RESUMEN
Uremic pruritus is one of the skin complications that perplex patients with end-stage renal disease undergoing hemodialysis or peritoneal dialysis. Because the specific pathogenesis is not clear, there is no unified treatment plan in the world. In August 2021, the US Food and Drug Administration approved the use of difelikefalin (under the trade name Korsuva) for the treatment of moderate to severe pruritus associated with chronic kidney disease in adult patients undergoing hemodialysis. Studies have shown that difelikefalin can remarkably reduce the intensity of pruritus and improve sleep and pruritus-related quality of life. The recommended dose of difelikefalin is 0.5 μg/kg, and difelikefalin is well tolerated and has high safety. This paper reviews the pharmacological effects, pharmacokinetics, clinical efficacy and safety of difelikefalin.
RESUMEN
With the development of laparoscopic techniques, the requirement of fine dissection in surgeons is also growing. Laparoscopic technique has the advantages in the choice of anatomical level and nerve vascular protection for surgery. 4K laparoscopy provides more clear field of vision and more detailed anatomic prerequisites. Combined with surgical examples, the authors share experiences in protection of plant nerve during 4K laparoscopic radical resection of colorectal cancer.
RESUMEN
With the development of laparoscopic technology, surgeon's requirements for precise anatomy are gradually increasing. Laparoscopic system has great advantages in the selection of anatomical level, the protection of nerve and blood vessel in surgery. 4K laparoscopic system can provide high-definition vision of operative field, which is conducive to precise anatomical operation. The authors share the practical team cooperation experience of laparoscope left hemi-colectomy for colon cancer in order to provide references for surgical colleagues.
RESUMEN
OBJECTIVE:To evaluate the efficacy and safety of tolvaptan in the treatment of liver cirrhosis ascites with hyponatremia systematically,in order to provide reference for clinical drug use. METHODS:Retrieved from The Cochrane Library, PubMed,CNKI and Wanfang database,etc.,randomized controlled trials(RCTs)about tolvaptan combined with routine treatment plan(trial group)versus routine treatment plan with or without placebo(control group)in the treatment of liver cirrhosis ascites with hyponatremia were collected. The qualities of included studies were evaluated according to modified Jadad scale after extracting data. Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS:A total of 16 RCTs were included, involving 1 271 patients.The results of Meta-analysis showed that serum sodium concentration[MD=6.51,95%CI(4.64,8.39),P<0.001],24 h urine volume [MD=1.36,95%CI(1.01,1.70),P<0.001],response rate of ascites and edema [RD=0.27,95%CI (0.20,0.35),P<0.001],body weight improvement[MD=-1.11,95%CI(-1.31,-0.91),P<0.001]and abdomen circumference improvement [MD=-2.13,95%CI(-2.96,-1.31),P<0.001] of trial group were significantly superior to those of control group, with statistical significance.There was no statistical significance in the levels of blood potassium,blood pressure,heart rate,TBiL,Scr or BUN between 2 groups before and after treatment(P>0.05). The level of ALT in trial group was significantly lower than control group,with statistical significance(P=0.003). Subgroup analysis showed that there was no statistical significance in 24 h urine volume when traditional diuretics were given only in control group or not used in two groups(P>0.05);the serum sodium concentration and 24 h urine volume of other subgroups were significantly higher than those of control group,with statistical significance(P<0.001). The incidence of ADR in trial group was higher than control group as dry mouth,thirst,frequent urination,insomnia,with statistical significance(P<0.05). Total incidence of ADR in trial group was slightly higher than control group,without statistical significance (P>0.05). CONCLUSIONS:Tolvaptan has good therapeutic efficacy for liver cirrhosis ascites with hyponatremia,can effectively improves serum sodium concentration,24 h urine volume,ascites and edema,body weight and abdomen circumference,but rarely affects blood potassium,heart rate,blood pressure,liver and renal function.However,ADR as thirst should be paid attention.
RESUMEN
Objective To study a correlativity of amplitude of low frequency fluctuation change of restingstate brain activity and aphasia quotient in aphasia patients after stroke and investigate recovery and mechanism of the aphasia.Methods Adopting amplitude of low-frequency fluctuation (ALFF) in blood oxygenation level dependent functional MRI(BOLD-fMRI) and Siemens version 3.0T MR Scanner was used to obtain 12 aphasia patients and 20 normal volunteers of fMRI data.The fMRI data were processed with the software of DPARSF and analyzed by ALFF,and group analysis was performed with two sample t-test by REST software to obtain increased and decreased ALFF map.Brain regions,in which,ALFF of aphasia group was lower than that of normal control group,were done correlation analysis with aphasia quotient.Results As compared with those in normal subjects,the regions showing decreased ALFF in aphasia patients were distributed in left middle temporal gyrus,left medial prefrontal gyrus,right cerebellum,which were positively correlated with aphasia quotient (r Roi1 =0.48,r Roi2 =0.36,r Roi3 =0.28,respectively);while the regions showing increased ALFF covered left occipital lobe,precentral gyrus,insula,right precuneus.Conclusion As compared with those in normal subjects,the regions positively correlated with aphasia quotient show decreased ALFF in aphasia patients,which are one of the mechanisms of aphasia.The regions increased ALFF in aphasia patients may participate in language function of recovery.