Control group-B Research Articles

Efficacy of Laparoscopic-Assisted Subcostal Transversus Abdominis Plane (TAP) Block: A Double-Blind, Randomized Controlled Trial

Objective: To analyze efficacy of laparoscopic administered Transversus Abdominis Plane (TAP) block on pain scores and opioid consumption in the first 24 hours in patients undergoing laparoscopic cholecystectomy. Study design and setting: The randomized, double-blinded trial was conducted in surgical unit, Shalamar Medical & Dental College Lahore from September 2019 to March 2020. Methodology: 100 patients of either gender scheduled for elective laparoscopic cholecystectomy were included using consecutive probability sampling method. After informed consent, patients were randomized into Intervention TAP GroupA and Control Group-B. Intervention TAP Group-A received laparoscopic aided TAP block with 20ml 0.5% Ropivacaine in subcostal region while Control Group-B received 20ml saline solution which was used as placebo. Both groups received paracetamol 1gm intravenous eight-hourly and Ketorolac 30mg intravenous 12-hourly. Nalbuphine 5mg intravenous was administered as “rescue analgesic” in patients having pain score of four or above. Postoperative pain scores at rest and on coughing were documented using numerical rating scores (VAS) at 2, 4, 6, 12, and 24 hours. Results: There was a significant difference (p-value=0.038, 0.000, 0.025, 0.000, 0.000) in pain scores over the first 24 hours postoperatively in laparoscopically assisted Intervention TAP Group-A. The total nalbuphine consumption was significantly reduced in Intervention TAP Group-A as compared to Control Group-B. Conclusions: Laparoscopic administered TAP block significantly reduced postoperative pain and total opioid consumption following laparoscopic cholecystectomy

Comparison of Enhanced Recovery after Surgery Protocols with Conventional Treatment Protocols in Patients Undergoing Emergency Laparotomy: A Randomised Controlled Study

Introduction: Enhanced Recovery After Surgery (ERAS) is a multimodal and multidisciplinary approach intended to reduce the length of stay, postoperative complications, and readmission rates. The benefits of ERAS protocols in elective surgery are well established; however, the evidence to support their safety and efficacy in emergency surgery is rare. Aim: To compare the modified ERAS protocol with conventional management protocol following emergency laparotomy regarding the time taken to recover bowel function and the incidence of postoperative complications, duration of postoperative hospital stay, need for readmission, and 30 day mortality. Materials and Methods: The present study was a randomised controlled study conducted in the Department of General Surgery, Pt BD Sharma Institute of Medical Sciences, Rohtak, Haryana, India over a period of two years from June 2017 to May 2019. It included a total of 70 patients who presented in an emergency with perforation peritonitis. A total of 10 patients were excluded based on the exclusion criteria, and the remaining 60 patients were randomised into the Group-A (case group/ERAS group) and the control Group-B (control group/conventional group), with 30 patients in each group. Postoperative outcomes like postoperative complications, time of appearance of bowel sounds, time to first flatus, time to first defaecation, time to resumption of normal diet, and length of hospital stay were noted in both groups. Results: The length of hospital stay was shorter in the case group (8.83±4.69 days) compared to the control group (12.23±8.65 days); however, the difference was not statistically significant (p=0.064). Similarly, the difference in the time taken for the recovery of bowel sounds, postoperative complications, and 30 day mortality was also statistically insignificant between the two groups. No patient required readmission in either group. Conclusion: The use of ERAS protocols in emergency surgery is feasible, but all the elements of ERAS are difficult to apply in an emergency setting. Hence, a tailored approach to the ERAS protocols has to be used in emergency surgery. However, no significant benefit was noted in the group following modified ERAS protocols compared to the group following conventional protocols.

