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PURPOSE: Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment. METHODS: A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts. RESULTS: Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the Definition of Surgical Success/Failure after OSA Surgery. Regarding the Predictive Factors of Surgical Failure in OSA Surgery, consensus was reached on 10 out of 13 statements. In the context of the Diagnostic Workup in OSA Surgery, consensus was achieved on 9 out of 13 statements. Lastly, in Treatment in Surgical Failure Cases, consensus was reached on 12 out of 24 statements. CONCLUSION: The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.

Purpose: Positron emission tomography/computed tomography (PET/CT) imaging has been widely used in clinical practice. Long axial field-of-view (LAFOV) systems have enhanced clinical practice by leveraging their technological advantages and have emerged as the new state-of-the-art PET imaging modalities. A consensus was conducted to explore expert views in this emerging field to comprehensively elucidate the proposed workflow in LAFOV PET/CT examinations and highlight the potential challenges inherent in the workflow. Methods: A multidisciplinary task group formed by 28 experts from six countries over the world discussed and approved the consensus based on the published guidelines, peer-reviewed articles of LAFOV PET/CT, and the collective experience from clinical practice. This consensus focuses on the workflow that allows for a broader range of imaging protocols of LAFOV PET/CT, catering to diverse patient needs and in line with precision medicine principles. Results: This consensus describes the workflows and imaging protocols of LAFOV PET/CT for various imaging scenarios including routine static imaging, dynamic imaging, low-activity imaging, fast imaging, prolonged imaging, delayed imaging, and dual-tracer imaging. In addition, imaging reconstruction and reviewing specific to LAFOV PET/CT imaging, as well as the main challenges facing installation and application of LAFOV PET/CT scanner were also summarized. Conclusion: This consensus summarized the various imaging workflow, imaging protocol, and challenges of LAFOV PET/CT imaging, aiming to enhance the clinical and research applications of these scanners. [ABSTRACT FROM AUTHOR]

Background: Seizure threshold increases with age and the frequency of electroconvulsive therapy (ECT). Therefore, therapeutic seizures can be difficult to induce, even at maximum stimulus charge with available ECT devices. Such cases are known as difficult-to-induce-seizures electroconvulsive therapy cases (DECs). However, no clinical guidelines exist for DECs; thus, clinicians often face difficulties determining treatment strategies. This study aimed to obtain a consensus among clinical experts regarding the treatment of DECs. Methods: We asked Japanese ECT experts to rate 14 approaches under six conditions of DECs on a 9-point Likert scale (1 = "disagree" to 9 = "agree"). Based on responses from 195 experts, the approaches were classified as first-line (95% confidence interval mean ≥ 6.5), second-line (mean, 3.5–6.5), or third-line strategies (mean < 3.5). Approaches rated 9 points by at least 50% of the respondents were considered "treatments of choice." Results: To avoid difficult seizure induction, dose reduction of benzodiazepine receptor agonist (BZRA) (8.33 ± 1.25), dose reduction or discontinuation of antiepileptic drugs (AEDs) or other drugs that may make seizure induction difficult (8.16 ± 1.18), and ensure hyperventilation (7.95 ± 1.47) were classified as treatments of choice. First-line treatment strategies were BRZA discontinuation (7.89 ± 1.45), stimulation timing adjustment (7.00 ± 2.00), and anesthetic dose reduction (6.93 ± 1.94). Dose reduction or discontinuation of AEDs or other drugs that might make seizure induction difficult and ensure hyperventilation were the treatments of choice across all patient conditions. The results of rating approaches for patients with mood disorders and schizophrenia were similar, with differences observed among the approaches for patients with catatonia, high risk of cognitive impairment, and cardiovascular events. Conclusions: ECT expert recommendations are useful and can assist in clinical decision-making. Our results suggest that while some strategies are applicable across all conditions, others should be tailored to meet the specific needs of patients. These recommendations should be further evaluated in future clinical studies. [ABSTRACT FROM AUTHOR]

Lung cancer has the highest incidence and mortality rates among malignant tumors in both men and women in China. According to the latest analysis of the incidence of malignant tumors released by the National Cancer Center in 2022, there were 1.060 6 million new cases of lung cancer and 733 300 deaths, resulting in a significant treatment burden. In recent years, research into the mechanisms of combining immune checkpoint inhibitors with radiation therapy has deepened, and clinical evidence is rapidly accumulating, making this area a clinical focus. However, there are still many questions regarding treatment choices, highlighting the urgent need for standardized guidance. To further promote the standardization of the combined use of immunotherapy and radiation therapy in China, the Expert Committee on Quality Control of Lung Cancer, National Quality Control Center for Cancer and the Multidisciplinary Committee on Oncology of Chinese Medical Doctor Association organized a group of multidisciplinary experts to conduct in-depth discussions on the synergistic mechanisms, application models, and safety of immune checkpoint inhibitors combined with radiation therapy in lung cancer (including non-small cell lung cancer and small cell lung cancer). This effort led to the formation of the "Expert consensus on immune checkpoint inhibitors combined with radiation therapy for lung cancer in China" (referred to as "the consensus"). This consensus aims to provide guidance for the combined use of immunotherapy and radiation therapy, effectively benefiting lung cancer patients. [ABSTRACT FROM AUTHOR]

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts' experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Drug package inserts are a crucial foundation for clinical medication practices and serve as the legal basis for guiding rational drug use and ensuring patient safety and efficacy. As rare disease treatments evolve, current package inserts often need to meet the clinical requirements for treating such conditions, frequently resulting in off-label drug use. This consensus is derived from discussions between Guangdong Pharmaceutical Association Hematologic Rare Diseases Group experts. The consensus aims to provide a framework and reference for the clinical application of off-label drug use in treating rare hematologic diseases. [ABSTRACT FROM AUTHOR]

Objective: To present the first Brazilian real-world results with galcanezumab and provide a consensus expert opinion on the prophylactic treatment of cluster headache (CH) in Brazil. Methods: The first part of the study (real-world results) was observational, prospective, uncontrolled, and descriptive. A sample of 44 consecutive patients with episodic or chronic CH were evaluated and treated in a traditional tertiary clinic from March 2020 to June 2024. The second part (consensus expert opinion) consisted of a survey completed by ten Brazilian headache clinicians with at least 25 years of clinical experience, who published at least 15 headache papers and attended at least 15 national or international headache conferences. Results: Forty-four patients (86.4% men, 13.6% women) were included. The average age was 45.9 ± 14.2 years. The diagnosis was made 27.3 ± 13.6 years after the onset of headache bouts. In 84.1% of the patients, CH was classified as episodic. Verapamil, lithium, or verapamil plus lithium were prescribed to respectively, 25%, 9.1%, and 6.8% of patients. Galcanezumab was prescribed to all and the majority (65.9%) used a dose of 300 mg once. There was a reduction in headache frequency of ≥ 50% at 3 weeks in 65.9% of patients for all doses of galcanezumab, and in 72.4% of those using galcanezumab 300 mg. Verapamil was recommended as a first-line treatment by 6 of 10 experts and a second-line treatment by the other 4 experts; galcanezumab was recommended as a first-line treatment by 4 of 10 experts and as a second-line treatment by 3 of 10 experts. Conclusions: This study presented the first real-world data with galcanezumab in Brazilian patients with CH and showed a reduction in headache frequency in most patients. A survey of Brazilian experts not meant to represent the country's guidelines, favored galcanezumab as either the first or the second option in prophylaxis. Collectively, these results highlighted galcanezumab's promising efficacy as a new tool in CH patients. [ABSTRACT FROM AUTHOR]

