The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography

Objectives This study was designed to evaluate whether the absence of coronary calcium could rule out >= 50% coronary stenosis or the need for revascularization. Background The latest American Heart Association guidelines suggest that a calcium score (CS) of zero might exclude the need for coronary angiography among symptomatic patients. Methods A substudy was made of the CORE64 (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors) multicenter trial comparing the diagnostic performance of 64-detector computed tomography to conventional angiography. Patients clinically referred for conventional angiography were asked to undergo a CS scan up to 30 days before. Results In all, 291 patients were included, of whom 214 (73%) were male, and the mean age was 59.3 +/- 10.0 years. A total of 14 (5%) patients had low, 218 (75%) had intermediate, and 59 (20%) had high pre-test probability of obstructive coronary artery disease. The overall prevalence of >= 50% stenosis was 56%. A total of 72 patients had CS = 0, among whom 14 (19%) had at least 1 >= 50% stenosis. The overall sensitivity for CS = 0 to predict the absence of >= 50% stenosis was 45%, specificity was 91%, negative predictive value was 68%, and positive predictive value was 81%. Additionally, revascularization was performed in 9 (12.5%) CS = 0 patients within 30 days of the CS. From a total of 383 vessels without any coronary calcification, 47 (12%) presented with >= 50% stenosis; and from a total of 64 totally occluded vessels, 13 (20%) had no calcium. Conclusions The absence of coronary calcification does not exclude obstructive stenosis or the need for revascularization among patients with high enough suspicion of coronary artery disease to be referred for coronary angiography, in contrast with the published recommendations. Total coronary occlusion frequently occurs in the absence of any detectable calcification. (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218) (J Am Coll Cardiol 2010;55:627-34) (C) 2010 by the American College of Cardiology Foundation

Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective ""CORE-64"" trial (""Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors""). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows.

Diagnostic Performance of Coronary Angiography by 64-Row CT

Background: The accuracy of multidetector computed tomographic (CT) angiography involving 64 detectors has not been well established. Methods: We conducted a multicenter study to examine the accuracy of 64-row, 0.5-mm multidetector CT angiography as compared with conventional coronary angiography in patients with suspected coronary artery disease. Nine centers enrolled patients who underwent calcium scoring and multidetector CT angiography before conventional coronary angiography. In 291 patients with calcium scores of 600 or less, segments 1.5 mm or more in diameter were analyzed by means of CT and conventional angiography at independent core laboratories. Stenoses of 50% or more were considered obstructive. The area under the receiver-operating-characteristic curve (AUC) was used to evaluate diagnostic accuracy relative to that of conventional angiography and subsequent revascularization status, whereas disease severity was assessed with the use of the modified Duke Coronary Artery Disease Index. Results: A total of 56% of patients had obstructive coronary artery disease. The patient-based diagnostic accuracy of quantitative CT angiography for detecting or ruling out stenoses of 50% or more according to conventional angiography revealed an AUC of 0.93 (95% confidence interval [CI], 0.90 to 0.96), with a sensitivity of 85% (95% CI, 79 to 90), a specificity of 90% (95% CI, 83 to 94), a positive predictive value of 91% (95% CI, 86 to 95), and a negative predictive value of 83% (95% CI, 75 to 89). CT angiography was similar to conventional angiography in its ability to identify patients who subsequently underwent revascularization: the AUC was 0.84 (95% CI, 0.79 to 0.88) for multidetector CT angiography and 0.82 (95% CI, 0.77 to 0.86) for conventional angiography. A per-vessel analysis of 866 vessels yielded an AUC of 0.91 (95% CI, 0.88 to 0.93). Disease severity ascertained by CT and conventional angiography was well correlated (r=0.81; 95% CI, 0.76 to 0.84). Two patients had important reactions to contrast medium after CT angiography. Conclusions: Multidetector CT angiography accurately identifies the presence and severity of obstructive coronary artery disease and subsequent revascularization in symptomatic patients. The negative and positive predictive values indicate that multidetector CT angiography cannot replace conventional coronary angiography at present. (ClinicalTrials.gov number, NCT00738218.).

