Cooling dialysate during in-center hemodialysis:Beneficial and deleterious effects

The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and effcacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confrm the encouraging outcomes mentioned here.

Postpartum intrauterine device contraception: A review

AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period （within 10 min）, early post placenta period （10 min to 72 h）, and de-layed/interval period （greater than 6 wk）. Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS： IUD insertion in the immediate postpartum （within 10 min of placental delivery）, early postpartum （10 min up to 72 h） and Interval/Delayed （6 wk onward） were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal （copper） IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION： IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.

CLOSED REDUCTION AND PERCUTANEOUS K-WIRES FIXATION OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

To observe the effects of closed reduction and percutaneous K wires fixation of displacd supracondylar humerus fracture in children MethodsRetrospective review of fourteen patients who sustained displaced supracondylar fracture of distal humerus treated by closed reduction and percutaneous K wires fixation Results. All patients’ K wires were removed at 4 weeks post operation Their elbow function regained at 8 weeks The average period of followed up was 10 month (varies from 6 to 18 month), all fractures healed very well without any permanent complications Two transient nerves palsy,ulnar and radial nerve each, recovered completely at 12 weeks and 16 weeks post operation respectively Conclusion. Closed reduction and percutaneous K wires fixation is a safe and efficient treatment for displaced humerus surpracondylar fracture in children

Single incision slings:Are they ready for real life?

AIM： To review of the efficacy and safety outcomes of different single incision slings （SIS） systems, also in comparison with traditional slings.METHODS： A literature search was conducted in PubMed/MEDLINE database. The research was re-stricted to randomized and/or prospective trials and retrospective studies, published after 2006, with at least 20 patients with non-neurogenic stress urinary incontinence （SUI）. The studies had to assess effcacy and/or safety of the SIS with a minimum follow-up of 12 mo. All the paper assessing the performance of tension free vaginal tape secur were excluded from this review. The fnal selection included 19 papers fulflling the aforementioned criteria. Two authors independently reviewed the selected papers.RESULTS： Four different SIS systems were analysed： Ajust , Ophira , Altis and MiniArc . The average objective cure rate was 88%. Overall no statistically significant differences were found between SIS and traditional mid-urethral slings （MUS） in terms of objective cure （all P 〉 0.005）. Only one paper showed a statistically lower success rate in MiniArc？ vs Advant-age？ slings （40% vs 90%） and higher rates of failure in the SIS group. Since there was a great variability in terms of tests performed, it was not possible to com-pare subjective cure between studies. The vast part of the studies showed no major complications after SIS surgery. We also observed very low reported pain rates in SIS patients. The RCTs on Ajust？ and MiniArc？, showed better outcomes in terms of post-operative pain compared to MUS. None of the patients reported long- term pain complains. CONCLUSION： SIS showed similar effcacy to that of traditional slings but lower short-term pain, complication and failure rates.

Safety and Efficacy of Digoxin TherapymWhere Are We Now？

The aim of our study was to determine the criteria and key factors for the effectiveness of digoxin therapy. A prospective opened-type study was carried out in conditions of everyday clinical practice. The concentrations of digoxin were quantified from blood samples taken following the achievement of drug steady-state （using AxSYM microparticle enzyme immunoassay-MEIA）. The risk/benefit ratio was evaluated based upon the correlation between measured blood concentrations of the drug and clinical response. Study results （100 decompensated patients） revealed that therapy indication field was correctly covered, showing a higher prevalence in elderly. On average, each examinee had 2 or 3 comorbidities. Applied daily dose of digoxin ranged from 0.053 mg to 0.25 mg. Renal function was assessed by creatinine clearance which is one of the key factors for the accomplishment of optimal digoxin serum concentrations （p 〈 0.05）. Co-administration of seven drugs was complicating factor for the management of rational therapy. 76/100 patients were within referent range （0.8-2.0 ng/mL）, while 13/100 were above the upper limit. Four side effects in total were recorded （nausea, vomiting, confusion）, whereas in only two patients digoxin was excluded from the therapy. Digoxin confirmed the justifiability of its use in contemporary clinical practice.

Comparison of the effect and safety of Kuntai capsule and hormone replacement therapy in patients with perimenopausal syndrome:a systematic review and Meta-analysis

OBJECTIVE: To assess the effectiveness and safety of Kuntai capsule and hormone replacement therapy in treatment of perimenopausal syndrome.METHODS: Articles were retrieved from the databases Cochrane Database of Systematic Reviews,Pub Med, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database. Only randomized controlled trials were included; 15 trials involving1243 patients were identified from January 2005 to April 2015. A systemic review and Meta-analysis of publications was performed. The review was limit-ed to randomized controlled trials that compared Kuntai capsule and hormone replacement therapy to treat perimenopausal syndrome for at least 3months. The primary outcome assessed was the treatment efficacy at 3 months, including effective rate of Kupperman menopausal scores, Kupperman menopausal scores, and blood estradiol(E2) or blood follicle stimulating hormone(FSH) levels.Other outcomes assessed were safety or adverse events, such as gastrointestinal complaints, breast distending pain, or vaginal bleeding.RESULTS: Kupperman menopausal scores showed no significant difference in effective rate [odds ratio(OR): 1.05, 95% confidence intervals(CI): 0.71 to1.55] and changes in FSH level [mean difference(MD): 2.14, 95% CI:-2.36 to 6.65]. There was a significant statistical difference in Kupperman menopausal scores(MD:-1.14, 95% CI:-2.03 to-0.25)and changes in E2level(MD:-16.41, 95% CI:-18.83to-13.69). There were fewer adverse events in the Kuntai capsule group than in the hormone replacement therapy group(OR: = 0.35, 95% CI: 0.25 to0.48, P < 0.01).CONCLUSION: Compared with hormone replacement therapy, Kuntai capsule can improve perimenopausal symptoms and blood E2 levels, and reduce the incidence of adverse events.