Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.
Radiation proctopathy, which can be categorized as acute and chronic, is defined as the radiation damage to the rectum caused by radiation therapy in patients with pelvic malignancies. Chronic radiation proctopathy can cause complications such as rectal bleeding, which severely affects patients’ quality of life. At present, endoscopic therapy has become the primary method for diagnosis and treatment of bleeding from chronic radiation proctopathy. In October 2019, the American Society for Gastrointestinal Endoscopy (ASGE) published "ASGE guideline on the role of endoscopy for bleeding from chronic radiation". The guideline described the effectiveness and safety of different endoscopic therapies such as argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, cryoablation, etc. in the treatment of bleeding from chronic radiation. This paper interprets it to provide references for clinicians in the treatment of bleeding from chronic radiation.
Directed acyclic graphs (DAGs) are essential tools based on prior assumptions, capable of clearly depicting causal relationships between variables, aiding in the identification of confounders and assessment of bias. They have been widely applied in the field of epidemiology. However, the construction of DAGs is prone to the subjectivity of researchers. This paper interprets the DAGs construction and application guidelines from the BMJ and elaborates on the seven steps for building DAGs: clarifying the research question and target population, identifying relevant variables, reaching consensus and pre-registering, determining data collection or datasets based on the consensus graph, selecting analysis methods and variable measurement, conducting sensitivity analysis, and reporting the DAGs. By following these steps, researchers can construct DAGs more scientifically, identify the minimal sufficient adjustment set, and enhance the scientific validity and reliability of their studies. Despite its advantages, DAGs have limitations. For instance, failure to consider all relevant factors may lead to unexplained disturbances in the analysis results or incorrect causal inferences, thus failing to verify other key assumptions in causal reasoning. Therefore, it is recommended to integrate DAGs with data-driven methods to maximize their strengths and compensate for their shortcomings.
Glycogen storage disease type Ib (GSD Ib) is a rare disorder of glycogen metabolism, often complicated by neutropenia/neutrophil dysfunction, leading to recurrent infections and the development of inflammatory bowel disease (IBD), which severely impacts patients’ quality of life. Empagliflozin, an SGLT2 inhibitor, has demonstrated the ability to restore neutrophil counts and function, thereby improving the immunodeficiency state in GSD Ib patients. This consensus aims to provide clinical practice recommendations for the use of empagliflozin in GSD Ib based on current evidence and expert experience. The purpose of this document is to outline these key points and offer guidance for the clinical application of empagliflozin in GSD Ib.
Surgical site infections are the common healthcare-associated infections. This article introduced the guidelines on the prevention and control of surgical site infection in using from background, making progress, and recommendations, to give directions for clinicians and infection prevention and control professionals choosing appropriately for decreasing surgical site infection risks.
Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis with perforation remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.
The management of malignant pleural effusion remains a clinical challenge. In November 2018, American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology summarized the recent advances and provided 7 recommendations for clinical problems of the management of malignant pleural effusion. This paper interprets these recommendations to provide references for management and research on malignant pleural effusion.
ObjectiveTo analyse the quality of implementation in clinical application guidelines of the Chinese patent medicines for the treatment of common diseases. MethodsWe retrieved clinical application guidelines of the Chinese patent medicines for the treatment of common diseases published from February, 2019 to August, 2022 in databases. The clinical practice guideline (CPG) implementation evaluation tool was used to evaluate the implementation of the included guidelines. ResultsA total of 29 guidelines were included. The implementation quality of included guidelines was moderate. Thirteen (44.8%) were high quality and 16 (55.2%) were moderate quality. ConclusionThe quality of implementation of clinical application guidelines of the Chinese patent medicines for the treatment of common diseases is higher than that of other traditional Chinese medicine CPG. The CPG implementation evaluation tool can be used in traditional Chinese medicine CPGs and particularity of TCM should also be considered.
With the popularization of digestive endoscopy in children, colonoscopy has been widely used. As the basis of digestive endoscopy, bowel preparation directly affects the diagnosis and treatment results of colonoscopy. Compared with adults, the functioning of important organs of children is immature, and their ability of cognition, communication and tolerance are weak. Their structure of the digestive tract is also significantly different in different ages. However, there have been no existing evidence-based guidelines on bowel preparation for digestive endoscopy of Chinese children. Therefore, it is important to develop evidence-based guidelines for bowel preparation combined with the clinical practice in China. In order to provide guidance and decision-making basis for Chinese pediatricians, we collaborated with multidisciplinary experts, based on existing evidence, adopted the grading of recommendations assessment, development and evaluation (GRADE) approach, followed the Reporting Items for Practice Guidelines in Healthcare (RIGHT) to develop this guideline for bowel preparation related to the diagnosis and treatment of children's digestive endoscopy.