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Trujillo, one of the main provinces of Peru, is home to a multicultural population, coming from the Coast, Sierra and Selva; of different ideologies, cultures, and ancestral knowledge about the correct use of medicinal flora. In this sense and in an effort to rescue this ancestral knowledge, the ethnobotanical study of the medicinal flora of the province of Trujillo was carried out. For which 96 semi - structured interviews were applied, using the "snowball" technique; followed by the collection, taxonomic determination and calculation of ethnobotanical indices: Use Value Index (IVU) and Informant Consensus Factor Index (FCI). It is concluded that the inhabitants of Trujillo make use of 102 species of medicinal flora, distributed in 95 genera and 46 families for the treatment and/or cure of 62 diseases. Of the total species, 24 turned out to be the most important (according to their IVU) for the cure of diseases of the Trujillo po pulation.
Trujillo, una de las principales provincias de Perú, alberga una población pluricultural, procedente de la Costa, Sierra y Selv a; de distintas ideologías, culturas, y saberes ancestrales sobre el correcto uso de la flora medicinal. En tal sentido y en el afán de rescatar ese conocimiento ancestral, se realizó el estudio etnobotánico de la flora medicinal de la provincia de Trujill o. Para lo cual se aplicaron 96 entrevistas semiestructuradas, empleando la técnica "bola de nieve"; seguido de la colecta, determinación taxonómica y cálculo de Índices etnobotánicos: Índice de valor de Uso (IVU) e Índice de Factor de Consenso del Informa nte (FCI). Se concluye que los pobladores trujillanos hacen uso de 102 especies de flora medicinal, distribuidas en 95 géneros y 46 familias para el tratamiento y/o cura de 62 enfermedades. Del total de especies, 24 resultaron ser las más importantes (segú n su IVU) para la cura de enfermedades del poblador Trujillano.
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Plantas Medicinais/química , Etnobotânica , Peru , Medicina Tradicional/história , Medicina Tradicional/métodosRESUMO
In August 2023， the European Society for Organ Transplantation （ESOT） published the ESOT Consensus Statement on Biomarkers in Liver Transplantation online. The consensus statement focuses on biomarkers in liver transplantation， clinical applicability， and future needs and explores the role of new biomarkers in predicting liver transplantation outcomes by reviewing the literature on primary disease recurrence， development of chronic kidney disease （CKD）， and safe weaning of immunosuppression. This consensus statement conducts studies from the four aspects of recurrent liver disease after liver transplantation， recurrent hepatocellular carcinoma， weaning of immunosuppression， and CKD progression， emphasizes the importance of biomarkers in predicting or detecting disease recurrence， and proposes that large-scale prospective studies are still needed to improve the quality of evidence. The author’s team gives an excerpt of the consensus statement and systematically introduces the four aspects of the consensus statement and related discussions and conclusions， in order to provide more evidence-based medical evidence for identifying and exploring new biomarkers for liver transplantation.
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@#<p>Bartter syndrome (BS) is a rare inherited salt-losing renal tubular disorder characterized by secondary hyperaldosteronism with hypokalemia and hypochloremic metabolic alkalosis, and normal or low blood pressure. In severe cases, preterm delivery, hypovolemia, ventricular arrhythmia, rhabdo-myolysis, renal failure, growth failure and sensorineural deafness may occur. In recent years, research on BS has made significant progress. The Bartter Syndrome Consensus Working Group has performed a systematic literature review, and based on evidence-based medicine, summarized aspects related to BS, including clinical manifestations and classification, diagnosis, treatment strategies, and management of complications. This consensus provides an important reference for the better diagnosis and treatment of BS.</p>
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@#OBJECTIVE To provide reference for guiding the individualized drug therapy management of imatinib for gastrointestinal stromal tumor （GIST）， with the goal of enhancing patient survival rates and improving their quality of life. METHODS Using a nominal group technique， a multidisciplinary （clinical， pharmaceutical and evidence-based） expert panel was formed to create the Consensus of Chinese Experts on Individualized Medication Management of Imatinib for Gastrointestinal Stromal Tumors outline through joint discussions. The expert panel conducted systematic retrieval， analysis， and summarization of the outline’s content， and reached relevant consensus based on China’s current situation， clinical needs， and research evidence. An external expert panel was also formed， comprising experienced multidisciplinary experts in clinical practice. Delphi method questionnaire was employed to openly collect the external experts’ opinions， which were then organized， summarized， analyzed， provided with feedback， revised， and finally formed into a consensus. RESULTS & CONCLUSIONS The drafting of this consensus included the clinical application of imatinib in neoadjuvant therapy for GIST patients， adjuvant therapy for adult patients with significant risk of recurrence after surgical resection， and drug therapy for patients with recurrent， metastatic， or unresectable tumors； pharmaceutical monitoring and long-term medication management. This consensus provides standardized processes and methods for medical institutions in individualized drug therapy management for GIST patients and holds significant importance in improving the clinical efficacy of imatinib and ensuring drug safety.
