Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

A review of public health guidelines for postpartum physical activity and sedentary behavior from around the world

Background:The period following pregnancy is a critical time window when future habits with respect to physical activity(PA) and sedentary behavior(SB) are established;therefore,it warrants guidance.The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide.Methods:To identity guidelines published since 2010,we performed a(a) systematic search of 4 databases(CINAHL,Global Health,PubMed,and SPORTDiscus),(b) structured repeatable web-based search separately for 194 countries,and(c) separate web-based search.Only the most recent guideline was included for each country.Results:We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines.The continents with guidelines included Europe(n=12),Asia(n=5),Oceania(n=2),Africa(n=1),North America(n=1),and South America(n=1).The most common benefits recorded for PA included weight control/management(n=10),reducing the risk of postpartum depression or depressive symptoms(n=9),and improving mood/well-being(n=8).Postpartum guidelines specified exercises to engage in,including pelvic floor exercises(n=17);muscle strengthening,weight training,or resistance exercises(n=13);aerobics/general aerobic activity(n=13);walking(n=11);cycling(n=9);and swimming(n=9).Eleven guidelines remarked on the interaction between PA and breastfeeding;several guidelines stated that PA did not impact breast milk quantity(n=7),breast milk quality(n=6),or infant growth(n=3).For SB,suggestions included limiting long-term sitting and interrupting sitting with PA.Conclusion:Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.

Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Impact of glucagon-like peptide receptor agonists on endoscopy and its preoperative management: Guidelines, challenges, and future directions

Glucagon-like peptide receptor agonists(GLP-1RA)are used to treat type 2 diabetes mellitus and,more recently,have garnered attention for their effect-iveness in promoting weight loss.They have been associated with several gastrointestinal adverse effects,including nausea and vomiting.These side effects are presumed to be due to increased residual gastric contents.Given the potential risk of aspiration and based on limited data,the American Society of Anesthesi-ologists updated the guidelines concerning the preoperative management of patients on GLP-1RA in 2023.They included the duration of mandated cessation of GLP-1RA before sedation and usage of“full stomach”precautions if these medications were not appropriately held before the procedure.This has led to additional challenges,such as extended waiting time,higher costs,and increased risk for patients.In this editorial,we review the current societal guidelines,clinical practice,and future directions regarding the usage of GLP-1RA in patients undergoing an endoscopic procedure.

Fever assessment in children under five: Are we following the guidelines?