Prospective study on biochemical markers causing recurrent miscarriages in Iraqi women of reproductive age

Objective: To compare the levels of elemental calcium, vitamin D3, malondialdehyde and super oxide dismutaseenzymes in serum of women having recurrent miscarriages with normal healthy pregnant women.Method: The prospective study was conducted at Al-Karkh Maternity Hospital, Baghdad, Iraq, and Al-Alawia MaternityHospital, Baghdad, Iraq, from February to August 2022, and comprised adult pregnant women having recurrentmiscarriages without being hypertensive or diabetic in group A and normal healthy pregnant women in control groupB. Blood samples were obtained from all the subjects. Besides, placental tissues were obtained from some membersfrom both the groups. Levels of elemental calcium, vitamin D3, malondialdehyde and superoxide dismutase enzymesin serum were evaluated and compared between the groups. Malondialdehyde and super oxide dismutase enzymesin the placental tissues were also compared. Data was analysed using SPSS 20.Results: Of the 140 women, 70(50%) were in each of the 2 groups. The overall age range of the sample was 18-43years. Placental tissues were obtained from 40(57.14%) in group A and 30(42.85%) in group B. In group A, miscarriagewas reported in the first trimester in 45(62.3%) cases, 21(30%) in the second trimester and 4(5.7%) in the third trimester.Mean level of serum elemental calcium, vitamin D3, malondialdehyde and super oxide dismutase were significantlydifferent between the groups (p<0.05), and the same was the case with the placental tissues (p<0.05).Conclusion: The causes of recurrent miscarriage in women could be attributed to changes in the levels of elementalcalcium, vitamin D3, super oxide dismutase and malondialdehyde in serum and placental tissues.Keywords: Pregnancy, Abortion, Spontaneous, Malondialdehyde, Cholecalciferol, Placenta, Vitamins, Oxides.

In-vivo anticoccidial efficacy of green synthesized iron-oxide nanoparticles using Ficus racemosa Linn leaf extract. (Moraceae) against Emeria tenella infection in broiler chicks

Coccidiosis is an acute gastrointestinal parasitic disease and causes approximately $2.80 to $3.27 per m2 loss in a broiler farm of a 33-day-old flock. In this study, iron oxide nanoparticles (IONPs) were green synthesized using the aqueous leaf extract of Ficus racemosa as a reducing and capping agent to reduce the emerging resistance in coccidia spores against conventional treatments and boost the immune level in broilers. These IONPs were evaluated for their impacts on the growth performance, biochemistry, blood profile, and histology in the coccidiodized broiler chicken with Emeria tenella under in vivo conditions. The characteristics and stability of particles were obtained using UV-Vis spectroscopy, Fourier transforms infrared (FTIR), X-Ray diffraction (XRD), energy dispersive X-ray absorption (EDX), scanning electron microscopy (SEM), zeta potential and zeta size. The results indicated that IONPs at the moderate dose of 15 mg/kg (p = 0.001) reduced the coccidial impacts by eliminating oocyst shedding per gram feces (up to 91%) and reducing clinical symptoms (lesions (LS = 0), bloody diarrhea (No), and mortality (0%) in chicken at day 10 of treatment as compared to the negative control group-B (infected & non-treated). A dose-dependent and time-dependent trend were observed during treatments (10, 15, and 20 mg/kg) of 1–3 weeks using IONPs against the coccidial impacts on the growth parameters (body weight gain, mean feed consumption, feed conversion ratio) and biochemistry (plasma glucose, total protein, uric acid, ALT, AST, and ALP) in chickens. Additionally, F. racemosa IONPs at a dose of 15 and 20 mg/kg significantly recovered the parasitized and highly damaged hepatocytes, liver tissues, and ceca tissues after 1–3 weeks of treatment in broiler chickens. Overall, the 15 mg/kg concentration of IONPs exhibited fast recovery and growth enhancement in coccidiodized broilers. Therefore, the 15 mg/kg dose of green synthesized IONPs using leaf extract of F. racemosa could be a potential and safe anticoccidial agent with targeted implications in the poultry industry.

Clinical effect of reduning combined with gamma globulin treatment on symptom improvement serum levels of IL-6, 25-(OH)D and LDH in children with severe mycoplasma pneumonia.

