Success Rate and Complications of Internal Jugular Vein Catheterization With and Without Ultrasonography Guide

Background: Central venous catheterization (CVC) is an important procedure in emergency departments (EDs). Despite existence of ultrasonography (US) devices in every ED, CVC is done using anatomical landmarks in many EDs in Iran. Objectives: This study aimed to compare the traditional landmark method vs. US-guided method of CVC placement in terms of complications and success rate. Patients and Methods: In this randomized controlled trial, patients who were candidate for internal jugular vein catheterization, and referred to Baqiyatallah Hospital ED were randomly allocated into US-guided CVC and anatomical landmarks guided CVC groups. Central vein access time, number of attempts, success rate, and complications in each group were evaluated. Mann-Whitney U, chi-square and Fisher exact tests along with Pearson and Spearman correlation coefficients were used to analyze the data. Results: Out of 100 patients, 56 were male and 44 were female. No significant differences were found between the US-guided and traditional landmark methods of CVC insertion in terms of age, gender, BMI, and site of catheter insertion. The mean access time was significantly lower in the US-guided group (37.12 ± 17.33 s vs. 63.42 ± 35.19 s, P < 0.001). The mean number of attempts was also significantly lower in the US-guided group (1.12 ± 0.3 vs. 1.58 ± 0.64 times, P < 0.001). Eighty-eight percent of patients in the US-guided group were catheterized in the first attempt, while 50% of patients in the traditional landmark group were catheterized in the second or more attempts (P < 0.001). The success rate was 100% in the US-guided group, while it was 88% in the landmark group (P = 0.013). Moreover, the rate of complications was significantly lower in the US-guided group (4% vs. 24%, P = 0.004). Conclusions: The US-guided method for CVC placement was superior to the traditional landmark method in terms of access time, number of attempts, success rate, and fewer complications

Limits on the Time Evolution of Space Dimensions from Newton's Constant

Limits are imposed upon the possible rate of change of extra spatial dimensions in a decrumpling model Universe with time variable spatial dimensions (TVSD) by considering the time variation of (1+3)-dimensional Newton's constant. Previous studies on the time variation of (1+3)-dimensional Newton's constant in TVSD theory had not been included the effects of the volume of the extra dimensions and the effects of the surface area of the unit sphere in D-space dimensions. Our main result is that the absolute value of the present rate of change of spatial dimensions to be less than about 10^{-14}yr^{-1}. Our results would appear to provide a prima facie case for ruling the TVSD model out. We show that based on observational bounds on the present-day variation of Newton's constant, one would have to conclude that the spatial dimension of the Universe when the Universe was at the Planck scale to be less than or equal to 3.09. If the dimension of space when the Universe was at the Planck scale is constrained to be fractional and very close to 3, then the whole edifice of TVSD model loses credibility.Comment: 22 pages, accepted for publication in Int.J.Mod.Phys.

The Prevalence of Amblyopia in 7-year-old Schoolchildren in Iran

Purpose: To determine the prevalence of amblyopia in schoolchildren aged 7 years in Iran, its relation with refractive errors, and its determinants. Methods: In this cross-sectional study, cluster sampling was done from elementary school students in 7 cities in Iran. In all schools, an optometrist conducted all tests, including measurement of uncorrected and corrected visual acuity, cycloplegic refraction, and cover test. In this study, amblyopia was defined as best corrected visual acuity 20/30 or less or a 2-line interocular optotype acuity difference with no pathology. Results: Of the 4157 students selected for the study, 3675 participated and final analyses were done with data from 3547 children. The prevalence of amblyopia was 1.88 (95 CI: 1.24-2.52) (n=63). The prevalence was 1.91 (95 CI: 0.85-2.97) in boys and 1.85 (95 CI: 1.12-2.58) in girls (p=0.92). Among these cases, 60.30 (n=38) were unilateral. Also, 61.9 were strabismic, 27.0 were anisometropic, 9.5 were isometropic, and one case (1.6) was due to congenital cataracts. Amblyopic individuals were more hypermetropic and the mean cylinder error was significantly higher. Conclusion: Necessary attention should be paid to amblyopia, although its prevalence in Iran is mid-range when compared with other countries. Amblyopia is more common in hyperopic and astigmatic individuals and therefore it is important to pay more attention to this refractive error during childhood. Since strabismus is the most common cause of amblyopia in Iran, children need to be checked for strabismus before the age of 5 years. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted

Fermionic microstates within Painlev\'e-Gullstrand black hole

We consider the quantum vacuum of fermionic field in the presence of a black-hole background as a possible candidate for the stabilized black hole. The stable vacuum state (as well as thermal equilibrium states with arbitrary temperature) can exist if we use the Painlev\'e-Gullstrand description of the black hole, and the superluminal dispersion of the particle spectrum at high energy, which is introduced in the free-falling frame. Such choice is inspired by the analogy between the quantum vacuum and the ground state of quantum liquid, in which the event horizon for the low-energy fermionic quasiparticles also can arise. The quantum vacuum is characterized by the Fermi surface, which appears behind the event horizon. We do not consider the back reaction, and thus there is no guarantee that the stable black hole exists. But if it does exist, the Fermi surface behind the horizon would be the necessary attribute of its vacuum state. We also consider exact discrete spectrum of fermions inside the horizon which allows us to discuss the problem of fermion zero modes.Comment: LaTeX, 20 pages, 2 figure

The randomised uterine septum transsection trial (TRUST) : Design and protocol

Peer reviewedPublisher PD

Acute hypoxia-reoxygenation and vascular oxygen sensing in the chicken embryo.