Patient Characteristics as Predictors of Image Quality and Diagnostic Accuracy of MDCT Compared With Conventional Coronary Angiography for Detecting Coronary Artery Stenoses: CORE-64 Multicenter International Trial

OBJECTIVE. The purpose of the study was to investigate patient characteristics associated with image quality and their impact on the diagnostic accuracy of MDCT for the detection of coronary artery stenosis. MATERIALS AND METHODS. Two hundred ninety-one patients with a coronary artery calcification (CAC) score of <= 600 Agatston units (214 men and 77 women; mean age, 59.3 +/- 10.0 years [SD]) were analyzed. An overall image quality score was derived using an ordinal scale. The accuracy of quantitative MDCT to detect significant (>= 50%) stenoses was assessed using quantitative coronary angiography (QCA) per patient and per vessel using a modified 19-segment model. The effect of CAC, obesity, heart rate, and heart rate variability on image quality and accuracy were evaluated by multiple logistic regression. Image quality and accuracy were further analyzed in subgroups of significant predictor variables. Diagnostic analysis was determined for image quality strata using receiver operating characteristic (ROC) curves. RESULTS. Increasing body mass index (BMI) (odds ratio [OR] = 0.89, p < 0.001), increasing heart rate (OR = 0.90, p < 0.001), and the presence of breathing artifact (OR = 4.97, p = 0.001) were associated with poorer image quality whereas sex, CAC score, and heart rate variability were not. Compared with examinations of white patients, studies of black patients had significantly poorer image quality (OR = 0.58, p = 0.04). At a vessel level, CAC score (10 Agatston units) (OR = 1.03, p = 0.012) and patient age (OR = 1.02, p = 0.04) were significantly associated with the diagnostic accuracy of quantitative MDCT compared with QCA. A trend was observed in differences in the areas under the ROC curves across image quality strata at the vessel level (p = 0.08). CONCLUSION. Image quality is significantly associated with patient ethnicity, BMI, mean scan heart rate, and the presence of breathing artifact but not with CAC score at a patient level. At a vessel level, CAC score and age were associated with reduced diagnostic accuracy.

Quantitative CT analysis of the glabellar and anterior nasal spine regions for the placement of implants for nasal prosthesis retention

Objectives: The aim of this study was to determine the precision of the measurements of 2 craniometric anatomic points-glabella and anterior nasal spine-in order to verify their possibility as potential locations for placing implants aimed at nasal prostheses retention. Methods: Twenty-six dry human skulls were scanned in a high-resolution spiral tomography with 1-mm axial slice thickness and 1-mm interval reconstruction using a bone tissue filter. Images obtained were stored and transferred to an independent workstation containing e-film imaging software. The measurements (in the glabella and anterior nasal fossa) were made independently by 2 observers twice for each measurement. Data were submitted to statistical analysis (parametric t test). Results: The results demonstrated no statistically significant difference between interobserver and intraobserver measurements (P > .05). The standard error was found to be between 0.49 mm and 0.84 mrn for measurements in bone protocol, indicating a high /eve/ of precision. Conclusions: The measurements obtained in anterior nasal spine and glabella were considered precise and reproducible. Mean values of such measurements pointed to the possibility of implant placement in these regions, particularly in the anterior nasal spine.

Discovery in IC10 of the farthest known symbiotic star

We report the discovery of the first known symbiotic star in IC10, a starburst galaxy belonging to the Local Group, at a distance of similar to 750 kpc. The symbiotic star was identified during a survey of emission-line objects. It shines at V = 24.62 +/- 0.04, V - R(C) = 2.77 +/- 0.05 and R(C) - I(C) = 2.39 +/- 0.02, and suffers from E(B-V) = 0.85 +/- 0.05 reddening. The spectrum of the cool component well matches that of solar neighbourhood M8III giants. The observed emission lines belong to Balmer series, [S II], [N II] and [O III]. They suggest a low electronic density, negligible optical depth effects and 35 000 < T(eff) < 90 000 K for the ionizing source. The spectrum of the new symbiotic star in IC10 is an almost perfect copy of that of Hen 2-147, a well-known Galactic symbiotic star and Mira.

Intragroup diffuse light in compact groups of galaxies - II. HCG 15, 35 and 51

This continuing study of intragroup light in compact groups of galaxies aims to establish new constraints to models of formation and evolution of galaxy groups, specially of compact groups, which are a key part in the evolution of larger structures, such as clusters. In this paper we present three additional groups (HCG 15, 35 and 51) using deep wide-field B- and R-band images observed with the LAICA camera at the 3.5-m telescope at the Calar Alto observatory (CAHA). This instrument provides us with very stable flat-fielding, a mandatory condition for reliably measuring intragroup diffuse light. The images were analysed with the OV_WAV package, a wavelet technique that allows us to uncover the intragroup component in an unprecedented way. We have detected that 19, 15 and 26 per cent of the total light of HCG 15, 35 and 51, respectively, are in the diffuse component, with colours that are compatible with old stellar populations and with mean surface brightness that can be its low as 28.4 B mag arcsec(-2). Dynamical masses, crossing times and mass-to-light ratios were recalculated using the new group parameters. Also tidal features were analysed using the wavelet technique.