Objectives:To investigate the effects of Reduning combined with gamma globulin on symptom improvement and serum levels of interleukin-6 (IL-6), 25-hydroxyvitamin D[25-(OH)D] and lactate dehydrogenase (LDH) in children with severe mycoplasma pneumonia (MP).Methods:A total of 123 children with severe MP admitted to the Changzhou Cancer Hospital affiliated to Soochow University from May 2018 to April 2020 were selected as subjects and randomly divided into three groups: control Group-A, control Group-B and the observation group, with 41 cases in each group. Control Group-A was given with Reduning, control Group-B was treated with gamma globulin, while the observation group was treated with Reduning injection combined with gamma globulin. The clinical efficacy, symptom improvement, incidence of adverse reactions, serum levels of IL-6, 25-(OH)D, LDH, Toll-like receptor 4/myeloid differentiation factor 88 (TLR4/MyD88) signaling pathway and T lymphocyte subsets before and after treatment were statistically compared between the three groups.Results:The total effective rate of treatment in the observation group was higher than that in control Group-A and control Group-B (p<0.05); The time for body temperature, lung rales, and cough to return to normal in the observation group was shorter than that in control Group-A and control Group-B (p<0.05). After treatment, the observation group had lower serum levels of IL-6, LDH, and higher levels of 25-(OH)D compared with control Group-A and control Group-B (p<0.05). Moreover, the observation group had lower serum expressions of TLR4 and MyD88 (p<0.05), higher serum levels of CD4+, CD4+/CD8+, and lower CD8+ compared with control Group-A and control Group-B (p<0.05). No significant difference can be seen in the comparison of the incidence of adverse reactions between the three groups (p>0.05).Conclusions:Reduning combined with gamma globulin in the treatment of severe MP is worthy of clinical promotion and application. With such a treatment regimen, the immune function of children with severe MP can be significantly enhanced, the inflammatory response can be suppressed, and symptom improvement can be promoted, further improving the treatment outcome.

Effect of acupuncture at the EX-HN3 (Yintang) point on pre operative anxiety levels in patients undergoing surgery under general anaesthesia

Pre-operative anxiety is unpleasant state of psychological distress, uneasiness or tension. Increased pre-operative anxiety has correlation with increased post-operative pain, analgesic requirement and prolonged hospitalisation. Due to the associated side effects with pharmacological methods many non-pharmacological methods have been adopted. Acupuncture lacks side effects and is of relatively low cost. Hence we assess the pre-operative anxiety levels in patients undergoing surgical procedures by using acupuncture at EX-HN3 (Yintang) point.To assess the effect of acupuncture on pre-operative anxiety levels in patients undergoing surgery under general anaesthesia.A total of 240 patients undergoing surgery under general anaesthesia will be included in the study. Patients will be randomized in to two groups.Group A: Patients receiving acupuncture at EX-HN3 (Yintang) point.Group B: Patients not receiving acupuncture.At the pre-operative visit, on the day of surgery before and after acupuncture therapy, the patient will be assessed for anxiety scores using.The two groups were comparable demographically. Pre-operative anxiety levels as assessed by objective criteria (HR, BP, RR) shown significant reduction in intervention group(P&amp;#60;0.001) compared to the control group(P=0.0556). The scores on STAI-S6 and Amsterdam scale were reduced in acupuncture Group A(P&amp;#60;0.001) (P&amp;#60;0.001) compared to control GroupB(P=0.47) (P=0.0095) respectively.Acupuncture at EX-HN3 (Yintang) point decreases pre operative anxiety levels effectively in patient undergoing surgery under general anaesthesia.

