The incidence of colorectal cancer ranks second among cancers in China and colorectal cancer is also one of the most common malignant tumors in the digestive system. With the development of medical research and technology, the diagnostic and therapeutic strategies of colorectal cancer are continuously evolving. The National Comprehensive Cancer Network (NCCN) is closely following the forefront and released the 2024 V1/V2 versions of the NCCN Clinical Practice Guidelines for Rectal Cancer on January 29 and April 4, 2024 respectively. The two revisions of the guidelines mainly focus on the latest research progress in molecular detection, immunotherapy, targeted therapy, neoadjuvant therapy and disease surveillance. This article analyzed the key updates of the 2024 V1/V2 NCCN guidelines, aiming to provide a more accurate reference for clinical rectal cancer diagnosis and treatment practice.
In 2024, the National Comprehensive Cancer Network (NCCN) has updated three editions of the Clinical Practice Guidelines for Gastric Cancer. These updates encompass multiple crucial areas of diagnosis, treatment, and follow-up monitoring for gastric cancer. It elevates the significance of next-generation sequencing in precision therapy for gastric cancer, refines the limitations for Epstein-Barr virus (EBV) testing and first-line immunotherapy in advanced stages. Adjustments have been made to the preoperative medication cycle for neoadjuvant immunotherapy, a new NTRK-targeted therapy drug was added in the second-line therapy, and a more detailed approach to postoperative monitoring and supplementation for nutritional deficiencies has been introduced. Notably, this version marks the first inclusion of endoscopic treatment pathways for early-stage gastric cancer and diagnostic and treatment pathways for single peritoneal metastasis in advanced gastric cancer. Additionally, it provides a comprehensive elaboration on the application principles of several emerging surgical techniques combined with intraperitoneal treatments. The updated content fully embodies the trend towards precision, personalized, and multidisciplinary treatment. This article will focus on the diagnosis, surgical treatment, systemic treatment, follow-up monitoring and other aspects of the guideline, in order to provide guidance and help for clinical practice.
The 2024.V4 of the NCCN Clinical Practice Guidelines for Colon Cancer provides important updates on pathological testing of systemic therapy for colon cancer, dose of chemoradiotherapy, and treatment and management of metastatic colon cancer. Firstly, the guidelines emphasize the importance of genomic testing in the systemic treatment of metastatic colon cancer. Secondly, the dose of chemoradiotherapy and targeted therapeutic targets of locally advanced colon cancer were modified. Finally, the new drug repitinib for the second-line treatment of metastatic colon cancer provides a new option for patients with positive neurotrophic tyrosine receptor kinase (NTRK) gene fusion. In terms of patient management, the importance of general practice to patients' quality of life and psychological support was emphasized. Through the interpretation of the above content, this paper is expected to provide references for the diagnosis, treatment and prognosis of colon cancer, ensure that patients receive timely specialized treatment, and provide references for the precision treatment of colon cancer.
Cardiac emergencies occur rapidly and pose a serious threat to the health and lives of patients. Female cardiac emergencies have been under-researched, under-diagnosed and under-treated due to gender bias and atypical symptoms for a long time. There are clear gender differences in the pathophysiological mechanisms, risk factors, management and outcomes of female cardiac emergencies. In China, the prevalence of female cardiac emergencies is notably high, and research on it has commenced relatively late. There is no authoritative guideline for female cardiac emergencies, so it is urgent to enhance the management strategies for these conditions. To standardize the management of cardiac emergencies in women and enhance health outcomes, clinicians from general medicine, cardiology and emergency medicine were convened to interpret the clinical statement titled Management of Female Cardiac Emergencies published in 2024 by the Association for Acute Cardiovascular Care and other organizations.
The British and Irish Hypertension Society (BIHS) summarized guidelines from the National Institute for Health and Care Excellence (NICE), the European Society of Cardiology and the European Society of Hypertension (ESH), and published Adult Hypertension Referral Pathway and Therapeutic Management in the Journal of Human Hypertension on January 9, 2023. Based on the existing evidence and expert opinions, this article focuses on the referral criteria of hypertensive patients and the treatment of patients during the referral waiting period, so as to optimize the management of hypertensive patients by primary doctors. The purpose of this article is to interpret the core points of the consensus statement to provide recommendations for primary care physicians in China on the referral criteria and treatment of hypertensive patients during referral waiting period. In view of the complexity and regionalism of China's primary medical problems, it is still necessary for primary doctors to conduct comprehensive evaluation and practice the clinical practice plan that is most beneficial to patients.