BACKGROUND Fever is a common cause of medical consultation and hospital admission,particularly among children.Recently,the United Kingdom’s National Institute for Health and Care Excellence(NICE)updated its guidelines for assessing fever in children under five years of age.The efficient assessment and management of children with fever are crucial for improving patient outcomes.AIM To evaluate fever assessment in hospitalized children and to assess its adherence with the NICE Fever in under 5s guideline.METHODS We conducted a retrospective cohort review of the electronic medical records of children under five years of age at the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between June and July 2023.Demographic data,vital signs during the first 48 h of admission,route of temperature measurement,and indications for admission were gathered.Fever was defined according to the NICE guideline.The children were divided into five groups according to their age(0-3 months,>3-6 months,>6-12 months,>12-36 months,and>36-60 months).Patients with and without fever were compared in terms of demography,indication for admission,route of temperature measurement,and other vital signs.Compliance with the NICE Fever in the under 5s guideline was assessed.Full compliance was defined as>95%,partial compliance as 70%-95%,and minimal compliance as≤69%.Pearson’sχ^(2),Student’s t test,the Mann-Whitney U test,and Spearman’s correlation coefficient(rs)were used for comparison.RESULTS Of the 136 patients reviewed,80(58.8%)were boys.The median age at admission was 14.2[interquartile range(IQR):1.7-44.4]months,with the most common age group being 36-60 months.Thirty-six(26.4%)patients had fever,and 100(73.6%)were afebrile.The commonest age group for febrile patients(>12-36 months)was older than the commonest age group for afebrile patients(0-3 months)(P=0.027).The median weight was 8.3(IQR:4.0-13.3)kg.Patients with fever had higher weight than those without fever[10.2(IQR:7.3-13.0)vs 7.1(IQR:3.8-13.3)kg,respectively](P=0.034).Gastrointestinal disease was the leading indication for hospital admission(n=47,34.6%).Patients with central nervous system diseases and fever of unknown etiology were more likely to be febrile(P=0.030 and P=0.011,respectively).The mean heart rate was higher in the febrile group than the afebrile group(140±24 vs 126±20 beats per minute,respectively)[P=0.001(confidence interval:5.8-21.9)]with a positive correlation between body temperature and heart rate,r=0.242,n=136,P=0.004.A higher proportion of febrile patients received paracetamol(n=35,81.3%)compared to the afebrile patients(n=8,18.6%)(P<0.001).The axillary route was the most commonly used for temperature measurements(n=40/42,95.2%),followed by the rectal route(n=2/42,4.8%).The department demonstrated full compliance with the NICE guideline for five criteria:the type of thermometer used,route and frequency of temperature measurement,frequency of heart rate measurement,and use of antipyretics as needed.Partial compliance was noted for two criteria,the threshold of fever at 38°C or more,and the respiratory rate assessment in febrile patients.Minimal compliance or no record was observed for the remaining three criteria;routine assessment of capillary refill,temperature reassessment 1-2 h after each antipyretic intake,and refraining from the use of tepid sponging.CONCLUSION This study showed that fever assessment in hospitalized children under five years of age was appropriate,but certain areas of adherence to the NICE guideline still need to be improved.

International experts consensus guidelines on robotic liver resection in 2023

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.

Associations between meeting 24-hour movement guidelines and quality of life among children and adolescents with autism spectrum disorder

Background:The Canadian 24-hour movement behavior(24-HMB)guidelines suggest that a limited amount of screen time use,an adequate level of physical activity(PA),and sufficient sleep duration are beneficial for ensuring and optimizing the health and quality of life(QoL)of children and adolescents.However,this topic has yet to be examined for children and adolescents with autism spectrum disorder(ASD)specifically.The aim of this cross-sectional observational study was to examine the associations between meeting 24-HMB guidelines and several QoLrelated indicators among a national sample of American children and adolescents with ASD.Methods:Data were taken from the 2020 U.S.National Survey of Children’s Health dataset.Participants(n=956)aged 617 years and currently diagnosed with ASD were included.The exposure of interest was adherence to the 24-HMB guidelines.Outcomes were QoL indicators,including learning interest/curiosity,repeating grades,adaptive ability,victimization by bullying,and behavioral problems.Categorical variables were described with unweighted sample counts and weighted percentages.Age,sex,race,preterm birth status,medication,behavioral treatment,household poverty level,and the educational level of the primary caregivers were included as covariates.Odds ratio(OR)and 95%confidence interval(95%CI)were used to present the strength of association between adherence to 24-HMB guidelines and QoL-related indicators.Results:Overall,452 participants(45.34%)met 1 of the 3 recommendations,216(22.65%)met 2 recommendations,whereas only 39 participants(5.04%)met all 3 recommendations.Compared with meeting none of the recommendations,meeting both sleep duration and PA recommendations(OR=3.92,95%CI:1.639.48,p<0.001)or all 3 recommendations(OR=2.11,95%CI:1.034.35,p=0.04)was associated with higher odds of showing learning interest/curiosity.Meeting both screen time and PA recommendations(OR=0.15,95%CI:0.040.61,p<0.05)or both sleep duration and PA recommendations(OR=0.24,95%CI:0.070.87,p<0.05)was associated with lower odds of repeating any grades.With respect to adaptive ability,participants who met only the PA recommendation of the 24-HMB were less likely to have difficulties dressing or bathing(OR=0.11,95%CI:0.020.66,p<0.05)than those who did not.For participants who met all 3 recommendations(OR=0.38,95%CI:0.150.99,p=0.05),the odds of being victimized by bullying was lower.Participants who adhered to both sleep duration and PA recommendations were less likely to present with severe behavioral problems(OR=0.17,95%CI:0.040.71,p<0.05)than those who did not meet those guidelines.Conclusion:Significant associations were found between adhering to 24-HMB guidelines and selected QoL indicators.These findings highlight the importance of maintaining a healthy lifestyle as a key factor in promoting and preserving the QoL of children with ASD.