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In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.
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@# In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.
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The most important revision of the Consensus of Chinese experts on pneumoconiosis treatment (2024) is to attach importance to antifibrotic treatment, and recommend tetrandrine and nintedanib for the treatment of silicosis and coal worker's pneumoconiosis, especially in patients with rapidly progressing silicosis. The second most important revision is a positive attitude towards lung transplantation which is recommended for patients with end-stage pneumoconiosis who do not respond to medically optimized conservative treatment as early as possible. In addition, new updates also include the addition of the application of metagenomic next-generation sequencing (mNGS) in pneumoconiosis with pulmonary infection, the diagnosis and treatment of pneumoconiosis with nontuberculous mycobacteriosis (NTM), and high-flow nasal cannula oxygen therapy (HFNC) in pneumoconiosis with respiratory failure therapies. The evidence and recommendations of the current version are assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.
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@#Pneumoconiosis is the most serious occupational disease in China, and the prevention and treatment of pneumoconiosis attracts extensive social concerns. As a pulmonary interstitial fibrotic disease, pneumoconiosis is featured by disrupted lung tissue structure and impaired lung function. With available evidence on tetrandrine and nintedanib demonstrably retarding the progression of pneumoconiosis fibrosis, antifibrotic treatment of pneumoconiosis, especially rapidly progressive silicosis, should be emphasized. Pneumoconiosis patients could maintain an average level of quality of life and capabilities in social activities through comprehensive health management, early initiation of antifibrotic treatment, active prevention and treatment of pulmonary tuberculosis and other complications and comorbidities, as well as regular rehabilitation treatment and training.
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In 2020， an international expert panel proposed to replace nonalcoholic fatty liver disease with metabolic associated fatty liver disease （MAFLD）. Recent studies have shown that there is a higher risk of chronic kidney disease （CKD） in the MAFLD population and that MAFLD is an independent risk factor for CKD. However， up to now， there are still no guidelines on the prevention and treatment of MAFLD-related CKD. Based on the Delphi method， the authors led a multidisciplinary team of 50 authoritative experts from 26 countries to reach a consensus on some open-ended research issues about the association between MAFLD and CKD， which can help to clarify the important clinical association between MAFLD and the risk of CKD and improve the understanding of the epidemiology， pathogenesis， management， and treatment of MAFLD and CKD， so as to establish a framework for the early prevention and management of these two common and interrelated diseases.
