Acute Retinal Necrosis Syndrome (ARN) is a severe, vision-threatening ocular disease caused by herpesvirus infections. It is characterized by abrupt onset and rapid progression, often leading to irreversible visual impairment due to complications in the affected eye such as rhegmatogenous retinal detachment, optic atrophy, and intractable hypotony—and potential involvement of the fellow eye if not promptly diagnosed and treated. As ARN is relatively uncommon, many ophthalmologists lack sufficient experience in diagnosing ARN. In addition, its management is complex, typically involving antiviral therapy, corticosteroids, and vitrectomy. Currently, diagnostic and therapeutic approaches to ARN in hospitals across China are largely based on individual clinical experience, underscoring the urgent need for a standardized clinical protocol. To address this, the Fundus Diseases Group in Ophthalmology Branch of Chinese Medical Association and the Professional Committee of Fundus Diseases in Ophthalmology Branch of Chinese Medical Doctor Association have jointly developed Expert consensus on the diagnosis and treatment of acute retinal necrosis syndrome. The consensus is informed by a comprehensive review of the literature, the latest clinical research findings, and consideration of the current socio-economic context in China. Following multiple rounds of expert review and revision, the final version has been completed. This document provides a detailed account of ARN, covering clinical manifestations, imaging and etiological assessments, diagnostic and differential diagnostic criteria, as well as medical and surgical treatment strategies. It is intended to serve as a practical guide for both subspecialized and general ophthalmologists. Developed in accordance with the principles of evidence-based medicine and adapted to China's clinical realities, the consensus offers practical guidance for the diagnosis and management of ARN. While the proposed clinical pathway is designed to meet the needs of most patients, clinicians are encouraged to tailor treatment plans based on individual patient factors, including disease severity, therapeutic options, and economic considerations.
In the research process of uveal melanoma (UM), the Collaborative Ocular Melanoma Study (COMS) is a landmark and outstanding clinical study. Its research conclusions are the foundation for today's UM clinical work and guidelines. COMS is the first and largest randomized clinical trials conducted to date, comparing the survival outcomes of two or more treatment regimens for primary malignant intraocular tumors with high reliability. Its research design, methods, and conclusions are still widely cited in this day. Learning from the research experience of COMS, summarizing research data based on Asian populations, and studying treatment methods suitable for Asian UM patients is a powerful supplement to COMS data, but also an expansion of this global research, further improving the level of UM diagnosis and treatment in China.
ObjectiveTo evaluate the quality differences in recommendations generated by large language models (LLM) and clinical practitioners for sarcopenia-related questions. MethodsA sarcopenia knowledge base was constructed based on the latest domestic and international research and consensus guidelines. Using the Python environment, a locally deployed and sarcopenia-focused hybrid vertical LLM (referred to as LC) was implemented via LangChain-LLM. Eight fixed questions covering etiology, diagnosis, and prevention were selected, along with eight virtual patient cases. The evaluation team assessed the quality of answers generated by LC and written by clinical practitioners. Quantitative analysis was performed on the precision, recall, and F1 scores (harmonic mean of precision and recall) of treatment recommendations. ResultsThe responses were generally perceived as "possibly written by humans or AI", with a stronger inclination toward being AI-generated, although the accuracy of such judgments was low. Regarding answer quality attributes, LC's responses were superior to those of clinical practitioners in guideline consistency (P<0.01), exhibited similar acceptability (P>0.05), showed better practicality (P<0.05), and had a lower proportion of "1–2 errors" (P<0.05). Quantitative analysis of treatment recommendations indicated that LC and GPT-4.0 outperformed clinical practitioners in recall and F1 scores (P<0.05), with minimal differences between LC and GPT-4.0. ConclusionThe locally deployed sarcopenia-focused hybrid vertical LLM demonstrates high accuracy and applicability in addressing sarcopenia-related issues, outperforming clinical practitioners and exhibiting strong clinical decision-support capabilities.
Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus. Considering complicated conditions, poor general condition, severe infection and poor outcomes as the feature characteristics of Chinese DFU patients, comprehensive and systematic evaluation, including general condition, region of the foot, and psychological status, is essential and fundamental for successful treatment. This commentary summarizes the evaluation contents in scientific and standardized diagnosis and treatment of diabetic foot ulcer, and looking forward to reducing morbidity, recurrence rate and mortality, and increasing limb salvage rate.
Retinal vein occlusion (RVO) is a common clinical disease in ophthalmology. In recent years, with the emergence of drugs such as anti-vascular endothelial growth factor drugs and sustained release of intraocular glucocorticoids, the therapeutic effect and prognosis of RVO patients have been significantly improved. Nevertheless, in different regions and hospitals at all levels in China, the diagnosis and treatment strategies for RVO are mostly based on their own accumulated experience, and there is still room for improvement in the awareness of ophthalmologists on early intervention of RVO and the popularity of related knowledge, and a set of standardized clinical diagnosis and treatment paths is urgently needed. To this end, Fundus Diseases Group in Ophthalmology Branch of Chinese Medical Association, Professional Committee of Fundus Diseases in Ophthalmology Branch of Chinese Medical Doctor Association through systematic and in-depth literature research and analysis of the latest clinical research results, and combined with the current social and economic development of China, jointly drafted the draft of Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China. After several reviews and revisions by the core expert group, the consensus was finalized. This consensus is elaborated in terms of the definition and classification of RVO, etiology and pathogenesis, initial diagnosis and treatment path consensus, and follow-up diagnosis and treatment assessment and follow-up management, aiming to provide easy to understand and grasp practical guidance for ophthalmic specialists and general ophthalmology practitioners. This consensus strictly follows the basic principles of evidence-based medicine, fully considers China's national conditions and existing diagnosis and treatment conditions, and puts forward principled recommendations with general guiding significance for the clinical diagnosis and treatment practice of RVO, aiming to meet the diagnosis and treatment needs of most patients. When applying this consensus to guide practice, clinicians should take into account the specific disease characteristics of patients, combined with various factors such as available treatment means and patients' economic status, and implement individualized comprehensive treatment plans, so as to meet the diversified diagnosis and treatment needs of the majority of RVO patients.
