Search

We present the results of near-infrared spectroscopic observations of the K-band-selected candidate galaxies in the protocluster at z = 3.09 in the SSA22 field. We observed 67 candidates with KAB < 24 and confirmed redshifts of the 39 galaxies at 2.0 < zspec < 3.4. Of the 67 candidates, 24 are certainly protocluster members with 3.04 ⩽ zspec ⩽ 3.12, which are massive red galaxies that have been unidentified in previous optical observations of the SSA22 protocluster. Many distant red galaxies (J – KAB > 1.4), hyper extremely red objects (J – KAB > 2.1), Spitzer MIPS 24 μm sources, active galactic nuclei (AGNs) as well as the counterparts of Lyα blobs and the AzTEC/ASTE 1.1 mm sources in the SSA22 field are also found to be protocluster members. The mass of the SSA22 protocluster is estimated to be ∼2-5 × 1014M☼, and this system is plausibly a progenitor of the most massive clusters of galaxies in the current universe. The reddest (J – KAB ⩾ 2.4) protocluster galaxies are massive galaxies with Mstar ∼ 1011M☼ showing quiescent star formation activities and plausibly dominated by old stellar populations. Most of these massive quiescent galaxies host moderately luminous AGNs detected by X-ray. There are no significant differences in the [O III] λ5007/Hβ emission line ratios and [O III] λ5007 line widths and spatial extents of the protocluster galaxies from those of massive galaxies at z ∼ 2-3 in the general field. [ABSTRACT FROM AUTHOR]

We have identified a very interesting Lyα emitter (LAE), whose Lyα emission line has an extremely large observed equivalent width of EW0 = 436+422– 149 Å, which corresponds to an extraordinarily large intrinsic rest-frame equivalent width of EWint0 = 872+844– 298 Å after the average intergalactic absorption correction. The object was spectroscopically confirmed to be a real LAE by its apparent asymmetric Lyα line profile detected at z = 6.538. The continuum emission of the object was definitely detected in our deep z′-band image; thus, its EW0 was reliably determined. Follow-up deep near-infrared spectroscopy revealed emission lines of neither He II λ1640 as an apparent signature of Population III (Pop III) nor C IV λ1549 as proof of an active nucleus. No detection of the short-lived He II λ1640 line is not necessarily inconsistent with the interpretation that the underlying stellar population of the object is dominated by Pop III. We found that the observed extremely large EW0 of the Lyα emission and the upper limit on the EW0 of the He II λ1640 emission can be explained by population synthesis models favoring a very young age less than 2-4 Myr and massive metal-poor (Z < 10–5) or even metal-free stars. The observed large EW0 of Lyα is insufficiently explained by Population I/II synthesis models with Z ⩾ 10–3. However, we cannot conclusively rule out the possibility that this object is composed of a normal stellar population with a clumpy dust distribution, which could enhance the Lyα EW0, though its significance is still unclear. [ABSTRACT FROM AUTHOR]

We present new spectroscopic observations of Ly α (Ly α) Blob 2 (z ∼ 3.1). We observed extended Ly α emission in three distinct regions, where the highest Ly α surface brightness (SB) centre is far away from the known continuum sources. We searched through the MOSFIRE slits that cover the high Ly α SB regions, but were unable to detect any significant nebular emission near the highest SB centre. We further mapped the flux ratio of the blue peak to the red peak and found it is anticorrelated with Ly α SB with a power-law index of ∼ –0.4. We used radiative transfer models with both multiphase, clumpy, and shell geometries and successfully reproduced the diverse Ly α morphologies. We found that most spectra suggest outflow-dominated kinematics, while 4/15 spectra imply inflows. A significant correlation exists between parameter pairs, and the multiphase, clumpy model may alleviate previously reported discrepancies. We also modelled Ly α spectra at different positions simultaneously and found that the variation of the inferred clump outflow velocities can be approximately explained by line-of-sight projection effects. Our results support the 'central powering  + scattering' scenario, i.e. the Ly α photons are generated by a central powering source and then scatter with outflowing, multiphase H   i gas while propagating outwards. The infalling of cool gas near the blob outskirts shapes the observed blue-dominated Ly α profiles, but its energy contribution to the total Ly α luminosity is less than 10 per cent, i.e. minor compared to the photoionization by star-forming galaxies and/or AGNs. [ABSTRACT FROM AUTHOR]

