Efficacy and safety of difelikefalin in the treatment of hemodialysis patients with pruritus: A meta-analysis and systematic review.

BACKGROUND: The incidence of pruritus associated with hemodialysis (HD) patients can be as high as 70%, and ~ 40% of patients suffer from moderate to severe systemic pruritus. Difelikefalin (CR845), a peripheral restrictor κ-opioid receptor agonist, activates opioid receptors on peripheral neurons and immune cells to relieve pruritus in patients. However, the clinical effect of difelikefalin on HD-related pruritus is unclear. Therefore, the purpose of this meta-analysis and systematic review was to investigate the safety and efficacy of difelikefalin in the treatment of HD-associated pruritus. OBJECTIVE: This study explored the efficacy and safety of difelikefalin in the treatment of pruritus in HD patients by systematic review and meta-analysis. MATERIALS AND METHODS: Randomized controlled trials on difelikefalin in the treatment of pruritus in HD patients were retrieved from PubMed, Embase, Cochrane Library, and Web of Science electronic databases. The retrieval deadline was January 1, 2023. Stata 15.0 software was used for data analysis of the included studies. RESULTS: A total of 4 randomized controlled trials were included, totaling 1,268 patients (736 patients in the experimental group and 532 patients in the control group). Results of the meta-analysis showed that, compared with the control group, difelikefalin could significantly improve the Worst Itch Numeric Rating Scale score (improvement > 3; risk ratio (RR) = 1.28, 95% confidence interval (CI) (1.07, 1.53)), decrease the 5-D itch score (standardized mean difference = -0.43, 95% CI (-0.55, -0.30)), and significantly improve adverse events (RR = 1.33, 95% CI (1.13, 1.56)). CONCLUSION: Although difelikefalin can improve itching symptoms in HD patients, it can also increase adverse reactions based on the current literature. Therefore, more studies are needed to further explore the safety and efficacy of difelikefalin treatment.

Opportunity for marine fisheries reform in China.

China's 13th Five-Year Plan, launched in March 2016, provides a sound policy platform for the protection of marine ecosystems and the restoration of capture fisheries within China's exclusive economic zone. What distinguishes China among many other countries striving for marine fisheries reform is its size-accounting for almost one-fifth of global catch volume-and the unique cultural context of its economic and resource management. In this paper, we trace the history of Chinese government priorities, policies, and outcomes related to marine fisheries since the 1978 Economic Reform, and examine how the current leadership's agenda for "ecological civilization" could successfully transform marine resource management in the coming years. We show how China, like many other countries, has experienced a decline in the average trophic level of its capture fisheries during the past few decades, and how its policy design, implementation, and enforcement have influenced the status of its wild fish stocks. To reverse the trend in declining fish stocks, the government is introducing a series of new programs for sustainable fisheries and aquaculture, with greater traceability and accountability in marine resource management and area controls on coastal development. As impressive as these new plans are on paper, we conclude that serious institutional reforms will be needed to achieve a true paradigm shift in marine fisheries management in China. In particular, we recommend new institutions for science-based fisheries management, secure fishing access, policy consistency across provinces, educational programs for fisheries managers, and increasing public access to scientific data.

Exploring psychosocial factors associated with frailty incidence among patients undergoing maintenance hemodialysis.

AIM AND OBJECTIVE: We investigated the correlation between the frailty status of maintenance haemodialysis (MHD) patients and psychosocial factors. BACKGROUND: Varying degrees of frailty have been reported in MHD patients, which affect their quality of life. DESIGN: We adopted a cross-sectional design in this study. METHODS: Clinical data of 187 patients at our centre were collected from December 2017-June 2018 using a cross-sectional survey. Psychosocial factors were measured using the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, 10-item Connor-Davidson Resilience Scale (CD-RISC), Chronic Disease Self-Efficacy Scales and Perceived Social Support Scale. Frailty status was estimated using the fatigue, resistance, ambulation, illnesses and loss of weight (FRAIL) scale. Spearman's correlation and multiple logistic regression analysis were conducted to identify the risk factors for frailty. This study complied with the STROBE checklist. RESULTS: Of 187 patients, 11 cases (5.9%) of frailty were identified. Patient's age, comorbidities, parathyroid hormone level, sleep quality and depression were positively correlated with frailty (p < .05), while psychological resilience and social support were negatively correlated with frailty (p < .05). Logistic regression analysis revealed four risk factors for frailty among MHD patients, including age (p = .004), comorbidities (p = .023), depression (p = .023) and sleep disorders (p = .029). Conversely, protective factors included high psychological resilience (p = .019) and social support (p = .039). CONCLUSION: Among MHD patients, the risk factors for frailty included age, comorbidity, depression and sleep disturbance, whereas the protective factors included psychological resilience and social support. RELEVANCE TO CLINICAL PRACTICE: Frailty is not only common among older patients, but also among people of all age groups suffering from chronic diseases. Therefore, it is important to consider the health status of MHD patients and adopt targeted nursing strategies to alleviate symptoms of frailty and improve physical condition by the following ways: postpone the progress of comorbidities, improve sleep quality, control the symptoms of depression, foster psychological resilience and facilitate support from social and family.