Observation on the Clinical Curative Effect of Acupuncture for Stroke Hemiplegia According to Muscle Tension Evolution Rule

Objective: Patients with hemiplegia after stroke were treated with acupuncture according to the evolution of muscle tension combined with rehabilitation exercises, conventional acupuncture combined with rehabilitation exercises, and rehabilitation exercises alone, then the clinical effects were compared.&lt;br/&gt; Methods: According to the random number table method, 125 stroke hemiplegia patients were randomly divided into three groups: control group A (n = 42), control group B (n = 40), and observation group (n = 43). Patients in control group A were treated with rehabilitation exercise therapy, patients in control group B were treated with conventional acupuncture combined with rehabilitation exercises, and patients in the observation group were treated with staging acupuncture according to the evolution of muscle tension combined with rehabilitation exercises once a day for four weeks. Before and after treatment, patients were evaluated using the simplified Fugl–Meyer assessment (FMA) scale, modified Barthel index (MBI), and nerve function imperfection (NFI). The differences within and between groups were evaluated, and clinical efficacies after treatment were compared.&lt;br/&gt; Results: Before treatment, the differences in FMA, MBI, and NFI scores among the three groups were not statistically significant (P &gt; 0.05). After treatment, the FMA score and MBI of the three groups were significantly improved, and the NFI scores were significantly reduced. Afterreduced. After treatment, FMA and MBI scores were in the following order: observation group &gt; control group B, control group B &gt; control group A (P &lt; 0.05). NFI scores were in the following order: observation group &lt; control group B, control group B &lt; control group A (P &lt; 0.05). &lt;br/&gt; Conclusion: The curative effects were in the following order: acupuncture according to the evolution of muscle tension combined with rehabilitation exercises &gt; conventional acupuncture combined with rehabilitation exercises &gt; rehabilitation exercises alone.

Specific Cytokine Assay for the Diagnosis and Prognosis of Malaria in Adult Patients in a Holoendemic Lagos, Nigeria

Background: During Plasmodium falciparum infection, cytokines are said to be elevated in the peripheral blood and may contribute to parasite clearance and also, likely to be responsible for many of the symptoms and pathological changes observed during malaria disease. Aim: this study evaluated specific cytokines as possible tool for diagnosis and prognosis of uncomplicated malaria in adult patients. Methods: Prospective 147 apparently malaria adult patients were microscopically screened and parasite load quantified. Blood donors (n=30) were used as control group A (CA) and parasite negative patients (n=26) as control group B (CB). The study took place between Aug. and Dec. 2014. The Cytokines (IL 12 and IL 18) levels were measured using ELIZA method. The data generated were analyzed using SPSS (15) two step cluster analysis for categorical variable and ANOVA excel single factor package was used to test significance differences between test and control groups. Results: Only 34/147 (23.1 %) were malarial positive, with mean parasite density of 2,384 ± 26,191 parasites/μl. Uncomplicated adult malaria had lower (30.2 ± 56.7ng/L) IL-12 concentration when compared with the controls and higher (30.9 ± 36.5ng/L) IL-18 for CA and not for CB. The mean analyses of variance between the groups were not statistically significant at 95% confidence interval: IL- 12 T versus (vs.) CA, P=0.899; IL-12 T vs. CB, P=0.600. For cytokine IL-18 (T) vs. CA, P=0.674; IL-18 (T) vs. CB, P=0.509. There was no significant difference between the two control groups: IL -12 CA vs. CB, P=0.7696 and IL-18 CA vs. CB, P=0.599. Conclusion: Excluding the outliers, the low production of IL-12 with higher level of IL-18 by majority of the patients indicates protective characteristics of pro-inflammatory cytokines studied; this is prognostic in nature. However, the report of mean ratio (IL-12/lL18) of 0.886, 0.955 and 0.916 ng/L for the T, CA and CB respectively were not discriminatory and therefore not diagnostic.

