Cutaneous squamous cell carcinoma (cSCC) is the second most common human skin tumor. In recent years, the incidence of cSCC is increasing annually. Although most cSCC is curable after basic treatment, the advanced cSCC progresses rapidly and poses a significant risk for the impact on quality of life and death. In 2017, the latest version of cSCC management guideline was developed by the American Academy of Dermatology (AAD) based on extensive evidence-based medical evidence, including cSCC biopsy techniques, histopathological assessment, clinical staging and grading, surgical and nonsurgical treatment, follow-up, recurrence prevention, and management of the advanced cSCC. The purpose of this article is to briefly introduce and interpretate this guideline.
The Standards of Medical Care in Diabetes released by the American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies, the Standards of Medical Care in Diabetes is annually updated by ADA. The statements of ADA on diagnosis, assessment, and management in diabetes are recommended for clinicians, patients, and researchers. The latest edition of Standards of Medical Care in Diabetes was published in a supplementary issue of Diabetes Care in January 2018. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
In November 2019, the American Heart Association updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. This update is not a comprehensive revision of the 2015 version. The updates for children and newborns mainly include three aspects: ① Pediatric basic life support: A. It is recommended that emergency medical dispatch centers offer dispatcher-assisted CPR instructions for presumed pediatric cardiac arrest. B. It is recommended that emergency dispatchers provide CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress. ② Pediatric advanced life support: A. The bag-mask ventilation is reasonable compared with advanced airway interventions (endotracheal intubation or supraglottic airway) in the management of children during out-of-hospital cardiac arrest (OHCA). B. The extracorporeal CPR may be considered for pediatric patients with cardiac diagnoses who have in-hospital cardiac arrest (IHCA) in settings with existing extracorporeal membrane oxygenation protocols, expertise, and equipment. C. Continuous measurement of core temperature during targeted temperature management is recommended; for infants or children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, targeted temperature management is recommened. ③ Neonatal resuscitation: A. In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. B. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. C. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen.
Objective To evaluate evidence from American medical risk monitoring and precaution system (AMRMPS) which may affect the construction of Chinese medical risk monitoring and precaution system (CMRMPS). Methods We searched relevant databases and Internet resources to identify literature on AMRMPS, medical errors, and patient safety. We used the quality evaluation system for medical risk management literature to extract and evaluate data. Results In 1999, a report from the Institute of Medicine (IOM) not only showed the severity and cause of medical errors in America but also gave the solution of it. In 2000, the Quality Interagency Coordination Task Force (QuIC) was appointed to assess the IOM report and take specific steps to improve AMRMPS. After 5 years, a well-developed medical risk management system was established with the improvement in the public awareness of medical errors, patient safety, performance criteria of medical safety, information technology and error reporting system. There was still some weakness of this system in risk precaution and prevention. Conclusion The experience from AMRMPS can be used to establish the CMRMPS. Firstly, we should disseminate and strengthen the awareness of medical risk and patient safety in public. Secondly, we should establish hospital audit system which includes auditing of medical staff and course of medical risk in continuing and academic education. Thirdly, we should develop regulations and guidelines on health care, medical purchase and drug supply which will benefit in management of regular work. Fourthly, we should develop computer information system for hospital which will regulate the management without the disturbance from human. Lastly, we should emphasize outcome evaluations and strive for perfection during the process.
American Heart Association (AHA) updated the advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest in the AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care in November 2018. Based on the latest progress of relative evidence-based clinical evidence and 2015 AHA guidelines for cardiopulmonary resuscitation and cardiovascular emergency cardiovascular care. This update gave recommends on the use of antiarrhythmic drugs during resuscitation from adult shock-refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest and immediately after restoration of spontaneous circulation following shock-refractory VF/pVT cardiac arrest, respectively. This review aims to interpret this update by reviewing the literature and comparing the recommends in this update with other guidelines.
In October 2020, the American Heart Association issued the 2020 edition of guidelines for cardiopulmonary resuscitation and cardiovascular first aid, which comprehensively revised cardiopulmonary resuscitation and emergency cardiovascular care guidelines related to adults, children, newborns, resuscitation education science and treatment system. According to the latest edition of International Liaison Committee on Resuscitation’s classes of recommendation and levels of evidence, relevant suggestions are put forward. This article interprets the main updated and revised content, including children’s basic and advanced life support and neonatal resuscitation, in order to better guide emergency personnel and improve the quality of cardiopulmonary resuscitation and cardiovascular first aid.
Surgical management of osteoarthritis of the knee: evidence based guideline contains 38 recommendations pertaining to the preoperative, perioperative, and postoperative care of patients with knee osteoarthritis (KOA) who are considering surgical treatment. Compared with the domestic consensus on diagnosis and treatment for KOA, this clinical practice guideline (CPG) prepared by the American Academy of Orthopedic Surgeons (AAOS) has some advantages in terms of methodology selection and recommendation. Therefore, it is necessary for us to interpret this CPG to speed up the understanding and dissemination of the CPG. The ultimate aims are to: ① strengthen the standardization and understanding of surgical treatment of KOA; ② enhance the understanding of clinicians for this CPG in treating KOA; ③ speed up the development of guideline development methodologies in China; ④ provide methodological guidance for the development of CPG based on the current situation in China.
