2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma

The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues in PTMC management have received researchers'attention.To further improve the clinical management of PTMC in China,

Guidelines for the diagnosis and treatment of chronic pancreatitis in China(2018 edition)

Chronic pancreatitis(CP)is a progressive inflammatory disease of pancreas that alters the organ’s normal structure and functions.CP seriously affects the quality of life of patients and greatly increases the public medical burden of society.In recent years,the incidence of CP has increased worldwide.The concepts of etiology and therapies have been continuously updated.

Mexican Guidelines for the Diagnosis and Treatment of Chronic Myeloid Leukaemia

Background: This document includes recommendations and guidelines issued by a group of Mexican researchers and specialists gathered in the First National Colloquium for the Diagnosis and Management of Chronic Myeloid Leukaemia (CML) by initiative of Instituto Nacional de Cancerología and with the support of the Leukaemia Department of the MD Anderson Cancer Center. Mexico lacks of updated information taken from its own reality on the diagnosis and treatment of CML and other haematological disorders;besides, there are no national guidelines. Aim: To publish a consensus document with guidelines for the management of CML adjusted to the national environment and overall characteristics. Method: The participants answered a DELPHI questionnaire about the overall aspects of the disease, aiming to target controversial topics, discuss them in the colloquium, and to agree on the best ones. After those meetings, a final document was drawn up. Results: The group presents recommendations for definition, diagnosis, prognosis, monitoring, and treatment of CML in Mexico. Conclusions: Having consensus guidelines for the clinical management of CML in our country will enable the consensual practice of Mexican specialists regarding the clinical approach to CML, as well as optimize the resources which allow the rational planning of the medical care strategies.

Systematic Evaluation of Guidelines for the Diagnosis and Treatment of Hepatitis E Virus Infection

Background and Aims:The hepatitis E virus(HEV)is a zoonotic disease,and infection with HEV in humans primarily causes acute infections and can progress to chronic manifestation in immunocompromised individuals.Over the past decade,guidelines for diagnosing and treating HEV infection have been developed.This study aimed to systematically assess the quality of current guidelines for diagnosing and treating HEV infection,and we analyzed the differences in guideline quality and primary recommendations and explored possible reasons for these differences.Methods:Guidelines published between 2013 and 2022 were searched,and studies were identified using selection criteria.The study assessed the quality of the included guidelines using the Appraisal of Guidelines for Research and Evaluation tool,extracted the primary recommendations in the guidelines,determined the highest level of evidence supporting the recommendations,and reclassified the evidence using the Oxford Centre for Evidence-Based Medicine grading system.Results:Seven guidelines were included in the final analysis.The quality of the guidelines varied widely.The discrepancies may have been caused by the lack of external experts,the failure to consider influencing factors in guideline application,and the lack of consideration of the public’s opinion.Analysis of the heterogeneity in primary recommendations revealed differences in algorithms for managing chronic HEV infection,the dosage of ribavirin,and a low level of evidence supporting the primary recommendations.Conclusions:Guideline quality and primary recommendations vary considerably.Refinement by guideline developers and researchers would facilitate updating and applying guidelines for diagnosing and treating HEV infection.

Guidelines for the standardized diagnosis and treatment of non-specific orbital inflammation(2024)

Non-specific orbital inflammation(NSOI)is a noninfectious orbital inflammation.Although it is often considered the most common diagnosis in orbital biopsies,it is an exclusionary diagnosis that requires ruling out systemic disease or other possible causes.Its characteristics include acute orbital signs and symptoms,including pain,proptosis,periorbital edema,chemosis,diplopia,and visual impairment.The clinical manifestations and histological findings of NSOI are heterogeneous,without specific diagnostic criteria or treatment guidelines,which poses significant challenges for diagnosis and treatment.This guideline provides a detailed description of the definition,classification,diagnosis,and treatment of NSOI.

Pathogenesis, diagnosis, and treatment of epilepsy: electromagnetic stimulation-mediated neuromodulation therapy and new technologies

Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.

Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)

Breast cancer is the most common cancer among women worldwide.It has been estimated that about 416000 new cases and over 117000 deaths of breast cancer occurred in China in 2020.Among the new cases of breast cancer diagnosed each year,3-10%have distant metastasis at the time of initial diagnosis.In addition,approxi-mately 30%of patients with early-stage breast cancer may eventually experience recurrence or metastases.The 5-year survival rate of patients with advanced breast cancer is only 20%with a median overall survival of 2-3 years.Although advanced breast cancer remains incurable at present,new therapeutic options and multidisci-plinary treatment could be utilized to alleviate symptoms,improve quality of life,and prolong patients’survival.The choice of treatment regimens for patients with advanced breast cancer is very important,and the optimal treatment strategy beyond the first-and second-line therapy is often lacking.Herein,the China Advanced Breast Cancer Guideline Panel discussed and summarized recent clinical evidence,updated the guidelines for the diag-nosis and treatment of advanced breast cancer based on the 2020 edition,and formulated the“Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)”for clinicians’reference.

