Weeks In Control Group Research Articles

Effect of Meconium Stained Liquor on Mode of Delivery and Fetomaternal Outcome in a Tertiary Level Hospital

Background: The appearance of meconium-stained liquor during labour is generally considered to be a sign of hypoxia and a predictor of poor fetal outcome.It is one of the clinical events where normal pregnancy can turn into a high risk one for the mother as well as for the foetus.
 Objective: To evaluate the obstetric outcome in meconium stained liquor during labour.
 Study design: Prospective comparative study.
 Study setting and period: Gynaecology and Obstetrics department of Sir Salimullah Medical College and Mitford Hospital (SSMC and MH), Dhaka, between January 2019 to June 2019.
 Study population: The study patients in labour with meconium stained amniotic fluid and women in labour but having clear amniotic fluid who admitted for delivery during study period.
 Result: A total 75 cases were enrolled in the study as case and 75 cases were enrolled as control. The mean age was found 29.14±5.59 years in case group and 28.9±6.2 years in control group. Patients received irregular ANC was 20(26.7%) and 25(33.3%) in case and control group respectively. Patients who did not receive ANC was 24(32.0%) in case group and 12(16.0%) in control group. Mean gestational age at delivery was found 38.87±1.4 weeks in case group and 38.75±1.6 weeks in control group. Primigravida was predominant in both groups. Caesarean deliveries were high (80.0%) in cases and it was much higher with thick meconium (74.7%) as compared to thin meconium (25.3%). APGAR scores in first minute and fifth minute were also low in cases. Birth asphyxia was found 20.0% in case group and 6.3% in control group. Meconium aspiration syndrome 25.0% and convulsion 3.8% developed only in cases. Neonatal ward admission was 22.0% in case group and 6.3% in control group. Neonatal mortality was higher (3.8%) in cases than control 1.3%. Majority (6.65%) patients had post partum hemorrhage in case group and 3(4.0%) in control group.
 Conclusion: Meconium stained amniotic fluid were associated with higher rate of caesarian delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission, and mortality. Electronic foetal monitoring, timely obstetrical intervention and neonatal care can reduce associated complications and improve foetal outcome.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 43-49

Association Between Periodontal Diseases and Preeclampsia

Objective: The goal of this study is to examine whether or not periodontal disease is linked to preeclampsia. Methodology: One hundred participants (fifty cases and fifty controls) were recruited in the research after providing informed consent. Demographic details such as age, address, smoking, and parity was recorded. All periodontal disease pregnant women were allotted in cases group and normotensive pregnant women were allotted control group, the association between the two groups was investigated by applying O.R and chi square test. Results: Mean age was calculated as 25.81+3.91 years in cases and 24.71+5.73 years in control group, mean gestational age was 37.11+3.62 weeks in cases and 38.11+3.24 weeks in control group. The association of periodontal diseases and pre-eclampsia shows that 24(48%) in cases and 10(20%) in control group, O.R 3.69 and p-value=0.003. Conclusion: We came to the conclusion that there is a high link between the association between periodontal diseases and preeclampsia. Keyword: Pregnant women, periodontal disease, preeclampsia, association

RTID-06. A RANDOMIZED CONTROLLED TRIAL USING ACCELERATOR-BASED BNCT SYSTEM FOR REFRACTORY RECURRENT HIGH-GRADE MENINGIOMA

Abstract BACKGROUNDS Recently, nuclear reactors have been replaced with accelerator-based neutron sources (ABNS) for boron neutron capture therapy (BNCT). High-grade meningiomas (HGM) are refractory, especially recurred after some radiotherapy. We are now applying randomized controlled trial (RCT) of “A phase II clinical trial using accelerator-based BNCT system for refractory recurrent high-grade meningioma”. STUDY DESIGN PMDA in Japan which is a counter part of FDA in USA suggested the importance of RCT even for this exploratory clinical trial for HGM. Along to this suggestion, we prepared 2 study groups, BNCT test treatment group and control best supportive care (BSC) group. Progression free survival (PFS) was set-up as primary endpoint. Rescue BNCT is allowed for control group patients, if they showed progress disease (PD) during observation. Two-dimensional modified Macdonald criteria is adopted for assessment. METHODS The trial started in August 2019. Eighteen subjects were enrolled and divided in 12 and 6 subjects for BNCT and control BSC group, respectively. Cyclotron-based ABNS system was used for neutron source. Neutron-irradiation time is determined not to exceed to 7.5 Gy-Eq for scalp dose which was referencing preceding phase I trial for malignant gliomas. The last patient-in was August 2021. INTERIM RESULTS (as of April 30, 2022): All 6 cases of control group were judges as PD. Seven out of 11 cases of BNCT group were judged as PD. One case of BNCT group dropped out from the study with withdrawal of consent. Median PFS were 8 and 64 weeks for control group and BNCT group, respectively. Log-rank test showed marked statistical difference with p-value of 0.000401 between these 2 groups. CONCLUSIONS This RCT showed a marked difference of PFS between accelerator-based BNCT group and control group, so far. We will keep on observation at least next 2 years for other endpoints.