The transoral robotic thyroidectomy (TORT) has been increasingly adopted for minimally invasive thyroid surgery and it has proved to have better cosmetic results and comparable surgical outcomes with open operations. Most reports on TORT are case series, or single center, small-sample controlled, retrospective studies, and clinical guidelines have not been established so far. To better promote the standardized implementation and widespread adoption of TORT in China, the expert panel have organized thyroid minimally invasive surgery experts and some robotic thyroidectomy experts in China jointly formulate the Chinese expert consensus on transoral vestibular approach robotic thyroidectomy and parathyroidectomy (2024 edition) based on the latest relevant literature and clinical experiences from multiple centers. This consensus aims to provide guidance and reference for colleagues. [ABSTRACT FROM AUTHOR]

Objectives: There have been significant advances in the medical management of severe postpartum hemorrhage (sPPH) over recent decades, which is reflected in numerous published guidelines. To date, many of the currently available national and international guidelines recommend recombinant factor VIIa (rFVIIa) to be used only at a very late stage in the course of sPPH, as a "last resort", before or after hysterectomy. Based on new safety data, rFVIIa has recently been approved by the European Medicines Agency (EMA) and Swissmedic for use in sPPH, if uterotonics are insufficient to achieve hemostasis, which in fact is significantly earlier in the course of postpartum hemorrhage (PPH). We therefore aimed to develop expert consensus guidance as a step toward standardizing care with the use of rFVIIa for clinicians managing women experiencing life-threatening sPPH. Methods: The consensus process consisted of one face-to-face meeting with a group of nine experts, including eight obstetrician-gynecologists and a hematologist highly experienced in sPPH care in tertiary care perinatal centers. The panel was representative of multidisciplinary expertise in the European obstetrics community and provided consensus opinion in answer to pre-defined questions around clinical practice with rFVIIa in the management of sPPH. Recommendations have been based on current national and international guidelines, extensive clinical experience, and consensus opinion, as well as the availability of efficacy and new safety data. Results: The expert panel developed 17 consensus statements in response to the 13 pre-defined questions on the use of rFVIIa in the management of sPPH including: available efficacy and safety data and the need for interdisciplinary expertise between obstetricians, anesthesiologists, and hematologists in the management of sPPH. Based on novel data, the experts recommend: (1) earlier administration of rFVIIa in patients with sPPH who do not respond to uterotonic administration to optimize the efficacy of rFVIIa; (2) the importance of hematological parameter prerequisites prior to the administration of rFVIIa to maximize efficacy; and (3) continued evaluation or initiation of further invasive procedures according to standard practice. Furthermore, recommendations on the timing of rFVIIa treatment within the sPPH management algorithm are outlined in a range of specified clinical scenarios and settings, including vaginal delivery, cesarean section, and smaller birthing units before transfer to a tertiary care center. The panel agreed that according to available, and new data, as well as real-world experience, there is no evidence that the use of rFVIIa in patients with sPPH increases the risk of thromboembolism. The authors acknowledge that there is still limited clinical effectiveness data, as well as pharmacoeconomic data, on the use of rFVIIa in sPPH, and recommend further clinical trials and efficacy investigation. Conclusions: This expert panel provides consensus guidance based on recently available data, clinical experience, and expert opinion, augmented by the recent approval of rFVIIa for use in sPPH by the EMA. These consensus statements are intended to support clinical care for sPPH and may help to provide the impetus and a starting point for updates to existing clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Patients with solid tumors have an increased risk of developing pneumonia during the management of tumor. The prevention, diagnosis, and treatment of pneumonia in these patients have different characteristics compared to the general population, such as the correction of specific risk factors for pneumonia, the rational use of prophylactic antimicrobial drugs, the strategy of invasive sampling diagnostic techniques application, the differential diagnosis from anti-tumor treatment associated pulmonary adverse events, and the consideration of pathogens and drug resistance in empirical antimicrobial treatment. In order to standardize the diagnosis, treatment, and prevention of pneumonia in patients with solid tumors, Oncology Respiratory Disease Committee of China Anti-Cancer Association initiated the "Chinese expert consensus on the diagnosis and treatment of pneumonia in patients with solid tumors (2024 edition)". Based on a review of the latest evidence in this field, the consensus provides diagnostic and treatment pathways as well as recommendations. This consensus applies to oncologists, pulmonologists, infectious disease physicians, surgeons, emergency medicine physicians, and general practice healthcare professionals involved in the management of solid tumors in adults. [ABSTRACT FROM AUTHOR]

Bladder cancer is one of the common malignant tumors in urology. According to statistics, there were 613 791 new cases of bladder cancer in the world in 2022, and the number of new cases of bladder cancer in China was approximately 92 900, accounting for approximately 15% of new cases of bladder cancer in the world, ranking 11th in the spectrum of malignant tumors in China, among which there are approximately 73 200 new cases in males, ranking 8th in the spectrum of male malignant tumors. Bladder urothelial cancer accounts for approximately 90% of all bladder malignant tumors. It can be divided into non-muscle-invasive bladder cancer and muscle-invasive bladder cancer according to whether it invades the bladder muscle layer. Radical cystectomy is the standard treatment for muscle invasive bladder cancer patients and bacillus calmetteguerin (BCG) unresponsive high-risk non-muscle invasive bladder cancer patients. Nevertheless, due to the patient's underlying diseases and the deterioration of the quality of life caused by surgery, many patients refused or are not suitable for radical cystectomy. Therefore, it is vital to find a bladder-preserving treatment that can achieve cure other than radical cystectomy. Bladder-preserving therapy that balances tumor control and quality of life serves as an alternative and supplement to radical cystectomy. This consensus is based on contemporary evidence-based medicine, combined with native clinical practice and experiences of bladder preservation in a multidisciplinary treatment manner. To some extent, this consensus serves as a guidance for bladder preservation of bladder cancer in China. The consensus aims to discuss issues including organizational structure and workflow of multidisciplinary treatment, the selection of patients for bladder-preserving therapy, treatment options and regimens, efficacy evaluation, follow-up, as well as regimen choices of recurrence after bladder-preserving therapy [ABSTRACT FROM AUTHOR]

