A Search for Lyman alpha Emitters at Redshift 3.7

We present the results of a survey for emission-line objects based on optical intermediate-band ($\lambda_{\rm c}$ = 5736 \AA ~ and $\Delta\lambda$ = 280 \AA) and broad-band ($B$, $V$, $R$, and $i^\prime$) observations of the Subaru/XMM-Newton Deep Field on the 8.2 m Subaru telescope with the Subaru Prime Focus Camera, Suprime-Cam. All the data were obtained during the guaranteed time observations of the Suprime-Cam instrument. The intermediate-band image covered a sky area with 10\minpoint62 \times 12\minpoint40 \approx 132 arcmin$^2$ in the Subaru/XMM-Newton Deep Field (Ouchi et al.). Using this image, we have found 23 emission-line sources whose observed emission-line equivalent widths are greater than 250 \AA. Their optical multicolor properties indicate that six emission-line sources are Ly$\alpha$ emitters at $z \approx$ 3.7 ($\Delta z \approx 0.22$). They are either intense starburst galaxies or active galactic nuclei like quasars at $z \approx$ 3.7. Two more emission-line sources may also be Ly$\alpha$ emitters at $z \approx$ 3.7 although their multicolor properties are marginal. Among the remaining 15 emission-line objects, eight objects appear strong emission-line galaxies at lower redshift; e.g., [O {\sc ii}] $\lambda$3727 emitters at $z \approx 0.54$, H$\beta$ at $z \approx 0.18$, or [O {\sc iii}]$\lambda$5007 emitters at $z \approx 0.15$. The remaining seven objects are unclassified because they are too faint to be detected in broad-band images. We discuss observational properties of these strong emission-line sources. In particular, our data allow us to estimate the star formation density at $z \approx 3.7$ for the first time.Comment: Accepted for publication in AJ;14 pages, 26 figures (all figures are JPEG file

Association between rapid serum sodium correction and rhabdomyolysis in water intoxication: a retrospective cohort study

Abstract Background Patients with water intoxication may develop rhabdomyolysis. Existing studies suggest a relationship between the serum sodium correction rate and rhabdomyolysis. The aim of the present study was to determine the association between the sodium correction rate and rhabdomyolysis in patients with water intoxication. Methods Medical records from all cases of water intoxication presenting to the emergency department and admitted to a single tertiary emergency hospital between September 2012 and August 2016 were examined retrospectively. Serum sodium correction rate was defined as the difference in serum sodium levels at admission and approximately 24 h after admission, divided by time. The primary outcome was rhabdomyolysis, defined as peak creatine kinase level ≥ 1500 IU/L. Logistic regression analysis was used to calculate the adjusted odds ratio of the serum sodium correction rate controlling for age, sex, convulsion, lying down for >8 h before admission to the emergency department, and serum sodium level on admission. Results A total of 56 cases of water intoxication were included in the study. The median serum sodium correction rate was 1.02 mEq/L/h, and 32 patients (62.5%) had rhabdomyolysis. Logistic regression analysis showed that serum sodium correction rate was an independent risk factor of rhabdomyolysis (adjusted odds ratio, 1.53 per 0.1 mEq/L/h; 95% confidence interval, 1.18–1.97). Conclusions Rapid correction of serum sodium was associated with rhabdomyolysis in patients with water intoxication. Therefore, strict control of serum sodium levels might be needed in such patients

Decreasing skeletal muscle as a risk factor for mortality in elderly patients with sepsis: a retrospective cohort study