Abstract： Currently, there are two significant tendencies in the advancement and progress of video-assisted thoracoscopic surgery（VATS）, firstly, the widening surgical indications for VATS techniques, and secondly, the use of single-port VATS which is less invasive and more cosmetic. This article focuses in particular on four aspects of single-port VATS, including；（1）the individualized incision approach and its characteristics of single-port VATS；（2）single-port VATS for the treatment of pneumothorax and the development of related techniques and equipment；（3）single-port VATS for the diagnosis and treatment of thoracic diseases such as lung lobectomy；（4）the advantages and disadvantages of single-port VATS in clinical practice.
The spine is one of the most common sites for bone metastases from malignant tumors, and its incidence is increasing year by year. It often leads to severe pain, pathological fractures, nerve compression, and spinal cord dysfunction, seriously affecting the quality of life of patients. The comprehensive treatment of spinal metastases with both traditional Chinese and Western medicine has shown significant efficacy, especially in improving clinical symptoms, promoting postoperative recovery as soon as possible, and enhancing the quality of life. Based on the latest research progress at home and abroad and from the perspective of clinical application, this guideline, grounded in evidence-based medical evidence, has formed 25 recommendations covering treatment objectives, efficacy evaluation, rational selection of traditional Chinese medicine, treatment plans, and postoperative rehabilitation. It provides diagnostic and therapeutic suggestions for orthopedic oncologists, oncologists, radiologists, pain specialists, and other professionals engaged in traditional Chinese medicine, Western medicine, or integrated traditional Chinese and Western medicine, as well as specialized nurses.
Diabetic retinopathy (DR), a microvascular complication from diabetes, is the leading cause of blindness among working-age population. The blindness and low vision caused by DR has become a major public health issue. DR is a condition that occurs when diabetes affects the microvasculature and nerve tissue in the retina. Diabetic macular edema (DME), featured by thickened retina from capillary leakage in the macular area, mainly impacts central vision. The diagnostic assessment and treatment options of DR have improved dramatically in recent years. Recent advances in diagnostic assessment include the introduction of wide-field imaging and optical coherence tomography angiography, which have helped clinicians in the detection of certain biomarkers that can identify disease at an early stage and predict response to treatment in DME. Recently, treatment of DR and DME has been diversified: apart from the classic laser photocoagulation therapy, anti-vascular endothelial growth factor has become the first-line therapy for central-involved DME. In addition, steroids and micropulse laser have maintained a role in the management of DME in specific situations. Different combinations of medicine, surgery and laser treatments offered various options for patients, while making it more challenging for clinical doctors to propose the most appropriate solution. In such circumstances, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association, and National Clinical Research Center for Eye Diseases incorporated the best updated knowledge and evidence and developed Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022). The guideline aims to standardize and offer a comprehensive guide for DR prevention, screening, referral and follow-up schedule, and appropriate management of DR in different stage, including DME, as well as systemic management and patient education.
ObjectiveRecent advancements in the researches on cholangiocarcinoma (CC) related genes methylation in CC were reviewed and the clinical significances of aberrant DNA methylation for the diagnosis and treatment of CC were discussed. MethodsRelevant literatures about the relation between CC-related genes methylation and CC published recently were collected and reviewed. ResultsThe genesis of CC resulted from abnormal expressions of many genes. Many researches had shown that the abnormal methylation of CC-related genes had a close relation with CC. Epigenetic alteration had been acknowledged as an important mechanism contributing to early CC carcinogenesis. ConclusionsAbnormal methylation of CC-related genes is related with CC. The detection of CC-related genes methylation might provide new specific biomarkers for early noninvasive diagnosis of this disease. Using epigenetic agents such as azacytidine to modulate the activities of DNA methyltransferase and reverse the methylation status of CC-related gene might be an attractive strategy for future treatment of CC, which could be combined with conventional therapies.
The high incidence of hydatid disease in seven northwestern provinces, is one of the reason of "Poverty due to illness, and return poverty due to illness" in China. The incidence of chest hydatid disease in China after hepatic hydatid disease ranks second. Department of thoracic surgery in the First Affiliated Hospital of Xinjiang Medical University is on the domestic leading position of the treatment of chest hydatid disease. Since 1956 the first case of pulmonary hydatid cyst were completed, we have successfully finished the surgical treatment of pediatric chest hydatid disease, chest hydatid disease complex, huge pulmonary hydatid cyst, mediastinal and pleural hydatid cyst, and rib hydatid in our department. To further standardize the treatment of chest hydatid disease, a special formulation of "technical specification for chest hydatid disease diagnosis expert consensus" by our department were produced, in order to help clinicians treat chest hydatid disease by more suitable strategies. This consensus was released in July 2015, for the original version. The definition, diagnosis, treatment principle, and prevention of chest hydatid disease were elaborated and clinical experiences of 60 years were combined with in this consensus, in order to help the clinicians for diagnosis, treatment, and prevention of hydatid disease.