Lung cancer is the malignant tumour with the highest morbidity and mortality rate in China, among which non-small cell lung cancer (NSCLC) is the main pathological type of lung cancer, accounting for about 80% to 85%. Radical surgery is the standard treatment for early-stage NSCLC, but postoperative recurrence is an inevitable problem in clinical practice. Adding perioperative chemotherapy to surgery can only increase the 5-year overall survival rate by about 5%. There is an urgent need for better systemic treatments. In recent years, immunotherapeutic drugs, represented by PD-1/PD-L1 monoclonal antibodies, have brought breakthroughs from subsequent-line treatment to front-line treatment for NSCLC. Several Phase Ⅲ studies on perioperative immunotherapy have shown that adding immunotherapy during the neoadjuvant and adjuvant treatment can significantly improve survival outcomes for patients, leading to the development of a new standard treatment for resectable NSCLC. In January 2024, the first PD-1 monoclonal antibodies (Toripalimab) were approved for perioperative treatment of NSCLC in China, starting a new era of perioperative immunotherapy. At present, there is still a lack of unified consensus on the application of perioperative immunotherapy at all levels of medical institutions. In order to provide diagnostic and treatment guidance for clinicians, promote the standardization of clinical practice for immunotherapy in resectable NSCLC, and clarify the controversial opinions regarding perioperative immunotherapy, Lung Cancer Expert Committee of the China Anti-Cancer Association, Chinese Thoracic Oncology Group and Lung Cancer Expert Committee of the Chinese Medical Association Oncology Society jointly published this Consensus and Controversy to provide a guidance for the standardized management of perioperative immunotherapy for NSCLC. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common malignant tumor among women in the world. According to data from the World Health Organization, in 2020, there were approximately 2.26 million new breast cancer cases worldwide, accounting for 11.7% of all new cancer cases. In recent years, with the rapid development of molecular biology and gene detection technology, the research on advanced breast cancer continues to deepen, and the treatment methods are constantly enriched. Gene targeted therapy significantly prolongs the survival period of patients with advanced breast cancer, which is of great significance for molecular pathological diagnosis, targeted drug selection and treatment mode optimization of patients with advanced breast cancer. Based on the development of literature and clinical research, the consensus expert committee formulated the "Expert consensus on clinical application of next-generation sequencing in advanced breast cancer (2024 edition)". Compared with the "Chinese Expert Consensus on Hot Issues of Gene Testing for Advanced breast cancer (2021)", the 2024 consensus adopts new evidence-based medical evidence, aiming to provide more comprehensive gene testing information for patients with advanced breast cancer, so as to develop more accurate treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Quality indicators (QIs) are used to standardize care and improve outcomes in patients with pulmonary arterial hypertension (PAH). It is important that QIs are validated within specific healthcare contexts. Therefore, this study aimed to validate QIs for PAH management in Japan using a modified Delphi consensus method. Methods: QI candidates were identified from published European QIs and clinical practice guidelines. An expert panel of 11 PAH specialists from diverse Japanese institutions anonymously rated the 36 initial QI candidates in two rounds using a nine-point appropriateness scale. Results: In the first round, 35 QIs received a median score of ≥7 points. A panel discussion was held between rounds to address the single low-scored QI, biomarker modifications, and invasive examinations, resulting in 36 modified QIs. In the second round, all modified QIs received median scores of ≥7 points and were judged to be valid as the final Japanese set of QIs. Conclusions: The findings of this study validated a set of QIs for PAH management tailored to the Japanese healthcare context. These QIs can be used to standardize care, identify areas for improvement, and ultimately enhance outcomes for Japanese patients with PAH. [ABSTRACT FROM AUTHOR]

Background: Pertussis resurgence has been reported worldwide in the past two decades. Pertussis is still endemic and difficult to control though with universal vaccination in children. The resurgence may be related to multiple variables, such as increased disease awareness and laboratory tests, waning of immunity following vaccination, and/or genetic mutations of Bordetella pertussis. For better pertussis prevention, diagnosis, and management, we called up an expert panel to develop this expert consensus to provide new concepts in diagnosis and treatment for clinical practice. Data sources: The expert groups collected clinical evidence, summarized their clinical experiences, evaluated preliminary recommendations or guidelines, and then organized open-ended discussions to form the recommendations. This consensus was developed by reviewing the literature and studies in databases, including PubMed, Cochrane, EMBASE, the China Biomedical Database, and the Chinese Journal Full-text Database up to May 2024. The search terms included "pertussis" or "whooping cough", "children", "diagnosis", and "treatment". Results: The burden of pertussis has also changed from infants to school children and adults, and these age groups have consequently become the main source of infection for vulnerable population including infants and newborns. In China, a high prevalence of erythromycin-resistant Bordetella pertussis (ERBP) has been reported in the past decade. ERBP may lead to failed clinical empirical treatment with macrolides, which poses a great challenge for pertussis management and control. For better management of pertussis, a flow diagram for diagnosis and treatment of pertussis was presented in this consensus. This consensus also described the diagnostic criteria for pertussis, high-risk cases, and severe pertussis. Macrolides can still be used to treat confirmed erythromycin-sensitive B. pertussis (ESBP) infections, whereas oral trimethoprim–sulfamethoxazole therapy is the initial treatment option for children older than two months. For infants younger than two months, severe patients, or those exhibiting a high degree of sulfonamide allergy, intravenous administration of piperacillin or cefoperazone–sulbactam is advised. Conclusions: This expert consensus provides a comprehensive guidance and a reference for the diagnosis and treatment of pertussis in children. [ABSTRACT FROM AUTHOR]