We present observations of [N  ii ] 205 μm, [O  iii ] 88 μm, and dust emission in a strongly-lensed, submillimeter galaxy (SMG) at z = 6.0, G09.83808, with the Atacama Large Millimeter/submillimeter Array (ALMA). Both [N  ii ] and [O  iii ] line emissions are detected at >12σ in the |${0{^{\prime \prime}_{.}}8}$| -resolution maps. Lens modeling indicates that the spatial distribution of the dust continuum emission is well characterized by a compact disk with an effective radius of 0.64 ± 0.02 kpc and a high infrared surface brightness of ΣIR = (1.8 ± 0.3) × 1012  L ⊙ kpc−2. This result supports that G09.83808 is the progenitor of compact quiescent galaxies at z ∼ 4, where the majority of its stars are expected to be formed through a strong and short burst of star formation. G09.83808 and other lensed SMGs show a decreasing trend in the [N  ii ] line to infrared luminosity ratio with increasing continuum flux density ratio between 63 and 158 μm, as seen in local luminous infrared galaxies (LIRGs). The decreasing trend can be reproduced by photoionization models with increasing ionization parameters. Furthermore, by combining the [N  ii ]/[O  iii ] luminosity ratio with far-infrared continuum flux density ratio in G09.83808, we infer that the gas phase metallicity is already Z ≈ 0.5–0.7  Z ⊙. G09.83808 is likely one of the earliest galaxies that has been chemically enriched at the end of reionization. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the effects of gardening on hemodynamic response, rating of perceived exertion (RPE) during exercise, and body weight in patients in whom phase 2 cardiac rehabilitation (CR) was interrupted due to the Coronavirus disease 2019 (COVID-19) pandemic. Among 76 outpatients participating in consecutive phase 2 CR in both periods from March to April and June to July 2020, which were before and after CR interruption, respectively, at Sanda City Hospital were enrolled. The inclusion criterion was outpatients whose CR was interrupted due to COVID-19. Patients under the age of 65 were excluded. We compared the data of hemodynamic response and RPE during exercise on the last day before interruption and the first day after interruption when aerobic exercise was performed at the same exercise intensity in the gardener group and the non-gardener group. Forty-one patients were enrolled in the final analysis. After CR interruption, the gardener group did not show any significant difference in all items, whereas the non-gardener group experienced significant increase in HR (Peak) (p = 0.004) and worsening of the Borg scale scores for both dyspnea and lower extremity fatigue (p = 0.039 and p = 0.009, respectively). Older phase 2 CR patients engaged in gardening did not show any deterioration in hemodynamic response or RPE during exercise, despite CR interruption and refraining from going outside. Gardening may be recommended as one of the activities that can maintain or improve physical function in older phase 2 CR patients during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper presents the results from the first wide and deep dual narrow-band survey to select Hα and [O ii] line emitters at z= 1.47 ± 0.02, exploiting synergies between the United Kingdom Infrared Telescope and the Subaru telescope by using matched narrow-band filters in the H and z′ bands. The Hα survey at z= 1.47 reaches a 3σ flux limit of FHα≈ 7 × 10−17 erg s−1 cm−2 (corresponding to a limiting star formation rate (SFR) in Hα of ≈7 M⊙ yr−1) and detects ≈200 Hα emitters over 0.7 deg2, while the much deeper [O ii] survey reaches an effective flux of ≈7 × 10−18 erg s−1 cm−2 (SFR in [O ii] of ∼1 M⊙ yr−1), detecting ≈1400 z= 1.47 [O ii] emitters in a matched comoving volume of ∼2.5 × 105 Mpc3. The combined survey results in the identification of 190 simultaneous Hα and [O ii] emitters at z= 1.47. Hα and [O ii] luminosity functions are derived and both are shown to evolve significantly from z∼ 0 in a consistent way. The SFR density of the Universe at z= 1.47 is evaluated, with the Hα analysis yielding ρSFR= 0.16 ± 0.05 M⊙ yr−1 Mpc−3 and the [O ii] analysis ρSFR= 0.17 ± 0.04 M⊙ yr−1 Mpc−3. The measurements are combined with other studies, providing a self-consistent measurement of the star formation history of the Universe over the last ∼11 Gyr. By using a large comparison sample at z∼ 0.1, derived from the Sloan Digital Sky Survey (SDSS), [O ii]/Hα line ratios are calibrated as probes of dust extinction. Hα emitters at z∼ 1.47 show on average AHα≈ 1 mag, the same as found by SDSS in the local Universe. It is shown that although dust extinction correlates with SFR, the relation evolves by about ∼0.5 mag from z∼ 1.5 to ∼0, with local relations overpredicting the dust extinction corrections at high z by that amount. Stellar mass is found to be a much more fundamental extinction predictor, with the same relation between mass and dust extinction being valid at both z∼ 0 and ∼1.5, at least for low and moderate stellar masses. The evolution in the extinction-SFR relation is therefore interpreted as being due to the evolution in median specific SFRs over cosmic time. Dust extinction corrections as a function of optical colours are also derived and shown to be broadly valid at both z∼ 0 and ∼1.5, offering simpler mechanisms for estimating extinction in moderately star-forming systems over the last ∼9 Gyr. [ABSTRACT FROM AUTHOR]

The anaerobic threshold (AT), obtained during cardiopulmonary exercise testing (CPET), is an important prognostic measure and can be used to develop an exercise prescription in patients after a myocardial infarction (post-MI). The purpose of this study was to examine the central and peripheral determinants of AT in post-MI patients end-tidal oxygen partial pressure (PETO2) measures. We performed cardiopulmonary exercise testing (CPET) on 148 consecutively enrolled post-MI patients to determine PETO2 measured at the AT (AT PETO2) and ΔPETO2 (difference between resting PETO2 and AT PETO2). We subsequently investigated the relationship between these measures of PETO2 and the individual AT for each patient. Multivariate linear regression analysis indicated that AT PETO2 and ΔPETO2 were independently and significantly associated with the AT (β = −0.344, p < 0.001 and β = 0.228, p < 0.001, respectively). Furthermore, the independent factors of AT PETO2 were left ventricular ejection fraction (p = 0.005), resting ventilatory equivalent for carbon dioxide (p = 0.002), and resting dead-space gas volume to tidal volume ratio (p < 0.001). However, the independent factors for ΔPETO2 were history of diabetes (p = 0.047), estimated glomerular filtration rate (p = 0.001), and resting systolic blood pressure (p = 0.017). These findings suggested that AT PETO2 was associated with central determinants; whereas, and ΔPETO2 was associated with peripheral determinants, The AT PETO2 and ΔPETO2 provide variable insight regarding the cause of exercise intolerance and can be used to determine appropriate therapies. [ABSTRACT FROM AUTHOR]