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ObjectiveTo evaluate the methodological and reporting quality of clinical practice guidelines for Chinese patent medicine （CPM） with internationally recognized tools the appraisal of guidelines for research and evaluation （AGEREE） Ⅱ and reporting items for practice guidelines in healthcare （RIGHT）， thereby providing refe-rence for the clinical application and future development of CPM guidelines. MethodsDatabases including CNKI， VIP， Wanfang and Sinomed were searched for CPM guidelines， as well as medlive.cn， websites of China Association of Chinese Medicine and Chinese Medical Association， and reference lists of the included papers. The quality of the guidelines was evaluated using the AGREE Ⅱand RIGHT tools， and consistency tests were performed using Interclass Correlation Coefficient， and descriptive analysis and chi-square test were used to analyze the reporting rate for each domain and the average score for each item. ResultsFinally， 140 CPM guidelines were included， of which 51 were disease-oriented and 89 were drug-oriented， all of which were issued by China. For 51 disease-oriented CPM guidelines， the highest average score of all six AGREE Ⅱ domains was 73.32% for clarity， and the lowest was 26.80% for application； for 89 drug-oriented CPM guidelines， the highest average score was 55.62% for scope and purpose， and the lowest was 31.32% for rigour of development. In terms of the seven domains of the RIGHT checklist， the highest reporting rate was 68.26% for background， and lowest was 27.45% for other areas regarding the disease-oriented CPM guidelines； the highest reporting rate was 61.31% for background， and the lowest was 4.49% for other areas regarding drug-oriented CPM guidelines. The average reporting rate was higher for disease-oriented than drug-oriented CPM guidelines in three domains of AGREE Ⅱ （rigour of development， clarity of presentation， editorial independence）， as well as four domains of RIGHT checklist （basic information， evidence， funding and declaration and management of interests， and other areas）. ConclusionThe overall methodology and reporting quality of the current CPM guidelines still need to be improved. It is recommended that future guideline development teams should strictly refer to the AGREE Ⅱ and RIGHT checklist， and take into account of the characteristics of CPM guidelines and relevant methodo-logical suggestions in the development and reporting of CPM guidelines， thereby guiding the clinical use of CPM in a better way.
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Recommendation formation is a key component of clinical practice guidelines for Chinese patent medicine （CPM）， and should encompass the determination of the strength and direction of the recommendation， the rationale for the recommendation， and the methodology for implementing the recommendation. Recommendations can be formed through formal consensus and informal consensus. The strength and direction of recommendations for CPM guidelines should be determined by considering the quality of evidence for CPMs， the priority of the clinical questions， the pros and cons of efficacy and adverse effects， patient acceptance， the feasibility of the recommendation and the availability of resources， social fairness， economic benefits， and other influencing factors. In order to better guide guideline developers to consider these factors more rationally， this article provideed a detailed explanation of each factor in the context of the characteristics of TCM.
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OBJECTIVE To explore the whole-process pharmaceutical care model of iodine contrast medium and promote the rational clinical use of iodine contrast medium. METHODS Clinical Professional Committee on Rational Drug Use of China Medical Education Association and Expert Committee on Drug Evaluation and Clinical Research of Guangdong Pharmaceutical Association organized domestic experts to establish a working group on the Consensus on the whole-process pharmaceutical care for iodine contrast medium. The working group conducted literature searches， evidence-based analysis， and discussions on the development process， indications， contraindications， adverse drug reactions， drug interactions， drug use for special population， pharmaceutical care， and other key topics to summarize the content and process of the whole-process pharmaceutical care for iodine contrast medium. This consensus was ultimately formed. RESULTS The consensus on whole-process pharmaceutical care for iodine contrast medium included an evaluation of the patient， renal function， combined drug use， and hydration regimen before examination， the presence of contrast agent extravasation or suspected acute adverse reactions during examination， observation time points and follow-up after examination， and the presentation of specific work in each stage through pharmaceutical care flowchart. The medication monitoring record form was also formed to record the work situation. CONCLUSIONS The consensus has established a whole-process pharmaceutical care system for iodine contrast medium， providing scientific evidence for clinical physicians and nursing staff in the rational use of such special drugs， and also serving as a reference for pharmacists in providing related pharmaceutical care.