Fetal/perinatal hypoxia is one of the most common causes of perinatal morbidity and mortality and is frequently accompannied by vascular dysfunction. However, the mechanisms involved have not been fully delineated. We hypothesized that exposure to acute hypoxia-reoxygenation induces alterations in vascular O2 sensing/signaling as well as in endothelial function in the chicken embryo pulmonary artery (PA), mesenteric artery (MA), femoral artery (FA), and ductus arteriosus (DA). Noninternally pipped 19-day embryos were exposed to 10% O2 for 30 min followed by reoxygenation with 21% O2 or 80% O2 Another group was constantly maintained at 21% O2 or at 21% O2 for 30 min and then exposed to 80% O2 Following treatment, responses of isolated blood vessels to hypoxia as well as endothelium-dependent (acetylcholine) and -independent (sodium nitroprusside and forskolin) relaxation were investigated in a wire myograph. Hypoxia increased venous blood lactate from 2.03 ± 0.18 to 15.98 ± 0.73 mmol/L (P < 0.001) and reduced hatchability to 0%. However, ex vivo hypoxic contraction of PA and MA, hypoxic relaxation of FA, and normoxic contraction of DA were not significantly different in any of the experimental groups. Relaxations induced by acetylcholine, sodium nitroprusside, and forskolin in PA, MA, FA, and DA rings were also similar in the four groups. In conclusion, exposure to acute hypoxia-reoxygenation did not affect vascular oxygen sensing or reactivity in the chicken embryo. This suggests that direct effects of acute hypoxia-reoxygenation on vascular function does not play a role in the pathophysiology of hypoxic cardiovascular injury in the perinatal period

TeV and Superheavy Mass-Scale Particles from Supersymmetric Topological Defects, the Extragalactic Gamma-ray Background, and the Highest Energy Cosmic Rays

Cosmic topological defects in a wide class of supersymmetric theories can simultaneously be sources of higgs particles of mass comparable to the supersymmetry breaking scale $\sim$ TeV, as well as superheavy gauge bosons of mass $\sim\eta$, where $\eta$ (>> 1 TeV) denotes the associated gauge symmetry breaking scale. For cosmic strings with $\eta\sim 10^{14}$ GeV, the higgs decay can account for the extragalactic diffuse gamma ray background above $\sim$ 10 GeV, while the gauge boson decay may explain the highest energy cosmic ray flux above $\sim 10^{11}$ GeV, provided that particle production is the dominant energy loss mechanism for cosmic strings, as recent simulations suggest. By the same token, cosmic strings with $\eta$ much above $\sim 10^{14}$ GeV will be ruled out.Comment: 4 pages, Revtex, includes 1 figure, major changes in text, arguments made more general, main conclusions unchanged, version accepted for publication in PR

Contribution of NADPH Oxidase to Membrane CD38 Internalization and Activation in Coronary Arterial Myocytes

The CD38-ADP-ribosylcyclase-mediated Ca2+ signaling pathway importantly contributes to the vasomotor response in different arteries. Although there is evidence indicating that the activation of CD38-ADP-ribosylcyclase is associated with CD38 internalization, the molecular mechanism mediating CD38 internalization and consequent activation in response to a variety of physiological and pathological stimuli remains poorly understood. Recent studies have shown that CD38 may sense redox signals and is thereby activated to produce cellular response and that the NADPH oxidase isoform, NOX1, is a major resource to produce superoxide (O2·−) in coronary arterial myocytes (CAMs) in response to muscarinic receptor agonist, which uses CD38-ADP-ribosylcyclase signaling pathway to exert its action in these CAMs. These findings led us hypothesize that NOX1-derived O2·− serves in an autocrine fashion to enhance CD38 internalization, leading to redox activation of CD38-ADP-ribosylcyclase activity in mouse CAMs. To test this hypothesis, confocal microscopy, flow cytometry and a membrane protein biotinylation assay were used in the present study. We first demonstrated that CD38 internalization induced by endothelin-1 (ET-1) was inhibited by silencing of NOX1 gene, but not NOX4 gene. Correspondingly, NOX1 gene silencing abolished ET-1-induced O2·− production and increased CD38-ADP-ribosylcyclase activity in CAMs, while activation of NOX1 by overexpression of Rac1 or Vav2 or administration of exogenous O2·−significantly increased CD38 internalization in CAMs. Lastly, ET-1 was found to markedly increase membrane raft clustering as shown by increased colocalization of cholera toxin-B with CD38 and NOX1. Taken together, these results provide direct evidence that Rac1-NOX1-dependent O2·− production mediates CD38 internalization in CAMs, which may represent an important mechanism linking receptor activation with CD38 activity in these cells