We present observations of a giant Lyα blob (LAB) in the SSA22 protocluster at z = 3.1, SSA22-LAB1, taken with the Atacama Large Millimeter/submillimeter Array. Dust continuum, along with [C ii ] 158 μm and CO(4–3) line emission have been detected in LAB1, showing complex morphology and kinematics across a ∼100 kpc central region. Seven galaxies at z = 3.0987–3.1016 in the surroundings are identified in [C ii ] and dust continuum emission, with two of them potential companions or tidal structures associated with the most massive galaxies. Spatially resolved [C ii ] and infrared luminosity ratios for the widely distributed media (L[Cɪɪ]/LIR ≈ 10−2−10−3) suggest that the observed extended interstellar media are likely to have originated from star formation activity and the contribution from shocked gas is probably not dominant. LAB1 is found to harbor a total molecular gas mass Mmol = (8.7 ± 2.0) × 1010M⊙, concentrated in the core region of the Lyα-emitting area. While (primarily obscured) star formation activity in the LAB1 core is one of the most plausible power sources for the Lyα emission, multiple major mergers found in the core may also play a role in making LAB1 exceptionally bright and extended in Lyα as a result of cooling radiation induced by gravitational interactions. [ABSTRACT FROM AUTHOR]

We present a detailed investigation of millimeter-wave line emitters ALMA J010748.3-173028 (ALMA-J0107a) and ALMA J010747.0-173010 (ALMA-J0107b), which were serendipitously uncovered in the background of the nearby galaxy VV 114 with spectral scan observations at λ = 2–3 mm. Via Atacama Large Millimeter/submillimeter Array (ALMA) detection of CO(4–3), CO(3–2), and [C i ](1–0) lines for both sources, their spectroscopic redshifts are unambiguously determined to be z = 2.4666 ± 0.0002 and z = 2.3100 ± 0.0002, respectively. We obtain the apparent molecular gas masses Mgas of these two line emitters from [C i ] line fluxes as (11.2 ± 3.1) × 1010M⊙ and (4.2 ± 1.2) × 1010M⊙, respectively. The observed CO(4–3) velocity field of ALMA-J0107a exhibits a clear velocity gradient across the CO disk, and we find that ALMA-J0107a is characterized by an inclined rotating disk with a significant turbulence, that is, a deprojected maximum rotation velocity to velocity dispersion ratio of 1.3 ± 0.3. We find that the dynamical mass of ALMA-J0107a within the CO-emitting disk computed from the derived kinetic parameters, (1.1 ± 0.2) × 1010M⊙, is an order of magnitude smaller than the molecular gas mass derived from dust continuum emission, (3.2 ± 1.6) × 1011M⊙. We suggest this source is magnified by a gravitational lens with a magnification of μ ≳ 10, which is consistent with the measured offset from the empirical correlation between CO-line luminosity and width. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the effects of the interruption of cardiac rehabilitation (CR) and refraining from going outside due to the COVID-19 pandemic on hemodynamic response and rating of perceived exertion (RPE) during exercise including differences by age in phase 2 CR outpatients. Among 76 outpatients participating in consecutive phase 2 CR in both periods from March to April and June to July 2020, which were before and after CR interruption, respectively, at Sanda City Hospital were enrolled. The inclusion criterion was outpatients whose CR was interrupted due to COVID-19. We compared the data of hemodynamic response and RPE during exercise on the last day before interruption and the first day after interruption when aerobic exercise was performed at the same exercise intensity in the < 75 years group and ≥ 75 years group. Fifty-three patients were enrolled in the final analysis. Post-CR interruption, peak heart rate increased significantly (p = 0.009) in the < 75 years group, whereas in the ≥ 75 years group, weight and body mass index decreased significantly (p = 0.009, 0.011, respectively) and Borg scale scores for both dyspnea and lower extremities fatigue worsened significantly (both, p < 0.001). CR interruption and refraining from going outside due to the COVID-19 pandemic affected the hemodynamic response, RPE during exercise and body weight in phase 2 CR outpatients. In particular, patients aged ≥ 75 years appeared to be placed at an increased risk of frailty. [ABSTRACT FROM AUTHOR]

We present results of the cross-correlation Lyα intensity mapping with Subaru/Hyper Suprime-Cam (HSC) ultra-deep narrowband images and Lyα emitters (LAEs) at z = 5.7 and 6.6 in a total area of 4 deg2. Although an overwhelming amount of data quality controls have been performed for the narrowband images, we further conduct extensive analyses evaluating systematics of large-scale point-spread function wings, sky subtractions, and unknown errors based on physically uncorrelated signals and sources found in real HSC images and object catalogs, respectively. Removing the systematics, we carefully calculate cross-correlations between Lyα intensity of the narrowband images and the LAEs. We tentatively identify very diffuse Lyα emission with the ≃3σ (≃2σ) significance at ≳100 comoving kiloparsecs (ckpc) far from the LAEs at z = 5.7 (6.6), around and probably even beyond a virial radius of star-forming galaxies with Mh ∼ 1011M⊙. The diffuse Lyα emission possibly extends up to 1000 ckpc with the surface brightness of 10−20–10−19 erg s−1 cm−2 arcsec−2. We confirm that the small-scale (<150 ckpc) Lyα radial profiles of LAEs are consistent with those obtained by recent Multi-Unit Spectroscopic Explorer observations. Comparisons with numerical simulations suggest that the large-scale (∼150–1000 ckpc) Lyα emission are not explained by unresolved faint neighboring galaxies including satellites, but by a combination of Lyα photons emitted from the central LAE and other unknown sources, such as cold-gas streams and galactic outflow. We find no evolution in the Lyα radial profiles of our LAEs from z = 5.7 to 6.6, where theoretical models predict a flattening of the profile slope made by cosmic reionization, albeit with our moderately large observational errors. [ABSTRACT FROM AUTHOR]