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ObjectiveTo evaluate the quality of research and evidence related to antihypertensive Chinese patent medicines combined with western medicines for the treatment of hypertension， synthesize and update the evidence， form expert consensus， and provide evidence for clinical decision-making. MethodThe databases of China National Knowledge Infrastructure （CNKI）， WanFang Data Knowledge Service Platform （WanFang）， Vip Chinese Science and Technology Journal Database （VIP）， Chinese Biomedical Literature Service System （Sinomed）， National Library of Medicine （PubMed）， Cochrane Library， Web of Science， and US Clinical Trials Registry were searched for randomized controlled trials of antihypertensive Chinese medicine combined with western medicine for the treatment of hypertension from database construction to July 31， 2022. The quality of the literature was evaluated using the bias risk assessment tool in Cochrane Handbook 6.3. Evidence synthesis of main outcome indicators was performed using R software. The Grading of Recommendations Assessment， Development， and Evaluation profiler （GRADEprofiler） 3.6 was employed to evaluate the quality of evidence. Expert consensus was formed based on the Delphi method after two rounds of voting. Result64 pieces of literature were included， and the results of literature quality evaluation and risk of bias showed that 70.31% （45/64） of the studies indicated some risks， and 29.69% （19/64） indicated high risks. Compared with conventional western medicines， the combination of Chinese patent medicines with western medicines can significantly lower systolic pressure （SBP） and diastolic pressure （DBP）， increase the effective rate of antihypertensive， reduce the incidence of adverse reactions， endothelin-1， and traditional Chinese medicine syndrome scores. Egger's test showed that Songling Xuemaikang capsules reduced SBP and DBP. Tianma Gouteng granules reduced SBP and DBP and increased the effective rate of antihypertensive， and Xinmaitong capsules reduced SBP and increased the effective rate of antihypertensive， without significant publication bias. Songling Xuemaikang capsules increased the effective rate of antihypertensive， and Xinmaitong capsules decreased DBP， with significant publication bias. The results of the GRADE evidence quality evaluation showed that most evidence was at grades B and C. Finally， four strong recommendations and 14 weak recommendations were formed. ConclusionCompared with conventional western medicines for the treatment of hypertension， antihypertensive Chinese patent medicines combined with western medicines have advantages in reducing blood pressure and improving drug use safety， but they are mostly weak recommendations in terms of efficacy， and more high-quality evidence is needed.
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@#his consensus aims to introduce the applications of 4K high-definition technology and fluorescence technology in thoracic surgery, summarize and categorize the technical support for pulmonary segment surgery, and innovatively propose technical support for precise sleeve resection of pulmonary segments. It provides a reference for clinical use, points out the direction for the research and innovation of domestically produced high-end endoscopes, promotes the widespread application of excellent domestically produced medical endoscopes, and facilitates the development of domestically produced medical equipment.
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Pancreatic cancer is a relatively common tumor of the digestive system， with difficulties in early-stage diagnosis and an extremely high degree of malignancy. Molecular diagnostic technology based on tumor biomarkers， combined with the existing gold standard in clinical practice， is of great clinical significance to achieve early accurate identification， timely treatment and intervention， and reduction in mortality. Previous studies have shown that miRNAs show high specificity in terms of types and expression levels in different pathological stages of pancreatic cancer and can thus be used in monitoring the development and progression of pancreatic cancer. Since a single miRNA has a limited diagnostic potential， the combination of different miRNAs may effectively improve the diagnostic efficiency of early-stage pancreas carcinogenesis. Based on related research advances in recent years， this consensus document aims to fill the gap in molecular diagnostic technology in the guidelines for the clinical diagnosis and treatment of pancreatic cancer and provide expert guidance and recommendations.
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Stem cell clinical research is a hot frontier research. The ethical review of stem cell clinical research is full of challenges. Currently, clinical researches lack specific operational guidelines. Considered the related laws and regulations, and the operability of practical work, experts from the field of stem cells, such as law, ethics and management, will form a consensus on the basis of full discussion and continuous revision. It will provide reference for the operation of the ethics committee of corresponding institutions, and lay a certain foundation for the establishment of national expert consensus in the future, so as to promote the effective guidance of ethical review practice and quality evaluation of stem cell research.
