Hemodynamic impact of ephedrine on hypotension during general anesthesia : a prospective cohort study on middle-aged and older patients

Background Ephedrine is a mixed α- and β-agonist vasopressor that is frequently used for the correction of hypotension during general anesthesia. β-responsiveness has been shown to decrease with age; therefore, this study aimed to determine whether aging would reduce the pressor effect of ephedrine on hypotension during general anesthesia. Methods Seventy-five patients aged ≥ 45 years were included in this study, with 25 patients allocated to each of the three age groups: 45–64 years, 65–74 years, and ≥ 75 years. All patients received propofol, remifentanil, and rocuronium for the induction of general anesthesia, followed by desflurane and remifentanil. Cardiac output (CO) was estimated using esCCO technology. Ephedrine (0.1 mg/kg) was administered for the correction of hypotension. The primary and secondary outcome measures were changes in the mean arterial pressure (MAP) and CO, respectively, at 5 min after the administration of ephedrine. Results The administration of ephedrine significantly increased MAP (p < 0.001, mean difference: 8.34 [95% confidence interval (CI), 5.95–10.75] mmHg) and CO (p < 0.001, mean difference: 7.43 [95% CI, 5.20–9.65] %) across all groups. However, analysis of variance revealed that the degree of elevation of MAP (F [2, 72] = 0.546, p = 0.581, η2 = 0.015 [95% CI, 0.000–0.089]) and CO (F [2, 72] = 2.023, p = 0.140, η2 = 0.053 [95% CI, 0.000–0.162]) did not differ significantly among the groups. Similarly, Spearman’s rank correlation and multiple regression analysis revealed no significant relation between age and the changes in MAP or CO after the administration of ephedrine. Conclusion The administration of ephedrine significantly increased MAP and CO; however, no significant correlation with age was observed in patients aged > 45 years. These findings suggest that ephedrine is effective for the correction of hypotension during general anesthesia, even in elderly patients

Rotation in the NGC 1333 IRAS 4C Outflow

We report molecular line observations of the NGC 1333 IRAS 4C outflow in the Perseus Molecular Cloud with the Atacama Large Millimeter/Submillimeter Array. The CCH and CS emission reveal an outflow cavity structure with clear signatures of rotation with respect to the outflow axis. The rotation is detected from about 120 au up to about 1400 au above the envelope/disk mid-plane. As the distance to the central source increases, the rotation velocity of the outflow decreases while the outflow radius increases, which gives a flat specific angular momentum distribution along the outflow. The mean specific angular momentum of the outflow is about 100 au km/s. Based on reasonable assumptions on the outward velocity of the outflow and the protostar mass, we estimate the range of outflow launching radii to be 5-15 au. Such a launching radius rules out that this outflow is launched as an X-wind, but rather, it is more consistent to be a slow disk wind launched from relatively large radii on the disk. The radius of the centrifugal barrier is roughly estimated, and the role of the centrifugal barrier in the outflow launching is discussed.Comment: Accepted to ApJ. 29 pages, 8 figure

The Co-evolution of Disk and Star in Embedded Stages: The Case of the Very Low-mass Protostar

We have observed the CCH (N=3-2, J=7/2-5/2, F=4-3 and 3-2) and SO (6_7-5_6) emission at a 0"2 angular resolution toward the low-mass Class 0 protostellar source IRAS 15398-3359 with ALMA. The CCH emission traces the infalling-rotating envelope near the protostar with the outflow cavity extended along the northeast-southwest axis. On the other hand, the SO emission has a compact distribution around the protostar. The CCH emission is relatively weak at the continuum peak position, while the SO emission has a sharp peak there. Although the maximum velocity shift of the CCH emission is about 1 km s^-1 from the systemic velocity, a velocity shift higher than 2 km s^{-1} is seen for the SO emission. This high velocity component is most likely associated with the Keplerian rotation around the protostar. The protostellar mass is estimated to be 0.007^{+0.004}_{-0.003} from the velocity profile of the SO emission. With this protostellar mass, the velocity structure of the CCH emission can be explained by the model of the infalling-rotating envelope, where the radius of the centrifugal barrier is estimated to be 40 au from the comparison with the model. The disk mass evaluated from the dust continuum emission by assuming the dust temperature of 20 K-100 K is 0.1-0.9 times the stellar mass, resulting in the Toomre Q parameter of 0.4-5. Hence, the disk structure may be partly unstable. All these results suggest that a rotationally-supported disk can be formed in the earliest stages of the protostellar evolution

Infalling-Rotating Motion and Associated Chemical Change in the Envelope of IRAS 16293-2422 Source A Studied with ALMA

