Daytime hip arthroplasty refers to a medical procedure where a patient undergoes admission, surgery, and discharge all within a single day (24 hours). The establishment of daytime hip arthroplasty centers signifies a significant paradigm shift in the development model of modern hospitals. While numerous nationally accredited large medical institutions are undertaking daytime hip arthroplasty in various forms and scales, there remains a lack of standardized system processes and criteria. In this context, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Bone and Joint Specialty Committee of the China Ambulatory Surgery Alliance, Joint Surgery Branch of the Chinese Orthopedic Association, and Osteoarthritis Study Group of the Chinese Association of Orthopedic Surgeons have collaboratively organized experts in the relevant field domestically. Leveraging international experiences in daytime hip arthroplasty and integrating them with the clinical practices of well-established medical institutions conducting daytime surgeries in China, they have arrived at consensus recommendations. These recommendations cover the establishment of daytime hip arthroplasty centers, policies, procedures, and perioperative management. The ultimate goal is to provide reference points and guidance for the standardized implementation of daytime hip arthroplasty.
ObjectiveTo assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. MethodsThe medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. ResultsThe upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. ConclusionThe effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.
The consensus was authored by National Society of Congenital Heart Diseases. After employing the Delphi process and incorporating literature reviews and expert discussions, seven recommendations were ultimately formulated. The consensus provides a detailed elaboration on the pathoanatomy, pathophysiology, clinical manifestations, diagnostic methods, and surgical treatment approaches for aortic valve diseases in children. It emphasizes that the treatment of aortic valve diseases in children should take into account the needs of growth and development, and recommends surgical strategies for different age groups and types of lesions, including valve plasty, Ross procedure, valve replacement, and balloon dilation. Specifically, aortic valve plasty is recommended for neonates and infants, while surgical options for older children are more diversified. The consensus only discusses isolated aortic valve disease and does not cover cases complicated with other heart malformations.
In recent years, enhanced recovery after surgery (ERAS) has been widely used in spine surgery and achieved satisfactory results. In order to standardize the ERAS implementation process and application in percutaneous endoscopic interlaminar lumbar decompression/discectomy (PEID), we reviewed the literatures and cited evidence-based medicine data, and had a national comprehensive discussion among experts of the Group of Minimally Invasive Spinal Surgery and Enhanced Recovery, Professional Committee of Orthopedic Surgery and Enhanced Recovery, Association of China Rehabilitation Technology Transformation and Promotion. Altogether, the up-to-date expert consensus have been achieved. The consensus may provide the reference for clinical treatment in aspect of the standardization of surgical operations, the reduction of surgical trauma and complications, the optimization of perioperative pain and sleep management, the prevention of venous thrombosis, and the guidance of patients’ functional training and perioperative education.
Novel coronavirus pneumonia is a new type of respiratory infectious disease that has rapidly spread in many countries or regions around the world. The World Health Organization (WHO) named it “coronavirus disease 2019 (COVID-19)”. Glucocorticoids (GC) have certain application value in patients with COVID-19, but they need to be used with caution and strict indications and dosage. Application of large doses of GC can also cause osteonecrosis of femoral head (ONFH). On the basis of the latest literature and evidence-based medical evidence on the fight against COVID-19 epidemic and steroid ONFH diagnosis and treatment, the Bone Circulation and Osteonecrosis Professional Committee, Shockwave Medical Specialty Committee of Chinese Research Hospital Association organized Chinese bone necrosis related experts to jointly write this consensus, focusing on the prevention strategy and the protective management measures in the ONFH diagnosis and treatment process during the prevention and control of COVID-19, which can provide reference for hospitals at all levels to carry out early prevention and treatment of ONFH.
Osteonecrosis of the femoral head (ONFH) is a common and refractory disease in the clinic. Although the exact pathophysiological mechanism is not fully understood, it is believed to be closely related to the interruption of intra-bone circulation and eventual bone tissue death. The prevention and treatment of ONFH is always a great challenge for orthopedists. The diagnostic level of ONFH has been continuously improved with the development of imaging techniques such as MRI and the in-depth understanding of the disease in recent years.There are many treatment methods for ONFH, which are generally considered individually and comprehensively according to factors such as the patient’s age, osteonecrosis stage, classification, and compliance with joint-sparing treatment. There is currently no unified standard. ONFH staging and classification play an important reference value for doctors to choose treatment options. In recent years, based on the characteristics of ONFH in Chinese people, the academic community has proposed Chinese staging and China-Japan Friendship Hospital (CJFH) classification. The consensus also introduces them together with the international Association Research Circulation Osseous (ARCO) staging to provide guidance for individualized treatment of ONFH. In order to further standardize the diagnosis of ONFH and expand the treatment of ONFH, the Association Related to Circulation Osseous, Chinese Microcirculation Society (CSM-ARCO) organized domestic experts in the field of ONFH to jointly formulate the expert consensus, in order to provide reference for the standardized diagnosis of ONFH and the selection of individualized diagnosis and treatment techniques.
