Comparing the effect of using normal saline, N-acetyl cysteine and not using them in endotracheal tube suction on physiologic parameters and the amount of secretions in intubated patients under mechanical ventilation

Aims: Today a large number of patients hospitalized in Intensive Care Unit need mechanical ventilation via an artificial air way. Since these patients have endotracheal tube, endotracheal suctioning is necessary for increasing oxygenation, cleaning the airway and keeping it open. But this method consists of various side effects such as increased blood pressure and heart rate and respiratory rate, cyanosis, dizziness and increased intracranial pressure and hypoxia. This study aimed at comparing the effect of using normal saline serum, N-acetyl cysteine and not using them in endotracheal suctioning on physiologic parameters and the amount of secretions in intubated patients under mechanical ventilation. Material & Methods: It was a controlled clinical trial study with random allocation that was performed on 54 intubated patients hospitalized in ICU of health educational centers of Babol Medical Sciences University in 2014. Endotracheal tube suctioning was performed for each patient once without saline, the second time with 3 ml of normal saline and the third time with 2 ml of N-acetyl cysteine. Blood pressure, Heart rate, Respiratory rate, Arterial oxygen saturation were measured and recorded before each stage of suctioning and two and five minutes after that. Amount of secretions was measured after each method of suctioning. Data were analyzed by SPSS16 statistical software, variance analysis with repeated measures, ANOVA and paired t statistical tests. Results: Blood pressure, Heart rate and Respiratory rate were increased after suction in all the three groups, but these changes were higher in the group that received normal saline. Mean decrease of Arterial oxygen saturation was more in the method of receiving normal saline (p<0.05). The amount of secretion was more in the method of receiving N-acetyl cysteine (p=0.004). Conclusions: Endotracheal tube suctioning by using normal saline had more adverse effects on post- suction physiological parameters in compare with the other two methods. Therefore, it is recommended to not use normal saline in endotracheal tube suctioning to the possible extent, and if removing secretions is required, endotracheal N_acetyl cysteine should be used according to the patient's condition

Sensitivity or resistance to steroid therapy in children with idiopathic nephrotic syndrome is not associated with polymorphism of angiotensin converting enzyme (ACE)

It's about years that the relation between renin angiotensin aldosterone system (RAS) and involving enzymes such as angiotensin converting enzyme (ACE) with nephrotic syndrome is under the focus of researchers and also there are a lot of meta-analyses. However there were few studies investigated the relation of ACE polymorphism and sensitivity or resistance to steroid therapy in children. So we intend to do that. In the current study the sample size was 40 children. Among them, 22 patients were sensitive and 18 patients were resistant to steroid therapy. The samples were collected from Ali-Asghar pediatric hospital in Tehran, Iran. We used polymerase chain reaction (PCR) for the genotyping. After that, we used Chi-squared test for statistical analysis. The statistical analysis showed no significant correlation between ACE polymorphism and sensitivity or resistance to steroid therapy (P = 0.77). Although the frequency of DD genotype was higher in the resistant group, but this difference was not statistically significant. Finally we found that although based on previous studies, D allele and DD genotype are more frequent in children with idiopathic nephrotic syndrome in comparison to healthy children, but the resistance or sensitivity to steroid therapy in children is not associated with ACE polymorphism. Further meta-analysis on the studies done on children is suggested. � 2016 Parisadat Ahmadi et al

Fermat's principle in quantum gravitational optics

Interactions incorporating the vacuum polarization effects in curved backgrounds modify the null cone structure in such a way that the photon trajectories would not be the space-time geodesics anymore. The gravitational birefringence introduced as a direct consequence of these effects, will allow shifts in the photon velocities leading to polarization dependent superluminal propagation. Taking these effects into account we study Fermat's principle in the context of the 1+3 (threading) formulation of the space-time decomposition. We find an expression for the modified spacetime refractive index and show it is proportional to the light cone correction to the first order. Consequences of this modification on polarization sum rules and spatial light paths are considered.Comment: 13 Pages, REVTex format, section on gravitomagnetic monopoles is removed along with its references, new references adde