We have analyzed rotational spectral line emission of OCS, CH3OH, HCOOCH3, and H2CS observed toward the low-mass Class 0 protostellar source IRAS 16293-2422 Source A at a sub-arcsecond resolution (~0".6 x 0".5) with ALMA. Significant chemical differentiation is found at a 50 AU scale. The OCS line is found to well trace the infalling-rotating envelope in this source. On the other hand, the CH3OH and HCOOCH3 distributions are found to be concentrated around the inner part of the infalling-rotating envelope. With a simple ballistic model of the infalling-rotating envelope, the radius of the centrifugal barrier (a half of the centrifugal radius) and the protostellar mass are evaluated from the OCS data to be from 40 to 60 AU and from 0.5 to 1.0 Msun, respectively, assuming the inclination angle of the envelope/disk structure to be 60 degrees (90 degrees for the edge-on configuration). Although the protostellar mass is correlated with the inclination angle, the radius of the centrifugal barrier is not. This is the first indication of the centrifugal barrier of the infalling-rotating envelope in a hot corino source. CH3OH and HCOOCH3 may be liberated from ice mantles due to weak accretion shocks around the centrifugal barrier, and/or due to protostellar heating. The H2CS emission seems to come from the disk component inside the centrifugal barrier in addition to the envelope component. The centrifugal barrier plays a central role not only in the formation of a rotationally-supported disk but also in the chemical evolution from the envelope to the protoplanetary disk

Subarcsecond Analysis of Infalling-Rotating Envelope around the Class I Protostar IRAS 04365+2535

Sub-arcsecond images of the rotational line emission of CS and SO have been obtained toward the Class I protostar IRAS 04365$+$2535 in TMC-1A with ALMA. A compact component around the protostar is clearly detected in the CS and SO emission. The velocity structure of the compact component of CS reveals infalling-rotating motion conserving the angular momentum. It is well explained by a ballistic model of an infalling-rotating envelope with the radius of the centrifugal barrier (a half of the centrifugal radius) of 50 AU, although the distribution of the infalling gas is asymmetric around the protostar. The distribution of SO is mostly concentrated around the radius of the centrifugal barrier of the simple model. Thus a drastic change in chemical composition of the gas infalling onto the protostar is found to occur at a 50 AU scale probably due to accretion shocks, demonstrating that the infalling material is significantly processed before being delivered into the disk.Comment: 15 March 2016, ApJ, accepte

Vertical Structure of the Transition Zone from Infalling Rotating Envelope to Disk in the Class 0 Protostar, IRAS04368+2557

We have resolved for the first time the radial and vertical structure of the almost edge-on envelope/disk system of the low-mass Class 0 protostar L1527. For that, we have used ALMA observations with a spatial resolution of 0.25$^{\prime\prime}$$\times$0.13$^{\prime\prime}$ and 0.37$^{\prime\prime}$$\times$0.23$^{\prime\prime}$ at 0.8 mm and 1.2 mm, respectively. The L1527 dust continuum emission has a deconvolved size of 78 au $\times$ 21 au, and shows a flared disk-like structure. A thin infalling-rotating envelope is seen in the CCH emission outward of about 150 au, and its thickness is increased by a factor of 2 inward of it. This radius lies between the centrifugal radius (200 au) and the centrifugal barrier of the infalling-rotating envelope (100 au). The gas stagnates in front of the centrifugal barrier and moves toward vertical directions. SO emission is concentrated around and inside the centrifugal barrier. The rotation speed of the SO emitting gas is found to be decelerated around the centrifugal barrier. A part of the angular momentum could be extracted by the gas which moves away from the mid-plane around the centrifugal barrier. If this is the case, the centrifugal barrier would be related to the launching mechanism of low velocity outflows, such as disk winds

Chemical survey toward young stellar objects in the Perseus molecular cloud complex

Chemical diversity of the gas in low-mass protostellar cores is widely recognized. In order to explore its origin, a survey of chemical composition toward 36 Class 0/I protostars in the Perseus molecular cloud complex, which are selected in an unbiased way under certain physical conditions, has been conducted with IRAM 30 m and NRO 45 m telescope. Multiple lines of C2H, c-C3H2 and CH3OH have been observed to characterize the chemical composition averaged over a 1000 au scale around the protostar. The derived beam-averaged column densities show significant chemical diversity among the sources, where the column density ratios of C2H/CH3OH are spread out by 2 orders of magnitude. From previous studies, the hot corino sources have abundant CH3OH but deficient C2H, their C2H/CH3OH column density ratios being relatively low. In contrast, the warm-carbon-chain chemistry (WCCC) sources are found to reveal the high C2H/CH3OH column density ratios. We find that the majority of the sources have intermediate characters between these two distinct chemistry types. A possible trend is seen between the C2H/CH3OH ratio and the distance of the source from the edge of a molecular cloud. The sources located near cloud edges or in isolated clouds tend to have a high C2H/CH3OH ratio. On the other hand, the sources having a low C2H/CH3OH ratio tend to be located in inner regions of the molecular cloud complex. This result gives an important clue to an understanding of the origin of the chemical diversity of protostellar cores in terms of environmental effects.Comment: Accepted for publication in ApJ

Do Natural Disaster Affect the Poor Disproportionately? Price Change and Welfare Impact in the Aftermath of Typhoon Milenyo in the Rural Philippines

This paper illustrates the sharp contrast in welfare impacts between the rich and the poor caused by typhoon Milenyo in a Philippine village. We find that fish prices dropped sharply due to the damage caused to fish pens near the village, leading to positive net welfare gains among the wealthy. In contrast , the poor do not consume much fish and thus did not gain from the sharp decline in prices. Finally, co nsumption reallocation played an important role as an ex post risk coping measure, albeit only among the wealthy, who are relatively well protected against typhoons.Embargo Period 24 monthshttp://www.grips.ac.jp/list/jp/facultyinfo/estudillo_jonna