Evidence-based guidelines for greener,healthier,more resilient neighbourhoods:Introducing the 3–30–300 rule

The important contributions of urban trees and green spaces to for example,climate moderation and public health have been recognized.This paper discusses guidelines and norms that promote the benefi ts of viewing green,living amongst green,and having easy access to green spaces for recreational use.Having trees and other vegetation in sight from one’s home,place of work,or school has important mental health and performance benefi ts.Local tree canopy cover is positively associated with cooling and other aspects of climate moderation.With public green spaces in proximity to one’s home stimulates regular use of these areas and results in positive impacts on mental,physical,and social health.After analyzing existing guidelines and rules for urban green space planning and provision,a new,comprehensive guideline is presented,known as the‘3–30–300 rule’for urban forestry.This guideline aims to provide equitable access to trees and green spaces and their benefi ts by setting the thresholds of having at least 3 well-established trees in view from every home,school,and place of work,no less than a 30%tree canopy in every neighbourhood;and no more than 300 m to the nearest public green space from every residence.Current implementation of this new guideline is discussed,as well as the advantages and disadvantages of using this evidence-based but also clear and simple rules.

Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

AIM:To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis,treatment,and best practices of diabetic macular edema(DME).The experts'panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula.The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load.METHODS:On two different occasions,a panel of 14 retinal specialists from Malaysia,together with an external expert,responded to a questionnaire on management of DME.A consensus was sought by voting after compiling,analyzing and discussion on first-phase replies on the round table discussion.A recommendation was deemed to have attained consensus when 12 out of the 14 panellists(85%)agreed with it.RESULTS:The terms target response,adequate response,nonresponse,and inadequate response were developed when the DME patients'treatment responses were first characterized.The panelists reached agreement on a number of DME treatment-related issues,including the need to classify patients prior to treatment,firstline treatment options,the right time to switch between treatment modalities,and side effects associated with steroids.From this agreement,recommendations were derived and a treatment algorithm was created.CONCLUSION:A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.

博物馆手册类文本汉译策略——以Guidelines for Disaster Preparedness in Museums为例

博物馆安全是博物馆工作的重中之重,博物馆的安全为保障博物馆正常运转发挥重要作用。自2019年新冠肺炎疫情暴发以来,博物馆面临的安全形势十分严峻,主要表现为应急措施匮乏、灾害防范不到位以及管理体制不完善等问题。这给全球博物馆的发展带来了新的安全挑战,为博物馆安全提出了更高的要求,如何预防与应对博物馆突发事件成为博物馆安全的重要任务。该文选取了一篇国际博物馆协会官方发布的国际通用手册Guidelines for Disaster Preparedness in Museums为研究对象,从词汇、句法及篇章三个方面分析博物馆手册类文本的特点,归纳三种翻译策略,以期促进我国博物馆健康发展,为博物馆手册文本的翻译研究贡献绵薄之力。

Revitalizing case reports: Standardized guidelines and mentorship

Despite a decrease in publication,case reports remain essential in medical literature as they offer detailed descriptions of individual patient cases and valuable insights for future management.These reports adhere to a standardized structure comprising sections such as abstract,introduction,case report,discussion,and conclusion.Obtaining informed consent and adhering to guidelines is essential.Case reports contribute to evidence-based medicine by detecting new therapies and adverse events.They also facilitate clear reporting,guideline adherence,and mentorship programs.These reports are vital for documenting rare occurrences,assisting clinicians in timely management,and communicating novel information to busy medical professionals.Following case report guidelines ensures comprehensive and standardized reporting,enhancing the acceptance and quality of case reports,and advancing medical knowledge.