Efficacy of Nebulized Magnesium Sulphate in the Treatment of Acute Bronchial Asthma Compared to Nebulized Salbutamol: A Randomized Control Trial

Background: Nebulized salbutamol is commonly used in treatment of asthma in children. The use of nebulized MgSO4 is one of the different treatment options available during acute exacerbation.&#x0D; Objective: To compare the efficacy of nebulized MgSO4 with nebulized salbutamol in the treatment of acute asthma in children.&#x0D; Materials and method: This randomized controlled study was conducted in Dhaka Medical College Hospital between January to December 2016. Children of 7-12 years with acute exacerbation of asthma were randomized into study group-A (MgSO4 group, n=30) and control group-B (Salbutamol group, n=30). Children of both groups were treated with serial nebulization thrice at 20 minute intervals by either 2.4 ml (4% MgSO4, 96 mg) or salbutamol (0.15 mg/kg minimum 2.5 mg) with 2.5 ml of isotonic normal saline.&#x0D; Results: The mean final PEFR were not different between the two groups (275.0±41.42 L/min in MgS04 group and 263±36.17 L/min in salbutamol group). The increase in PEF was statistically significant and comparable in both groups (by 35.1% in the MgS04 group and by 42.1% in the salbutamol group). Fischl score improvement was comparable and significant in both groups (4.31 to 0.43 in MgS04 group and 4.29 to 0.76 in salbutamol group). Statistically significant increase in oxygen saturation and reduction of heart rate was found in MgS04 group without any side effects. Nebulized MgSO4 was found having significant bronchodilator effect which is comparable to salbutamol.&#x0D; Conclusion: Nebulized MgS04 was found equally effective as nebulized salbutamol in the treatment of severe acute asthma in children.&#x0D; Bangladesh J Child Health 2020; VOL 44 (1) :24-29

Evaluation of basic surgical skill workshop at undergraduate level in the discipline of surgery.

Objective:To evaluate the effectiveness of basic surgical skill workshop at under graduate level.Methods:This was randomized controlled study (cross-over design) conducted at Al-Nafees Medical College and hospital from 1st January to November 30th 2017. Undergraduate medical students of Year-5 MBBS were randomized into two groups to undergo surgical skills training. One was workshop or interventional Group-A, other was traditional teaching or control Group-B. Online random sampling calculator was used for randomization. Both groups were given a pretest and post-test in the form of two OSATS station.Results:Total 49 students were enrolled in the study; Group-A had 25 whereas Group-B had 24 students. There was significant difference (p=0.000) in mean post-test scores of Group-A (36.28±6.75) and Group-B (24.17±5.09) out of 53 on OSATS station-1. Significant statistical difference (p=0.000) in the mean score of post-tests of Group-A (26.08±18.34) and Group-B (14.42±9.24) out of 37 was also noted on OSATS station-2. There was no significant difference in mean pretest scores on both stations in both groups.Conclusions:This study has suggestions in development of curriculum as it provides a quantitative substantiation indicating that workshop teaching as a learning strategy can essentially augment traditional teaching of technical skills to undergraduate medical students.

Effect of Underwater Gait Training with a Progressive Increase in Speed on Balance, Gait, and Endurance in Stroke Patients

Purpose: This study aimed to investigate the effect of progressive speed increase during underwater gait training on stroke patients’ bal ance, gait, and endurance, as well as to compare the effects of underwater gait training and land gait training. Methods: Subjects were randomly allocated into three groups. Underwater gait training group (n=10), land gait training group (n=9) and control group (n=9). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. The patients were assessed before and after the experiment in terms of the Berg balance scale, characteristics of gait, and 6-min ute walking test. Results: The beneficial effect perceived in the speed increase underwater gait training (UGT) group was significantly greater than in the groups who were trained with speed increase land gait training (LGT) group, and the control group regarding the following aspects: the Berg balance scale, the affected step length, the affected stride length, and the 6-minute walking test (p<0.05). The LGT group showed a more significant effect on the Berg balance scale, the affected step length, the affected stride length, and the 6-minute walking test (p<0.05), compared to the control group. Furthermore, the UGT group showed a significantly greater effect on the gait speed when compared to the control groupb (p<0.05). Conclusion: This study shows that progressive UGT is effective in improving balance, gait, and endurance in stroke patients. Therefore, we believe that progressive UGT may be used as a method for general physical therapy in patients with stroke.

