Background:The effect of in-hospital rapid cooling by intravenous ice-cold fluids for comatose survivors of out-of-hospital cardiac arrest (OHCA) is unclear.Methods and Results:From the J-PULSE-HYPO ...study registry, data for 248 comatose survivors with return of spontaneous circulation (ROSC) who were treated with therapeutic hypothermia (34℃ for 12–72 h) after witnessed shockable OHCA were extracted. Patients were divided into 2 groups by the median collapse-to-ROSC interval (18 min), and then into 2 groups by cooling method (rapid cooling by intravenous ice-cold fluids vs. standard cooling). The primary endpoint was favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after OHCA. In the whole cohort, the shorter collapse-to-ROSC interval group had significantly higher favorable neurological outcome than the longer collapse-to-ROSC interval group (78.2% vs. 46.8%, P<0.001). In the shorter collapse-to-ROSC interval group, no significant difference was observed in favorable neurological outcome between the 2 cooling groups (rapid cooling group: 79.4% vs. standard cooling group: 77.0%, P=0.75). In the longer collapse-to-ROSC interval group, however, favorable neurological outcome was significant higher in the rapid cooling group than in the standard cooling group (60.7% vs. 33.3%, P<0.01) and the adjusted odds ratio after rapid cooling was 3.069 (95% confidence interval 1.423–6.616, P=0.004).Conclusions:In-hospital rapid cooling by intravenous ice-cold fluids improved neurologically intact survival in comatose survivors whose collapse-to-ROSC interval was delayed over 18 min after shockable OHCA.
The European Resuscitation Council guidelines recommend a slow rate of rewarming of 0.25 °C/h–0.5 °C/h for out-of-hospital cardiac arrest (OHCA) patients receiving therapeutic hypothermia (TH). ...Conversely, a very slow rewarming of 1 °C/day is generally applied in Japan. The rewarming duration ranged from less than 24 h up to more than 50 h. No randomized control trials have examined the optimal rewarming speed for TH in OHCA patients. Therefore, we examined the association between the rewarming duration and neurological outcomes in OHCA patients who received TH.
This study was a secondary analysis of the Japanese Population-based Utstein-style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia (J-PULSE-HYPO) study registry, a multicenter prospective cohort study. Patients suffering from OHCA who received TH (target temperature, 34 °C) after the return of spontaneous circulation from 2005 to 2011 in 14 hospitals throughout Japan were enrolled. The rewarming duration was defined as the time from the beginning of rewarming at a target temperature of 34 °C until reaching 36 °C. The primary outcome was an unfavorable neurological outcome at hospital discharge, i.e., a cerebral performance category of 3–5.
The J-PULSE-HYPO study enrolled 452 OHCA patients. Of these, 328 were analyzed; 79.9% survived to hospital discharge, of which 56.4% had a favorable neurological outcome. Multivariable logistic regression analysis revealed that the rewarming duration was independently associated with unfavorable neurological outcomes odds ratio (per 5 h), 0.89; 95% confidence interval, 0.79–0.99; p = 0.032.
A longer rewarming duration was significantly associated with and was an independent predictor of favorable neurological outcomes in OHCA patients who received TH.
Power balance in the smallest tokamak Kimata, Sora; Okamoto, Atsushi; Fujita, Takaaki ...
AIP advances,
04/2022, Letnik:
12, Številka:
4
Journal Article
Recenzirano
Odprti dostop
The ion temperature of the smallest tokamak, the major radius of 0.1 m, is measured using Doppler broadening spectroscopy. Experiments are performed for helium discharge. Ion temperature Ti = 0.7eV ...is obtained from the Doppler broadened line spectrum of the helium ion. The electron temperature and density measured using line emission intensities of the helium atom are Te = 4.7eV and ne = 3.2 × 1018m−3. The major radius R0 = 0.11m and the minor radius a = 0.03m are obtained from magnetic measurements. Then, the energy flow from the electron to the ion is evaluated as well as ohmic heating and power losses due to atomic processes. The main loss channel for electron stored energy is conduction even though the tokamak is immersed in the residual neutral gas. Total energy confinement time τE = 2.3µs is determined from the power balance, which is comparable with that deduced from the neo-Alcator scaling law.