Aim: Worsening renal function (WRF) induced by acute myocardial infarction (AMI) is a strong predictor of cardiovascular events and mortality. Peak oxygen uptake may contribute to prognosis in AMI patients with WRF, however, the impact of WRF on peak oxygen uptake is unclear. Methods: Among 154 patients with AMI who underwent emergency percutaneous coronary intervention and participated in phase II cardiac rehabilitation, those who underwent cardiopulmonary exercise testing were consecutively enrolled. WRF was defined as a ≥20% decrease in estimated glomerular filtration rate (eGFR [ml/min/1.73 m2]) from admission to that at cardiopulmonary exercise testing. The association of WRF with peak oxygen uptake was evaluated by multivariate regression analysis. The non‐WRF group was divided into two subgroups according to eGFR <60/≥60 at cardiopulmonary exercise testing, and eGFR at cardiopulmonary exercise testing and peak oxygen uptake of all three groups were compared. Results: Ninety‐four patients were enrolled in the final analysis. Multiple linear regression analysis showed that WRF was associated with peak oxygen uptake (p =.003). Comparing the non‐WRF group with eGFR at cardiopulmonary exercise testing <60 and the WRF group, although eGFR at cardiopulmonary exercise testing was similar (p = 1.000), peak oxygen uptake in the WRF group was significantly lower (p =.026). Conclusion: WRF, not eGFR at cardiopulmonary exercise testing was significantly associated with peak oxygen uptake in patients with AMI. This result suggests that when considering the relationship between renal function and peak oxygen uptake, WRF must be taken into account. SUMMARY AT A GLANCE: This is a retrospective cohort study on 94 patients followed for up to 6 months in Japan showing that worsening of kidney function after acute myocardial infarction (MI) is associated with peak oxygen uptake on exercise test, and this association is independent of baseline kidney function. Thus a decline is kidney function post MI may have implications for worse outcomes than the absolute level of kidney function. [ABSTRACT FROM AUTHOR]

We present our new Atacama Large Millimeter/Submillimeter Array (ALMA) observations targeting [O iii ]88 μm, [C ii ]158 μm, [N ii ]122 μm, and dust-continuum emission for three Lyman break galaxies at z = 6.0293–6.2037, identified in the Subaru/Hyper Suprime-Cam survey. We clearly detect [O iii ] and [C ii ] lines from all of the galaxies at 4.3–11.8σ levels, and identify multi-band dust-continuum emission in two of the three galaxies, allowing us to estimate infrared luminosities and dust temperatures simultaneously. In conjunction with previous ALMA observations for six galaxies at z > 6, we confirm that all the nine z = 6–9 galaxies have high [O iii ]/[C ii ] ratios of , ∼10 times higher than z ∼ 0 galaxies. We also find a positive correlation between the [O iii ]/[C ii ] ratio and the Lyα equivalent width (EW) at the ∼90% significance level. We carefully investigate physical origins of the high [O iii ]/[C ii ] ratios at z = 6–9 using Cloudy, and find that high density of the interstellar medium, low C/O abundance ratio, and the cosmic microwave background attenuation are responsible to only a part of the z = 6–9 galaxies. Instead, the observed high [O iii ]/[C ii ] ratios are explained by 10–100 times higher ionization parameters or low photodissociation region (PDR) covering fractions of 0%–10%, both of which are consistent with our [N ii ] observations. The latter scenario can be reproduced with a density-bounded nebula with PDR deficit, which would enhance the Lyα, Lyman continuum, and ionizing photons escape from galaxies, consistent with the [O iii ]/[C ii ]-Lyα EW correlation we find. [ABSTRACT FROM AUTHOR]

We present an IGM H i tomographic map in a survey volume of (cMpc3) centered at MAMMOTH-1 nebula and three neighboring quasars at z = 2.3. The MAMMOTH-1 nebula is an enormous Lyα nebula (ELAN), hosted by a type-II quasar dubbed MAMMOTH1-QSO, that extends over cMpc with no clear physical origin. Here we investigate the H i -gas distribution around MAMMOTH1-QSO with the ELAN and three neighboring type-I quasars, making the IGM H i tomographic map with a spatial resolution of 2.6 h−1 cMpc. Our H i tomographic map is reconstructed with H i Lyα forest absorption of bright background objects at z = 2.4–2.9: one eBOSS quasar and 16 Keck/LRIS galaxy spectra. We estimate the radial profile of H i overdensity for MAMMOTH1-QSO, and find that MAMMOTH1-QSO resides in a volume with fairly weak H i absorption. This suggests that MAMMOTH1-QSO may have a proximity zone where quasar illuminates and photoionizes the surrounding H i gas and suppresses H i absorption, and that the ELAN is probably a photoionized cloud embedded in the cosmic web. The H i radial profile of MAMMOTH1-QSO is very similar to those of three neighboring type-I quasars at z = 2.3, which is compatible with the AGN unification model. We compare the distributions of the H i absorption and star-forming galaxies in our survey volume, and identify a spatial offset between density peaks of star-forming galaxies and H i gas. This segregation may suggest anisotropic UV background radiation created by star-forming galaxy density fluctuations. [ABSTRACT FROM AUTHOR]