12-week Moderate-intensity Brisk Walking Improved Chronotropic Response In 40- To 69-year-old Patients With Hypertension

PURPOSE: The aim of this study was to investigate the effect of 12-week brisk walking on chronotropic response in 40- to 69-year-old hypertensive patients in order to provide a scientific theory for improving the prognosis of hypertension with exercise. METHODS: In this study, we included 68 hypertensive patients aged 40-69 in Beijing and Hebei Province in 12-week brisk walking intervention, and 34 hypertensive patients age- and gender-matched as control group. The patients included were free of beta blocker therapy. Participants in exercise group underwent 12-week brisk walking 3 times a week, with the intensity gradually increased from 40-49% to 50-59% heart rate reserve, and the duration gradually increased from 30 to 60 minutes each time. Resting blood pressure, resting heart rate and peak oxygen consumption (VO2peak) were measured. Chronotropic parameters were calculated according to the formula, including metabolic chronotropic relationship (MCR), chronotropic response index (CRI) at all stages. %Δ means the percentage of the difference of indicators between before and after intervention. RESULTS: (1) The systolic blood pressure of hypertensive patients was decreased after intervention of 12-week brisk walking (135.60 ± 13.08 vs 128.52 ± 12.62 mmHg, p < 0.0001) compared to the control group. (2) The %ΔMCR was increased in exercise group after intervention compared to the control group. ((-0.94 ± 25.20) vs (7.14 ± 27.11) %, p = 0.013). (3) The CRI at 50 W- and 75 W-load, CRI2 and CRI3, were decreased after 12 weeks in control group (CRI2: 0.87 ± 0.22 vs 0.77 ± 0.20, p = 0.033; CRI3: 0.96 ± 0.12 vs 0.89 ± 0.10, p = 0.022), while no statistical difference was seen in the exercise group. (4) VO2peak was increased in exercise group after intervention compared to the control group (29.23 ± 4.84 vs 30.52 ± 5.21 mL/kg/min, p = 0.008). (5) The %ΔVO2peak was positively correlated with the %ΔMCR in exercise group (r = 0.269, p = 0.027). CONCLUSIONS: The 12-week moderate-intensity brisk walking significantly reduced systolic blood pressure and improved chronotropic response in 40- to 69-year-old hypertensive patients. Furthermore, the improvement of chronotropic response was associated with increased cardiopulmonary fitness. Supported by National Key Research and Development Program in China (NO. 2016YFC1300202).

Placental dysfunction in congenital heart disease: Insights from anatomical pathology

Women with congenital heart disease are at increased risk of obstetric and fetal complications during pregnancy. Placental dysfunction seems to emerge among the different etiological hypotheses. However, studies supporting this pathway are scarce, especially histopathological studies. The objectives of this study were to describe the placental lesions observed in pregnant women with CHD and to compare these findings with placentas from a control group of healthy women. In this single-center prospective study, we reported the results of 69 histopathological analyses (43 placentas from CHD and 26 from healthy women). Pathological findings were classified according to the Amsterdam Placental Workshop Group Consensus. In the control group, patients with comorbidities or risk factors for pre-eclampsia or fetal growth restriction were excluded. Patients were matched for age and BMI. Median gestational age at delivery was 38 [36–38.5] weeks for CHD group vs. 39.4 [38.5–40] weeks for control group ( P < 0.001). Pathologies were identified in 84% of CHD placentas vs. 42% of healthy placentas ( P < 0.001). Among the CHD group, there was 49% of anatomic pathologies, the main one being low placental weight for gestational age (95%). There was also 46% of vascular, 16% of infectious and 9% of inflammatory pathologies. The rate of small placentas for gestational age was significantly higher in the CHD group (46% vs. 15%, P = 0.009). As vascular pathologies, maternal vascular malperfusion (MVM) was significantly more frequent in CHD placentas (28% vs. 8%, P = 0.043). There was no significant difference between groups for infectious, inflammatory and other lesions: choriomanionitis, chorangiosis and villitis ( Fig. 1 ). Pregnant women with CHD had significantly more placental histopathologic abnormalities than healthy women. The most common placental pathologies were anatomic and vascular abnormalities. Small placenta for gestational age and MVM were significantly more present in CHD placentas. These results support the hypothesis of placental dysfunction in CHD women.