A two-armed pattern in flickering maps of the nova-like variable UU aquarii

We report the analysis of a uniform sample of 31 light curves of the nova-like variable UU Aqr with eclipse-mapping techniques. The data were combined to derive eclipse maps of the average steady-light component, the long-term brightness changes, and the low- and high-frequency flickering components. The long-term variability responsible for the ""low-brightness`` and ""high-brightness`` states is explained in terms of the response of a viscous disk to changes of 20%-50% in the mass transfer rate from the donor star. Low- and high-frequency flickering maps are dominated by emission from two asymmetric arcs reminiscent of those seen in the outbursting dwarf nova IP Peg, and they are similarly interpreted as manifestations of a tidally induced spiral shock wave in the outer regions of a large accretion disk. The asymmetric arcs are also seen in the map of the steady light aside from the broad brightness distribution of a roughly steady-state disk. The arcs account for 25% of the steady-light flux and are a long-lasting feature in the accretion disk of UU Aqr. We infer an opening angle of 10 degrees +/- 3 degrees for the spiral arcs. The results suggest that the flickering in UU Aqr is caused by turbulence generated after the collision of disk gas with the density-enhanced spiral wave in the accretion disk.

CHEMICAL EVOLUTION OF THE GALACTIC BULGE: SINGLE AND DOUBLE INFALL MODELS

Recent work, has produced a wealth of data concerning the chemical evolution of the Galactic bulge, both for stars and nebulae. Present theoretical models generally adopt it limited range of such constraints, frequenfly using it single chemical element (usually iron), which is not enough to describe it unambiguously. In this work, we take into account contraints involving,9 Many chemical elements as possible, basically obtained from bulge nebulae and stars. Our main goal is to show that different scenarios can describe, at least partially the abundance distribution and several dishuice-independent correlations for these objects . Three classes of models were developed. The first is it one-zone, single-infall model, the. Second is it one-zone, double-infall model and the third is a multizone, double-infall model. We show that a one-zone model with it single infall episode is able to reproduce some of the observational data, but the best results tire achieved using it multizone, double-infall model.

Photometric redshifts and k-corrections for the Sloan Digital Sky Survey Data Release 7

We present a catalogue of galaxy photometric redshifts and k-corrections for the Sloan Digital Sky Survey Data Release 7 (SDSS-DR7), available on the World Wide Web. The photometric redshifts were estimated with an artificial neural network using five ugriz bands, concentration indices and Petrosian radii in the g and r bands. We have explored our redshift estimates with different training sets, thus concluding that the best choice for improving redshift accuracy comprises the main galaxy sample (MGS), the luminous red galaxies and the galaxies of active galactic nuclei covering the redshift range 0 < z < 0.3. For the MGS, the photometric redshift estimates agree with the spectroscopic values within rms = 0.0227. The distribution of photometric redshifts derived in the range 0 < z(phot) < 0.6 agrees well with the model predictions. k-corrections were derived by calibration of the k-correct_v4.2 code results for the MGS with the reference-frame (z = 0.1) (g - r) colours. We adopt a linear dependence of k-corrections on redshift and (g - r) colours that provide suitable distributions of luminosity and colours for galaxies up to redshift z(phot) = 0.6 comparable to the results in the literature. Thus, our k-correction estimate procedure is a powerful, low computational time algorithm capable of reproducing suitable results that can be used for testing galaxy properties at intermediate redshifts using the large SDSS data base.

Modelling the warm H(2) infrared emission of the Helix nebula cometary knots

Molecular hydrogen emission is commonly observed in planetary nebulae. Images taken in infrared H(2) emission lines show that at least part of the molecular emission is produced inside the ionized region. In the best studied case, the Helix nebula, the H(2) emission is produced inside cometary knots (CKs), comet-shaped structures believed to be clumps of dense neutral gas embedded within the ionized gas. Most of the H(2) emission of the CKs seems to be produced in a thin layer between the ionized diffuse gas and the neutral material of the knot, in a mini-photodissociation region (mini-PDR). However, PDR models published so far cannot fully explain all the characteristics of the H(2) emission of the CKs. In this work, we use the photoionization code AANGABA to study the H(2) emission of the CKs, particularly that produced in the interface H(+)/H(0) of the knot, where a significant fraction of the H(2) 1-0 S(1) emission seems to be produced. Our results show that the production of molecular hydrogen in such a region may explain several characteristics of the observed emission, particularly the high excitation temperature of the H(2) infrared lines. We find that the temperature derived from H(2) observations, even of a single knot, will depend very strongly on the observed transitions, with much higher temperatures derived from excited levels. We also proposed that the separation between the H alpha and [N II] peak emission observed in the images of CKs may be an effect of the distance of the knot from the star, since for knots farther from the central star the [N II] line is produced closer to the border of the CK than H alpha.