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At present，there is a lack of consensus on the diagnosis， treatment and management of erectile dysfunction（ED）/premature ejaculation（PE） comorbidity in China. To develop a clinical diagnosis and treatment strategy for ED/PE comorbidity， according to the guidelines for ED/PE comorbidity published in China and abroad in recent years and combined with the clinical practice of many urology and andrology research units in China，the clinical experts organized by the Branch of Sexology of Traditional Chinese Medicine， China Sexology Association formed this consensus through consensus drafting， academic review， expert correspondence interview and full discussion at the review meeting based on the existing evidence-based medical evidence. Based on the clinical experience of doctors，research evidence，patients' wishes and living environment factors，this consensus comprehensively evaluates the diagnosis and treatment norms of ED/PE comorbidity with integrated traditional Chinese and Western medicine，aiming at the diagnosis and treatment orientation and value of integrated traditional Chinese and Western medicine，so as to benefit the whole process management of more patients. Traditional Chinese medicine diagnosis pays attention to the collection of four diagnostic information of inspection， auscultation， inquiry and palpation， and carries out pattern differentiation of six meridians， pattern differentiation of Wei-defence， Qi， Ying nutrients and blood， and pattern differentiation of zang-fu organs as described in the Shanghanlun （《伤寒论》）. Based on the synergy of traditional Chinese and Western medicine， the advantages of the overall regulation of traditional Chinese medicine are brought into play， and the individualized treatment of integrated traditional Chinese and Western medicine is implemented. Internal treatment of traditional Chinese medicine is based on the pattern differentiation of yin and yang described in Section Ⅱ， Chapter Ⅳ Syndrome Differentiation of Surgical Diseases in Surgery of Traditional Chinese Medicine. As stated in Leijing： Yinyanglei （《类经·阴阳类》）， "Human diseases ... must have their roots， either in Yin or in Yang. Although there are many pathological changes， their roots are one." Huangdineijing：Suwen： Yinyangyingxiangdalun（《黄帝内经·素问·阴阳应象大论》） states that "Those who are good at diagnosis should look at the color and pulse， and differentiate Yin and Yang syndromes first." This consensus describes the yang and yin syndromes according to the principle that "Yin and Yang syndromes differentiation should be the priority in the pattern differentiation by the eight principles." In addition， for the syndromes of ED/PE comorbidity， based on the same treatment of different diseases， Chaihu Guizhitang， Wenjingtang and Buzhong Yiqitang are used， which can be referred to.
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OBJECTIVE To evaluate the quality of guidelines/consensus on therapeutic drug monitoring （TDM） of anti-tumor necrosis factor-α （TNF-α） in patients with inflammatory bowel disease （IBD） in China and globally. METHODS PubMed， Embase， CNKI， Wanfang data， VIP， and release websites of guidelines/consensus in China and globally were searched to collect guidelines/expert consensus on TDM with anti-TNF-α for IBD patients. The search period was from database establishment to June 2023. After two investigators independently screened the literature and extracted the data， the methodological quality of the included guidelines/consensuses was evaluated using the Appraisal of Guidelines for Research and Evaluation Ⅱ. The main recommendations of the included guidelines/consensuses were summarized. RESULTS A total of 9 articles were included， 3 were guidelines and 6 were expert consensus. The standardized percentages of the 9 guidelines/consensus in the 6 dimensions （scope and aims， participants， rigor of formulation， clarity of expression， application， and editorial independence） were 90.43%， 41.98%， 52.55%， 85.49%， 19.00%， and 76.85%， respectively. Eight guidelines/consensus had a recommendation of grade B and one consensus of grade C. The main recommendations involve TDM application scenarios， threshold ranges， strategy adjustments， detection methods， and interpretation of results. Most guidelines/consensus recommend passive TDM for non-responders. It is recommended to set the TDM concentration range according to the expected treatment results and make strategy adjustments in combination with the disease condition and TDM results. Additionally， the same test method is recommended for the same patient. Some guidelines/consensus hold that no differences were noted in the interpretation of results between biosimilar and original drug. CONCLUSIONS The overall quality of the included guidelines/consensus was fair， with relatively consistent recommendation. Clinicians need to understand the characteristics and limitations of TDM with this class of drugs， and interpret and apply results of TDM in combination with specific clinical treatment goals.
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To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.
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At present， there is no consensus on the diagnosis， treatment， and management of pulmonary nodules with integrated traditional Chinese and Western Medicine in China. To establish the clinical management strategy of pulmonary nodules with integrated medicine， a consensus was formed after full discussion by the experts from the Cancer Committee of Chinese Association of Integrative Medicine and the Cancer Committee of Beijing Association of Chinese Medicine according to the guidelines for pulmonary nodules issued in recent years and the clinical practice of multiple hospitals in the treatment of cancers with integrated Chinese and Western medicine. This consensus involves the existing clinical management guidelines of pulmonary nodules and the intervention methods of traditional Chinese medicine （TCM）. Considering the therapeutic positioning and value of TCM， this consensus standardizes the whole-process management of pulmonary nodules with integrated traditional Chinese and Western medicine， which will help more patients.