Comparison of Mean Weight, Length and Head Circumference in Preterm Neonates with Zinc Supplement Group Versus without Zinc Supplement Group

Objective: To compare mean weight, length and head circumference in preterm neonates with zinc supplement group versus without zinc supplement group. Design of the Study: Randomized controlled trial Study Settings: The study was carried out in the Pediatric Department of Lahore General Hospital Lahore from February 2021 to July 2021. Material and Methods: There were two groups of babies: one that received Zinc supplementation and one that did not (not treated with Zinc supplements). An electronic weighing scale was used to measure weight prior to intervention. Mothers were given two bottles of supplement containing zinc when their newborns were 7 to 21 days old, before being discharged from the hospital, and encouraged to feed their babies orally at a dose of 2 mg/kg/day with other multivitamins for six weeks (study group). For the same period of time, the participants in the control group were advised to take only multivitamins. Additionally, anthropometric measurements such as weight, height, and head circumference were taken. Results of the Study: In our study, mean age was calculated as 33.74+1.36 weeks in study and 33.64+1.38 weeks in control group, 54.76%(n=23) in study and 59.52%(n=25) in control group were male while 45.24%(n=19) in study and 40.48%(n=17) in control group were females Conclusion: Preterm neonates supplemented with zinc were significantly better than those without zinc supplementation with regards to mean weight, length and head circumference Keywords: Preterm neonates, zinc supplementation, birthweight, body length, head circumference

Intestinal microbiome and its relationship with necrotizing enterocolitis in very low birth weight preterm infants

Objective: To explore the composition of intestinal microflora prior to onset of necrotizing enterocolitis (NEC) in very low birth weight preterm infants. Methods: This was a multicenter prospective nested case-control study. A total of 46 very low birth weight preterm infants (birth weight <1 500 g and gestional age <35 weeks) within 24 h of life admitted into Neonatal Intensive Care Unit of Children's Hospital of Soochow University and Suzhou Municipal Hospital from April 20 to November 20, 2018 were enrolled. Baseline clinical data and fecal samples of these infants were collected. The subsequent sampling time points were 1st, 4th and 7th day in the first week of life then once per week consecutively. The endpoint of sampling was NEC occurrence, patient discharge or the 8th week post-discharge, whichever came first. Fecal samples were analyzed by 16 S rDNA high-throughput nucleotide sequencing. The control cases were infants without NEC who were matched to the NEC cases with a ratio of 1∶1. The operational taxonomic units (OTU), sequence number and shannon diversity index of the fecal samples were analyzed. Continuous variables were compared with t-test or non-parametric test, and χ2 test or Fisher's exact test was used for categorical variables. Results: There were 23 patients in each group. The gestational age was (29.4±1.8) weeks in NEC group and (29.9±1.6) weeks in control group, including 13 males (57%) and 11 males (48%) in each group, respectively. Species abundance showed that the Firmicutes in both groups decreased temporarily at 7 days of age and then increased with age in control group, but not in NEC group, the Proteobacteria in both groups increased at 7 days of age and then decreased in control group, but kept increasing in NEC group. Regarding the other levels of taxonomy, compared with that of the control group, the NEC group had lower abundance of Proteobacteria, γ-proteobacteria and Enterobacteriaceae at 7 days of age, while higer abundance of Faecalibacterium at 14 days of age, meanwhile, lower Clostridium and Streptococcus at 21 days of age, lower Firmicutes, Clostridia and Clostridium perfringens and higher Proteobacteria and γ-proteobacteria at 28 days of age, these differences were all statistically significant (U=43.00, 43.00, 45.00, 80.00, 74.00, 76.00, 19.00, 8.00, 36.00, 25.00, 25.00,all P<0.05). The shannon index of NEC group was both lower than that of the controls at 21 days of age (2.4 (1.4, 3.0) vs. 3.1 (2.6, 4.0), U=67.00, P=0.027) and 28 days of age (2.4 (1.4, 2.8) vs. 3.9 (3.3, 4.2), U=12.00, P=0.001). Conclusions: The intestinal microflora profile of very low birth weight preterm infants has already changed prior to NEC development. The emergence of differential flora and the reduction of microflora diversity may facilitate early identification and prevention of NEC.

Histomorphometrical Study of Placental Villi in Preeclampsia: A Case-control Study

Introduction: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. In this disorder, placental morphology and cellular arrangement are altered so that oxygen delivery from mother to foetus is greatly disturbed, which ultimately results in cellular oxidative stress. Morphological and histological changes are both indicative of the pathogenesis of maternal and foetal morbidity and mortality in women with preeclampsia. Aim: To study the gross and histomorphometric features of placenta in patients with preeclampsia. Materials and Methods: This case-control study was conducted from January 2017 to December 2017 at Jawaharlal Nehru Medical College Hospital in Belagavi, Karnataka, India. Total 120 placentas of preeclampsia patients (60) and normal controls (60) were studied, which were received at Pathology Department of the institute. Immediately after delivery, gross parameters were recorded. For histomorphometrical study, full-depth tissue samples of placenta were fixed in 10% neutral buffered formalin solution for 24-48 hours, and then they were processed by graded concentrations of alcohol and embedded in paraffin to make blocks. The 5 μm thick sections were cut and slides were stained with hematoxylin and eosin and the sections were studied. Values were calculated by mean±SD using Students unpaired t-test and chi-square test, p-value of &lt;0.05 was considered as significant. Results: The mean maternal age of the study participants was 23.93±4.40 years in preeclampsia group and 23.85±3.44 years in control group. The gestational age was 36.42±2.69 weeks in preeclampsia group and 38.20±2.11 weeks in control group, the difference was statistically significant. Other parameters such as neonatal weight, placental weight, placental thickness and placental diameter had statistically significant difference between both the groups. Morphological findings of placental terminal villi showed that the mean surface area was larger (2500.05±245 µm2) in preeclampsia group compared to control group (1878.01±214.53 µm2) and this difference was statistically significant. Conclusion: The gross reduction of the preeclampsia placenta like decreased placental weight and diameter disturbs the normal placentation and pathologically these results in histological and morphometric changes in the placenta. Due to oxidative stress in preeclampsia placental morphology is altered.

