Evidence and Expert Opinions:Drying Needling versus Acupuncture(Ⅰ)--The American Alliance for Professional Acupuncture Safety(AAPAS)White Paper 2016

In the last twenty years, in the United States and other Western countries, dry needling （DN） became a hot and debatable topic, not only in academic but also in legal fields. This White Paper is to provide the authoritative information of DN versus acupuncture to academic scholars, healthcare professional administrators, lawmakers, and the general public through providing the authoritative evidence and experts＇ opinions regarding critical issues of DN versus acupuncture, and then reach consensus. DN is the use of dry needles alone, either solid filiform acupuncture needles or hollow-core hypodermic needles, to insert into the body for the treatment of muscle pain and related myofascial pain syndrome. DN is sometimes also known as intramuscular stimulation, trigger points （TrP） acupuncture, TrP DN, myofascial TrP DN, or biomedical acupuncture. InWestern countries, DN is a form of simplified acupuncture using biomedical language in treating myofascial pain, a contemporary development of a portion of Ashi point acupuncture from Chinese acupuncture. It seeks to redefine acupuncture by reframing its theoretical principles in a Western manner. DN-like needling with filiform needles have been widely used in Chinese acupuncture practice over the past 2,000 years, and with hypodermic needles has been used in China in acupuncture practice for at least 72 years. In Eastern countries, such as China, since late of 1800s or earlier, DN is a common name of acupuncture among acupuncturists and the general public, which has a broader scope of indications, not limited to treating the myofascial pain.

Interests of Livestock Activities within Agroforestry Systems in Guadeloupe: Stakeholders’ Opinions and Farmers’ Perceptions

The Valab project (Integrated Ecosystemic value-enhancement of the Guadeloupean Forest Agrobiodiversity) is a participatory action research that aims to explore the feasibility of diversification activities within the forest understorey. In the exploratory phase of the project, we studied stakeholders’ opinions on the positive and negative impacts of introducing livestock activities within a forest environment, as well as breeders’ constraints or motivations for setting up livestock units within agroforestry systems in the private forests of Guadeloupe. To establish a diagnosis of the current situation, 51 stakeholders (St) and 49 farmers (Fr) were interviewed on their perceptions, opinions, motivations and preferences. Forty-one percent of the St has had a generally positive appreciation of livestock activities, while on the opposite 31% have had a resolutely negative posture depending on their area of expertise. Their views on the possible positive effects or negative interactions between livestock and agroforestry activities were analysed in order to suggest possible approaches for the authorities or associations. Unanimously, the farmers replied that their motivations followed economic strategies: for self-consumption or sale. But their decision-making processes were also non-economic. Many of them (36% Fr) gave importance to their activity in the construction of their identity, whether it was through a desire to perpetuate traditions or to maintain family activities. The main constraints identified were natural constraints (61% Fr), including topography, climate and predators. While 28% of Fr notified their motivations for environmental protection. Another constraint was of a technical nature (44% Fr) since farmers asked for more technical references or support services. Further researches are required to study the interactions between animals and the undergrowth by describing their respective ecosystem services in order to enhance their positive interactions.

Management of nonalcoholic fatty liver disease in the Middle East

The prevalence of nonalcoholic fatty liver disease(NAFLD)in the Middle East is increasing in parallel to an increase in the prevalence of associated risk factors such as obesity,metabolic syndrome,and type 2 diabetes mellitus.About 20%to 30%of the patients progress to develop nonalcoholic steatohepatitis(NASH),a histological subtype of NAFLD,with features of hepatocyte injury such as hepatocyte ballooning.NASH can progress to fibrosis,cirrhosis,and even hepatocellular carcinoma.NAFLD thus causes a substantial burden on healthcare systems and it is imperative that appropriate strategies are discussed at a regional level to facilitate effective management tailored to the needs of the region.To fulfil this unmet need,expert gastroenterologists,hepatologists,and endocrinologists from the region came together in three advisory board meetings that were conducted in Saudi Arabia,United Arab Emirates,and Kuwait,to discuss current local challenges in NAFLD screening and diagnosis,and the different available management options.The experts discussed the disease burden of NAFLD/NASH in the Middle East;screening,diagnosis,and referral patterns in NAFLD;and available treatment options for NAFLD and NASH.This paper summarizes the discussions and opinion of the expert panel on the management of NAFLD/NASH and also presents an extensive literature review on the topic.