We report on the detection of the [C  ii ] 157.7 μ m emission from the Lyman break galaxy (LBG) MACS0416_Y1 at z  = 8.3113, by using the Atacama Large Millimeter/submillimeter Array (ALMA). The luminosity ratio of [O  iii ] 88 μ m (from previous campaigns) to [C  ii ] is 9.3 ± 2.6, indicative of hard interstellar radiation fields and/or a low covering fraction of photodissociation regions. The emission of [C  ii ] is cospatial to the 850 μ m dust emission (90 μ m rest frame, from previous campaigns), however the peak [C  ii ] emission does not agree with the peak [O  iii ] emission, suggesting that the lines originate from different conditions in the interstellar medium. We fail to detect continuum emission at 1.5 mm (160 μ m rest frame) down to 18 μ Jy (3σ). This non-detection places a strong limits on the dust spectrum, considering the 137 ± 26 μ Jy continuum emission at 850 μ m. This suggests an unusually warm dust component (T > 80 K, 90 per cent confidence limit), and/or a steep dust-emissivity index (βdust > 2), compared to galaxy-wide dust emission found at lower redshifts (typically T ∼ 30–50 K, βdust ∼ 1–2). If such temperatures are common, this would reduce the required dust mass and relax the dust production problem at the highest redshifts. We therefore warn against the use of only single-wavelength information to derive physical properties, recommend a more thorough examination of dust temperatures in the early Universe, and stress the need for instrumentation that probes the peak of warm dust in the Epoch of Reionization. [ABSTRACT FROM AUTHOR]

Objective Although corticotropin is a representative secretagogue of aldosterone, the utility of the cosyntropin stimulation test (C- ST) in diagnosing primary aldosteronism ( PA) has not been elucidated. Aim of the study was to evaluate the clinical utility of C- ST for confirmatory testing and subtype classification of PA. Design, Setting and Patients In this retrospective study, we identified patients with hypertension and positive case-detection results for PA who underwent C- ST and saline infusion testing ( SIT) between 2006 and 2013 at eight referral centres in Japan. PA and essential hypertension ( EH) were distinguished based on SIT results. PA subtype classification was determined by adrenal venous sampling ( AVS). Plasma aldosterone concentration ( PAC) was measured before and 30 and 60 min after intravenous cosyntropin administration. The ability of C- ST to distinguish PA from EH and to distinguish unilateral from bilateral disease was assessed by the area under the receiver operating characteristic curve. Results Of 205 patients with hypertension and positive case-detection results, 139 (68%) had PA based on SIT results. Eighteen patients in whom AVS was unsuccessful were excluded from analysis. The baseline PAC before C- ST was significantly higher ( P < 0·01) in patients with PA than in those with EH. However, the degree of difference in PAC between patients with PA and EH was not enhanced by the administration of cosyntropin. In addition, the administration of cosyntropin did not improve the distinction between bilateral and unilateral PA subtypes. Conclusions C- ST has no utility as a confirmatory and subtype testing of PA when the diagnosis of PA is based on the positive results in SIT. [ABSTRACT FROM AUTHOR]

Context Although adrenal vein sampling (AVS) is the standard method for subtype diagnosis in primary aldosteronism (PA), protocol details including the sampling position in the adrenal vein are not standardized. Objective To establish the optimum sampling position in the left adrenal vein based on postoperative outcome in PA patients. Design and Setting Retrospective study in nine referral centres. Participants Of 496 consecutive PA patients who underwent AVS between 2006 and 2013, 217 with successful AVS under cosyntropin stimulation, and with concomitant data from two positions: proximal (common trunk) and distal (central vein) to the junction with the inferior phrenic vein, were included. Main outcome measures Discordant rate of subtype diagnosis between common trunk and central vein, and postoperative outcomes in patients with discordant results. Results Subtype diagnosis using common trunk and central vein was discordant in 10 (4.6%) of the 217 patients (κ = 0.87, P < 0.05). Of these 10 patients, eight with left unilateral subtype and two with bilateral subtype using common trunk data showed bilateral subtype and unilateral subtype, respectively, using central vein data. Five patients with left unilateral subtype and one with bilateral subtype by common trunk data underwent unilateral adrenalectomy. All six patients were cured of PA after adrenalectomy, resulting in false-negative rates of 17% (1/ 6) by common trunk data, and 83% (5/6) by central vein data. Conclusion In view of its better potential diagnostic accuracy, technical ease, lower cost and lower risk of vein rupture, blood sampling from the common trunk of the left adrenal vein may be preferable as the standard method of AVS in patients with PA, although additional studies in a larger number of cases are required. [ABSTRACT FROM AUTHOR]

Objectives Adrenal vein sampling ( AVS) is the standard criterion for the subtype diagnosis in primary aldosteronism ( PA). Although lateralized index ( LI) ≥4 after cosyntropin stimulation is the commonly recommended cut-off for unilateral aldosterone hypersecretion, many of the referral centres in the world use LI cut-off of <4 without sufficient evidence for its diagnostic accuracy. Aim The aim of the study was to establish the diagnostic significance of contralateral ( CL) aldosterone suppression for the subtype diagnosis in patients with LI <4 in AVS. Design and patients A retrospective multicentre study was conducted in Japan. Of 124 PA patients subjected to unilateral adrenalectomy after successful AVS with cosyntropin administration, 29 patients with LI < 4 were included in the study. The patients were divided into Group A with CL suppression ( n = 16) and Group B ( n = 13) without CL suppression. Three outcome indices were assessed after 6 months postoperatively: normalization/significant improvement of hypertension, normalization of the aldosterone to renin ratio ( ARR) and normalization of hypokalaemia. Results The normalization/significant improvement of hypertension was 81% in Group A and 54% in Group B ( P = 0·2). The normalization of ARR was 100% in Group A and 46% in Group B ( P = 0·004). Hypokalaemia was normalized in all patients of both groups. The overall cure rate of PA based on meeting all the three criteria was 81% in Group A and 31% in Group B ( P = 0·01). Conclusions In patients with PA, where the LI is <4 on AVS, CL suppression of aldosterone is an accurate predictor of a unilateral source of aldosterone excess. CL suppression data should be interpreted in conjunction with computed tomographic adrenal imaging findings to guide surgical management. [ABSTRACT FROM AUTHOR]