Obstetrics outcome in pulmonary tuberculosis

BackgroundTo evaluate the maternal and perinatal outcome in pulmonary tuberculosis cases as compared to low risk pregnancies in a tertiary referral hospital. MethodsA total of 15 cases of pulmonary tuberculosis over a period of two years who delivered in our unit was studied in the retrospective study. The maternal and perinatal outcome in them was compared with 191 low risk pregnancies who delivered at the same time in the hospital after taking into account inclusion and exclusion criteria. ResultsThe mean age and mean parity was 25.73 ± 2.85 and 28.75 ± 3.11, 2.1 and 1.9 in the 2 groups. Symptoms of pulmonary tuberculosis were cough (100%), chest pain (80%), expectoration (100%), hemoptysis (33.3%), fever (93.33%), anorexia (86.66%) and loss of weight (80%). Symptoms in study patients were significantly more common in study patients. The presence of associated medical problems was similar in the 2 groups. The prevalence of oligoamnios, gestational diabetes mellitus, antepartum hemorrhage and intrahepatic cholestasis was similar in the 2 groups. Prevalence of preterm labor was 53.33% in study group which was significantly higher than in controls (8.9%). Risk of premature rupture of membrane was also significantly higher in the study groups (53.33%) as compared to control groups (8.9%). Mean gestational age was also significantly lower (36.2 weeks) in study group as compared to 38.6 weeks in control group. The incidence of cesarean delivery was similar in the 2 groups (26.66% vs 28.79%). The mean birth weights was 2308.6 gm in the study group as compared to 2707.56 gm in control group. Fetal growth restrictions and Respiratory distress syndrome in babies was significantly higher in study group than in control group. Low APGAR score (<8) was also higher (33.3%) in study group as compared to control group (2.61%). ConclusionPulmonary tuberculosis during pregnancy is associated with increased perinatal morbidity, low birth weight, poor APGAR and increased respiratory distress rates.

Effect of Teriparatide in Fracture Healing in Lower Limbs- An Interventional Study

Introduction: Many of the trauma patients presenting to the orthopaedic departments suffer from lower limb fractures. This often leads to prolonged period of morbidity and absence from work. Fracture healing can be delayed in elderly patients, postmenopausal women and in communited fractures. Teriparatide (TPH) given subcutaneously for 6 to 9 months, in such cases, may promote clinical and radiological union of bone. Aim: To know the effect of TPH in improving clinical and radiological union and also to evaluate early weight bearing, improvement in pain and functional outcome. Materials and Methods: In this prospective interventional study, a total of 125 patients were initially enrolled for the study and then after meeting inclusion criteria total 104 patients were selected for the study. They were allocated into two groups by randomisation by 1:1 method-group A was test group of 52 cases in which subcutaneous injection TPH 20 mcg daily (for six months) was given along with standard dosage of calcium and vitamin D; while in 52 cases in group B (control group) only calcium and vitamin D were given. Injection TPH was started within 10 days of fracture and given for six months. No placebo injection was given in control group. Time to weight bearing, time to clinical and radiological union and pain by Visual Analogue Score (VAS) were noted at regular follow-up at one month, three months, six months and 12 months and were compared in both the groups. Functional outcome by Disabilities of the Arm, Shoulder and Hand (DASH) score was noted as an additional tool, as DASH score questionnaire shows many activities of daily living that require mobility and stability of lower limb too. Adverse reactions were noted and compared within test and control groups. The collected data were analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0 software and Mann-Whitney U test was used to calculate p-value. Results: Average time period for full weight bearing with or without support for test group A was 11±2.7 weeks and 16±1.8 weeks in control group B (p-0.001). Average time to clinical union in test group was 12±1.9 weeks and in control group 16±2.2 weeks (p-0.001). Average time to radiological union was 13±1.4 weeks in test group while 22±2.2 weeks in control group (p-0.001). Pain score by VAS and functional outcome by DASH were improved in test group (p-0.001). There was no difference in adverse reactions in both the groups (p&gt;0.05). Conclusion: Regular intake of TPH 20 mcg subcutaneous daily for six months can reduce time to clinical and radiological fracture union, promote early weight bearing and provide better pain control. Hence, better functional outcome and prefracture ambulatory status can be achieved with no significant adverse events.

