master-disciple teaching. In terms of principle, method, recipe, and medicines, many innovations have been made, with 30.6% of famous TCM experts proposing new theories, 11.1% advocating staged treatment of chronic renal failure, and 47.2% summarizing the treatment methods. The formation of the academic thoughts of contemporary famous TCM experts and schools on the treatment of chronic renal failure is closely related to the learning mode, era, and work area. Contemporary famous TCM experts and schools have the academic characteristics of combining classical and clinical theories and paying more attention to TCM with western medicine supplemented. The field of TCM nephropathy has the characteristics of simultaneous inheritance and innovation. On the basis of inheriting the classical theories of TCM, it absorbs modern medical theories, combines clinical diagnosis with the syndrome and treatment law of contemporary diseases, and makes innovations in principle, method, recipe, and medicines, which has significant clinical efficacy in the treatment of chronic renal failure.

Chinese expert consensus on the rehabilitation treatment and nursing practice for stable coronary artery disease

Cardiac rehabilitation, with exercise training as the core component, has well-known benefits for stable coronary heart disease. This therapeutic approach is gradually gaining wide application in domestic clinical practice and is currently recommended by major guidelines at home and abroad. In recent years, more progress has been made in the technical specifications and nursing practice of rehabilitation treatment for coronary heart disease. This consensus is written by experts from the Professional Committee of Cardiopulmonary Prevention and Rehabilitation of the Chinese Rehabilitation Medical Association and the Cardiovascular Rehabilitation Committee of the Chinese Medical Association, with a view to further promoting the development of physical therapy and nursing practice for stable coronary heart disease in China.

Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases (2023 Edition).

Since the four working groups of the Chinese Society of Cardiology issued first expert consensus on coronary microvascular diseases (CMVD) in 2017, international consensus documents on CMVD have increased rapidly. Although some of these documents made preliminary recommendations for the diagnosis and treatment of CMVD, they did not provide classification of recommendations and levels of evidence. In order to summarize recent progress in the field of CMVD, standardize the methods and procedures of diagnosis and treatment, and identify the scientific questions for future research, the four working groups of the Chinese Society of Cardiology updated the 2017 version of the Chinese expert consensus on CMVD and adopted a series of measures to ensure the quality of this document. The current consensus has raised a new classification of CMVD, summarized new epidemiological findings for different types of CMVD, analyzed key pathological and molecular mechanisms, evaluated classical and novel diagnostic technologies, recommended diagnostic pathways and criteria, and therapeutic strategies and medications, for patients with CMVD. In view of the current progress and knowledge gaps of CMVD, future directions were proposed. It is hoped that this expert consensus will further expedite the research progress of CMVD in both basic and clinical scenarios.

Chinese expert consensus on the management of patients with hematologic malignancies infected with SARS-CoV-2.

In December 2022, the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) became dominant in China due to its high infectivity and lower mortality rate. The risk of critical illness and mortality among patients with hematologic malignancies who contracted SARS-CoV-2 was particularly high. The aim of this study was to draft a consensus to facilitate effective treatments for these patients based on the type and severity of the disease. Following the outbreak of the novel coronavirus in China, a steering committee consisting of experienced hematologists was formed by the Specialized Committee of Oncology and Microecology of the Chinese Anti-Cancer Association. The expert group drafted a consensus on the management and intervention measures for different types of hematologic malignancies based on the clinical characteristics of the Omicron variant of the SARS-CoV-2 infection, along with relevant guidelines and literature. The expert group drafted independent recommendations on several important aspects based on the epidemiology of the Omicron variant in China and the unique vulnerability of patients with hematologic malignancies. These included prophylactic vaccinations for those with hematologic malignancies, the use of plasma from blood donors who recovered from the novel coronavirus infection, the establishment of negative pressure wards, the use of steady-state mobilization of peripheral blood hematopoietic stem cells, the provision of psychological support for patients and medical staff, and a focus on maintaining a healthy intestinal microecology.