Patients with heart disease have a low anaerobic threshold (AT), and the determinants of AT may differ, depending on the severity of renal dysfunction. This study aimed to verify the determinants of AT for each stage of renal function in patients with heart disease. We consecutively enrolled 250 patients with heart disease who underwent cardiopulmonary exercise testing in our institution. The patients were divided into 3 groups by their estimated glomerular filtration rate (eGFR): <45, 45 to 59, and ≥60 ml/min/1.73 m 2 . A multivariate linear regression analysis was performed to evaluate the independent determinants of AT for each group. In total, 201 patients were analyzed. AT decreased with the deterioration of renal function (eGFR <45, 10.9 ± 2.1 vs eGFR 45 to 59, 12.4 ± 2.5 vs eGFR ≥60, 14.0 ± 2.6 ml/min/kg, p <0.001). In the eGFR <45 group, left ventricular ejection fraction and hemoglobin were significantly associated with AT (β = 0.427, p = 0.006 and β = 0.488, p = 0.002, respectively). In the eGFR 45 to 59 and ≥60 groups, ΔP ET O 2 (end-tidal oxygen partial pressure from rest to AT) showed a significant association with AT (β = 0.576, p <0.001 and β = 0.308, p = 0.003, respectively). The determinants of AT depended on the stage of renal dysfunction in patients with heart disease. In conclusion, in the eGFR <45 group, the determinants of AT were left ventricular ejection fraction and hemoglobin, whereas in the eGFR 45 to 59 and eGFR ≥60 groups, the determinant of AT was ΔP ET O 2 ., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Context: Adrenocorticotropin (ACTH) loading is used to increase the success rate of adrenal vein sampling (AVS)., Objective: We aimed to determine the effect of intraprocedural cortisol measurement (ICM) on ACTH-stimulated AVS (AS-AVS) owing to a lack of reliable data on this topic., Methods: This multicenter, retrospective, observational study took place in 28 tertiary centers in Japan. Among 4057 patients enrolled, 2396 received both basal AVS (B-AVS) and AS-AVS and were divided into 2 groups according to whether ICM was used. The effect of ICM on AS-AVS was measured., Results: In patients who underwent both AVS procedures, the ICM group had significantly higher success rates for both B-AVS and AS-AVS than the non-ICM group did. However, the probability of failure of AS-AVS after a successful B-AVS and the probability of success of AS-AVS after a failed B-AVS were not significantly different in the 2 groups. For subtype diagnosis, propensity-score matching revealed no significant difference between the 2 groups, and the discrepancy rate between B-AVS and AS-AVS for subtype diagnosis was also not significantly different., Conclusion: ICM significantly increased the success rate of B-AVS and AS-AVS in protocols in which both AVS procedures were performed and had no effect on subtype diagnosis. However, in protocols in which both AVS procedures were performed, the results suggest ICM may not be necessary when performing AS-AVS if ICM is used only when B-AVS is performed. Our study suggests that ICM during AVS plays an important role and should be recommended., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society.)

Background: Identifying the causes of low peak oxygen uptake (peak V̇ O 2 ) in heart disease patients with renal dysfunction is necessary for prognostic improvement strategies. The purpose of this study was to verify the determinants of peak V̇ O 2 for each stage of renal function in heart disease patients, focusing on end-tidal oxygen partial pressure ( PETO 2 )., Methods: Two hundred fifty heart disease patients who underwent cardiopulmonary exercise testing (CPET) in our institution were consecutively enrolled. Patients were divided into three groups by their estimated glomerular filtration rate (eGFR): < 45, 45-59 and ≥ 60 mL/min/1.73 m 2 . Patient characteristics and CPET parameters including Δ 2 (rest-anaerobic threshold) were compared between the groups. The relationship between Δ PETO PETO 2 and peak V̇ O 2 was also investigated for each group., Results: In total, 201 patients were analyzed. Δ PETO 2 decreased with the deterioration of renal function (eGFR < 45, 0.1 mmHg vs. eGFR 45-59, 2.4 mmHg vs. eGFR ≥ 60, 5.2 mmHg, p < 0.001). In the eGFR < 45 group, left ventricular ejection fraction (LVEF) and hemoglobin (Hb) were significantly associated with peak V̇ O 2 β = 0.518, p < 0.001 and β = 0.567, p < 0.001, respectively), whereas Δ PETO 2 was not. In the eGFR 45-59 group, age, Hb, and Δ PETO 2 showed a significant association with peak V̇ O 2 ( β = -0.354, p = 0.006; β = 0.258, p = 0.007; β = 0.501, p < 0.001; respectively). In the univariate analysis, eGFR 45-59 group showed the highest coefficient of determination of Δ PETO 2 to peak V̇ O 2 ( R 2 = 0.247, p < 0.001)., Conclusions: The determinants of peak V̇ O 2 in heart disease patients depended on the stage of renal function. The determinants of peak V̇ O 2 in patients with eGFR < 45 were LVEF and Hb, while Δ PETO 2 was the strongest predictor of peak V̇ O 2 in patients with eGFR 45-59., Competing Interests: The author declares no conflict of interest. Kazuhiro P. Izawa is serving as one of the guest editor of this journal. We declare that Kazuhiro P. Izawa had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Brian Tomlinson., (Copyright: © 2022 The Author(s). Published by IMR Press.)