Background Ethnic medicine holds numerous advantages in the treatment of premature ventricular complexes (PVCs). However, there is a concerning trend of abuse of ethnic medicine, particularly in the absence of tailored clinical drug recommendations specifically designed for this purpose. Consequently, it is of crucial importance to standardize the diagnosis and treatment of PVCs within the context of ethnic medicine. Objective To establish the clinical problems and outcome indicators of the Expert Consensus on Clinical Application of Ethnic Medicine in the Treatment of Palpitation (Arrhythmia-Premature Ventricular Complexes) . Methods The inquiring experts were members of the consensus expert group, encompassing experts in the fields of cardiology, evidence-based medicine, and pharmacology. Specifically, within cardiology, they comprised multi-ethnic medical experts in traditional Chinese medicine, Tibetan medicine, Mongolian medicine, Uyghur medicine, Dai medicine, Korean medicine, and Zhuang medicine. Drawing from the available literature and expert interview reports, the research team conducted a comprehensive search of relevant literature on the treatment of PVCs using various ethnic medical practices. In April 2023, a series of one-on-one online interviews were conducted with 14 multi-ethnic medical experts. Following the integration of the interview results and expert experiences, the consensus steering committee and working group jointly drafted the initial proposals for clinical questions and outcome indicators, subsequently designing a survey questionnaire. Between May and July 2023, two rounds of questionnaire surveys were conducted, rigorously evaluating the positivity, concentration, coordination, and reliability of the questionnaire responses. Results The expert panel was characterized by its multidisciplinary collaboration, authority, and geographical representation. The two rounds of the Delphi method yielded a positive coefficient of 99.1%. For the five background questions, the mean score was greater than 4, with the full scale exceeding 40%. For the ten prospective questions, the mean score was greater than 3.9, with the full scale surpassing 35%. Additionally, the nine outcome indicators achieved a mean score greater than 7, with the full scale exceeding 30%. The mean coefficient of variation for these metrics was 14.9%, 16.3%, and 17.6%. The Kendall harmony coefficients for clinical questions and outcome indicators were 0.267 and 0.316. The chi-square test showed a P-value of less than 0.05. The Cronbach's α coefficients were 0.913 and 0.905, both exceeding 0.7, suggesting high reliability. Overall, the quality control results were satisfactory, indicating a high degree of credibility in the questionnaire design. Conclusion Utilizing the Delphi method, we have identified the clinical problems and outcome indicators that need to be addressed in the development of the Expert Consensus on Clinical Application of Ethnic Medicine in the Treatment of Palpitation (Arrhythmia-Premature Ventricular Complexes), laying a solid foundation for the subsequent formulation of the consensus.

Abstract Background Seasonal vaccination is the mainstay of human influenza prevention. Licensed influenza vaccines are regularly updated to account for viral mutations and antigenic drift and are standardised for their haemagglutinin content. However, vaccine effectiveness remains suboptimal. Neuraminidase (NA) evolves more gradually than hemagglutinin and has been demonstrated to provide added clinical benefits. However, NA is not currently a mandated or standardised component of influenza vaccines. Methods Here, we collated expert opinions on the importance of NA in influenza vaccines in a two-stage Delphi survey. Nine statements about NA were formulated by a steering committee based on a targeted literature review. In the survey’s first round, panellists recruited from three continents were requested to report on their agreement with each statement and estimate the strength of evidence for each statement. Panellists were also requested to explain their choice of answer and suggest revisions to the statements. Consensus was considered reached if ≥ 75% of panellists agreed with a statement. If consensus was not reached for a statement, this statement was revised and included in the survey’s second round. Results Nine panellists with a broad range of NA-related expertise, including clinical, research, and public health experience, completed the survey. They agreed that anti-NA responses acquired via natural infection or vaccination are associated with protective immunity independently of haemagglutinin and that NA provided additional advantages including improving disease severity metrics. The experts identified several knowledge gaps concerning heterologous cross-reactivity of vaccine-induced anti-NA antibodies, correlations between anti-NA titres and reduced transmission or infection risks, and differences in anti-NA responses to seasonal influenza vaccines. Conclusions NA is an important influenza vaccine component and is associated with specific benefits. These benefits would likely be greater if NA content were standardised. Additional research is needed to optimise vaccines for anti-NA effects.

Primary health governance is a crucial part of the national health governance system and plays a key role in achieving universal health. However, primary health governance currently faces many challenges. The Expert Consensus on Primary Health Governance is led by the Public Health Security and Health Professional Committee of the Public Safety Science and Technology Society, in collaboration with experts from multiple disciplines. The aim of this consensus is to integrate evidence-based scientific evidence, practical wisdom, and experience from multidisciplinary experts in primary health-related fields. This consensus addresses the connotations, significance, objectives, basic principles, system construction elements, capacity building elements, institutional elements, and technical means of primary health governance. It provides scientific, systematic, and operable consensus opinions and suggestions to enhance the level of primary health governance, standardize primary health governance practices, promote the equalization of primary health services, strengthen the cultivation of primary health governance talents, and drive innovation in health governance. This will provide scientific basis and recommendations to support the realization of the "Healthy China 2030".

The rapid development of new technologies such as artificial intelligence and large language models has brought new transformations to clinical medical practice. Both domestically and internationally, research and practical exploration of intelligent general practitioners have begun, but a consensus has yet to be formed. Against this backdrop, experts and scholars from Tsinghua University Vanke School of Public Health, Peking University School of Public Health, Chinese Association of General Practitioners of Chinese Medical Doctor Association and several other domestic institutions collaboratively developed a consensus. The background of these experts spans multiple disciplines, including general medicine, public health, artificial intelligence, and evidence-based medicine. Based on extensive literature review both domestically and internationally and through multiple rounds of expert discussions, the Chinese Expert Consensus on Artificial Intelligent General Practitioner (AIGP) was finally formulated. It includes 17 core consensus concerning the definition, characteristics, applications, challenges and recommendations of AIGP. This consensus aims to provide scientific references to promote the empowerment of general practitioners with intelligent technology and enhance the smart service level of primary healthcare.

Chronic obstructive pulmonary disease (COPD) is one of the major chronic airway diseases, with the highest prevalence among individuals over 60 years old, significantly impacting the health of elderly patients. Guidelines of prevention and treatment for COPD in domestic and abroad recommend pulmonary rehabilitation as a complementary and effective adjunct to pharmacological treatment. Pulmonary rehabilitation can significantly improve patients' respiratory function and physical fitness, alleviate symptoms, reduce hospitalization and mortality rates. However, the specific contents of pulmonary rehabilitation for elderly patients with COPD in different stages were different. This expert consensus elaborates on the assessment and treatment methods of pulmonary rehabilitation for elderly patients with COPD in the acute exacerbation stage, post-exacerbation remission stage and outpatient stable stage, aiming to provide guidance for pulmonary rehabilitation treatment at different stages of COPD. This expert consensus identifies common functional impairments of elderly patients with COPD, including respiratory dysfunction, exercise tolerance impairment, psychological issues, swallowing dysfunction and cognitive impairment. It recommends a comprehensive assessment for multifaceted impairments of elderly patients with COPD based on the International Classification of Functioning, Disability and Health (ICF) framework from four aspects including body structure, body function (respiratory function, cardiac function, motor function, psychological and cognitive function, swallowing function, and nutritional factors), activity and participation, and environmental factors. Pulmonary rehabilitation is suitable for all patients with relevant symptoms of COPD and/or those at high risk of acute exacerbations (high-level evidence). The rehabilitation team, treatment plan, and treatment location should be adjusted in time as the condition evolves and changes, to establish a full-cycle rehabilitation. Smoking cessation is a crucial intervention to slow down the decline of lung function and the progression of COPD (high-level evidence). Through adequate nutritional support, elderly patients with COPD can improve nutritional status, and enhance physical strength and quality of life, so as to better manage the disease and promote rehabilitation (low to moderate-level evidence). Oxygen therapy is recommended for patients with advanced COPD who remain hypoxemic at rest (low to moderate-level evidence). Some emerging rehabilitation treatments (such as neuromuscular electrical stimulation, acupuncture and certain traditional Chinese medicines) may be beneficial for elderly patients with COPD (low to moderate-level evidence). Rehabilitation treatment process was divided into phase Ⅰ, phase Ⅱ and phase Ⅲ of pulmonary rehabilitation based on the different stages of elderly patients with COPD in this expert consensus. It further details the target population, implementation location, rehabilitation content, assessment content, participating disciplines and rehabilitation goals for each phase in the rehabilitation process. The consensus emphasizes that multidisciplinary personnel, including clinical respiratory specialists, primary care physicians, rehabilitation physicians/therapists, nurses, nutritionists, psychiatrists/psychologists and social workers should actively coordinate and collaborate in the full-cycle rehabilitation process for elderly patients with COPD.