Diagnosis and Management of Knee Osteoarthritis：Chinese Medicine Expert Consensus(2015)

Literature review shows that Chinese medicine and other related treatment are still the main stream treatment of knee osteoarthritis.Currently,there is short of handbook guiding Chinese medicine from evidence-based medical evidence,so it is a top priority to develop a clinical guideline from the expert consensus.After several rounds of discussion during the conference and examination by letter,which has collected opinions from nearly one hundred experts,consensus was reached.Nonpharmacologic interventions include health education,medical exercise,acupuncture,massage,acupotomology,and physiotherapy.Pharmacological interventions are as follows.Topical application includes fumigation,application,hot compressed,ironing and iontophoresis with Chinese herbs,etc.Chinese patent medicine for external use includes plaster,ointment,etc.Western medicine for external use mainly includes emulsion,ointment,plaster and embrocation containing nonsteroidal anti-inflammatory drugs（NSAIDs）.Intraarticular injection mainly includes sodium hyaluronic acid,chitosan（for injection） with prudent use of glucocorticoid.Chinese herbal medicine and Chinese patent medicine can be taken referring to syndrome differentiation which mainly includes syndromes of qi stagnation and blood stasis,cold dampness,deficiency of Gan（Liver） and Shen（Kidney）,deficiency of qi and blood.Western medicine mainly includes analgesic,NSAIDs,diseases modifying drugs.Surgery procedures mainly include joint irrigation,arthroscopic surgery,osteotomy,arthroplasty,etc.

Clinical Application of Transient Elastography in the Diagnosis of Liver Fibrosis:an Expert Panel Review and Opinion

Liver fibrosis evaluation is pivotal for treatment decisions and prognosis assessment in patients with chronic liver disease. Liver transient elastography (TE) is a newly developed non-invasive technique for diagnosis of liver fibrosis. It can assess the state of liver fibrosis by liver stiffness measurements, and offers better performance for the diagnosis of liver cirrhosis than serum biological markers. It has now been approved for clinical use in China. The aim of this review is to provide a guide for clinicians to apply this technique appropriately. The recommendations are made under the auspices of China Foundation for Hepatitis Prevention and Control, and have been prepared by a panel experts, who have reviewed and summarized the clinical studies on TE in order to develop these recommendations.

The Rational Thinking of Expert Opinion and Communicating in Courtroom

Since the past half century,expert testimony has played an increasingly important role in Chinese litigation.As the amount of expert testimony has grown,the issues about its admissibility and scientific foundation related to evidence are becoming to be questioned commonly.Since eighteenth central committee(China)adopted the decision of the Central Committee of China on several important issues in promoting the legal system,the evidence was redefined to become the predominance in the whole proceeding.This article reviews the expert knowledge implicit in the opinions.It argues that the expert opinions ask judges to be aware of the role of communicationg between participants.Expert opinion is not only gained from laboratory,but also socially constructed in the rational expression and communication,which requir us think logically in terms of legal perceptions of science and expert knowledge in the empirical world.

Methodological Approaches to Developing and Establishing the Body of Evidence on Post-marketing Chinese Medicine Safety

ABSTRACT Evidence based medicine demands the highest form of scientific evidence to demonstrate the efficacy and clinical effectiveness for any therapeutic intervention in order to provide best care. It is however accepted that in the absence of scientific evidence, personal experience and expert opinion together with professional judgement are critical. Obtaining evidence for drug safety, post- marketing surveillance （PMS） has focussed on follow up of observational cohorts exposed to a particular drug in order to estimate the incidence of adverse drug reactions （ADRs）. Evidence on PMS of Chinese herbal products is still limited, in particular for herbal injections. The aim of this article is to suggest a new model of ascertaining the safety of Chinese medicine using a more comprehensive approach for collecting data. To collect safety data on the Chinese herbal injection, Kudiezi, a mixed methods approach is proposed using 18 hospital information systems to detectADRs in order to prospectively observe 30,000 patients over 3 years. Evidence will also be collected using a questionnaire survey and through a sample of semi structured interviews. This information based on the expert opinion and the experience of clinicians will produce additional data on the frequency and types of side effects in clinical practice. Furthermore semi structured interviews with a random sample of patients receiving the injection will be carried out to ascertain any potential side effects missed. It is hoped that this comprehensive approach to data collection will accumulate wider evidence based on individual traditional Chinese medicine care and treatment and provide important feedback to the national data collection system to ensure completeness of ADR data recording, monitoring and any potential wider effects through developing improved ADR guidelines.

Practical Straits of the Forensic Examination in China

With the revision of the Criminal Procedural Law of the PRC and the Civil Procedural Law of the PRC in 2012,it has entered a new historical stage of litigation system and made significant progress in forensic examination system in China.However,for a long time,the illegal forensic examinations have been commonly seen in forensic practice,the right to start the forensic examination process only lies with public security and judicial authorities,while the parties only have the limited right to apply for supplementary forensic examination or re‑examination.To the problem of experts’refusal to appear in court to testify,the Criminal Procedural Law and the Civil Procedural Law have further improved the expert testimony system,but the situation has not fundamentally changed.To compensate for judges’lack of knowledge of professional issues,the expert advisor system is introduced,but there are no workable rules.Besides,judges depend too much on and accept the expert opinions blindly become a common phenomenon in the proceedings.