Chinese expert consensus on neoadjuvant therapy for hepatocellular carcinoma (2023 edition)

Recurrence of hepatocellular carcinoma (HCC) after surgery is a major factor affecting the efficacy of the treatment of patients. Neoadjuvant treatment is an effective therapeutic method to reduce postoperative recurrence and prolong patient survival. However,there is no generally accepted neoadjuvant treatment regimen that has been proven to be effective so far. Recently,with the progress in systemic antitumor therapies,represented by targeted molecular agents and immune checkpoint inhibitors,and the improvement in local regional therapies,these treatment approaches have shown promising efficacy and safety in the field of neoadjuvant treatment for HCC. Under the organizational leadership of Committee of Digestive Surgery of Chinese Research Hospital Association and Committee of Liver Cancer of Chinese Anti-Cancer Association,Alliance of Chinese Expert Consensus on Neoadjuvant Therapy for Hepatocellular Carcinoma has discussed and revised several times and finally formulated the Chinese expert consensus on neoadjuvant therapy for hepatocellular carcinoma (2023 edition). This consensus aimed to review the Chinese characteristics of the diagnosis and treatment of HCC,to provide specific guidance and suggestions for preoperative treatment strategies for HCC,and further promote the management of the clinical pathway for neoadjuvant treatment of HCC.

Chinese expert consensus statement on the clinical application of AFP/AFP-L3%/DCP using GALAD and GALAD-like algorithm in HCC.

Primary hepatocellular carcinoma (HCC) is one of the most prevalent world-wide malignancies. Half of the newly developed HCC occurs in China. Optimizing the strategies for high-risk surveillance and early diagnosis are pivotal for improving 5-year survival. Constructing the scientific non-invasive detection technologies feasible for medical and healthcare institutions is among the key routes for elevating the efficacies of HCC identification and follow-up. Based on the Chinese and international guidelines, expert consensus statements, literatures and evidence-based clinical practice experiences, this consensus statement puts forward the clinical implications, application subjects, detection techniques and results interpretations of the triple-biomarker (AFP, AFP-L3%, DCP) based GALAD, GALAD like models for liver cancer. The compile of this consensus statement aims to address and push the reasonable application of the triple-biomarker (AFP, AFP-L3%, DCP) detections thus to maximize the clinical benefits and help improving the high risk surveillance, early diagnosis and prognosis of HCC.

Chinese expert consensus on laparoscopic hepatic segmentectomy and subsegmentectomy navigated by augmented- and mixed-reality technology combined with indocyanine green fluorescence imaging

Abstract Augmented- and mixed-reality technologies have pioneered the realization of real-time fusion and interactive projection for laparoscopic surgeries. Indocyanine green fluorescence imaging technology has enabled anatomical, functional, and radical hepatectomy through tumor identification and localization of target hepatic segments, driving a transformative shift in the management of hepatic surgical diseases, moving away from traditional, empirical diagnostic and treatment approaches toward digital, intelligent ones. The Hepatic Surgery Group of the Surgery Branch of the Chinese Medical Association, Digital Medicine Branch of the Chinese Medical Association, Digital Intelligent Surgery Committee of the Chinese Society of Research Hospitals, and Liver Cancer Committee of the Chinese Medical Doctor Association organized the relevant experts in China to formulate this consensus. This consensus provides a comprehensive outline of the principles, advantages, processes, and key considerations associated with the application of augmented reality and mixed-reality technology combined with indocyanine green fluorescence imaging technology for hepatic segmental and subsegmental resection. The purpose is to streamline and standardize the application of these technologies.

Chinese expert consensus on the overall management of liver function in conversion therapy for liver cancer (2022 edition).

Chinese expert consensus on the overall management of liver function in conversion therapy for liver cancer (2022 edition).

Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)

Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the "Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.