Accuracy Assessment and Guidelines for Manual Traffic Counts from Pre-Recorded Video Data

Traffic count is the fundamental data source for transportation planning, management, design, and effectiveness evaluation. Recording traffic flow and counting from the recorded videos are increasingly used due to convenience, high accuracy, and cost-effectiveness. Manual counting from pre-recorded video footage can be prone to inconsistencies and errors, leading to inaccurate counts. Besides, there are no standard guidelines for collecting video data and conducting manual counts from the recorded videos. This paper aims to comprehensively assess the accuracy of manual counts from pre-recorded videos and introduces guidelines for efficiently collecting video data and conducting manual counts by trained individuals. The accuracy assessment of the manual counts was conducted based on repeated counts, and the guidelines were provided from the experience of conducting a traffic survey on forty strip mall access points in Baton Rouge, Louisiana, USA. The percentage of total error, classification error, and interval error were found to be 1.05 percent, 1.08 percent, and 1.29 percent, respectively. Besides, the percent root mean square errors (RMSE) were found to be 1.13 percent, 1.21 percent, and 1.48 percent, respectively. Guidelines were provided for selecting survey sites, instruments and timeframe, fieldwork, and manual counts for an efficient traffic data collection survey.

Real-world 10-year retrospective study of the guidelines for diagnosis and treatment of primary liver cancer in China

BACKGROUND Hepatocellular carcinoma(HCC) is a common malignant tumor worldwide. Many regions across the world have issued various HCC diagnosis and treatment protocols to improve the diagnosis and targeted treatment of patients with HCC. However, real-world studies analysing the practice, application value, and existing problems of the China Liver Cancer(CNLC) staging system are scarce.AIM To analyze the current situation and problems associated with the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China.METHODS We collected the medical records of all patients with HCC admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2011 to December 31, 2019, and recorded the hospitalization information of those patients until December 31, 2020. All information on the diagnosis and treatment of the target patients was recorded, and their demographic and sociological characteristics, CNLC stages, screening situations, and treatment methods and effects were analyzed. The survival status of the patients was obtained from follow-up data.RESULTS This study included the medical records of 3022 patients with HCC. Among these cases, 304 patients were screened before HCC diagnosis;their early-stage diagnosis rate was 69.08%, which was significantly higher than that of patients with HCC who were diagnosed without screening and early detection(33.74%). Herein, patients with no clinical outcome at discharge were followed up, and the survival information of 1128 patients was obtained. A Cox model was used to analyse independent risk factors affecting overall survival, which were revealed as age > 50 years, no screening, alpha-fetoprotein > 400 ng/mL, Child–Pugh grade B, and middle and late CNLC stages. Based on the Cox model survival analysis, in our study, patients with HCC identified via screening had significant advantages in overall and tumorfree survival after hepatectomy.CONCLUSION Early diagnosis and treatment can be achieved by screening groups at high risk for HCC based on the guidelines;however, real-world compliance is poor.

Guidelines for the application of artificial intelligence in the diagnosis of anterior segment diseases(2023)