In the American Heart Association’s Scientific Sessions 2021, the results of six clinical trials related to cardiovascular surgery were revealed. The PALACS trial demonstrated that posterior left pericardiotomy during open heart surgery was associated with a significant reduction in postoperative atrial fibrillation; the EPICCURE study found that injection of mRNA encoding vascular endothelial growth factor (VEGF-A mRNA) directly into the myocardium of patients undergoing elective coronary artery bypass grafting (CABG) improved patients’ heart function; the VEST trial once again proved the safety and potential value of external stent for vein graft. This article will interpret the above-mentioned three studies.
The 2025 American Thyroid Association Guidelines for the Management of Differentiated Thyroid Cancer in Adults, supported centrally by evidence-based medical evidence, has introduced systematic updates to the diagnostic pathways, treatment regimens, and follow-up strategies for thyroid cancer. Its content not only covers multidisciplinary fields such as internal medicine, surgery, radiology, and pathology, but also fully incorporates perspectives from patient populations—further enhancing the alignment of the guidelines with clinical practice and achieving comprehensive coverage of the whole-course management for differentiated thyroid cancer. In the field of surgical management, the guidelines focus primarily on four core areas: the scientific definition of thyroid resection scope, the rational planning of lymph node dissection scope, the precise protection of the recurrent laryngeal nerve, and the whole-course preservation of parathyroid function. For these key aspects, the guideline has put forward specific and guiding recommendations based on rigorous evidence-based medical evidence and multidisciplinary team consensus. This article integrates the expert interpretation findings from the 2024 American Thyroid Association annual meeting, providing a prospective organization and summary of the key clinical practice points and basis for updates in its surgical management chapter.
ObjectiveTo compare the citations of Chinese literature in the 2015 and 2025 editions of the American Thyroid Association (ATA) guidelines, aiming to evaluate the progress in the field of differentiated thyroid cancer (DTC) research in China. MethodsChinese literature cited in the 2015 and 2025 ATA guidelines was collected and cataloged. A comparison was conducted between the two editions regarding the number of publications, source journals, affiliated institutions and their regional distribution, research types, and research foci of the cited literature. Results ① Changes in the quantity and regional distribution of Chinese citations: in the 2025 ATA guideline, the proportion of Chinese literature cited increased by nearly two times compared to the 2015 ATA guideline [8.8% (128/1 458) vs. 3.3% (36/1 078), P＜0.001]. The number of source journals increased by nearly three times (74 vs. 21), the number of contributing cities nearly doubled (29 vs. 13), and the number of involved healthcare institutions increased by nearly three times (65 vs. 18). In terms of regional distribution, compared to the 2015 ATA guideline, where institutions producing cited literature were mainly located in the Taiwan region (11 publications), the Hong Kong region (11 publications), and coastal and Beijing-Tianjin-Hebei rigions of the Chinese mainland (12 publications), the 2025 ATA guideline showed a expansion of distribution to medical centers in regions such as Beijing-Tianjin-Hebei, Yangtze River Delta, Pearl River Delta, Chengdu, and Changchun. Among these, West China Hospital of Sichuan University had the highest number of cited publications nationwide (20 publications). The proportion of cited literature from institutions in the Chinese mainland increased significantly compared to that from the Taiwan and Hong Kong regions [69.2% (45/65) vs. 16.9% (11/65) and 13.8% (9/65)]. ② Changes in research types of cited literature: clinical research constituted the majority [83.3% (30/36) and 97.7% (125/128), respectively] of the cited Chinese literature in both the 2015 and 2025 ATA guidelines. However, three basic research studies appeared in the 2025 ATA guideline. Cited literature in both editions was predominantly single-center studies [86.7% (26/30) and 93.8% (90/96), respectively]. ③ Changes in research foci of cited literature: the number of research foci involved in the 2025 ATA guideline (19 foci) increased by nearly doubled compared to the 2015 ATA guideline (11 foci). Among them, iodine-131 therapy was the most cited research focus in both editions. Among research foci with ≥5 citations, besides traditional areas such as tumor staging and prognosis, and surgical methods and extent which remained top-ranked, the ranking of recurrent laryngeal nerve protection rose. The ranking of some traditional research foci, such as molecular markers, imaging, preoperative diagnosis, declined. Notable newly prominent or significantly changed foci included ablation therapy (12 publications, ranked 2nd), comprehensive treatment (11 publications), lymph node metastasis (10 publications), parathyroid protection (7 publications), thyroid cancer and pregnancy risks (5 publications), and active surveillance (5 publications). ConclusionsCompared to the 2015 ATA guideline, the 2025 ATA guideline cites a higher proportion of Chinese literature, demonstrates a wider geographical distribution of publication origins (expanding from Taiwan region, Hong Kong region, and coastal developed area to major regional centers across China), and covered broader and more in-depth research foci. This suggests that the field of DTC in China has undergone robust development in recent years, with a gradual shift from traditional focuses such as cure rate and recurrence rate towards improving long-term quality of life, developing individualized, and precise comprehensive management models. China is playing an increasingly important role in establishing global DTC diagnostic and treatment standards. However, high-quality prospective, multicenter, randomized controlled trials remain to be strengthened.