China exhibits a high incidence of esophageal cancer. In the context of rapid population aging, esophageal cancer has become a significant threat to the health of Chinese elderly population. Currently, there is a lack of a clear definition or assessment method for esophageal cancer in elderly patients, and this population is frequently excluded in clinical trials. Consequently, high-level evidence and global consensus guidelines for the treatment of this population are unavailable. Since elderly patients with esophageal cancer cannot tolerate surgery and intensive chemotherapy, radiotherapy plays a vital role in their treatment. Based on recent research data on esophageal cancer in elderly patients, the expert consensus on radiotherapy for esophageal cancer in elderly patients in China was jointly developed by experts from the following organizations: Radiation Oncology Physician Branch, Chinese Medical Doctor Association; Radiation Oncology Branch, Chinese Medical Association; Professional Committee of Radiation Oncology, China Anti-Cancer Association; Expert Committee of Esophageal Cancer, Chinese Cancer Radiotherapy Alliance; Radiotherapy Sub-Committee, Professional Committee of Elderly Oncology, Gerontological Society of China. This consensus defines esophageal cancer in elderly patients, emphasizes the importance of nutritional assessment and intervention, and elaborates on the mode of radiotherapy alone and radiotherapy-based combined modality therapy mode. Moreover, this consensus organizes radiotherapy technology, radiation dose, and safety management, aiming to provide a foundational guide for clinical practice targeting esophageal cancer in elderly patients.

Test anxiety disorder is a group of symptoms related to stress caused by tests, exams, evaluations, and others. It is among the severe psychological problems in exams. Long-term test anxiety is likely to cause tension, fear, irritability, depression, and other negative emotions, and it disturbs working memory, attention, and other cognitive abilities and even leads to suicidal ideation. In order to standardize the clinical diagnosis and treatment of test anxiety disorder, under the organization of the Test Anxiety Disorder Collaboration of the Chinese Society of Psychosomatic Medicine, this expert consensus was formulated by 13 experts in the field of psychiatry and psychology. We collaborate and announce the expert consensus based on current research and clinical experience. We hope the consensus can provide clinicians with scientific and comprehensive guidance on test anxiety disorder, including epidemiology, etiology, clinical manifestations, evaluation, and treatment.

Neck injection aesthetic, a commonly performed clinical procedure, is still lacking in comprehensive guidelines or consensus. This expert consensus is co-authored by experts from the Injection Aesthetics of the National Quality Control Center of Plastic and Aesthetic Surgery. It elaborates on formulation method of consensus, the relevant contents of neck aesthetics and anatomy, botulinum toxin injections, filler injections, collagen stimulator injections, autologous tissue components injections, and combined treatments of injections with electrophoto-therapy. The consensus incorporates relevant evidence-based medical references, as well as multiple discussions. Ultimately, a basic clinical operational expert consensus was formulated, with the aim of serving as a reference for clinical physicians in their practice.

视网膜中央动脉阻塞（central retinal artery occlusion，CRAO）是一种血管神经眼科急症，发病后可导致患者单眼视力急骤下降甚至丧失，显著增加急性缺血性血管事件（如卒中、急性心肌梗死）、死亡和眼部新生血管等发生风险。CRAO被视为急性缺血性卒中的一种特殊类型，临床诊疗仍存在争议，尤其是不同专业背景的医师对CRAO的临床诊疗存在显著差异。因此，制定并推行符合我国国情的CRAO临床诊疗共识显得尤为迫切和必要。我们通过参考国际CRAO管理说明和实践模式，进行系统性文献检索，结合我国国情，制定了《中国视网膜中央动脉阻塞临床诊疗专家共识》（以下简称共识）初稿。经过核心专家组多次审议修订后，最终形成此共识。本共识围绕CRAO的流行病学、解剖及发病机制、危险因素、临床表现、辅助检查、分型、自然病程、视力恢复影响因素、首诊科室、快速评估、治疗（包括保守治疗、对因治疗、静脉溶栓和动脉内溶栓）、血管事件风险（包括急性缺血性血管事件、死亡）、继发眼部新生血管风险与治疗、二级预防和科学管理等方面进行详细且全面的阐述，旨在提高我国CRAO的整体管理水平。临床医师应用此共识时，建议根据患者的实际病情和诊疗中心的具体情况进行个体化诊疗。所有医疗人员要始终坚持“时间就是视觉”理念，尽快将CRAO患者转诊至就近的、具有CRAO诊疗能力的综合卒中中心进行诊治，争取最大限度地改善患者视力，减少并发症发生风险。 Abstract: Central retinal artery occlusion (CRAO) is a vascular neuro-ophthalmic emergency that causes a rapid decline or even loss of vision in one eye after onset. It also significantly increases the risk of acute ischemic vascular events (such as stroke, and acute myocardial infarction), death, and ocular neovascularization (ONV). CRAO is regarded as a special type of acute ischemic stroke, and there are still controversies in its clinical diagnosis and treatment, especially significant differences among physicians with different professional backgrounds. Therefore, it is particularly urgent and necessary to formulate and implement the consensus on the clinical diagnosis and treatment of CRAO that aligns with China’s national circumstances. By referring to international guidelines for CRAO management and practice patterns, conducting systematic literature searches, and combining with China’s national circumstances, we formulated the draft of the Expert Consensus on Clinical Diagnosis and Treatment of Central Retinal Artery Occlusion in China (hereinafter referred to as the consensus). After the core expert group deliberated and revised many times, this consensus was finally formed. This consensus provides a detailed and comprehensive explanation of CRAO’s epidemiology, anatomy and pathogenesis, risk factors, clinical manifestations, auxiliary examinations, classification, the natural course of the disease, factors affecting vision recovery, first contact departments, rapid assessment, treatment (including conservative treatment, etiological treatment, intravenous thrombolysis, and intra-arterial thrombolysis), risk of vascular events (including acute ischemic vascular events and death), risk and treatment of secondary ONV, secondary prevention and scientific management, in order to improve the overall management level of CRAO in our country. When clinicians apply this consensus, it is recommended to provide individualized diagnosis and treatment based on the actual condition of the patient and the specific circumstances of the clinic. All medical staff should always adhere to the concept that “time is vision” and refer CRAO patients to the nearest comprehensive stroke center with CRAO diagnosis and treatment capabilities as soon as possible, striving to maximize the improvement of patients’ vision and reduce the risk of complications.