The landscape of ophthalmology has obser ved monumental shifts with the advent of artificial intelligence(AI)technologies.This article is devoted to elaborating on the nuanced application of AI in the diagnostic realm of anterior segment eye diseases,an area ripe with potential yet complex in its imaging characteristics.Historically,AI’s entrenchment in ophthalmology was predominantly rooted in the posterior segment.However,the evolution of machine learning paradigms,particularly with the advent of deep learning methodologies,has reframed the focus.When combined with the exponential surge in available electronic image data pertaining to the anterior segment,AI’s role in diagnosing corneal,conjunctival,lens,and eyelid pathologies has been solidified and has emerged from the realm of theoretical to practical.In light of this transformative potential,collaborations between the Ophthalmic Imaging and Intelligent Medicine Subcommittee of the China Medical Education Association and the Ophthalmology Committee of the International Translational Medicine Association have been instrumental.These eminent bodies mobilized a consortium of experts to dissect and assimilate advancements from both national and international quarters.Their mandate was not limited to AI’s application in anterior segment pathologies like the cornea,conjunctiva,lens,and eyelids,but also ventured into deciphering the existing impediments and envisioning future trajectories.After iterative deliberations,the consensus synthesized herein serves as a touchstone,assisting ophthalmologists in optimally integrating AI into their diagnostic decisions and bolstering clinical research.Through this guideline,we aspire to offer a comprehensive framework,ensuring that clinical decisions are not merely informed but transformed by AI.By building upon existing literature yet maintaining the highest standards of originality,this document stands as a testament to both innovation and academic integrity,in line with the ethos of renowned journals such as Ophthalmology.

Systematic evaluation of maternal and infant health literacy assessment tools based on COSMIN guidelines

Background:To systematically evaluate the measurement performance of the maternal and child health literacy scale and the study’s methodological quality and to provide a reference for selecting and developing related health outcome measurement tools.Methods:Databases such as CNKI,PubMed,and Embase were searched,and the search time frame was established until January 2023.The literature was independently screened by two researchers.The methodological quality and measurement performance of the included scales were evaluated using the health measurement tool selection criteria,and the evaluation results were summarized and analyzed using descriptive analysis.Results:A total of six papers were included,covering six specific scales,with significant differences in the methodological quality and measurement performance of their development studies,none of which evaluated hypothesis testing,the validity of scales,cross-cultural validity,measurement error,or responsiveness.Conclusion:The methodological quality and scale measurement performance of the maternal health literacy inventory in pregnancy,the women’s reproductive health literacy in pregnancy questionnaire,and the maternal and infant health literacy scale development studies are relatively high,but the number of studies on maternal and infant health literacy specific scales is relatively insufficient,and more studies should be conducted in the future.

Knowledge of“Guidelines for the prevention of intravascular catheter-related infections(2011)”:A survey of intensive care unit nursing staffs in China

Aims and objectives:To evaluate intensive care unit(ICU)nurses'knowledge of the updated guidelines for the prevention of intravascular catheter-related infections;to identify the factors that affect the nurses'knowledge and to explore the barriers to adherence to evidence-based guidelines in clinical practice in China.Methods:Cross-sectional surveys were carried out in Chinese ICUs from January 2013 to March 2014.The nurses'demographic information,knowledge of the guidelines,and barriers to adherence were assessed by a validated questionnaire and then analyzed statistically.Results:The questionnaires were completed by 455 ICU nurses from 4 provinces of China.The mean score was 8.17 of 20,and higher scores were significantly associated with province,years of experience,and years of ICU experience.Forty-nine(10.7%)nurses had not heard of the guidelines,whereas 231(50.7%)nurses heard of the guidelines but did not receive training for them.Trained nurses'scores were higher than untrained nurses'scores.The three main barriers to compliance with the guidelines were an unfamiliarity with them,an excessive workload due to a shortage of nurses,and a lack of training.Conclusions:ICU nurses'knowledge of the updated guidelines is quite low,which could be a potential risk factor for patient safety.Multidisciplinary interventions and continuous.

Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for head and neck cancer 2018 (English version)

Contents1. Principles of diagnosis and treatment of head and neck cancer2. Diagnosis principles of head and neck cancer2.1 Image diagnosis2.2 Pathological diagnosis2.3 Staging3. Treatment principles of early and locally advanced head and neck squamous cell carcinoma3.1 Treatment of oral cancer3.1.1 Treatment of early oral cancer3.1.2 Treatment of locally advanced oral cancer.