Primary graft dysfunction (PGD) is the most common and significant complication affecting long-term survival rates after lung transplantation. The occurrence of PGD is closely related to donor-recipient risk factors, surgical procedures, and perioperative management. Early identification and standardized intervention are crucial for improving prognosis. This consensus was developed by a multidisciplinary expert group in the field of lung transplantation in China, based on a systematic literature review, evidence-based medical evidence, and clinical practice experience. It systematically outlines the definition and classification of PGD, the main pathological mechanisms, donor-recipient and perioperative risk factors, and establishes a dynamic early warning mechanism and graded treatment standard process. This consensus emphasizes the construction of a complete closed-loop management system through comprehensive preoperative assessment, multiparameter monitoring during surgery, standardized postoperative intervention, and follow-up management after discharge. The aim is to standardize clinical practices, reduce the incidence of PGD, promote graft function recovery, and improve long-term survival rates for patients. The consensus employs the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the strength of recommendations and the level of evidence, providing a scientific, systematic, and actionable clinical guidance framework for lung transplantation centers.
Neurofibromatosis type 1 (NF1) is an autosomal dominant neoplastic disease caused by mutations in the NF1 gene and one of the most challenging diseases to treat. Patients have a characteristic phenotype with neurofibromas as the main features in different forms, including numerous cutaneous neurofibromas, plexiform neurofibromas involving the primary nerves, or malignant peripheral nerve sheath tumors with a very short survival period after malignant transformation. NF1 patients also suffer from multi-system involvement, with a high rate of deformity and disability, making complete surgical resection more difficult. Currently, there is no consensus on the diagnosis and treatment of NF1 in China, and different disciplines have different understandings of NF1. Multidisciplinary systematic evaluations and cooperative treatments are the keys to improve the treatment, quality of life, and prognosis of NF1 patients. In 2020, the Department of Plastic Surgery of the Ninth People’s Hospital of Shanghai Jiaotong University School of Medicine led the establishment of the first multi-center collaboration group for NF1 in China. Furthermore, the group had worked with renowned experts from the various departments including surgical oncology, medical oncology, dermatology, reproductive medicine, et al. in China to formulate the “Expert consensus on diagnosis and management of neurofibromatosis type 1 (2021 edition)”, aiming to promote standardized and homogeneous treatment covering the whole life cycle of NF1 patients and improve the treatment level and outcome of NF1 patients in China.
Diabetes retinopathy (DR) is listed as one of the chronic diseases that should be focused on in the “14th Five-Year” National Eye Health Plan (2021-2025). Early screening is one of the effective measures to reduce blindness caused by DR. Establishing an efficient and practical community screening model is a powerful guarantee for completing early screening. The Ocular Fundus Diseases Group of the Ophthalmology Branch of the Chinese Medical Association has led the development of Expert consensus on community screening of diabetic retinopathy among DR community screening experts that is suitable for the current national situation, in order to guide and promote the further improvement of DR community screening work in China. This Expert Consensus provides detailed specifications on the current domestic trend of DR, the necessity of screening, the role of artificial intelligence grading, screening process, and quality control. This interpretation further emphasizes the importance of DR community screening, while emphasizing the responsibilities of different departments in the screening process. Finally, recommendations are provided for the sustainability of DR community screening. It is hoped that the screening rate of DR in China can be improved and blindness can be reduced by DR through Expert consensus on community screening of diabetic retinopathy and interpretation of the content.
In order to further regulate the application of 3D reconstruction in thoracic surgery, the Chinese Expert Consensus Group on the Application of Integrated 3D Reconstruction with Artificial Intelligence in Thoracic Surgery conducted discussions and developed this consensus. This consensus is based on the clinical experience and existing prospective or retrospective studies of 3D reconstruction technology in various scenarios of thoracic surgery and summarizes recommendations, and also appends a list of 3D reconstruction technology application scenarios that are currently controversial, not fully studied, or still in the exploratory stage, to provide direction and evidence for future clinical research and disease diagnosis and treatment, and to reach a consensus.