Chinese expert consensus on the application of circulating tumor cell detection in the diagnosis and treatment of gastrointestinal neoplasms (2023 edition)

Circulating tumor cell (CTC), as a novel tumor marker, has the characteristics of non-invasive, dynamic monitoring and high accuracy, and provides precise molecular characteristics of tumors and helps understand the changes in tumor development. Therefore, CTC has important clinical value in the dynamic monitoring of tumor progression. In order to standardize and guide the application of CTC detection in the diagnosis and treatment of gastrointestinal neoplasms, Gastric Cancer Group of Oncology Branch of Chinese Medical Association, Colorectal Cancer Professional Committee of Chinese Medical Doctor Association, Colorectal Cancer Professional Committee of Chinese Anti-Cancer Association, Gastric Cancer Professional Committee of Chinese Anti-Cancer Association, Digestive Tract Polyp and Precancerous Lesion Professional Committee of Chinese Anti-Cancer Association, jointly convened some domestic experts to discuss and formulate the Chinese expert consensus on the application of circulating tumor cell detection in the diagnosis and treatment of gastrointestinal neoplasms (2023 edition). The consensus provides opinions on the detection technology and clinical application of CTC detection in the diagnosis and treatment of gastrointestinal neoplasms, including the prediction of tumor prognosis, the monitoring of tumor recurrence and metastasis, the evaluation of treatment response, and the additional diagnostic value, providing guidance for clinical application.

Understanding Chinese authoritative experts and their roles in China's COVID‐19 policy response process: A combined perspective of institutional and multiple‐streams framework

AbstractThis study is among the first to examine the defining characteristics of Chinese authoritative experts and their roles in crisis policy response by integrating both institutional and multiple‐streams framework. The study argues that the defining characteristics of authoritative experts in China include standing as role models for the public, being adaptively embedded into the policy‐making system, and usually engaging in policy process by becoming a member of a formal experts group. Authoritative experts can act as problem brokers in the problem stream, as policy advocates in the policy stream, and as legitimacy enhancers in politics stream, depending on the nature and dynamics of the crisis and the socio‐political context. The theoretical argument was based on and supported by empirical evidence from China's COVID‐19 policy response in the early stage.

Chinese Expert Consensus on the Clinical Practice of Non-small Cell Lung Cancer Fusion Gene Detection Based on RNA-based NGS

RNA-based next-generation sequencing (NGS) has been recommended as a method for detecting fusion genes in non-small cell lung cancer (NSCLC) according to clinical practice guidelines and expert consensus. The primary targetable alterations in NSCLC consist of gene mutations and fusions, making the detection of gene mutations and fusions indispensable for assessing the feasibility of targeted therapies. Currently, the integration of DNA-based NGS and RNA-based NGS allows for simultaneous detection of gene mutations and fusions and has been partially implemented in clinical practice. However, standardized guidelines and criteria for the significance, application scenarios, and quality control of RNA-based NGS in fusion gene detection are still lacking in China. This consensus aims to provide further clarity on the practical significance, application scenarios, and quality control measures of RNA-based NGS in fusion gene detection. Additionally, it offers guiding recommendations to facilitate the clinical implementation of RNA-based NGS in the diagnosis and treatment of NSCLC, ultimately maximizing the benefits for patients from fusion gene detection. .

Chinese experts' consensus guideline on preimplantation genetic testing of monogenic disorders.

Recent developments in molecular biological technologies and genetic diagnostic methods, accompanying with updates of relevant terminologies, have enabled the improvements of new strategies of preimplantation genetic testing for monogenic (single gene) disorders (PGT-M) to prevent the transmission of inherited diseases. However, there has been much in the way of published consensus on PGT-M. To properly regulate the application of PGT-M, Chinese experts in reproductive medicine and genetics have jointly developed this consensus statement. The consensus includes indications for patient selection, genetic and reproductive counseling, informed consent, diagnostic strategies, report generation, interpretation of results and patient follow-ups. This consensus statement serves to assist in establishment of evidence-based clinical and laboratory practices for PGT-M.