Hypertensive disorders of pregnancy (HDP) is one of the most common complications of pregnancy and one of the leading causes of maternal mortality worldwide. In 2023, the Society of Obstetricians of Australia and New Zealand released the A Summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand Hypertension in Pregnancy Guideline. This article interprets its key contents and proposes suggestions on non-drug intervention measures and refined management processes for HDP in China, in order to provide a new basis for the management of HDP in China.
Obesity and hypertension are global public health problems that place a huge burden on individual health and social economy. There is a close correlation between obesity and hypertension, both are major risk factors for cardiovascular diseases. In 2023, the Obesity Medicine Association (OMA) conducted a deep investigation into the mechanisms of obesity-related hypertension and published the Clinical Practice Statement on Obesity and Hypertension in the Obesity Pillars. This statement presents new recommendations for the prevention and treatment of obesity and hypertension. It also identifies ten important considerations for managing these disorders. The goal of this article's interpretation of the OMA statement is to help primary care physicians treat patients with obesity and hypertension more effectively by furthering the updating of China's clinical guidelines for these illnesses.
Artificial Intelligence (AI) is an emerging technology to improve healthcare services. With the joint promotion of government agencies and academic departments around the world, a large number of studies have demonstrated that AI can improve the diagnosis, treatment and prevention of cardiovascular disease. However, there are still some limitations in its development and application, and it has not yet been widely used in clinical practice. Based on this, the American Heart Association (AHA) published the Use of Artificial Intelligence in Improving Outcomes in Heart Disease: a Scientific Statement from the American Heart Association in Circulation on April 2, 2024. This statement reviews the research progress of AI in the diagnosis, classification and treatment of cardiovascular disease, puts forward the existing problems and potential solutions, and builds a framework for the future application of AI in the cardiovascular disease. This article aims to interpret the statement for providing advice and direction for the application and research of AI in cardiovascular disease in China.
Neighborhoods and Cardiovascular Health was drafted by a writing group of experts in cardiology, epidemiology, and preventive medicine and has been published in December 2023 in Circulation: Cardiovascular Quality and Outcomes, the official journal of the American Heart Association (AHA). The American Heart Association provides a roadmap on how to use current knowledge about neighborhoods influence on cardiovascular disease to develop and implement effective interventions to improve cardiovascular health at the population, health system, neighborhoods, and individual levels. Reducing the inequity burden of cardiovascular disease among deprived populations by influencing and improving the neighborhoods environment where possible. Our country is also faced with the problem of imbalance of neighborhoods infrastructure between urban and rural areas as well as between urban and rural areas. The interpretation of this scientific statement may provide new perspectives and ideas for the prevention and control of cardiovascular diseases in China at the community level, which will help to improve the prevention and control of cardiovascular diseases and the cardiovascular health of the public.
The Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START) were initially developed by a panel of experts from Cork University Hospital, Ireland in 2008, and underwent a second update in 2015. Since their inception, these criteria have played a pivotal role in identifying potentially inappropriate medication use in the elderly, enhancing oversight of medication misuse in older individuals, and reducing adverse drug events among the elderly. In 2023, the third edition of the STOPP/START criteria was released, providing updated and more practical evidence-based guidance. Building upon the second edition, this iteration includes the addition, revision, and removal of certain criteria, resulting in a total of 190 new standards for potentially inappropriate medication use. This latest version incorporates the most recent research findings and clinical evidence related to appropriate medication use in older adults. We provide a detailed analysis of the STOPP/START criteria (version 3), offering valuable insights for the updating and refinement of potentially inappropriate medication criteria in our country. Furthermore, it presents recommendations for future research in this field.
High prevalence and low control rate of hypertension have brought a significant disease burden globally. In order to improve the level of hypertension prevention and treatment, remote healthcare and digital medicine have been rapidly developed and widely used worldwide. Currently, there are no relevant regulations in China for these technologies. In 2023, the Italian Society of Arterial Hypertension issued a position statement to guide the development, validation, and clinical use of remote medicine and digital healthcare. This article will interpret this position paper, focusing on the forms of application of telemedicine and digital healthcare in managing hypertension and its related cardiovascular diseases, key research evidence, existing advantages, as well as current opportunities and challenges. The aim is to guide general practitioners in China on how to utilize these technologies in managing hypertension and related cardiovascular conditions.
