Since 2016, the guidelines for the management of adults with hospital-acquired pneumonia (HAP) / ventilator-associated pneumonia (VAP) have been updated in the United States, Europe, and China, respectively. The differences among these guidelines are demonstrated in this paper. The definition of VAP, how to evaluate the effect of anti-infection therapy, and the prevention strategy are controversial. The consensuses contain diagnostic value of respiratory secretions achieved by noninvasive way for VAP and shorter anti-infection course for VAP. Importantly, pathogenic spectrum for HAP in China is different from others, which is essential for clinical practice.
The diagnostic frequency of multiple pulmonary tumor nodules has increased significantly in clinical practice. Among patients with multiple pulmonary nodules, distinguishing between separate primary lung carcinomas and intrapulmonary metastases is critical for accurate tumor staging, therapeutic decision-making, and prognostic evaluation. The consensus document "Differentiating separate primary lung adenocarcinomas from intrapulmonary metastases with emphasis on pathological and molecular considerations: Recommendations from the International Association for the Study of Lung Cancer Pathology Committee" highlights the pivotal role of integrated pathological and molecular analyses in diagnosing and differentiating primary lung adenocarcinomas from intrapulmonary metastatic lesions. It further proposes a combined four-step histologic and molecular classification algorithm for addressing multiple pulmonary tumor nodules of adenocarcinoma histology, providing clinicians with enhanced diagnostic tools to refine staging accuracy, guide therapeutic strategies, and improve prognostic predictions for lung adenocarcinoma. Building on current advancements in global research, this article offers a comprehensive interpretation of the consensus recommendations.
Heart failure with preserved ejection fraction (HFpEF) is the main type of heart failure (HF), accounting for more than half of the incidence of HF. However, the etiology, pathogenesis, treatment and prognosis of HFpEF are still not fully understood. Recommendations for HFpEF are in different chapters in the 2022 AHA/ACC/HFSA guideline for the management of heart failure. This paper interpreted the definition, stage, diagnosis, epidemiology, clinical evaluation, stage treatment, acute attack stage, comorbidity management, vulnerable population and research prospect of HFpEF, which aimed to provide the latest thinking in terms of the management of HFpEF for clinicians.
Uniportal video-assisted thoracic surgery (UniVATS) is a significant approach of mini-invasive surgery for lung cancer. UniVATS was first used for treatment of lung cancer in 2010. The European consensus and the Chinese consensus were published in 2019 and 2020 respectively. The latest Chinese consensus included the definition of UniVATS, indications for lung cancer treatment, safety and feasibility, surgical skills, learning curve, short-term and long-term results, providing suggestions for the standardization of uniportal video-assisted thoracic surgery, which are essential to improve the quality of surgery and reduce the incidence of related complications. The Chinese consensus also summarized the current status of subxiphoid UniVATS and non-intubated UniVATS for lung cancer. Considering the technical difficulties and challenges, the application of both technologies in clinical treatment has certain limitation. This article aims to give an interpretation of the results of the Chinese consensus and the similarities and to compare the differences with the European consensus, and to provide a reference for the majority of thoracic surgery colleagues.
Chinese Medical Association Guidelines for Clinical Diagnosis and Treatment of Lung Cancer (2023 Edition) has been released in July 2023. Based on the 2022 edition, the 2023 edition of the guideline has been updated in the aspects of lung cancer screening, pathology, surgical standards, neoadjuvant therapy, targeted therapy and treatment of advanced lung cancer. This article will give a brief introduction to these updated parts.
The incidence of thyroid cancer has increased significantly worldwide in recent years, and it has become one of the top ten malignant tumors. The relevant guidelines for thyroid cancer have been formulated one after another. Surgery is an important method for the treatment of thyroid cancer. Standardized surgery can effectively improve the prognosis and quality of life, while inappropriate treatment will increase the risk of recurrence and reduce the survival rate. In 2022, the first domestic guideline for thyroid cancer covering all pathological types, “CACA Guidelines for Holistic Integrative Management of Thyroid Cancer” was officially released. Compared with the previous guidelines, the recommendations of the CACA guidelines are more in line with China’s national conditions, focusing on the integration of multidisciplinary resources, and minimizing the risk of complications while ensuring the treatment effect.
Lung cancer is the malignant tumor with the highest incidence rate in men and the highest mortality rate in men and women in China, and the incidence and mortality rates are still increasing. Lung cancer screening is an important initiative for early detection of lung cancer and improvement of prognosis. The National Comprehensive Cancer Network (NCCN) updates the NCCN Clinical Practice Guidelines for Lung Cancer Screening annually, and the 2023 V2 edition was released in May 2023. The guidelines are based on the latest research advances and high-level evidence-based medical evidence to establish screening criteria for lung cancer, especially for non-small cell lung cancer, which is the most common and highly regarded type of lung cancer, and has received widespread attention from physicians worldwide. In this article, the latest version of the guideline will be interpreted based on China's national situation and Chinese lung cancer screening guidelines, with the aim of providing an updated reference for lung cancer screening in China.
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.
The Universal Definition and Classification of Heart Failure consensus has proposed the universal definition, classification and staging criteria of heart failure. The prevalence of heart failure is still increasing, and the phenotype of heart failure with preserved ejection fraction (HFpEF) is becoming more and more common. Neuro-endocrine antagonists are effective in treating patients with heart failure with reduced ejection fraction (HFrEF). However, there is no effective drug that can improve the clinical prognosis of patients with HFpEF. The pathophysiological mechanism of HFpEF involves metabolic-inflammatory mechanism disorders, epicardial fat tissue accumulation, and coronary microvascular dysfunction. The exploratory treatment of these mechanisms requires further research to confirm whether it is beneficial to patients with HFpEF. In addition, the improvement of ejection fraction and the recovery of cardiac function in patients with HFrEF after treatment cannot interrupt the drug treatment of heart failure.