Accuracy of Visual inspection with acetic acid (VIA) for early detection of cervical dysplasia in Tehran, Iran

Objective: To evaluate the accuracy of visual inspection with 5 acetic acid (VIA) when used to detect cervical cancer and its precursors. Methods: The study population included women attended Family Planning and Gynecological Clinic in Bagher Abad Health Center and Mirza Koochak Khan Hospital for regular cervical screening tests. After obtaining informed consent from each woman, VIA was performed. One hundred with a positive VIA test and 100 women with a negative VIA test were randomly selected for this study. Cytology and colposcopy examination were performed for all 200 cases and cervical biopsies were conducted for those individuals showing abnormal colposcopic findings. Results: Nine cases in VIA-positive group and two cases in VIA-negative group had an abnormal cytology. Ninety five women in the VIA-positive group and 25 in the VIA-negative group had abnormal colposcopic findings. From biopsy examination, 67 (71) of cases in the VIA-positive group and 3 (12) cases in the VIA-negative group had a final diagnosis of dysplasia. Among biopsied samples, only 7 cases of VIA-positive group showed abnormal result and the remaining were normal. Based on these results, VIA test sensitivity and specificity were 95.7 and 44.0 respectively, while they were 10 and 92 for cytology tests. Conclusions: The results of this study indicate that although VIA is a sensitive screening test for detection of cervical dysplasia, it can not be used by itself. Applying VIA along with Pap smears helps to detect a higher number of cases with cancer precursor lesions

Malignant mixed mullerian tumor of the uterus associated with tamoxifen therapy in a patient with a history of breast cancer

Tamoxifen is the drug of choice in the treatment of breast cancer. Recent reports show an increased incidence of endometrial carcinoma in patients taking tamoxifen. In this article, we report a case of malignant mixed mullerian tumor after tamoxifen use. Copyright © 2006 by Razi Institute for Drug Research (RIDR)

Adsorption of Multi-block and Random Copolymer on a Solid Surface: Critical Behavior and Phase Diagram

The adsorption of a single multi-block $AB$-copolymer on a solid planar substrate is investigated by means of computer simulations and scaling analysis. It is shown that the problem can be mapped onto an effective homopolymer adsorption problem. In particular we discuss how the critical adsorption energy and the fraction of adsorbed monomers depend on the block length $M$ of sticking monomers $A$, and on the total length $N$ of the polymer chains. Also the adsorption of the random copolymers is considered and found to be well described within the framework of the annealed approximation. For a better test of our theoretical prediction, two different Monte Carlo (MC) simulation methods were employed: a) off-lattice dynamic bead-spring model, based on the standard Metropolis algorithm (MA), and b) coarse-grained lattice model using the Pruned-enriched Rosenbluth method (PERM) which enables tests for very long chains. The findings of both methods are fully consistent and in good agreement with theoretical predictions.Comment: 27 pages, 12 figure

Resource offload consolidation based on deep-reinforcement learning approach in cyber-physical systems.

In cyber-physical systems, it is advantageous to leverage cloud with edge resources to distribute the workload for processing and computing user data at the point of generation. Services offered by cloud are not flexible enough against variations in the size of underlying data, which leads to increased latency, violation of deadline and higher cost. On the other hand, resolving above-mentioned issues with edge devices with limited resources is also challenging. In this work, a novel reinforcement learning algorithm, Capacity-Cost Ratio-Reinforcement Learning (CCR-RL), is proposed which considers both resource utilization and cost for the target cyber-physical systems. In CCR-RL, the task offloading decision is made considering data arrival rate, edge device computation power, and underlying transmission capacity. Then, a deep learning model is created to allocate resources based on the underlying communication and computation rate. Moreover, new algorithms are proposed to regulate the allocation of communication and computation resources for the workload among edge devices and edge servers. The simulation results demonstrate that the proposed method can achieve a minimal latency and a reduced processing cost compared to the state-of-the-art schemes