《急性缺血性卒中中等血管闭塞管理中国专家共识2024》是由中国卒中学会神经介入分会组织专家根据近年来血管内治疗急性颅内中等血管闭塞领域研究的新进展和新的循证医学证据进行的分析和总结。此次共识编写涵盖颅内中等血管的定义，中等血管闭塞的发病率、预后、诊断、静脉/动脉溶栓治疗、血管内治疗以及具体的血管内治疗技术等内容，旨在为从事卒中防治尤其是急性缺血性卒中血管内治疗、护理及康复的相关专业人员和社会工作者，以及政府相关管理机构、卫生事业管理人员、医药企业、卫生保健需求方和其他利益相关者提供指导意见。 Abstract: Chinese Expert Consensus on the Management of Medium Vessel Occlusion in Acute Ischemic Stroke 2024 is a summary and analysis conducted by experts organized by the Chinese Interventional Neuroradiology Society of Chinese Stroke Association, based on recent advancements and new evidence-based medical findings in the field of endovascular treatment for acute intracranial medium vessel occlusion. This consensus covers the definition of intracranial medium vessels, the incidence, prognosis, diagnosis, intravenous thrombolysis/intra-arterial thrombolysis, endovascular treatment, and specific techniques of endovascular treatment. The aim is to provide guidance for professionals and social workers engaged in stroke prevention and treatment, especially those specializing in endovascular treatment, nursing, and rehabilitation of acute ischemic stroke, as well as relevant governmental agencies, healthcare administrators, pharmaceutical companies, healthcare demand parties, and other stakeholders.

With the increasing proportion of human papilloma virus (HPV) infection in the pathogenic factors of oropharyngeal cancer, a series of changes have occurred in the surgical treatment. While the treatment mode has been improved, there are still many problems, including the inconsistency between diagnosis and treatment modes, the lack of popularization of reconstruction technology, the imperfect post-treatment rehabilitation system, and the lack of effective preventive measures. Especially in terms of treatment mode for early oropharyngeal cancer, there is no unified conclusion whether it is surgery alone or radiotherapy alone, and whether robotic minimally invasive surgery has better functional protection than radiotherapy. For advanced oropharyngeal cancer, there is greater controversy over the treatment mode. It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy, or a treatment mode of surgery combined with postoperative chemoradiotherapy. In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer, this expert consensus, based on the characteristics and treatment status of oropharyngeal cancer in China and combined with the international latest theories and practices, forms consensus opinions in multiple aspects of preoperative evaluation, surgical indication determination, primary tumor resection, neck lymph node dissection, postoperative defect repair, postoperative complication management prognosis and follow-up of oropharyngeal cancer patients. The key points include: ① Before the treatment of oropharyngeal cancer, the expression of P16 protein should be detected to clarify HPV status; ② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resection of oropharyngeal cancer. Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction; ③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months, it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment; ④ Early-stage oropharyngeal cancer patients may opt for either surgery alone or radiation therapy alone. For intermediate and advanced stages, HPV-related oropharyngeal cancer generally prioritizes radiation therapy, with concurrent chemotherapy considered based on tumor staging. Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma (including primary and recurrent) and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy; ⑤ For primary exogenous T1-2 oropharyngeal cancer, direct surgery through the oral approach or da Vinci robotic surgery is preferred. For T3-4 patients with advanced oropharyngeal cancer, it is recommended to use temporary mandibulectomy approach and lateral pharyngotomy approach for surgery as appropriate; ⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth >3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients, selective neck dissection of levels IB to IV is recommended. For cN+ HPV unrelated oropharyngeal cancer patients, therapeutic neck dissection in regions I-V is advised; ⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node, or imaging suggests continuous enlargement of lymph nodes, the patient should undergo neck dissection; ⑧ For patients with suspected extracapsular invasion preoperatively, lymph node dissection should include removal of surrounding muscle and adipose connective tissue; ⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps, with priority given to adjacent flaps, followed by distal pedicled flaps, and finally free flaps. The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Background Lumbar disc herniation is one of the most common causes of low back pain, and the number of cases has been increasing year by year in recent years. High-quality guidelines can standardize clinical diagnosis and treatment behaviors and improve medical quality, and screening and formulating high-quality guidelines are of great significance for standardizing the clinical practice of lumbar intervertebral disc herniation. Objective To systematically evaluate the methodological quality of clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation, and to analyze the high-quality guidelines and consensus recommendations, in order to provide reference for the prevention and treatment of lumbar intervertebral disc herniation. Methods Clinical practice guidelines and expert consensus on lumbar intervertebral disc herniation were searched from the establishment of each database to October 31, 2023. At the same time, Dangdang.com and others were manually searched to obtain the guidelines for lumbar intervertebral disc herniation published in the form of monographs. After the consistency evaluation was passed by two researchers, the methodological quality of the included guidelines and consensus was evaluated using the AGREE Ⅱ tool, and the high-quality guidelines and consensus recommendations were analyzed. Results A total of 15 guidelines and consensus were included, and the final recommendation level of 9 guidelines was B (can be recommended after modification), and 6 guidelines and consensus were C (not recommended for the time being). Recommendations mainly include bed rest, medication, surgical treatment, etc. Conclusion The methodological quality of the clinical practice guidelines and expert consensus for lumbar intervertebral disc herniation needs to be further improved, and some treatment methods are controversial, and the recommendations of the guidelines need to be further improved and unified to optimize clinical practice.

Obstructive sleep apnea (OSA) is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases, and affects cognitive function and multi-system organ function in the elderly. Therefore, it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society, as the initiator, organized domestic experts in related fields to repeatedly discuss the operation process, requirements, specific ways and methods of noninvasive positive pressure ventilation (NPPV) treatment for elderly OSA patients with reference to domestic and international clinical studies, and finally made this expert consensus, which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.