The Effect of Stretching and Strengthening Exercise in the Management of Lateral Epicondylitis

Background: Lateral Epicondylitis (LE) is a common overuse injury of Elbow that generates pain over the lateral aspect of elbow. LE is one of the most common causes of elbow and forearm pain encountered in clinical practice commonly associated with resistant wrist or finger extension and gripping activities. The management of LE is enlightened by various form physical modalities and therapeutic exercise like stretching and strengthening exercise. The purpose of this prospective study was to investigate the effects of stretching and strengthening exercises on pain and grip strength of LE. Materials and methods : Eighty patients were enrolled, non-randomized, and divided into 2 groups an experimental Group-A of 40 (44.5 ± 1.5 years) whose receive therapeutic exercise in the form of stretching and strengthening of common extensor forearm muscle and a control Group-B of 40 (41.4 ±2.5 years). Study duration was about one year. Both Group received UST over the lateral aspect of elbow with the 3MHz frequency and 0.5 watt/cm2 intensity for 5 min three sessions per week for six weeks. They were evaluated at every weeks of treatment for six weeks. Comparison between Group-A and Group-B was done with Wilcoxon Rank sum test and unpaired ttest. Results: By the end of the trial period, statistical data analysis in between the two groups showed a significant improvement in pain scores of VAS and the maximal isometric grip strength at sixth week. Conclusion: This study depicts that therapeutic exercise is more effective in reducing pain and improvement of grip strength. So, stretching and strengthening exercise should be considered as a main therapeutic armamentarium in the management of LE.&#x0D; JCMCTA 2019 ; 30 (1) : 36-42

Effects of different ceramic primers and surface treatments on the shear bond strength of restorative composite resin to zirconium.

Data are limited about the effect of ceramic primers on the bond of zirconia to restorative resin composite. The aim of this study was to assess the effect of different surface treatments and two ceramic primers on shear bond strength (SBS) of zirconia to restorative resin composite. 100 samples of zirconium ceramic blocks were randomly divided into 5 groups (n = 20) and received the following surface treatments: a)Control groupb)AL2O3 abrasionc)Nd:YAG laserd)Er:YAG lasere)Bur preparation.Next, each group was divided into two subgroups of 20. In ten out of 20 specimens in each group, monobond plus and Tetric ceram composite resin were applied on the surface. ZPrime Plus and Elite composite were applied on the surfaces of the remaining 10 specimens in each group. Samples were then subjected to shear bond strength test in a universal testing machine until fracture. The mean SBS were calculated and statistically analyzed by two-way ANOVA and T-Test. P < 0.05 was considered statistically significant. In ZPrime plus subgroups, diamond bur yielded the highest bond strength. Laser groups showed no significant difference with the control group. In monobond plus subgroups, SBS of air abrasion and diamond bur subgroups was highest and Nd:YAG laser showed the lowest SBS. The lowest bond strength belonged to the Nd:YAG laser subgroup of monobond plus group. Type of surface preparation significantly affected the bond strength.

TAP Block in Postoperative Analgesia, A First Time Clinical Trial In Bangladesh

Background: In perioperative care, a reliable pain management is a vital appeal. Over recent years, Transversus Abdominis Plane (TAP) block is introduced as an important component of multimodal analgesia.Objective: To evaluate efficacy of TAP block in postoperative analgesia for Total Abdominal Hysterectomy (TAH) with subarachnoid block (SAB) in comparison of morphine consumption and VAS score.Methods: 60 patients were randomly allocated into 2 groups (TAP group-A &amp; control group-B). Standard SAB was applied to all patients for elective TAH. Immediate after operation classical TAP block was performed through both Lumber Triangle Of Petit (LTOP) of group A patients. Both groups were placed in Post Anesthesia Care Unit (PACU), arranged a common standard postoperative analgesic regimen for all, observed periodically and documented it accordingly in pre-designed data sheet.Results: TAP block prolonged the mean time of 1st required I/V morphine (TAP vs control, mean±SD 271.23±40.34 vs 195.33±22.16 min., p=0.001HS). Morphine requirement was also reduced (17.4±5.4 vs 26.2±4.4 mg, p=0.001HS). Pain VAS scores at rest and movement were also reduced at all time period (p? 0.01 to 0.001). There was no complication attributed to the TAP block.Conclusion: TAP block provided considerably effective postoperative analgesia in first 24 hours after major abdominal surgery like TAH.Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 3-11

The developmental gross morphology of pancreas in chick embryo after prenatal administration of valproic acid.