Left ventricular hypertrophy (LVH) is often seen in patients with primary aldosteronism (PA), and the prevalence of LVH is reportedly higher among patients with PA than patients with essential hypertension. However, the correlation between aldosterone levels and LVH is undefined, and how aldosterone affects LVH in patients with PA remains unclear. We, therefore, retrospectively assessed a large PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) to reveal the factors associated with LVH in patients with PA without suspected autonomous cortisol secretion. In the 1186 patients with PA studied, the basal plasma aldosterone concentration, plasma renin activity, and the aldosterone-to-renin ratio did not significantly correlate with left ventricular LV mass index (LVMI) in single or multiple regression analyses. However, the plasma aldosterone concentration after the captopril challenge test or saline-infusion test, which are associated with autonomous aldosterone secretion, correlated significantly with LVMI, even after adjusting for patients' backgrounds, including age and blood pressure. In addition, hypokalemia and the unilateral subtype also correlated with LVMI. Longitudinal subanalysis of medically or surgically treated patients with PA showed significant reductions in LVMI in both the surgery (63.0±18.1 to 55.3±19.5 g/m 2.7 , P <0.001) and drug treatment (56.8±14.1 to 52.1±13.5 g/m 2.7 , P <0.001) groups. Our results suggest the autonomous aldosterone secretion level, not the basal aldosterone level itself, is relevant to LVH in patients with PA. In addition, the elevated LVMI seen in patients with PA is at least partially reversible with surgical or medical treatment.

Primary aldosteronism causes renal structural damage after glomerular hyperfiltration, and primary aldosteronism-specific treatment leads to an acute fall in estimated glomerular filtration rate (eGFR). We investigated whether this change affected the long-term eGFR slope in a retrospective cohort from the multicenter Japan Primary Aldosteronism Study. We allocated patients with primary aldosteronism to the adrenalectomy (n=202) and MR (mineralocorticoid receptor) antagonist (n=303) groups based on their treatment history and analyzed the association between the initial eGFR fall and long-term eGFR slope. The increased age, low serum potassium levels, high eGFR, and high plasma aldosterone levels were independent predictors for a large initial eGFR fall in both groups. Our analysis of tertiles based on the initial eGFR fall revealed that in the MR antagonist group, patients with a small initial eGFR fall had a significantly steeper long-term eGFR slope than those with a large initial fall (tertile 1 versus 2, P=0.025; tertile 1 versus 3, P=0.017). These associations were not identified in the adrenalectomy group. Thus, the smaller the acute fall in eGFR by initiation of MR antagonists, the greater was the rate of long-term eGFR decline. While the acute fall in eGFR induced by primary aldosteronism-specific treatment is occasionally a clinical concern, our findings highlight the favorable implications of the acute fall with respect to long-term renal outcomes.

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Adrenal vein sampling (AVS) is an established method for finding patients with the unilateral subtype of PA, for which adrenalectomy is an applicable treatment. In this study, we analyzed a large database of patients with PA who underwent adrenal vein sampling, to investigate the sex differences in the impact of age at diagnosis on the subtype and cause of PA. In 2122 patients, women with the unilateral subtype were younger than men with the same subtype and women with the bilateral subtype. Younger age and older age were associated with unilateral PA in women and men, respectively. After stratification by tertiles of age, there was a trend of decreased and increased incidence of unilateral PA with aging in women and men, respectively. Male sex was a predictor of unilateral PA in middle-aged and older patients but not in younger patients. We also found that obesity, a known factor associated with idiopathic hyperaldosteronism, was positively associated with bilateral PA in younger patients but not in older patients. These findings suggest that the proportion of operable patients with unilateral PA differs depending on the combination of sex and age, and that other than obesity, the cause of PA is also associated with the bilateral subtype in older patients.

Background: Adrenal venous sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism. Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve the success rate of AVS, although the effects on lateralization and its outcomes in unilateral primary aldosteronism are unclear., Methods: The success rate and lateralization indices were examined in a cohort of 2197 Japanese patients with primary aldosteronism from 28 centres who underwent AVS. Outcomes were analysed in 267 patients with aldosterone-producing adenomas (APAs)., Results: ACTH loading during AVS improved the success rate from 67 to 89%, while lateralization indices decreased from 62 to 28%. Bolus, bolus along with continuous infusion or continuous infusion of ACTH did not affect both indices. The absence of clinical success (i.e. unchanged or increased blood pressure) was 33% and absence of biochemical success (persistent hypokalaemia or persistently raised aldosterone-to-renin ratio, or both) was 15%. The clinical and biochemical success rates did not differ between the three groups [lateralization index >2 in basal condition (LIb) and lateralization index >4 after ACTH loading (lateralization indices), and LIb >2 + lateralization indices<4, LIb<2+lateralization indices>4]. The three groups (LIb>4+lateralization indices>4, LIb>4+lateralization indices<4 and LIb<4+lateralization indices>4) did not show any significant differences of clinical and biochemical outcome., Conclusion: ACTH loading during AVS improved the success rate but decreased laterality. ACTH did not affect the clinical and biochemical outcomes in APA patients. These data showed that the use of ACTH during AVS was helpful for improving the success rate, but did not contribute to better outcomes.