Chronic coronary disease (CCD) refers to chronic heart or vascular disease caused by insufficient blood flow into or out of the heart. The incidence and mortality rates of CCD are high, resulting in significant personal, economic, and societal burdens. In July 2023, the American Heart Association (AHA) and the American College of Cardiology (ACC), along with other academic organizations, jointly released the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease. This guideline provides a on the evidence-based and patient-centered approach to comprehensive management of patients with CCD. It covers the epidemiology of CCD, patient assessment, diagnosis, risk stratification, treatment, management of special populations, patient follow-up, and related considerations. The guideline emphasizes the importance of a healthy diet, regular physical exercise, and tobacco avoidance for cardiovascular health. It also updates the recommendations for the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) and provides the latest evidence-based recommendations for clinical practice. This article provides a key interpretation of the management strategies outlined in the guideline, aiming to provide a basis for the development and update of relevant guidelines in China. The goal is to standardize and improve the specialized diagnosis and care for patients with CCD, with the ultimate aim of providing evidence-based guidance for clinical practice and improving the prognosis of patients with CCD.
Pituitary prolactinoma is a neuroendocrine disease caused by excessive pituitary prolactin-cell adenoma synthesis and prolactin secretion. The standardized diagnosis and treatment of pituitary prolactinoma in of great significance for recovering and maintaining pituitary function and improving life quality of the patients. In January 2022, the International Chapter of Clinical Endocrinology (ICCE) and the Italian Association of Clinical Endocrinologists (AME) published a position statement on pituitary prolactinoma in the European Journal of Endocrinology: 2022 ICCE/AME Position Statement for Clinical Practice in Pituitary Prolactinoma (abbreviated as 2022 ICCE/AME position statement) . Based on the latest medical evidence, 2022 ICCE/AME position statement conducts a systematic review, analysis and recommendations on the clinical diagnosis and treatment of pituitary prolactinoma. This article provides an update on the diagnosis and treatment of pituitary prolactinoma, special populations, dopamine agonist resistance, and invasive prolactinoma in the 2022 ICCE/AME position statement, which is hoped to be helpful to the awareness of pituitary prolactinoma among general practitioners and endocrinologists, and provide a reference for the clinical practice of standardized diagnosis and treatment.
Regular physical activity is a cornerstone of diabetes management, and more precise guidance on exercise prescriptions is needed in children and adolescents with diabetes due to the complexity of glycemic changes, however, there are relatively few guidelines for this population. As the continuous exploration of experts and scholars in this field, after five years, the International Society for Pediatric and Adolescent Diabetes (ISPAD) updated its guidelines on exercise for children and adolescents with diabetes in 2022. The guidelines target the service population more precisely to the children and adolescents with type 1 diabetes and provide comprehensive guidance from the perspectives of exercise types, exercise timing, blood glucose fluctuations during exercise, insulin adjustment and nutritional supplementation. This article interprets the main contents and key updates of the 2022 ISPAD guidelines, aiming to provide more scientific exercise prescriptions for children and adolescents with diabetes in China.
Cancer cachexia is a cancer-related, multi-factorial, irreversible clinical syndrome characterized by progressive nutritional consumption, which greatly reduces the survival expectation and quality of life of cancer patient. In 2010, the European Palliative Care Research Collaborative published the Clinical Practice Guideline on Cancer Cachexia in Advanced Cancer Patients, which based on clinical evidence, providing recommendations about cachexia classification and treatment in patients with advanced cancer. However, the guideline is mainly applicable to patients with advanced cancer who may present with refractory cachexia. Based on the continuously updated evidence, the European Society of Medical Oncology released the Cancer Cachexia in Adult Patients: ESMO Clinical Practice Guideline, which provides a more clear structural framework for the management of cancer cachexia, focusing on all cancer patient who may develop into cachexia, making recommendations in terms of screening, evaluation and multimodal management of cachexia. This paper interprets and summarizes the key points of the guideline in order to provide a reference for clinical management of cancer cachexia in China.
Persistent genital arousal disorder (PGAD) and genito-pelvic dysesthesia (GPD) are jointly known as PGAD/GPD, which is a newly discovered condition in recent years, featured by spontaneous or secondary persistent genital arousal and/or dysesthesia in the genital and pelvic areas. PGAD/GPD mainly affects women, which can seriously influence the physical and mental health of the sufferers due to the specificity of its symptoms. Most patients have anxiety, depression, and even the suicidal tendency. The medical community abroad has paid attention to PGAD/GPD, and included it in the International Classification of Diseases-11th Revision (ICD-11) . Given the fact that this newly discovered condition is under-recognized among domestic health providers at present, we summarized the current research on PGAD/GPD abroad and introduced the epidemiological characteristics, pathophysiological mechanisms, diagnosis and treatment methods of PGAD/GPD based on the review of the latest expert consensus of the International Society for the Study of Women's Sexual Health (ISSWSH) , and discussed the future research direction of PGAD/GPD and the coping strategies that should be taken by the domestic medical community, with a view to arousing medical workers' attention to the disease in China.