COMPARISON OF PERINATAL OUTCOME IN TWIN PREGNANCY WITH AND WITHOUT CERVICAL CERCLAGE

Background: The incidence of multifetal pregnancies has registered increase globally. Babies born from multiplebirth pregnancies are much more likely to result in premature birth than those from single pregnancies. Knowledge of role of cervical cerclage in preventing preterm birth especially in twin pregnancy can be helpful to prevent complication related to preterm birth and ultimately of low birth weight babies. Methods: Depending upon who opt for the procedure 100 patients were divided equally into two groups: 1)Twin pregnancy with cervical cerclage; 2)Twin pregnancy without cervical cerclage. We measured maternal outcomes which include time for which patient required to be hospitalized, maternal pyrexia, cervical or bladder injury and other maternal morbidity and perinatal outcomes which include preterm delivery (delivery before 37 completed weeks), low birth weight (birth weight ≤2000 g), IUGR, perinatal mortality, indicators of perinatal morbidity (APGAR scores and neonatal unit admission), stillbirth, second trimester loss and presence of congenital malformations. Results: In Study group 22% delivered before 34 weeks of gestation, 46% delivered between 34 and 37 weeks of gestation, 32% delivered after 37 weeks of gestation compared to 44%, 48% and 8% respectively in Control group. The mean gestational age at delivery was 35.3 weeks in Study group and was 33.2 weeks in Control group. In study group 47% neonates had birth weight less than 2Kg and in Control group 69% neonates had birth weight less than 2Kg. In Study group 95% had Apgar score more than 6 whereas in Control group 86% had APGAR score more than 6. The mean APGAR for Study group was 8.5 and for Control group was 7.5. 45% neonates had complications in Study group whereas 67% neonates in Control group. Overall Low birth weight was most common complications in both the groups. Respiratory distress was more common in Control group. Conclusions: In spite of close vigilance, preterm birth in twin gestation is common and unpredictable. It is difficult to predict those who may require cervical cerclage although all multiple pregnancies are at high risk. Cerclage should be considered an option for patients with twin pregnancies in the second trimester to prolong the duration of gestation as close to term as possible.

Clinical application of dynamic locking screw in treating humeral shaft fracture

To compare clinical effect of dynamic locking screws and common screws in treating humeral shaft fractures. From January 2016 to October 2018, clinical data of 46 patients with humeral shaft fracture were retrospectively analyzed, which were divided into dynamic locking screw internal fixation group (treatment group) and ordinary screw internal fixation group (control group). In treatment group, there were 14 males and 10 females, aged from 20 to 61 years old with an average of (36.8±10.9) years old;22 patients in control group, there were 13 males and 9 females, aged from 19 to 60 years old with an average of (35.9±12.8) years old. Length of incision, operation time, amount of bleeding, fracture healing time and complications were compared between two groups, Constant-Murley score of shoulder joint and Mayo score of elbow joint at 3 and 9 months after operation were compared to evaluate clinical effect. Forty six patients were followed up from 9 to 43 months with an average of (18.6±7.9) months. There were no statistical differences in length of incision, operation time, amount of bleeding between two groups (P>0.05);fracture healing time in treatment group was (12.2±3.2) weeks, and (15.6±4.7) weeks in control group;there was difference between two groups (P<0.05). Constant-Murley score and Mayo score of elbow joint at 3 months after operation in treatment group were 84.9±5.9 and 81.8±6.7, while in control group were 74.6±9.2 and 71.5±10.7;there were differences between two groups (P<0.05). There were no statistical differences in Constant-Murley score and Mayo score of elbow joint between two groups at 9 months after operation (P>0.05);One patient occurred neural paralysis in treatment group;1 patient occurred delayedunion, 2 patients occurred bone nonunion and 1 patient occurred broken nail in control group;while there was no statistical difference between two groups in complication. Both of dynamic locking screws and ordinary screws could effectively treat humeral shaft fractures. dynamic locking screws has an advantage in fracture healing time, and recovery of early shoulder and elbow function. However, the active time of this technology is not too long in China, further study on long-term efficacy of large samples is needed.

Evaluation of therapeutic effects of the ultramicro needle knife combined with cervical spine fine adjusting on youth cervical curvature abnormality case