Chinese guidelines for the diagnosis and treatment of hand, foot and mouth disease (2018 edition)

Background Hand, foot, and mouth disease (HFMD) is a common infectious disease in childhood caused by an enterovirus (EV), and which is principally seen in children under 5 years of age. To promote diagnostic awareness and effective treat-ments, to further standardize and strengthen the clinical management and to reduce the mortality of HFMD, the guidelines for diagnosis and treatment have been developed. Methods National Health Commission of China assembled an expert committee for a revision of the guidelines. The com-mittee included 33 members who are specialized in diagnosis and treatment of HFMD. Results Early recognition of severe cases is utmost important in diagnosis and treatment of patients with HFMD. The key to diagnosis and treatment of severe cases lies in the timely and accurate recognition of stages 2 and 3 of HFMD, in order to stop progression to stage 4. Clinicians should particularly pay attention to those EV-A71 cases in children aged less than 3 years, and those with disease duration less than 3 days. The following indicators should alert the clinician of possible deterioration and impending critical disease: (1) persistent hyperthermia;(2) involvement of nervous system;(3) worsening respiratory rate and rhythm;(4) circulatory dysfunction;(5) elevated peripheral WBC count;(6) elevated blood glucose and (7) elevated blood lactic acid. For treatment, most mild cases can be treated as outpatients. Patients should be isolated to avoid cross-infection. Intense treatment modalities should be given for those severe cases. Conclusion The guidelines can provide systematic guidance on the diagnosis and management of HFMD.

Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021)

Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.

Guidelines for the Diagnosis and Treatment of Rosacea in China(2021 Edition)

Rosacea is a chronic inflammatory skin disease that primarily affects the centrofacial areas and mainly manifests as recurrent flushing and erythema.In recent years,there has been progress in the understanding of the diagnosis and treatment of rosacea.Therefore,a group of dermatological experts updated the guidelines based on the 2016 expert consensus statement on rosacea diagnosis and treatment in China.These new guidelines propose diagnostic criteria for rosacea at different sites to further standardize the diagnosis and treatment of rosacea in China.

Chinese guidelines for diagnosis and treatment of urothelial carcinoma of bladder 2018 (English version)

Contents1. Overview2. Risk factors for urothelial carcinoma of bladder3. Diagnosis of urothelial carcinoma of bladder3.1 Signs and symptoms of urothelial carcinoma of bladder3.1.1 Symptoms3.1.2 Signs3.2 Imaging examination3.2.1 Ultrasonography3.2.2 CT examination3.2.3 MRI examination3.2.4 IVU3.2.5 Chest plain X-ray film/CT plain scan3.2.6 Bone scintigraphy3.2.7 Positron emission tomography-CT (PET-CT).

Guidelines for the Diagnosis and Treatment of Psoriasis in China: 2019 Concise Edition

Psoriasis is an immune-mediated chronic,recurrent,systemic inflammatory disease induced by the combination of hereditary and environmental factors.The etiology of psoriasis involves hereditary,immune,environmental,and other factors,and its pathogenesis is considered to involve excessive proliferation of keratinocytes or inflammatory activation of synovial cells and chondrocytes within joints;these processes are caused by an immune response that is mainly mediated by T lymphocytes and various other immune cells.Psoriasis is an incurable disease,and the goal of treatment is to control the progression of disease and maintain long-term efficacy.Treatment protocols should be based on the patients’conditions.Patients with mild psoriasis can be mainly treated with topical agents,and those with moderate to severe psoriasis can be treated with systemic medications.Targeted biological agents can be appropriately chosen for cases of psoriasis that are resistant to traditional systemic treatment.New drugs and treatments for psoriasis continue to evolve and emerge,and our updated guidelines are designed to deliver new achievements from China and physicians worldwide and to keep pace with global progress on psoriasis research.Compared with the previous two editions,part of contents have been modified and revised in the present guidelines;this will further facilitate standardization and increase the efficiency of the diagnosis and treatment of psoriasis in China,and improve patients’quality of life.

Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)

The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.

China guidelines for the diagnosis and treatment of myasthenia gravis

Myasthenia gravis(MG)is neuromuscular disorder induced neurotransmission defects at the neuromuscular junctions.MG is an autoimmune disease in which the autologous immune system,including the corresponding antibodies,immune cells and complement systems,attacks the cholinergic receptor(AChRs)of the postsynaptic membrane,resulting in weakness of skeletal muscle.A rare portion of MG cases is mediated with antibodies specific to muscle specific kinase(MuSK)and low-density lipoprotein receptor related protein 4(LRP4).The major clinical symptoms of MG are presented as weakness of skeletal muscle,fatigue prone,which are worsened after exercise.Adequate rest and treatment with cholinesterase inhibitors could significantly relieve and reduce the symptoms.The average onset rate is about 8-20 cases per 100,000 people.

