Systematic review of the accuracy of dual-source cardiac CT for detection of Arterial Stenosis in difficult to image patient groups

__Purpose:__ To assess the diagnostic performance of dual-source cardiac (DSC) computed tomography (CT) newer-generation CT instruments for identifying anatomically significant coronary artery disease (CAD) in patients who are difficult to image by using 64-section CT. __Materials and Methods:__ A literature search comprised bibliographic databases (January 1, 2000, to March 22, 2011, with a pragmatic update on September 6, 2012), trial registries, and conference proceedings. Only studies using invasive coronary angiography as reference standard were included. Risk of bias was assessed (QUADAS-2). Results were stratified according to patient group on the basis of clinical characteristics. Summary estimates of sensitivity and specificity of DSC CT for detecting 50% or greater arterial stenosis were calculated by using a bivariate summary receiver operating characteristic or random-effects model. __Results:__ Twenty-five studies reported accuracy of DSC CT for diagnosing CAD in difficult to image patients; in 22 studies, one of two CT units of the same manufacturer (Somatom Definition or Somatom Definition Flash) was used, and in the remaining three, a different CT unit of another manufacturer (Aquilion One) was used. The pooled, per-patient estimates of sensitivity were 97.7% (95% confidence interval [CI]: 88.0%, 99.9%) and 97.7% (95% CI: 93.2%, 99.3%) for patients with arrhythmias and high heart rates, respectively. The corresponding pooled estimates of specificity were 81.7% (95% CI: 71.6%, 89.4%) and 86.3% (95% CI: 80.2%, 90.7%), respectively. All data were acquired by using Somatom Definition. In two studies with Somatom and one study with Aquilion One, sensitivity estimates of 90% or greater were reported in patients with previous stent implantations; specificities were 81.7% and 89.5% for Somatom and 81.0% for Aquilion One. In patients with high coronary calcium scores, previous bypass grafts, or obesity, only per-segment or per-artery data were available. Sensitivity estimates remained high (.90% in all but one study), and specificities ranged from 79.1% to 100%. All data were acquired by using Somatom Definition. __Conclusion:__ DSC CT may be sufficiently accurate to diagnose clinically significant CAD in some or all difficult to image patients

Reactive nitrogen and sulphate wet deposition at Zeppelin Station, Ny-Ålesund, Svalbard

As a potent fertilizer, reactive nitrogen plays an important role in Arctic ecosystems. Since the Arctic is a nutrient-limited environment, changes in nitrogen deposition can have severe impacts on local ecosystems. To quantify the amount of nitrogen deposited through snow and rain events, precipitation sampling was performed at Zeppelin Station, Svalbard, from November 2009 until May 2011. The samples were analysed for , nss- and concentrations, and the deposition of single precipitation events was calculated using precipitation measurements taken at nearby Ny-Ålesund. The majority of observed events showed concentrations ranging from 0.01 to 0.1 mg L−1 N for and and from 0.02 to 0.3 mg L−1 S for nss-. The majority of calculated depositions ranged from 0.01 to 0.1 mg m−2 N for and and from 0.02 to 0.3 mg m−2 S for nss-. The budget was controlled by strong deposition events, caused by long-lasting precipitation episodes that lasted for several days and which had raised concentrations of nitrogen and sulphur. Three future scenarios of increasing precipitation in the Arctic were considered. The results showed that deposition is mainly controlled by the amount of precipitation, which leads to the conclusion that increased precipitation might cause increases in deposition of the same magnitude