To study the therapeutic effects of the ultramicro needle-knife combine with cervical spine fine adjusting on youth cervical curvature abnormality case. From November 2016 to October 2018, 88 young patients with abnormal curvature of cervical spine were treated. Due to loss of follow up, 86 cases were actually completely including 37 males and 49 females, ranging in age from 20 to 40 years old, with an average of (30.55±5.21) years old, and the course of disease ranged from 1 to 42 months, with a mean of (14.21±7.38) months. All the patients were divided into two groups:treatment group (44 cases) and control group (42 cases). The patients in the treatment group were treated with ultramicro needle-knife and cervical spine fine adjusting, and the patients in the control group were treated with conventional acupuncture and manipulation. The treatments were done 1 time per week in the treatment group while 3 times per week in control group every week, with a duration of 3 weeks for both groups. Before treatment, 3 weeks after treatment, and at the end of 1 month follow-up, the score of neck pain questionnaire(NPQ), range of the motion(ROM) in the cervical region and the D values of cervical physiological curvature were recorded. The efficacy at the end of treatment and in the follow up was evaluated. During the treatment, the patients were also required to correct the bad posture in daily life, to sleep in a low pillow position, and put a moderately columnar pillow behind the neck for 0.5 hours every morning and evening. Two patients in the control group were dropped out after 3 weeks treatment. No adverse reactions were found in the 2 groups during the treatment period. Compared with those before treatment, all scores at all the observation time points were significantly improved between two groups after treatment(all P<0.05). The NPQ scores of cervical symptoms were different significantly between two groups(all P<0.05). The changing range of the the NPQ score of cervical symptoms and cervical spine alignment curve of the treatment group were better than those of the control group (P<0.05).There was statistical difference in NPQ scores between different time points, in the other words, there was time effect(F=203.63, P=0.000). There was interaction between time factor and group factor(F=4.964, P=0.012). There was no statistical difference in the changing range of the ROM score between two groups (all P>0.05). There was statistical difference in ROM scores between different time points, there was time effect (F=240.32), P=0.000). There was no interaction between time factor and group factor (F=0.311, P=0.734). The effective rate of the treatment group and control group were 90.91%(40 / 44) and 80.95%(34 / 42) respectively, the treatment group was more effective than the control group (P<0.05). During the follow-up period, the effective rate of the treatment group and the control group were 84.09%(37 / 44) and 76.19%(32 / 42) respectively. Obviously, the difference of total effective rate between two groups had no statistical signification(P>0.05) in the follow-up duration. The method of needle knife combined with cervical spine fine adjusting has a better therapeutic efficiency than conventional acupuncturecombined with manipulation in treating youth cervical curvature abnormality patients. Because this novel method can recover the cervical curvature, relieve the neck pain, and improve cervical mobility.

SUN-632 The Impact of Vitamin D Deficiency on Pregnancy in Type 1 Diabetes

Vitamin D deficiency during pregnancy may not only impair maternal skeletal preservation and fetal skeletal formation but also influence fetal “imprinting” that may affect chronic disease susceptibility soon after birth as well as later in life.Vitamin D deficiency has been linked to multiple adverse perinatal outcomes in pregnancy including; pre-eclampsia, gestational diabetes, low birth weight, bacterial vaginosis, pre-term delivery and caesarean section. Aim: to assess 25-hydroxy vitamin D (25OHD) concentrations in women with type 1 diabetes (T1DM) during pregnancy, post-delivery and also foetal (cord blood) 25OHD concentrations and to examine relationships between these. The second aim of the study to examine potential relationships between maternal 25OHD and glycosylated haemoglobin (HbA1c) throughout pregnancy. Materials and methods: This was an observational study of 42 pregnant controls without diabetes and 39 pregnant women with T1DM. Maternal serum 25OHD was measured serially throughout the pregnancy and post-delivery. Cord blood 25OHD was measured at delivery. 25OHD was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS). HbA1c was measured serially throughout the pregnancy. Control and T1DM groups were not significantly different in age or number of previous miscarriages. As expected, the T1DM group exhibited significantly higher HbA1c levels, and also had significantly increased incidence of preeclampsia (2 of 42 cases (4,8%) in control group and 5 of 39 cases in T1DM group (12,8%)) (p= 0,03). Delivery gestational age was significantly lower for babies born to mothers with T1DM (39,6±1,4 weeks in control group and 37,6±2,1 in T1DM group (p= 0,001).Vitamin D deficiency, defined as 25OHD levels,25 nmol/L, was apparent in both the control and the T1DM groups across the entire pregnancy. Greater than 90% of pregnant women were classified as insufficient at each time-point, regardless of whether they had T1DM or not. This meant that 10% of this pregnant population were at a sufficient level at some point throughout pregnancy. Similar to maternal vitamin D levels, the neonates had a high incidence of 25OHD deficiency at birth. Also were shown correlations between cord blood and maternal vitamin D. Maternal 25OHD correlated positively with cord 25OHD at all 3 trimesters in the T1DM group. Conclusions: in T1DM pregnancy, low vitamin D levels persist throughout gestation and post-delivery; maternal vitamin D levels exhibit a significant negative relationship with HbA1c levels, supporting a potential role for this vitamin in maintaining glycaemic control; larger studies investigating whether low vitamin D levels are a risk factor for preterm delivery and preeclampsia in women with diabetes are needed.