There have been several clinical studies examining the factors associated with cardiovascular disease (CVD) in patients with primary aldosteronism (PA); however, their results have left it unclear whether CVD is affected by the plasma aldosterone concentration or hypokalemia. We assessed the PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) and compared the prevalence of CVD among patients with PA with that among age-, sex-, and blood pressure-matched essential hypertension patients and participants with hypertension in a general population cohort. We also performed binary logistic regression analysis to determine which parameters significantly increased the odds ratio for CVD. Of the 2582 patients with PA studied, the prevalence of CVD, including stroke (cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage), ischemic heart disease (myocardial infarction or angina pectoris), and heart failure, was 9.4% (stroke, 7.4%; ischemic heart disease, 2.1%; and heart failure, 0.6%). The prevalence of CVD, especially stroke, was higher among the patients with PA than those with essential hypertension/hypertension. Hypokalemia (K + ≤3.5 mEq/L) and the unilateral subtype significantly increased adjusted odds ratios for CVD. Although aldosterone levels were not linearly related to the adjusted odds ratio for CVD, patients with plasma aldosterone concentrations ≥125 pg/mL had significantly higher adjusted odds ratios for CVD than those with plasma aldosterone concentrations <125 pg/mL. Thus, patients with PA seem to be at a higher risk of developing CVD than patients with essential hypertension. Moreover, patients with PA presenting with hypokalemia, the unilateral subtype, or plasma aldosterone concentration ≥125 pg/mL are at a greater risk of CVD and have a greater need for PA-specific treatments than others., (© 2018 American Heart Association, Inc.)

Subtype diagnosis of primary aldosteronism (PA) by adrenal vein sampling (AVS) is recommended as a mandatory step for indicating adrenal surgery. It is a technically demanding procedure, especially in the right adrenal vein. The aim of the study was to predict the subtype diagnosis in the absence of values from the right AVS. From the databases of nine centers (WAVES-J), 308 patients with PA who underwent successful AVS were studied. Based on the ipsilateral ratio (IR) (aldosterone/cortisol ratio of the left adrenal vein [A/C left AV ] / aldosterone/cortisol ratio of the inferior vena cava [A/C IVC ]), the patients were divided into two groups: the patients with IR ≥ 1.0 (n = 262) and those with IR < 1.0 (n = 46). In patients with IR > 1.0, the A/C left AV was significantly higher in patients with the left unilateral subtype than in patients with the bilateral subtype. Receiver operating characteristic (ROC) curve analysis revealed that an A/C left AV cutoff >68 showed 70.8% sensitivity and 93.5% specificity for the left unilateral subtype. On the other hand, in patients with IR < 1.0, the A/C left AV was significantly lower in patients with the right unilateral subtype. ROC analysis revealed that an A/C left AV cutoff <9 showed 86.7% sensitivity and 75.0% specificity for the right unilateral subtype. Hence, the combination of the IR and A/C ratio in the left adrenal vein is useful for predicting the subtype. The present results provide important information for patients with PA in whom AVS was unsuccessful in the right adrenal vein.

Lyman-alpha emitters are thought to be young, low-mass galaxies with ages of approximately 10(8) yr (refs 1, 2). An overdensity of them in one region of the sky (the SSA 22 field) traces out a filamentary structure in the early Universe at a redshift of z approximately 3.1 (equivalent to 15 per cent of the age of the Universe) and is believed to mark a forming protocluster. Galaxies that are bright at (sub)millimetre wavelengths are undergoing violent episodes of star formation, and there is evidence that they are preferentially associated with high-redshift radio galaxies, so the question of whether they are also associated with the most significant large-scale structure growing at high redshift (as outlined by Lyman-alpha emitters) naturally arises. Here we report an imaging survey of 1,100-microm emission in the SSA 22 region. We find an enhancement of submillimetre galaxies near the core of the protocluster, and a large-scale correlation between the submillimetre galaxies and the low-mass Lyman-alpha emitters, suggesting synchronous formation of the two very different types of star-forming galaxy within the same structure at high redshift. These results are in general agreement with our understanding of the formation of cosmic structure.

Acute pulmonary thromboembolism (APTE) and deep venous thrombosis (DVT) are categorized into venous thromboembolism. APTE is one of the most critical post-operative complications because of its high mortality. Meanwhile, DVT is responsible for more than 80-95% of APTE cases. APTE occurred in 6 patients and DVT in 3 patients in the post-operative period during the past eleven years at our hospital. The median age of these patients, 5 men and 4 women, was 62 years (45-77). In many cases, the course of APTE showed a rapid progression. Four of the six patients with APTE died, and two of these four patients died within a few hours following the onset. Once it occurs, it is often lethal. Therefore, the prevention of thromboembolism is most important. In this study, we examined these 6 APTE cases and 3 DVT cases and discussed low dose heparin and intermittent sequential pneumatic compression (ISPC), prophylaxis against APTE in the post-operative period. We have been using ISPC for the high-risk group of thromboembolism in the post-operative period since 1999. In addition to using ISPC, we have been administering low dose heparin since November 2001. These 3 cases of DVT occurred regardless of adoption of ISPC. However, there were no cases of APTE after adoption of ISPC, and no cases of DVT or APTE after adoption of ISPC and administration of low dose heparin.