2018 Chinese Guidelines for Prevention and Treatment of Hypertension——A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension

Table of Contents Preamble 1 Prevalence of hypertension in Chinese population 1.1 Prevalence,incidence and epidemic trend of hypertension in Chinese population 1.2 Awareness,treatment and control of Hypertension in China 1.3 Important risk factors for hypertension in Chinese population 2 Hypertension and cardiovascular risk 2.1 Relationship between blood pressure and cardiovascular risk 2.2 Cardiovascular risk characteristics of hypertension population in China 3 Diagnostic evaluation 3.1 Medical history 3.2 Physical examination 3.3 Laboratory examinations 3.4 Genetic analysis 3.5 BP measurement 3.6 Evaluation of target organ damage.

Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for colorectal cancer 2018(English version)

Contents1. General guidelines for diagnosis and treatment of colorectal cancer2. Diagnostic principles for colorectal cancer2.1 Colorectal cancer screening of asymptomatic healthy population2.2 Basic diagnostic principles2.2.1 Colorectal cancer diagnosis2.2.2 Appendix on colorectal cancer imaging staging and diagnosis2.3 Principles of pathological diagnosis2.4 Staging.

Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update

In 2010, a panel of Chinese pathologists reported the first expert consensus for the pathological diagnosis of primary liver cancers to address the many contradictions and inconsistencies in the pathological characteristics and diagnostic criteria for PLC. Since then considerable clinicopathological studies have been conducted globally, prompting us to update the practice guidelines for the pathological diagnosis of PLC. In April 18, 2014, a Guideline Committee consisting of 40 specialists from seven Chinese Societies(including Chinese Society of Liver Cancer, Chinese Anti-Cancer Association; Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Pathology, Chinese Anti-Cancer Association; Digestive Disease Group, Chinese Society of Pathology, Chinese Medical Association; Chinese Society of Surgery, Chinese Medical Association; Chinese Society of Clinical Oncology, Chinese Anti-Cancer Association; Pathological Group of Hepatobiliary Tumor and Liver Transplantation, Chinese Society of Pathology, Chinese Medical Association) was created for the formulation of the first guidelines for the standardization of the pathological diagnosis of PLC, mainly focusing on the following topics: gross specimen sampling, concepts and diagnostic criteria of small hepatocellular carcinoma(SHCC), microvascular invasion(MVI), satellite nodules,and immunohistochemical and molecular diagnosis. The present updated guidelines are reflective of current clinicopathological studies, and include a novel 7-point baseline sampling protocol, which stipulate that at least four tissue specimens should be sampled at the junction of the tumor and adjacent liver tissues in a 1:1 ratio at the 12, 3, 6 and 9 o'clock reference positions. For the purposes of molecular pathological examination, at least one specimen should be sampled at the intratumoral zone, but more specimens should be sampled for tumors harboring different textures or colors. Specimens should be sampled at both adjacent and distant peritumoral liver tissues or the tumor margin in order to observe MVI, satellite nodules and dysplastic foci/nodules distributed throughout the background liver tissues. Complete sampling of whole SHCC ≤ 3 cm should be performed to assess its biological behavior, and in clinical practice, therapeutic borders should be also preserved, even in SHCC. The diagnostic criteria of MVI and satellite nodules, immunohistochemical panels, as well as molecular diagnostic principles, such as clonal typing, for recurrent HCC and multinodule HCC were also proposed and recommended. The standardized process of pathological examination is aimed at ensuring the accuracy of pathological PLC diagnoses as well as providing a valuable frame of reference for the clinical assessment of tumor invasive potential, the risk of postoperative recurrence, long-term survival, and the development of individualized treatment regimens. The updated guidelines could ensure the accuracy of pathological diagnoses of PLC, and provide a valuable frame of reference for its clinical assessment.