The health-related quality of life among patients on maintenance haemodialysis: Evaluation using the "EQ-5D".

PURPOSE: We conducted a cross-sectional investigation of health-related quality of life (HRQOL) among maintenance haemodialysis (MHD) patients, and determined important predictive factors of HRQOL in these patients. METHODS: Psychological factors were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI) and the General Self-Efficacy Scale (GSES). HRQOL was evaluated with the EQ-5D. Laboratory data (albumin, haemoglobin and C-reactive protein) were collected for medical evaluation. We also collected participants' demographic data, including gender, age, et al. This study was in compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS: The mean EQ-5D score was 0.86 ± 0.12, mean HADS-anxiety score was 5.27 ± 3.41, mean HADS-depression score was 5.29 ± 3.58, mean PSQI score was 7.00 ± 4.23 and mean GSES score was 6.86 ± 2.03. Participants' mean haemoglobin was 108.18 ± 16.45 g/L, mean albumin was 41.80 ± 4.61 g/L and mean C-reactive protein was 8.88 ± 18.50 mg/L. HRQOL was negatively correlated with HADS-anxiety (r = -0.390, p < 0.001), HADS-depression (r = -0.385, p < 0.001), PSQI (r = -0.285, p < 0.001) and C-reactive protein (r = -0.198, p = 0.034). HRQOL was positively correlated with GSES (r = 0.205, p = 0.007). Age (p < 0.001), anxiety (p < 0.001), depression (p = 0.002), and postdialysis unemployment (p < 0.001) were independent risk factors for HRQOL. CONCLUSION: Different health interventions should be implemented to improve patients' HRQOL. RELEVANCE TO CLINICAL PRACTICE: The results will provide evidence for establishing healthcare interventions to maintain or improve HRQOL among this patient population.

The Diagnostic Efficacy of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI-RADS) and the American Thyroid Association (ATA) Risk Stratification Systems for Thyroid Nodules.

BACKGROUND: This study is aimed at evaluating the diagnostic efficacy of ultrasound-based risk stratification for thyroid nodules in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) risk stratification systems. METHODS: 286 patients with thyroid cancer were included in the tumor group, with 259 nontumor cases included in the nontumor group. The ACR TI-RADS and ATA risk stratification systems assessed all thyroid nodules for malignant risks. The diagnostic effect of ACR and ATA risk stratification system for thyroid nodules was evaluated by receiver operating characteristic (ROC) analysis using postoperative pathological diagnosis as the gold standard. RESULTS: The distributions and mean scores of ACR and ATA rating risk stratification were significantly different between the tumor and nontumor groups. The lesion diameter > 1 cm subgroup had higher malignant ultrasound feature rates detected and ACR and ATA scores. A significant difference was not found in the ACR and ATA scores between patients with or without Hashimoto's disease. The area under the receiver operating curve (AUC) for the ACR TI-RADS and the ATA systems was 0.891 and 0.896, respectively. The ACR had better specificity (0.90) while the ATA system had higher sensitivity (0.92), with both scenarios having almost the same overall diagnostic accuracy (0.84). CONCLUSION: Both the ACR TI-RADS and the ATA risk stratification systems provide a clinically feasible thyroid malignant risk classification, with high thyroid nodule malignant risk diagnostic efficacy.

China's little-known efforts to protect its marine ecosystems safeguard some habitats but omit others.

China's stature as the world's major producer and consumer of seafood is legendary, but its long-standing tradition of protecting marine life domestically is virtually unknown. We present the most comprehensive database on area-based marine conservation in China including 326 sites that conserve 12.98% of China's seas and address 142 conservation objectives. Twenty-two percent of shallow habitats (<10 meters) were fully or highly protected and 20% of waters 10 to 50 meters deep were conserved to some degree. Ecosystems in deeper waters (>50 meters) are critical to protect, yet <5% of these waters in China were conserved, primarily in areas with the highest chlorophyll-α concentrations. Habitats such as underwater canyons and seamounts beyond the continental shelf had no area-based protection. While China has made progress in marine protection within its boundaries, there is more work to be done to ensure that the full suite of marine life is safeguarded.

Factors related to spiritual health in Chinese haemodialysis patients: A multicentre cross-sectional study.

Aim: This study aimed to investigate the current situation of the spiritual health of maintenance haemodialysis (MHD) patients in China and analyse the influencing factors. Methods: A total of 418 patients who underwent maintenance haemodialysis in three grade A tertiary hospitals were selected. The influencing factors were evaluated with demographic questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12), Family APGAR Index, Herth Hope Index (HHI) and Acceptance of Illness Scale (AIS). Results: Spiritual health was positively correlated with the HHI, Family APGAR and AIS scores. Nationality, HHI score, Family APGAR score and AIS score were independent influencing factors of spiritual health. MHD patients had a moderate level of spiritual health. Nationality, hope, family function and acceptance of illness were significant predictors of spiritual health. Patients who have higher hope levels, better family functioning and better illness acceptance may maintain better spiritual health.