Low-level laser therapy in treatment of chemoradiotherapy-induced mucositis in head and neck cancer: results of a randomised, triple blind, multicentre phase III trial

BackgroundLow-level laser therapy (LLLT) also called Photobiomodulation therapy (PBMT) could reduce oral mucositis (OM) incidence and severity in head and neck cancer patients treated by chemoradiotherapy, however randomised data about efficacy and safety are missing with curative dose 4 J/cm2.MethodsThis phase III trial was conducted in patients with oral cavity, or oro/hypopharyngeal cancers (stage III or IV). Patients were treated by lasertherapy on OM lesions grade ≥ 2 (4 J/cm2 or placebo), during chemoradiotherapy and until recovery. Severity of OM (incidence and duration of grades ≥3) was used as primary endpoint and blindly assessed.ResultsAmong 97 randomised patients, 83 patients (85.6%) could be assessed finally (erroneous inclusions, chemoradiotherapy interruptions) and 32 patients had no lasertherapy because of unreachable OM lesions. Randomisation and population characteristics (sex ratio, age, chemoradiotherapy procedures, toxicities incidence) were still comparable between the two LLLT/PBMT groups. An acute OM (grade ≥ 3) was observed in 41 patients (49.4%): 23 patients (54.8%) of the active laser group versus 18 (43.9%) in the control group (modified intend to treat, p = 0.32). Median time before occurrence of OM ≥ grade 3 in half of the patients was 8 weeks in active laser group (vs. 9 weeks in control group). However, 95% of patients exhibited a very good tolerance of LLLT/PBMT.ConclusionsThis study assessed LLLT/PBMT according to the Multinational Association of Supportive care in Cancer recommendations but lacked power. LLLT/PBMT was well tolerated with a good safety profile, which promotes its use in clinical routine for severe OM treatment.Trial registrationClinicalTrials.gov Identifier: NCT01772706.Title: Laser Mucite ORL: Effectiveness of Laser Therapy for Mucositis Induced by a Radio-chemotherapy in Head and Neck Cancer (LaserMucite).Study Start Date: October 2008.Primary Completion Date: October 2016.Responsible Party: Institut de Cancérologie de l’Ouest – Paul Papin.Principal Investigator: Eric Jadaud, M.D., Institut de Cancérologie de l’Ouest – Paul Papin.Funding: French Ministry of Health, French national funding scheme (PHRC 2008).

Evaluation of the effect of hypnobirthing education during antenatal period on fear of childbirth

Objectives: The objective of this research was to analyse the effect of hypnobirthing education given to pregnant women during antenatal period on fear of childbirth. Methods: This is an educational interventional case-control study. A total of 51 pregnant women were studied together during the 12th week of pregnancy. Ethical Committee and related consents were taken. Data was evaluated by using descriptive statistics. Results: The age average of the pregnant in the control group was 28.70 ± 5.42 years while it was 25.74 ± 5.16 years for the case group. Women's gestational week averages were 20.87 weeks for study and 24.10 weeks for control group. In the study, the pre-training scale scores of the cases and control groups were compared with the average level of birth fear of the groups (t = 1.848, p = 0.073). There was a significant difference between pre- and post-hypnotic scale scores in the birth preparation class (t = -5.329, p &amp;lt; 0.001). Before the training; 48% of the case group. Fifty-two percent of the control group is adequately informed about the hypnobirthing problem. Conclusions: It was found that among the pregnant women who had attended birth preparation classes, positive labour perception of the intervention group pregnant women was higher than that of the control group pregnant women who hadn’t had hypnobirthing education and there was a significant difference between them.

THE EFFECT OF INTRA-ARTICULAR APPLICATION OF ALLOGENIC MESENCHYMAL STEM CELL COMBINE WITH VEGF TO GRAFT TUNNEL HEALING AND AUTOGRAFT TENDON INTEGRATION IN ACL RECONSTRUCTION; A BIOMECHANICAL STUDY

Graft-tunnel healing is the most determination factors in successful of Anterior Cruciate Ligament (ACL) reconstruction. The application of bone marrow derived mesenchymal stem cell (MSC) and vascular endothelial growth factor (VEGF) are one of integration biological augmentation method that often used in ACL reconstruction. Combination intra-articular post ACL reconstruction is expected to accelerate healing time and integration strength of tendon graft that used in bone tunnel. This method is experimental laboratory using animal model. The research is randomized post test only controlled group design. Five New Zealand white rabbit knee are used for ACL reconstruction with harmstring tendon graft and treated with combination allograft MSC and VEGF intra-articular, while five other rabbit knee as control without treatment. The evaluation is tensile test in third and six weeks post operation. Data was analyzed statistically and comparatively to compare the influence of MSC and VEGF to integration strength of graft tunnel healing. All the samples from treatment and control group found no complication after surgery. On third weeks evaluation, found a difference in failure tension load in both groups but not statistically significant (p&gt;0,05), while on six weeks evaluation, found a statistically significant difference. Treatment group has a failure tension load higher than control group. While failure type of ACL tendon graft on 3 weeks evaluation, only 2 of 5 graft have pullout failure in treatment group. However, at three weeks in control group, the failure type of the tendon graft was a midsubtance rupture in intra-articular part during biomechanical tension test. The use of BM-MSC and VEGF intra-articular can increase tension failure load. It is expected that combination of BM-MSC and VEGF can increase integration process between bone graft and healing post ACL reconstruction, so that rehabilitation and mobilisation can be done earlier.Keywords: Graft-tunnel healing, ACL reconstruction, Vascular Endothelial Growth Factor (VEGF), Bone Marrow Derived Mesenchymal Stem Cell (BMMSC)