Guidelines for the Diagnosis and Treatment of Dengue in China

Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease.As a dengue non-endemic country,China has experienced several dengue outbreaks in recent years.However,dengue patients in China display clinical characteristics that are distinct from those of patients in dengue-endemic countries.To standardize the diagnosis and treatment of dengue fever,the experts at the Society of Infectious Diseases,Society of Tropical Medicine and Parasitology of the Chinese Medical Association,and the Society of Emergency Medicine of China Association of Chinese Medicine have developed a guideline after reviewing the following guidelines and data:guidelines for diagnosis,treatment,prevention,and control of dengue(World Health Organization,2009);the guidelines for diagnosis and treatment of dengue(National Health and Family Planning Commission of the People’s Republic of China,2014,Edition 2);health industry standard of the People’s Republic of China“diagnosis for dengue fever(WS216-2018)”;and systemic reports on dengue.The new guideline includes eight aspects:introduction,terminology,epidemiology and prevention,etiology and pathogenesis,clinical features,diagnosis,treatment,and problems to be solved.

Chinese Guidelines for the Diagnosis and Treatment of HIV/AIDS (2021 Edition)

Acquired immunodeficiency syndrome(AIDS)is an important public health problem in China.In 2005,the first edition of the guidelines for the diagnosis and treatment of AIDS was formulated by the AIDS Professional Group of Society of Infectious Diseases of Chinese Medical Association,which was updated in 2011,2015,and 2018,respectively.The 2021 edition of the guidelines has been revised based on the fourth edition and updated according to the national clinical practice and the latest research findings on opportunistic infections,antiretro viral therapy,post-exposure prophylaxis,pre-exposure prophylaxis(PrEP),whole-course management of human immunodeficiency virus infections,and prevention of mother to child transmission.The 2021 edition also introduces in detail the indications,medication regimen,follow-up and monitoring,and precautions for PrEP.This guide will be updated regularly according to the latest clinical evidence.

The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms(2020)

Pancreatic neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancreatic Surgery Association,which consisted of surgical oncologists,gastroenterologists,medical oncologists,endocrinologists,radiologists,pathologists,and nuclear medicine specialists.By reviewing the important issues regarding the diagnosis and treatment of pNENs,the committee concluded evidence-based statements and recommendations in this article,in order to further improve the management of pNENs patients in China.

Chinese Guidelines for the Diagnosis and Treatment of Urticaria:2018 Update

Urticaria is a common dermatological condition that is characterized by wheals and pruritus.Certain types of urticaria can be resistant to treatment,and recurrence is common.These guidelines supplement and improve upon the previous version(published in 2014)of the Guidelines for the Diagnosis and Treatment of Urticaria in China,and incorporate recent research advances in urticaria.These guidelines are suitable for both Chinese adults and children of Han nationality with urticaria.These guidelines update and broaden the definition,pathogenesis,classification,diagnosis,and treatment of urticaria,and serve as a scientific and authoritative reference for the diagnosis and management of urticaria.

Clinical practice guidelines for the diagnosis and treatment of inflammatory breast cancer:Chinese Society of Breast Surgery(CSBrS)Practice Guidelines 2022

To improve the diagnosis and treatment of inflammatory breast cancer(IBC),the Chinese Society of Breast Surgery(CSBrS)of the Chinese Medical Association identified the key clinical issues for clinical practice guidelines through literature research and evaluated the relevant evidence with reference to the Grading of Recommendations Assessment,Development and Evaluation(GRADE).[1]Level of evidence standard and recommendation strength criteria are shown in previous publication.[2]Recommendation strength review committee was comprised of 31 members and all the members are breast surgeons.The target audience are Chinese breast disease specialists.The recommendation is shown in Table 1.

The diagnosis and treatment of lumbar disc herniation with radiculopathy: interpretation of NASS guidelines for evidence-based medicine

Lumbar disc herniation with radiculopathy refers to a localized displacement of disc material beyond the normal margins of the intervertebral disc space resulting in pain,weakness or numbness in a myotomal or dermatomal distribution.North American Spine Society(NASS)released a new version of clinical guidelines for diagnosis and treatment of lumbar disc herniation with radiculopathy.For providing the best and effective diagnosis and treatment plan,this guidelines use a systematic review of literature and evidence-based medical evidence analysis to identify different recommended intensities,focus on the common problems of diagnosis and treatment.This article gives a brief explanation of guidelines with the clinical practice in China,so as to provide a reference for clinicians and researchers.