To determine the effects of prenatal administration of valproic acid on the developmental gross morphology of pancreas in chick embryo. Experimental study. Anatomy Department, Regional Centre, College of Physicians and Surgeons, Islamabad, from February 2010 to February 2011. An experimental group-A and control group-B, comprised of 30 eggs each. Freshly laid fertilized chicken eggs of experimental group were injected with valproic acid, incubated and hatched. Eggs of control group underwent sham treatment using normal saline. The chicks were sacrificed on hatching or day 22 of incubation, whichever was earlier. The pancreata of only alive chicks of both groups were dissected out, and evaluated for gross morphology in terms of length and weight by statistically comparing with control ones. Then pancreata were stained with aldehyde fuchsin and orange-G stain to study other obvious histological effects, if any. Chicken embryos exposed to valproic acid in ovo, showed significant decrease in length and weight of pancreata. The mean of length (cm) of pancreata in group-A was 2.208 ± 0.166, and group-B was 2.300 ± 0.102 (p=0.008). The mean of weight (g) of pancreata in group-A was 0.032 ± 0.009, and group-B was 0.048 ± 0.005 (p=0.001). Valproic acid exposure showed retarding effect on the gross development of pancreas as depicted by decrease in the length and weight of pancreata.

Women's use of nipple shields-Their influence on breastfeeding duration after a process-oriented education for health professionals.

This study investigated if a process-oriented training for health professionals will influence women's use and reasons for using a nipple shield, the baby's weight, and the duration of breastfeeding. An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support. Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with those for the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, at 3 months, and at 9 months postpartum. The mothers' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy, the babies had difficulty in grasping over the nipple, and the mothers had pain or wound on the nipple. For the mothers in the IG group, there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration. In contrast, the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields. In the IG, there were no significant difference between the use of nipple shields and the babies' weights at 3 or 9 months. The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields (p=0.02). A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems, where the problems are remedied by the use of nipple shields.

Detection of the expression level of miR-140 using realtime fluorescent quantitative PCR in knee synovial fluid of osteoarthritis patients

To examine the expression of microRNA-140 (miR-140) in osteoarthritis (OA) graded by X-ray diagnosis criteria of Kellgren and Lawrence and to provide a theoretical basis for further studing the role of miR-140 in OA development. Knee synovial fluid specimens were collected in 40 OA patients (the OA group), the OA group was divided into 4 subgroups according to X-ray diagnosis criteria of Kellgren and Lawrence: gradeIsubgroup (n=10), gradeII subgroup (n=10), gradeIII subgroup (n=10), and grade IV subgroup(n=10). Twenty patients served as a control group (the control group), including meniscus injury, cruciate ligament injury, trauma patients. The expression level of miR-140 in the knee synovial fluid was detected by real-time fluorescent quantitative polymerase chain reaction (stem-loop RT-qPCR, TaqMan). U6 snRNA was used as the reference control, and Ct value was calculated. MiR-140 was detected in all knee synovial fluid specimens. The expression level of miR-140 in the OA group was much lower than that in the control groupb (P<0.05). There was significant difference in the expression level of miR-140 between the grade IV subgroup and the gradeI, gradeII and gradeIII subgroups (all P<0.05). The expression levels of miR-140 was negatively related to the severity of OA (r=-0.917, P<0.05). MiR-140 in human knee synovial fluid can be detected conveniently by real-time PCR. The expression level of miR-140 decreases in the knee synovial fluid in OA patients, and is negatively related to the severity of OA. This may be related to the occurrence and development of OA, and can provide early potential diagnostic molecular target.