Diabetic microvascular disease (DMiVD) is the most common chronic complication of diabetes mellitus, and early identification and effective intervention can significantly improve patients' quality of life and prognosis. The Diabetes and Microcirculation Professional Committee of Chinese Society of Microcirculation and the Primary Endocrine and Metabolic Diseases Group of the Chinese Society of Endocrinology have convened experts in the field to revise the Expert Consensus on Screening and Prevention of Diabetic Microvascular Diseases for Primary Care (2024), based on the 2021 edition, considering the latest research advances and the specific needs of primary care. This consensus elaborates the screening methods, comprehensive management and prevention strategies for DMiVD (diabetic retinopathy, diabetic kidney disease, distal symmetric polyneuropathy and diabetic cardiomyopathy), clarifies the graded diagnosis and treatment and referral processes, emphasizes the importance of preventing and treating DMiVD, and offers guidance and recommendations for physicians, particularly primary care physicians and general practitioners. The aim is to reduce the incidence, progression, and disability associated with DMiVD, ultimately lowering morbidity and mortality rates.

Hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia are collectively referred to as the "three highs", which often coexist in the same individual. It significantly increases the risk of hospitalization, death, and relevant burdens for affected people. It is necessary to jointly control the risk and standardize the treatment of hypertension, T2DM and dyslipidemia. Primary healthcare institutions have become the main battlefield for the prevention and treatment of chronic diseases. Existing clinical evidence provides important insights into the prevention, treatment, and management of the "three highs", although norms, consensus, and guidelines for the co-management of the "three highs" in primary healthcare institutions at domestic and foreign are current not available. Four academic organizations led by Beijing Hypertension Association organized primary healthcare workers and invited experts and scholars from medical fields of cardiovascular diseases, endocrine, pharmacy, and public health services to participate in the consensus. Through widely soliciting clinical practice needs of primary healthcare workers, integrating and evaluating the evidence related to the prevention and treatment of the "three highs" in primary healthcare institutions, the consensus for primary healthcare in the prevention and treatment of the "three highs" including 21 opinions was developed after multiple rounds of discussions, revisions, and voting. The recommended opinions of this consensus aim to improve the awareness and ability of primary healthcare workers in the prevention and treatment of the "three highs", provide scientific strategic support, implement management with primary healthcare characteristics, and lay a solid foundation for comorbidity co-management.

177Lu- prostate specific membrane antigen (PSMA) radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China. Based on domestic clinical practice and experimental data and referred to international experience and viewpoints, the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Abstract Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts’ experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.

Prostate cancer is one of the most common malignancies in men, and radical prostatectomy (RP) is the primary treatment method for localized and locally advanced prostate cancer. However, due to surgical trauma, patients undergoing RP often face postoperative complications such as sexual dysfunction and urinary incontinence, leading to varying degrees of decline in quality of life. Currently, there is a lack of standardized clinical guidelines for postoperative rehabilitation in these patients. To address this issue, the present consensus was developed using evidence-based medicine approaches, including a thorough review and evaluation of relevant literature, quality grading, and evidence synthesis. An initial draft was created and subsequently refined through expert meetings, discussions and Delphi surveys. This process involved three rounds of consultations with 29 experts from 24 different hospitals across various specialties, including urology, oncology, rehabilitation medicine, nutrition and psychology. The results were systematically summarized under the guidance of the Committee of Integrated Rehabilitation for Urogenital Tumors, Chinese Anti-Cancer Association, culminating in the formulation of the “Chinese expert consensus on perioperative integrated rehabilitation for radical prostatectomy (2024 edition)”. This consensus aimed to provide standardized integrated rehabilitation recommendations for patients undergoing RP, with the goals of improving postoperative recovery efficiency and reducing the impact of both short- and long-term complications on survival and quality of life. The consensus has been registered on Practice guideline REgistration for transPAREncy (PREPARE) with the registration number PREPARE-2024CN666. The consensus covers several key areas, including comprehensive perioperative assessment, application of the Enhanced Recovery After Surgery (ERAS) principles, management and treatment of common postoperative complications, and psychological and social support for patients. Regarding perioperative assessment, the consensus emphasizes a thorough evaluation of patients’ physical and psychological conditions before surgery, including nutritional status, pelvic floor function and psychological state, to develop individualized rehabilitation plans and optimize preoperative preparation, thereby laying a solid foundation for postoperative recovery. The application of ERAS principles includes reducing preoperative fasting and fluid restrictions, improving perioperative management, providing preoperative education, and implementing psychological interventions, all of which effectively reduce the incidence of postoperative complications and accelerate recovery. For common postoperative complications such as urinary incontinence and sexual dysfunction, the consensus recommends various rehabilitation measures, including pelvic floor muscle training (PFMT) and biofeedback therapy, to alleviate symptoms and improve quality of life. Additionally, the consensus underscores the importance of psychological and social support, advising comprehensive support for patients in the postoperative period. The publication of this consensus provides clinical practitioners with standardized guidelines for postoperative rehabilitation, which can enhance the recovery efficiency of patients undergoing RP, reduce the incidence of complications, and significantly improve the quality of life. As more clinical studies are conducted in the future, the content of this consensus will be continuously validated and refined, offering more comprehensive and personalized rehabilitation guidance for prostate cancer patients.

Abstract Background Eating disorders (EDs) constitute a considerable burden for individuals and society, but adequate and timely professional treatment is rare. Evidence-based Digital Mental Health Interventions (DMHIs) have the potential both to reduce this treatment gap and to increase treatment effectiveness. However, their integration into routine care is lacking. Understanding practitioners’ attitudes towards DMHIs for EDs is crucial for their effective use. Aims To investigate the consensus among German ED treatment experts on the relevance of different influencing factors for DMHI use in EDs. Methods This Delphi study consisted of two rounds and was conducted online with an initial sample of N = 24 ED experts (M age=41.96, SD age=9.92, n = 22 female). Prior to the Delphi rounds, semi-structured qualitative telephone interviews were performed to explore participants’ attitudes, experiences, and expectations towards DMHIs. In order to construct the Delphi survey, content analysis was applied to a subset of ten interviews. A total of 63 influencing factors were identified and grouped into three main categories: contextual conditions, design, and content of DMHIs. In both Delphi rounds, the interview participants were subsequently invited to rate each of the factors with regard to their importance on 10-point scales. Group percentages and individual ratings of the first round (n = 23) were presented in the second round (n = 21). Consensus was calculated for each item (defined as IQR ≤ 2). Results Importance ratings were high across items (M = 7.88, SD = 2.07, Mdn = 8). In the first round, 48% of the items reached consensus, with its most important (Mdn = 10) factors referring to data security, evidence base, technical requirements, usability, and specific DMHI content (psychoeducation, crisis intervention). In the second Delphi round, a consensus was reached on 73% of the items. No consensus was reached on 17 items. Conclusions The findings on practitioners’ attitudes and priorities have relevant implications for subsequent DMHI development, dissemination, and implementation strategies, indicating that the highest-rated factors should be highlighted in the process.

