Prohormones in the early diagnosis of cardiac syncope

Background--The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional-pro-A-type natriuretic peptide (MRproANP), C-terminal proendothelin 1, copeptin, and midregionalproadrenomedullin. Methods and Results--We prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study. ED probability of cardiac syncope was quantified by the treating ED physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1-year follow-up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of MRproANP, C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (P < 0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76-0.84), 0.69 (95% CI, 0.64-0.74), 0.58 (95% CI, 0.52-0.63), and 0.68 (95% CI, 0.63-0.73), respectively. In conjunction with the ED probability (0.86; 95% CI, 0.82-0.90), MRproANP, but not the other prohormone, improved the area under the curve to 0.90 (95% CI, 0.87-0.93), which was significantly higher than for the ED probability alone (P=0.003). An algorithm to rule out cardiac syncope combining an MRproANP level of < 77 pmol/L and an ED probability of < 20% had a sensitivity and a negative predictive value of 99%. Conclusions--The use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients presenting to the ED with syncope

High Resolution Mid - Infrared Imaging of the AGB Star RV Boo with the Steward Observatory Adaptive Optics System

We present high resolution (~0.1"), very high Strehl ratio (0.97+-0.03) mid-infrared (IR) adaptive optics (AO) images of the AGB star RV Boo utilizing the MMT adaptive secondary AO system. RV Boo was observed at a number of wavelengths over two epochs (9.8 um in May 2003, 8.8, 9.8 and 11.7 um in February 2004) and appeared slightly extended at all wavelengths. While the extension is very slight at 8.8 and 11.7 um data, the extension is somewhat more pronounced at 9.8 um. With such high Strehls we can achieve super-resolutions of 0.1" by deconvolving RV Boo with a point-spread function (PSF) derived from an unresolved star. We tentatively resolve RV Boo into a 0.16" FWHM extension at a position angle of 120 degrees. At a distance of 390(+250)(-100) pc, this corresponds to a FWHM of 60(+40)(-15) AU. We measure a total flux at 9.8 um of 145+-24 Jy for the disk and star. Based on a dust thermal emission model for the observed IR spectral energy distribution and the 9.8 um AO image, we derive a disk dust mass of 1.6x10^-6 Msun and an inclination of 30 to 45 degrees from edge-on. We discuss whether the dust disk observed around RV Boo is an example of the early stages in the formation of asymmetric structure in planetary nebula.Comment: 24 pages, 8 figures, accepted by Ap

Imaging the Cool Hypergiant NML Cygni's Dusty Circumstellar Envelope with Adaptive Optics

We present sub-arcsec angular resolution, high-Strehl ratio mid-IR adaptive optics images of the powerful OH/IR source and cool hypergiant NML Cyg at 8.8, 9.8 and 11.7 um. These images reveal once more the complexity in the dusty envelope surrounding this star. We spatially resolve the physical structures (radius ~0.14", ~240 AU adopting a distance of 1.74 kpc) responsible for NML Cyg's deep 10 um silicate dust absorption feature. We also detect an asymmetric excess, at separations of ~0.3" to 0.5" (~520 to 870 AU), NW from the star. The colors of this excess are consistent with thermal emission of hot, optically thin dust. This excess is oriented in the direction of the Cyg OB2 stellar association, and is likely due to the disruption of NML Cyg's dusty wind with the near-UV radiation flux from the massive hot stars within Cyg OB2. This interaction was predicted in our previous paper (Schuster et al. 2006), to explain the geometry of an inverted photo-dissociation region observed at optical wavelengths.Comment: Accepted for publication on The Astrophysical Journa

High Resolution Images of Orbital Motion in the Trapezium Cluster: First Scientific Results from the MMT Deformable Secondary Mirror Adaptive Optics System

We present the first scientific images obtained with a deformable secondary mirror adaptive optics system. We utilized the 6.5m MMT AO system to produce high-resolution (FWHM=0.07'') near infrared (1.6 um) images of the young (~1 Myr) Orion Trapezium theta 1 Ori cluster members. A combination of high spatial resolution and high signal to noise allowed the positions of these stars to be measured to within ~0.003'' accuracies. Including previous speckle data (Weigelt et al. 1999), we analyze a six year baseline of high-resolution observations of this cluster. Over this baseline we are sensitive to relative proper motions of only ~0.002''/yr (4.2 km/s at 450 pc). At such sensitivities we detect orbital motion in the very tight theta 1 Ori B2B3 (52 AU separation) and theta 1 Ori A1A2 (94 AU separation) systems. Such motions are consistent with those independently observed by Schertl et al. (2003) with speckle interferometry, giving us confidence that these very small (~0.002''/yr) orbital motions are real. All five members of the theta 1 Ori B system appear likely gravitationally bound. The very lowest mass member of the theta 1 Ori B system (B4) has K' ~11.66 and an estimated mass of ~0.2 Msun. There was very little motion (4+/-15 km/s) detected of B4 w.r.t B1 or B2, hence B4 is possibly part of the theta 1 Ori B group. We suspect that if this very low mass member is physically associated it most likely is in an unstable (non-hierarchical) orbital position and will soon be ejected from the group. The theta 1 Ori B system appears to be a good example of a star formation ``mini-cluster'' which may eject the lowest mass members of the cluster in the near future. This ``ejection'' process could play a major role in the formation of low mass stars and brown dwarfs.Comment: To appear in the December 10, 2003 issue of the Astrophysical Journal 21 pages, 14 figures (some in color, but print OK in B&W

Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis.

Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016). Study Selection: Cohort studies involving adults presenting to the ED with possible acute coronary syndrome in whom an ECG and hs-cTnT measurements were obtained and AMI outcomes adjudicated during initial hospitalization. Data Extraction: Investigators of studies provided data on the number of low-risk patients (no new ischemia on ECG and hs-cTnT measurements <0.005 µg/L) and the number who had AMI during hospitalization (primary outcome) or a major adverse cardiac event (MACE) or death within 30 days (secondary outcomes), by risk classification (low or not low risk). Two independent epidemiologists rated risk of bias of studies. Data Synthesis: Of 9241 patients in 11 cohort studies, 2825 (30.6%) were classified as low risk. Fourteen (0.5%) low-risk patients had AMI. Sensitivity of the risk classification for AMI ranged from 87.5% to 100% in individual studies. Pooled estimated sensitivity was 98.7% (95% CI, 96.6% to 99.5%). Sensitivity for 30-day MACEs ranged from 87.9% to 100%; pooled sensitivity was 98.0% (CI, 94.7% to 99.3%). No low-risk patients died. Limitation: Few studies, variation in timing and methods of reference standard troponin tests, and heterogeneity of risk and prevalence of AMI across studies. Conclusion: A single hs-cTnT concentration below the limit of detection in combination with a nonischemic ECG may successfully rule out AMI in patients presenting to EDs with possible emergency acute coronary syndrome. Primary Funding Source: Emergency Care Foundation

CHEOPS: a space telescope for ultra-high precision photometry of exoplanet transits

The CHaracterising ExOPlanet Satellite (CHEOPS) is a joint ESA-Switzerland space mission dedicated to search for exoplanet transits by means of ultra-high precision photometry whose launch readiness is expected end 2017. The CHEOPS instrument will be the first space telescope dedicated to search for transits on bright stars already known to host planets. By being able to point at nearly any location on the sky, it will provide the unique capability of determining accurate radii for a subset of those planets for which the mass has already been estimated from ground-based spectroscopic surveys. CHEOPS will also provide precision radii for new planets discovered by the next generation ground-based transits surveys (Neptune-size and smaller). The main science goals of the CHEOPS mission will be to study the structure of exoplanets with radii typically ranging from 1 to 6 Earth radii orbiting bright stars. With an accurate knowledge of masses and radii for an unprecedented sample of planets, CHEOPS will set new constraints on the structure and hence on the formation and evolution of planets in this mass range. To reach its goals CHEOPS will measure photometric signals with a precision of 20 ppm in 6 hours of integration time for a 9th magnitude star. This corresponds to a signal to noise of 5 for a transit of an Earth-sized planet orbiting a solar-sized star (0.9 solar radii). This precision will be achieved by using a single frame-transfer backside illuminated CCD detector cool down at 233K and stabilized within {10 mK . The CHEOPS optical design is based on a Ritchey-Chretien style telescope with 300 mm effective aperture diameter, which provides a defocussed image of the target star while minimizing straylight using a dedicated field stop and baffle system. As CHEOPS will be in a LEO orbit, straylight suppression is a key point to allow the observation of faint stars. The telescope will be the only payload on a spacecraft platform providing pointing stability of < 8 arcsec rms, power of 60W for instrument operations and downlink transmission of at least 1.2GBit/day. Both CHEOPS paylaod and platform will rely mainly on components with flight heritage. The baseline CHEOPS mission fits within the technical readiness requirements, short development time and the cost envelope defined by ESA in its first call for S-missions. It represents a breakthrough opportunity in furthering our understanding of the formation and evolution of planetary systems

The CHEOPS (characterising exoplanet satellite) mission: telescope optical design, development status and main technical and programmatic challenges

CHEOPS (CHaracterising ExOPlanet Satellite) is the first ESA Small Mission as part of the ESA Cosmic Vision program 2015-2025 and it is planned launch readiness end of 2017. The mission lead is performed in a partnership between Switzerland, led by the University of Bern, and the European Space Agency with important contributions from Austria, Belgium, France, Germany, Hungary, Italy, Portugal, Spain, Sweden, and the United Kingdom. The CHEOPS mission will be the first space telescope dedicated to search for exoplanetary transits on bright stars already known to host planets by performing ultrahigh precision photometry on bright starts whose mass has been already estimated through spectroscopic surveys on ground based observations. The number of exoplanets in the mass range 1-30 MEarth for which both mass and radius are known with a good precision is extremely limited also considering the last two decades of high-precision radial velocity measurement campaigns and the highly successful space missions dedicated to exoplanets transit searches (CoRoT and Kepler)