The effect of low-level laser 810 nm and light-emitting diode photobiomodulation (626 nm) on the stability of the implant and inflammatory markers interleukin-1 beta and prostaglandin E2, around implants

One of the most common problems in edentulous patients is the low stability of lower dentures. The most effective method to overcome this problem is implant-supported overdentures. After placing an implant, for the process of osseointegration to be complete and successful, it is better that patients do not use their denture for few months. This may be nonconvenient for patient because they are unable to speak and eat properly. The aim of this study was to evaluate the effect of low level laser (LLL) and light-emitting diode (LED) photobiomodulation on implant stability as well as their effect on interleukin-1 beta (IL-1β) and prostaglandin E2 (PGE2) biomarkers around implant in lower anterior region (over denture). In this clinical trial, 36 implants were placed in fully edentulous mandibles (12 people per person - three implants in areas of midline and canine). Each of the implants was randomly placed in one of three groups of laser, LED, and control. LLL (power of 50 mw and the amount of 20 J/cm2 for each implant) and LED with dose (20 mw/cm2) were irradiated on the day of surgery (zero), 3, 7, 10, and 14 days. The stability of implants was measured on the day of surgery and weeks 3, 4, and 8 after surgery with Periotest. The inflammatory biomarkers of IL-1β and PGE2 were also collected from gingival crevicular fluid around implants in 4 and 8 weeks. The collected data were analyzed by ANOVA statistical tests.pvalue<0.05 considered significant. The amounts of Periotest significantly increased 3rd week after surgery in the control group (P < 0.001). However, the laser group and LED group were associated with minimal changes, which indicates lower stability of implant in 3rd week in control group but no changes in stability of test groups (laser and LED). Laser and LED had no effect on the level of IL-1β and PGE2 in 4 and 8 weeks. The use of LLL or LED has a positive effect on the stability of the implants 3 weeks after surgery.

Locking system strengthened by biomimetic mineralized collagen putty for the treatment of osteoporotic proximal humeral fractures.

The current study is to observe the effect of the locking system strengthened by biomimetic mineralized collagen putty for the treatment of senile proximal humeral osteoporotic fractures. From January 2012 to December 2015, 80 cases of senile patients with osteoporotic proximal humeral fractures were randomly divided into an observation group and a control group, each group with a total of 40 cases. The control group was simply treated with locking plate. The observation group was treated with locking plate in combination with biomimetic mineralized collagen putty. The therapeutic effect thereby was observed. The excellent and satisfactory rate was 90% in observation group and was 72.5% in control group. The difference between the two groups was statistically significant (χ2 = 5.3312, P < 0.05). The fracture healing time was 11.82 ± 3.62 weeks in observation group and 19.78 ± 5.46 weeks in control group. The shoulder joint function score was 89.63 ± 8.12 in observation group and 76.92 ± 8.18 in control group. There was significant difference between the two groups (t = 7.1272; 12.7834, P < 0.05). The complication rate was 10% in the observation group and 32.5% in the control group (χ2 = 7.3786, P < 0.05). Locking system strengthened by biomimetic mineralized collagen putty has advantages such as accelerating healing of senile proximal humeral fracture, improving the therapeutic effect, reducing the complications. As one of the optimal internal fixation method, it provides a new option for better treatment of senile osteoporotic fracture.

Effects of combination of maternal hydration and hands and knees posture on nursing of breech pregnancy

Objective To compare the effects of combination of maternal hydration and hands and knees posture with simple hands and knees posture on correction of breech pregnancy. Methods One hundred patients who were diagnosed breech pregnancy from November 2015 to November 2016 were assigned to experimental group and control group with 50 cases each according to individual willingness. The patients in experimental group received the combination of maternal hydration and hands and knees posture; while the patients in control group received simple hands and knees posture. Results Amniotic fluid index was (18.94±2.44)cm in experimental group and (15.97±2.33)cm in control group, the difference had statistic significance (t=6.239, P<0.05). The effective transfer rate and successfully used time was 92%(46/50), (2.10±0.75) weeks in experimental group and 64%(32/50), (4.27±0.98) weeks in control group, the difference had statistic significance (χ2=11.422, P<0.05; t=-12.463, P<0.05). For primipara and multipara, the effective transfer rate was 90.91%(30/33), 16/17 in experimental group, and 68.75%(22/32), 10/18 in control group, the difference had statistic significance (χ2=4.986, 6.806, all P<0.05). The rate of vaginal and cesarean section deliveries was 86%(43/50), 14%(7/50) in experimental group, and 56%(28/50), 44%(22/50) in control group, the difference had statistic significance(χ2=10.928, P=0.001). Patients who had fetal movement or who didn′t have time to do correction or missed was 17.10%(46/269), 1.49%(4/269) in experimental group, and 12.55%(22/255), 7.06%(18/255) in control group. Conclusions Therapic effects of combination of maternal hydration and hands and knees posture is much better than that of the simple hands and knees posture therapy on correction of breech pregnancy, which is worthy of popularization and application in clinic. Key words: Maternal hydration; Hands and knees posture therapy; Nursing care; Breech pregnancy