Background: In the recent decade, there has been substantial progress in the technologies and philosophies associated with diagnosing and treating anterior cruciate ligament (ACL) injuries in China. The therapeutic efficacy of ACL reconstruction in re-establishing the stability of the knee joint has garnered widespread acknowledgment. However, the path toward standardizing diagnostic and treatment protocols remains to be further developed and refined. Objective: In this context, the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM) collaboratively developed an expert consensus on diagnosing and treating ACL injury, aiming to enhance medical quality through refining professional standards. Methods: The consensus drafting team invited experts across the Greater China region, including the mainland, Hong Kong, Macau, and Taiwan, to formulate and review the consensus using a modified Delphi method as a standardization approach. As members of the CSSM Lower Limb Study Group and the CAOS Arthroscopy and Sports Medicine Study Group, invited experts concentrated on two pivotal issues: “Graft Selection” and “Clinical Outcome Evaluation” during the second part of the consensus development. Results: This focused discussion ultimately led to a strong consensus on nine specific consensus terms. Conclusion: The consensus clearly states that ACL reconstruction has no definitive “gold standard” graft choice. Autografts have advantages in healing capability but are limited in availability and have potential donor site morbidities; allografts reduce surgical trauma but incur additional costs, and there are concerns about slow healing, quality control issues, and a higher failure rate in young athletes; synthetic ligaments allow for early rehabilitation and fast return to sport, but the surgery is technically demanding and incurs additional costs. When choosing a graft, one should comprehensively consider the graft's characteristics, the doctor's technical ability, and the patient's needs. When evaluating clinical outcomes, it is essential to ensure an adequate sample size and follow-up rate, and the research should include patient subjective scoring, joint function and stability, complications, surgical failure, and the return to sport results. Medium and long-term follow-ups should not overlook the assessment of knee osteoarthritis.

Given the increasingly widespread application of automation technology in transfusion compatibility testing, in order to reduce the systemic and hidden risks of automated testing equipment, to provide guidance for the standardized application of automation technology in transfusion compatibility testing, to improve the quality of transfusion compatibility testing, and to ensure the safety of clinical blood use, the Working Party on Clinical Transfusion Management of the Chinese Society of Blood Transfusion has organized experts in clinical blood transfusion, transfusion compatibility testing, management, production and maintenance to jointly develop this expert consensus based on clinical research results, survey data and related clinical practice at home and abroad.

Background/Objectives: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by progressive impairment of neuronal transmission due to focal demyelination. The most common form is RRMS (relapsing-remitting multiple sclerosis), which, under the influence of certain factors, can progress to SPMS (secondary progressive multiple sclerosis). Our study aimed to validate the criteria proposed by a working group of the Romanian Society of Neurology versus the criteria proposed by a group of experts from Spain, Karolinska, and Croatia concerning the progression from RRMS to SPMS. Methods: This was done by gathering epidemiological data (age, gender) and by applying clinical tests such as the 9HPT (9-hole peg test), 25FWT (25-foot walk test), and EDSS (expanded disability status scale) tests and the SDMT test (symbol digit modalities test). The present research is a cohort study that included a number of 120 patients diagnosed with MS according to the McDonald Diagnostic Criteria 2017. The study was carried out between January 2023 and April 2024, including patients hospitalized in the Neurology Clinic of the Clinical Rehabilitation Hospital from Iasi, Romania. The data were collected at baseline (T0) and at a 12-month interval (T1). Results: The statistical analysis was conducted using Kaiser–Meyer–Olkin analysis, which indicated a value of 0.683, thus validating the clinical tests used. The correlation matrix and the linear regression for all the tests showed highly significant statistical results. Furthermore, the ROC curve analysis of the criteria suggested by the working group of the Romanian Society of Neurology demonstrated that the EDSS, 9HPT, and 25FWT are highly sensitive in diagnosing SPMS, an opinion that is shared with the Spanish experts, but not with the Karolinska expert panel. Using the criteria given by the Croatian expert group in the ROC curve analysis showed that only the EDSS was strongly significant for the progression to the SPMS phase. Conclusions: In conclusion, all clinical methods used demonstrated that they are valid and can contribute to identifying patients with an increased risk of progression. The model proposed by the Romanian Society of Neurology working group is similar to other countries' expert opinions and can be used to detect the risk of disease progression and establish a more tailored therapeutic management of SPMS. [ABSTRACT FROM AUTHOR]

Autologous skin grafting is a commonly used technique in trauma repair. However, there is currently no unified standard or operational protocol for this procedure. Different hospitals and medical teams often rely on their own experience and habits, resulting in varying rates of skin graft survival. To standardize the operation of autologous skin grafting and improve graft survival, the expert group has developed clinical practice recommendations based on advances in wound treatment both domestically and internationally, as well as relevant evidence from evidence-based medicine. These recommendations cover six key areas: wound bed preparation, graft preparation, skin suturing and fixation, grafting with different goals (either to close the wound or restore function), grafting for special sites, and perioperative management. The recommendations are based on the Oxford Centre for Evidence-Based Medicine (OCEBM) grading system and provide a standardized clinical practice guide for medical professionals involved in wound repair, burn and plastic surgery. [ABSTRACT FROM AUTHOR]

Background. Barriers to early mobilisation in healthcare settings encompass various factors, including practical challenges, accountability and the crucial role of leadership. Objective. To gain consensus from multidisciplinary team members in South African (SA) and Zimbabwean public sector hospitals to formulate implementation strategies addressing identified barriers for early mobilisation. Methods. An online two-round modified Delphi study including 23 experts from SA and Zimbabwe was undertaken. The implementation strategies were aligned with the Consolidated Framework for Implementation Research that outlines five areas impacting implementation. Results. The expert panel included intensive care unit (ICU) clinicians, academics and managers, who participated in both Delphi rounds. The median years of ICU experience was 8.5 (range 5 - 17) years, with 16 (80.0%) having a general ICU background. The panel reached consensus on several strategies to standardise early mobilisation practices in ICUs, including defining specific early mobilisation activities, appointing champion leaders, ensuring timely management of fractures, promoting patient admission to specialised units, creating dedicated physiotherapy positions, and providing skills training for staff responsible for implementing early mobilisation activities in ICUs. Conclusion. The strategies developed represent an important step toward implementation of early mobilisation in routine ICU patient care. [ABSTRACT FROM AUTHOR]

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