Abstract Background Older patients account for the majority of patients with sepsis. The objective of this study was to determine if decreased skeletal muscle mass is associated with outcomes in elderly patients with sepsis. Methods Patients (60\ua0years and older) who were admitted to a tertiary medical center intensive care unit with a primary diagnosis of sepsis between January 2012 and February 2016 were included. Patients who had not undergone abdominal computed tomography on the day of admission, had cardiopulmonary arrest on arrival, or had iliopsoas abscess were excluded from the analyses. Cross-sectional muscle area at the 3rd lumber vertebra was quantified, and the relation to in-hospital mortality was analyzed. Multivariable logistic regression analysis that included sex and APACHE II score as explanatory variables was performed. The optimal cutoff value to define decreased muscle mass (sarcopenia) was calculated using receiver operating characteristic curve analysis, and the odds ratio for in-hospital mortality was determined. Results There were 150 elderly patients with sepsis (median age, 75\ua0years) enrolled; in-hospital mortality and median APACHE II score were 38.7 and 24%, respectively. The skeletal muscle area of deceased patients was significantly lower than that of the survival group ( P \u2009<\u20090.001). The multivariable logistic regression analysis demonstrated that decreased muscle mass was significantly associated with increased mortality (odds ratio\u2009=\u20090.94, 95% confidence interval\u2009=\u20090.90 to 0.97, P \u2009<\u20090.001). The optimal cutoff value of skeletal muscle area to predict in-hospital mortality was 45.2\ua0cm 2 for men and 39.0\ua0cm 2 for women. With these cutoff values, the adjusted odds ratio for decreased muscle area was 3.27 (95% CI, 1.61 to 6.63, P \u2009=\u20090.001). Conclusions Less skeletal muscle mass is associated with higher in-hospital mortality in elderly patients with sepsis. The results of this study suggest that identifying patients with low muscularity contributes to better stratification in this population

Neurological outcomes and duration from cardiac arrest to the initiation of extracorporeal membrane oxygenation in patients with out-of-hospital cardiac arrest: a retrospective study

Abstract Background We investigated the relationship between neurological outcomes and duration from cardiac arrest (CA) to the initiation of extracorporeal membrane oxygenation (ECMO) (CA-to-ECMO) in patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) and determined the ideal time at which ECPR should be performed. Methods During the time period in which this study was conducted, 3451 patients experienced OHCA. This study finally included 79 patients aged 18 years or older whose OHCA had been witnessed and who underwent ECPR in the emergency room between January 2011 and December 2015. Our primary endpoint was survival to hospital discharge with good neurological outcomes (a cerebral performance category of 1 or 2). Results Of the 79 patients included, 11 had good neurological outcomes. The median duration from CA-to-ECMO was significantly shorter in the good neurological outcome group (33 min, interquartile range [IQR], 27–50 vs. 46 min, IQR, 42–56: p = 0.03). After controlling for potential confounders, we found that the adjusted odds ratio of CA-to-ECMO time for a good neurological outcome was 0.92 (95% confidence interval: 0.87–0.98, p = 0.007). The area under the receiver operating characteristic curve of CA-to-ECMO for predicting a good neurological outcome was 0.71, and the optimal CA-to-ECMO cutoff time was 40 min. The dynamic probability of survival with good neurological outcomes based on CA-to-ECMO time showed that the survival rate with good neurological outcome decreased abruptly from over 30% to approximately 15% when the CA-to-ECMO time exceeded 40 min. Discussion In this study, CA-to-ECMO time was significantly shorter among patients with good neurological outcomes, and significantly associated with good neurological outcomes at hospital discharge. In addition, the probability of survival with good neurological outcome decreased when the CA-to-ECMO time exceeded 40 minutes. The indication for ECPR for patients with OHCA should include several factors. However, the duration of CPR before the initiation of ECMO is a key factor and an independent factor for good neurological outcomes in patients with OHCA treated with ECPR. Therefore, the upper limit of CA-to-ECMO time should be inevitably included in the indication for ECPR for patients with OHCA. In the present study, there was a large difference in the rate of survival to hospital discharge with good neurological outcome between the patients with a CA-to-ECMO time within 40 minutes and those whose time was over 40 minutes. Based on the present study, the time limit of the duration of CPR before the initiation of ECMO might be around 40 minutes. We should consider ECPR in patients with OHCA if they are relatively young, have a witness and no terminal disease, and the initiation of ECMO is presumed to be within this time period. Conclusions The duration from CA-to-ECMO was significantly associated with good neurological outcomes. The indication for patients with OHCA should include a criterion for the ideal time to initiate ECPR

Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report

Abstract Background Patients with left ventricular outflow tract obstruction who do not exhibit a dynamic pressure gradient at rest, experience pressure gradient increases of ≥ 30 mmHg only during specific situations; this is called latent left ventricular outflow tract obstruction. It is provoked by increased cardiac contraction and preload and afterload depletion. There are a few reports of patients with it developing cardiac arrest. We present a case of latent left ventricular outflow tract obstruction in which the patient with a sigmoid septum experienced refractory pulseless electrical activity due to conventional advanced cardiac life support. Case presentation A 73-year-old Asian woman on escitalopram and lorazepam was transported to our hospital for chest and back pain with altered consciousness. On arrival, she was in shock and developed pulseless electrical activity. After initiation of conventional cardiopulmonary resuscitation according to adult advanced cardiovascular life support guidelines, she could not regain spontaneous circulation. She was ultimately resuscitated via venoarterial extracorporeal membrane oxygenation initiation. The only abnormal laboratory result at admission was anemia. Her hemodynamic status stabilized after red blood cell transfusion, and venoarterial extracorporeal membrane oxygenation was subsequently terminated. Transthoracic echocardiography showed a sigmoid septum; dobutamine-infused Doppler echocardiography revealed a significant outflow gradient, and continuous monitoring showed Brockenbrough–Braunwald sign, which confirmed a diagnosis of latent left ventricular outflow tract obstruction due to a sigmoid septum. As a result, carvedilol and verapamil were initiated. A follow-up dobutamine-infused Doppler echocardiography showed a reduction of outflow gradient, and she was discharged without any sequelae. Latent left ventricular outflow tract obstruction worsened due to increasing cardiac contraction and the depletion of preload and afterload. Depleted preload occurred due to dehydration and anemia, whereas depleted afterload occurred due to the prescribed drugs, which subsequently caused pulseless electrical activity. Moreover, β-stimulation from the adrenaline probably enhanced the hypercontractile state and caused refractory pulseless electrical activity in our case. Conclusions Patients with latent left ventricular outflow tract obstruction can progress to cardiogenic shock and pulseless electrical activity due to increased cardiac contraction and depletion of preload and afterload. We should consider the patient’s underlying conditions that induced pulseless electrical activity

Additional file 1: Figure S1. of Effect of ultrasonography and fluoroscopic guidance on the incidence of complications of cannulation in extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a retrospective observational study

Cannulation method details of the comparison and exposure group. (PDF 8931 kb

Chest compression-related fatal internal mammary artery injuries manifesting after venoarterial extracorporeal membrane oxygenation: a case series

Abstract Background Cardiopulmonary resuscitation-related bleeding, especially internal mammary artery injuries, can become life-threatening complications after initiating venoarterial extracorporeal membrane oxygenation owing to the frequent involvement of concomitant anticoagulant treatment, antiplatelet treatment, targeted temperature management, and bleeding coagulopathy. We report the cases of five patients who experienced this complication and discuss their management. Case presentation We retrospectively evaluated five patients with cardiopulmonary resuscitation-related internal mammary artery injuries who were treated between February 2011 and February 2016 at our institution. All five patients were Asian men, aged 56 to 68-years old, who had received concomitant intravenously administered unfractionated heparin (3000 units) with antiplatelet therapy. Four patients received targeted temperature management. The injuries and hematomas were detected using contrast-enhanced computed tomography in all cases. Three patients were treated using transcatheter arterial embolization within 6 hours following cardiopulmonary arrest, and two were resuscitated and received appropriate treatment following early recognition of their injuries. Two patients died of hemorrhagic shock with delayed intervention. Four of the five patients had excessively prolonged activated partial thromboplastin times before their interventions. Conclusions Computed tomography should be performed as soon as possible after the return of spontaneous circulation to identify injuries and consider appropriate treatments for patients who have experienced cardiac arrest. Delayed bleeding may develop after treating hypovolemic shock and relieving arterial spasms; therefore, transcatheter arterial embolization should be performed aggressively to prevent delayed bleeding even in the absence of extravasation. This approach may be superior to thoracotomy because it is less invasive, causes less bleeding, and can selectively stop arterial bleeding sooner. A 3000-unit intravenous bolus of unfractionated heparin may be redundant; heparin-free extracorporeal cardiopulmonary resuscitation may be a more appropriate alternative. Unfractionated heparin treatment can commence after the bleeding has stopped