Background:Because the initial (on admission) Glasgow Coma Scale (GCS) examination has not been fully evaluated in comatose survivors of cardiac arrest (CA) who receive therapeutic hypothermia (TH), ...the aim of the present study was to determine any association between the admission GCS motor score and neurologic outcomes in patients with out-of-hospital CA who receive TH.Methods and Results:In the J-PULSE-HYPO study registry, patients with bystander-witnessed CA were eligible for inclusion. Patients were divided into 3 groups based on GCS motor score (1, 2–3, and 4–5) to assess various effects on neurologic outcome. Univariate and multivariate analyses were performed to identify independent predictors of good neurologic outcome at 90 days. Of 452 patients, 302 were enrolled. There was a significant difference among the 3 patient groups with regard to neurologic outcome at 90 days in the univariate analysis. Multiple logistic regression analyses showed that the GCS motor score on admission, age >65 years, bystander cardiopulmonary resuscitation, the time from collapse to return of spontaneous circulation, and pupil size <4 mm were independent predictors of a good neurologic outcome at 90 days in cases of CA (GCS motor score, 4–5: odds ratio, 8.18; 95% confidence interval: 1.90–60.28; P<0.01).Conclusions:GCS motor score is an independent predictor of good neurologic outcome at 90 days in patients sustaining out-of-hospital CA who receive TH. (Circ J 2015; 79: 2201–2208)
By using newly installed local helical coils (ULT coils), it is expected that helical magnetic field will be reinforced and then the rotational transform and the cross-sectional area of the last ...closed flux surface (LCFS) will get larger in TOKASTAR-2. Electron beam mapping and plasma measurement with an electrostatic probe were made to confirm improvement in the helical field. As the result, large closed flux surfaces were measured by using the ULT coils. In plasma measurement, it was observed that the plasma pressure changed according to the movement of the calculated LCFS, though change in the plasma pressure at the position of the calculated LCFS was not clear. Furthermore, it was confirmed that helical magnetic field confined plasma from plasma decay after turning off the plasma heating power.
Abstract Aim This study investigated the value of regional cerebral oxygen saturation (rSO2 ) monitoring upon arrival at the hospital for predicting post-cardiac arrest intervention outcomes. Methods ...We enrolled 1195 patients with out-of-hospital cardiac arrest of presumed cardiac cause from the Japan-Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry. The primary endpoint was a good neurologic outcome (cerebral performance categories 1 or 2 CPC1/2) 90 days post-event. Results A total of 68 patients (6%) had good neurologic outcomes. We found a mean rSO2 of 21% ± 13%. A receiver operating characteristic curve analysis indicated an optimal rSO2 cut-off of ≥40% for good neurologic outcomes (area under the curve 0.92, sensitivity 0.81, specificity 0.96). Good neurologic outcomes were observed in 53% (55/103) and 1% (13/1092) of patients with high (≥40%) and low (<40%) rSO2 , respectively. Even without return of spontaneous circulation (ROSC) upon arrival at the hospital, 30% (9/30) of patients with high rSO2 had good neurologic outcomes. Furthermore, 16 patients demonstrating ROSC upon arrival at the hospital and low rSO2 had poor neurologic outcomes. Multivariate analyses indicated that high rSO2 was independently associated with good neurologic outcomes (odds ratio = 14.07, P < 0.001). Patients with high rSO2 showed favourable neurologic prognoses if they had undergone therapeutic hypothermia or coronary angiography (CPC1/2, 69% 54/78). However, 24% (25/103) of those with high rSO2 did not undergo these procedures and exhibited unfavourable neurologic prognoses (CPC1/2, 4% 1/25). Conclusion rSO2 is a good indicator of 90-day neurologic outcomes for post-cardiac arrest intervention patients.