Gas streaming motions towards the nucleus of M81

We present two-dimensional stellar and gaseous kinematics of the inner 120 x 250 pc2 of the LINER/Seyfert 1 galaxy M81, from optical spectra obtained with the Gemini Multi-Object Spectrograph (GMOS) integral field spectrograph on the Gemini-North telescope at a spatial resolution of approximate to 10 pc. The stellar velocity field shows circular rotation and, overall, is very similar to the published large-scale velocity field, but deviations are observed close to the minor axis which can be attributed to stellar motions possibly associated with a nuclear bar. The stellar velocity dispersion of the bulge is 162 +/- 15 km s-1, in good agreement with previous measurements and leading to a black hole mass of M(BH) = 5.5+3.6(-2.0) x 107 M(circle dot) based on the M(BH)-Sigma relationship. The gas kinematics is dominated by non-circular motions and the subtraction of the stellar velocity field reveals blueshifts of approximate to-100 km s-1 on the far side of the galaxy and a few redshifts on the near side. These characteristics can be interpreted in terms of streaming towards the centre if the gas is in the plane. On the basis of the observed velocities and geometry of the flow, we estimate a mass inflow rate in ionized gas of approximate to 4.0 x 10-3 M(circle dot) yr-1, which is of the order of the accretion rate necessary to power the LINER nucleus of M81. We have also applied the technique of principal component analysis (PCA) to our data, which reveals the presence of a rotating nuclear gas disc within approximate to 50 pc from the nucleus and a compact outflow, approximately perpendicular to the disc. The PCA combined with the observed gas velocity field shows that the nuclear disc is being fed by gas circulating in the galaxy plane. The presence of the outflow is supported by a compact jet seen in radio observations at a similar orientation, as well as by an enhancement of the [O i]/H alpha line ratio, probably resulting from shock excitation of the circumnuclear gas by the radio jet. With these observations we are thus resolving both the feeding - via the nuclear disc and observed gas inflow, and the feedback - via the outflow, around the low-luminosity active nucleus of M81.

Lines of heavy elements and Fe II in the UV of CS 31082-001

The abundance of heavy r-elements may provide a better understanding of the r-process, and the determination of several reference r-elements should allow a better determination of a star`s age. The space UV region (lambda < 3000 angstrom) presents a large number of lines of the heavy elements, and in the case of some elements, such as Bi, Pt, Au, detectable lines are not available elsewhere. The extreme ""r-process star"" CS 31082-001 ([Fe/H] = -2.9) was observed in the space UV to determine abundances of the heaviest stable elements, using STIS on board Hubble Space Telescope.

PLANETARY NEBULAE IN THE INNER MILKY WAY II: THE BULGE-DISK TRANSITION

In this work, a sample of planetary nebulae located in the inner-disk and bulge of the Galaxy is used in order to find the galactocentric distance which better separates these two populations, from the point of view of abundances. Statistical distance scales are used to study the distribution of abundances across the disk-bulge interface. A Kolmogorov-Smirnov test is used to find the distance at which the chemical properties of these regions better separate. The results of the statistical analysis indicate that, on the average, the inner population has lower abundances than the outer. Additionally, for the a-element abundances, the inner population does not follow the disk radial gradient towards the galactic center. Based on our results, we suggest a bulge-disk interface at 1.5 kpc, marking the transition between the bulge and inner-disk of the Galaxy as defined by the intermediate mass population.

Diagnostic tool to analyse colour-magnitude diagrams of poorly populated stellar concentrations

The dynamical processes that lead to open cluster disruption cause its mass to decrease. To investigate such processes from the observational point of view, it is important to identify open cluster remnants (OCRs), which are intrinsically poorly populated. Due to their nature, distinguishing them from field star fluctuations is still an unresolved issue. In this work, we developed a statistical diagnostic tool to distinguish poorly populated star concentrations from background field fluctuations. We use 2MASS photometry to explore one of the conditions required for a stellar group to be a physical group: to produce distinct sequences in a colour-magnitude diagram (CMD). We use automated tools to (i) derive the limiting radius; (ii) decontaminate the field and assign membership probabilities; (iii) fit isochrones; and (iv) compare object and field CMDs, considering the isochrone solution, in order to verify the similarity. If the object cannot be statistically considered as a field fluctuation, we derive its probable age, distance modulus, reddening and uncertainties in a self-consistent way. As a test, we apply the tool to open clusters and comparison fields. Finally, we study the OCR candidates DoDz 6, NGC 272, ESO 435 SC48 and ESO 325 SC15. The tool is optimized to treat these low-statistic objects and to separate the best OCR candidates for studies on kinematics and chemical composition. The study of the possible OCRs will certainly provide a deep understanding of OCR properties and constraints for theoretical models, including insights into the evolution of open clusters and dissolution rates.