Relationship between lead, cadmium, zinc, manganese and iron in hair of environmentally exposed subjects

Trace level analysis of two toxic metals lead and cadmium and three essential metals zinc, manganese and iron was examined in hair of 25 workers of metals finishing units and metal recycling units of State of Rajasthan, India, as Exposed Group (EG). Twenty-five subjects as controls were selected from the office staff of the same units Control Group A (CGA) and 25 subjects selected from the population of State of Rajasthan, India, who were not exposed to metal pollution at their work place were selected as another control group Control Group B (CGB). Head hair samples were collected, decontaminated and digested followed by analysis for trace levels of Pb, Cd, Zn, Mn and Fe by Atomic Absorption Spectrophotometer (AAS), ECIL Model-AAS4141 using air acetylene flame. The significant levels of metals in between EG, CGA and CGB have been computed by Student’s ‘t’ test. The Pearson rank correlation of the data of five metals revealed significant positive correlation between Mn/Cd, Mn/Pb, Mn/Fe, Cd/Pb, Cd/Fe and Pb/Fe in hair of Exposed Group (EG), Mn/Zn, Mn/Cd, Mn/Pb, Zn/Cd, Zn/Pb, Cd/Pb and Cd/Fe in hair of Control Group A (CGA) and Mn/Cd in hair of Control Group B (CGB). Significant negative correlation was observed between Pb/Fe in hair of CGB.

A Process-Oriented Breastfeeding Training Program for Healthcare Professionals to Promote Breastfeeding: An Intervention Study

The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding. Ten municipalities in Sweden were randomized to either the intervention or control groups. The intervention included a process-oriented training program for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) living in either an intervention or control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, 3 months, and 9 months postpartum. As a result of the process-oriented training program for midwives and postnatal nurses, the IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03). A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.

Preventive oral supplementation with glutamine and arginine has beneficial effects on the intestinal mucosa and inflammatory cytokines in endotoxemic rats

The objective of this study was to evaluate the effect of oral supplementation with a combination of arginine and glutamine on the intestinal mucosa and inflammatory cytokines of lipopolysaccharide (LPS)-induced adult rats. Fifty Sprague-Dawley rats (average weight of 185 ± 15 g) were randomly divided into five groups: control group A (CA) and control group B (CB), both orally supplemented with 0.9% saline; group Arg, supplemented with 300 mg/kg day(-1) arginine; group Gln, supplemented with 300 mg/kg day(-1) glutamine; group AG, supplemented with 150 mg/kg day(-1) arginine and 150 mg/kg day(-1) glutamine. The experiment lasted for 2 weeks. Food intake and body weight were measured during the experiment. At 10.00 h of day 15, animals were injected with 4 mg/kg LPS (group CB, Arg, Gln, and AG) or sterile saline (group CA) after supplementation. Then at 14.00 h, all animals were killed and blood and tissue collected. The results showed that compared with group CB, arginine concentration tended to be increased (P > 0.05) in group Arg and AG, while there was no significant difference in glutamine concentration among the groups challenged with LPS. Oral supplementation with arginine or/and glutamine mitigated morphology impairment (lower villus height, P < 0.05) in the jejunum and ileum induced by LPS challenge. LPS administration resulted in a significant increase in TNF-α, IL-1β, IL-6 and IL-10 mRNA abundance. Arginine only significantly decreased TNF-α mRNA abundance in the ileum, while glutamine significantly decreased both TNF-α and IL-10 mRNA in the ileum. A combination of arginine and glutamine significantly decreased TNF-α and IL-1β mRNA abundance in both the jejunum and ileum, while they also significantly decreased anti-inflammatory IL-10 in the ileum. These results revealed that an oral supply of combined arginine and glutamine had more favorable effects on the intestinal mucosa and inflammatory cytokines than a supply of arginine or glutamine alone.