We investigated effects of the local helical magnetic field on the plasma vertical position to suppress Vertical Displacement Event (VDE) in TOKASTAR-2. Conditions for VDE occurrence were ...investigated on the vertical plasma position and the current of coils for elongating the plasma, with and without the helical field, and no clear effects of the helical field were observed. Even though the helical coil currents were increased and the plasma vertical position were adjusted, the existing local helical coils were not effective to stabilize the plasma vertical position, resulting in the plasma current quench. We evaluated the effective radial field, which is expected to stabilize the plasma vertical position, using magnetic field line trace calculation. We found that the distribution and magnitude of the effective radial field generated by the existing helical coils were not appropriate for stabilization of the plasma vertical position. We designed new local helical coils consisting of triangular coils located on the upper and lower sides of the plasma. The new coils can generate the effective radial magnetic field, which is expected to stabilize the plasma vertical position.
In this paper, a method for estimating the radial profile of electron density ne using a single line-of-sight signal by the He I line intensity ratio method is proposed. By applying this method to ...cylindrical helium plasma,in which electron temperature was almost uniform and density was uniform in the center, we tried to estimate the parameters representing spatial distribution. It was confirmed that a good distribution estimation result could be obtained by considering the sensitivity factor, the rate at which the line intensity ratio changes as the parameters change, during optimization. Two methods of considering a sensitivity factor are proposed: using the best combination of intensity ratios for analysis in terms of the sensitivity factor, and weighting the objective function using the sensitivity factor. The former method can be analyzed in short computational time, although its applicability is limited. The latter method can be used when it is not obvious which set of intensity ratios is best to use, although it takes more computational time compared with the former method. Both methods reproduce the parameter of a radial density profile.
Background: Mild hypothermia is an effective therapy for patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. However, evidence of the effectiveness of ...therapeutic hypothermia (TH) remains unclear. Methods and Results: A multicenter registry in Japan (J-PULSE-HYPO study registry) was conducted to investigate the effectiveness of TH for post-resuscitation neurological dysfunction developing after out-of-hospital cardiac arrest from 14 institutions, between January 2005 and December 2009. The committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming. There were 452 patients (375 men) enrolled into the registry. The mean age was 58.6±13.5 years. Initial electrocardiogram rhythm at the time of occurrence of the cardiac arrest showed 68.9% had ventricular fibrillation or pulseless ventricular tachycardia, 13.7% had pulseless electrical activity, and 9.1% had asystole. The median interval from the occurrence of cardiac arrest to ROSC was 26min. The target core temperature during TH was 33.9±0.4°C and the mean duration of cooling was 31.5±13.9h. Intra-aortic balloon pumping was used in 40.1% and percutaneous cardiopulmonary support in 22.6% of patients. At 30 days after cardiac arrest, the proportion of survival was 80.1% and the proportion of patients with favorable neurological functions, with a cerebral performance category score of 1 or 2, was 55.3%. Conclusions: The J-PULSE-HYPO study registry showed a clinical aspect of TH. (Circ J 2011; 75: 1063-1070)
Background: Although therapeutic hypothermia is an effective therapy for comatose adults experiencing out-of-hospital shockable cardiac arrest, there is insufficient evidence that is also applicable ...for those with out-of-hospital non-shockable cardiac arrest. Methods and Results: Of 452 comatose adults treated with therapeutic hypothermia after return of spontaneous circulation (ROSC) subsequent to an out-of-hospital cardiac arrest of cardiac etiology, 372 who had a bystander-witnessed cardiac arrest, target core temperature of 32–34°C and cooling duration of 12–72h were eligible for this study (75 cases of non-shockable cardiac arrest, 297 cases of shockable cardiac arrest). The median collapse-to-ROSC interval was significantly longer in the non-shockable group than in the shockable group (30min vs. 22min, P=0.008), resulting in a significantly lower frequency of 30-day favorable neurological outcome in the non-shockable group compared with the shockable group (32% vs. 66%, P<0.001). However, an analysis of data in quartiles assigned to varying lengths of collapse-to-ROSC interval revealed a similar frequency of 30-day favorable neurological outcome among both groups when the collapse-to-ROSC interval was ≤16min (90% non-shockable group vs. 92% shockable group; odds ratio 0.80, 95% confidence interval 0.09–7.24, P=0.84). Conclusions: Post-ROSC cooling is an effective treatment for patients with non-shockable cardiac arrest when the time interval from collapse to ROSC is short. (Circ J 2012; 76: 2579–2585)
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